Cardiovascular Research Institute,1 Department of Biochemistry and Biophysics, University of California, San Francisco, California 94143-0130,3 Department of Molecular Biology, The University of Texas Southwestern Medical Center, Dallas, Texas 75235-91482
Received 29 September 2003/ Returned for modification 24 November 2003/ Accepted 2 February 2004
| ABSTRACT |
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| INTRODUCTION |
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The MEF2 family comprises four vertebrate genes, mef2a to -d, and a single gene in Drosophila melanogaster (8). Inactivation of the Drosophila Mef2 gene results in a complete loss of muscle differentiation (9, 33, 53), and targeted disruption of the mouse mef2c gene leads to embryonic lethality due to cardiovascular defects (4, 34, 35). In addition, expression of a dominant-negative form of MEF2 in cultured skeletal muscle cells resulted in a failure of myoblasts to differentiate (49). MEF2 factors bind to a consensus A/T-rich sequence, YTA(A/T4)TAR, found in the control regions of nearly every skeletal or cardiac muscle gene analyzed in vivo (1, 8). MEF2 factors are also expressed in vertebrate smooth muscle cells (18); however, to date no transcriptional targets of MEF2 in smooth muscle have been identified in vivo.
The product of the HRC gene, the histidine-rich calcium-binding protein (HRCBP), is localized to the sarcoplasmic reticulum (SR) of cardiac and skeletal muscle and to calciosomes within arterial smooth muscle cells (20, 21, 51). HRCBP binds calcium in vitro with low affinity and high capacity (20, 52) and is present in the lumen of the junctional SR, the site of calcium release by the ryanodine receptor (15, 20, 29, 55). The function of HRCBP is not known, but its expression pattern, subcellular localization to the lumen of the SR, and association with components of the calcium release channel complex suggest a possible role in calcium release during excitation-contraction coupling (15, 20, 21, 25, 29). The expression of HRC in cardiac, skeletal, and smooth muscle suggests the possibility that HRC is the target of a common transcriptional program in the three muscle lineages.
In this study, we investigated the transcriptional regulation of the HRC gene in vivo using a transgenic approach. We identify the cis-regulatory promoter and enhancer sequences from the HRC gene and show that the HRC enhancer is dependent on an evolutionarily conserved, high-affinity MEF2 site for function in all three muscle lineages. Furthermore, the entire HRC enhancer sequence lacks any discernible CArG motifs and is not activated by SRF, suggesting that the HRC enhancer directs smooth muscle expression in an SRF-independent manner. Thus, these studies identify the HRC enhancer as the first example of a MEF2-dependent, CArG box-independent transcriptional target in vascular smooth muscle and represent the first analysis of the transcriptional regulation of an SR gene in vivo.
| MATERIALS AND METHODS |
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-actin (SMaa) promoter and enhancer, including 1.1 kb of upstream sequence and 2.7 kb from the first intron, was amplified from genomic DNA using the 5' primer 5'-ACACCATAAAACAAGTGCATGAGC-3' and the 3' primer 5'-GCAGCGTCTCAGGGTTCTGCA-3'. This fragment was confirmed by sequencing and was cloned into plasmid AUG-ß-gal for transfection analyses. This construct is nearly identical to the rat SMaa promoter and enhancer, which has been described previously (37). The expression plasmids pCDNA1.MEF2A and pCDNA1.MEF2C are also described elsewhere (6). Plasmid pCGN.SRF contains the mouse SRF cDNA under control of the cytomegalovirus promoter (57). The MEF2 mutation in the HRC enhancer was generated using the PCR mutagenesis technique of gene splicing by overlap extension (gene SOEing) (24) to create the following mutant sequence in the context of the full-length 2,726-bp HRC fragment: 5'-CCTCCGAGCTGGATCCTCCGCCCTGGCCTAG-3'. The entire sequence of the mutant fragment was confirmed by sequencing on both strands. The GenBank accession numbers for the sequences of the human and mouse HRC enhancers are AY321454 and AY321455, respectively. Generation of transgenic mice. Transgenic reporter fragments were digested and gel purified using standard techniques and were suspended in 5 mM Tris-Cl, 0.2 mM EDTA (pH 7.4) at a concentration of 2 ng/µl for pronuclear injection as described previously (23). Injected embryos were implanted into pseudopregnant CD-1 females, and embryos were collected at indicated time points for transient analysis or were allowed to develop to adulthood for establishment of stable transgenic lines. DNA was extracted from the yolk sac and amnion of embryos or from tail biopsies from mice by digestion in tail lysis buffer (100 mM NaCl, 25 mM EDTA, 1% sodium dodecyl sulfate, 10 mM Tris-Cl, 200 µg of proteinase K/ml; pH 8.0) at 56°C overnight. Digested samples were extracted once with phenol-chloroform and ethanol precipitated. DNA preparations were digested with EcoRV and analyzed by Southern blotting using a radiolabeled lacZ probe. All experiments using animals complied with federal and institutional guidelines and were reviewed and approved by the UCSF Institutional Animal Care and Use Committee.
