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1 Pediatric Heart Lung Center, University of Colorado School of Medicine, Denver, CO, USA
* To whom correspondence should be addressed. E-mail: steven.abman{at}uchsc.edu.
Persistent pulmonary hypertension of the newborn (PPHN) is partly due to impaired NO-cGMP signaling. BAY 41-2272 is a novel direct activator of sGC, but whether this drug may be an effective therapy for PPHN is unknown. We hypothesized that BAY41-2272 would cause pulmonary vasodilation in a model of severe PPHN. To test this hypothesis, we compared the hemodynamic response of BAY 41-2272 to acetylcholine, an endothelium dependent vasodilator, and sildenafil, a selective inhibitor of PDE5 in chronically instrumented fetal lambs at 1 and 5 days after partial ligation of the ductus arteriosus. After 9 days, we delivered the animals by cesarean section to measure their hemodynamic responses to inhaled NO (iNO), sildenafil and BAY 41-2272 alone or combined with iNO. BAY 41-2272 caused marked pulmonary vasodilation, as characterized by a 2-fold increase in blood flow and a nearly 60% fall in PVR at day 1. Effectiveness of BAY41-2272-induced pulmonary vasodilation increased during the development of pulmonary hypertension. Despite a similar effect at day 1, the pulmonary vasodilator response to BAY 41-2272 was greater than sildenafil at day 5. At birth, BAY 41-2272 dramatically reduced PVR and augmented the pulmonary vasodilation induced by iNO. We concluded that BAY 41-2272 causes potent pulmonary vasodilation in fetal and neonatal sheep with severe pulmonary hypertension. We speculate that BAY41-2272 may provide a novel treatment for severe PPHN, especially in newborns with partial response to iNO therapy.
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