The vascular tone of the foetal lung

Early developmental phenotypes in the cystic fibrosis sheep model

Highly effective modulator therapies for cystic fibrosis (CF) make it a treatable condition for many people. However, although CF respiratory illness occurs after birth, other organ systems particularly in the digestive tract are damaged before birth. We use an ovine model of CF to investigate the in utero origins of CF disease since the sheep closely mirrors critical aspects of human development. Wildtype (WT) and CFTR ^-/- sheep tissues were collected at 50, 65, 80, 100, and 120 days of gestation and term (147 days) and used for histological, electrophysiological, and molecular analysis. Histological abnormalities are evident in CFTR-/- ^-/-  animals by 80 days of gestation, equivalent to 21 weeks in humans. Acinar and ductal dilation, mucus obstruction, and fibrosis are observed in the pancreas; biliary fibrosis, cholestasis, and gallbladder hypoplasia in the liver; and intestinal meconium obstruction, as seen at birth in all large animal models of CF. Concurrently, cystic fibrosis transmembrane conductance regulator (CFTR)-dependent short circuit current is present in WT tracheal epithelium by 80 days gestation and is absent from CFTR ^-/- tissues. Transcriptomic profiles of tracheal tissues confirm the early expression of CFTR and suggest that its loss does not globally impair tracheal differentiation.

Lung Circulation

The circulation of the lung is unique both in volume and function. For example, it is the only organ with two circulations: the pulmonary circulation, the main function of which is gas exchange, and the bronchial circulation, a systemic vascular supply that provides oxygenated blood to the walls of the conducting airways, pulmonary arteries and veins. The pulmonary circulation accommodates the entire cardiac output, maintaining high blood flow at low intravascular arterial pressure. As compared with the systemic circulation, pulmonary arteries have thinner walls with much less vascular smooth muscle and a relative lack of basal tone. Factors controlling pulmonary blood flow include vascular structure, gravity, mechanical effects of breathing, and the influence of neural and humoral factors. Pulmonary vascular tone is also altered by hypoxia, which causes pulmonary vasoconstriction. If the hypoxic stimulus persists for a prolonged period, contraction is accompanied by remodeling of the vasculature, resulting in pulmonary hypertension. In addition, genetic and environmental factors can also confer susceptibility to development of pulmonary hypertension. Under normal conditions, the endothelium forms a tight barrier, actively regulating interstitial fluid homeostasis. Infection and inflammation compromise normal barrier homeostasis, resulting in increased permeability and edema formation. This article focuses on reviewing the basics of the lung circulation (pulmonary and bronchial), normal development and transition at birth and vasoregulation. Mechanisms contributing to pathological conditions in the pulmonary circulation, in particular when barrier function is disrupted and during development of pulmonary hypertension, will also be discussed.

Update on PPHN: mechanisms and treatment

Persistent pulmonary hypertension of the newborn (PPHN) is a syndrome of failed circulatory adaptation at birth, seen in about 2/1000 live born infants. While it is mostly seen in term and near-term infants, it can be recognized in some premature infants with respiratory distress or bronchopulmonary dysplasia. Most commonly, PPHN is secondary to delayed or impaired relaxation of the pulmonary vasculature associated with diverse neonatal pulmonary pathologies, such as meconium aspiration syndrome, congenital diaphragmatic hernia, and respiratory distress syndrome. Gentle ventilation strategies, lung recruitment, inhaled nitric oxide, and surfactant therapy have improved outcome and reduced the need for extracorporeal membrane oxygenation (ECMO) in PPHN. Newer modalities of treatment discussed in this article include systemic and inhaled vasodilators like sildenafil, prostaglandin E1, prostacyclin, and endothelin antagonists. With prompt recognition/treatment and early referral to ECMO centers, the mortality rate for PPHN has significantly decreased. However, the risk of potential neurodevelopmental impairment warrants close follow-up after discharge for infants with PPHN.

