Nasal ventilation alters mesenchymal cell turnover and improves alveolarization in preterm lambs

Brent Reyburn, Marlana Li, Drew B. Metcalfe, Nicholas J. Kroll, Jeremy Alvord, Albert Wint, Mar Janna Dahl, Jiancheng Sun, Li Dong, Zheng Ming Wang, Christopher Callaway, Robert A. McKnight, Laurie Moyer-Mileur, Bradley A. Yoder, Donald Null, Robert H. Lane, Kurt H. Albertine

Research output: Contribution to journalArticlepeer-review

52 Scopus citations


Rationale: Bronchopulmonary dysplasia (BPD) is a frequent cause of morbidity in preterm infants that is characterized by prolonged need for ventilatory support in an intensive care environment. BPD is characterized histopathologically by persistently thick, cellular distal airspace walls. In normally developing lungs, by comparison, remodeling of the immature parenchymal architecture is characterized by thinning of the future alveolar walls, a process predicated on cell loss through apoptosis. Objectives:We hypothesized that minimizing lung injury, using high-frequency nasal ventilation to provide positive distending pressure with minimal assisted tidal volume displacement, would increase apoptosis and decrease proliferation among mesenchymal cells in the distal airspace walls compared with a conventional mode of support (intermittent mandatory ventilation). Methods: Accordingly, we compared two groups of preterm lambs: one group managed by high-frequency nasal ventilation and a second group managed by intermittent mandatory ventilation. Each group was maintained for 3 days. Measurements and Main Results: Oxygenation and ventilation targets were sustained with lower airway pressures and less supplemental oxygen in the high-frequency nasal ventilation group, in which alveolarization progressed. Thinning of the distal airspace walls was accompanied by more apoptosis, and less proliferation, among mesenchymal cells of the high-frequency nasal ventilation group, based on morphometric, protein abundance, and mRNA expression indices of apoptosis and proliferation. Conclusions: Our study shows that high-frequency nasal ventilation preserves the balance between mesenchymal cell apoptosis and proliferation in the distal airspace walls, such that alveolarization progresses.

Original languageEnglish (US)
Pages (from-to)407-418
Number of pages12
JournalAmerican Journal of Respiratory and Critical Care Medicine
Issue number4
StatePublished - Aug 15 2008
Externally publishedYes


  • Alveolar formation
  • Bronchopulmonary dysplasia
  • Chronic lung disease of prematurity
  • Morphometry
  • Stereology

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine


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