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Surfactant Replacement in Patients with Ards: Results of Clinical Trials

  • Roger G. Spragg
  • Robert M. Smith
Chapter
Part of the NATO ASI Series book series (NSSA, volume 297)

Abstract

Since the first medical description of the acute respiratory distress syndrome (ARDS) three decades ago, there has been growing evidence that disturbance of the lung surfactant system may contribute to the pathophysiology of that syndrome. Initial descriptions of patients with ARDS documented abnormalities of lung surfactant biophysical function. Understanding of the complexity of the lung surfactant system has matured, and it is now possible to describe both biophysical and non-biophysical functions of that system, how the various components of lung surfactant may be altered in disease states, and how those alterations may contribute to lung surfactant dysfunction. Such understanding forms a rational basis for design and evaluation of studies of lung surfactant administration to patients with ARDS.

Keywords

Acute Lung Injury Acute Respiratory Distress Syndrome Adult Respiratory Distress Syndrome Surfactant Protein Pulmonary Surfactant 
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.
    R. J. King, Pulmonary surfactant, J.Appl.Physiol. 53:1 (1982).PubMedCrossRefGoogle Scholar
  2. 2.
    M. Hallman, R.G. Spragg, J.H. Harrell, K.M. Moser, and L. Gluck, Evidence of lung surfactant abnormality in respiratory failure: study of bronchoalveolar lavage phospholipids, surface activity, phospholipase activity, and plasma myoinositol, J.Clin.Invest. 70:673 (1982).PubMedCrossRefGoogle Scholar
  3. 3.
    S. A. Shelley, J.U. Balis, J.E. Paciga, CG. Espinoza, and A.V. Richman, Biochemical composition of adult human lung surfactant, Lung 160:195 (1982).PubMedCrossRefGoogle Scholar
  4. 4.
    S. Yu, G.R. Harding, M. Smith, and F. Possmayer, Bovine pulmonary surfactant: chemical composition and physical properties, Lipids 18:522 (1983).PubMedCrossRefGoogle Scholar
  5. 5.
    J. R. Wright, R.E. Wager, R.L. Hamilton, M. Huang, and J. A. Clements, Uptake of lung surfactant subfractions into lamellar bodies of adult rabbit lungs, J.Appl.Physiol. 60:817 (1986).PubMedGoogle Scholar
  6. 6.
    T. R. Korfhagen, M.D. Bruno, G.F. Ross, K.M. Huelsman, M. Ikegami, A.H. Jobe, S.E. Wert, B.R. Stripp, R.E. Morris, S.W. Glasser, C.J. Bachurski, H.S. Iwamoto, and J.A. Whitsett, Altered surfactant function and structure in SP-A gene targeted mice, Proc Natl.Acad.Sci. U.S.A. 93:9594 (1996).PubMedCrossRefGoogle Scholar
  7. 7.
    H. T. Akinbi, J.S. Breslin, M. Ikegami, H.S. Iwamoto, J.C. Clark, J.A. Whitsett, A.H. Jobe, and T.E. Weaver, Rescue of SP-B knockout mice with a truncated SP-B proprotein. Function of the Cterminal propeptide, J Biol.Chem. 272:9640 (1997).PubMedCrossRefGoogle Scholar
  8. 8.
    J. C. Clark, T.E. Weaver, H.S. Iwamoto, M. Ikegami, A.H. Jobe, W.M. Hull, and J.A. Whitsett, Decreased lung compliance and air trapping in heterozygous SP-B-deficient mice, Am.JRespir.Cell Mol.Biol. 16:46 (1997).Google Scholar
  9. 9.
    L. M. Nogee, D.E. de Mello, L.P. Dehner, and H.R. Colten, Brief report: deficiency of pulmonary surfactant protein B in congenital alveolar proteinosis, N.Engl. J Med. 328:406 (1993).PubMedCrossRefGoogle Scholar
