Dd. Ivy et al., PROLONGED ENDOTHELIN A RECEPTOR BLOCKADE ATTENUATES CHRONIC PULMONARY-HYPERTENSION IN THE OVINE FETUS, The Journal of clinical investigation, 99(6), 1997, pp. 1179-1186
Based on past studies of an experimental model of severe intrauterine
pulmonary hypertension, we hypothesized that endothelin-1 (ET-1) contr
ibutes to high pulmonary vascular resistance (PVR), hypertensive lung
structural changes, and right ventricular hypertrophy (RVH) caused by
prolonged closure of the ductus arteriosus. To test this hypothesis, w
e studied the effects of BQ 123, a selective ET(A) receptor antagonist
, after ligation of the ductus arteriosus in utero. In 19 late gestati
on fetal lambs (126 +/- 3 d; 147 d, term) we ligated the ductus arteri
osus at surgery, and treated animals with either BQ 123 (1 mg/d) or ve
hicle (0.1% DMSO, HTN) in the pulmonary artery for 8 d. Chronic BQ 123
treatment attenuated the rise in mean pulmonary artery pressure (PAP)
s d after ductus arteriosus ligation (78 +/- 2, HTN vs. 70 +/- 4 mmHg
, BQ 123, P < 0.05). To study the effects of ET(A) blockade at birth,
15 animals were delivered by cesarean section and ventilated with 10%
oxygen (O-2), 100% O-2 and inhaled nitric oxide (NO). Lambs treated wi
th BQ 123 had lower PVR after delivery during ventilation with 10% O-2
, 100% O-2, and inhaled NO (HTN vs. BQ 123, Pt 0.05 for each intervent
ion). Acute BQ 123 treatment (2 mg/30 min) lowered PVR in three HTN an
imals ventilated with 100% O-2 and inhaled NO (P < 0.05). Chronic BQ 1
23 treatment prevented the development of RVH as determined by the rat
io of the right ventricle/left ventricle + septum (0.79 +/- 0.03, HTN
vs. 0.57 +/- 0.06, BQ 123, P < 0.05) and attenuated the increase in wa
ll thickless of small pulmonary arteries (61 +/- 2, HTN vs. 50 +/- 2%,
BQ 123, P < 0.05). In summary, chronic intrauterine ET(A) receptor bl
ockade decreased PAP in utero, decreased RVH and distal muscularizatio
n of small pulmonary arteries, and increased the fall in PVR at delive
ry. We conclude that ET(A) receptor stimulation contributes to the pat
hogenesis and pathophysiology of experimental perinatal pulmonary hype
rtension.