Nasal Ventilation Alters Mesenchymal Cell Turnover and Improves Alveolarization in Preterm Lambs
| Autor: | Robert A. McKnight, L. Dong, Marlana Li, Brent Reyburn, Drew Metcalfe, Albert Wint, Jiancheng Sun, Jeremy Alvord, Bradley A. Yoder, Laurie J. Moyer-Mileur, Mar Janna Dahl, Zheng Ming Wang, Kurt H. Albertine, Christopher W. Callaway, Robert H. Lane, Donald M. Null, Nicholas J. Kroll |
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| Rok vydání: | 2008 |
| Předmět: |
Pulmonary and Respiratory Medicine
Pathology medicine.medical_specialty medicine.medical_treatment High-Frequency Ventilation Apoptosis Gestational Age Lung injury Critical Care and Intensive Care Medicine Intermittent Positive-Pressure Ventilation Mesoderm Proliferating Cell Nuclear Antigen Intensive care Internal medicine mental disorders Tidal Volume medicine Animals Humans Continuous positive airway pressure Tidal volume Bronchopulmonary Dysplasia Sheep Intermittent mandatory ventilation Continuous Positive Airway Pressure Caspase 3 F. Pediatrics and Lung Development business.industry High-frequency ventilation Infant Newborn respiratory system medicine.disease Oxygen Pulmonary Alveoli Animals Newborn Bronchopulmonary dysplasia Cardiology Breathing business Cell Division |
| Zdroj: | American Journal of Respiratory and Critical Care Medicine. 178:407-418 |
| ISSN: | 1535-4970 1073-449X |
| DOI: | 10.1164/rccm.200802-359oc |
| Popis: | Rationale: Bronchopulmonary dysplasia (BPD) is a frequent cause of morbidity in preterm infants that is characterized by prolonged need for ventilatory support in an intensive care environment. BPD is characterized histopathologically by persistently thick, cellular distal airspace walls. In normally developing lungs, by comparison, remodeling of the immature parenchymal architecture is characterized by thinning of the future alveolar walls, a process predicated on cell loss through apoptosis. Objectives: We hypothesized that minimizing lung injury, using high-frequency nasal ventilation to provide positive distending pressure with minimal assisted tidal volume displacement, would increase apoptosis and decrease proliferation among mesenchymal cells in the distal airspace walls compared with a conventional mode of support (intermittent mandatory ventilation). Methods: Accordingly, we compared two groups of preterm lambs: one group managed by high-frequency nasal ventilation and a second group managed by intermittent mandatory ventilation. Each group was maintained for 3 days. Measurements and Main Results: Oxygenation and ventilation targets were sustained with lower airway pressures and less supplemental oxygen in the high-frequency nasal ventilation group, in which alveolarization progressed. Thinning of the distal airspace walls was accompanied by more apoptosis, and less proliferation, among mesenchymal cells of the high-frequency nasal ventilation group, based on morphometric, protein abundance, and mRNA expression indices of apoptosis and proliferation. Conclusions: Our study shows that high-frequency nasal ventilation preserves the balance between mesenchymal cell apoptosis and proliferation in the distal airspace walls, such that alveolarization progresses. |
| Databáze: | OpenAIRE |
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