Abstract
Laboratory evidence has recently confirmed clinical reports suggesting that the surfactant system is abnormal in congenital diaphragmatic hernia (CDH). Autopsy series show that, although both lungs are affected by the maldevelopment, the ipsilateral lung is more severely affected. The aim of this study was to examine the surfactant status in each lung in a lamb model of CDH. The lamb CDH model was created on the left side at 80 d of gestation and delivered near term. Subsequently, the lungs were removed and separated from each other. Bronchoalveolar lavage and type II pneumocyte isolations were performed on each side separately. Lavage analyses showed decreased phospholipid (0.12 versus 0.42 mg/g), per cent phosphatidylcholine(51% versus 79%) surfactant-associated protein A (0.20versus 2.68 mg/g), and surfactant-associated protein-B (0.35versus 2.21 mg/g) in CDH lungs compared with control lungs. However, no differences were seen between the ipsilateral and contralateral lungs of either CDH or control groups. This was in contrast to the phosphatidylcholine biosynthetic abilities of type II cells isolated from CDH lungs, which were not only lower than those from control lungs (0.15 versus 0.40 nmol/106 cells/h), but were also significantly worse in the ipsilateral CDH lung compared with the contralateral CDH lung (0.10 versus 0.20 nmol/106 cells/h). Further studies utilizing radiolabeled exogenous surfactant injected in the lower contralateral lung indicate that discrepancies between the presence of type II cell function differences between lungs, and the lack of biochemical differences between the two lungs in CDH, may be due to in utero mixing of lung fluid.
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Abbreviations
- CDH:
-
congenital diaphragmatic hernia
- BAL:
-
bronchoalveolar lavage
- DPPC:
-
dipalmitoylphosphatidylcholine
- PC:
-
phosphatidylcholine
- MEM:
-
minimal essential medium
- SP:
-
surfactant-associated protein
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Acknowledgements
The authors thank Jon Rossman, Terri Jones, Cindy Maloney, and June Sokolowski for their technical assistance. We also thank Drs. Jeffery Whitsett and William Hull for surfactant protein analyses.
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Supported in part by the Women and Children's Health and Research Foundation, American Lung Association, National Institutes of Health Grants HL 36543 and HL 45170, and U.S. Surgical Corp., Norwalk, CT.
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Wilcox, D., Glick, P., Karamanoukian, H. et al. Contributions by Individual Lungs to the Surfactant Status in Congenital Diaphragmatic Hernia. Pediatr Res 41, 686–691 (1997). https://doi.org/10.1203/00006450-199705000-00014
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DOI: https://doi.org/10.1203/00006450-199705000-00014
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