ABSTRACT. We studied the interactions of corticosteroids, thyroid hormones, and @-agonist on surfactant phospholipids, pulmonary mechanics, and @-receptor binding in fetal lambs. We infused cortisol (450 pg/h for 48 h), thyrotropin-releasing hormone (TRH) (25 pg/h for 48 h), and ritodrine (1.3 pg/kg/min for 24 h) independently, and in double (cortisol plus @-agonist, cortisol plus TRH), and in triple (cortisol plus TRH plus @-agonist) combinations into chronically catheterized fetal lambs between 0.88 and 0.90 gestation. Infusion of the triple combination of cortisol plus TRH plus @-agonist resulted in a 20.9-fold increase in the saturated phosphatidylcholine content of fetal lung lavage, in a 5.8-fold increase in the saturated phosphatidylcholine content of whole fetal lung, and in a 13.3-fold increase in the saturated phosphatidylcholine content of fetal tracheal fluid. In addition, lung stability to inflation increased 3-fold, and lung stability to deflation increased 8-fold. The increases in the saturated phosphatidylcholine content of fetal lung lavage and tracheal fluid were greater than the effects of each hormone acting independently, or in the double combinations. The @-receptor maximal binding capacity was increased 30% by the combined infusion of cortisol and TRH. In addition, the maximal binding capacity after cortisol plus TRH plus @-agonist infusion was 54% greater than the maximal binding capacity after 8-agonist infusion. We conclude that the triple combination of cortisol, TRH, and P-agonist increases fetal lamb lung surfactant phospholipids better than do any of the hormones acting either independently, or in double combinations, and also improves pulmonary mechanics better than single hormones or the double combination of TRH and cortisol ( p < 0.01). We speculate that the interaction of cortisol and TRH enhances the capacity of the fetal lamb lung to respond to @-adrenergic stimulation, and that the triple combination of cortisol plus TRH plus @-agonist might prepare the fetal lung for air breathing more effectively than each of the hormones acting either independently, or In the double combinations. (Pediatr Res 24: 166-170,1988) Received January 4, 1988; accepted March 18, 1988
AbbreviationsBmax, maximal binding capacity DHA, dihydroalprenolol K, dissociation constant RDS, respiratory distress syndrome SPC, saturated phosphatidylcholine TRH, thyrotropin-releasing hormone V40, lung volume at 40 cm water air inflation pressure V10, lung volume at 10 cm water air deflation pressure T4, thyroxine 1'3, tri-iodothyronine TTI, free thyroxine index PG, phosphatidylglycerol Since Liggins (1) first described glucocorticoid effects on fetal lamb lung in 1969, evidence has accumulated that the fetal lung is also responsive to other hormones, including thyroid hormones and P-agonists (2). Glucocorticoids and thyroid hormones act at different points in the pathways of surfactant phospholipid synthesis (2), whereas (3-agonists stimulate surfactant release and also regulate the production of fetal lung...