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未成熟肺的氧毒性-第 1 部分:病理机制理解和临床前观点。

Oxygen Toxicity to the Immature Lung-Part I: Pathomechanistic Understanding and Preclinical Perspectives.

机构信息

Department of General Pediatrics and Neonatology, Justus-Liebig-University, Universities of Giessen and Marburg Lung Center (UGMLC), 35392 Giessen, Germany.

Department of Internal Medicine II, Universities of Giessen and Marburg Lung Center (UGMLC), Cardiopulmonary Institute (CPI), 35392 Giessen, Germany.

出版信息

Int J Mol Sci. 2021 Oct 12;22(20):11006. doi: 10.3390/ijms222011006.

Abstract

In utero, the fetus and its lungs develop in a hypoxic environment, where HIF-1α and VEGFA signaling constitute major determinants of further development. Disruption of this homeostasis after preterm delivery and extrauterine exposure to high fractions of oxygen are among the key events leading to bronchopulmonary dysplasia (BPD). Reactive oxygen species (ROS) production constitutes the initial driver of pulmonary inflammation and cell death, altered gene expression, and vasoconstriction, leading to the distortion of further lung development. From preclinical studies mainly performed on rodents over the past two decades, the deleterious effects of oxygen toxicity and the injurious insults and downstream cascades arising from ROS production are well recognized. This article provides a concise overview of disease drivers and different therapeutic approaches that have been successfully tested within experimental models. Despite current studies, clinical researchers are still faced with an unmet clinical need, and many of these strategies have not proven to be equally effective in clinical trials. In light of this challenge, adapting experimental models to the complexity of the clinical situation and pursuing new directions constitute appropriate actions to overcome this dilemma. Our review intends to stimulate research activities towards the understanding of an important issue of immature lung injury.

摘要

在子宫内,胎儿及其肺部在缺氧环境中发育,其中 HIF-1α 和 VEGFA 信号构成了进一步发育的主要决定因素。早产儿出生后和宫外暴露于高氧分数会破坏这种体内平衡,这是导致支气管肺发育不良(BPD)的关键事件之一。活性氧(ROS)的产生是导致肺炎症和细胞死亡、基因表达改变和血管收缩的最初驱动因素,从而导致进一步的肺发育畸形。过去二十年来,主要在啮齿动物上进行的临床前研究已经充分认识到了氧毒性的有害影响以及 ROS 产生所带来的损伤性刺激及其下游级联反应。本文简要概述了疾病驱动因素和不同的治疗方法,这些方法已在实验模型中得到成功验证。尽管目前有许多研究,但临床研究人员仍面临着未满足的临床需求,而且许多这些策略在临床试验中并未被证明同样有效。鉴于这一挑战,使实验模型适应临床情况的复杂性并寻求新的方向是克服这一困境的适当措施。我们的综述旨在激发对未成熟肺损伤这一重要问题的研究活动。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b8ec/8540649/4a4ecb5d3601/ijms-22-11006-g001.jpg

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