Alveolar Surfactant and ARDS

  • W. Seeger
  • A. Günther
  • H. D. Walmrath
Conference paper
Part of the Update in Intensive Care and Emergency Medicine book series (UICM, volume 30)

Abstract

The acute respiratory distress syndrome (ARDS) characterizes different states of acute impairment of pulmonary gas exchange. Underlying noxious events may directly affect lung parenchyma from the alveolar side (e.g. gastric acid aspiration), or — more classically — the lung vasculature may be the primary target site of circulating humoral or cellular mediators activated under conditions of systemic inflammatory events such as sepsis or severe polytrauma [1]. Key pathophysiological features of the initial “exudative” phase of ARDS include:
  1. 1.

    increased capillary endothelial and alveolar epithelial permeability.

     
  2. 2.

    leakage of protein rich edema fluid into interstitial and alveolar spaces.

     
  3. 3.

    increased pulmonary vascular resistance with maldistribution of pulmonary perfusion.

     
  4. 4.

    alveolar instability with formation of atelectases and ventilatory inhomogenities.

     
  5. 5.

    severe disturbances of gas exchange characterized by ventilation-perfusion mismatch and extensive shunt flow.

     

Keywords

Acute Respiratory Distress Syndrome Adult Respiratory Distress Syndrome Acute Respiratory Distress Syndrome Patient Alveolar Space Surfactant Replacement 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
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References

