The ductus arteriosus (DA) is a fetal shunt vessel between the pulmonary artery and the aorta that closes promptly after birth. Failure of postnatal DA closure is a major cause of morbidity and mortality particularly in preterm neonates. The events leading to DA closure are incompletely understood. Here we show that platelets have an essential role in DA closure. Using intravital microscopy of neonatal mice, we observed that platelets are recruited to the luminal aspect of the DA during closure. DA closure is impaired in neonates with malfunctioning platelet adhesion or aggregation or with defective platelet biogenesis. Defective DA closure resulted in a left-to-right shunt with increased pulmonary perfusion, pulmonary vascular remodeling and right ventricular hypertrophy. Our findings indicate that platelets are crucial for DA closure by promoting thrombotic sealing of the constricted DA and by supporting luminal remodeling. A retrospective clinical study revealed that thrombocytopenia is an independent predictor for failure of DA closure in preterm human newborns, indicating that platelets are likely to contribute to DA closure in humans.

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We thank M. Shakibaei, S. Reder and J. Schwarz for their support. This work was supported by the Deutsche Forschungsgemeinschaft and the Ernst und Berta-Grimmke Foundation.

Author information


  1. Deutsches Herzzentrum, Klinik für Herz- und Kreislauferkrankungen, Technische Universität, Munich, Germany.

    • Katrin Echtler
    • , Konstantin Stark
    • , Michael Lorenz
    • , Sandra Kerstan
    • , Marie-Luise von Bruehl
    • , Julinda Mehilli
    • , Adnan Kastrati
    •  & Steffen Massberg
  2. Helmholtz Zentrum München, Deutsches Forschungszentrum für Umwelt und Gesundheit, Institut für Pathologie, Neuherberg, Germany.

    • Axel Walch
    •  & Luise Jennen
  3. Institut für Allgemeine Pathologie und Pathologische Anatomie, Technische Universität, Munich, Germany.

    • Martina Rudelius
    •  & Stefan Seidl
  4. Helmholtz Zentrum München, Deutsches Forschungszentrum für Umwelt und Gesundheit, Institut für Molekulare Immunologie, Munich, Germany.

    • Elisabeth Kremmer
  5. Harvard Medical School, Children's Hospital, Boston, Massachusetts, USA.

    • Nikla R Emambokus
  6. Institute for Biomedical Research, Birmingham University, Birmingham, UK.

    • Jon Frampton
  7. Universitätsklinikum Heidelberg, Medizinische Klinik, Heidelberg, Germany.

    • Berend Isermann
  8. Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Perinatalzentrum, Ludwig-Maximilians Universität, Munich, Germany.

    • Orsolya Genzel-Boroviczény
  9. Deutsches Herzzentrum, Klinik für Herz- und Gefäßchirurgie, Technische Universität, Munich, Germany.

    • Christian Schreiber
  10. Nuklearmedizinische Klinik des Klinikums Rechts der Isar, Technische Universität, Munich, Germany.

    • Markus Schwaiger
  11. Department of Medical Oncology & Cancer Biology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA.

    • Ramesh A Shivdasani
  12. Immune Disease Institute and Department of Pathology, Harvard Medical School, Boston, Massachusetts, USA.

    • Steffen Massberg


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K.E., K.S., M.-L.v.B. and S.M. designed the experiments. K.E. established and performed intravital confocal and epifluorescence microscopy and angiography in neonatal pups and, in cooperation with M.S., performed cardiac output distribution analysis. K.S., S.S. and M.R. planned and performed histological and immunohistochemical analysis. K.S., L.J. and A.W. performed laser-capture microdissection and transmission electron microscopy. M.L. performed RNA analysis, and S.K. performed flow cytometric analysis of cells. E.K. generated the antibody to GpVI. R.A.S., B.I., N.R.E. and J.F. provided the Itga2b−/− and Nfe2−/− mice. O.G.B., J.M. and A.K. planned and performed statistical analysis of the retrospective study in preterm babies. C.S. helped with the acquisition of human DA specimens. K.E. and S.M. analyzed the data and composed the manuscript.

Corresponding author

Correspondence to Steffen Massberg.

Supplementary information

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  1. 1.

    Supplementary Text and Figures

    Supplementary Figures 1–9, Supplementary Tables 1–5 and Supplementary Methods


  1. 1.

    Supplementary Movie 1

    Platelet adhesion and aggregation in the neonate mouse ductus arteriosus. The neonates were delivered at day 18.5 of gestation (i.e. few hours prior to the expected birth) by abdominal caesarean section and the DA exposed. The adhesion and aggregation of DCF-labeled platelets (green) was monitored in vivo 15 min after birth using a confocal fluorescence laser bundle microscopy (for details see Materials and Methods). In the movie persistent flow as well as platelet aggregate formation in the residual lumen of the contracted DA can be observed.

  2. 2.

    Supplementary Movie 2

    3D-animation of a contracted, but not fully occluded human DA imaged using 2-photon microscopy. Frozen sections were stained with DAPI (blue) and platelet CD41-specific antibody (red). The white line indicates the luminal surface (visible when exciting collagen autofluorescence). The movie was processed using Adobe After Effects software.

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