Mef2c is a MADS (MCM1-agamous
IntroductionHematopoiesis is a tightly regulated system in which mature blood cells are constantly replenished from hematopoietic stem cells in the bone marrow, and which responds quickly to foreign invasion or environmental stress. The molecular pathways controlling normal and stress-related hematopoiesis are often targets of oncogenic lesions, the accumulation of which leads to leukemia. In particular, transcriptions factors that play pivotal roles in regulating the differentiation of myeloid cells into active mediators of the innate immune system-granulocytes, macrophages (developing through monocytes), and dendritic cells-are frequently deregulated in acute myeloid leukemia (AML). 1,2 These include the Ets-family member PU.1, the Runt transcription factor RUNX1, the interferon-regulatory factor-8 (IRF-8), and the basic leucine zipper protein (bZIP) factors C/EBP␣, c-JUN, and JUNB. Extensive cross-talk exists between these transcription factors-most likely enabling a quick and expedient response to stress signals, but also ensuring the return to homeostasis. Understanding the complex controls of monocytic and granulocytic differentiation not only provides insight into the innate immune response but also into AML.Recent studies have revealed a role of myocyte enhancer factor 2 (MEF2) transcription factors in acute leukemia. The gene encoding Mef2d has been identified at the breakpoint of a variant t(1;19) in acute lymphoblastic leukemia (ALL), [3][4][5] and the gene encoding Mef2c has recently been shown to be up-regulated in leukemic stem cells of MLL-associated leukemia (Krivtsov et al 6 and M.S., A.S., M. Forster, A.E., M.A., R. Delwel, J. Löhler, R. Slany, E.N.O., and C.S., manuscript submitted), which is associated with myelomonocytic or monocytic phenotypes. 7 Interestingly, both genes have been found as targets of retroviral integration sites in leukemia induced by murine leukemia virus. 8 The Mef2 proteins belong to a distinct class of the MADS (MCM1-agamous-deficient serum response factor) family of transcription factors, and were originally identified as important regulators of myogenic differentiation. 9 There are 4 vertebrate MEF2 genes, which are expressed in distinct but overlapping patterns during embryogenesis. Similar to other MADS domain proteins, MEF2 proteins associate with a variety of transcription cofactors to control specific sets of downstream target genes-and their activity is profoundly influenced by developmental cues and signals from the extracellular environment through several transcriptional and posttranslational controls. 10 The importance of Mef2c in the development of skeletal, cardiac, and smooth muscle is well documented, 9 and more recently, its role in craniofacial and bone development has been revealed. 11,12 Accumulating evidence also supports the importance of MEF2 transcription factors in neuronal differentiation and survival 13,14 and in mediating T-cell receptor-mediated apoptosis and cytokine expression 15,16 ; however, their role in n...