  1. 1.
    Seeger W, Lasch HG (1987) Septic lung. Rev Infect Dis 9: 570 – 579CrossRefGoogle Scholar
  2. 2.
    Akino T (1992) Lipid components of the surfactant system. In: Robertson B, van Golde LMG, Batenburg JJ (eds) Pulmonary Surfactant, Elsevier Science, Amsterdam, pp 19 – 32Google Scholar
  3. 3.
    Whitsett JA, Baatz JE (1992) Hydrophobic surfactant proteins SP-B and SP-C: Molecular biology, structure and function. In: Robertson B, van Golde LMG, Batenburg JJ (eds) Pulmonary Surfactant, Elsevier Science, Amsterdam, pp 33 – 54Google Scholar
  4. 4.
    Possmayer F (1988) A proposed nomenclature for pulmonary surfactant-associated proteins. Am Rev Respir Dis 138: 990 – 996PubMedGoogle Scholar
  5. 5.
    Hawgood S (1989) Pulmonary surfactant apoproteins: A review of protein and genomic structure. Am J Physiol 257 (Lung Cell Mol Physiol 1): L13 – L22PubMedGoogle Scholar
  6. 6.
    Goerke J, Clements JA (1986) Alveolar surface tension and lung surfactant. In: Macklem PT, Mead J (eds) Handbook of physiology. American Physiological Society, Bethesda, pp 247 – 261Google Scholar
  7. 7.
    Hawgood S, Benson BJ, Schilling J, Damm D, Clements JA, White RT (1987) Nucleotide and amino acid sequences of pulmonary surfactant protein SP18 and evidence for cooperation between SP18 and SP28-36 in surfactant lipid adsorption. Proc Natl Sci USA 84: 66 – 70CrossRefGoogle Scholar
  8. 8.
    Revak SD, Merritt TA, Degryse E, et al (1988) Use of human surfactant low molecular apoproteins in the reconstitution of surfactant biologic activity. J Clin Invest 81: 826 – 833PubMedCrossRefGoogle Scholar
  9. 9.
    Seeger W, Giinther A, Thede C (1992) Differential sensitivity to fibrinogen-inhibition of SP- C versus SP-B based surfactants. Am J Physiol (Lung Cell Mol Physiol 5 ): L286 – L291Google Scholar
  10. 10.
    Yu SH, Possmayer F (1988) Comparative studies on the biophysical activities of the low molecular weight hydrophobic proteins purified from bovine pulmonary surfactant. Biochim Biophys Acta 961: 337 – 350PubMedGoogle Scholar
  11. 11.
    Gross NJ, Schultz RM (1992) Requirements for extracellular metabolism of pulmonary surfactant: Tentative identification of serine protease. Am J Physiol 262: L446 – L453PubMedGoogle Scholar
  12. 12.
    Gross NJ, Bublys V, D’Anza J, Brown C (1995) The role of (1-antitrypsin in the control of extracellular surfactant metabolism. Am J Physiol 268: L438 – L445PubMedGoogle Scholar
  13. 13.
    Cockshutt AM, Weitz J, Possmayer F (1990) Pulmonary surfactant-associated protein A enhances the surface activity of lipid extract surfactant and reverses inhibition by blood proteins in vitro. Biochemistry 29: 8424 – 8429PubMedCrossRefGoogle Scholar
  14. 14.
    Ross GF, Notter RH, Meuth J, Whitsett JA (1986) Phospholipid binding and biophysical activity of pulmonary surfactant-associated protein (SAP)-35 and its non-collagenous COOH- terminal domains. J Biol Chem 261 (30): 14283 – 14291PubMedGoogle Scholar
  15. 15.
    Kuroki Y, Mason R, Voelker D (1988) Pulmonary surfactant apoprotein A structure and modulation of surfactant secretion by rat alveolar type II cells. J Biol Chem 263: 3388 – 3394PubMedGoogle Scholar
  16. 16.
    Rice WR, Ross GF, Singleton FM, Dingle S, Whitsett JA (1987) Surfactant-associated protein inhibits phospholipid secretion from type II cells. J Appl Physiol 63: 692 – 698PubMedGoogle Scholar
  17. 17.
    Wissel H, Looman AC, Fritzsche I, Riistow B, Stevens PA. (1996) SP-A-binding protein BP55 is involved in surfactant endocytosis by type II pneumocytes. Am J Appl Physiol 271: L432 – L440Google Scholar
  18. 18.
    Iwaarden JF van, Welmers B, Verhoef J, Haagsman HP, Golde van LMG (1990) Pulmonary surfactant protein A enhances the host defense mechanism of rat alveolar macrophages. Am J Respir Cell Mol Biol 2: 91 – 98PubMedGoogle Scholar
  19. 19.
    Iwaarden JF van, Strijp van JAG, Erbskamp MJM, Welmers AC, Verhoef J, Golde van LMG (1991) Surfactant protein A is opsonin in phagocytosis of herpes simplex virus type 1 by rat alveolar macrophages. Am J Physiol (Lung Cell Mol Physiol) 5: L204 – L209Google Scholar
  20. 20.
    Iwaarden JF van, Shimizu H, van Golde PHM, Voelker DR, van Golde LMG (1992) Rat surfactant protein D enhances the production of oxygen radicals by rat alveolar macrophages. Bi- ochem J 286: 5 – 8Google Scholar
  21. 21.
