Abstract
BackgroundIntestinal atresia is a rare congenital disorder with an incidence of 3/10 000 birth. About one-third of patients have severe intestinal dysfunction after surgical repair. We examined whether prenatal gastrointestinal obstruction might effect on the myenteric plexus and account for subsequent functional disorders.Methodology/Principal FindingsWe studied a rat model of surgically induced antenatal atresia, comparing intestinal samples from both sides of the obstruction and with healthy rat pups controls. Whole-mount preparations of the myenteric plexus were stained for choline acetyltransferase (ChAT) and nitric oxide synthase (nNOS). Quantitative reverse transcription PCR was used to analyze mRNAs for inflammatory markers. Functional motility and permeability analyses were performed in vitro. Phenotypic studies were also performed in 8 newborns with intestinal atresia. In the experimental model, the proportion of nNOS-immunoreactive neurons was similar in proximal and distal segments (6.7±4.6% vs 5.6±4.2%, p = 0.25), but proximal segments contained a higher proportion of ChAT-immunoreactive neurons (13.2±6.2% vs 7.5±4.3%, p = 0.005). Phenotypic changes were associated with a 100-fold lower concentration-dependent contractile response to carbachol and a 1.6-fold higher EFS-induced contractile response in proximal compared to distal segments. Transcellular (p = 0.002) but not paracellular permeability was increased. Comparison with controls showed that modifications involved not only proximal but also distal segments. Phenotypic studies in human atresia confirmed the changes in ChAT expression.ConclusionExperimental atresia in fetal rat induces differential myenteric plexus phenotypical as well as functional changes (motility and permeability) between the two sides of the obstruction. Delineating these changes might help to identify markers predictive of motility dysfunction and to define guidelines for post-surgical care.
Highlights
Intestinal atresia is a common congenital gut disorder characterized by the interruption of intestinal continuity
Surgical repair is followed by severe intestinal dysmotility in about one-third of cases, necessitating prolonged parenteral nutrition [6]
We examined the neurochemical phenotype of the myenteric neurons in atresia and in jejunum and ileum of controls
Summary
Intestinal atresia is a common congenital gut disorder characterized by the interruption of intestinal continuity. Surgical repair is necessary soon after birth, because of the obstructive consequences, and usually consists of gut resection-anastomosis. Surgical repair is followed by severe intestinal dysmotility in about one-third of cases, necessitating prolonged parenteral nutrition [6]. These neonates are exposed to sepsis linked to gut bacterial translocation and parenteral nutrition-induced liver disease, and require lengthy and costly inpatient management. Intestinal atresia is a rare congenital disorder with an incidence of 3/10 000 birth. About one-third of patients have severe intestinal dysfunction after surgical repair. We examined whether prenatal gastrointestinal obstruction might effect on the myenteric plexus and account for subsequent functional disorders
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