Effects of tracheal occlusion with retinoic acid administration on normal lung development

Prenat Diagn. 2017 May;37(5):427-434. doi: 10.1002/pd.5012. Epub 2017 Apr 16.


Introduction: Tracheal occlusion (TO) is an investigational therapy for severe congenital diaphragmatic hernia that decreases pulmonary hypoplasia, but sustained TO also induces deficient surfactant synthesis. Intramuscular maternal administration of retinoic acid (RA) in a surgical rabbit model of congenital diaphragmatic hernia showed a beneficial effect on lung maturation. We evaluated the potential of RA delivery into the trachea and studied the combined effects of TO and RA on normal lung development.

Methods: Experiments were performed on normal rabbit fetuses. Liposomes and capric triglyceride (Miglyol® ), alone and with RA, were administered in the trachea just before TO (d26). Lung morphology and surfactant production were studied at term (d30).

Results: Tracheal occlusion increased lung weight and enhanced alveolar development but increased apoptotic activity and decreased surfactant expression. Tracheal injection of RA improved surfactant production to levels of normal controls.

Conclusion: We established the potential of liposome and Miglyol as RA vehicle for delivering this bioactive molecule in the fetal airways. Tracheal RA injection seems to oppose the effects of TO in fetuses with normal lungs. © 2017 John Wiley & Sons, Ltd.

MeSH terms

  • Airway Obstruction* / embryology
  • Airway Obstruction* / pathology
  • Animals
  • Female
  • Fetal Organ Maturity / drug effects
  • Lung / drug effects*
  • Lung / embryology*
  • Lung / metabolism
  • Pregnancy
  • Pulmonary Surfactants / metabolism
  • Rabbits
  • Trachea / pathology*
  • Tretinoin / pharmacology*


  • Pulmonary Surfactants
  • Tretinoin