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Simonato M, Padalino M, Vedovelli L, Carollo C, Sartori A, Vida V, Gregori D, Carnielli V, Cogo P. Effect of preoperative pulmonary hemodynamic and cardiopulmonary bypass on lung function in children with congenital heart disease. Eur J Pediatr 2023:10.1007/s00431-023-04926-0. [PMID: 36933017 PMCID: PMC10257631 DOI: 10.1007/s00431-023-04926-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/24/2023] [Accepted: 03/06/2023] [Indexed: 03/19/2023]
Abstract
In children with congenital heart disease (CHD), pulmonary blood flow (Qp) contributes to alterations of pulmonary mechanics and gas exchange, while cardiopulmonary bypass (CPB) induces lung edema. We aimed to determine the effect of hemodynamics on lung function and lung epithelial lining fluid (ELF) biomarkers in biventricular CHD children undergoing CPB. CHD children were classified as high Qp (n = 43) and low Qp (n = 17), according to preoperative cardiac morphology and arterial oxygen saturation. We measured ELF surfactant protein B (SP-B) and myeloperoxidase activity (MPO) as indexes of lung inflammation and ELF albumin as index of alveolar capillary leak in tracheal aspirate (TA) samples collected before surgery and in 6 hourly intervals within 24 h after surgery. At the same time points, we recorded dynamic compliance and oxygenation index (OI). The same biomarkers were measured in TA samples collected from 16 infants with no cardiorespiratory diseases at the time of endotracheal intubation for elective surgery. Preoperative ELF biomarkers in CHD children were significantly increased than those found in controls. In the high Qp, ELF MPO and SP-B peaked 6 h after surgery and tended to decrease afterward, while they tended to increase within the first 24 h in the low Qp. ELF albumin peaked 6 h after surgery and decreased afterwards in both CHD groups. Dynamic compliance/kg and OI significantly improved after surgery only in the High Qp. Conclusion: In CHD children, lung mechanics, OI, and ELF biomarkers were significantly affected by CPB, according to the preoperative pulmonary hemodynamics. What is Known: • Congenital heart disease children, before cardiopulmonary run, exhibit changes in respiratory mechanics, gas exchange, and lung inflammatory biomarkers that are related to the preoperative pulmonary hemodynamics. • Cardiopulmonary bypass induces alteration of lung function and epithelial lining fluid biomarkers according to preoperative hemodynamics. What is New: • Our findings can help to identify children with congenital heart disease at high risk of postoperative lung injury who may benefit of tailored intensive care strategies, such as non-invasive ventilation techniques, fluid management, and anti-inflammatory drugs that can improve cardiopulmonary interaction in the perioperative period.
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Affiliation(s)
- Manuela Simonato
- Department of Women's and Children's Health, University of Padova, Corso Stati Uniti 4, 35127, Padua, Italy.,PCare Laboratory, Fondazione Istituto Di Ricerca Pediatrica, "Città Della Speranza", Padua, Italy
| | - Massimo Padalino
- Pediatric and Congenital Cardiac Surgical Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Luca Vedovelli
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Cristiana Carollo
- Anesthesiology and Intensive Care Unit, Department of Medicine-DIMED, University of Padova, Padua, Italy
| | - Anna Sartori
- Department of Women's and Children's Health, University of Padova, Corso Stati Uniti 4, 35127, Padua, Italy.
| | - Vladimiro Vida
- Pediatric and Congenital Cardiac Surgical Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Dario Gregori
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Virgilio Carnielli
- Division of Neonatology, Polytechnic University of Marche and "G. Salesi" Children's Hospital, Ancona, Italy
| | - Paola Cogo
- Department of Medicine, University Hospital S. Maria Della Misericordia, University of Udine, Udine, Italy
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Verlato G, Simonato M, Giambelluca S, Fantinato M, Correani A, Cavicchiolo ME, Priante E, Carnielli V, Cogo P. Surfactant Components and Tracheal Aspirate Inflammatory Markers in Preterm Infants with Respiratory Distress Syndrome. J Pediatr 2018; 203:442-446. [PMID: 30270169 DOI: 10.1016/j.jpeds.2018.08.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 07/11/2018] [Accepted: 08/09/2018] [Indexed: 12/16/2022]
Abstract
In 93 preterm infants ≤32 weeks of gestational age and 12 control infants, epithelial lining fluid disaturated-phosphatidylcholine, surfactant protein A and B, albumin, and myeloperoxidase activity were assessed after intubation and before exogenous surfactant administration. We found that disaturated-phosphatidylcholine, surfactant protein B, and myeloperoxidase were significantly higher in preterms with chorioamnionitis.
