The artificial placenta: Continued lung development during extracorporeal support in a preterm lamb model

• Published in: Journal of pediatric surgery Vol. 53; no. 10; pp. 1896 - 1903
• Main Authors: Church, Joseph T., Coughlin, Megan A., Perkins, Elena M., Hoffman, Hayley R., Barks, John D., Rabah, Raja, Bentley, J. Kelley, Hershenson, Marc B., Bartlett, Robert H., Mychaliska, George B.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2018
• Subjects: Animals; Animals, Newborn; Artificial Organs; Artificial placenta; Disease Models, Animal; Extracorporeal life support; Extracorporeal Membrane Oxygenation; Female; Gestational Age; Lung - growth & development; Lung - physiology; Lung development; Placenta - physiology; Pregnancy; Premature Birth - therapy; Prematurity; Sheep; Lung development; Artificial placenta; Prematurity; Extracorporeal life support
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2018.06.001

An artificial placenta (AP) utilizing extracorporeal life support (ECLS) could avoid the harm of mechanical ventilation (MV) while allowing the lungs to develop. AP lambs (n = 5) were delivered at 118 days gestational age (GA; term = 145 days) and placed on venovenous ECLS (VV-ECLS) with jugular drainage and umbilical vein reinfusion. Lungs remained fluid-filled. After 10 days, lambs were ventilated. MV control lambs were delivered at 118 (“early MV”; n = 5) or 128 days (“late MV”; n = 5), and ventilated. Compliance and oxygenation index (OI) were calculated. After sacrifice, lungs were procured and H&E-stained slides scored for lung injury. Slides were also immunostained for PDGFR-α and α-actin; alveolar development was quantified by the area fraction of alveolar septal tips staining double-positive for both markers. Compliance of AP lambs was 2.79 ± 0.81 Cdyn compared to 0.83 ± 0.19 and 3.04 ± 0.99 for early and late MV, respectively. OI in AP lambs was lower than early MV lambs (6.20 ± 2.10 vs. 36.8 ± 16.8) and lung injury lower as well (1.8 ± 1.6 vs. 6.0 ± 1.2). Double-positive area fractions were higher in AP lambs (0.012 ± 0.003) than early (0.003 ± 0.0005) and late (0.004 ± 0.002) MV controls. Lung development continues and lungs are protected from injury during AP support relative to mechanical ventilation. n/a (basic/translational science).