The role of transcription factor Pitx1 and its regulation by hypoxia in Adolescent Idiopathic Scoliosis par

Adolescent Idiopathic Scoliosis is a lateral curvature of the spine greater than 10 degrees, with an unknown cause, affecting primarily adolescents. Previous mouse model studies showed that partial inactivation of Pitx1 gene resulted in the development of severe spinal deformities in Pitx1 +/mice, which is strikingly similar to the AIS phenotype. Based on this observation, we postulated that loss of Pitx1 function might have a role in AIS and could be regulated through specific molecular mechanisms. Indeed, expression studies revealed a loss of Pitx1 expression in osteoblasts derived from AIS patients, at the mRNA level. We hypothesized that the loss of Pitx1 in AIS could be triggered by hypoxic factors, since Pitx1 is known to be repressed by hypoxia and that HIF-2 alpha was up regulated in AIS osteoblasts even under normoxic conditions. Also, we found a mutation in the ODD domain of HIF-1 alpha in some AIS patients (3.1%), which is known to stabilize and enhance HIF-1 alpha transcriptional activity in normoxic conditions. We confirmed through EMSA the existence of a functional hypoxia response element on Pitx1 promoter. However, co-transfection assays with HIF-1 alpha and HIF-2 alpha expression vectors in the presence of their beta subunit ARNT led to the activation of Pitx1 promoter in human osteoblast cell line MG-63 cells and osteoblasts from control subjects. Interestingly, no Pitx1 promoter activity was observed in AIS osteoblasts, even after the co expression of HIF2 alpha and ARNT, consolidating the fact that Pitx1 expression is abrogated in AIS. Taken together, our findings show an important role for Pitx1 in AIS and hypoxic factors could be one of its regulators.