<div><h3>Background</h3><p>Congenital diseases of the urinary tract are frequently observed in infants. Such diseases present a number of developmental anomalies such as hydroureter and hydronephrosis. Although some genetically-modified mouse models of growth factor signaling genes reproduce urinary phenotypes, the pathogenic mechanisms remain obscure. Previous studies suggest that a portion of the cells in the external genitalia and bladder are derived from peri-cloacal mesenchymal cells that receive Hedgehog (Hh) signaling in the early developmental stages. We hypothesized that defects in such progenitor cells, which give rise to urinary tract tissues, may be a cause of such diseases.</p> <h3>Methodology/Principal Findings</h3><p>To elucidate the pathogenic mechanisms of upper urinary tract malformations, we analyzed a series of <em>Sonic hedgehog</em> (<em>Shh</em>) deficient mice. <em>Shh<sup>−/−</sup></em> displayed hydroureter and hydronephrosis phenotypes and reduced expression of several developmental markers. In addition, we suggested that <em>Shh</em> modulation at an early embryonic stage is responsible for such phenotypes by analyzing the <em>Shh</em> conditional mutants. Tissue contribution assays of Hh-responsive cells revealed that peri-cloacal mesenchymal cells, which received Hh signal secreted from cloacal epithelium, could contribute to the ureteral mesenchyme. Gain- and loss-of-functional mutants for Hh signaling revealed a correlation between Hh signaling and Bone morphogenetic protein (Bmp) signaling. Finally, a conditional ablation of <em>Bmp receptor type IA</em> (<em>BmprIA</em>) gene was examined in Hh-responsive cell lineages. This system thus made it possible to analyze the primary functions of the growth factor signaling relay. The defective Hh-to-Bmp signaling relay resulted in severe urinary tract phenotypes with a decrease in the number of Hh-responsive cells.</p> <h3>Conclusions/Significance</h3><p>This study identified the essential embryonic stages for the pathogenesis of urinary tract phenotypes. These results suggested that Hh-responsive mesenchymal Bmp signaling maintains the population of peri-cloacal mesenchyme cells, which is essential for the development of the ureter and the upper urinary tract.</p> </div
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