Serotonin contributes to high pulmonary vascular tone in a sheep model of persistent pulmonary hypertension of the newborn

Although past studies demonstrate that altered serotonin (5-HT) signaling is present in adults with idiopathic pulmonary arterial hypertension, whether serotonin contributes to the pathogenesis of persistent pulmonary hypertension of the newborn (PPHN) is unknown. We hypothesized that 5-HT contributes to increased pulmonary vascular resistance (PVR) in a sheep model of PPHN and that selective 5-HT reuptake inhibitor (SSRI) treatment increases PVR in this model. We studied the hemodynamic effects of 5-HT, ketanserin (5-HT2A receptor antagonist), and sertraline, an SSRI, on pulmonary hemodynamics of the late gestation fetal sheep with PPHN caused by prolonged constriction of the ductus arteriosis. Brief intrapulmonary infusions of 5-HT increased PVR from 1.0 ± 0.07 (baseline) to 1.4 ± 0.22 mmHg/ml per minute of treatment (P < 0.05). Ketanserin decreased PVR from 1.1 ± 0.15 (baseline) to 0.82 ± 0.09 mmHg/ml per minute of treatment (P < 0.05). Sertraline increased PVR from 1.1 ± 0.17 (baseline) to 1.4 ± 0.17 mmHg/ml per minute of treatment (P = 0.01). In addition, we studied 5-HT production and activity in vitro in experimental PPHN. Compared with controls, pulmonary artery endothelial cells from fetal sheep with PPHN exhibited increased expression of tryptophan hydroxylase 1 and 5-HT production by twofold and 56%, respectively. Compared with controls, 5-HT2A R expression was increased in lung homogenates and pulmonary artery smooth muscle cell lysates by 35% and 32%, respectively. We concluded that increased 5-HT contributes to high PVR in experimental PPHN through activation of the 5-HT2A receptor and that SSRI infusion further increases PVR in this model.

Pulmonary vascular effects of serotonin and selective serotonin reuptake inhibitors in the late-gestation ovine fetus

Maternal use of selective serotonin (5-HT) reuptake inhibitors (SSRIs) is associated with an increased risk for persistent pulmonary hypertension of the newborn (PPHN), but little is known about 5-HT signaling in the developing lung. We hypothesize that 5-HT plays a key role in maintaining high pulmonary vascular resistance (PVR) in the fetus and that fetal exposure to SSRIs increases 5-HT activity and causes pulmonary hypertension. We studied the hemodynamic effects of 5-HT, 5-HT receptor antagonists, and SSRIs in chronically prepared fetal sheep. Brief infusions of 5-HT (3-20 μg) increased PVR in a dose-related fashion. Ketanserin, a 5-HT 2A receptor antagonist, caused pulmonary vasodilation and inhibited 5-HT-induced pulmonary vasoconstriction. In contrast, intrapulmonary infusions of GR127945 and SB206553, 5-HT 1B and 5-HT 2B receptor antagonists, respectively, had no effect on basal PVR or 5-HT-induced vasoconstriction. Pretreatment with fasudil, a Rho kinase inhibitor, blunted the effects of 5-HT infusion. Brief infusions of the SSRIs, sertraline and fluoxetine, caused potent and sustained elevations of PVR, which was sustained for over 60 min after the infusion. SSRI-induced pulmonary vasoconstriction was reversed by infusion of ketanserin and did not affect the acute vasodilator effects of acetylcholine. We conclude that 5-HT causes pulmonary vasoconstriction, contributes to maintenance of high PVR in the normal fetus through stimulation of 5-HT 2A receptors and Rho kinase activation, and mediates the hypertensive effects of SSRIs. We speculate that prolonged exposure to SSRIs can induce PPHN through direct effects on the fetal pulmonary circulation.

The normal electrocardiogram in the newborn and neonatal period and its progression

Description of the progression of the normal newborn and neonatal electrocardiogram (ECG) in the first year of life include dare the mechanisms for the changes in the muscle masses of the pulmonary and systemic circulations and the resulting affect on the electrocardiogram included also is a description of the T wave detailed as well is a description from data from northern Italy of the QT interval using a large population base.

