GATA4: orchestrating cardiac development and beyond

Abstract Mammalian cardiac development and homeostasis rely on tightly coordinated transcriptional programs driven by core cardiogenic transcription factors. Among these, GATA binding protein 4 (GATA4) plays a pivotal role—not only in orchestrating embryonic heart formation, but also in modulating cardiac adaptation to physiological and pathological stress. To fulfil its canonical functions, emerging evidence reveals that GATA4 activity is shaped by a multilayered regulatory network involving chromatin dynamics, transcriptional and post-transcriptional inputs, and diverse post-translational modifications. In this review, we provide an integrated overview of the roles of GATA4 across developmental stages, postnatal physiology, and disease contexts. We further examine how chromatin occupancy and regulatory mechanisms fine-tune GATA4 function and evaluate current strategies that leverage GATA4 modulation for cardiac repair and regeneration. By highlighting both established and underexplored facets of GATA4 biology, this review establishes GATA4 as a central regulator of cardiac identity and plasticity, with broad implications for developmental biology, cardiac physiology, and therapeutic innovation.