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The Sox9 protein has been implicated in both initiation and progression of multiple solid tumors.<ref name="The versatile functions of Sox9 in">{{cite journal |last1=Jo |first1=A |last2=Denduluri |first2=S |last3=Zhang |first3=B |last4=Wang |first4=Z |last5=Yin |first5=L |last6=Yan |first6=Z |last7=Kang |first7=R |last8=Shi |first8=LL |last9=Mok |first9=J |last10=Lee |first10=MJ |last11=Haydon |first11=RC |title=The versatile functions of Sox9 in development, stem cells, and human diseases. |journal=Genes & Diseases |date=December 2014 |volume=1 |issue=2 |pages=149–161 |doi=10.1016/j.gendis.2014.09.004 |pmid=25685828|pmc=4326072 }}</ref> Its role as a master regulator of [[morphogenesis]] during [[Development of the human body|human development]] makes it an ideal candidate for perturbation in malignant tissues. Specifically, Sox9 appears to induce invasiveness and therapy-resistance in prostate,<ref name="Transient Sox9 Expression Facilitat">{{cite journal |last1=Nouri |first1=M |last2=Massah |first2=S |last3=Caradec |first3=J |last4=Lubik |first4=AA |last5=Li |first5=N |last6=Truong |first6=S |last7=Lee |first7=AR |last8=Fazli |first8=L |last9=Ramnarine |first9=VR |last10=Lovnicki |first10=JM |last11=Moore |first11=J |last12=Wang |first12=M |last13=Foo |first13=J |last14=Gleave |first14=ME |last15=Hollier |first15=BG |last16=Nelson |first16=C |last17=Collins |first17=C |last18=Dong |first18=X |last19=Buttyan |first19=R |title=Transient Sox9 Expression Facilitates Resistance to Androgen-Targeted Therapy in Prostate Cancer. |journal=Clinical Cancer Research |date=9 January 2020 |volume=26 |issue=7 |pages=1678–1689 |doi=10.1158/1078-0432.CCR-19-0098 |pmid=31919137|doi-access=free }}</ref> colorectal,<ref>{{cite journal |last1=Prévostel |first1=C |last2=Blache |first2=P |title=The dose-dependent effect of SOX9 and its incidence in colorectal cancer. |journal=European Journal of Cancer |date=November 2017 |volume=86 |pages=150–157 |doi=10.1016/j.ejca.2017.08.037 |pmid=28988015}}</ref> breast<ref>{{cite journal |last1=Grimm |first1=D |last2=Bauer |first2=J |last3=Wise |first3=P |last4=Krüger |first4=M |last5=Simonsen |first5=U |last6=Wehland |first6=M |last7=Infanger |first7=M |last8=Corydon |first8=TJ |title=The role of SOX family members in solid tumours and metastasis. |journal=Seminars in Cancer Biology |date=23 March 2019 |doi=10.1016/j.semcancer.2019.03.004 |pmid=30914279|doi-access=free }}</ref> and other cancers, and therefore promotes lethal metastasis.<ref>{{cite journal |last1=Aguilar-Medina |first1=M |last2=Avendaño-Félix |first2=M |last3=Lizárraga-Verdugo |first3=E |last4=Bermúdez |first4=M |last5=Romero-Quintana |first5=JG |last6=Ramos-Payan |first6=R |last7=Ruíz-García |first7=E |last8=López-Camarillo |first8=C |title=SOX9 Stem-Cell Factor: Clinical and Functional Relevance in Cancer. |journal=Journal of Oncology |date=2019 |volume=2019 |pages=6754040 |doi=10.1155/2019/6754040 |pmid=31057614|pmc=6463569 }}</ref> Many of these oncogenic effects of Sox9 appear dose dependent.<ref>{{cite journal |last1=Yang |first1=X |last2=Liang |first2=R |last3=Liu |first3=C |last4=Liu |first4=JA |last5=Cheung |first5=MPL |last6=Liu |first6=X |last7=Man |first7=OY |last8=Guan |first8=XY |last9=Lung |first9=HL |last10=Cheung |first10=M |title=SOX9 is a dose-dependent metastatic fate determinant in melanoma. |journal=Journal of Experimental & Clinical Cancer Research : CR |date=14 January 2019 |volume=38 |issue=1 |pages=17 |doi=10.1186/s13046-018-0998-6 |pmid=30642390|pmc=6330758 }}</ref><ref name="Transient Sox9 Expression Facilitat"/><ref name="The versatile functions of Sox9 in"/>
 
Chondrocyte-specific enhancer of the transcription activation of SOX9 can be induced by hypoxia which is the deprivation of oxygen supply at the tissue level. This process effects the mesenchymal cell function and is correlated to the activation of the pro alpha1(II) collagen gene (Coll2a), as this is the downstream target of SOX9. A multitude of tests have proven that the genes expressed by chondrocytes are affected by hypoxia-induced changes. ST2 cells were shown to be affected by hypoxia, specifically by expression of the SOX9 gene as well as HIF-1a. When HIF-1a was removed from the pathway, hypoxia was unable to transactivate SOX9. Based on this study, it is shown that hypoxia induces the differentiation of mesenchymal cells through the chondrocyte pathway by activating SOX9 by way of HIF-1a.<ref>{{Cite journal|last=Robins|first=Jared C.|last2=Akeno|first2=Nagako|last3=Mukherjee|first3=Aditi|last4=Dalal|first4=Ravi R.|last5=Aronow|first5=Bruce J.|last6=Koopman|first6=Peter|last7=Clemens|first7=Thomas L.|date=2005-09-01|title=Hypoxia induces chondrocyte-specific gene expression in mesenchymal cells in association with transcriptional activation of Sox9|url=http://www.sciencedirect.com/science/article/pii/S8756328205002085|journal=Bone|language=en|volume=37|issue=3|pages=313–322|doi=10.1016/j.bone.2005.04.040|issn=8756-3282}}</ref> These pathways are ultimately going to affect the development and function of the skeletal system.<ref name=":0">{{Cite journal|last=Amarilio|first=Roy|last2=Viukov|first2=Sergey V.|last3=Sharir|first3=Amnon|last4=Eshkar-Oren|first4=Idit|last5=Johnson|first5=Randall S.|last6=Zelzer|first6=Elazar|date=2007-11-01|title=HIF1α regulation of Sox9 is necessary to maintain differentiation of hypoxic prechondrogenic cells during early skeletogenesis|url=https://dev.biologists.org/content/134/21/3917|journal=Development|language=en|volume=134|issue=21|pages=3917–3928|doi=10.1242/dev.008441|issn=0950-1991|pmid=17913788}}</ref> The remodeling of the vasculature can also experience inhibited expression by these same genes.<ref name=":0" />
 
== SOX9 localisation and dynamics ==