Loss of Elp3 impairs the maturation tempo of brain ependymal cells

Conditional deletion of Elp3 in the mouse forebrain leads to microcephaly at birth. In this study, we demonstrate that these mice also develop postnatal hydrocephalus, associated with an enlargement of the brain ventricles. In wild-type mice, ependymal motile cilia are properly aligned to facilitate the circulation of cerebrospinal fluid (CSF) within the ventricles. Our findings reveal that Elp3 loss induces endoplasmic reticulum (ER) stress and upregulation of ATF4 expression in ependymal cell progenitors, which compromises Notch signaling and accelerates their maturation. This is accompanied by a disruption in the establishment of rotational and translational polarities of the motile cilia of maturing ependymal cells, resulting in disorganized cilia bundles. Collectively, these molecular abnormalities lead to the premature and abnormal development of ependymal cells, culminating in cilia beating dysfunction, impaired CSF clearance, and the development of hydrocephalus.