3 Prof. Sofie LATEST-fetus as a Patient, Lung Maturation. Ro

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PREPARINGFetal Lung Maturation

Role of Vitamins and Minerals



INTRODUCTION

Survival of preterm fetus depends on thematurational stage of the lung.

The pulmonary system is among the lastof fetal organ system to mature, bothfunctionally and structurally

5 stages of lung development

The viability of the human fetus increasesafter 25 weeks’ gestation (saccular stage)



Morphogenesis



ostnatal development

The proliferation of alveoli, accompanying vessels, continous after

birth until the adult number of alveoli is reached (by 2-3 years of

age).

Stabilization of the morphological pattern of the lungs does not

occur until about 8 years of age.

Alveolar size and surface area continue to increase beyondadolescence.

Hislop AA,J Anat 2002;201:325 Haworth SG, Hislop AA. Semin in Neonatol 2003:8:1

Hislop AA. Paediatr Resp Rew 2005;6:35





The action of corticosteroidintervention to Fetal Lung

Increase protein production

Increase in surfactant synthesis

Increase in surfactant secretion

Induction of pulmonary ß-adrenergic receptors

Stimulation of production of fibroblast —

pneumonocyte factor

Increase in plasma levels of triiodothyronine

Conversion of thyroxine to triiodothyronine

Induction of conversion of noradrenaline to

Adrenaline

Stimulation of glycogenolysis



Corticosteroid intervention

Only prevent RDS in + 40-50% of pretermcases

Increased fetal and maternal RBP

(invitro/invivo (steroidal efficacy or retinoidutilization?)

No evidence glucocorticosteroid interventionare effective in promoting lung maturation

before 24 weeks (before alveolirization) The Glucocorticoids did not promote further

structural development



Other methods to acceleratefetal lung maturation

Thyroid hormones

Bromhexine metabolite VIII

Carnitine Thyrotropin Stimulating Hormone

Schellenberg JC, Liggins GC. New approaches to hormonal acceleration of fetal lungmaturation. J.Perinat.Med.15(1987);447-52



Vitamins and Mineral inPregnancy

Have an essential roles in cellularmetabolism, maintenance and growththroughout life.

Folic acid, the minerals zinc, iron andcopper and the antioxidant vitaminsA, D and E are of particular

importance during pregnancy. They are also central components of

many enzymes and transcription

factors.



Animal studiesNutrition is important to normal lung

development and maturation

Malnutrition can delay somatic growth

and the development of new alveoli. Early malnutrition has been shown to

alter surfactant lipid compositionCurle DC, Adamson IYR: Retarded development of neonatal rat lung by maternal

malnutrition. J.Histochem Cytochem 1978; 26:401-8

Masuyama H, Hiramatsu Y, Kudo T. Effect of retinoids on fetal lung development in therat. Biol Neonate 1995; 67:264-273

DeSanti A, McDowell E, Strum J. Airway branching patterns and cytodifferentiation incultured fetal hamster lung. Tissue Cell 1992; 24: 853-68.)



Effects of a 50% reduction in maternalplasma retinol concentrations on late fetaldevelopment in rats.



Vitamin A and the Lung

The Lungs are sensitives to maternal vitamin A deficiency.

Result immature lungs

= reduced bronchial branching

= reduced elastin (important for alveolar maturation) Influences lung capacity in the neonates

Administration all trans-Retinoic Acid:

Promotes septation and increases number of alveoli

Increase expression of mRNA cellular RBP

Increase plasma level VEGF and lung alveolardevelopment



Conceptual framework for how maternal micron utr ient status m ay affect the organ funct ion

Chris tian P , and Stewart C P J. Nutr. 2010;140:437-445

©2010 by American Society for Nutrition



VITAMIN A / RETINOIC ACID

• Essential for lung maturation

Stimulating effect on lung growth and maturation

- initial growth

- maturation lung epithelium

- accelerate fetal lung branching

- alveogenesis- favor cholin incorporation into phosphatidylcholine

Surfactant



VITAMIN D

Plays a role in lung development due tovitamin D’s interaction with vitamin A.

During the third trimester the need for vitamin

D of pregnancy increased. Vitamin D Deficiency Alters Lung Growth and

Decreases Lung Function

Graeme R. Zosky,Luke J. Berry, John G. Elliot, Alan L.James, Shelley Gorman, and Prue H. HartAmerican Journal of Respiratory and Critical CareMedicine, Vol. 183, No. 10 (2011), pp. 1336-1343.



VITAMIN E

Increase transcription of surfactantsproteins acting directly to type IIcells.

Improves Lung Growth in Fetal Rats

Yoshimura S, Masuzaki H, Nakayama D, Kitajima M, Yoshida

A, Ishimaru T. Acta Med Nagasaki 47: 117-121. 2002



MINERALS

Zn is a central part of > 300 enzymesand proteins

Fe, Zn, Ca (Hormonal adaptations)

Chr ist ian P , and Stewart C P J . Nutr. 2010;140:437-445



CONCLUSION

Some Vitamins ( A , D and E, folate,B12) and Minerals (Zn, Fe, Ca) areessensial for growth and maturationof the Lung



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