Hidden Microatelectases Increase Vulnerability to Ventilation-Induced Lung Injury

Mechanical ventilation of lungs suffering from microatelectases may trigger the development of acute lung injury (ALI). Direct lung injury by bleomycin results in surfactant dysfunction and microatelectases at day 1 while tissue elastance and oxygenation remain normal. Computational simulations of alveolar micromechanics 1-day post-bleomycin predict persisting microatelectases throughout the respiratory cycle and increased alveolar strain during low positive end-expiratory pressure (PEEP) ventilation. As such, we hypothesize that mechanical ventilation in presence of microatelectases, which occur at low but not at higher PEEP, aggravates and unmasks ALI in the bleomycin injury model. Rats were randomized and challenged with bleomycin (B) or not (H = healthy). One day after bleomycin instillation the animals were ventilated for 3 h with PEEP 1 (PEEP1) or 5 cmH₂O (PEEP5) and a tidal volume of 10 ml/kg bodyweight. Tissue elastance was repetitively measured after a recruitment maneuver to investigate the degree of distal airspace instability. The right lung was subjected to bronchoalveolar lavage (BAL), the left lung was fixed for design-based stereology at light- and electron microscopic level. Prior to mechanical ventilation, lung tissue elastance did not differ. During mechanical ventilation tissue elastance increased in bleomycin-injured lungs ventilated with PEEP = 1 cmH₂O but remained stable in all other groups. Measurements at the conclusion of ventilation showed the largest time-dependent increase in tissue elastance after recruitment in B/PEEP1, indicating increased instability of distal airspaces. These lung mechanical findings correlated with BAL measurements including elevated BAL neutrophilic granulocytes as well as BAL protein and albumin in B/PEEP1. Moreover, the increased septal wall thickness and volume of peri-bronchiolar-vascular connective tissue in B/PEEP1 suggested aggravation of interstitial edema by ventilation in presence of microatelectases. At the electron microscopic level, the largest surface area of injured alveolar epithelial was observed in bleomycin-challenged lungs after PEEP = 1 cmH₂O ventilation. After bleomycin treatment cellular markers of endoplasmic reticulum stress (p-Perk and p-EIF-2α) were positive within the septal wall and ventilation with PEEP = 1 cmH₂O ventilation increased the surface area stained positively for p-EIF-2α. In conclusion, hidden microatelectases are linked with an increased pulmonary vulnerability for mechanical ventilation characterized by an aggravation of epithelial injury.

pH-Responsive Wormlike Micelles Formed by an Anionic Surfactant Derived from Rosin

A novel pH-responsive wormlike micellar viscoelastic solution was constructed by a rosin-based anionic surfactant (Na-MPA-AZO-Na) in the presence of cetyltrimethylammonium bromide (CTAB). The viscoelasticity, aggregate morphology, and pH-responsiveness of the pH-responsive wormlike micelles have been investigated through the method of rheology and cryogenic-transmission electron microscopy. Its corresponding mechanism has been studied using ¹H NMR and ¹H-¹H 2D NOESY HNMR. The zero-shear viscosity (η₀) of the wormlike micellar solution rapidly decreases by 3 orders of magnitude as the pH increases from 5.21 to 9.56. The viscoelastic fluids and water-like solutions can be converted by tuning the pH between 3.62 and 12.00, and the corresponding aggregates also transform between wormlike micelles and spherical micelles. In addition, the wormlike micellar cross-sectional diameter is approximately 10 nm, which is remarkably larger than that of the common wormlike micelles. The phenomenon can be attributed to the large steric volume of the rosin rigid skeleton. When the pH is 12.00, a "pseudo" Gemini surfactant is constructed by Na-MPA-AZO-Na and CTAB through the electrostatic interactions. Wormlike micelles also can be formed with the increasing concentrations. The η₀ of the wormlike micellar system shows strong dependence on concentration with an exponent of 9.6 (η₀ ∝ C^9.6). This work further promotes new applications of forest resources.

