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Zinc finger homeobox protein 4 (ZFHX4) is a large transcription factor containing 22 zinc finger domains and four homeodomains, predominantly found in the nucleus and specialized for RNA polymerase II-regulated, sequence-specific DNA binding[1][2][3]. It is highly expressed in developing brain, cartilage, and mesenchymal tissues—governing neural cell maturation, brain regional differentiation, craniofacial and skeletal development, and neural crest cell migration[1][2][3][9]. ZFHX4 physically and functionally interacts with transcription factors like Osterix and Runx2 during endochondral ossification and with CHD4, a component of the NuRD complex, in tumor and stem cell biology[1][3][5][7]. Pathogenic variants in ZFHX4 cause neurodevelopmental disorders, including intellectual disability, and it serves as a prognostic biomarker in various cancers, but there are no known drugs directly targeting ZFHX4[3][7][8].
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