NDST1 and congenital diaphragmatic hernia: Furthermore, Zhang et al. (117) have noted that absence of the heparan sulfate biosynthetic enzyme N-deacetylase-N-sulfotransferase-1 (Ndst1) in the mouse endothelium interferes with vascular development in the primordial diaphragm, resulting in hypoxia as well as diaphragmatic hypoplasia and central-type CDH.