A Novel Experimental Study on the Rheological Properties and Thermal Conductivity of Halloysite Nanofluids

Nanofluids obtained from halloysite and de-ionized water (DI) were prepared by using surfactants and changing pH for heat-transfer applications. The halloysite nanotubes (HNTs) nanofluids were studied for several volume fractions (0.5, 1.0, and 1.5 vol%) and temperatures (20, 30, 40, 50, and 60 °C). The properties of HNTs were studied with a scanning electron microscope (SEM), energy-dispersive X-ray analysis (EDX), Fourier-transform infrared (FT-IR) spectroscopy, X-ray powder diffraction (XRD), Raman spectroscopy and thermogravimetry/differential thermal analysis (TG/DTA). The stability of the nanofluids was proven by zeta potentials measurements and visual observation. With surfactants, the HNT nanofluids had the highest thermal conductivity increment of 18.30% for 1.5 vol% concentration in comparison with the base fluid. The thermal conductivity enhancement of nanofluids containing surfactant was slightly higher than nanofluids with pH = 12. The prepared nanofluids were Newtonian. The viscosity enhancements of the nanofluid were 11% and 12.8% at 30 °C for 0.5% volume concentration with surfactants and at pH = 12, respectively. Empirical correlations of viscosity and thermal conductivity for these nanofluids were proposed for practical applications.

The effect of maternal protein restriction during perinatal life on the inflammatory response in pediatric rats

Fetal growth restriction can affect health outcomes in postnatal life. This study tested the hypothesis that the response to an inflammatory pulmonary insult is altered in pediatric fetal growth restricted rats. Using a low-protein diet during gestation and postnatal life, growth-restricted male and female rats and healthy control rats were exposed to an inflammatory insult via the intratracheal instillation of heat-killed bacteria. After 6 h, animal lungs were examined for lung inflammation and status of the surfactant system. The results showed that in response to an inflammatory insult, neutrophil infiltration was decreased in both male and female rats in the growth-restricted animals compared with the control rats. The amount of surfactant was increased in the growth-restricted animals compared with the control rats, regardless of the inflammatory insult. It is concluded that fetal growth restriction results in increased surfactant and altered neutrophil responses following pulmonary insult.

Intratracheal budesonide/surfactant attenuates hyperoxia-induced lung injury in preterm rabbits

Recent clinical trials have shown improvements in neonatal outcomes after intratracheal administration of a combination of budesonide/surfactant (ITBS) in infants at risk of bronchopulmonary dysplasia. However, the effect of ITBS on lung function and alveolar structure is not known. We aimed to determine the effect of ITBS on lung function, parenchymal structure, and inflammatory cytokine expression in a relevant preterm animal model for bronchopulmonary dysplasia. Premature neonatal rabbits were administered a single dose of ITBS on the day of delivery and exposed to 95% oxygen. Following 7 days of hyperoxia, in vivo forced oscillation and pressure-volume maneuvers were performed to examine pulmonary function. Histological and molecular analysis was performed to assess alveolar and extracellular matrix (ECM) morphology, along with gene expression of connective tissue growth factor (CTGF), IL-8, and CCL-2. ITBS attenuated the functional effect of hyperoxia-induced lung injury and limited the change to respiratory system impedance, measured using the forced oscillation technique. Treatment effects were most obvious in the small airways, with significant effects on small airway resistance and small airway reactance. In addition, ITBS mitigated the decrease in inspiratory capacity and static compliance. ITBS restricted alveolar septal thickening without altering the mean linear intercept and mitigated hyperoxia-induced remodeling of the ECM. These structural changes were associated with improved inspiratory capacity and lung compliance. Gene expression of CTGF, IL-8, and CCL-2 was significantly downregulated in the lung. Treatment with ITBS shortly after delivery attenuated the functional and structural consequences of hyperoxia-induced lung injury to day 7 of life in the preterm rabbit.

Role of Formulation Parameters on Intravitreal Dosing Accuracy Using 1 mL Hypodermic Syringes

PURPOSE

Evaluation of product viscosity, density and aeration on the dose delivery and accuracy for intravitreal injections with commonly used commercially available hypodermic 1 mL syringes.

METHODS

Six commercially available hypodermic 1 mL syringes with different specifications were used for the study. Syringes were filled with the test solutions with different densities and viscosities. Syringes were also subjected to shaking stress to introduce aeration in the test solutions in the presence of different surfactant concentrations with and without high antibody concentration. Target intravitreal volumes of 100 μL, 50 μL and 30 μL were tested to assess dosing accuracy in a controlled simulated administration setup using DIN ISO 11040-4 guidelines and Zwick/Roell Z010 TN instrument.

RESULTS

With increasing product viscosity, higher volumes and hence doses were delivered especially for very low volumes like 50 μL and 30 μL. No impact of increasing product density was found on the delivered dose. The presence of surfactants or high protein concentration can lead to aeration, which also negatively affects the dose accuracy and precision.