X-Gal staining and immunohistochemistry. ß-Galactosidase expression from lacZ transgenic embryos, embryonic tissues, and adult tissues was detected by 5-bromo-4-chloro-3-indolyl-ß-D-galactopyranoside (X-Gal) staining as described previously (16). Some embryos were dehydrated in ethanol and cleared for 1 to 3 h in a 1:1 mixture of benzyl alcohol and benzyl benzoate prior to photography for better visualization of staining under the skin. For transverse sections, embryos were collected at 11.5 days postcoitum (dpc), fixed, and stained with X-Gal. Following staining, the embryos were fixed in 4% paraformaldehyde in phosphate-buffered saline (PBS), rinsed, and dehydrated with a series of ethanol washes (70 to 100%) followed by three brief washes in xylene. Samples were then mounted in paraffin, and transverse sections were cut at a thickness of 5 µm using a Leica RM 2155 microtome and mounted on glass slides. Sections were counterstained with Nuclear Fast Red to visualize embryonic structures. For antibody staining, embryos were collected, fixed, and sectioned as described above. The sections were rehydrated through a series of ethanol washes (100 to 70%) and then were placed in PBS for 5 min. The sections were then blocked for 20 min in 3% normal goat serum diluted in PBS. Incubation in both primary antibodies was performed concurrently for 1 h at room temperature in a humid chamber. Mouse monoclonal anti-skeletal muscle myosin (MY-32; Sigma) and rabbit anti-ß-galactosidase (ICN) were diluted 1:300 in 3% normal goat serum. Following incubation with the primary antibodies, the sections were washed three times for 10 min each with PBS. The secondary antibodies, Oregon Green-conjugated goat anti-rabbit (Molecular Probes) and tetramethyl rhodamine isocyanate (TRITC)-conjugated anti-mouse (Sigma), were diluted 1:300 into 3% normal goat serum and incubated for 1 h at room temperature in a humid chamber in the dark, followed by three washes in PBS. Slides were mounted using a SlowFade Light antifade kit (Molecular Probes) and photographed on a fluorescence microscope.
Cell culture, transfections, and reporter assays. C3H10T1/2 (10T1/2) cells were maintained in Dulbecco modified Eagle medium (DMEM) supplemented with 10% fetal calf serum. C2C12 myoblasts were maintained in DMEM plus 15% fetal calf serum. For generation of myotubes, C2C12 cells were maintained in DMEM plus 2% horse serum as described previously for the transfection of myotubes (5). Transfections were performed by calcium phosphate precipitation in 60-mm-diameter dishes as described elsewhere (16). In transfections of the reporter plasmid only into 10T1/2 cells, C2C12 myoblasts, and C2C12 myotubes, 10 µg of the HRC-CAT reporter (2609 to +117), the myogenin-CAT reporter (pMYO1565CAT), pCAT-Basic (Promega), or a constitutively active simian virus 40 (SV40)-CAT plasmid were used. Within each cell type, transfections were normalized as described previously (5). To account for differences in transfection efficiencies between the different cell types, the activity of SV40-CAT was set to 100% in each set of transfections for each cell type, and the data are expressed as a percentage of the activity obtained with SV40-CAT in that cell type. The activity of SV40-CAT is roughly equivalent among the three cell types used in these studies when normalized for transfection efficiency (5). For trans-activation analyses, 5 µg of HRC-lacZ or the SMaa-lacZ reporter was transfected along with either 5 µg of pCDNA1.MEF2A, 5 µg of pCDNA1.MEF2C, or 5 µg of pCDNA1.SRF expression plasmid by calcium phosphate precipitation. In samples where a cDNA expression plasmid was not transfected, an equal amount of the parental pCDNA1/amp expression vector (Invitrogen) was transfected. For chloramphenicol acetyltransferase (CAT) assays, transfected cells were harvested, and cellular extracts were prepared by sonication, heat inactivated, and normalized as described previously (14). CAT activity was determined as described previously (56). Reactions were conducted for 5 h at 37°C. Conversion to acetylated forms was analyzed by thin-layer chromatography and quantitated by phosphorimager analysis (Molecular Dynamics, Inc.). For ß-galactosidase assays, transfected cells were harvested and cellular extracts were prepared by sonication and normalized as described previously (16). Chemiluminescent ß-galactosidase assays were performed using the luminescent ß-gal kit (Clontech) according to the manufacturer's recommendations, and relative light units were detected using a Tropix TR717 microplate luminometer (PE Applied Biosystems).
