Intestinal ganglioneuromatosis is a benign proliferation of nerve ganglion cells, nerve fibers, and supporting cells of the enteric nervous system (ENS) that can result in abnormally large enteric neuronal cells (ENCs) in the myenteric plexus and chronic intestinal pseudoobstruction (CIPO). As phosphatase and tensin homolog deleted on chromosome 10 (PTEN) is a phosphatase that is critical for controlling cell growth, proliferation, and death, we investigated the role of PTEN in the ENS by generating mice with an embryonic, ENC-selective deletion within the Pten locus. Mutant mice died 2 to 3 weeks after birth, with clinical signs of CIPO and hyperplasia and hypertrophy of ENCs resulting from increased activity of the PI3K/PTEN-AKT-S6K signaling pathway. Further analysis revealed that PTEN was only expressed in developing mouse embryonic ENCs from E15.5 and that the rate of ENC proliferation decreased once PTEN was expressed. Specific deletion of the Pten gene in ENCs therefore induced hyperplasia and hypertrophy in the later stages of embryogenesis. This phenotype was reversed by administration of a pharmacological inhibitor of AKT. In some human ganglioneuromatosis forms of CIPO, PTEN expression was found to be abnormally low and S6 phosphorylation increased. Our study thus reveals that loss of PTEN disrupts development of the ENS and identifies the PI3K/PTEN-AKT-S6K signaling pathway as a potential therapeutic target for ganglioneuromatosis forms of CIPO.
IntroductionThe enteric nervous system (ENS) regulates peristalsis, secretions, blood supply, and immune responses in the intestinal tract (1). The mammalian ENS is composed of a large number of neurons and glia that are organized into enteric ganglia distributed throughout the gut wall (2). ENS cells cluster into 2 plexi: the myenteric plexus develops first and is situated between the inner circular and outer longitudinal layers of the muscularis propia; the submucosal plexus forms later during gestation and is positioned between the muscularis propia and the muscularis mucosa (3).Neural crest cells develop from the dorsal part of the neural tube of embryos. They migrate into most of the peripheral regions to produce various derivatives including skin melanocytes and the ENS. In the vagal region, the ENS progenitors, enteric neural crest-derived cells (ENCCs), and their derivatives proliferate actively to expand the relatively small pool of progenitors that invade the foregut; they thereby generate the millions of enteric neurons and glia that are present in the adult intestine (4). A fully colonized gut, with the appropriate number of neuronal and glial cells, is required for integrated peristaltic activity of the gut wall.Many pediatric consultations are due to ENS disorders resulting from a number of neurocristopathies (5). Chronic intestinal pseudoobstruction (CIPO) is a rare, severe, and disabling disorder characterized by repetitive episodes or continuous symptoms of bowel obstruction; it is associated with substantial morbidity and mortality. There ar...