Fasudil inhibits the myogenic response in the fetal pulmonary circulation

In addition to high pulmonary vascular resistance (PVR) and low pulmonary blood flow, the fetal pulmonary circulation is characterized by mechanisms that oppose vasodilation. Past work suggests that high myogenic tone contributes to high PVR and may contribute to autoregulation of blood flow in the fetal lung. Rho-kinase (ROCK) can mediate the myogenic response in the adult systemic circulation, but whether high ROCK activity contributes to the myogenic response and modulates time-dependent vasodilation in the developing lung circulation are unknown. We studied the effects of fasudil, a ROCK inhibitor, on the hemodynamic response during acute compression of the ductus arteriosus (DA) in chronically prepared, late-gestation fetal sheep. Acute DA compression simultaneously induces two opposing responses: 1) blood flow-induced vasodilation through increased shear stress that is mediated by NO release and 2) stretch-induced vasoconstriction (i.e., the myogenic response). The myogenic response was assessed during acute DA compression after treatment with N(omega)-nitro-L-arginine, an inhibitor of nitric oxide synthase, to block flow-induced vasodilation and unmask the myogenic response. Intrapulmonary fasudil infusion (100 microg over 10 min) did not enhance flow-induced vasodilation during brief DA compression but reduced the myogenic response by 90% (P<0.05). During prolonged DA compression, fasudil prevented the time-dependent decline in left pulmonary artery blood flow at 2 h (183+/-29 vs. 110+/-11 ml/min with and without fasudil, respectively; P<0.001). We conclude that high ROCK activity opposes pulmonary vasodilation in utero and that the myogenic response maintains high PVR in the normal fetal lung through ROCK activation.

Fetal oxygenation and Doppler ultrasonography of cardiovascular hemodynamics in a chronic near-term sheep model

OBJECTIVE

We hypothesized that a decrease in fetal oxygenation without acidemia in a near-term fetal sheep leads to cardiovascular hemodynamic changes that are detectable by Doppler ultrasonography.

STUDY DESIGN

Twelve ewes and fetuses were instrumented at 112 to 127 days of gestation. After a 5-day recovery period, experiments were performed with general anesthesia. Uterine and placental volume blood flows and fetal arterial and venous blood pressures were measured. Fetal cardiovascular hemodynamics was assessed by Doppler ultrasonography. All the measurements were performed at baseline, during fetal hypo-oxygenation, and at recovery phase.

RESULTS

A drop in fetal Po2 was related to increased (P < .05) weight-indexed right ventricular and combined cardiac outputs and proximal branch pulmonary artery pulsatility index values. The increase in proximal branch pulmonary artery pulsatility index values correlated (R = .59; P < .05) with the decrease in fetal oxygen saturation. In the aortic isthmus, the time-velocity integral ratio between antegrade and retrograde blood flow components decreased (P < .05) when fetal Po2 dropped.

CONCLUSION

During decreased fetal oxygenation Doppler ultrasonography demonstrated increased fetal cardiac output and pulmonary arterial vascular impedance and a relative increase in the retrograde blood flow component in the aortic isthmus.

The fetal lung. 1: Developmental aspects

A literature survey is presented on normal fetal development during the embryonic, pseudoglandular, canalicular, saccular and alveolar stages in the human fetus. Normal anatomical and physiological aspects of fetal lung development including the fetal pulmonary circulation are described. Factors which may influence fetal lung growth and consequently may play a role in the development of pulmonary hypoplasia are discussed, such as intrauterine and intrathoracic space, lung fluid, fetal breathing movements, normal balance of volume and pressure in the lung and interference with the blood supply.

NO causes perinatal pulmonary vasodilation through K+-channel activation and intracellular Ca2+ release

