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Surfactant Protein A (SP-A) and Angiotensin Converting Enzyme (ACE) as Early Biomarkers for Pulmonary Edema Formation in Ventilated Human Lung Lobes

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Abstract

Objective

Ex vivo perfused and ventilated lung lobes frequently develop pulmonary edema. We were looking for a suitable and early detectable biomarker in the perfusion fluid indicating lung cell damage and loss of tissue integrity in ventilated human lung lobes. Therefore, we elucidated whether surfactant protein A (SP-A) and angiotensin-converting enzyme (ACE) were measurable in the perfusion fluid and whether they were suitable indicators for edema formation occurring within the experimental time frame of 1–2 h.

Methods

Patients (n = 39) undergoing a lobectomy, bilobectomy or pneumonectomy due to primary bronchial cell carcinoma were included in the studies. Lung lobes were extracorporally ventilated and perfused for up to 2 h. Two different perfusion fluids were used, plain perfusion buffer and perfusion buffer containing packed erythrocytes or buffy coats. Perfusion fluid samples were analyzed for SP-A and ACE using immunoassays served as perfusion fluids.

Results

SP-A and ACE concentrations were analyzed in fluid sample sets of 39 and 33 perfusion experiments, respectively. Degrees of edema formation were arbitrarily classified into three groups (≤29, 30–59, ≥60 % weight gain). The maximum increase of SP-A and ACE concentrations in the perfusate was significantly higher for more pronounced edemas in case of perfusions using a mixture of blood components and buffer. Interestingly, the time courses of ACE and SP-A were highly similar.

Conclusion

We suggest that SP-A and ACE are promising early biochemical markers for the development for pulmonary edema formation in the ex vivo lung lobe perfusion.

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Acknowledgments

We express our gratitude to PD Dr. Cordula Stamme from the Research center in Borstel, Germany, for providing us with purified SP-A standard protein. M. Gnadt was supported by a PhD grant from GlaxoSmithKline (GSK).

Conflict of interest

All authors declare that they do not have any conflict of interest with regard to the content of the present manuscript.

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Authors and Affiliations

  1. Institut für Pharmazie und Lebensmittelchemie, Universität Würzburg, Am Hubland, 97074, Würzburg, Germany

    Mirjam Gnadt & Petra Högger

  2. Thoraxzentrum Bezirk Unterfranken, Münnerstadt, Germany

    Boris Kardziev

  3. Universität Würzburg, Medizinische Klinik und Poliklinik I, Würzburg, Germany

    Michael Schmidt

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  1. Mirjam Gnadt
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  2. Boris Kardziev
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  4. Petra Högger
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Correspondence to Petra Högger.

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Gnadt, M., Kardziev, B., Schmidt, M. et al. Surfactant Protein A (SP-A) and Angiotensin Converting Enzyme (ACE) as Early Biomarkers for Pulmonary Edema Formation in Ventilated Human Lung Lobes. Lung 190, 431–440 (2012). https://doi.org/10.1007/s00408-012-9386-8

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  • DOI: https://doi.org/10.1007/s00408-012-9386-8

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