EMSAs. DNA-binding reactions were performed as described previously (16). Briefly, double-stranded oligonucleotides for use in binding reactions were labeled with [32P]dCTP using Klenow to fill in overhanging 5' ends and purified on a nondenaturing polyacrylamide-Tris-borate-EDTA gel. Binding reactions were preincubated at room temperature in 1x binding buffer (40 mM KCl, 15 mM HEPES [pH 7.9], 1 mM EDTA, 0.5 mM dithiothreitol, 5% glycerol) containing 2 µg of reticulocyte lysate containing recombinant MEF2A or SRF protein or 2 µg of unprogrammed reticulocyte lysate, 1 µg of poly(dI-dC), and competitor DNA (100-fold excess where indicated) for 10 min prior to probe addition. Recombinant MEF2A and SRF proteins were generated from plasmid pCDNA1.MEF2A and plasmid pCDNA1.SRF by transcribing with T7 polymerase and translating in vitro using the TNT Quick coupled transcription-translation system as described in the manufacturer's directions (Promega). Reaction mixtures were incubated an additional 20 min at room temperature after probe addition and electrophoresed on a 6% nondenaturing polyacrylamide gel. The oligonucleotides for the myogenin MEF2 site and a mutant form of that site have been described previously (59). The oligonucleotides for the SMaa intronic CArG box and a mutant form of that site have also been described previously (37). The sense-strand sequences of the oligonucleotides used for electrophoretic mobility shift assays (EMSAs) were as follows: wild-type MEF2 site, 5'-TCCCAGCTGTATTTATAGCCCTGGCCTAGCCCA-3'; mutant MEF2 site, 5'-TCCCAGCTGGATCCTCCGCCCTGGCCTAGCCCA-3'.
| RESULTS |
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An evolutionarily conserved upstream region is required for HRC function in vivo.
As a first step towards defining the cis-acting elements within the HRC enhancer required to direct cardiac, skeletal, and arterial smooth muscle-specific transcription in vivo, we performed deletional analyses of the HRC upstream region to identify the minimal sequence required for expression of lacZ (Fig. 4). Deletion from 2609 to 770 had no effect on expression in skeletal muscle, but this deletion had a dramatic effect on cardiac and smooth muscle expression, which was only faintly detectable (Fig. 4, constructs 1 and 2). Deletion of the upstream region to 510 had a more dramatic effect, completely eliminating expression in all three muscle lineages (Fig. 4, construct 3). Importantly, deletion of this 261-bp region (
510-770) in the context of the entire 2609 to +117 HRC enhancer fragment also completely eliminated expression of lacZ in transgenic mouse embryos (Fig. 4, construct 4). Since the region of the HRC enhancer between 770 and 510 was required for expression, we tested whether this region was also sufficient for expression in vivo. We cloned this 261-bp region of the HRC gene into plasmid HSP68-lacZ (HSP68/510-770) such that if functional enhancer sequences were present, lacZ would be transcribed due to the presence of the heterologous, minimal HSP68 promoter (27). This small region from the HRC gene was sufficient to drive strong expression in skeletal muscle, but it directed only very weak expression in cardiac and smooth muscle (Fig. 4, construct 5). These results, combined with the observation that deletion from 2600 to 770 had the same effect on transgene function, indicate that sequences upstream of 770 are required for the full expression of HRC in cardiac and smooth muscle. Taken together, all of the results summarized in Fig. 4 showed that the 261-bp region between 770 and 510 was absolutely required for HRC enhancer function in all three muscle lineages in vivo.