Evidence suggests that nitric oxide (NO) causes perinatal pulmonary vasodilation through K+-channel activation. We hypothesized that this effect worked through cGMP-dependent kinase-mediated activation of Ca2+-activated K+ channel that requires release of intracellular Ca2+ from a ryanodine-sensitive store. We studied the effects of 1) K+-channel blockade with tetraethylammonium, 4-aminopyridine, a voltage-dependent K+-channel blocker, or glibenclamide, an ATP-sensitive K+-channel blocker; 2) cyclic nucleotide-sensitive kinase blockade with either KT-5823, a guanylate-sensitive kinase blocker, or H-89, an adenylate-sensitive kinase blocker; and 3) blockade of intracellular Ca2+ release with ryanodine on NO-induced pulmonary vasodilation in acutely prepared late-gestation fetal lambs. N-nitro-L-arginine, a competitive inhibitor of endothelium-derived NO synthase, was infused into the left pulmonary artery, and tracheotomy was placed. The animals were ventilated with 100% oxygen for 20 min, followed by ventilation with 100% oxygen and inhaled NO at 20 parts/million (ppm) for 20 min. This represents the control period. In separate protocols, the animals received an intrapulmonary infusion of the different blockers and were ventilated as above. Tetraethylammonium (n = 6 animals) and KT-5823 (n = 4 animals) attenuated the response, whereas ryanodine (n = 5 animals) blocked NO-induced perinatal pulmonary vasodilation. 4-Aminopyridine (n = 5 animals), glibenclamide (n = 5 animals), and H-89 (n = 4 animals) did not affect NO-induced pulmonary vasodilation. We conclude that NO causes perinatal pulmonary vasodilation through cGMP-dependent kinase-mediated activation of Ca2+-activated K+ channels and release of Ca2+ from ryanodine-sensitive stores.

Developmental changes in lung cGMP phosphodiesterase-5 activity, protein, and message

During transitional circulation, the pulmonary vascular bed undergoes a rapid and profound reduction in both tone and vascular smooth-muscle (VSM) content. 3',5'-Guanylate cyclic monophosphate (cGMP) is a crucial mediator in the regulation of pulmonary vascular resistance (PVR) and VSM proliferation. Hydrolysis of cGMP is achieved predominately by cGMP-specific phosphodiesterases (PDEs). Among the cGMP-specific PDEs, PDE5 is quantitatively prevalent in lung tissue. We have investigated the levels of pulmonary PDE5 enzymatic activity, protein, and messenger RNA (mRNA) in ovine and mouse lung during perinatal development. We report that within 1 h following birth, PDE5 activity, protein, and mRNA levels decrease in both species, in a manner that correlates with known decreases in PVR in early transition. However, from 4 to 7 d following birth, a secondary increase in PDE5 activity, protein, and mRNA occurs in both ovine and mouse lung, suggesting a complex regulation of PVR and VSM proliferation in late perinatal development. Our data imply that PDE5 may be an important mediator in the regulation of PVR in normal and possibly in pathologic states, and may ultimately provide a basis for PDE5 inhibitors as a treatment for pulmonary hypertension.

Irreversibility of birth-related changes in the pulmonary circulation

We hypothesized that establishing conditions of hypoxia and fluid filling of the airways in lungs of newborns would reproduce the high levels of pulmonary vascular resistance (PVR) observed in the fetal state. We assessed the hemodynamics of the left pulmonary circulation of 1- to 3-day-old lambs during a variety of airway states while attempting to reestablish fetal conditions. Eleven animals were studied during both normoxemia and hypoxemia in a baseline airway state with a positive end-expiratory pressure (PEEP) of 4 cm H2O, and in experimental airway states, of atelectasis, and fluid filling to 15 and 30 mL/kg and with PEEP of 12 cm H2O. PVR increased while pulmonary blood flow decreased with all airway state changes as compared to baseline, suggesting a passive mechanism for these changes. With the addition of hypoxemia there was a further increase in PVR in all states accompanied by an increase in pulmonary blood flow, indicating that active vasoconstriction was responsible for the increase in PVR. The combined effects of hypoxemia and fluid filling, designed to approximate the fetal state, increased PVR to only 20-30% of fetal values. Thus, additional factors appear to be important in maintaining the high PVR of the fetal state. We speculate that ventilation of the lungs at birth irreversibly alters these factors.