    Tenner AJ, Robinson SL, Borchelt J, Wright JR (1989) Human pulmonary surfactant protein (SP-A), a protein structurally homologous to Clq, can enhance FcR- and CRl-mediated phagocytosis. J Biol Chem 264: 13923 – 13928PubMedGoogle Scholar
  22. 22.
    Collaborative European Multicenter Study Group (1988) Surfactant replacement therapy for severe neonatal respiratory distress syndrome: An international randomized clinical trial. Pediatrics 82: 683 – 691Google Scholar
  23. 23.
    Hennes HM, Lee MB, Rimm AA, Shapiro DL (1991) Surfactant replacement therapy in respiratory distress syndrome. Am J Dis Chest 145: 102 – 104Google Scholar
  24. 24.
    Petty TL, Silvers GW, Paul GW, Stanford RE (1979) Abnormalities in lung elastic properties and surfactant function in adult respiratory distress syndrome. Chest 75: 571 – 575PubMedCrossRefGoogle Scholar
  25. 25.
    Gregory TJ, Longmore WJ, Moxley MA, et al (1991) Surfactant chemical composition and biophysical activity in acute respiratory distress syndrome. J Clin Invest 88: 1976 – 1981PubMedCrossRefGoogle Scholar
  26. 26.
    Hallman M, Spragg R, Harrell JH, Moser KM, Gluck, L (1982) Evidence of lung surfactant abnormality in respiratory failure. J Clin Invest 70: 673 – 683PubMedCrossRefGoogle Scholar
  27. 27.
    Pison U, Seeger W, Buchhorn R, et al (1989) Surfactant abnormalities in patients with respiratory failure after multiple trauma. Am Rev Respir Dis 140: 1033 – 1039PubMedGoogle Scholar
  28. 28.
    Giinther AG, Siebert C, Schmidt R, et al (1996) Surfactant alterations in severe pneumonia, acute respiratory distress syndrome, and cardiogenic lung edema. Am J Respir Crit Care Med 153: 176 – 184Google Scholar
  29. 29.
    Fuchimukai T, Fuchiwara T, Takahashi A, Enhorning G (1987) Artificial pulmonary surfactant inhibited by proteins. J Appl Physiol 62: 429 – 437PubMedCrossRefGoogle Scholar
  30. 30.
    Kobayashi T, Nitta K, Ganzuka M, Inui S, Grossmann G, Robertson B (1991) Inactivation of exogenous surfactant by pulmonary edema fluid. Pediatric Research 29: 353 – 356PubMedCrossRefGoogle Scholar
  31. 31.
    Seeger W, Walmrath D, Menger M, Neuhof H (1986) Increased lung vascular permeability after arachidonic acid and hydrostatic challenge. J Appl Physiol 61: 1781 – 1789PubMedGoogle Scholar
  32. 32.
    Tierney DF, Johnson RP (1965) Altered surface tension of lung extracts and lung mechanics. J Appl Physiol 20: 1253 – 1260Google Scholar
  33. 33.
    Holm BA, Notter RH, Finkelstein JN (1985) Surface property changes from interactions of albumin with natural lung surfactant and extracted lung lipids. Chem Phys Lipids 38: 287 – 298PubMedCrossRefGoogle Scholar
  34. 34.
    Seeger W, Stohr G, Wolf HRD, Neuhof H (1985) Alteration of surfactant function due to protein leakage: Special interaction with fibrin monomer. J Appl Physiol 58: 326 – 338PubMedGoogle Scholar
  35. 35.
    Holm BA, Notter RH (1987) Effects of hemoglobin and cell membrane lipids on pulmonary surfactant activity. J Appl Physiol 63: 1434 – 1442PubMedGoogle Scholar
  36. 36.
    O’Brodovich HM, Weitz JI, Possmayer F (1990) Effect of fibrinogen degradation products and lung ground substance on surface function. Biol Neonate 57: 325 – 333PubMedCrossRefGoogle Scholar
  37. 37.
    Seeger W, Thede C, Giinther A, Grube C (1991) Surface properties and sensitivity to protein- inhibition of a recombinant apoprotein C-based phospholipid mixture in vitro - Comparison to natural surfactant. Biochim Biophys Acta 1081: 45 – 52PubMedGoogle Scholar
  38. 38.
    Venkitaraman AR, Baatz JE, Whitsett JA, Hall SB, Notter RH (1991) Biophysical inhibition of synthetic phospholipid-lung surfactant apoprotein admixtures by plasma proteins. Chem Phys Lipids 57: 49 – 57PubMedCrossRefGoogle Scholar
  39. 39.
    Bachofen M, Weibel EF (1982) Structural alterations of lung parenchyma in the adult respiratory distress syndrome. Clin Chest Med 3: 35 – 56PubMedGoogle Scholar
  40. 40.
    Burkhardt A (1989) Alveolitis and collapse in the pathogenesis of pulmonary fibrosis. Am Rev Respir Dis 140: 513 – 524PubMedGoogle Scholar
  41. 41.
    Jackson LK (1982) Idiopathic pulmonary fibrosis. Clin Chest Med 3: 579 – 592PubMedGoogle Scholar
  42. 42.
    Spencer H (1977) Pathology of the lung. WB Saunders, Philadelphia, pp 235 – 240Google Scholar
  43. 43.
    Chapman HA, Reilly J J, Kobzik L (1988) Role of plasminogen activator in degradation of extracellular matrix protein by live human alveolar macrophages. Am Rev Respir Dis 137: 412 – 419PubMedGoogle Scholar
