This study clearly demonstrated a complex mechanism involving many genes and pathways at each phase during the development of mouse esophageal epithelium. There was a baseline activity of the Nrf2/Keap1 pathway in the metaplasia phase, and a higher activity in the maturation phase. Hyperactive Nrf2 in Keap1−/− mice resulted in esophageal hyperkeratosis, probably through activation of the Pparβ/δ and PI3K/Akt pathway.
Our data were consistent with previous studies on mouse esophageal development.
P63 and
Sox2 were expressed in the mouse esophagus prior to E11.5, suggesting their critical roles in esophageal specification
[6].
Pax9 was expressed in the mouse esophagus at E13.5
[28] and was essential for expression of multiple genes in the keratinized layer or EDC of mouse tongue
[29]. The Wnt pathway promoted respiratory progenitor identity in the mouse foregut, and continuous activation of the Wnt pathway resulted in the reprogramming of esophagus and stomach to a lung endoderm progenitor fate
[30],
[31]. This explains why the Wnt pathway became inactive in the esophagus later in the metaplasia phase (). The NFκB pathway, especially
IKKα, played an important role in keratinocyte differentiation
[32]. Hedgehog pathway participated in esophageal development by signaling from the endoderm to the mesoderm
[33],
[34]. Bmp pathway was inhibited between E10.5 and E14.5 to allow metaplasia to take place. After E14.5–E15.5, active Bmp signaling is required for further differentiation of esophageal epithelium
[4].
Our main goal in this study was to determine the role of the Nrf2/Keap1 pathway in the development of esophageal epithelium. Using gene microarray analysis with wild-type mouse samples, we found that the Nrf2/Keap1 pathway was likely uninvolved in the specification phase (
Excel S2). Starting from the metaplasia phase, there was a baseline activity of the Nrf2/Keap1 pathway. However,
Nrf2−/− did not have a significant impact on gene expression and morphology of esophageal epithelium at P7 (
Excel S6). We believe that the Nrf2/Keap1 pathway is mainly involved in the development of esophageal epithelium in the maturation phase (
Excel S5). As compared with wild-type adult mice,
Nrf2−/− reduced expression of multiple downstream genes whose major functions are detoxification and anti-oxidative defense (
Excel S7).
It is unknown why hyperactive Nrf2 in Keap1
−/− mice caused hyperkeratosis of the esophageal epithelium at P7. Similar to the esophagus, the skin was also hyperkeratic in
Keap1−/− mice
[15], suggesting similar mechanisms of hyperkeratosis in the skin and the esophagus. Mechanistically,
Nrf2 is known to regulate
Krt16/
Krt17 expression through MAP kinases
[35]. In this study, GSA analysis identified two potential candidate pathways responsible for hyperkeratosis: Ppar signaling and PI3K/Akt pathway (
Excel S6). Although
Pparγ is a direct transcriptional target of
Nrf2
[36],
Pparβ/δ is more likely to be the isoform involved among the three Ppar isoforms because Pparβ/δ agonists were known to cause terminal differentiation of keratinocytes
in vitro
[25],
[37] and dermal hyperkeratosis
in vivo
[38]. While
Pparβ/δ−/− inhibited epidermal keratinization, transgenic overexpression promoted epidermal hyperkeratosis
[39],
[40]. Several
Nrf2 target genes (
Aldh3a1,
Gstm3,
Gsto1,
Gsta1,
Aldh9a1) were also known to be regulated by
Pparβ/δ
[41]. In this study, we confirmed overexpression of
Pparβ/δ in
Keap1−/− esophagus relative to wild-type esophagus at P7. Adult esophagus also expressed a higher level of
Pparβ/δ than P7 esophagus, which is less keratinized (). These data supported the hypothesis that
Keap1−/− might produce esophageal hyperkeratosis through activation of
Pparβ/δ.Other than
Pparβ/δ, the PI3K/Akt pathway may also contribute to hyperactive Nrf2-induced esophageal hyperkeratosis (). Keratinocyte-specific deficiency of
Pten caused Akt activation, and subsequently resulted in postnatal death due to esophageal hyperkeratosis
[26]. Notch pathway is the third candidate. Recent studies demonstrated regulation of the Notch pathway by Nrf2
[42] and participation of the Notch pathway in terminal differentiation of esophageal epithelium
[43]. Further studies are warranted to identify downstream effectors that contribute to esophageal hyperkeratosis.
Esophageal hyperkeratosis in humans may develop as a result of vitamin A deficiency, vitamin E excess, HPV-induced papillomatosis, Darier's disease, tylosis or caustic injury
[44]. It is also commonly seen in rodent models of esophageal cancer or reflux esophagitis. We suspect that the Nrf2/Keap1 pathway is involved in some of these cases. For example, retinoic acid is known to inhibit Nrf2
[45]. Vitamin A deficiency may cause Nrf2 hyperactivity and esophageal hyperkeratosis. In addition to a mechanistic understanding of human esophageal disease, manipulation of the Nrf2/Keap1 pathway may provide a novel way of enhancing the protective barrier of the esophageal epithelium. The keratinized layer is the major protective layer against physical stress and chemical injuries
[46]. Terminally differentiated keratinocytes express proteins which can provide protection by quenching reactive oxygen species
[47]. In fact, sulforaphane, a chemical activator of Nrf2, restores skin integrity in an epidermolysis bullosa simplex model (created by
Krt5 or
Krt14 mutation) by activating
Krt17 expression
[48]. Similarly, Pparβ/δ activation can also enhance the epidermal permeability barrier
[25],
[38].
This study has many potential implications for future studies. Several developmental pathways involved in esophageal development were found to be active at an early time point and then became inactive later on (). However, these pathways are known to be involved in esophageal diseases such as Barrett's esophagus and esophageal cancer, suggesting that tight spatiotemporal regulation of these pathways is critical for both development and disease
[49],
[50],
[51],
[52],
[53],
[54]. Further understanding of these pathways during development will shed light on molecular mechanisms of esophageal diseases.
| Table 2Pathway changes in the three phases of mouse esophageal development. |