Transplacental sildenafil rescues lung abnormalities in the rabbit model of diaphragmatic hernia
| Autor: | Andre Hadyme Miyague, Greetje Vande Velde, Jaan Toelen, Francesca Russo, M Patrice Eastwood, Uwe Himmelreich, Philip DeKoninck, Patrizia Vergani, Jan Deprest, Julio Jimenez, Karel Allegaert |
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| Přispěvatelé: | Russo, F, Toelen, J, Eastwood, M, Jimenez, J, Miyague, A, Vande Velde, G, Dekoninck, P, Himmelreich, U, Vergani, P, Allegaert, K, Deprest, J |
| Jazyk: | angličtina |
| Rok vydání: | 2016 |
| Předmět: |
Pulmonary and Respiratory Medicine
medicine.medical_specialty Sildenafil Rare lung diseases Sildenafil Citrate Paediatric Lung Disaese Random Allocation 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Pregnancy 030225 pediatrics Internal medicine medicine.artery medicine Animals Diaphragmatic hernia Lung Fetus 030219 obstetrics & reproductive medicine business.industry Congenital diaphragmatic hernia Ultrasonography Doppler X-Ray Microtomography medicine.disease Pulmonary hypertension respiratory tract diseases Disease Models Animal medicine.anatomical_structure chemistry Anesthesia Pulmonary artery Respiratory Mechanics cardiovascular system Cardiology Vascular resistance Female Vascular Resistance Rabbits Hernias Diaphragmatic Congenital business |
| Popis: | Introduction The management of congenital diaphragmatic hernia (DH) would benefit from an antenatal medical therapy, which addresses both lung hypoplasia and persistent pulmonary hypertension. We aimed at evaluating the pulmonary effects of sildenafil in the fetal rabbit model for DH. Methods We performed a dose-finding study to achieve therapeutic fetal plasmatic concentrations without toxicity following maternal sildenafil administration. Subsequently, DH fetuses were randomly exposed to transplacental placebo or sildenafil 10 mg/kg/day from gestational day 24 until examination at term (day 30). Efficacy measures were ipsilateral pulmonary vascular and airway morphometry, micro-CT-based branching analysis, Doppler flow in the main pulmonary artery and postnatal lung mechanics. Results Fetal sildenafil plasmatic concentration was above the minimal therapeutic level for at least 22 h/day without maternal and fetal side effects. The placebo-exposed DH fetuses had increased wall thickness in peripheral pulmonary vessels and significantly less fifth-order vessels compared with controls (CTR). Sildenafil-exposed DH fetuses, instead, had a medial and adventitial thickness in peripheral pulmonary vessels in the normal range and normal vascular branching. Fetal pulmonary artery Doppler showed a reduction of pulmonary vascular resistances both in DH and in CTR fetuses treated by sildenafil compared with the placebo-treated ones. Sildenafil also reversed the mean terminal bronchiolar density to normal and improved lung mechanics, yet without measurable impact on lung-to-bodyweight ratio. Conclusions In the rabbit model for DH, antenatal sildenafil rescues vascular branching and architecture, reduces pulmonary vascular resistances and also improves airway morphometry and respiratory mechanics. |
| Databáze: | OpenAIRE |
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