CONCLUSION

Formulation parameters like viscosity can have an impact on dose delivery using hypodermic syringes for intravitreal injections and on the resulting glide force.

Lung function and exercise capacity in prematurely born young people

OBJECTIVES

To determine if lung function abnormalities in young people born very prematurely routinely exposed to antenatal corticosteroids and postnatal surfactant were associated with reduced exercise capacity.

WORKING HYPOTHESIS

In the current era, lung function abnormalities would not be associated with exercise intolerance STUDY DESIGN: Follow-up of young people from the United Kingdom Oscillation study (UKOS).

PATIENT-SUBJECT SELECTION

One hundred twenty-six young people of 797 recruited to UKOS, born at a mean gestational age of 27 weeks were assessed at a mean age of 17 years.

METHODOLOGY

Forced expiratory flow at 75% of the expired vital capacity (FEF₇₅ ), forced expiratory volume in 1 second (FEV₁ ) and lung volumes (forced vital capacity [FVC]) and residual volume (RV) and functional residual capacity (FRC_pleth ) were assessed. Abnormal lung function was below the fifth centile and very abnormal lung function below the 2.5th centile. Exercise capacity was assessed using a modified shuttle sprint test and self-reported hours of exercise.

RESULTS

Thirty-nine young people had an abnormal FEF₇₅ with an adjusted reduction in sprint distance of 114 m (P = .018) and an adjusted difference in self-reported exercise of 0.73 hours (P = .036). Twenty-seven young people had a very abnormal FEF₇₅ with an adjusted reduction in sprint distance of 159 m (P = .002) and adjusted reduction in self-reported exercise of 1.15 hours (P = .002).

CONCLUSION

Very prematurely born young people with abnormal airway function had a significant reduction in exercise capacity.

A Newly Observed Mutation of the ABCA3 Gene Causing Lethal Respiratory Failure of a Full-Term Newborn: A Case Report

Respiratory distress syndrome caused by a secondary surfactant deficiency is one of the most common diagnoses requiring admission to the Neonatal Intensive Care Unit. We illustrate the case of a term female newborn without prenatal and peripartal risks. There had been significant signs of respiratory distress 4 h after delivery. The condition gradually worsened to the point of needing oscillatory ventilation. The most common infectious and non-infectious causes were excluded. Considering the course of illness, a congenital surfactant deficiency was suspected. There nevertheless was no significant improvement after administration of surfactant. Following a short period of palliative care, the child died at 34 days of age due to respiratory failure. DNA diagnostics revealed compound heterozygosity of ABCA3 functional mutations leading to the p.Pro147Leu and p.Pro246Leu exchanges. The second identified mutation of ABCA3 c.737C>T had not to date been described in connection with primary surfactant deficiency.

Improving lung aeration in ventilated newborn preterm rabbits with a partially aerated lung

Preterm newborns commonly receive intermittent positive pressure ventilation (iPPV) at birth, but the optimal approach that facilitates uniform lung aeration is unknown, particularly in a partially aerated lung. As both inflation time and exogenous surfactant facilitate uniform lung aeration, we investigated whether they can improve lung aeration and lung mechanics in a partially aerated lung immediately after birth. Preterm rabbit kittens (29 days of gestation, term ~32 days) were delivered by caesarean section and partial lung aeration was created by intubating and mechanically ventilating the right lung. The tube was then withdrawn to ventilate both lungs using inflation times of 0.2 s or 1.0 s, with or without exogenous surfactant (200 mg/kg; Curosurf) and a tidal volume (Vt) of 8 mL/kg. Simultaneous phase contrast X-ray imaging and plethysmography were used to measure lung aeration and mechanics. Kittens ventilated with longer inflation times (1.0 s) reached their target Vt with fewer inflations, required lower inflation pressures (28.5 ± 1.1 vs. 33.5 ± 1.3 cmH₂O, P = 0.01) and had higher dynamic lung compliances (0.54 ± 0.3 vs. 0.40 ± 0.3 cmH₂O·mL^-1·kg^-1, P = 0.003). Surfactant increased functional residual capacity (FRC; 31.9 ± 3.2 vs. 18.0 ± 3.9 mL/kg, P = 0.02) and the proportion of the Vt entering the previously unaerated lung but had no effect on dynamic lung compliance. Combining early surfactant treatment with longer inflation times increases FRC levels, improves dynamic lung compliance, reduces inflation pressures and markedly increases the proportion of the lungs being ventilated during iPPV in preterm kittens with a partially aerated lung.NEW & NOTEWORTHY Preterm newborns commonly receive intermittent positive pressure ventilation (iPPV) at birth, but the optimal approach that facilitates uniform lung aeration is unknown, particularly in a partially aerated lung. Using phase contrast X-ray imaging, we showed that combining a long inflation time (1.0 s) with surfactant improved lung mechanics and aeration in the immediate newborn period. The current clinical practice of using short inflation times during iPPV might be suboptimal and a different approach is needed.

