Secretory phospholipase A2 and neonatal respiratory distress: pilot study on broncho-alveolar lavage
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Secretory phospholipase A2 hydrolyzes phosphoglycerides and it has been shown to be involved in alveolar inflammation and surfactant degradation. It plays an important role in acute lung injury but it has never been studied in newborn infants. We were aimed to investigate the phospholipase A2 activity in neonatal lung injury and its relationship with ventilatory findings.
Third level university hospital NICU.
We measured phospholipase activity in broncho-alveolar lavage fluid of 21 neonates with hyaline membrane disease, 10 with pneumonia or sepsis and 10 controls, ventilated for extrapulmonary reasons. Fluid was obtained before surfactant administration on the first day of life and phospholipase activity was measured using an ultrasensitive enzymatic method. Before lavage, lung mechanics in pressure controlled synchronized intermittent mandatory ventilation was analyzed.
Phospholipase A2 was higher in babies ventilated for sepsis/pneumonia compared to hyaline membrane disease and to control babies. Phospholipase correlated negatively with dynamic compliance, positively with inspired oxygen fraction, mean airway pressure and oxygenation index. These correlations still remained significant after multivariate analysis, adjusting for possible confounding factors. Phospholipase was not correlated with blood and alveolar pH, gestational age, birth weight, blood gases, Apgar score, tidal volume, surfactant need and ventilation time.
These are the first data about phospholipase A2 in neonates. The enzyme plays a role in neonatal lung injury, especially in infection related respiratory failure. It is associated with lung stiffness, higher mean airway pressure and need for oxygen.
KeywordsPhospholipase A2 Lung injury Newborn infants Neonatal respiratory distress syndrome
We thank Mr. Maurizio Ginepro, MEng (bioengineer) for his invaluable technical help about lung mechanics measurements. We have no funding or competing interests to declare.
- 3.Waite M (1996) Phospholipases. In: Vance DE, Vance JE (eds) Biochemistry of lipids, lipoproteins and membranes, 3rd edn edn. Elsevier , AmsterdamGoogle Scholar
- 7.Avery G (2005) Avery’s diseases of the newborn. In: Taeusch HW, Ballard R, Gleason CA (eds) 8th edn. Elsevier/Saunders, Amsterdam/Philadelphia Google Scholar
- 10.De Luca D, Baroni S, Piastra M, Pietrini D, Romagnoli C, Zecca E (2007) Secretory phospholipase A2 and lung mechanics in neonatal acute lung injury: preliminary results. Acta Paediatr 96(suppl 456):83 (abstract)Google Scholar
- 11.Walti H, Couchard M, Relier JP (1989) Neonatal diagnosis of respiratory distress syndrome. Eur Respir J 2(suppl 2):22s–27sGoogle Scholar
- 15.Capoluongo E, Ameglio F, Lulli P, Minucci A, Santonocito C, Concolino P, Di Stasio E, Boccacci S, Vendettuoli V, Giuratrabocchetta G, De Cunto A, Tana M, Romagnoli C, Zuppi C, Vento G (2007) Epithelial lining fluid free IGF-I-to-PAPP-A ratio is associated with bronchopulmonary dysplasia in preterm infants. Am J Physiol Endocrinol Metab 292:E308–E313PubMedCrossRefGoogle Scholar
- 16.Rennard SI, Basset G, Lecossier D, O’Donnell KM, Pinkston P, Martin PG, Crystal RG (1986) Estimation of volume of epithelial lining fluid recovered by lavage using urea as marker of dilution. Appl Physiol 60:532–538Google Scholar
- 19.Norusis M (2004) SPSS 13.0 advanced statistical procedures companion. Prentice Hall Inc., Upper Saddle-RiverGoogle Scholar
- 25.Sweet D, Bevilacqua G, Carnielli V, Greisen G, Plavka R, Didrik Saugstad O, Simeoni U, Speer CP, Valls-I-Soler A, Halliday H, Working Group on Prematurity of the World Association of Perinatal Medicine, European Association of Perinatal Medicine (2007) European consensus guidelines on the management of neonatal respiratory distress syndrome. J Perinat Med 35:175–186Google Scholar
- 26.Arbibe L, Koumanov K, Vial D, Rougeot C, Faure G, Havet N, Longacre S, Vargaftig BB, Bereziat G, Voelker DR, Wolf C, Touqui L (1998) Generation of lyso-phospholipids from surfactant in acute lung injury is mediated by type-II phospholipase A2 and inhibited by a direct surfactant protein A-phospholipase A2 protein interaction. J Clin Invest 102:1152–1160PubMedCrossRefGoogle Scholar
- 29.Anzueto A, Baughman RP, Guntupalli KK, Weg JG, Wiedmann HP, Raventos AA, Lemaire F, Long W, Zaccardelli DS, Pattishall EN (1996) Aerosolized surfactant in adults with sepsis-induced acute respiratory distress syndrome. Exosurf Acute Respiratory Distress Syndrome Sepsis Study Group. N Engl J Med 344:1417–1421CrossRefGoogle Scholar
- 32.Kim DK, Fukuda T, Thompson BT, Cockrill B, Hales C, Bonventre JV (1995) Bronchoalveolar lavage fluid phospholipase A2 activities are increased in human adult respiratory distress syndrome. Am J Physiol 269:109–118Google Scholar
- 33.Abraham E, Naum C, Bandi V, Gervich D, Lowry SF, Wunderink R, Schein RM, Macias W, Skerjanec S, Dmitrienko A, Farid N, Forgue ST, Jiang F (2003) Efficacy and safety of LY315920Na/S-5920, a selective inhibitor of 14-kDa group IIA secretory phospholipase A2, in patients with suspected sepsis and organ failure. Crit Care Med 31:718–728PubMedCrossRefGoogle Scholar