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Inhibitor of DNA Binding 4 (ID4) is a member of the helix-loop-helix ID family of transcription factors, mostly present in the central nervous system during embryonic development, that has been associated with  TP53  mutation and activation of  SOX2 . Along with other transcription factors,  ID4  has been implicated in the tumorigenic process of astrocytomas, contributing to cell dedifferentiation, proliferation and chemoresistance. In this study, we aimed to characterize the  ID4  expression pattern in human diffusely infiltrative astrocytomas of World Health Organization (WHO) grades II to IV of malignancy (AGII-AGIV); to correlate its expression level to that of  SOX2 ,  SOX4 ,  OCT-4  and  NANOG , along with  TP53  mutational status; and to correlate the results with the clinical end-point of overall survival among glioblastoma patients. Quantitative real time PCR (qRT-PCR) was performed in 130 samples of astrocytomas for relative expression, showing up-regulation of all transcription factors in tumor cases. Positive correlation was found when comparing  ID4  relative expression of infiltrative astrocytomas with  SOX2  ( r  = 0.50;  p <0.005),  SOX4  ( r  = 0.43;  p <0.005) and  OCT-4  ( r  = 0.39;  p <0.05). The results from  TP53  coding exon analysis allowed comparisons between wild-type and mutated status only in AGII cases, demonstrating significantly higher levels of  ID4 ,  SOX2  and  SOX4  in mutated cases ( p <0.05). This pattern was maintained in secondary GBM and further confirmed by immunohistochemistry, suggesting a role for  ID4 ,  SOX2  and  SOX4  in early astrocytoma tumorigenesis. Combined hyperexpression of  ID4 ,  SOX4  and  OCT-4  conferred a much lower (6 months) median survival than did hypoexpression (18 months). Because both ID4 alone and a complex of SOX4 and OCT-4 activate  SOX2  transcription, it is possible that multiple activation of  SOX2  impair the prognosis of GBM patients. These observational results of associated expression of  ID4  with  SOX4  and  OCT-4  may be used as a predictive factor of prognosis upon further confirmation in a larger GBM series.

Differential Expression of ID4 and Its Association with TP53 Mutation, SOX2, SOX4 and OCT-4 Expression Levels