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The vertebrate body plan has bilateral symmetry and left-right asymmetries that are highly conserved. The molecular pathways for left-right development are beginning to be elucidated. Several distinct mechanisms to initiate the vertebrate left-right axis have been proposed. These mechanisms appear to converge on highly conserved expression patterns of genes in the transforming growth factor-beta (TGFbeta) family of cell-cell signaling factors, nodal and lefty-2, and subsequently the expression of the transcription regulator Pitx2, in left lateral plate mesoderm. It is possible that downstream signaling pathways diverge in distinct classes of vertebrates.

One of the most striking features of the vertebrate body plan is that most exterior structures are bilaterally symmetric while many interior structures are left-right asymmetric. Left-right asymmetries are displayed in the heart, the circulatory, digestive and respiratory systems and in the central nervous system. A fundamental question in the study of all patterning events, including left-right axis formation, is how does asymmetry arise from apparent symmetry. A second important question that is perhaps unique to the study of left-right development, is how does the left-right axis align with the asymmetries that develop along the orthogonal axes; dorsal-ventral and anterior-posterior. Recent experiments in Xenopus laevis and zebrafish address both of these questions and have identified signaling molecules and interactions with midline cells that regulate left-right development.