Pediatric Surgery International

, Volume 35, Issue 1, pp 63–69 | Cite as

Endoplasmic reticulum stress response is activated in pulmonary hypoplasia secondary to congenital diaphragmatic hernia, but is decreased by administration of amniotic fluid stem cells

  • Areti Tzanetakis
  • Lina Antounians
  • Alyssa Belfiore
  • Qi Ma
  • Mark Stasiewicz
  • Ornella Pellerito
  • Augusto ZaniEmail author
Original Article



Pulmonary hypoplasia secondary to congenital diaphragmatic hernia (CDH) is characterized by impaired epithelial homeostasis. Recently, amniotic fluid stem cells (AFSCs) have been shown to promote growth in hypoplastic lungs of rat fetuses with CDH. Herein, we investigated whether CDH hypoplastic lungs mount an endoplasmic reticulum (ER) stress response and whether AFSCs could re-establish pulmonary epithelial homeostasis.


Primary epithelial cells were isolated from fetal rat lungs at E14.5 from control and nitrofen-exposed dams at E9.5. Nitrofen-exposed epithelial cells were grown in medium alone or co-cultured with AFSCs. Epithelial cell cultures were compared for apoptosis (TUNEL), cytotoxicity (LIVE/DEAD assay), proliferation (5′EdU), and ER stress (CHOP, Bcl-2) using one-way ANOVA (Dunn’s post-test).


Compared to control, nitrofen-exposed epithelial cells had increased cytotoxicity and apoptosis, reduced proliferation, and activated ER stress. AFSCs restored apoptosis, proliferation, and ER stress back to control levels, and significantly reduced cytotoxicity.


This study shows for the first time that ER stress-induced apoptosis is activated in the pulmonary epithelium of hypoplastic lungs from fetuses with CDH. AFSC treatment restores epithelial cellular homeostasis by attenuating the ER stress response and apoptosis, by increasing proliferation and migration ability, and by reducing cytotoxicity.


CDH Nitrofen ER stress Cellular homeostasis Regenerative medicine 



The authors are indebted to Prof. Paolo De Coppi for providing the amniotic fluid stem cells used in this study.


This work was supported by SickKids start-up funds and by the Canadian Institutes of Health Research (CIHR)—SickKids Foundation New Investigator Research Grant (NI18—1270R).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Ethical approval for experiments conducted AUP #39168.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Areti Tzanetakis
    • 1
    • 2
  • Lina Antounians
    • 1
    • 2
  • Alyssa Belfiore
    • 1
    • 2
  • Qi Ma
    • 1
    • 2
  • Mark Stasiewicz
    • 1
    • 2
  • Ornella Pellerito
    • 1
    • 2
  • Augusto Zani
    • 1
    • 2
    Email author
  1. 1.Developmental and Stem Cell Biology Program, PGCRLThe Hospital for Sick ChildrenTorontoCanada
  2. 2.Division of General and Thoracic Surgery, Department of SurgeryThe Hospital for Sick ChildrenTorontoCanada

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