Craniosynostosis and altered patterns of fetal TGF-beta expression induced by intrauterine constraint

Plast Reconstr Surg. 2002 Jun;109(7):2338-46; discussion 2347-54. doi: 10.1097/00006534-200206000-00028.


Recent work has demonstrated that fusion of the calvarial sutures is mediated by locally elaborated soluble growth factors, including the transforming growth factor-betas (TGF-betas), leading some to speculate that external biomechanical forces play little role in suture development. Clinical evidence has long suggested, however, that fetal head constraint may play a critical role in the pathogenesis of many cases of nonsyndromic craniosynostosis. The purpose of these experiments was to test the hypothesis that intrauterine constraint leads to an alteration in normal patterns of TGF-beta expression and that these alterations are associated with craniosynostosis. Fetal constraint was induced by allowing C57Bl/6 murine fetuses to grow for 2.5 days beyond the normal 20-day gestation by performing uterine cerclage on the eighteenth day. Cranial suture morphology was examined in hematoxylin and eosin-stained sections and in cleared whole-mount specimens, double stained with alizarin red S and Alcian blue. Expression patterns of TGF-beta1 and TGF-beta3 were examined by immunohistochemical techniques. Gross and microscopic examination of the cranial sutures of 17 constrained fetuses revealed changes that ranged from narrowing to complete osseous obliteration of the coronal and squamosal sutures. All sutures of 14 nonconstrained control pups remained patent. Fetal head constraint was associated with increased TGF-beta1 immunoreactivity within the new bone and the underlying dura when compared with nonconstrained age-matched controls. TGF-beta3 immunoreactivity was associated with the dura underlying patent, nonconstrained sutures, whereas constraint-induced synostosis was characterized by down-regulation of dural TGF-beta3 expression. These experiments confirm the ability of intrauterine constraint to induce premature fusion of the cranial sutures and provide evidence that intrauterine head constraint induces the expression of osteogenic growth factors in fetal calvarial bone and the underlying dura.

MeSH terms

  • Animals
  • Cranial Sutures / pathology
  • Craniosynostoses / embryology*
  • Craniosynostoses / metabolism
  • Craniosynostoses / pathology
  • Craniosynostoses / physiopathology
  • Female
  • Immunohistochemistry
  • Mice
  • Mice, Inbred C57BL
  • Pressure
  • Skull / embryology
  • Skull / metabolism*
  • Skull / physiopathology
  • Transforming Growth Factor beta / metabolism*


  • Transforming Growth Factor beta