  10. 10.
    M. Ikegami and A. Jobe, Surfactant metabolism, Semin.Perinatol. 17:233 (1993).PubMedGoogle Scholar
  11. 11.
    K. Miyamura, L.E. Leigh, J. Lu, J. Hopkin, A. Lopez Bernai, and K.B. Reid, Surfactant protein D binding to alveolar macrophages, Biochem. J 300:237 (1994).PubMedGoogle Scholar
  12. 12.
    H. Manz-Keinke, H. Plattner, and J. Schlepper-Schäfer, Lung surfactant protein A (SP-A) enhances serum-independent phagocytosis of bacteria by alveolar macrophages, Eur. J Cell Biol. 57:95 (1992).PubMedGoogle Scholar
  13. 13.
    H. Weber, P. Heilmann, B. Meyer, and K.L. Maier, Effect of canine surfactant protein (SP-A) on the respiratory burst of phagocytic cells, FEBS Lett. 270:90 (1990).PubMedCrossRefGoogle Scholar
  14. 14.
    A. Ahuja, N. Oh, W. Chao, R.G. Spragg, and R.M. Smith, Inhibition of the human neutrophil respiratory burst by native and synthetic surfactant, Am. J Respir.Cell Mol.Biol. 14:496 (1996).PubMedGoogle Scholar
  15. 15.
    M. J. Thomassen, J.M. Antal, M.J. Connors, D.P. Meeker, and H.P. Wiedemann, Characterization of exosurf (surfactant)-mediated suppression of stimulated human alveolar macrophage cytokine responses, Am.JRespir.Cell Mol.Biol. 10:399 (1994).Google Scholar
  16. 16.
    M. J. Thomassen, J.M. Antal, L.T. Divis, and H.P. Wiedemann, Regulation of human alveolar macrophage inflammatory cytokines by tyloxapol: a component of the synthetic surfactant Exosurf, ClinJmmunol Immunopathol 77:201 (1995).CrossRefGoogle Scholar
  17. 17.
    C. P. Speer, B. Gotze, B. Robertson, and T. Curstedt, [Effect of natural porcine surfactant (Curosurf) on the function of neutrophilic granulocytes] Einfluss von naturlichem porcinen Surfactant (Curosurf) auf die Funktion neutrophiler Granulozyten, Monatsschr.Kinderheilkd. 138:737 (1990).PubMedGoogle Scholar
  18. 18.
    C. P. Speer, B. Gotze, T. Curstedt, and B. Robertson, Phagocytic functions and tumor necrosis factor secretion of human monocytes exposed to natural porcine surfactant (Curosurf), Pediatr.Res 30:69 (1991).PubMedGoogle Scholar
  19. 19.
    D. C. Anderson, B.J. Hughes, and C.W. Smith, Abnormal mobility of neonatal polymorphonuclear leukocytes. Relationship to impaired redistribution of surface adhesion sites by chemotactic factor or colchicine, J Clin.Invest. 68:863 (1981).PubMedCrossRefGoogle Scholar
  20. 20.
    A. Suwabe, K. Otake, N. Yakuwa, H. Suzuki, and K. Takahashi, [Effects of surfactant TA on adherence and structure of human peripheral blood neutrophils], Nippon.Kyobu.Shikkan.Gakkai.Zasshi. 34:290 (1996).PubMedGoogle Scholar
  21. 21.
    J. M. Antal, L.T. Divis, S.C. Erzurum, H.P. Wiedemann, and M.J. Thomassen, Surfactant suppresses NF-kappa B activation in human monocytic cells, Am.J Respir.Cell Mol.Biol. 14:374 (1996).PubMedGoogle Scholar
  22. 22.
    W. Chao, R.G. Spragg, and R.M. Smith, Inhibitory effect of porcine surfactant on the respiratory burst oxidase in human neutrophils. Attenuation of p47phox and p67phox membrane translocation as the mechanism, J.Clin.Invest. 96:2654 (1995).PubMedCrossRefGoogle Scholar
  23. 23.
    T. L. Petty, O.K. Reiss, G.W. Paul, G.W. Silvers, and N.D. Elkins, Characteristics of pulmonary surfactant in adult respiratory distress syndrome associated with trauma and shock, Am.Rev.Respir.Dis. 115:531 (1977).PubMedGoogle Scholar
