Lung growth and maturation after tracheal occlusion in diaphragmatic hernia.
Tracheal occlusion (TO) was performed at 120 d of gestation by noninvasive endoscopic technique using a releasable latex balloon, in fetal lambs with diaphragmatic hernia (DH) established at 85 d. The lungs were studied at 139 d in five fetuses with DH + TO, five fetuses with DH only, and six control fetuses. Fluid retention consecutive to TO allowed fetal lungs to grow. Histological pulmonary structure was more mature in DH + TO than in DH alone. The growth-inducing effect of TO was however incomplete, with an increased protein/DNA ratio. Tissue phospholipids were increased, but this was not reflected in the surfactant compartment. The major surfactant component, disaturated phosphatidylcholine, was reduced to 58% of its control value in DH, and further reduced to 17.5% of its control value in DH + TO. The proportion of surfactant protein B immunoreactive cells, assumed to represent the proportion of type II cells, was increased in DH (27% of all parenchymal cells), and reduced in DH + TO (7.8%) as compared with control fetuses (15%). In conclusion, although noninvasive tracheal occlusion in utero is feasible and may partly compensate the adverse effects of DH on lung organogenesis, it reduces the number of type II cells and induces a dramatic surfactant deficit. Using this technique in human fetuses requires careful consideration until further evaluation of lung functional characteristics has been achieved in this experimental model.
Benachi
A
A
Unité de Médecine Foetale, Hôpital Port-Royal-Baudelocque, Paris, France.
Chailley-Heu
B
B
Delezoide
A L
AL
Dommergues
M
M
Brunelle
F
F
Dumez
Y
Y
Bourbon
J R
JR
D000818:Animals; D001999:Bronchoscopy; D002404:Catheterization / Q000295:instrumentation; D004247:DNA / Q000032:analysis; D004195:Disease Models, Animal; D005314:Embryonic and Fetal Development; D004867:Equipment Design; D015633:Extravascular Lung Water / Q000502:physiology; D005240:Feasibility Studies; D005315:Fetal Diseases / Q000628:therapy*; D005325:Fetal Organ Maturity; D019085:Fluorescent Antibody Technique, Direct; D005865:Gestational Age; D006548:Hernia, Diaphragmatic / Q000196:embryology / Q000628:therapy*; D006801:Humans; D007840:Latex; D008168:Lung / Q000737:chemistry / Q000166:cytology / Q000196:embryology*; D009929:Organ Size; D010713:Phosphatidylcholines / Q000032:analysis; D010743:Phospholipids / Q000032:analysis; D011506:Proteins / Q000032:analysis; D011650:Pulmonary Alveoli / Q000196:embryology; D011663:Pulmonary Surfactants / Q000032:analysis; D011961:Receptors, Fc / Q000032:analysis; D012756:Sheep; D014132:Trachea / Q000196:embryology*
C045281:IgA receptor; D007840:Latex; D010713:Phosphatidylcholines; D010743:Phospholipids; D011506:Proteins; D011663:Pulmonary Surfactants; D011961:Receptors, Fc; D004247:DNA