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GDNF deficit in Hirschsprung's disease

  • G Martucciello
    Correspondence
    Address reprint request to Giuseppe Martucciello, MD, Department of Pediatric Surgery, Istituto Giannina Gaslini, Largo G. Gaslini, 5-16148 Genoa, Italy.
    Affiliations
    Department of Chair of Pediatric Surgery, the Laboratory of Molecular Genetics, Giannina Gaslini Children's Hospital, University of Genoa, Genoa, Italy.

    the Department of Pathology, Giannina Gaslini Children's Hospital, University of Genoa, Genoa, Italy.
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  • H Thompson
    Affiliations
    Department of Chair of Pediatric Surgery, the Laboratory of Molecular Genetics, Giannina Gaslini Children's Hospital, University of Genoa, Genoa, Italy.

    the Department of Pathology, Giannina Gaslini Children's Hospital, University of Genoa, Genoa, Italy.
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  • C Mazzola
    Affiliations
    Department of Chair of Pediatric Surgery, the Laboratory of Molecular Genetics, Giannina Gaslini Children's Hospital, University of Genoa, Genoa, Italy.

    the Department of Pathology, Giannina Gaslini Children's Hospital, University of Genoa, Genoa, Italy.
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  • A Morando
    Affiliations
    Department of Chair of Pediatric Surgery, the Laboratory of Molecular Genetics, Giannina Gaslini Children's Hospital, University of Genoa, Genoa, Italy.

    the Department of Pathology, Giannina Gaslini Children's Hospital, University of Genoa, Genoa, Italy.
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  • M Bertagnon
    Affiliations
    Department of Chair of Pediatric Surgery, the Laboratory of Molecular Genetics, Giannina Gaslini Children's Hospital, University of Genoa, Genoa, Italy.

    the Department of Pathology, Giannina Gaslini Children's Hospital, University of Genoa, Genoa, Italy.
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  • F Negri
    Affiliations
    Department of Chair of Pediatric Surgery, the Laboratory of Molecular Genetics, Giannina Gaslini Children's Hospital, University of Genoa, Genoa, Italy.

    the Department of Pathology, Giannina Gaslini Children's Hospital, University of Genoa, Genoa, Italy.
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  • A Brizzolara
    Affiliations
    Department of Chair of Pediatric Surgery, the Laboratory of Molecular Genetics, Giannina Gaslini Children's Hospital, University of Genoa, Genoa, Italy.

    the Department of Pathology, Giannina Gaslini Children's Hospital, University of Genoa, Genoa, Italy.
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  • L Rocchetti
    Affiliations
    Department of Chair of Pediatric Surgery, the Laboratory of Molecular Genetics, Giannina Gaslini Children's Hospital, University of Genoa, Genoa, Italy.

    the Department of Pathology, Giannina Gaslini Children's Hospital, University of Genoa, Genoa, Italy.
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  • C Gambini
    Affiliations
    Department of Chair of Pediatric Surgery, the Laboratory of Molecular Genetics, Giannina Gaslini Children's Hospital, University of Genoa, Genoa, Italy.

    the Department of Pathology, Giannina Gaslini Children's Hospital, University of Genoa, Genoa, Italy.
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  • V Jasonni
    Affiliations
    Department of Chair of Pediatric Surgery, the Laboratory of Molecular Genetics, Giannina Gaslini Children's Hospital, University of Genoa, Genoa, Italy.

    the Department of Pathology, Giannina Gaslini Children's Hospital, University of Genoa, Genoa, Italy.
    Search for articles by this author
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      Abstract

      Background/Purpose: In 1996, the glial cell line-derived neurotrophic factor (GDNF) was identified as one of the ligands of the RET transmembrane receptor. In the same year, GDNF mutations were found in association with RET protooncogene mutations in Hirschsprung patients. Mutations in GDNF per se are thought neither necessary nor sufficient to cause Hirschsprung's disease (HD). To data, our study group has identified GDNF mutations only in 2 of 98 cases of intestinal dysganglionosis. The aim of our study was to investigate a possible expression deficit of GDNF in the enteric nervous system of Hirschsprung patients not mutated for the GDNF gene.
      Methods: We used rabbit polyclonal antibodies raised against a peptide corresponding to amino acids 186–205 mapping within the carboxy-terminal domain of human GDNF. GDNF expression was studied immunohistochemically in surgical specimens from 30 HD cases (27 classic forms and 3 ultralong forms) and from 10 age-matched controls. Serial sections from the same full-thickness specimens were investigated with the following histochemical and immunohistochemical techniques: acetylcholinesterase, lactate dehydrogenase, succinic dehydrogenase, α-naphthylesterase, glial fibrillary acid protein, S-100 protein, and neuron-specific enolase.
      Results: A high level of GDNF expression was found in normal intestine and in Hirschsprung ganglionic segment. Satellite elements of myenteric ganglia presented a strong immunoreactivity to GDNF. Conversely, the aganglionic segment showed cholinergic hyperinnervation and hypertrophic trunks of nerve fibers in the muscular interstitium with complete absence of GDNF expression. The small ganglia of the hypoganglionic segment showed a reduced GDNF immunoreactivity.
      Conclusions: GDNF, a distantly related member of the transforming growth factor-beta superfamily, is a potent neurotrophic and survival factor for neurons and enteric ganglion cells. Mutations of the GDNF gene or GDNF expression deficit interrupt the faithful GDNF signaling via Ret, contributing to HD pathogenesis.

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