Enhancement of Diversity in Production and Application Utilizing Electrolytically Polymerized Rubber Sensors with MCF: 1st Report on Consummate Fabrication Combining Varied Kinds of Constituents with Porous Permeant Stocking-Like Rubber

To satisfy the requirement of haptic sensibility in rubber such as in the proposed hybrid skin (H-Skin), the authors have demonstrated a new method for solidifying rubber using electrolytic polymerization together with configured magnetic clusters of magnetic compound fluid (MCF) incorporated into the rubber by the application of a magnetic field. However, the rubber and magnetic fluid (MF) involved in the MCF rubber were water-soluble. In addition, the authors have demonstrated the practicability of using electrolytic polymerization with an emulsifier, polyvinyl alcohol (PVA), in which natural rubber (NR) or chloroprene rubber (CR) and silicone rubber (Q) can be mixed as water-soluble and water-insoluble rubbers, respectively. In this study, to enhance production, the feasibility of solidifying rubber by electrolytic polymerization is verified using varied water-insoluble rubber, varied water-insoluble MF, and varied surfactants to aid emulsion polymerization, except in the case of other kinds of rubber and MF which have been demonstrated until recent by the authors. Based on these diverse constituents, the authors propose a consummate fabrication process for multi-layered MCF rubber, which involves porous stocking-like rubber that can be permeated by any liquid. The investigation of this application is presented in the sequential second report.

Adverse neonatal outcomes associated with pregestational diabetes mellitus in infants born preterm

BACKGROUND

Pregestational diabetes mellitus is associated with a higher risk of adverse pregnancy outcomes. Based on the available data, it is unclear whether infants born preterm to mothers with pregestational diabetes mellitus are at a higher risk of adverse outcomes than other preterm infants.

OBJECTIVE

This study aimed to quantify the neonatal complications associated with pregestational diabetes mellitus in infants born preterm.

STUDY DESIGN

This was a retrospective cohort study of all nonanomalous singleton neonates born in Texas from 2006 to 2014. Analysis was limited to births between 24 and 36 weeks' gestation and excluded multiple births, stillbirths, fetal congenital anomalies, neonates born to mothers with gestational diabetes mellitus, and neonates born to mothers with chronic hypertension. Results were stratified by pregestational diabetes mellitus status. Neonatal outcomes of interest included infant death, neonatal intensive care unit admission, low 5-minute Apgar scores, assisted ventilation of >6 hours, surfactant administration, and seizures. Multivariate logistic regression analysis was performed to estimate the association between pregestational diabetes mellitus and neonatal outcomes controlling for potential confounding variables.

RESULTS

After predefined exclusions, 277,210 births were analyzed, 4164 of which were to mothers with pregestational diabetes mellitus. The comparison group consisted of mothers without pregestational diabetes mellitus. The preterm infant mortality rates between the pregestational diabetic and nondiabetic groups were similar. However, after adjusting for confounding variables, there was an increased risk of infant mortality for preterm neonates born to mothers with pregestational diabetes mellitus. In infants born preterm, pregestational diabetes mellitus was associated with an increased risk of infant death, low 5-minute Apgar score, prolonged assisted ventilation, surfactant requirement, and neonatal intensive care unit admission. Neonates born before 34 weeks' gestation had an increased risk of assisted ventilation of >6 hours, neonatal intensive care unit admission, and seizure. Neonates born to mothers with pregestational diabetes mellitus in the late preterm period between 34 and 36 weeks' gestation had an increased risk of low Apgar score at 5 minutes, assisted ventilation of >6 hours, surfactant use, and neonatal intensive care unit admission.

CONCLUSION

Pregestational diabetes mellitus is associated with a higher risk of adverse neonatal outcomes in infants born preterm.

