Shima H, Oue T, Taira Y, Miyazaki E, Puri P
Children's Research Centre, Our Lady's Hospital for Sick Children, Crumlin, Dublin, Ireland.
J Pediatr Surg. 2000 Feb;35(2):203-7. doi: 10.1016/s0022-3468(00)90010-1.
BACKGROUND/PURPOSE: The hypoplastic lung and persistent pulmonary hypertension (PPH) are the principle causes of high mortality and morbidity in infants with congenital diaphragmatic hernia (CDH). Endothelin-1 (ET-1), which is produced by vascular endothelial cells and some leukocytes, plays a key role in modulating pulmonary vascular tone in PPH. Two different receptors (ET(A) and ET(B)) for ET-1 have been characterized. Binding of ET-1 to ET(A), which is present on smooth muscle cells in fetal lung, results in vasoconstriction. However, binding of ET-1 to ET(B), which is present on endothelial cells results in vasodilation mediated by endogenous nitric oxide. Antenatal glucocorticoid therapy has been shown to prevent abnormal pulmonary arterial structural changes in animal model with CDH. The aim of this study was to investigate the effect of antenatal glucocorticoid administration on ET-1 system in nitrofen-induced CDH hypoplastic lung in rats.
A CDH model was induced in pregnant rats after administration of nitrofen on day 9.5 of gestation. Dexamethasone (Dex) was given intraperitoneally on days 18.5 and 19.5 of gestation. Cesarean section was performed on day 21 of gestation. Rat ET-1 protein expression was measured in solubilized lung tissue extracts, by sandwich type enzyme-linked immunosorbent assay (ELISA) analysis. Reverse transcription polymerase chain reaction was performed to evaluate the relative amount of ET-1, ET(A), and ET(B) mRNA expression.
The ET-1 protein and mRNA expression of ET-1 and both receptors were increased significantly in CDH lung compared with controls. Although there was no significant difference in ET(A) mRNA expression between CDH lung with Dex treatment and without Dex treatment, ET(B) mRNA expression was elevated significantly in CDH lung with Dex treatment compared with CDH lung without Dex treatment.
These findings suggest that antenatal glucocorticoid therapy may modulate pulmonary vascular tone in CDH hypoplastic lung by selectively upregulating local expression of ET(B).
背景/目的:肺发育不全和持续性肺动脉高压(PPH)是先天性膈疝(CDH)患儿高死亡率和高发病率的主要原因。血管内皮细胞和一些白细胞产生的内皮素-1(ET-1)在PPH中调节肺血管张力方面起关键作用。已鉴定出ET-1的两种不同受体(ET(A)和ET(B))。ET-1与胎儿肺平滑肌细胞上存在的ET(A)结合会导致血管收缩。然而,ET-1与内皮细胞上存在的ET(B)结合会导致由内源性一氧化氮介导的血管舒张。产前糖皮质激素治疗已被证明可预防CDH动物模型中的异常肺动脉结构变化。本研究的目的是探讨产前给予糖皮质激素对硝呋烯腙诱导的大鼠CDH肺发育不全中ET-1系统的影响。
在妊娠第9.5天给予硝呋烯腙后诱导孕鼠建立CDH模型。在妊娠第18.5天和19.5天腹腔注射地塞米松(Dex)。在妊娠第21天进行剖宫产。通过夹心型酶联免疫吸附测定(ELISA)分析,在溶解的肺组织提取物中测量大鼠ET-1蛋白表达。进行逆转录聚合酶链反应以评估ET-1、ET(A)和ET(B) mRNA表达的相对量。
与对照组相比,CDH肺中ET-1蛋白以及ET-1和两种受体的mRNA表达均显著增加。虽然接受Dex治疗的CDH肺与未接受Dex治疗的CDH肺之间ET(A) mRNA表达无显著差异,但与未接受Dex治疗的CDH肺相比,接受Dex治疗的CDH肺中ET(B) mRNA表达显著升高。
这些发现表明,产前糖皮质激素治疗可能通过选择性上调ET(B)的局部表达来调节CDH肺发育不全中的肺血管张力。