  24. 24.
    T. J. Gregory, W.J. Longmore, M.A. Moxley, J.A. Whitsett, CR. Reed, A.A.I. Fowler, L.D. Hudson, R.J. Maunder, C. Crim, and T.M. Hyers, Surfactant chemical composition and biophysical activity in acute respiratory distress syndrome, J.Clin.Invest. 88:1976 (1991).PubMedCrossRefGoogle Scholar
  25. 25.
    U. Pison, W. Seeger, R. Buchhorn, T. Joka, M. Brand, U. Obertacke, H. Neuhof, and K.P. Schmit-Neuerburg, Surfactant abnormalities in patients with respiratory failure after multiple trauma, Am.Rev.Respir.Dis. 140:1033 (1989).PubMedGoogle Scholar
  26. 26.
    U. Pison, U. Overtacke, M. Brand, W. Seeger, T. Joka, J. Bruch, and K.P. Schmit-Neuerburg, Altered pulmonary surfactant in uncomplicated and septicemia-complicated courses of acute respiratory failure, J. Trauma 30:19 (1990).PubMedCrossRefGoogle Scholar
  27. 27.
    W. Seeger, U. Pison, R. Buchhorn, U. Obertacke, and T. Joka, Surfactant abnormalities and adult respiratory failure., Lung 168 Suppl:891 (1990).PubMedCrossRefGoogle Scholar
  28. 28.
    B. A. Holm, G. Enhorning, and R.H. Notter, A biophysical mechanism by which plasma proteins inhibit lung surfactant activity, Chem.Phys.Lipids 49:49 (1988).PubMedCrossRefGoogle Scholar
  29. 29.
    B. A. Holm, L. Keicher, M.Y. Liu, J. Sokolowski, and G. Enhorning, Inhibition of pulmonary surfactant function by phospholipases, J.Appl.Physiol. 71:317 (1991).PubMedGoogle Scholar
  30. 30.
    J. Cifuentes, J. Ruiz-Oronoz, C. Myles, B. Nieves, W.A. Carlo, and S. Matalon, Interaction of surfactant mixtures with reactive oxygen and nitrogen species, J Appl. Physiol 78:1800 (1995).PubMedGoogle Scholar
  31. 31.
    I. Y. Haddad, S. Zhu, H. Ischiropoulos, and S. Matalon, Nitration of surfactant protein A results in decreased ability to aggregate lipids, Am. J Physiol 270:L281 (1996).PubMedGoogle Scholar
  32. 32.
    N. Gilliard, G.P. Heldt, J. Loredo, H. Gasser, H. Redl, T.A. Merritt, and R.G. Spragg, Exposure of the hydrophobic components of porcine lung surfactant to oxidant stress alters surface tension properties, J Clin. Invest. 93:2608 (1994).PubMedCrossRefGoogle Scholar
  33. 33.
    L. G. Fong, S. Parthasarathy, J.L. Witztum, and D. Steinberg, Nonenzymatic oxidative cleavage of peptide bonds in apoprotein B-100, J.Lipid Res. 28:1466 (1987).PubMedGoogle Scholar
  34. 34.
    W. Palinski, S. Yla-Herttuala, M.E. Rosenfeld, S.W. Butler, S.A. Socher, S. Parthasarathy, L.K. Curtiss, and J.L. Witztum, Antisera and monoclonal antibodies specific for epitopes generated during oxidative modification of low density lipoprotein, Arteriosclerosis 10:325 (1990).PubMedGoogle Scholar
  35. 35.
    R. A. Veldhuizen, L.A. McCaig, T. Akino, and J.F. Lewis, Pulmonary surfactant subfractions in patients with the acute respiratory distress syndrome, Am.J Respir.Crit.Care Med. 152:1867 (1995).PubMedGoogle Scholar
  36. 36.
    Lachmann, B. and van Daal, G. J. Adult respiratory distress syndrome: Animal models. Robertson, B., Van Golde, L. M. G., and Batenburg, J. J. Pulmonary surfactant: From molecular biology to clinical practice. (26), 635–663. 1992. New York, Elsevier. Ref Type: Book ChapterGoogle Scholar
  37. 37.