Surfactant-Mediated Airway and Acinar Interactions in a Multi-Scale Model of a Healthy Lung

We present a computational multi-scale model of an adult human lung that combines dynamic surfactant physicochemical interactions and parenchymal tethering between ~16 generations of airways and subtended acini. This model simulates the healthy lung by modeling nonlinear stress distributions from airway/alveolar interdependency. In concert with multi-component surfactant transport processes, this serves to stabilize highly compliant interacting structures. This computational model, with ~10 k degrees of freedom, demonstrates physiological processes in the normal lung such as multi-layer surfactant transport and pressure-volume hysteresis behavior. Furthermore, this model predicts non-equilibrium stress distributions due to compliance mismatches between airway and alveolar structures. This computational model provides a baseline for the exploration of multi-scale interactions of pathological conditions that can further our understanding of disease processes and guide the development of protective ventilation strategies for the treatment of acute respiratory distress syndrome (ARDS).

Volume Transition and Phase Coexistence in Polyelectrolyte Gels Interacting with Amphiphiles and Proteins

Polyelectrolyte gels have the capacity to absorb large amounts of multivalent species of opposite charge from aqueous solutions of low ionic strength, and release them at elevated ionic strengths. The reversibility offers the possibility to switch between “storage” and “release” modes, useful in applications such as drug delivery. The review focuses on systems where so-called volume phase transitions (VPT) of the gel network take place upon the absorption and release of proteins and self-assembling amphiphiles. We discuss the background in terms of thermodynamic driving forces behind complex formation in oppositely charged mixtures, the role played by cross-links in covalent gels, and general aspects of phase coexistence in networks in relation to Gibbs’ phase rule. We also briefly discuss a gel model frequently used in papers covered by the review. After that, we review papers dealing with collapse and swelling transitions of gels in contact with solution reservoirs of macroions and surfactants. Here we describe recent progress in our understanding of the conditions required for VPT, competing mechanisms, and hysteresis effects. We then review papers addressing equilibrium aspects of core–shell phase coexistence in gels in equilibrium. Here we first discuss early observations of phase separated gels and results showing how the phases affect each other. Then follows a review of recent theoretical and experimental studies providing evidence of thermodynamically stable core–shell phase separated states, and detailed analyses of the conditions under which they exist. Finally, we describe the results from investigations of mechanisms and kinetics of the collapse/swelling transitions induced by the loading/release of proteins, surfactants, and amphiphilic drug molecules.

Study of the Air-Entraining Behavior Based on the Interactions between Cement Particles and Selected Cationic, Anionic and Nonionic Surfactants

The essential role of the air void size distribution in air-entrained cementitious materials is widely accepted. However, how the air-entraining behavior is affected by features such as the molecular structure of air-entraining agents (AEAs), the type of solid particles, or the chemical environment of the pore solution in fresh mortars is still not well understood. Besides, methods to assess the interaction between AEAs and cement particles are limited. Thus, in this study, the air-entraining behaviors of three kinds of surfactant (cationic, anionic, and nonionic) were examined. The general working mechanisms of these surfactants were studied by zeta potential and attenuated total reflectance-Fourier transform infrared (ATR-FTIR) spectroscopy. Results indicate that the cationic surfactant entrains improper coarse air voids due to the strong electrical interaction between air bubbles formed by the cationic surfactant and negatively charged cement particles. The anionic surfactant interacts with the positively charged part of cement particles, and thus entrains finer air voids. The interaction between the nonionic surfactant and cement particles is very weak; as a result, the nonionic surfactant entrains the finest and homogeneous air voids.

Synthesis of an N-Heterocyclic Carbene-based Au(I) Coordinate Surfactant: Application for Alkyne Hydration Based on Au Nanoparticle Formation

