Pulmonary hypertension and oxidative stress: Where is the link?

Semin Fetal Neonatal Med. 2022 Aug;27(4):101347. doi: 10.1016/j.siny.2022.101347. Epub 2022 Apr 19.

Abstract

Oxidative stress can be associated with hyperoxia and hypoxia and is characterized by an increase in reactive oxygen (ROS) and nitrogen (RNS) species generated by an underlying disease process or by supplemental oxygen that exceeds the neutralization capacity of the organ system. ROS and RNS acting as free radicals can inactive several enzymes and vasodilators in the nitric oxide pathway promoting pulmonary vasoconstriction resulting in persistent pulmonary hypertension of the newborn (PPHN). Studies in animal models of PPHN have shown high ROS/RNS that is further increased by hyperoxic ventilation. In addition, antioxidant therapy increased PaO2 in these models, but clinical trials are lacking. We recommend targeting preductal SpO2 between 90 and 97%, PaO2 between 55 and 80 mmHg and avoiding FiO2 > 0.6-0.8 if possible during PPHN management. This review highlights the role of oxidative and nitrosative stress markers on PPHN and potential therapeutic interventions that may alleviate the consequences of increased oxidant stress during ventilation with supplemental oxygen.

Keywords: Antioxidant therapy; Free radical; Nitric oxide; Oxidative stress; Peroxynitrite; Persistent pulmonary hypertension; Superoxide anions.

Publication types

  • Review
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • Humans
  • Hyperoxia* / complications
  • Hypertension, Pulmonary* / therapy
  • Infant, Newborn
  • Nitric Oxide / metabolism
  • Nitric Oxide / therapeutic use
  • Oxidative Stress
  • Oxygen / therapeutic use
  • Persistent Fetal Circulation Syndrome* / drug therapy
  • Reactive Oxygen Species / metabolism
  • Reactive Oxygen Species / therapeutic use

Substances

  • Reactive Oxygen Species
  • Nitric Oxide
  • Oxygen