Pulmonary venous responses to thromboxane A2 analogue and atrial natriuretic peptide in lambs

To characterize pulmonary venous vasoactivity and the factors that modulate it, we determined venous responses to a vasoconstrictor agent, thromboxane A2 (TXA2) analogue U46619, and to a vasodilator agent, atrial natriuretic peptide (ANP), in 28 isolated blood-perfused lamb lungs under conditions of varying vascular tone and intraluminal pressures. TXA2 was given in a 5 micrograms/kg bolus followed by a steady infusion of 1 micrograms/kg/min to three groups of lungs: group 1, n = 4, with low vasomotor tone; group 2, n = 8, with moderate vasomotor tone; and group 3, n = 7, with moderate vasomotor tone and high venous intraluminal pressures. Group 3 lungs were reverse-perfused to obtain high venous pressures. ANP was given as two 10 micrograms/kg bolus injections, 5 minutes apart, to three groups of lungs: group 4, n = 4, with low vasomotor tone; group 5, n = 5, with moderate vasomotor tone; and group 6, n = 8, with high vasomotor tone. Group 6 lungs were vasoconstricted with TXA2 infusion. In all lungs, we measured blood flow and pressures in the pulmonary artery and left atrium and partitioned the venous segment by measuring pressures in 20-80-microns venules by micropuncture. We found that the venous constrictor response to TXA2 was greatest in lungs with moderate basal vasomotor tone and low venous intraluminal pressures. In lungs with low vasomotor tone or high venous intraluminal pressures, the venous response to TXA2 was attenuated. The vasodilator response to ANP was negligible in lungs with low vasomotor tone, probably because they were already maximally vasodilated, but similar in lungs with moderate and high vasomotor tone.(ABSTRACT TRUNCATED AT 250 WORDS)

Time-dependent response of fetal pulmonary blood flow to an increase in fetal oxygen tension

We describe the temporal characteristics of the response of the fetal pulmonary circulation to the vasodilatory stimulus of a sustained increase in fetal PO2 (5.1 +/- 0.7 Torr) in 13 chronically prepared fetal sheep. Left pulmonary artery blood flow was measured by electromagnetic flow transducer. Fetal PO2 was increased by delivery of 100% oxygen to the ewe and did not significantly change during the 2 h period of oxygen administration. Fetal left pulmonary artery blood flow slowly increased to a peak approximately 2.7 times the control value 40-50 min after the onset of increased PO2. It then steadily declined toward baseline over the next hour of increased PO2. Maximal pulmonary blood flow in response to the increase in PO2 increased with gestational age. Pulmonary arterial, aortic, and left atrial blood pressures did not change significantly in the animals in which measurements were made. We conclude that the changes in fetal pulmonary blood flow with increased fetal PO2 depend upon the time after the PO2 is increased. The adaptation seen during the second hour suggests the existence of mechanisms that tend to keep the fetal pulmonary circulation chronically constricted at any PO2 likely to be encountered in fetal life.

Pulmonary vascular disease in fatal meconium aspiration

Although not proved, it is generally accepted that pulmonary vasospasm is responsible for the persistent pulmonary hypertension frequently associated with meconium aspiration. We have studied the pulmonary vasculature in 11 consecutive infants with fatal meconium aspiration, applying morphometric techniques to pulmonary arteries distended with barium gelatin before fixation. In 10 of the 11 infants, persistent pulmonary hypertension was evident clinically, with right-to-left shunting through the foramen ovale or ductus arteriosus. In all but one, severe structural abnormal muscularization of the smallest intra-acinar arteries was present. These changes must have developed before birth. In only one infant was the structure of the intra-acinar precapillary arteries virtually normal, as would be expected if vasospasm alone had caused the hypertension. The persistent pulmonary hypertension associated with fatal meconium aspiration may be the result of a structurally abnormal pulmonary microcirculation.

