Angiogenic Therapy for Bronchopulmonary Dysplasia

Bronchopulmonary dysplasia (BPD) is one of the most common and significant medical complications associated with preterm birth, affecting 5000 to 10 000 babies annually. It was originally defined as a disorder occurring in infants who were ventilated for neonatal respiratory distress with the primary lung features being mucosal metaplasia of the airways, emphysema, widespread interstitial fibrosis, and remodeling of the small pulmonary arteries.1 Improvements in neonatal care, including antenatal steroids, surfactant therapy, better ventilator strategies, and improved nutritional support, although not reducing the incidence of the disease (the overall numbers of patients with BPD has increased), have led to the development of what is now called “the new BPD.” This so-called new BPD is characterized histopathologically primarily by an impairment of alveolar formation, which often leads to long-term global reductions in alveolar number and gas exchange surface area.2–4 This impairment of alveolar and vascular development is believed to contribute increased morbidity including the development of late cardiopulmonary disease, exercise intolerance, increased risk of asthma, pulmonary hypertension, and the development of chronic obstructive pulmonary disease in these infants as they grow into adulthood.4 Thus, therapies aimed at promoting lung alveolar and vascular growth in these infants may be highly beneficial in the prevention of these sequelae of premature birth.Article p 2477 BPD is a multifactorial disease resulting from the impact of injury (including oxygen toxicity, barotrauma, volutrauma, and infection) on the immature lung. Infants most susceptible to the development of BPD (<750 to 1000 g and 28 weeks’ gestation) are in an early stage of lung development, probably late cannilicular or early saccular.5 At this time, the lung is just beginning to develop the distal airspaces and microcirculation that will ultimately allow it to effectively serve its postnatal role in gas exchange. In the normal fetus, …