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1 University of Colorado School of Medicine, Pediatric Heart Lung Center, Sections of Neonatology and Pulmonary Medicine, Department of Pediatrics, Denver, Colorado, United States
* To whom correspondence should be addressed. E-mail: parker.thomas{at}tchden.org.
Mechanisms that maintain high pulmonary vascular resistance (PVR) in the fetal lung are poorly understood. Activation of the rho-kinase signal transduction pathway, which promotes actin-myosin interaction in vascular smooth muscle cells, is increased in the pulmonary circulation of adult animals with experimental pulmonary hypertension. However, the role of rho-kinase in the fetal lung is unknown. We hypothesized that activation of rho-kinase contributes to elevated PVR in the fetus. To address this hypothesis, we studied the pulmonary hemodynamic effects of brief (10 min) intrapulmonary infusions of two specific rho-kinase inhibitors, Y27632 (15-500 µg) and HA-1077 (500 µg), in late-gestation fetal lambs (n=9). Y-27632 caused potent, dose-dependent pulmonary vasodilation, lowering PVR from 0.67±0.18 to 0.16±0.02 mm Hg/ml/min (p<0.01) at the highest dose tested without lowering systemic arterial pressure. Despite brief infusions, Y27632-induced pulmonary vasodilation was sustained for 50 minutes. HA-1077 caused a similar fall in PVR, from 0.39±0.03 to 0.19±0.03 (p<0.05). To study nitric oxide (NO)-rho-kinase interactions in the fetal lung, we tested the effect of rho-kinase inhibition on pulmonary vasoconstriction caused by inhibition of endogenous NO production with L-NA (15-30 mg), a selective NO synthase antagonist. L-NA increased PVR by 127±73% above baseline under control conditions, but this vasoconstrictor response was completely prevented by treatment with Y27632 (p<0.05). We conclude that the rho-kinase signal transduction pathway maintains high PVR in the normal fetal lung and that activation of the rho-kinase pathway mediates pulmonary vasoconstriction after NOS inhibition. We speculate that rho-kinase inhibitors may provide novel therapy for neonatal pulmonary hypertension.
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