    B. Lachmann, B. Robertson, and J. Vogel, In vivo lung lavage as an experimental model of the respiratory distress syndrome, Acta Anaesthesiol.Scand. 24:231 (1980).PubMedCrossRefGoogle Scholar
  38. 38.
    S. Matalon, B.A. Holm, and R.H. Notter, Mitigation of pulmonary hyperoxic injury by administration of exogenous surfactant, J. Appl.Physiol. 62:756 (1987).PubMedGoogle Scholar
  39. 39.
    P. C. Engstrom, B.A. Holm, and S. Matalon, Surfactant replacement attenuates the increase in alveolar permeability in hyperoxia, J.Appl.Physiol. 67:688 (1989).PubMedGoogle Scholar
  40. 40.
    G. M. Loewen, B.A. Holm, L. Milanowski, L.M. Wild, R.H. Notter, and S. Matalon, Alveolar hyperoxic injury in rabbits receiving exogenous surfactant, J.Appl.Physiol. 66:1087 (1989).PubMedGoogle Scholar
  41. 41.
    Y. C. Huang, S.P. Caminiti, T.A. Fawcett, R.E. Moon, P.J. Fracica, F.J. Miller, S.L. Young, and C.A. Piantadosi, Natural surfactant and hyperoxic lung injury in primates. I. Physiology and biochemistry, J Appl.Physiol 76:991 (1994).PubMedGoogle Scholar
  42. 42.
    J. F. Lewis, M. Ikegami, and A.H. Jobe, Metabolism of exogenously administered surfactant in the acutely injured lungs of adult rabbits, Am.Rev.Respir.Dis. 145:19 (1992).PubMedGoogle Scholar
  43. 43.
    J. D. Harris, F.J. Jackson, M.A. Moxley, and W.J. Longmore, Effect of exogenous surfactant instillation on experimental acute lung injury, J. Appl.Physiol. 66:1846 (1989).PubMedGoogle Scholar
  44. 44.
    W. J. Lamm and R.K. Albert, Surfactant replacement improves lung recoil in rabbit lungs after acid aspiration, Am.Rev Respir.Dis. 142:1279 (1990).PubMedGoogle Scholar
  45. 45.
    D. Berry, M. Ikegami, and A. Jobe, Respiratory distress and surfactant inhibition following vagotomy in rabbits, Am.J. Physiol. 61:1741 (1986).Google Scholar
  46. 6.
    G. J. van Daal, K.L. So, D. Gommers, E.P. Eijking, R.B. Fievez, M.J. Sprenger, D.W. van Dam, and B. Lachmann, Intratracheal surfactant administration restores gas exchange in experimental adult respiratory distress syndrome associated with viral pneumonia, Anesth.Analg. 72:589 (1991).PubMedCrossRefGoogle Scholar
  47. 47.
    E. P. Eijking, D.S. Strayer, G.J. van Daal, R. Tenbrinck, T.A. Merritt, E. Hannappel, and B. Lachmann, In vivo and in vitro inactivation of bovine surfactant by an anti-surfactant monoclonal antibody, Eur. Respir. J 4:1245 (1991).PubMedGoogle Scholar
  48. 48.
    J. F. Lewis and A.H. Jobe, Surfactant and the adult respiratory distress syndrome, Am.Rev.Respir.Dis. 147:218 (1993).PubMedGoogle Scholar
  49. 49.
    N. Gilliard, P.M. Richman, T.A. Merritt, R.G. Spragg, Effect of volume and dose on the pulmonary distribution of exogenous surfactant administered to normal rabbits or to rabbits with oleic acid lung injury, Am. Rev. Respir. Dis. 141;743 (1990).PubMedGoogle Scholar
  50. 50.
    J. Lewis, M. Ikegami, R. Higuchi, A. Jobe, and D. Absolom, Nebulized vs. instilled exogenous surfactant in an adult lung injury model, J.Appl.Physiol. 71:1270 (1991).PubMedGoogle Scholar
  51. 51.
    J. Lewis, M. Ikegami, B. Tabor, A. Jobe, and D. Absalom, Aerosolized surfactant is preferentially deposited in normal versus injured regions of lung in a heterogenous lung injury model, Am.Rev.Respir.Dis. 145:A184 (1992).Google Scholar
  52. 52.