In this study, an N-heterocyclic carbene (NHC)-based metal coordinate surfactant (MCS), NHC-Au-MCS, in which the NHC framework afforded the bonding of the Au(I) at the linkage of the hydrophilic and hydrophobic moieties, was synthesized. The structure of NHC-Au-MCS was confirmed by ¹H and ¹³C NMR spectroscopic measurements together with elemental analysis. Matrix-assisted laser desorption/ionization (MALDI), laser desorption/ionization (LDI), and electrospray ionization mass spectrometry (ESI-MS) indicated the distinct reactivity of NHC-Au-MCS, such as the exchange of Br to Cl and the formation of a cationic Au complex, where the two NHC ligands were coordinated to an Au(I) center upon laser activation. The surface tension and dynamic light scattering (DLS) measurements revealed that the coordination of Au(I) to NHC reduced the critical micelle concentration (CMC) of NHC-Au-MCS (1.3×10^-5 M), which resulted in the formation of micelles at concentrations higher than the CMC in water. We also confirmed that the surface-active Au(I) complex of NHC-Au-MCS catalyzed the hydration of 1-dodecyne to 2-dodecanone in water in the absence of an organic solvent. On the basis of the detailed mechanistic investigations regarding the reactivity of NHC-Au-MCS, we revealed that NHC-Au-MCS partially translated into Au nanoparticles (AuNPs), which facilitated alkyne hydration. These mechanistic studies were supported by UV-vis measurements, transmission electron microscopy (TEM), and LDI-MS.

Nanoparticle Charge and Size Control Foliar Delivery Efficiency to Plant Cells and Organelles

Fundamental and quantitative understanding of the interactions between nanoparticles and plant leaves is crucial for advancing the field of nanoenabled agriculture. Herein, we systematically investigated and modeled how ζ potential (-52.3 mV to +36.6 mV) and hydrodynamic size (1.7-18 nm) of hydrophilic nanoparticles influence delivery efficiency and pathways to specific leaf cells and organelles. We studied interactions of nanoparticles of agricultural interest including carbon dots (CDs, 0.5 and 5 mg/mL), cerium oxide (CeO₂, 0.5 mg/mL), and silica (SiO₂, 0.5 mg/mL) nanoparticles with leaves of two major crop species having contrasting leaf anatomies: cotton (dicotyledon) and maize (monocotyledon). Biocompatible CDs allowed real-time tracking of nanoparticle translocation and distribution in planta by confocal fluorescence microscopy at high spatial (∼200 nm) and temporal (2-5 min) resolution. Nanoparticle formulations with surfactants (Silwet L-77) that reduced surface tension to 22 mN/m were found to be crucial for enabling rapid uptake (<10 min) of nanoparticles through the leaf stomata and cuticle pathways. Nanoparticle-leaf interaction (NLI) empirical models based on hydrodynamic size and ζ potential indicate that hydrophilic nanoparticles with <20 and 11 nm for cotton and maize, respectively, and positive charge (>15 mV), exhibit the highest foliar delivery efficiencies into guard cells (100%), extracellular space (90.3%), and chloroplasts (55.8%). Systematic assessments of nanoparticle-plant interactions would lead to the development of NLI models that predict the translocation and distribution of nanomaterials in plants based on their chemical and physical properties.

Generation of Complete Multi-Cell Type Lung Organoids From Human Embryonic and Patient-Specific Induced Pluripotent Stem Cells for Infectious Disease Modeling and Therapeutics Validation

The normal development of the pulmonary system is critical to transitioning from placental‐dependent fetal life to alveolar‐dependent newborn life. Human lung development and disease have been difficult to study due to the lack of an in vitro model system containing cells from the large airways and distal alveolus. This article describes a system that allows human embryonic stem cells (hESCs) and induced pluripotent stem cells (hiPSCs) to differentiate and form three‐dimensional (3D) structures that emulate the development, cytoarchitecture, and function of the lung (“organoids”), containing epithelial and mesenchymal cell populations, and including the production of surfactant and presence of ciliated cells. The organoids can also be invested with mesoderm derivatives, differentiated from the same human pluripotent stem cells, such as alveolar macrophages and vasculature. Such lung organoids may be used to study the impact of environmental modifiers and perturbagens (toxins, microbial or viral pathogens, alterations in microbiome) or the efficacy and safety of drugs, biologics, and gene transfer. © 2020 Wiley Periodicals LLC.

Basic Protocol: hESC/hiPSC dissection, definitive endoderm formation, and lung progenitor cell induction

Recent progress on surfactant protein A: cellular function in lung and kidney disease development

Pulmonary surfactant is a heterogeneous active surface complex made up of lipids and proteins. The major glycoprotein in surfactant is surfactant protein A (SP-A), which is released into the alveolar lumen from cytoplasmic lamellar bodies in type II alveolar epithelial cells. SP-A is involved in phospholipid absorption. SP-A together with other surfactant proteins and phospholipids prevent alveolar collapse during respiration by decreasing the surface tension of the air-liquid interface. Additionally, SP-A interacts with pathogens to prevent their propagation and regulate host immune responses. Studies in human and animal models have shown that deficiencies or mutations in surfactant components result in various lung or kidney pathologies, suggesting a role for SP-A in the development of lung and kidney diseases. In this mini-review, we discuss the current understanding of SP-A functions, recent findings of its dysfunction in specific lung and kidney pathologies, and how SP-A has been used as a biomarker to detect the outcome of lung diseases.

