Facts, Views & Vision
in ObGyn

Journal of the European Society for Gynaecological Endoscopy

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The fetal respiratory system as target for antenatal therapy

J. Toelen1,4,5, M. Carlon4, F. Claus6, R. Gijsbers4, I. Sandaite6, K. Dierickx7, R. Devlieger2, K. Devriendt8, A. Debeer3, M. Proesmans1, Z. Debyser4, J. A. Deprest2,5

Research Task Force on the “Fetal Lung Development”: from the Department of Woman and Child, (1Unit Child, 2Obstetrics & Gynaecology and 3Neonate), the 4Division of Molecular Medicine, the 5Centre for Surgical Technologies Departments, the 6Department of Medical Imaging, the 7Centre for Biomedical Ethics and Law and 8The Centre for Human Genetics, Faculty of Medicine, Katholieke Universiteit Leuven, Leuven, Belgium.

Correspondence at: Jan A Deprest, MD, PhD, Fetal Medicine Unit, Department of Obstetrics and Gynaecology, University Hospitals Leuven, Katholieke Universiteit Leuven, B-3000 Leuven, Belgium. Tel: + 32 16 34 42 15, fax: + 32 16 34 42 05, e-mail: Jan.Deprest@uz.kuleuven.be


Published online: Apr 11 2011

Abstract

The widespread use of prenatal ultrasound has made the fetus a patient. A number of conditions diagnosed as such may require therapy prior to birth. Herein we describe past, current and potential future procedures designed to treat pulmonary conditions in the antenatal period. When congenital cystic adenomatoid malformation (CCAM) is associated with fetal hydrops, treatment is required. Prior to viability this may be in utero resection of the pathologic lung lobe or shunting of cystic lesions. More recently, fetuses with isolated congenital diaphragmatic hernia (CDH) with lethal lung hypoplasia have been offered percutaneous fetal tracheal occlusion to provoke lung growth. A very rare condition is laryngeal atresia, which requires peripartum re-establishment of the airways. As we get more experience with access to the fetal airways, this may open the doors for novel therapies. One of these is gene delivery to treat fetuses with serious monogenic disorders or to induce transient overexpression of certain proteins. We review the individual hurdles that are being met by researchers when designing fetal gene therapeutic strategies, in particular for the fetal lung. Also the use of stem cells for pulmonary disorders is currently explored.