The results presented in this work suggest that the role of TCF4 is time-sensitive, as the obtained findings point out that Tcf4 influences granule cells in different ways depending on the time of the knockout. While a prenatal knockout of Tcf4 increases apoptosis and decreases proliferation, a postnatal Tcf4 loss leads to a significant increase in proliferation (Fig. 10, 17, and 23).
The observation that a gene can have opposing roles during development is not new; in fact, very similar results regarding another gene have just been published by Merk et al. (2018). Here, the role of the factor CREBBP, another gene identified to have somatic mutations in SHH MB and that is associated with the neurodevelopmental disorder Rubinstein-Taybi syndrome, was reported to have time-sensitive effects.
To get a better understanding of these different influences, knockouts at additional time points should be examined. As mentioned before, mice with a total Tcf4 knockout (Tcf4−/− mice) are not viable and are mostly stillborn (Flora et al., 2007), providing
A study performed by de Pontual et al. (2009), examining the expression pattern ofTcf4 during early development, could be used to determine suitable points to knock out Tcf4 and investigate how cells and the whole organism react to its loss. This might solve the question as to when a Tcf4 knockout leads to an upregulation in apotosis and when in cell proliferation.
The relevance of the different occurrences of a TCF4 loss are also demonstrated by the fact that a germline mutation in TCF4, as seen in PTHS, does not increase the tumour incidence in those patients, since there is only one case reported so far in which a PTHS patient developed cancer (Zweier et al., 2007).
Having a closer look into the different functions of TCF4 depending on the time of knockout will help shed more light onto its different roles in neurodevelopment and neuromaintenance, and identify whether PTHS is solely a neurodevelopmental disorder or if the lack of TCF4 throughout adult life contributes to the PTHS phenotype.
The Tcf4 knockout mouse model hGFAP-cre::Tcf4f l/f l presented in this thesis is a suitable model to investigate a homozygous Tcf4 knockout in vivo. With its similarity to PTHS, it can be used to examine this rare neurodevelopmental disorder. The hGFAP-cre::Tcf4f l/f l mouse is furthermore of special interest, as it is the only PTHS mouse model to date that is viable as a homozygous knockout and as such shows a very distinct phenotype not observed in any of the other published models.
The results obtained for this project point out that the function of TCF4 is time-sensitive with its effects differing depending on whether the knockout occurs prenatally or postnatally. More precise, there is a difference in the effects between a germline and a somatic TCF4 mutation. A prenatal knockout of Tcf4 leads to microcephaly most likely caused by a decrease in proliferation and an increase in apoptosis in granule cells.
It furthermore leads to migratory deficits in granule cells with its molecular cause still to be determined. It is tempting to propose that the glia plays an important part in this phenomenon. A postnatal knockout on the other hand causes an increase in proliferation in vitro.
The investigation of an acquired loss of TCF4 provided evidence for the protein to function as a tumour suppressor in medulloblastoma, as overexpression ofTCF4 improves overall survival rates in SHH MB. Moreover, the expression of wild-type TCF4 is able to decrease proliferation in a medulloblastoma cell line.
The findings presented in this thesis contribute to the understanding of the function of TCF4. However, further work is required for a more comprehensive picture of TCF4, its role in CNS development, and its influence on SHH MB. Especially the different effects of prenatal and postnatal TCF4 knockouts should be addressed in more detail. Sweatt (2013) already raised the question as to how different the effects ofTCF4 during develop-ment and adult stages are. The author explained that the PTHS symptoms are caused by theTCF4 knockout during the developmental stages but what happens in the adult brain remains unclear: ”It is unclear whether PTHS is caused exclusively by disruption of TCF4 function during development or whether loss of TCF4 in the mature CNS might also contribute to neurobehavioral and cognitive dysfunction in PTHS patients”(Sweatt, 2013).
Apart from the time-dependent effects of TCF4, other aspects mentioned in this thesis merit further investigation. For example, the development of the whole brain after loss of TCF4 with special focus on the hippocampus should be observed more closely.
This would also give a better estimate as to how well does the herein introduced mouse model mimic Pitt-Hopkins syndrome and in what ways can it be used to investigate this rare disorder. Moreover, behavioural studies and cognitive testing of this mouse model need to be carried out.
An even closer look into the cells and their behaviour itself, especially a better in-vestigation of migration and formation of cells as well as the development of dendritic arbours, will give a more comprehensive understanding in respect to the alteration of the anatomical structure in the cerebellum and cerebrum. As described before, this research should also include the role of the extracellular matrix and other cell types involved in the migratory process, specifically the glia. The question of whether
”distinct cell populations may require different TCF4 dosages and whether there is cell type-/region-specific vulnerability to pathologically altered TCF4 expression levels” (Jung et al., 2018) should also be addressed in future research intoTCF4.
A next step in this context would then be to investigate the effects of reintroducingTCF4 following its earlier knockout and to determine if there is the possibility of rescuing the phenotype. For example, by generating vectors using the foamy virus, which inserts its genome solely in a subset of proliferating cells in the brain such as hippocampal neurons (Counsell et al., 2018), the effect of reintroducing TCF4 in separate cell lineages could be investigated.
Furthermore, the examination of effects of TCF4 knockouts in the adult brain, i.e. at later time points than P5, would give more information about the function of TCF4 in general and its role in the adult brain in specific. Sweatt (2013) already proposed that
”a new understanding of the role of TCF4 in the fully developed CNS might allow the development of new therapeutic approaches to PTHS treatment based on restoration or augmentation of TCF4 function after CNS development is largely finished”. In particular, the inducible knockout system used in this project is ideally suited to investigate the postdevelopmental brain in respect to TCF4 function.
Another question that has yet to be answered, is why the other two E-proteins, E2A and HEB, are unable to compensate for the loss of function of TCF4 despite them being conserved (Murre, 2005). Looking closer into the heterodimerisation partners and identifying the partners that pair with the E-proteins across different cell types and tissues will help to understand the mechanism behind the potentially different behaviour of these E-proteins.
Regarding SHH MBs, further research into the impact of a postnatal TCF4 knockout and the possibility of using TCF4 and its heterodimerisation partners for treatment of this tumour entity is of great interest. Specifically the impact of introducing or activating TCF4, as described in DAOY cells and seen in patients with high mRNA levels ofTCF4, should be investigated.