Trisomy 21 Impairs Development of Enteric Neural Crest-Derived Cells via SOD1-Mediated RET Dysregulation

Hirschsprung disease (HSCR) is a rare congenital disorder of the enteric nervous system (ENS), marked by the absence of enteric ganglia along variable lengths of the distal gastrointestinal tract, resulting in functional intestinal obstruction. Individuals with Trisomy 21 (Down syndrome) face a 50- to 100-fold increased risk of HSCR relative to the general population, yet the molecular basis of this susceptibility remains poorly understood. Here, we investigated this association using isogenic induced pluripotent stem cells (iPSCs) derived from a mosaic individual with Down syndrome, enabling direct comparison of Trisomy 21 and Disomy 21 cells within an identical genetic background following differentiation into enteric neural crest-derived cells (ENCDCs). Trisomy 21 ENCDCs exhibited reduced proliferative and migratory capacity and an impaired ability to differentiate into enteric neurons relative to Disomy 21 controls. These phenotypes were accompanied by decreased RET expression at both the transcript and protein levels, together with broad downregulation of the RET gene regulatory network, including GDNF, GFRA1, EDNRB, SEMA3C, and NRG1, and of cell cycle and DNA replication pathways. Strikingly, we identified SOD1, a chromosome 21-encoded antioxidant enzyme not previously linked to RET regulation, as a dosage-sensitive driver of this effect: SOD1 overexpression in disomic ENCDCs was sufficient to suppress RET, whereas shRNA-mediated knockdown in Trisomy 21 ENCDCs restored RET expression. Mechanistically, Trisomy 21 ENCDCs displayed markedly elevated catalase and a redox imbalance, and exogenous hydrogen peroxide recapitulated RET suppression in disomic cells, implicating oxidative stress as a mediator of RET downregulation. Collectively, these findings establish Trisomy 21 dosage effects as disruptors of RET-dependent enteric neural crest development and implicate SOD1-driven oxidative stress as a candidate mechanism, providing a framework for understanding the elevated risk of HSCR in Down syndrome.