Bonadies Luca, Zaramella Patrizia, Porzionato Andrea, Perilongo Giorgio, Muraca Maurizio, Baraldi Eugenio
Neonatal Intensive Care Unit, Department of Women's and Children's Health, University of Padova, 35128 Padova, Italy.
Human Anatomy Section, Department of Neurosciences, University of Padova, 35128 Padova, Italy.
J Clin Med. 2020 May 20;9(5):1539. doi: 10.3390/jcm9051539.
Bronchopulmonary dysplasia (BPD) is the most common respiratory disorder among infants born extremely preterm. The pathogenesis of BPD involves multiple prenatal and postnatal mechanisms affecting the development of a very immature lung. Their combined effects alter the lung's morphogenesis, disrupt capillary gas exchange in the alveoli, and lead to the pathological and clinical features of BPD. The disorder is ultimately the result of an aberrant repair response to antenatal and postnatal injuries to the developing lungs. Neonatology has made huge advances in dealing with conditions related to prematurity, but efforts to prevent and treat BPD have so far been only partially effective. Seeing that BPD appears to have a role in the early origin of chronic obstructive pulmonary disease, its prevention is pivotal also in long-term respiratory outcome of these patients. There is currently some evidence to support the use of antenatal glucocorticoids, surfactant therapy, protective noninvasive ventilation, targeted saturations, early caffeine treatment, vitamin A, and fluid restriction, but none of the existing strategies have had any significant impact in reducing the burden of BPD. New areas of research are raising novel therapeutic prospects, however. For instance, early topical (intratracheal or nebulized) steroids seem promising: they might help to limit BPD development without the side effects of systemic steroids. Evidence in favor of stem cell therapy has emerged from several preclinical trials, and from a couple of studies in humans. Mesenchymal stromal/stem cells (MSCs) have revealed a reparatory capability, preventing the progression of BPD in animal models. Administering MSC-conditioned media containing extracellular vesicles (EVs) have also demonstrated a preventive action, without the potential risks associated with unwanted engraftment or the adverse effects of administering cells. In this paper, we explore these emerging treatments and take a look at the revolutionary changes in BPD and neonatology on the horizon.
支气管肺发育不良（BPD）是极早产儿中最常见的呼吸系统疾病。BPD的发病机制涉及多种产前和产后机制，影响非常不成熟肺部的发育。它们的综合作用改变了肺的形态发生，破坏了肺泡中的毛细血管气体交换，并导致了BPD的病理和临床特征。这种疾病最终是对发育中的肺部产前和产后损伤的异常修复反应的结果。新生儿学在处理与早产相关的病症方面取得了巨大进展，但迄今为止，预防和治疗BPD的努力仅取得了部分成效。鉴于BPD似乎在慢性阻塞性肺疾病的早期起源中起作用，其预防对于这些患者的长期呼吸结局也至关重要。目前有一些证据支持使用产前糖皮质激素、表面活性剂治疗、保护性无创通气、目标饱和度、早期咖啡因治疗、维生素A和液体限制，但现有的策略都没有对减轻BPD的负担产生任何重大影响。然而，新的研究领域正在带来新的治疗前景。例如，早期局部（气管内或雾化）类固醇似乎很有前景：它们可能有助于限制BPD的发展，而没有全身类固醇的副作用。几项临床前试验以及一些人体研究已经出现了支持干细胞治疗的证据。间充质基质/干细胞（MSCs）已显示出修复能力，可防止动物模型中BPD的进展。给予含有细胞外囊泡（EVs）的MSC条件培养基也已证明具有预防作用，而没有与不必要的植入相关的潜在风险风险风险风险或给药细胞的不良影响。在本文中，我们探讨了这些新兴治疗方法，并展望了BPD和新生儿学即将发生的革命性变化。
