Mafb-lineage activation of a short polyalanine (+5) PHOX2B mutation produces severe respiratory dysfunction with preserved postnatal weight gain among survivors in a mouse model of congenital central hypoventilation syndrome

Rationale: Congenital central hypoventilation syndrome (CCHS) is most commonly caused by polyalanine repeat mutations in PHOX2B. The in vivo consequences of the short five-alanine expansion and the contribution of specific hindbrain lineages to the resulting respiratory phenotype remain poorly understood. Objectives: To characterize the neonatal phenotype caused by the Phox2b25Ala/+ mutation and determine the contribution of the MafB lineage associated with the r5-r6 hindbrain territory. Methods: We generated a conditional Phox2b25Ala allele and studied mice with constitutive or MafB-lineage activation. Neonatal survival, growth, gastric milk content, ventilation, and hypercapnic responses were assessed in vivo. Respiratory-network activity and responses to extracellular acidification were recorded in E18.5 isolated brainstem-spinal cord preparations, and retrotrapezoid nucleus (RTN) development was examined histologically. Measurements and Main Results: Constitutive Phox2b25Ala/+ pups exhibited high neonatal mortality, markedly impaired weight gain, reduced gastric milk scores, hypoventilation, increased apnea time, and blunted ventilatory responses to CO2. Embryonic preparations showed a slower respiratory rhythm, an impaired response to acidification, and severe RTN dysgenesis. Activation of the mutant allele in the MafB lineage was also associated with severe respiratory dysfunction, RTN dysgenesis, and early neonatal mortality. In contrast, postnatal weight gain was preserved among surviving MafB-lineage mutants, and the reduction in gastric milk scores was significantly attenuated compared with constitutive mutants. Conclusions: A short PHOX2B polyalanine expansion reproduces major respiratory features of CCHS in mice. Activating the mutant allele in the MafB lineage is sufficient to cause severe respiratory dysfunction and neonatal mortality, whereas postnatal weight gain is preserved among survivors.