Pulmonary vasodilator responses to vagal stimulation and acetylcholine in the cat

Responses to vagal stimulation and acetylcholine were investigated in the feline pulmonary vascular bed under conditions of controlled pulmonary blood flow and constant left atrial pressure. Under baseline conditions, electrical stimulation of vagal efferent fibers increases lobar arterial pressure. However, when vasoconstrictor tone was increased, a depressor response was unmasked. The pressor response under baseline conditions and the depressor response under enhanced tone conditions were blocked by phenoxybenzamine and atropine. These data suggest that, in the cat, the vagus is composed of efferent fibers from both the sympathetic and parasympathetic systems. After treatment with 6-hydroxydopamine to destroy the integrity of the sympathetic system, vagal stimulation caused significant frequency-dependent decreases in lobar arterial pressure when lobar vascular tone was increased by infusion of a stable prostaglandin endoperoxide analog or ventilatory hypoxia. Injections of acetylcholine also caused significant dose-related decreases in lobar arterial pressure when lobar vascular resistance was elevated. Depressor responses to vagal stimulation and acetylcholine in 6-hydroxydopamine-treated animals were blocked by atropine and enhanced by physostigmine. Decreases in lobar arterial pressure in response to vagal stimulation in 6-hydroxydopamine-treated animals with enhanced tone were blocked by hexamethonium, whereas responses to injected acetylcholine were not altered by the ganglionic blocking agent. Decreases in lobar arterial pressure in response to vagal stimulation and acetylcholine were similar when the lung was ventilated and when the left lower lobe bronchus was obstructed. In addition, responses to vagal stimulation were similar when systemic arterial pressure was decreased to the level of pressure in the perfused lobar artery. Responses to acetylcholine were not altered after treatment with 5,8,11,14-eicosatetraynoic acid, a lipoxygenase inhibitor. The present data suggest that the feline pulmonary vascular bed is functionally innervated by cholinergic nerves and that vagal stimulation dilates the pulmonary vascular bed by releasing acetylcholine which acts on muscarinic receptors in pulmonary vessels.

Physiologic factors affecting pulmonary artery pressure in infants with persistent pulmonary hypertension

Indwelling pulmonary artery catheters were used for continuous monitoring of pulmonary artery pressure in ten infants with severe persistent pulmonary hypertention of the newborn. The labile nature of pulmonary artery pressure, with changes up to 50 mm Hg, was documented. Pulmonary artery pressure in the eight infants with suprasystemic pulmonary hypertension was analyzed at the time of maximum decrease in pressure (mean 36.1 mm Hg) and physiologic measurements were compared over an eight-hour period. During the study period when the infants were hyperventilated, as the Paco2 decreased from 48.9 to 28.3 mm Hg (P less than 0.02) the mean pulmonary artery pressure decreased by 36 mm Hg (P less than 0.001) to subsystemic pressure levels, and the mean AadeltaO2 decreased by 146 mm Hg (P less than 0.001). After the decrease in pulmonary artery pressure, patients were mechanically ventilated to maintain Paco2 in the range of 25 to 30 mm Hg until pulmonary hypertension gradually resolved in the six survivors.

Quantitative characteristics of the Feyrter cells and neuroepithelial bodies of the fetal rabbit lung in normoxia and short term chronic hypoxia

We report here quantitative data on the Feyrter (single) cells (APUD cells) and neuroepithelial bodies (grouped Feyrter cells), in the lungs of rabbit fetuses at 26, 27.5 and 29 days gestational age, during normoxia and short term chronic hypoxia. The apparent number of these cells declines during this period; we suggest that this might be due to increased hypoxemia. Moreover, the number of cells in the lungs of fetuses from short term chronically hypoxic mothers is lower than in the normoxic animals. These findings are in agreement with our previous studies in short term chronically hypoxic neonatal rabbits, and suggest that the increased hypoxemia in the fetus, caused by the induction of hypoxia in the mother, constitutes a stimulus for secretory activity of the Feyrter cells and neuroepithelial bodies (NEBs). This in turn could be part of the mechanism responsible for maintaining the pulmonary vasoconstriction due to hypoxemia. Our results from fetuses of normoxic does provide base line data on the chronological importance of the Feyrter cells and NEBs.

Meconium aspiration syndrome

Meconium aspiration syndrome is a perinatal problem which requires the full cooperation and coordination of obstetrical and pediatric personnel if it is to be avoided. Prompt, efficient delivery room management can minimize the sequelae of aspirated meconium. However, those infants who develop severe meconium aspiration syndrome are best managed in neonatal intensive care units where they can be closely monitored and vigorously treated.

