, Volume 1, Issue 6, pp 441-448
Date: 30 Oct 2012

Immunogenicity of Pulmonary Surfactant Preparations

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Summary

The increasing use of natural and synthetic surfactants to treat neonatal respiratory distress syndrome (RDS), and the likely extension of their use to other conditions, demands an understanding of the potential consequences of surfactant therapy. In particular, the ability of the body to produce antibodies against autologous or administered surfactants carries important long term implications that should be considered in planning treatment.

The proteins of natural surfactants and the phospholipids of natural and synthetic surfactants are both antigenic. Administered surfactant is immunogenic as administered, i.e. via the intratracheal route of instillation. Antibodies against surfactant constituents can inactivate surfactant in vitro and in vivo. The work of a number of groups suggests that at least some infants with neonatal RDS produce antibodies against surfactant constituents, although the role of these antibodies in the pathogenesis of RDS or its complications is still unclear. In addition, the presence of antibodies against surfactant might lead to future immunologically mediated damage. Circulating antibodies may inactivate surfactant following a primary lung injury however caused, and thus exacerbate the respiratory embarrassment caused by the primary insult.

Therefore, until more definitive data are available it is wise to assume that surfactant therapy is not without potential complications. One must safeguard against overconfident or indiscriminate use of surfactants. Exogenous surfactant therapy is effective in reducing the mortality of neonatal RDS; its use should be extended to other illnesses only after careful and controlled clinical trials.