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Thrombocytopenia in the first 24 hours after birth was not associated with PDA in this largest VLBW/ELBW infant cohort studied to date. Impaired platelet function, due to immaturity and critical illness, rather than platelet number, might play a role in ductus arteriosus patency.

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ABSTRACT:The ductus arteriosus (DA), a fetal arterial shunt vessel between the proximal descending aorta and the pulmonary artery, closes shortly after birth. Initial functional closure as a result of the DA's smooth muscle contraction is followed by definite anatomical closure. The latter involves several complex mechanisms like endothelial cushion formation and smooth muscle cell migration resulting in fibrosis and sealing of the vessel. These complex steps indicate highly specialized functions of the DA vascular smooth muscle cells (VSMCs), endothelial cells, and fibroblasts. Herein, we describe a new reproducible method for isolating VSMCs, endothelial cells, and fibroblasts of high viability from fetal rat DA using immunomagnetic cell sorting. Purity of the different cell cultures was assessed by immunohistochemistry and flow cytometry and ranged between 85 and 94%. The capability of the VSMCs to react to hypoxic stimuli was assessed by intracellular calcium and ATP measurements and by VEGF mRNA expression analysis. VSMCs respond to hypoxia with decreases in intracellular calcium concentrations and ATP levels, whereas VEGF mRNA expression increased 3.2-fold. The purified vessel-specific different cell types are suitable for subsequent gene expression profiling and functional studies and provide important tools for improving our understanding of the complex processes involved in the closure of the DA. T he ductus arteriosus (DA) is a shunt which connects the proximal descending aorta and the main pulmonary artery (PA). During fetal life, it serves to bypass the pulmonary circulation. The DA closes shortly after birth, and pulmonary blood flow increases during late gestation (1). After birth, an abrupt increase in oxygen tension results in ductal constriction, which is further promoted by falling levels of prostaglandin E2 because of an increased pulmonary metabolism and the elimination of placental prostaglandin. DA medial smooth muscle contraction leads to wall thickening, luminal obliteration, and shortening of the vessel. Permanent sealing of the DA is a process generated by the infolding of the endothelium, neointima formation, subintimal disruption, and vasa vasorum ingrowth resulting in subsequent vessel fibrosis. Several major molecular pathways are known to be involved in this programmed proliferation during permanent closure of the DA, e.g. NO signaling, the system of VEGF-promoted angiogenesis, and the cyclooxygenase/prostaglandin system (2-5).However, many questions concerning the exact function and cross-talk of these signaling pathways and the molecular basis for failed DA closure still remain unanswered (6). Previous studies investigating molecular events in the duct were in part hampered by the lack of an in vitro model that allows to study the processes in question separately in each of the different cell types of the DA instead of using the whole vessel (7). Herein, we describe an improved and reproducible method to culture organotypic vascular smooth muscle cells (VSMCs), fibroblasts, and e...

BackgroundThe role of platelets for mediating closure of the ductus arteriosus in human preterm infants is controversial. Especially, the effect of low platelet counts on pharmacological treatment failure is still unclear.MethodsIn this retrospective study of 471 preterm infants [<1,500 g birth weight (BW)], who were treated for a patent ductus arteriosus (PDA) with indomethacin or ibuprofen, we investigated whether platelet counts before or during pharmacological treatment had an impact on the successful closure of a hemodynamically significant PDA. The effects of other factors, such as sepsis, preeclampsia, gestational age, BW, and gender, were also evaluated.ResultsPlatelet counts before initiation of pharmacological PDA treatment did not differ between infants with later treatment success or failure. However, we found significant associations between low platelet counts during pharmacological PDA therapy and treatment failure (p < 0.05). Receiver operating characteristic (ROC) curve analysis showed that platelet counts after the first, and before and after the second cyclooxygenase inhibitor (COXI) cycle were significantly associated with treatment failure (area under the curve of >0.6). However, ROC curve analysis did not reveal a specific platelet cutoff-value that could predict PDA treatment failure. Multivariate logistic regression analysis showed that lower platelet counts, a lower BW, and preeclampsia were independently associated with COXI treatment failure.ConclusionWe provide further evidence for an association between low platelet counts during pharmacological therapy for symptomatic PDA and treatment failure, while platelet counts before initiation of therapy did not affect treatment outcome.