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Original article
Transplacental sildenafil rescues lung abnormalities in the rabbit model of diaphragmatic hernia
  1. Francesca M Russo1,2,
  2. Jaan Toelen1,3,
  3. M Patrice Eastwood1,
  4. Julio Jimenez1,4,
  5. Andre Hadyme Miyague1,
  6. Greetje Vande Velde5,
  7. Philip DeKoninck1,
  8. Uwe Himmelreich3,
  9. Patrizia Vergani6,
  10. Karel Allegaert1,7,
  11. Jan Deprest1,2,8
  1. 1Cluster Organ Systems, Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium
  2. 2Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
  3. 3Department of Pediatrics, University Hospitals Leuven, Leuven, Belgium
  4. 4Department of Obstetrics and Gynecology, Clinica Alemana, Santiago, Chile
  5. 5Department of Imaging and Pathology, Biomedical MRI/MoSAIC, KU Leuven, Leuven, Belgium
  6. 6Department of Obstetrics and Gynecology, University of Milano-Bicocca, Monza, Italy
  7. 7Department of Neonatalogy, University Hospitals Leuven, Leuven, Belgium
  8. 8Department of Obstetrics and Gynecology, Institute of Women's Health, University College London, London, UK
  1. Correspondence to Professor Jan Deprest, Fetal Medicine Unit, Division of Woman and Child, Department of Obstetrics and Gynaecology, University Hospitals Leuven, Herestraat 49, Leuven 3000, Belgium; jan.deprest{at}


Introduction The management of congenital diaphragmatic hernia (DH) would benefit from an antenatal medical therapy, which addresses both lung hypoplasia and persistent pulmonary hypertension. We aimed at evaluating the pulmonary effects of sildenafil in the fetal rabbit model for DH.

Methods We performed a dose-finding study to achieve therapeutic fetal plasmatic concentrations without toxicity following maternal sildenafil administration. Subsequently, DH fetuses were randomly exposed to transplacental placebo or sildenafil 10 mg/kg/day from gestational day 24 until examination at term (day 30). Efficacy measures were ipsilateral pulmonary vascular and airway morphometry, micro-CT-based branching analysis, Doppler flow in the main pulmonary artery and postnatal lung mechanics.

Results Fetal sildenafil plasmatic concentration was above the minimal therapeutic level for at least 22 h/day without maternal and fetal side effects. The placebo-exposed DH fetuses had increased wall thickness in peripheral pulmonary vessels and significantly less fifth-order vessels compared with controls (CTR). Sildenafil-exposed DH fetuses, instead, had a medial and adventitial thickness in peripheral pulmonary vessels in the normal range and normal vascular branching. Fetal pulmonary artery Doppler showed a reduction of pulmonary vascular resistances both in DH and in CTR fetuses treated by sildenafil compared with the placebo-treated ones. Sildenafil also reversed the mean terminal bronchiolar density to normal and improved lung mechanics, yet without measurable impact on lung-to-bodyweight ratio.

Conclusions In the rabbit model for DH, antenatal sildenafil rescues vascular branching and architecture, reduces pulmonary vascular resistances and also improves airway morphometry and respiratory mechanics.

  • Paediatric Lung Disaese
  • Rare lung diseases

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