Lung mast cells in rats exposed to acute hypoxia, and chronic hypoxia with recovery

Exposure to acute hypoxia (barometric pressure 263 mmHg) for 8 hours did not lead to increased numbers of mast cells in the lungs of rats. In contrast, in adult rats kept for 35 days at a barometric pressure of 380 mmHg there was a proliferation of mast cells around the pulmonary blood vessels and in the alveolar septa. This hyperplasia of lung mast cells in response to chronic hypoxia was reversible on removal of the hypoxic stimulus. There was a correlation between the logarithm of the perivascular lung mast cell density (defined in the paper) and the logarithm of the right ventricular weight. There was no increase in the mast cells in the carotid bodies of the hypoxic rats. Young male, old male, young female, and old female rats which had been subjected for 39 days to a barometric pressure of 380 mmHg showed a proliferation of mast cells around the pulmonary blood vessels and in the alveolar walls. This response was greatest in the adult animals and independent of their sex. In the age and sex experiment there was a correlation between the perivascular lung mast cell density and the medial thickness of the muscular pulmonary arteries. Since mast cell hyperplasia has been reported as preceding right ventricular hypertrophy, it is conceivable that mast cell proliferation in the lung may be a defence mechanism to limit the severity of hypoxic pulmonary hypertension rather than to mediate it.

Histamine H1- and H2-receptors in the cat and their roles during alveolar hypoxia

We sought to define the roles of H1-and H2-receptors in the cat and to evaluate the roles of these receptors during alveolar hypoxia. In pentobarbital anesthetized cats, we found that histamine infusion (1.1 microgram/kg/min for 3 min) increased cardiac output and decreased pulmonary and systemic vascular resistances. However, when cardiac output was held constant, histamine infusion induced pulmonary vasoconstriction. Histamine infusions after H1-and H2-receptor blockade (chlorpheniramine and metiamde, respctively) indicated that H2-receptors mediated systemic vasodilatation. In the lung, H1-receptors mediated vasoconstriction, and H2-receptors mediated vasodilatation. Hypoxia (10% O2) caused large increases in pulmonary vascular resistance which were not blocked by H1-, H2-, or combined H1- and H2-receptor blockade. In the intact cat, histamine does not appear to mediate hypoxic pulmonary hypertension.

The clinical profile of the newborn with persistent pulmonary hypertension. Observations in 19 affected neonates

In 19 neonates with severe cyanosis, normal chest x-rays, anatomically normal hearts, and a high incidence of perinatal complications, the clinical course was characterized by variable sustained cyanosis. Cardiac catheterization data showed high systemic or suprasystemic pulmonary artery pressure with right to left intracardiac shunting via the foramen ovale and ductus arteriosus. Arterial oxygen tension at an inspired oxygen concentration above 65% was helpful in distinguishing these patients from those with congenital heart disease, and for predicting prognosis.

Gestational changes in pulmonary vascular responses in fetal lambs in utero

Pulmonary arterial (PA) blood flow patterns, changes in pulmonary blood flow, and pulmonary vascular responses to graded hypoxemia and intravenous acetylcholine (ACh) were studied in 15 fetal lambs in utero 3-12 days after surgical implantation of an electromagnetic flow transducer and PA catheter. Phasic PA flow in the fetus was forward only during the first third of systole, almost zero during midsystole, and backward during late systole and early diastole. In contrast, neonatal lambs showed forward PA flow throughout systole. The constriction of the fetal pulmonary vasculature in response to progressive hypoxemia varied with gestational age. At 103 days there was no significant drop in PA flow and only a small increase in pulmonary vascular resistance (Rp) with hypoxemia. The greatest increase in Rp was seen in fetuses after 121 days of gestation. This response was unaffected by alpha- and beta-sympathetic and parasympathetic blockade. Similarly, the pulmonary vascular response to ACh injected into the fetal jugular vein depended on gestational age. Little or no increase in pulmonary flow was noted in the youngest fetus, whereas ACh produced a marked increase in pulmonary flow in festuses over 120 days of gestation. These data suggest that the mechanisms by which hypoxemia constricts and ACh relaxes the pulmonary vascular smooth muscle are not fully developed in fetal lambs at 100 days of gestation and furthermore, that these mechanisms progressively develop during the last third of gestation.

