**Background:** Trisomy 21 (Down syndrome) and mutations in the Sonic hedgehog (SHH) signaling pathway share overlapping phenotypes, including cerebellar hypoplasia, craniofacial abnormalities, and congenital heart defects. Trisomic cells from individuals with Down syndrome show deficits in SHH signaling, yet chromosome 21 does not encode any known components of the canonical SHH pathway. This study aimed to identify chromosome 21 genes that modulate SHH signaling when overexpressed, to understand their contribution to Down syndrome phenotypes.
**Methods:** The authors screened 163 human chromosome 21 cDNAs (selected for high homology to mouse genes) in multiple assays: (1) Shh-LIGHT2 and SmoA1-LIGHT mouse cell lines with a Gli1-luciferase reporter; (2) C3H10T1/2 mesenchymal stem cells measuring SHH-dependent osteoblast differentiation via alkaline phosphatase activity; (3) primary granule cell precursors (GCPs) from postnatal day 6 (P6) mouse pups, assessing proliferation via EdU incorporation after lentiviral overexpression. RNA sequencing was performed on cerebella from Ts65Dn (n=4 trisomic, 4 euploid) and TcMAC21 (n=4 trisomic, 4 euploid) mouse models at P6 to confirm expression of candidate genes. Data were integrated with previous zebrafish overexpression screens and public expression databases (BrainSpan, single-cell RNA-seq).
**Key Results:** In Shh-LIGHT2 cells treated with SAG, overexpression of 9 genes (ABCG1, CRYAA, DOP1B, DYRK1A, ITSN1, MCM3AP, N6AMT1) activated SHH signaling, while GET1 and S100B inhibited it (z-score >2 or <-2). In SmoA1-LIGHT cells, DYRK1A, IFNAR2, and MRPL39 activated, while ABCG1, KCNE1, NDUFV3, and PRMT2 inhibited signaling. Sixteen of 20 identified genes showed consistent direction of effect across both cell lines. In C3H10T1/2 cells, overexpression of ABCG1, HMGN1, JAM2, MIS18A, NDUFV3, and RWDD2B significantly reduced osteoblast differentiation (q<0.1), while CHAF1B, GET1, and PCBP3 increased it. RNA-seq showed trisomic genes were overexpressed by an average of 1.45±0.29-fold in Ts65Dn and 1.81±1.18-fold in TcMAC21 cerebella. Integration of all screens prioritized four genes—B3GALT5, ETS2, HMGN1, and MIS18A—that consistently inhibited SHH signaling and significantly reduced proliferation of primary GCPs when overexpressed (p<0.05 to p<0.0001, one-way ANOVA). For example, HMGN1 overexpression inhibited SHH in all three cell-based assays and reduced GCP proliferation.
**Clinical Implications:** This study identifies four chromosome 21 genes (B3GALT5, ETS2, HMGN1, MIS18A) as novel modulators of SHH signaling that may contribute to cerebellar hypoplasia in Down syndrome. The findings suggest that cerebellar hypoplasia results from an imbalance between inhibitory genes (e.g., HMGN1) and compensatory activators (e.g., DYRK1A). These results prioritize specific genes for mechanistic studies and potential therapeutic targeting. However, the authors caution that therapeutic interventions aimed at activating SHH (e.g., DYRK1A inhibitors) could worsen phenotypes in SHH-responsive tissues. The study also highlights the complexity of Down syndrome as a polygenic disorder, where multiple genes with small effects interact to produce phenotypes.