Skeletal progenitor LRP1-mediated endocytosis is critical for synovial joint formation and bone growth

Low-density lipoprotein receptor-related protein 1 (LRP1) is a multifunctional endocytic receptor whose dysfunction is linked to developmental dysplasia of the hip, osteoporosis and osteoarthritis. Our work addresses the critical question of how these skeletal pathologies emerge. Here, we show the abundant expression of LRP1 in skeletal progenitor cells at mouse embryonic stage E13.5 and onwards, especially in the perichondrium, the stem cell layer surrounding developing limbs essential for bone formation. Lrp1 deficiency in these stem cells causes joint fusion, malformation of cartilage/bone template and markedly delayed or lack of primary ossification along with aberrant accumulation of some of the LRP1 ligands at as early as E16.5. These early abnormalities result in multiple and persistent skeletal defects including a severe deficit in hip joint and patella, and markedly deformed and low-density long bones leading to dwarfism and impaired mobility. Mechanistically, we show that LRP1 regulates core non-canonical WNT/planar cell polarity (PCP) components that may explain the malformation of long bones. LRP1 directly binds to Wnt5a, facilitates its cell-association and endocytic recycling. Using Xenopus as a model system we show that loss or gain of LRP1 function leads to shortened tadpoles similar to Wnt5a and Wnt11 overexpression, indicating a role for LRP1 in WNT/PCP signalling. Finally, we show the colocalisation LRP1 and Wnt5a in the developing mouse limbs and that Lrp1 deficiency diminishes graded distribution of Wnt5a and Vangl2. We propose that skeletal progenitor LRP1 plays a critical role in formation and maturity of multiple bones and joints by regulating morphogen signalling, providing novel insights into the fundamental processes of morphogenesis and the emergence of skeletal pathologies.