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Affiliation(s)
- Giovanna Verlato
- Neonatal Intensive Care Unit, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
| | - Manuela Simonato
- Pediatric Research Foundation Institute "Città della Speranza", Padova, Italy; Division of Pediatrics, Department of Medicine, University of Udine, Udine, Italy
| | - Sonia Giambelluca
- Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Margherita Fantinato
- Neonatal Intensive Care Unit, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
| | - Alessio Correani
- Department of Clinical Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Maria Elena Cavicchiolo
- Neonatal Intensive Care Unit, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
| | - Elena Priante
- Neonatal Intensive Care Unit, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
| | - Virgilio Carnielli
- Department of Clinical Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Paola Cogo
- Division of Pediatrics, Department of Medicine, University of Udine, Udine, Italy
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Schenck DM, Fiegel J. Tensiometric and Phase Domain Behavior of Lung Surfactant on Mucus-like Viscoelastic Hydrogels. ACS APPLIED MATERIALS & INTERFACES 2016; 8:5917-5928. [PMID: 26894883 PMCID: PMC5226205 DOI: 10.1021/acsami.6b00294] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Lung surfactant has been observed at all surfaces of the airway lining fluids and is an important contributor to normal lung function. In the conducting airways, the surfactant film lies atop a viscoelastic mucus gel. In this work, we report on the characterization of the tensiometric and phase domain behavior of lung surfactant at the air-liquid interface of mucus-like viscoelastic gels. Poly(acrylic acid) hydrogels were formulated to serve as a model mucus with bulk rheological properties that matched those of tracheobronchial mucus secretions. Infasurf (Calfactant), a commercially available pulmonary surfactant derived from calf lung extract, was spread onto the hydrogel surface. The surface tension lowering ability and relaxation of Infasurf films on the hydrogels was quantified and compared to Infasurf behavior on an aqueous subphase. Infasurf phase domains during surface compression were characterized by fluorescence microscopy and phase shifting interferometry. We observed that increasing the bulk viscoelastic properties of the model mucus hydrogels reduced the ability of Infasurf films to lower surface tension and inhibited film relaxation. A shift in the formation of Infasurf condensed phase domains from smaller, more spherical domains to large, agglomerated, multilayer structures was observed with increasing viscoelastic properties of the subphase. These studies demonstrate that the surface behavior of lung surfactant on viscoelastic surfaces, such as those found in the conducting airways, differs significantly from aqueous, surfactant-laden systems.