  44. 44.
    Gross TJ, Simon RH, Sitrin RG (1992) Tissue factor procoagulant expression by rat alveolar epithelial cells. Am J Respir Cell Mol Biol 6: 397 – 403PubMedGoogle Scholar
  45. 45.
    Idell S, James KK, Levin EG, et al (1989) Local abnormalities in coagulation and fibrinolytic pathways predispose to alveolar fibrin deposition in the adult respiratory distress syndrome. J Clin Invest 84: 695 – 705PubMedCrossRefGoogle Scholar
  46. 46.
    Nakstadt B, Boye NP, Lyberg T (1987) Procoagulant activities in human alveolar macrophages. Eur J Respir Dis 71: 459 – 471Google Scholar
  47. 47.
    Idell S, Gonzalez KK, Bradford H, et al (1987) Procoagulant activity in bronchoalveolar lavage in the adult respiratory distress syndrome. Am Rev Respir Dis 136: 1466 – 1474PubMedGoogle Scholar
  48. 48.
    Idell S,Koenig KB, Fair DS, Martin TR,McLarty J, Maunder RJ (1991) Serial abnormalities of fibrin turnover in evolving adult respiratory distress syndrome. Am J Physiol (Lung Cell Mol Physiol) 5: L240 – L248Google Scholar
  49. 49.
    Seeger W, Hiibel J, Klapettek K, et al (1991) Procoagulant activity in bronchoalveolar lavage of severly traumatized patients - Relation to the development of acute respiratory distress. Thromb Res 61: 53 – 64PubMedCrossRefGoogle Scholar
  50. 50.
    Idell S, Gonzalez KK, MacArthur CK, et al (1987) Bronchoalveolar lavage procoagulant activity in bleomycin induced lung injury in marmosets. Am Rev Respir Dis 136: 124 – 133PubMedGoogle Scholar
  51. 51.
    Idell S, James KK, Gillies C, Fair DS, Thrall RS (1989) Abnormalities of pathways of fibrin turnover in lung lavage of rats with oleic acid and bleomycin-induced lung injury support alveolar fibrin deposition. Am J Pathol 135: 387 – 399PubMedGoogle Scholar
  52. 52.
    Idell S, Peterson BT, Gonzalez KK, et al (1988) Local abnormalities of coagulation and fibrinolysis and alveolar fibrin deposition in sheep with oleic acid-induced lung injury. Am Rev Respir Dis 138: 1282 – 1294PubMedGoogle Scholar
  53. 53.
    Bertozzi P, Astedt B, Zenzius L, et al (1990) Depressed broncho alveolar urokinase activity in patients with adult respiratory distress syndrome. N Engl J Med 322: 890 – 897PubMedCrossRefGoogle Scholar
  54. 54.
    Chapman HA, Bertozzi P, Sailor LZ, Nusrat AR (1990) Alveolar macrophage urokinase receptors localize enzyme activity to the cell surface. Am J Physiol 259 (Lung Cell Mol Physiol 3): L432 – L438PubMedGoogle Scholar
  55. 55.
    Hasday JD, Bachwich PR, Lynch JP, Sitrin RG (1988) Procoagulant and plasminogen activator activities of bronchoalveolar fluid in patients with pulmonary sarcoidosis. Exp Lung Res 14: 261 – 278PubMedCrossRefGoogle Scholar
  56. 56.
    Nakstad B, Lydberg T, Skjonsberg OH, Boye NP (1990) Local activation of the coagulation and fibrinolysis systems in lung disease. Thromb Res 57: 827 – 838PubMedCrossRefGoogle Scholar
  57. 57.
    Giinther A, Bleyl H, Seeger W (1993) Apoprotein-based synthetic surfactants inhibit plasmic cleavage of fibrinogen in vitro. Am J Physiol 265: L186 – L192Google Scholar
  58. 58.
    Giinther A, Kalinowski M, Elssner A, Seeger W (1994) Clot-embedded natural surfactant: Kinetics of fibrinolysis and surface activity. Am J Physiol 267: L618 – L624Google Scholar
  59. 59.
    Seeger W, Elssner A, Giinther A, Kraemer HJ, Kalinowski HO (1993) Lung surfactant phospholipids associate with polymerizing fibrin: Loss of surface activity. Am J Respir Cell Mol Biol 9: 213 – 220PubMedGoogle Scholar
  60. 60.
    Christner P, Fein A, Goldberg S, Lippmann M, Abrams W, Weinbaum G (1985) Collagenase in the lower respiratory tract of patients with adult respiratory distress syndrome. Am Rev Respir Dis 131: 690 – 695PubMedGoogle Scholar
  61. 61.
    Lee CT, Fein AM, Lippmann M, Holtzman H, Kimbel, Weinbaum G (1981) Elastolytic activity in pulmonary lavage fluid from patients with adult respiratory distress syndrome. N Engl J Med 304: 192 – 196PubMedCrossRefGoogle Scholar
  62. 62.
    Berry D, Ikegami M, Jobe A (1986) Respiratory distress and surfactant inhibition following vagotomy in rabbits. J Appl Physiol 61: 1741 – 1748PubMedGoogle Scholar
  63. 63.
    Lamm WJE, Albert RK (1990) Surfactant replacement improves lung recoil in rabbit lungs after acid aspiration. Am Rev Respir Dis 142: 1279 – 1283PubMedGoogle Scholar
  64. 64.
