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SRY interference of normal regulation of the RET gene suggests a potential role of the Y-chromosome gene in sexual dimorphism in Hirschsprung disease.
[hirschsprung disease]
The
Hirschsprung
disease
(
HSCR
)
is
a
complex
congenital
disorder
,
arising
from
abnormalities
in
enteric
nervous
system
(
ENS
)
development
.
There
is
a
gender
disparity
among
the
patients
,
with
the
male
to
female
ratio
as
high
as
5
:
1
.
Loss
-of-function
mutations
of
HSCR
genes
and
haploinsufficiency
of
their
gene
products
are
the
primary
pathogenic
mechanisms
for
disease
development
.
Recent
studies
identified
over
half
of
the
HSCR
disease
susceptibility
genes
as
targets
for
the
sex-determining
factor
SRY
,
suggesting
that
this
Y-
encoded
transcription
factor
could
be
involved
in
sexual
dimorphism
in
HSCR
.
Among
the
SRY
targets
,
the
tyrosine
kinase
receptor
RET
represents
the
most
important
disease
gene
,
whose
mutations
account
for
half
of
the
familial
and
up
to
one
-
third
of
the
sporadic
forms
of
HSCR
.
RET
is
regulated
by
a
distal
and
a
proximal
enhancer
at
its
promoter
,
in
which
PAX
3
and
NKX
2
-
1
are
the
resident
transcription
factors
respectively
.
We
show
that
the
SRY
-box
10
(
SOX
10
)
co
-activator
interacts
and
forms
transcriptional
complexes
with
PAX
3
and
NKX
2
-
1
in
a
sequence-independent
manner
and
exacerbates
their
respective
transactivation
activities
on
the
RET
promoter
.
SRY
competitively
displaces
SOX
10
in
such
transcription
complexes
and
represses
their
regulatory
functions
on
RET
.
Hence
SRY
could
be
a
Y-
located
negative
modifier
of
RET
expression
;
and
if
it
is
ectopically
expressed
during
ENS
development
,
such
SRY
repression
could
result
in
RET
protein
haploinsufficiency
and
promotion
of
HSCR
development
,
thereby
contributing
to
sexual
dimorphism
in
HSCR
.
Diseases
Validation
Diseases presenting
"competitively displaces"
symptom
hirschsprung disease
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