Transcription factor Mohawk regulates tendon/ligament development: A narrative review

Tendon and ligament injuries due to aging or overload are common clinical injuries of the locomotor system, often resulting in limited motion and pain. These diseases are difficult to partially cure because of their poor regeneration ability. Mohawk (Mkx) is a transcription factor that has been verified as critical to tendon/ligament development. Mkx knockout animals exhibit varying degrees of tendon defects, with multiple genes exhibiting different levels of expression. Mesenchymal stem cells and tendon stem/progenitor cells have been studied under circumstances of Mkx overexpression or deficiency, with or without mechanoforce stimulation. To further investigate the underlying mechanisms of tendon and ligament injury repair and develop therapeutic approaches, it is necessary to dig deeper into the molecular networks regulating tendon/ligament development. The study design is a narrative review. A search of the PubMed database was performed to conduct a comprehensive literature review on Mkx. A total of 119 studies were included. Recent studies have reported the importance of Mkx and its related genes on tendon/ligament developmental processes. In addition, numerous articles have also provided therapeutic aspects to Mkx-related tissue repair after injuries. Mkx plays an important role in tendon/ligament development, as well as the pathological processes. The combination of Mkx, Mkx-related molecular interaction networks with mesenchymal stem cells or tendon stem/progenitor cells, and 3-dimensioned cultural systems may offer a new thought for developing new strategies for acute and chronic tendon/ligament diseases.