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Affiliation(s)
- Daniel M. Schenck
- Department of Pharmaceutical Sciences and Experimental Therapeutics, The University of Iowa, Iowa City, IA, 52242, USA
| | - Jennifer Fiegel
- Department of Pharmaceutical Sciences and Experimental Therapeutics, The University of Iowa, Iowa City, IA, 52242, USA
- Department of Chemical and Biochemical Engineering, The University of Iowa, Iowa City, IA, 52242, USA
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Griese M, Lorenz E, Hengst M, Schams A, Wesselak T, Rauch D, Wittmann T, Kirchberger V, Escribano A, Schaible T, Baden W, Schulze J, Krude H, Aslanidis C, Schwerk N, Kappler M, Hartl D, Lohse P, Zarbock R. Surfactant proteins in pediatric interstitial lung disease. Pediatr Res 2016; 79:34-41. [PMID: 26375475 DOI: 10.1038/pr.2015.173] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 06/22/2015] [Indexed: 11/09/2022]
Abstract
BACKGROUND Children's interstitial lung diseases (chILD) comprise a broad spectrum of diseases. Besides the genetically defined surfactant dysfunction disorders, most entities pathologically involve the alveolar surfactant region, possibly affecting the surfactant proteins SP-B and SP-C. Therefore, our objective was to determine the value of quantitation of SP-B and SP-C levels in bronchoalveolar lavage fluid (BALF) for the diagnosis of chILD. METHODS Levels of SP-B and SP-C in BALF from 302 children with chILD and in controls were quantified using western blotting. In a subset, single-nucleotide polymorphisms (SNPs) in the SFTPC promoter were genotyped by direct sequencing. RESULTS While a lack of dimeric SP-B was found only in the sole subject with hereditary SP-B deficiency, low or absent SP-C was observed not only in surfactant dysfunction disorders but also in patients with other diffuse parenchymal lung diseases pathogenetically related to the alveolar surfactant region. Genetic analysis of the SFTPC promoter showed association of a single SNP with SP-C level. CONCLUSION SP-B levels may be used for screening for SP-B deficiency, while low SP-C levels may point out diseases caused by mutations in TTF1, SFTPC, ABCA3, and likely in other genes involved in surfactant metabolism that remain to be identified. We conclude that measurement of levels of SP-B and SP-C was useful for the differential diagnosis of chILD, and for the precise molecular diagnosis, sequencing of the genes is necessary.
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Affiliation(s)
- Matthias Griese
- Dr von Hauner Children´s Hospital, German Center for Lung Research (DZL), University of Munich, Munich, Germany
| | - Elke Lorenz
- Dr von Hauner Children´s Hospital, German Center for Lung Research (DZL), University of Munich, Munich, Germany
| | - Meike Hengst
- Dr von Hauner Children´s Hospital, German Center for Lung Research (DZL), University of Munich, Munich, Germany
| | - Andrea Schams
- Dr von Hauner Children´s Hospital, German Center for Lung Research (DZL), University of Munich, Munich, Germany
| | - Traudl Wesselak
- Dr von Hauner Children´s Hospital, German Center for Lung Research (DZL), University of Munich, Munich, Germany
| | - Daniela Rauch
- Dr von Hauner Children´s Hospital, German Center for Lung Research (DZL), University of Munich, Munich, Germany
| | - Thomas Wittmann
- Dr von Hauner Children´s Hospital, German Center for Lung Research (DZL), University of Munich, Munich, Germany
| | | | - Amparo Escribano
- Hospital Clinico Universitario, Unidad Neumologia Infantil, Valencia, Spain
| | - Thomas Schaible
- Neonatology, University Children's Hospital, Mannheim, Germany
| | - Winfried Baden
- Pediatric Cardiology, University Children's Hospital, Tuebingen, Germany
| | - Johannes Schulze
- Children´s Hospital, Johann Wolfgang Goethe-University, Frankfurt, Germany
| | - Heiko Krude
- Pediatric Endocrinology, Charite, Berlin, Germany
| | - Charalampos Aslanidis
- Institute for Clinical Chemistry and Laboratory Medicine, University of Regensburg, Regensburg, Germany
| | - Nicolaus Schwerk
- Pediatric Pulmonology, Hannover Medical School, Hannover, Germany
| | - Matthias Kappler
- Dr von Hauner Children´s Hospital, German Center for Lung Research (DZL), University of Munich, Munich, Germany
| | - Dominik Hartl
- Children's Hospital and Interdisciplinary Center for Infectious Diseases, University of Tuebingen, Tuebingen, Germany
| | - Peter Lohse
- Praxis für Humangenetik, CeGaT GmbH, Tübingen, Germany
| | - Ralf Zarbock
