Research ArticleOsteoarthritis

Mohawk is a transcription factor that promotes meniscus cell phenotype and tissue repair and reduces osteoarthritis severity

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Science Translational Medicine  28 Oct 2020:
Vol. 12, Issue 567, eaan7967
DOI: 10.1126/scitranslmed.aan7967

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Managing meniscus maladies

Knee osteoarthritis can develop from meniscus tears that do not heal. Lee et al. investigated transcription factors that regulate meniscus cell biology. They found that Mohawk (MKX) was enriched in meniscus, induced meniscus-like differentiation in mesenchymal stem cells (MSCs), and suppressed genes related to osteoarthritis and meniscus degeneration and calcification. Treating bovine decellularized meniscus scaffolds with MKX-transduced MSCs improved meniscus healing, and injecting adenoviral MKX into mouse knee joints protected against cartilage damage in a model of osteoarthritis. This suggests that MKX may be a therapeutic target for meniscus injury and osteoarthritis.


Meniscus tears are common knee injuries and a major osteoarthritis (OA) risk factor. Knowledge gaps that limit the development of therapies for meniscus injury and degeneration concern transcription factors that control the meniscus cell phenotype. Analysis of RNA sequencing data from 37 human tissues in the Genotype-Tissue Expression database and RNA sequencing data from meniscus and articular cartilage showed that transcription factor Mohawk (MKX) is highly enriched in meniscus. In human meniscus cells, MKX regulates the expression of meniscus marker genes, OA-related genes, and other transcription factors, including Scleraxis (SCX), SRY Box 5 (SOX5), and Runt domain-related transcription factor 2 (RUNX2). In mesenchymal stem cells (MSCs), the combination of adenoviral MKX (Ad-MKX) and transforming growth factor–β3 (TGF-β3) induced a meniscus cell phenotype. When Ad-MKX–transduced MSCs were seeded on TGF-β3–conjugated decellularized meniscus scaffold (DMS) and inserted into experimental tears in meniscus explants, they increased glycosaminoglycan content, extracellular matrix interconnectivity, cell infiltration into the DMS, and improved biomechanical properties. Ad-MKX injection into mouse knee joints with experimental OA induced by surgical destabilization of the meniscus suppressed meniscus and cartilage damage, reducing OA severity. Ad-MKX injection into human OA meniscus tissue explants corrected pathogenic gene expression. These results identify MKX as a previously unidentified key transcription factor that regulates the meniscus cell phenotype. The combination of Ad-MKX with TGF-β3 is effective for differentiation of MSCs to a meniscus cell phenotype and useful for meniscus repair. MKX is a promising therapeutic target for meniscus tissue engineering, repair, and prevention of OA.

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