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The data presented in Fig. 3 demonstrated that the HRC enhancer functions in arterial smooth muscle cells. Because the vast majority of smooth muscle genes described to date depend on the MEF2-related transcription factor SRF for activation in vivo (50), we wanted to test whether the HRC enhancer might also be a target of SRF. Even though the MEF2 site in the HRC enhancer meets the consensus sequence constraints for MEF2 binding (1) and does not match the CArG consensus for SRF binding (50), we wanted to exclude the possibility that the HRC MEF2 site might represent a noncanonical SRF-binding site. Under conditions in which MEF2 bound efficiently to the HRC MEF2 site (Fig. 5C, lane 2), SRF exhibited no detectable binding to the site (Fig. 5C, lane 5). The failure of SRF to exhibit any detectable binding to the HRC MEF2 site occurred in the same experiment in which SRF bound very robustly to the bona fide CArG box from the SMaa intronic enhancer (Fig. 5C, lane 9). Thus, the data presented in Fig. 5C further demonstrate that the HRC MEF2 site represents a bona fide MEF2 site and that it does not represent a binding site for SRF.
As an additional test for a potential role for SRF in the activation of HRC, we tested the ability of SRF to trans-activate the HRC enhancer (Fig. 5D). SRF cotransfection failed to cause any detectable activation over background (Fig. 5D, compare lanes 1 and 3) in the same experiment in which MEF2C trans-activated the HRC enhancer greater than 10-fold (Fig. 5D, compare lanes 1 and 2). Furthermore, SRF resulted in greater than 16-fold activation of the SMaa enhancer, a bona fide SRF target, in the same experiment in which it failed to activate HRC at all (Fig. 5D, lane 5). These results, taken together with the observation that the HRC enhancer lacks any recognizable CArG motifs, strongly suggest that HRC is not an SRF target gene.
The MEF2 site in the HRC enhancer is required for transgene expression in all three muscle lineages in vivo. To test the function of the HRC MEF2 site in vivo, we introduced a mutation in the MEF2 site in the context of the 2,726-bp HRC-lacZ transgene (Fig. 4, construct 1) and generated transgenic embryos. Mutation of the HRC MEF2 site completely abolished cardiac and smooth muscle expression (Fig. 6). Cardiac expression directed by the wild-type transgene was apparent throughout development and in adulthood (Fig. 6A to C, K, and L). Cardiac expression directed by the wild-type HRC enhancer was robust during embryonic development (Fig. 6B) and was reduced but remained easily detectable in the fetal and adult heart (Fig. 6K and L). Adult cardiac expression directed by the wild-type enhancer was somewhat variable among individual animals but was consistently present in the ventricles in every case. Very weak expression in the adult atria was rarely observed (data not shown). In contrast to the expression directed by the wild-type enhancer, no expression of the MEF2 mutant transgene was detected in the heart at any stage (Fig. 6E to G, O, and P). The wild-type transgene was expressed in arterial smooth muscle beginning at 11.5 dpc (Fig. 6C and D), and expression could also be detected easily in arterial smooth muscle at later stages in development (Fig. 6K) and in adulthood (Fig. 6L). Mutation of the HRC MEF2 site completely disrupted lacZ expression in smooth muscle at all stages. No smooth muscle expression of the MEF2 mutant transgene was observed in the embryo (Fig. 6G and H), fetus (Fig. 6O), or adult (Fig. 6P). Six independent MEF2 mutant lines were examined. None displayed any expression in cardiac or arterial smooth muscle. Seven independent transgenic lines were examined for the wild-type HRC enhancer construct. All displayed nearly identical patterns of expression. Taken together, the results presented in Fig. 6 clearly indicate that the MEF2 site in the HRC enhancer is required for function in cardiac and smooth muscle in vivo.
