Abstract
TLX2 (also known as HOX11L1, Ncx and Enx) is a transcription factor playing a crucial role in the development of the enteric nervous system, as confirmed by mice models exhibiting intestinal hyperganglionosis and pseudo-obstruction. However, congenital defects of TLX2 have been excluded as a major cause of intestinal motility disorders in patients affected with intestinal neuronal dysplasia (IND) or pseudo-obstruction. After demonstrating the direct regulation of TLX2 expression by the homeoprotein PHOX2B, in the present work, we have focused on its paralogue PHOX2A. By co-transfections, electrophoretic mobility shift assays and chromatin immunoprecipitation, we have demonstrated that PHOX2A, like PHOX2B, is involved in the cascade leading to TLX2 transactivation and presumably in the intestinal neuronal differentiation. Based on the hypothesis that missed activation of the TLX2 gene induces the development of enteric nervous system defects, PHOX2A and PHOX2B have been regarded as novel candidate genes involved in IND and pseudo-obstruction and consequently analyzed for mutations in a specific set of 26 patients. We have identified one still unreported PHOX2A variant; however, absence of any functional effect on TLX2 transactivation suggests that regulators or effectors other than the PHOX2 genes must act in the same pathway, likely playing a non redundant and direct role in the pathogenesis of such enteric disorders.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Parisi MA, Baldessari AE, Iida MH et al: Genetic background modifies intestinal pseudo-obstruction and the expression of a reporter gene in Hox11L1−/− mice. Gastroenterology 2003; 125: 1428–1440.
Hatano M, Aoki T, Dezawa M et al: A novel pathogenesis of megacolon in Ncx/HOX11L1 deficient mice. J Clin Invest 1997; 100: 795–801.
Shirasawa S, Yunker AM, Roth KA, Brown GA, Horning S, Korsmeyer SJ : Enx (HOX11L1)-deficient mice develop myenteric neuronal hyperplasia and megacolon. Nat Med 1997; 3: 646–650.
Meier-Ruge W : Casuistic of colon disorder with symptoms of Hirschsprung's disease. Verh Dtsch Ges Pathol 1971; 55: 506–510.
Meier-Ruge W, Gambazzi F, Wiebecke B, Käufeler RE, Schmid P, Schmidt CP : The neuropathological diagnosis of neuronal intestinal dysplasia (NID B). Eur J Pediatr Surg 1994; 4: 267–273.
De Giorgio R, Stanghellini V, Barbara G et al: Primary enteric neuropathies underlying gastrointestinal motor dysfunction. Scand J Gastroenterol 2000; 35: 114–122.
Newgreen D, Young HM : Enteric nervous system: development and developmental disturbances – part 1. Pediatr Dev Pathol 2002; 5: 224–247.
Scharli AF : Neuronal intestinal dysplasia. Pediat Surg Int 1992; 7: 2–7.
Costa M, Fava M, Seri M et al: Evaluation of the HOX11L1 gene as a candidate for congenital disorders of intestinal innervation. J Med Genet 2000; 37: E7.
Von Boyen GB, Krammer HJ, Suss A, Dembowski C, Ehrenreich H, Wedel T : Abnormalities of the enteric nervous system in heterozygous endothelin B receptor deficient (spotting lethal) rats resembling intestinal neuronal dysplasia. Gut 2002; 51: 414–419.
Fava M, Borghini S, Cinti R et al: HOX11L1, a promoter study to evaluate possible expression defects in intestinal motility disorders. Int J Mol Med 2002; 10: 101–106.
Gath R, Goessling A, Keller KM et al: Analysis of the RET, GDNF, EDN3, and EDNRB genes in patients with intestinal neuronal dysplasia and Hirschsprung disease. Gut 2001; 48: 671–675.
Borghini S, Bachetti T, Fava M et al: The TLX2 homeobox gene is a transcriptional target of PHOX2B in neural crest derived cells. Biochem J 2006; 395: 355–361.
Amiel J, Laudier B, Attie-Bitach T et al: Polyalanine expansion and frameshift mutations of the paired-like homeobox gene PHOX2B in congenital central hypoventilation syndrome. Nat Genet 2003; 33: 459–460.
Matera I, Bachetti T, Puppo F et al: PHOX2B mutations and polyalanine expansions correlate with the severity of the respiratory phenotype and associated symptoms in both congenital and late onset Central Hypoventilation syndrome. J Med Genet 2004; 41: 373–380.
Bachetti T, Borghini S, Ravazzolo R, Ceccherini I : An in vitro approach to test the possible role of candidate factors in the transcriptional regulation of the RET proto-oncogene. Gene Expression 2005; 12: 137–149.
Bachetti T, Matera I, Borghini S et al: Distinct pathogenetic mechanisms for PHOX2B associated polyalanine expansions and frameshift mutations in Congenital Central Hypoventilation syndrome. Hum Mol Genet 2005; 14: 1815–1824.
Cargnin F, Flora A, Di Lascio S et al: PHOX2B regulates its own expression by a transcriptional auto-regulatory mechanism. J Biol Chem 2005; 280: 37439–37448.
