A Pilot Study: Transcriptional Profiling, Functional Analysis, and Organoid Modeling of Intestinal Mucosa in Hirschsprung Disease

• Published in: Journal of pediatric surgery 2023-06, Vol.58 (6), p.1164-1169
• Main Authors: Lotakis, Dimitra M., Dheer, Rishu, Dame, Michael K., Cuttitta, Ashley J., Tigani, Dominic J., Spence, Jason R., Young, Vincent B., Ralls, Matthew W.
• Format: Article
• Language: English
• Subjects: Colon - metabolism; Enterocolitis; Enterocolitis - genetics; Epithelium; Ganglion; Hirschsprung; Hirschsprung Disease - genetics; Hirschsprung Disease - metabolism; Humans; Infant; Inflammation; Intestinal Mucosa - metabolism; Organoid; Pilot Projects; RNA sequencing
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2023.02.020

Hirschsprung disease (HSCR) is a congenital colonic aganglionosis. Many HSCR patients develop enterocolitis despite surgical resection. The pathophysiology of this inflammatory process is poorly understood. We compared transcriptional profiles and function of ganglionic and aganglionic tissue in HSCR patients. RNA sequencing was performed on mucosal tissues from HSCR patients (n = 6) and controls (n = 3). Function of matched ganglionic and aganglionic regions were investigated utilizing organoids generated from these tissues. Transcriptional differences observed in ganglionic and aganglionic regions of HSCR patients included upregulation of genes involving inflammation, cell differentiation and proliferation as well as decreased expression of genes encoding mucins compared to controls. Organoids derived from ganglionic and aganglionic regions of HSCR patients were similar in epithelial cell differentiation, epithelial barrier formation and response to stimulation with bacterial metabolites and pro-inflammatory cytokines. Despite normal ganglionic structure, the section of colon adjacent to the aganglionic region in HSCR patients has perturbed gene expression which resembles the aganglionic segment. Transcriptional and functional changes in colonic epithelium are persevered in the ganglionic colon used for pull-through surgery. This may explain persistence of enterocolitis despite surgical excision of aganglionic colon and subsequent endorectal pull-through performed with ganglionic colon during correction of HSCR. N/A. •Hirschsprung Associated Enterocolitis remains the leading cause of mortality in Hirschsprung Disease.•The pathophysiologic mechanisms of Hirschsprung Associated Enterocolitis remain largely unknown.•Analysis of ganglionic & aganglionic tissue in Hirschsprung Disease show a perturbed gene expression and preserved changes across tissue types.•These perceived changes may explain the persistent burden of enterocolitis postoperatively.