[Childhood Interstitial Lung Disease in Infancy. Classification, diagnosis and management]

Childhood interstitial lung diseases, which some authors refer to as diffuse diseases of the lung, constitute a group of entities that are characterized by remodeling of the interstitium and distal airspaces that cause disturbances of gas exchange in the lungs. While some entities have few symptoms and naturally evolve favorably, others are potentially lethal. Its etiology is very varied, including forms of genetic cause, infectious origin, associated with systemic diseases, drugs and some remain of unknown origin. At present, the development of genetic testing allows diagnosing a group of pathologies, avoiding sometimes a lung biopsy. Its treatment includes different immunosuppressive and immunomodulatory drugs, mainly corticosteroids and hydroxychloroquine, which aim to reduce inflammation, stabilize the disease and prevent the phenomena of remodeling and fibrosis. This consensus is focused on children under 2 years of age, because most of the new entities recently described are manifested at this age.

Endothelial Sash1 Is Required for Lung Maturation through Nitric Oxide Signaling

The sterile alpha motif (SAM) and SRC homology 3 (SH3) domain containing protein 1 (Sash1) acts as a scaffold in TLR4 signaling. We generated Sash1^-/- mice, which die in the perinatal period due to respiratory distress. Constitutive or endothelial-restricted Sash1 loss leads to a delay in maturation of alveolar epithelial cells causing reduced surfactant-associated protein synthesis. We show that Sash1 interacts with β-arrestin 1 downstream of the TLR4 pathway to activate Akt and endothelial nitric oxide synthase (eNOS) in microvascular endothelial cells. Generation of nitric oxide downstream of Sash1 in endothelial cells affects alveolar epithelial cells in a cGMP-dependent manner, inducing maturation of alveolar type 1 and 2 cells. Thus, we identify a critical cell nonautonomous function for Sash1 in embryonic development in which endothelial Sash1 regulates alveolar epithelial cell maturation and promotes pulmonary surfactant production through nitric oxide signaling. Lung immaturity is a major cause of respiratory distress and mortality in preterm infants, and these findings identify the endothelium as a potential target for therapy.

Functional characterization of four ATP-binding cassette transporter A3 gene (ABCA3) variants

ABCA3 transports phospholipids across lamellar body membranes in pulmonary alveolar type II cells and is required for surfactant assembly. Rare, biallelic, pathogenic ABCA3 variants result in lethal neonatal respiratory distress syndrome and childhood interstitial lung disease. Qualitative functional characterization of ABCA3 missense variants suggests two pathogenic classes: disrupted intracellular trafficking (type I mutant) or impaired ATPase-mediated phospholipid transport into the lamellar bodies (type II mutant). We qualitatively compared wild-type (WT-ABCA3) with four uncharacterized ABCA3 variants (c.418A>C;p.Asn140His, c.3609_3611delCTT;p.Phe1203del, c.3784A>G;p.Ser1262Gly, and c.4195G>A;p.Val1399Met) in A549 cells using protein processing, colocalization with intracellular organelles, lamellar body ultrastructure, and ATPase activity. We quantitatively measured lamellar body-like vesicle diameter and intracellular ABCA3 trafficking using fluorescence-based colocalization. Three ABCA3 variants (p.Asn140His, p.Ser1262Gly, and p.Val1399Met) were processed and trafficked normally and demonstrated well-organized lamellar body-like vesicles, but had reduced ATPase activity consistent with type II mutants. P.Phe1203del was processed normally, had reduced ATPase activity, and well-organized lamellar body-like vesicles, but quantitatively colocalized with both endoplasmic reticulum and lysosomal markers, an intermediate phenotype suggesting disruption of both intracellular trafficking and phospholipid transport. All ABCA3 mutants demonstrated mean vesicle diameters smaller than WT-ABCA3. Qualitative and quantitative functional characterization of ABCA3 variants informs mechanisms of pathogenicity.