Stanghellini V, Cogliandro RF, De Giorgio R et al: Natural history of chronic idiopathic intestinal pseudo-obstruction in adults: a single center study. Clin Gastroenterol Hepatol 2005; 3: 449–458.
Kim HS, Seo H, Yang C, Brunet JF, Kim KS : Noradrenergic-specific transcription of the dopamine beta-hydroxylase gene requires synergy of multiple cis-acting elements including at least two PHOX2A-binding sites. J Neurosci 1998; 18: 8247–8260.
Kapur RP : Neuronal dysplasia: a controversial pathological correlate of intestinal pseudo-obstruction. Am J Med Genet A 2003; 122: 287–293.
Vijayaraghavan R, Chandrashekar R, Melkote Jyotiprakash A, Kumar R, Rashmi MV, Shanmukhappa Belagavi C : Intestinal neuronal dysplasia (type B) causing fatal small bowel ischaemia in an adult: a case report. Eur J Gastroenterol Hepatol 2006; 18: 773–776.
Sasaki A, Kanai M, Kijima K et al: Molecular analysis of congenital central hypoventilation syndrome. Hum Genet 2003; 114: 22–26.
Garcia-Barcelo M, Sham MH, Lui VC, Chen BL, Ott J, Tam PK : Association study of PHOX2B as a candidate gene for Hirschsprung's disease. Gut 2003; 52: 563–567.
Toyota T, Yoshitsugu K, Ebihara M et al: Association between schizophrenia with ocular misalignment and polyalanine length variation in PMX2B. Hum Mol Genet 2004; 13: 551–561.
Adachi M, Browne D, Lewis EJ : Paired-like homeodomain proteins PHOX2A/Arix and PHOX2B/NBPhox have similar genetic organization and independently regulate dopamine beta-hydroxylase gene transcription. DNA Cell Biol 2000; 19: 539–554.
Coppola E, Pattyn A, Guthrie SC, Goridis C, Studer M : Reciprocal gene replacements reveal unique functions for Phox2 genes during neural differentiation. EMBO J 2005; 24: 4392–4403.
Pattyn A, Morin X, Goridis C, Brunet JF : Expression and interaction of the two closely related homeobox genes PHOX2A and PHOX2B during neurogenesis. Development 1997; 124: 4065–4075.
Pattyn A, Morin X, Cremer H, Goridis C, Brunet JF : The homeobox gene PHOX2B is essential for the development of autonomic neural crest derivatives. Nature 1999; 399: 366–370.
Morin X, Cremer H, Hirsch MR, Kapur RP, Goridis C, Brunet JF : Defects in sensory and autonomic ganglia and absence of locus coeruleus in mice deficient for the homeobox gene PHOX2A. Neuron 1997; 18: 411–423.
Nakano M, Yamada K, Fain J et al: Homozygous mutations in ARIX (PHOX2A) result in congenital fibrosis of the extraocular muscles type 2. Nat Genet 2001; 29: 315–320.
Chen S, Ji M, Paris M, Hullinger RL, Andrisani OM : The cAMP pathway regulates both transcription and activity of the paired homeobox transcription factor Phox2a required for development of neural crest-derived and central nervous system-derived catecholaminergic neurons. J Biol Chem 2005; 280: 41025–41036.
Howe DG, Clarke CM, Yan H et al: Inhibition of protein kinase A in murine enteric neurons causes lethal intestinal pseudo-obstruction. J Neurobiol 2006; 66: 256–272.
Iitsuka Y, Shimizu H, Kang MM et al: An enhancer element for expression of the Ncx (Enx, HOX11L1) gene in neural crest-derived cells. J Biol Chem 1999; 34: 24401–24407.
Martucciello G, Torre M, Pini Prato A et al: Associated anomalies in intestinal neuronal dysplasia. J Pediatr Surg 2002; 37: 219–223.
Acknowledgements
We are grateful to Mrs Loredana Velo for excellent secretarial assistance. The financial support of Italian Telethon (grant GGP04257) is gratefully acknowledged.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Borghini, S., Di Duca, M., Santamaria, G. et al. Transcriptional regulation of TLX2 and impaired intestinal innervation: possible role of the PHOX2A and PHOX2B genes. Eur J Hum Genet 15, 848–855 (2007). https://doi.org/10.1038/sj.ejhg.5201852
Received:
Revised:
Accepted:
Published:
Issue date:
DOI: https://doi.org/10.1038/sj.ejhg.5201852
Keywords
This article is cited by
-
Genetic background-dependent abnormalities of the enteric nervous system and intestinal function in Kif26a-deficient mice
Scientific Reports (2021)
-
Defining the transcriptomic landscape of the developing enteric nervous system and its cellular environment
BMC Genomics (2017)
-
rs224136 on Chromosome 10q21.1 and Variants in PHOX2B, NCF4 and FAM92B Are Not Major Genetic Risk Factors for Susceptibility to Crohn's Disease in the German Population
The American Journal of Gastroenterology (2009)