Sexual Dimorphism of Neonatal Lung Development

L. Gortner; J. Shen; E. Tutdibi

doi:10.1055/s-0033-1333758

Klinische Pädiatrie, Table of Contents

Klin Padiatr 2013; 225(02): 64-69
DOI: 10.1055/s-0033-1333758

Review

Sexual Dimorphism of Neonatal Lung Development

Sexueller Dimorphismus der neonatalen Lungenentwicklung

L. Gortner

¹Department of Pediatrics, Neonatology, University of the Saarland, Homburg, Germany

,

J. Shen

²Department of Pediatrics, Daping Hospital & Research Institute of Surgery of Third Military Medical University, Chongqing, China

,

E. Tutdibi

¹Department of Pediatrics, Neonatology, University of the Saarland, Homburg, Germany

› Author Affiliations

Abstract

Background:

Gender differences in overall neonatal survival and in short term pulmonary outcome have been reported. Furthermore gender differences in childhood chronic lung disorders have been described all in favor of females.

Methods:

A typical survey on published data regarding gender differences in lung development has been carried out.

Results:

1. Structural aspects of lung development: Lung development is regulated by a number of genes, being differently active in the terminal saccular and alveolar period. Gender differences have been described among others for regulation of vascular-endothelial and platelet derived growth factors (VEGF) and platelet-derived growth factor (PDGF), which are active during early lung development with a permissive effect of estrogens mediated by estrogen receptor beta (ER-β). 2. Functional aspects of lung development: Functional components of lung development mainly include surfactant synthesis. Regulation of surfactant protein synthesis was shown to be positively regulated by estrogens, thus favoring lung maturation in females. 3. Lung development and pregnancy complications: Inflammatory alterations induced by LPS lead to larger lung volumes under experimental conditions in females, whereas pulmonary prognosis after impaired intrauterine growth is not affected as clearly by gender.

Conclusion:

Epidemiological findings indicating an impaired male prognosis in neonatal lung disorders which can at least in part be explained by above described experimental findings. Increased estrogen concentrations in females acting via ER-β may be a key for understanding these findings.

Zusammenfassung

Hintergrund:

Geschlechtsunterschiede im Gesamtüberleben und in der pulmonalen Morbidität während der Neugeborenenperiode sind allgemein bekannt. Insbesondere werden Unterschiede zwischen beiden Geschlechtern in Hinblick auf die Entwicklung chronischer Lungenerkrankungen im Kindesalter beschrieben, wobei alle Autoren die Mädchen im Vorteil sehen.

Methodik:

Für unsere Übersichtsarbeit wurden in der Literatur publizierte Daten über sexuellen Dimorphismus der neonatalen Lungenentwicklung gesichtet und ausgewertet.

Ergebnisse:

1. Strukturelle Aspekte der Lungenentwicklung: die fetale Lungenentwicklung wird durch eine Anzahl von Genen reguliert, die während der (späten) sakkulären und alveolären Phase unterschiedlich aktiviert sind. Neben anderen Modulatoren, wird auch eine geschlechtsabhängige Regulation der Wachstumsfaktoren VEGF und PDGF berichtet, die während der Frühphase der Lungenreifung eine wichtige Rolle spielen und die durch Östrogen, vermittelt über Östrogenrezeptor β (ER-β), positiv beeinflusst werden. 2. Funktionelle Aspekte der Lugenentwicklung: die Surfactant-Synthese ist die wesentliche Komponente der funktionellen Lungenreifung. Östrogene zeigen einen günstigen Effekt auf die Surfactantproteinbildung, sodass Mädchen bei der Lungenreifung einen Vorteil aufweisen. 3. Lungenentwicklung und Schwangerschaftskomplikationen: unter experimentellen Bedingungen entwickeln weibliche Tiere durch LPS-induzierte, inflammatorische Prozesse größere Lungenvolumina. Jedoch beeinflusst das Geschlecht nicht eindeutig die pulmonale Prognose bei eingeschränktem intrauterinem Wachstum.

Schlussfolgerung:

Die epidemiologischen Daten belegen für das männliche Geschlecht hinsichtlich neonataler Lungenerkrankungen und Atemstörungen eine schlechtere Prognose, die nur teilweise durch die oben aufgeführten Ergebnisse der experimentellen Studien erklärt werden kann. Die ER-β-vermittelten Effekte der hohen Östrogenkonzentrationen bei Mädchen könnten der entscheidende Schlüssel zum Verständnis der Ergebnisse sein.

Key words

lung development - gender - estrogens - neonatal respiratory disorders - bronchopulmonary dysplasia

Schlüsselwörter

Lungenentwicklung - Geschlecht - Östrogene - neonatale Atemstörungen - bronchopulmonale Dysplasie

Full Text

References

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