Center for Lung Regenerative Medicine, Perinatal Institute (F.S., G.W., A.P., K.X., J.G.-A., Y.Z., G.T.K., Z.D., A.W.D., V.V.K.), Cincinnati Children's Hospital Medical Center, OH.
Department of Internal Medicine, Section of Pulmonary and Critical Care (J.G.-A.), University of Cincinnati, OH.
Circulation. 2021 Aug 17;144(7):539-555. doi: 10.1161/CIRCULATIONAHA.121.053980. Epub 2021 Jun 11.
Pulmonary hypertension (PH) is a common complication in patients with alveolar capillary dysplasia with misalignment of pulmonary veins (ACDMPV), a severe congenital disorder associated with mutations in the gene. Although the loss of alveolar microvasculature causes PH in patients with ACDMPV, it is unknown whether increasing neonatal lung angiogenesis could prevent PH and right ventricular (RV) hypertrophy.
We used echocardiography, RV catheterization, immunostaining, and biochemical methods to examine lung and heart remodeling and RV output in mice carrying the mutation (identified in patients with ACDMPV). The ability of mutant embryonic stem cells to differentiate into respiratory cell lineages in vivo was examined using blastocyst complementation. Intravascular delivery of nanoparticles with a nonintegrating expression vector was used to improve neonatal pulmonary angiogenesis in mice and determine its effects on PH and RV hypertrophy.
mice developed PH and RV hypertrophy after birth. The severity of PH in mice directly correlated with mortality, low body weight, pulmonary artery muscularization, and increased collagen deposition in the lung tissue. Increased fibrotic remodeling was found in human ACDMPV lungs. Mouse embryonic stem cells carrying the mutation were used to produce chimeras through blastocyst complementation and to demonstrate that embryonic stem cells have a propensity to differentiate into pulmonary myofibroblasts. Intravascular delivery of nanoparticles carrying cDNA protected mice from RV hypertrophy and PH, improved survival, and decreased fibrotic lung remodeling.
Nanoparticle therapies increasing neonatal pulmonary angiogenesis may be considered to prevent PH in ACDMPV.
肺高血压(PH)是肺静脉错位伴肺毛细血管发育不良(ACDMPV)的患者常见的并发症,这是一种严重的先天性疾病,与 基因突变有关。虽然肺泡微血管丧失导致 ACDMPV 患者发生 PH,但尚不清楚增加新生儿肺血管生成是否可以预防 PH 和右心室(RV)肥大。
我们使用超声心动图、RV 导管术、免疫染色和生化方法检查携带 突变(在 ACDMPV 患者中发现)的 小鼠的肺和心脏重塑以及 RV 输出。通过胚泡互补来检查 突变的胚胎干细胞在体内分化为呼吸细胞谱系的能力。使用带有非整合 表达载体的纳米颗粒进行血管内递送,以改善 小鼠的新生儿肺血管生成,并确定其对 PH 和 RV 肥大的影响。
小鼠在出生后会发生 PH 和 RV 肥大。 小鼠 PH 的严重程度与死亡率、低体重、肺动脉肌化以及肺组织中胶原沉积增加直接相关。在人类 ACDMPV 肺中发现了增加的纤维化重塑。携带 突变的小鼠胚胎干细胞通过胚泡互补产生嵌合体,并证明 胚胎干细胞具有分化为肺肌成纤维细胞的倾向。血管内递送携带 cDNA 的纳米颗粒可保护 小鼠免于 RV 肥大和 PH,提高存活率并减少纤维性肺重塑。
增加新生儿肺血管生成的纳米颗粒疗法可用于预防 ACDMPV 中的 PH。