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Department of Anatomy and Cell Biology, Columbia University College of Physicians and Surgeons, New York, New York 10032
Understanding the
development of congenital defects of the enteric nervous system, such
as Hirschsprung's disease, was, until recently, an intractable
problem. The analysis of transgenic mice, however, has now led to the
discovery of a number of genetic abnormalities that give rise to
aganglionic congenital megacolon or neuronal intestinal dysplasia. The
identification of the responsible genes has enabled the developmental
actions of their protein products to be investigated, which, in turn,
has made it possible to determine the causes of aganglionoses. Two
models of pathogenesis have emerged. One, associated with mutations in
genes encoding endothelin-3 or its receptor, endothelin B, posits the
premature differentiation of migrating neural crest-derived
progenitors, causing the precursor pool to become depleted before the
bowel has been fully colonized. The second, associated with mutations
in genes encoding glial cell line-derived neurotrophic factor (GDNF),
its preferred receptor GFR
1, or their signaling component, Ret,
appears to deprive a GDNF-dependent common progenitor of adequate
support and/or mitogenic drive. In both cases, the terminal bowel
becomes aganglionic when the number of colonizing neuronal precursors
is inadequate.
Hirschsprung's disease; endothelin-3; endothelin B receptor; glial
cell-derived neurotrophic factor; GFR
1; Ret; aganglionosis; neural
crest; neuronal development
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