    Lachmann, B. Surfactant replacement in acute respiratory failure: Animal studies and first clinical trials. Lachmann, B. Surfactant replacement therapy. 212–223. 1987. New York, Springer-Verlag. Ref Type: Book ChapterGoogle Scholar
  53. 53.
    S. Nosaka, T. Sakai, M. Yonekura, and K. Yoshikawa, Surfactant for adults with respiratory failure, Lancet 336:947 (1990).PubMedCrossRefGoogle Scholar
  54. 54.
    Lewis, J., Dhillon, J., and Frewen, T. Exogenous surfactant therapy in pediatric patients with ARDS. Am.J Respir.Crit.Care Med. 149, A125–A125. 1994. Ref Type: GenericGoogle Scholar
  55. 55.
    D. Walmrath, A. Günther, H.A. Ghofrani, R. Schermuly, T. Schneider, F. Grimminger, and W. Seeger, Bronchoscopic surfactant administration in patients with severe adult respiratory distress syndrome and sepsis, Am. J Respir.Crit.Care Med. 154:57 (1996).PubMedGoogle Scholar
  56. 56.
    D. F. Willson, J.H. Jiao, L.A. Bauman, A. Zaritsky, H. Craft, K. Dockery, D. Conrad, and H. Dalton, Calf s lung surfactant extract in acute hypoxemic respiratory failure in children, Crit.Care Med. 24:1316 (1996).PubMedCrossRefGoogle Scholar
  57. 57.
    R. G. Spragg, N. Gilliard, P. Richman, R.M. Smith, R.D. Hite, D. Pappert, B. Robertson, T. Curstedt, and D. Strayer, Acute effects of a single dose of porcine surfactant on patients with the adult respiratory distress syndrome, Chest 105:195 (1994).PubMedCrossRefGoogle Scholar
  58. 58.
    J. Weg, H. Reines, R. Balk, R. Tharratt, P. Kearney, T. Killian, D. Schölten, D. Zaccardelli, J. Horton, E. Pattishall, and and the Exosurf-ARDS Sepsis Study Group, Safety and efficacy of an aerosolized surfactant (Exosurf) in human sepsis-induced ARDS, Chest 100:137S (1992).Google Scholar
  59. 59.
    H. Wiedemann, R. Baughman, B. deBoisblanc, D. Schuster, E. Caldwell, J. Weg, R. Balk, S. Jenkinson, J. Wiegelt, R. Tharratt, J. Horton, E. Pattishall, W. Long, and and the Exosurf ARDS Sepsis Study Group, A multicenter trial in human sepsis-induced ARDS of an aerosolized synthetic surfactant (Exosurf), Am.Rev.Respir.Dis. 145:A184 (1992).Google Scholar
  60. 60.
    A. Anzueto, R. Baughman, K.K. Guntupalli, J.G. Weg, H.P. Wiedemann, A.A. Raventos, F. Lemaire, W. Long, D.S. Zaccardelli, and E.N. Pattishall, Aerosolized surfactants in adults with sepsis-induced acute respiratory distress syndrome, N. Engl. J. Med. 334:1417 (1996).PubMedCrossRefGoogle Scholar
  61. 61.
    T. J. Gregory, K.P. Steinberg, R. Spragg, J.E. Gadek, T.M. Hyers, W.J. Longmore, M.A. Moxley, G.Z. Cai, R.D. Hite, R.M. Smith, L.D. Hudson, C. Crim, P. Newton, B.R. Mitchell, and A.J. Gold, Bovine surfactant therapy for patients with acute respiratory distress syndrome, Am.J Respir.Crit.Care Med. 155:1309 (1997).PubMedGoogle Scholar
  62. 62.
    D. Walmrath, A. Gün ther, H.A. Ghofrani, R. Schermuly, T. Shneider, F. Grimminger, W. Seeger, Bronchoscopic surfactant administration in patients with severe adult respiratory distress syndrome and sepsis, Am. J. Respir. Crit. Care Med. 154;57, (1996).PubMedGoogle Scholar

Copyright information

© Plenum Press, New York 1998

Authors and Affiliations

  • Roger G. Spragg
    • 1
  • Robert M. Smith
    • 1
  1. 1.Department of MedicineUniversity of California San Diego VA Medical CenterSan DiegoUSA

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