Dose-Response Study on Surfactant Nebulization Therapy During Nasal Continuous Positive Airway Pressure Ventilation in Spontaneously Breathing Surfactant-Deficient Newborn Piglets

OBJECTIVES

The current clinical treatment of neonates with respiratory distress syndrome includes endotracheal intubation and intratracheal instillation of exogenous surfactant. Nebulization of surfactant offers an attractive alternative. The aims of this study were to test nebulization as a noninvasive method of administering surfactant and determine the optimal dose for the treatment of respiratory distress syndrome-associated pathophysiology of the neonatal lungs.

DESIGN

Prospective, randomized, animal model study.

SETTING

An experimental laboratory.

SUBJECTS

Thirty-six newborn piglets.

INTERVENTIONS

Different doses (100, 200, 400, and 600 mg/kg) of poractant alfa were administered via a vibrating membrane nebulizer (eFlow-Neos; Pari Pharma GmbH, Starnberg, Germany) or a bolus administration using the intubation-surfactant-extubation (Insure) technique (200 mg/kg) to spontaneously breathing newborn piglets (n = 6/group) with bronchoalveolar lavage-induced respiratory distress syndrome during nasal continuous positive airway pressure (180 min).

MEASUREMENTS AND MAIN RESULTS

Pulmonary, hemodynamic, and cerebral effects were assessed. Histologic analysis of lung and brain tissue was also performed. After repeated bronchoalveolar lavage, newborn piglets developed severe respiratory distress syndrome. Rapid improvement in pulmonary status was observed in the Insure group, whereas a dose-response effect was observed in nebulized surfactant groups. Nebulized poractant alfa was more effective at doses higher than 100 mg/kg and was associated with similar pulmonary, hemodynamic, and cerebral behavior to that in the Insure group, but improved lung injury scores.

CONCLUSIONS

In newborn piglets with severe bronchoalveolar lavage-induced respiratory distress syndrome, our results demonstrate that the administration of nebulized poractant alfa using an investigational customized eFlow-Neos nebulizer is an effective and safe noninvasive surfactant administration technique.

Surfactant Interactions with Protein-Coated Surfaces: Comparison between Colloidal and Macroscopically Flat Surfaces

Surface interactions with polymers or proteins are extensively studied in a range of industrial and biomedical applications to control surface modification, cleaning, or biofilm formation. In this study we compare surfactant interactions with protein-coated silica surfaces differing in the degree of curvature (macroscopically flat and colloidal nanometric spheres). The interaction with a flat surface was probed by means of surface plasmon resonance (SPR) while dynamic light scattering (DLS) was used to study the interaction with colloidal SiO₂ (radius 15 nm). First, the adsorption of bovine serum albumin (BSA) with both SiO₂ surfaces to create a monolayer of coating protein was studied. Subsequently, the interaction of these BSA-coated surfaces with a non-ionic surfactant (a decanol ethoxylated with an average number of eight ethoxy groups) was investigated. A fair comparison between the results obtained by these two techniques on different geometries required the correction of SPR data for bound water and DLS results for particle curvature. Thus, the treated data have excellent quantitative agreement independently of the geometry of the surface suggesting the formation of multilayers of C₁₀PEG over the protein coating. The results also show a marked different affinity of the surfactant towards BSA when the protein is deposited on a flat surface or individually dissolved in solution.

In vivo Raman spectroscopy study on the stimulation mechanism of surfactant

BACKGROUND

Surfactant is widely used in skin care products and cleansers, while it may cause physical discomfort. In this study, in vivo Raman spectroscopy was used to explore surfactant irritation mechanism on skin, which was not found in literature.

METHODS

Sodium dodecyl sulfate (SDS) was chosen to represent surfactant. Research on the negative effect of SDS was undertaken by scanning the two states of the skin (without and with the contact of SDS), respectively, on six volunteers, by means of Raman technique and skin magnifier.

RESULTS

The damage to the surface of normal skin by SDS was visible from the photographs taken by skin magnifier, and the apparent damage matched the damage that was happening underneath the skin elucidated by Raman spectra. Compared to the normal skin, the inter-cellular lipids (ICL) lateral packing order of the damaged skin was significantly reduced in 2-12 μm of skin depth (P < 0.05), deeper than 12 μm was not detected. The skin depth of 0-2 μm could not be determined due to strong interference of SDS. Significant change in the secondary and tertiary structures of keratin was not found.