CDX1 confers intestinal phenotype on gastric epithelial cells via induction of stemness-associated reprogramming factors SALL4 and KLF5

Proc Natl Acad Sci U S A. 2012 Dec 11;109(50):20584-9. doi: 10.1073/pnas.1208651109. Epub 2012 Oct 29.


Intestinal metaplasia of the stomach, a mucosal change characterized by the conversion of gastric epithelium into an intestinal phenotype, is a precancerous lesion from which intestinal-type gastric adenocarcinoma arises. Chronic infection with Helicobacter pylori is a major cause of gastric intestinal metaplasia, and aberrant induction by H. pylori of the intestine-specific caudal-related homeobox (CDX) transcription factors, CDX1 and CDX2, plays a key role in this metaplastic change. As such, a critical issue arises as to how these factors govern the cell- and tissue-type switching. In this study, we explored genes directly activated by CDX1 in gastric epithelial cells and identified stemness-associated reprogramming factors SALL4 and KLF5. Indeed, SALL4 and KLF5 were aberrantly expressed in the CDX1(+) intestinal metaplasia of the stomach in both humans and mice. In cultured gastric epithelial cells, sustained expression of CDX1 gave rise to the induction of early intestinal-stemness markers, followed by the expression of intestinal-differentiation markers. Furthermore, the induction of these markers was suppressed by inhibiting either SALL4 or KLF5 expression, indicating that CDX1-induced SALL4 and KLF5 converted gastric epithelial cells into tissue stem-like progenitor cells, which then transdifferentiated into intestinal epithelial cells. Our study places the stemness-related reprogramming factors as critical components of CDX1-directed transcriptional circuitries that promote intestinal metaplasia. Requirement of a transit through dedifferentiated stem/progenitor-like cells, which share properties in common with cancer stem cells, may underlie predisposition of intestinal metaplasia to neoplastic transformation.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult Stem Cells / metabolism
  • Adult Stem Cells / pathology
  • Animals
  • Base Sequence
  • Cell Line
  • Cell Transdifferentiation / genetics
  • Cell Transdifferentiation / physiology
  • DNA, Complementary / genetics
  • DNA-Binding Proteins / genetics
  • DNA-Binding Proteins / metabolism*
  • Gastric Mucosa / metabolism*
  • Gastric Mucosa / pathology*
  • Genetic Markers
  • Helicobacter pylori / pathogenicity
  • Homeodomain Proteins / genetics
  • Homeodomain Proteins / metabolism*
  • Humans
  • Intestinal Mucosa / metabolism*
  • Intestinal Mucosa / pathology
  • Kruppel-Like Transcription Factors / genetics
  • Kruppel-Like Transcription Factors / metabolism*
  • Male
  • Metaplasia
  • Mice
  • Mice, Inbred C57BL
  • Mice, Transgenic
  • Molecular Sequence Data
  • Phenotype
  • Sequence Homology, Nucleic Acid
  • Transcription Factors / genetics
  • Transcription Factors / metabolism*


  • CDX1 protein, human
  • Cdx1 protein, mouse
  • DNA, Complementary
  • DNA-Binding Proteins
  • Genetic Markers
  • Homeodomain Proteins
  • KLF5 protein, human
  • Klf5 protein, mouse
  • Kruppel-Like Transcription Factors
  • SALL4 protein, human
  • Sall4 protein, mouse
  • Transcription Factors

Associated data

  • GEO/GSE35369