The action of histamine on pulmonary vessels of cats and rats

1. The actions of histamine on pulmonary vascular smooth muscle have been studied in isolated cat and rat lungs perfused with blood, lobes of cat lung perfused in vivo and isolated strips of rat, cat and rabbit pulmonary artery. 2. In all the lung preparations histamine caused both dilatation and constriction. In the rat strips it caused both contraction and relaxation. Dilatation was only well shown when the vessels were in a prior constricted state. In any one lung dilatation occurred with smaller doses than constriction. 3. Histamine caused both increases and decreases in pulmonary artery pressure in collapsed lungs. In this condition these effects are unlikely to have been a consequence of changes in airway pressure. 4. From forward and reverse perfusions of lungs in the waterfall state, where changes in postalveolar vessels do not affect pulmonary artery pressure, it appeared that histamine caused both dilatation and constriction on both sides of the point of collapse caused by alveolar pressure. 5. Plots of the relationship between left atrial and pulmonary artery pressure (at constant alveolar pressure and blood flow) showed that histamine caused both increases and decreases in pulmonary vascular resistance and sometimes also increased the "Starling resistor" properties of lung vessels. 6. In plethysmograph experiments histamine caused moderate dilatation and constriction without affecting lung volume but strong vasoconstriction was accompanied by increases in lung volume.

Factors causing and reversing vasoconstriction in unventilated lung

Vasoconstriction occuring a unventilated or hypoxic lung was studied in dogs and cats to elucidate mechanisms which both cause and reverse it. Lungs were perfused in vivo at constant pressure or constant blood flow; alternatively blood flow and pressure were measured with minimal operative interference. Stimulus-response curves of lung vessels to hypoxia showed a large response within the physiological range of P02 values. Vasoconstriction in unventilated lung caused by bronchial occlusion sometimes matched that caused by an equal degree of ventilation hypoxia but was sometimes greater. Responses to both stimuli varied widely between animals and in one animal at different times. This could be due to variable availability of a transmitter or variable presence of vasodilator substances. Both histamine and beta-adrenoreceptor stimulants caused pulmonary vasodilatation in unventilated lung. Histamine caused pulmonary vasoconstriction and vasodilatation in different circumstances which could be blocked respectively by H1 and H2 antihistamine drugs. Potent alpha- and beta-adrenoreceptor action on pulmonary vessels was demonstrated in both species. Alpha-adrenoreceptor blocking drugs caused dilatation and beta-adrenoreceptor blocking drugs caused vasoconstriction. The possible role of histamine and catecholamines in causing or reversing hypoxic vasoconstriction or in maintaining pulmonary vascular tone is discussed.

Self-stimulation in utero

It is proposed that the human fetus, in utero and often of itself, experiences the physiological effects of passion. Devoid of the sensuality denoted by common psychological reference, this embryonic emotion predisposes the fetus for some distinctly human qualities.

The effects of maturation and prenatal hypoxia on the pulmonary and body fluid content and alveolar lining layer of foetal rabbits, and their relevance to the respiratory distress syndrome

Pulmonary fluid content, body fluid content and fluorescent alveolar lining layers have been studied in maturing rabbit foetuses and it has been shown that there is a steady decrease in the proportion of pulmonary and body fluid as the foetus matures. It is argued that these changes are related to alterations of capillary permeability as the foetus matures. It has been shown that alveolar lining layers can be demonstrated with increasing frequency as the foetus matures. It is suggested that any functional deficiency of surfactant production in immature foetuses can only be exaggerated by increased pulmonary capillary permeability.

Studies of prenatally hypoxic 28-29 and 30-31 (term) day-old foetuses have shown that these foetuses have increased pulmonary and body fluid content and a decreased frequency of demonstrable alveolar lining layers when compared to control animals. It is argued that all these changes can be explained on the basis of increased capillary permeability.

The relationship of these findings to the pathogenesis of the respiratory distress syndrome of the newly born is discussed.