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Published on: May 11, 2015
Early diagnosis and targeted approaches to pulmonary vascular disease in bronchopulmonary dysplasia
Catheline Hocq1, Laetitia Vanhoutte2, Axelle Guilloteau3
1Division of Neonatology, St-Luc University Hospital, Catholic University of Louvain, Brussels, Belgium.
Insights
Bronchopulmonary dysplasia-associated pulmonary hypertension (BPD-PH) in preterm infants is a serious condition. Early detection using imaging and biomarkers, alongside novel treatments, is crucial for better outcomes.
Area of Science:
- Neonatal Medicine
- Pediatric Cardiology
- Pulmonary Medicine
Background:
- Bronchopulmonary dysplasia (BPD) in preterm infants is frequently complicated by life-threatening pulmonary hypertension (PH).
- BPD-associated pulmonary hypertension (BPD-PH) development is intrinsically linked to impaired lung development and vascularization, with origins potentially starting in fetal life.
- The complex pathophysiology of BPD-PH, involving genetic, epigenetic, and environmental factors, presents significant management challenges due to poor reversibility and comorbidities.
Purpose of the Study:
- To review current screening and diagnostic imaging techniques for BPD-PH, assessing their clinical utility, applicability, and limitations in neonates.
- To explore biochemical markers as potential adjuncts for early detection and monitoring of pulmonary vascular disease progression in BPD-PH.
- To summarize available and investigational pharmacological treatments for BPD-PH, including potential early-stage interventions in fetuses and neonates.
Main Methods:
- Comprehensive literature review of state-of-the-art screening and diagnostic imaging modalities for BPD-PH.
- Analysis of studies investigating biochemical markers for early detection and progression monitoring of pulmonary vascular disease.
- Review of current and preclinical pharmacological agents and therapeutic strategies for BPD-PH management and prevention.
Main Results:
- Current imaging techniques offer valuable insights but have limitations in the specific neonatal population.
- Biochemical markers show promise for complementing imaging in early BPD-PH detection and monitoring.
- A range of pharmacological treatments are available or under investigation, with potential for early intervention strategies.
Conclusions:
- Early recognition and intervention are critical for improving long-term outcomes in BPD-PH.
- Combining multiple imaging and biochemical biomarkers holds emerging value but requires further validation through large-scale studies.
- Future research directions include combined pharmacological regimens and cell-based therapies for potential cure and prevention of BPD-PH.
Abstract:
Pulmonary hypertension has emerged as a life-threatening disease in preterm infants suffering from bronchopulmonary dysplasia (BPD). Its development is closely linked to respiratory disease, as vasculogenesis and alveologenesis are closely interconnected. Once clinically significant, BPD-associated pulmonary hypertension (BPD-PH) can be challenging to manage, due to poor reversibility and multiple comorbidities frequently associated. The pulmonary vascular disease process underlying BPD-PH is the result of multiple innate and acquired factors, and emerging evidence suggests that it progressively develops since birth and, in certain instances, may begin as early as fetal life. Therefore, early recognition and intervention are of great importance in order to improve long-term outcomes. Based on the most recent knowledge of BPD-PH pathophysiology, we review state-of-the-art screening and diagnostic imaging techniques currently available, their utility for clinicians, and their applicability and limitations in this specific population. We also discuss some biochemical markers studied in humans as a possible complement to imaging for the detection of pulmonary vascular disease at its early stages and the monitoring of its progression. In the second part, we review pharmacological agents currently available for BPD-PH treatment or under preclinical investigation, and discuss their applicability, as well as possible approaches for early-stage interventions in fetuses and neonates. IMPACT: BPD-associated PH is a complex disease involving genetic and epigenetic factors, as well as environmental exposures starting from fetal life. The value of combining multiple imaging and biochemical biomarkers is emerging, but requires larger, multicenter studies for validation and diffusion. Since "single-bullet" approaches have proven elusive so far, combined pharmacological regimen and cell-based therapies may represent important avenues for research leading to future cure and prevention.
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