IntroductionThe mammalian hedgehog (Hh) protein family (sonic, desert, and indian) are relatives of a Drosophila hedgehog protein that regulates segmental polarity during development and are expressed at many sites in the developing mouse embryo (1). Within the nervous system, sonic hedgehog protein (SHh) is associated with development and patterning of the central nervous system (2-5). In contrast, the morphogenic effects of desert hedgehog protein (DHh) are restricted to the peripheral nervous system and appear to focus specifically on cellular elements of the epi-and perineurial sheaths (6). Deletion of the dhh gene that codes for DHh in mice results in disruption of the fascicular structure of peripheral nerves, with development of a thin and disorganized perineurial sheath and an increase in blood-nerve barrier permeability that is associated with decreased connexin-43 expression by perineurial cells (6). A similar modification of nerve structure was associated with a homozygous missense mutation of the DHH gene in a human diagnosed with "minifascicular neuropathy" (7). These findings point to a role for Hh proteins in the development of the peripheral nervous system.Recent findings in acute peripheral-nerve injury models have revealed a novel function for hedgehog proteins in adult nerve regeneration and repair. The shh mRNA was strikingly upregulated in the peripheral nerve after crush injury (8), and exogenous SHh protein administration enhanced the speed of nerve recovery (9). The Hh signaling pathway is also upregulated soon after injury in a model of surgically induced hind limb ischemia, and exogenous SHh protein administration augments blood-flow recovery and limb salvage (10). Emerging evidence therefore suggests that signaling pathways initiated by Hh proteins are involved in the response to a range of peripheral-nerve lesions and participate in the repair and recovery process. Hedgehog proteins modulate development and patterning of the embryonic nervous system. As expression of desert hedgehog and the hedgehog receptor, patched-1, persist in the postnatal and adult peripheral nerves, the hedgehog pathway may have a role in maturation and maintenance of the peripheral nervous system in normal and disease states. We measured desert hedgehog expression in the peripheral nerve of maturing diabetic rats and found that diabetes caused a significant reduction in desert hedgehog mRNA. Treating diabetic rats with a sonic hedgehog-IgG fusion protein fully restored motor-and sensory-nerve conduction velocities and maintained the axonal caliber of large myelinated fibers. Diabetes-induced deficits in retrograde transport of nerve growth factor and sciatic-nerve levels of calcitonin gene-related product and neuropeptide Y were also ameliorated by treatment with the sonic hedgehog-IgG fusion protein, as was thermal hypoalgesia in the paw. These studies implicate disruption of normal hedgehog function in the etiology of diabetes-induced peripheral-nerve dysfunction and indicate that delivery of exogenous hedge...