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1 Department of Pediatrics, Akita University School of Medicine, Akita, 010, Japan; 2 Department of Pediatrics, Leiden University, 2300 RA Leiden, The Netherlands; and 3 Departments of Pediatrics and Obstetrics, Gynecology, and Reproductive Science, and Cardiovascular Research Institute, University of California, San Francisco, California 94143
Fetal pulmonary blood flow
is regulated by various vasoactive substances. One, calcitonin
gene-related peptide (CGRP), increases pulmonary blood flow. We
examined four key physiological mechanisms underlying this response
using the blocker drugs CGRP receptor blocker
(CGRP8-37), nitric oxide synthase inhibitor
[N
-nitro-L-arginine
(L-NNA)], adenosine triphosphate-dependent potassium (KATP) channel blocker (glibenclamide), and cyclooxygenase
inhibitor (indomethacin) in 17 near-term fetal sheep. Catheters were
placed in the left (LPA) and main pulmonary arteries, and an ultrasonic flow transducer was placed around the LPA to measure flow continuously. CGRP was injected directly into the LPA (mean 1.02 µg/kg) before and
after blockade, and responses to CGRP were statistically compared. Before blockade, CGRP increased LPA blood flow from 23 ± 25 to 145 ± 77 ml/min (means ± SD), and these increases were
significantly attenuated by CGRP8-37
(n = 6; 91% inhibition), L-NNA
(n = 6; 86% inhibition), and glibenclamide
(n = 6; 69% inhibition). No significant changes were
found with indomethacin (n = 6; 4% inhibition). Thus,
in the fetal pulmonary circulation, CGRP increases pulmonary blood flow
not only through its specific receptor but also, in part, through
nitric oxide release and KATP channel activation.
pulmonary vascular resistance; fetus; nitric oxide; adenosine triphosphate-dependent potassium channel; indomethacin
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