Alveolar capillary dysplasia

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Alveolar capillary dysplasia (ACD, also congenital alveolar dysplasia) is a very rare congenital malformation involving abnormal development of the capillary vascular system around the alveoli of the lungs. It is a rare cause of persistent pulmonary hypertension in infants[1]

Cause

ACD is a genetic disorder. This is known because ACD has been reported in multiple families. There is more than one form of ACD. In some families, a form of ACD known as alveolar capillary dysplasia with misalignment of pulmonary veins (ACD/MPV) has been linked to the gene FOXF1 on chromosome 16 q24.1-q24.2.[2]

Diagnosis

ACD commonly is diagnosed postmortem, by a pathologist.

Sometimes ACD is diagnosed clinically.[3] This is common when there is a family history of ACD, but rare otherwise. A clinical differential diagnosis of ACD excludes fetal atelectasis.[4]

ACD is not detectable by prenatal imaging. However, some babies with ACD have associated congenital malformations that are detectable by imaging. The identification of genes involved in ACD offers the potential for prenatal testing and genetic counseling.

Treatment

Most babies with ACD have normal Apgar scores at 1 and 5 minutes, but within minutes or hours present with hypoxia and upon investigation are found to have hypoxemia and pulmonary hypertension. Initial treatments address the hypoxia, usually beginning with supplemental oxygen and arrangements for urgent transport to a neonatal intensive care unit.

Therapies that have been tried to extend life include extracorporeal membrane oxygenation and nitric oxide. These are supportive therapies for persistent pulmonary hypertension; they do not treat the ACD. The objective of therapy is to keep the baby alive long enough to obtain a lung transplant.[5] To date no such case has been reported.

Research

Actress NiCole Robinson and her husband Craig Snyder lost a baby to ACD; with his first wife, Craig lost two more babies to ACD. They have founded an organization to support research into ACD.

Advance in experimental treatment

According to the St. Louis Children's Hospital (the Level I pediatric trauma center and pediatric teaching hospital for the Washington University School of Medicine), which is noted worldwide for its record in pediatric pulmonary transplantation, a type of artificial lung device, the Quadrox, was used after ECMO as a bridge to a dual lung transplant in ten-month-old Eleni Scott of the St. Louis suburb of Florissant, Missouri, who after transplantation returned to her home. Doctors have said it is too early to presume it will continue to work here or work in other pediatric patients as an experiment, much less a successful, curative standard therapy, but the infant has survived thus far, meaning that there might be hope for sufferers of this rare condition. For more information, please see the link to the news release.[6]

History

ACD was first described in 1948.[7][4] A familial association of ACD/MPV was first reported in 1994.[8]

References

  1. Cater G, Thibeault DW, Beatty EC, Kilbride HW, Huntrakoon M (1989). "Misalignment of lung vessels and alveolar capillary dysplasia: a cause of persistent pulmonary hypertension". J Pediatr. 114 (2): 293–300. PMID 2915290.
  2. Stankiewicz P, Sen P, Bhatt SS, Storer M, Xia Z, Bejjani BA, Ou Z, Wiszniewska J, Driscoll DJ, Bolivar J, Bauer M, Zackai EH, McDonald-McGinn D, Nowaczyk MM, Murray M, Shaikh TH, Martin V, Tyreman M, Simonic I, Willatt L, Paterson J, Mehta S, Rajan D, Fitzgerald T, Gribble S, Prigmore E, Patel A, Shaffer LG, Carter NP, Cheung SW, Langston C, Shaw-Smith C (2009). "Genomic and genic deletions of the FOX gene cluster on 16q24.1 and inactivating mutations of FOXF1 cause alveolar capillary dysplasia and other malformations". American Journal of Human Genetics. 84 (6): 780–91. doi:10.1016/j.ajhg.2009.05.005. PMC 2694971. PMID 19500772. Unknown parameter |month= ignored (help)
  3. Liet JM, Joubert M, Gournay V, Godon N, Godde F, Nomballais MF, Roze JC (1998). "[Neonatal hypoxemia due to misaligned pulmonary vessels with alveolar capillary dysplasia]". Archives De Pédiatrie : Organe Officiel De La Sociéte Française De Pédiatrie (in French). 5 (1): 27–30. PMID 10223108. Unknown parameter |month= ignored (help)
  4. 4.0 4.1 MacMahon HE (1948). "Congenital alveolar dysplasia of the lungs". The American Journal of Pathology. 24 (4): 919–31. PMC 1942746. PMID 18874417. Unknown parameter |month= ignored (help)
  5. Kitayama Y, Kamata S, Okuyama H, Usui N, Sawai T, Kobayashi T, Fukui Y, Okada A (1997). "Nitric oxide inhalation therapy for an infant with persistent pulmonary hypertension caused by misalignment of pulmonary veins with alveolar capillary dysplasia". Journal of Pediatric Surgery. 32 (1): 99–100. PMID 9021581. Unknown parameter |month= ignored (help)
  6. http://www.stlouischildrens.org/articles/features/2012/new-medical-approach-helps-baby-with-rare-disease
  7. MacMahon HE (1948). "Congenital alveolar dysplasia; a developmental anomaly involving pulmonary alveoli". Pediatrics. 2 (1): 43–57. PMID 18874463. Unknown parameter |month= ignored (help)
  8. Boggs S, Harris MC, Hoffman DJ, Goel R, McDonald-McGinn D, Langston C, Zackai E, Ruchelli E (1994). "Misalignment of pulmonary veins with alveolar capillary dysplasia: affected siblings and variable phenotypic expression". The Journal of Pediatrics. 124 (1): 125–8. doi:10.1016/S0022-3476(94)70267-5. PMID 8283361. Unknown parameter |month= ignored (help)


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