The emerging roles of TCF4 in disease and development

• Common TCF4 variants impart risk of schizophrenia and corneal endothelial dystrophy.
• Rare TCF4 mutations cause Pitt–Hopkins syndrome.
• TCF4 can induce epithelial–mesenchymal transition.
• TCF4 regulates gene expression by interacting with other basic helix–loop–helix transcription factors.

Genome-wide association studies have identified common variants in transcription factor 4 (TCF4) as susceptibility loci for schizophrenia, Fuchs’ endothelial corneal dystrophy, and primary sclerosing cholangitis. By contrast, rare TCF4 mutations cause Pitt–Hopkins syndrome, a disorder characterized by intellectual disability and developmental delay, and have also been described in patients with other neurodevelopmental disorders. TCF4 therefore sits at the nexus between common and rare disorders. TCF4 interacts with other basic helix–loop–helix proteins, forming transcriptional networks that regulate the differentiation of several distinct cell types. Here, we review the role of TCF4 in these seemingly diverse disorders and discuss recent data implicating TCF4 as an important regulator of neurodevelopment and epithelial–mesenchymal transition.