- Dr von Hauner Children´s Hospital, German Center for Lung Research (DZL), University of Munich, Munich, Germany
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Simonato M, Baritussio A, Pioselli B, Ori C, Catinella S, Carnielli VP, Cogo PE. Surfactant protein C metabolism in human infants and adult patients by stable isotope tracer and mass spectrometry. Anal Bioanal Chem 2014; 406:6225-33. [PMID: 25182966 DOI: 10.1007/s00216-014-8014-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 06/29/2014] [Accepted: 06/30/2014] [Indexed: 12/25/2022]
Abstract
Surfactant protein C (SP-C) is deemed as the surfactant protein most specifically expressed in type II alveolar epithelial cells and plays an important role in surfactant function. SP-C turnover in humans and its meaning in the clinical context have never been approached. In this study, we used mass spectrometry to investigate SP-C turnover in humans. We studied four infants and eight adults requiring mechanical ventilation. All patients had no lung disease. Patients received a 24-h continuous infusion of (13)C-leucine as precursor of SP-C, and serial tracheal aspirates and plasma samples were obtained every 6 h till 48 h. SP-C was isolated from tracheal aspirates by sorbent-phase chromatography. (13)C-leucine SP-C enrichment could be successfully measured in three infant and in four adult samples by using mass spectrometry coupled with a gas chromatographer. Median SP-C fractional synthesis rate, secretion time, and peak time were 15.7 (14.1-27.5)%/day, 6.0 (4.7-11.5) h, and 24 (20-27) h. In conclusion, this study shows that it is feasible to accurately determine SP-C turnover in humans by stable isotopes.
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Affiliation(s)
- Manuela Simonato
- Women's and Children's Health Department, University of Padova, 35128, Padova, Italy,
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Hu G, Jiao B, Shi X, Valle RP, Fan Q, Zuo YY. Physicochemical properties of nanoparticles regulate translocation across pulmonary surfactant monolayer and formation of lipoprotein corona. ACS NANO 2013; 7:10525-33. [PMID: 24266809 PMCID: PMC5362675 DOI: 10.1021/nn4054683] [Citation(s) in RCA: 151] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Interaction with the pulmonary surfactant film, being the first line of host defense, represents the initial bio-nano interaction in the lungs. Such interaction determines the fate of the inhaled nanoparticles and their potential therapeutic or toxicological effect. Despite considerable progress in optimizing physicochemical properties of nanoparticles for improved delivery and targeting, the mechanisms by which inhaled nanoparticles interact with the pulmonary surfactant film are still largely unknown. Here, using combined in vitro and in silico methods, we show how hydrophobicity and surface charge of nanoparticles differentially regulate the translocation and interaction with the pulmonary surfactant film. While hydrophilic nanoparticles generally translocate quickly across the pulmonary surfactant film, a significant portion of hydrophobic nanoparticles are trapped by the surfactant film and encapsulated in lipid protrusions upon film compression. Our results support a novel model of pulmonary surfactant lipoprotein corona associated with inhaled nanoparticles of different physicochemical properties. Our data suggest that the study of pulmonary nanotoxicology and nanoparticle-based pulmonary drug delivery should consider this lipoprotein corona.
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Affiliation(s)
- Guoqing Hu
- The State Key Laboratory of Nonlinear Mechanics (LNM), Institute of Mechanics, Chinese Academy of Sciences, Beijing, 100190, China
- Address correspondence to ;
| | - Bao Jiao
- The State Key Laboratory of Nonlinear Mechanics (LNM), Institute of Mechanics, Chinese Academy of Sciences, Beijing, 100190, China
| | - Xinghua Shi
- The State Key Laboratory of Nonlinear Mechanics (LNM), Institute of Mechanics, Chinese Academy of Sciences, Beijing, 100190, China
| | - Russell P. Valle
- Department of Mechanical Engineering, University of Hawaii at Manoa, Honolulu, Hawaii 96822, United States
| | - Qihui Fan
- Department of Mechanical Engineering, University of Hawaii at Manoa, Honolulu, Hawaii 96822, United States
| | - Yi Y. Zuo
- Department of Mechanical Engineering, University of Hawaii at Manoa, Honolulu, Hawaii 96822, United States
- Address correspondence to ;
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