The wild-type HRC enhancer directed easily detectable lacZ expression to skeletal muscle by 9.0 dpc (Fig. 6A), and this expression was maintained throughout development and adulthood (Fig. 6). Activity of the MEF2 mutant enhancer could be detected at 9.0 dpc in somites (Fig. 6E), although expression was slightly weaker than that observed with the wild-type enhancer (Fig. 6A). By 11.5 dpc, the difference in the activities of the wild-type and mutant enhancers became more pronounced in skeletal muscle. The wild-type HRC enhancer directed robust lacZ expression to myoblasts in the hypaxial and epaxial somites and to the muscles of the forelimb bud (Fig. 6B and C). Expression of the MEF2 mutant transgene at 11.5 dpc could also be observed in epaxial and hypaxial muscles within the somites and in the myoblasts of the forelimb bud (Fig. 6F and G). However, the overall expression level of lacZ directed by the MEF2 mutant transgene was severely reduced in the somites, such that expression was nearly undetectable in rostral somites (Fig. 6F and G). Interestingly, expression of the mutant transgene was quite robust in dorsal limb muscles (Fig. 6F and G) compared to that of the wild-type HRC-lacZ transgene (Fig. 6B and C). The disparity in skeletal muscle expression directed by the wild-type versus the mutant transgenes continued to become more pronounced throughout development, such that the wild-type transgene was expressed at very high levels at 13.5 dpc (Fig. 6I) and at 16.5 dpc (Fig. 6J). The MEF2 mutant transgene was only very weakly expressed by 13.5 dpc (Fig. 6M) and was essentially inactive by 16.5 dpc (Fig. 6N) and in the adult (data not shown).
The disparity in the expression directed by the wild-type and mutant transgenes at 11.5 and 13.5 dpc in the somites and limbs prompted us to examine lacZ transgene expression in skeletal muscle in more detail (Fig. 7). At 11.5 dpc, the wild-type enhancer directed strong expression within the myotomal compartment of the somites (Fig. 7A and B) but directed only weak expression of lacZ to the forelimb bud (Fig. 7C). By contrast, activity of the MEF2 mutant enhancer was barely detectable in the somites (Fig. 7D and E), but it directed very robust expression in the forelimb bud (Fig. 7F). We compared ß-galactosidase expression in the somites to the expression of skeletal muscle myosin heavy chain by immunofluorescence using antibodies directed against both proteins (Fig. 7). ß-Galactosidase protein expression in caudal somites at 11.5 dpc (Fig. 7G) completely overlapped with the expression of myosin (Fig. 7H and I) and appeared to be restricted to mononucleated muscle cells. Expression in more rostral somites at 11.5 dpc or in caudal somites at later times in development was present in mononucleated myosin-positive cells and in myosin-positive multinucleated myotubes (data not shown). Somitic expression of ß-galactosidase protein directed by the MEF2 mutant transgene at 11.5 dpc was much weaker than that of the wild-type transgene, although it could be detected (Fig. 7J). As with the wild-type transgene, expression overlapped the expression of myosin and was restricted to mononucleated cells in caudal somites, although many myosin-positive cells were not positive for ß-galactosidase at this stage (Fig. 7K and L).
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| DISCUSSION |
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Several other genes expressed in vascular smooth muscle have had the cis-regulatory regions controlling their expression in vivo defined in transgenic analyses. In nearly every smooth muscle gene described to date, expression is dependent on the presence of one or more SRF-binding CArG boxes in the promoter or enhancer (26, 30, 32, 37-39, 44, 50), and a number of smooth muscle enhancers are able to discriminate arterial from venous smooth muscle expression in vivo, including the SM22
, CRP1, and desmin enhancers (31, 32, 44). In each of these cases, smooth muscle expression is largely restricted to arteries and is dependent on one or more conserved CArG boxes in the enhancer (26, 30, 32, 44).
While most smooth muscle genes defined to date are SRF dependent in vivo, there have been a few exceptions to this model. A recent paper by Chang et al. showed that the cysteine-rich protein 2 (CRP2) enhancer directed lacZ expression in smooth muscle in a pattern that was restricted to arteries in vivo through a CArG-independent pathway (12). Notably, the CRP2 enhancer also does not contain any MEF2 sites (12). The mouse aortic carboxypeptidase-like protein (ACLP) gene promoter directs expression to both venous and arterial smooth muscle in vivo, and it also lacks any discernible CArG or MEF2 elements (28). Importantly, the promoter and enhancer elements from the HRC gene are sufficient to direct expression to arterial smooth muscle in vivo, yet the HRC enhancer lacks any CArG motifs and cannot be trans-activated by SRF (Fig. 5D), suggesting that the HRC enhancer functions in smooth muscle via an SRF-independent pathway.