    Lewis JF, Ikegami M, Higuchi R, Jobe A, Absolom D (1991) Nebulized versus instilled exogenous surfactant in an adult injury model. J Appl Physiol 71: 1270 – 1276PubMedGoogle Scholar
  65. 65.
    Lewis JF, Ikegami M, Jobe AH (1992) Metabolism of exogenously administered surfactant in the acutely injured lungs of adult rabbits. Am Rev Respir Dis 145: 19 – 23PubMedGoogle Scholar
  66. 66.
    Strohmaier W, Redl H, Schlag G (1990) Studies of the potential role of a semisynthetic surfactant preparation in an experimental aspiration trauma in rabbits. Exp Lung Res 16: 101 – 110PubMedCrossRefGoogle Scholar
  67. 67.
    Zelter M, Escudies BJ, Hoeffel JM, Murray JF (1990) Effects of aerosolized artificial surfactant on repeated oleic acid injury in sheep. Am Rev Respir Dis 141: 1014 – 1019PubMedGoogle Scholar
  68. 68.
    Robertson B, Lachmann B (1988) Experimental evaluation of surfactants for replacement therapy. Exp Lung Res 14: 279 – 310PubMedCrossRefGoogle Scholar
  69. 69.
    Berggren P, Lachmann B, Curstedt T, Grossmann G, Robertson B (1986) Gas exchange and lung morphology after surfactant replacement in experimental adult respiratory distress syndrome induced by repeated lung lavage. Acta Anaesthesiol Scand 30: 321 – 328PubMedCrossRefGoogle Scholar
  70. 70.
    Hall SB, Venkitaraman AR, Whitsett JA, Holm BA, Notter RH (1992) Importance of hydrophobic apoproteins as constituents of clinical exogenous surfactants. Am Rev Respir Dis 145: 24 – 30PubMedGoogle Scholar
  71. 71.
    Kobayashi T, Ganzuka M, Taniguchi J, Nitta K, Murakami S (1990) Lung lavage and surfactant replacement for hydrochloric acid aspiration in rabbits. Acta Anaesthesiol Scand 34: 216 – 221PubMedCrossRefGoogle Scholar
  72. 72.
    van Daal GJ, So KL, Gommers D, et al (1991) Intratracheal surfactant administration restores gas exchange in experimental adult respiratory distress syndrome associated with viral pneumonia. Anesth Analg 72: 589 – 595PubMedCrossRefGoogle Scholar
  73. 73.
    Huang YC, Fawcett TA, Moon RE, et al (1992) Exogenous surfactant treatment improves VA/Q abnormalities in hyperoxic lung injury. Am Rev Respir Dis 145: A609 (Abst)Google Scholar
  74. 74.
    Bredenberg CE, Paskanik AM, Nieman GF (1983) High surface tension pulmonary edema. J Surg Res 34: 515 – 523PubMedCrossRefGoogle Scholar
  75. 75.
    Nieman GF, Bredenberg CE (1985) High surface tension pulmonary edema induced by detergent aerosol. J Appl Physiol 58: 129 – 136PubMedGoogle Scholar
  76. 76.
    Kaneko T, Sato T, Katsuya H, Miyauchi Y (1990) Surfactant therapy for pulmonary edema due to intratracheally injected bile acid. Crit Care Med 18: 77 – 83PubMedCrossRefGoogle Scholar
  77. 77.
    Albert RK, Lakshminarayan S, Hildebrandt J, Kirk W (1979) Increased surface tension favours pulmonary edema formation in anaesthetized dogs’ lungs. J Clin Invest 63: 1015 – 1018PubMedCrossRefGoogle Scholar
  78. 78.
    Nieman GF, Goyette D, Paskanik A, Brendenberg C (1990) Surfactant displacement by plasma lavage results in pulmonary edema. Surgery 107: 677 – 683PubMedGoogle Scholar
  79. 79.
    Evander E, Wollmer P, Jonson B, Lachmann B (1987) Pulmonary clearance of inhaled 99mTc- DTPA: Effects of surfactant depletion by lung lavage. J Appl Physiol 62: 1611 – 1614PubMedGoogle Scholar
  80. 80.
    Ikegami M, Jobe AH, Tabor BL, Rider ED, Lewis JF (1992) Lung albumin recovery in surfactant-treated preterm ventilated lambs. Am Rev Respir Dis 145: 1005 – 1008PubMedGoogle Scholar
  81. 81.
    Jefferies AL, Coates G, O’Brodovich H (1984) Pulmonary epithelial permeability in hyaline- membrane disease. N Engl J Med 311: 1075 – 1080PubMedCrossRefGoogle Scholar
  82. 82.
    Hasleton PS (1983) Adult respiratory distress syndrome: A review. Histopathology 7: 327 – 332Google Scholar
  83. 83.
    Gregory TJ, Gadek JE, Weilnad JE, et al (1994) Survanta supplementation in patients with acute respiratory distress syndrome (ARDS). Am J Respir Crit Care Med 149: A567 (Abst)Google Scholar
  84. 84.
    Walmrath D, Giinther A, Ghofrani AG, et al (1996) Bronchoscopic surfactant administration in patients with severe adult respiratory distress syndrome and sepsis. Am Respir Crit Care Med 154: 57 – 62Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1998

Authors and Affiliations

  • W. Seeger
  • A. Günther
  • H. D. Walmrath

There are no affiliations available

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