The cis-acting elements controlling the expression of several cardiac and skeletal muscle genes with products restricted to the SR have been analyzed in cell culture studies. These include the sarcoplasmic endoplasmic reticulum calcium ATPase 1 and 2 genes, the ryanodine receptor 1 and 2 genes, the phospholamban gene, and the calsequestrin gene (2, 3, 19, 43, 48, 54). The majority of these promoters contain at least one consensus MEF2 site, although no direct role for MEF2 has been demonstrated for any SR gene in vivo prior to the present study. It will be interesting to determine if other SR genes are also dependent on MEF2 for expression in vivo and if the genes are coordinately regulated at the transcriptional level.
As noted above, mutation of the MEF2 site in the HRC enhancer had a dramatic impact on expression in all three muscle lineages in vivo, but the initial activation in skeletal muscle did not appear to require the MEF2 site. The MEF2 mutant HRC enhancer was activated in somites almost as robustly as the wild-type enhancer at the earliest stages of transgene expression, but it failed to continue to express lacZ at levels comparable to the wild-type transgene (Fig. 6 and 7). Likewise, expression directed by the HRC enhancer in the dorsal limb muscles appeared to be independent of the MEF2 site at the time of initial activation (Fig. 6F and 7F). However, at later stages in development and in adulthood, the MEF2 mutant HRC-lacZ transgene was not expressed in any muscles, including those in the limbs (Fig. 6 and 7). These observations support a model for HRC expression in which the initial activation of the enhancer in skeletal muscle is MEF2 independent but in which maintenance of expression is MEF2 dependent. Furthermore, our data suggest that MEF2 factors may actually be playing an early repressive role on the HRC enhancer in skeletal muscle, since the initial activation in dorsal limb muscles is more robust when the MEF2 site is mutated (Fig. 6F and G and 7F). The observation that limb muscle expression in the MEF2 site mutant is more robust and appears to be activated precociously is consistent with a potential role for a MEF2-dependent recruitment of histone deacetylases (HDACs) to the enhancer (42). In this model, a MEF2-HDAC complex bound at the MEF2 site would repress activation by myogenic bHLH factors bound at a nearby E box (36, 42) until HDAC proteins were displaced and shuttled out of the nucleus (41, 42).
A hallmark of MEF2 transcription factor function is the potential ability to serve as either an activator or repressor of transcription in skeletal muscle due to the recruitment of either positive or negative transcriptional coregulators (42). MEF2 recruitment of HDAC proteins results in transcriptional repression, while displacement of HDACs by MyoD interaction with MEF2 results in strong activation of transcription (41, 42). Mutation of the MEF2 site in the HRC enhancer appears to disrupt an early repressive effect of MEF2 on the enhancer in skeletal muscles, particularly in the limbs (Fig. 6 and 7). In contrast to its initial robust activation in skeletal muscle, the MEF2 mutant enhancer was never expressed in cardiac or smooth muscle, even at the earliest times of HRC expression (Fig. 6). This observation suggests that MEF2 may play an essential role in the initial activation of HRC in cardiac and smooth muscle. While MEF2 may be crucial for the initiation of HRC transcription in these lineages, we consider it unlikely that MEF2 is the only critical regulator of HRC in cardiac and smooth muscle. Instead, we favor a model in which MEF2 cooperates with other lineage-specific or -restricted transcription factors. This type of cooperative model for MEF2 factors has been demonstrated in skeletal muscle transcription, where MEF2 proteins cooperate with myogenic bHLH proteins to activate transcription (7, 45). Similarly, the cardiac-restricted transcription factor GATA4 has been shown to recruit MEF2 proteins to target promoters, resulting in transcriptional synergy (46). A cooperative model for transcriptional activation in smooth muscle has been demonstrated for SRF (10) but, to date, no coregulators of MEF2 activity have been identified in smooth muscle. It seems likely that additional MEF2 transcriptional coregulators function in the activation of HRC and other genes in each muscle lineage, and it will be interesting to determine whether previously unidentified MEF2 cofactors are responsible for the activation of the HRC enhancer in cardiac and smooth muscle.
| ACKNOWLEDGMENTS |
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E.J.J. and E.D. were supported in part by fellowships from the American Heart Association, Western States Affiliate. A.B.H. was supported by a Howard Hughes Medical Institute Predoctoral Fellowship. This work was supported by the D.W. Reynolds Center for Clinical Cardiovascular Research to E.N.O., by a grant from the American Heart Association, Western States Affiliate, to B.L.B., and by grants from the National Institutes of Health to E.N.O. and B.L.B.
| FOOTNOTES |
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