Lung volumes and alveolar expansion pattern in immature rabbits treated with serum-diluted surfactant

Fluorocarbon-hybrid pulmonary surfactants for replacement therapy--a Langmuir monolayer study

Effective additives to pulmonary surfactant (PS) preparations for therapy of respiratory distress syndrome (RDS) are being intensively sought. We report here the investigation of the effects of partially fluorinated amphiphiles (PFA) on the surface behavior of a model PS formulation. When small amounts of a partially fluorinated alcohol C(8)F(17)C(m)H(2m)OH (F8HmOH, m = 5 and 11) are added to the PS model preparation (a dipalmitoylphosphatidylcholine (DPPC)/Hel 13-5 peptide mixture) considered here, the effectiveness of the latter in in vitro pulmonary functions is enhanced. The mechanism for the improved efficacy depends on the hydrophobic chain length of the added PFA molecules. The shorter PFA, F8H5OH, when incorporated in the monolayer of the PS model preparation, promotes a disordered liquid-expanded (LE) phase upon lateral compression (fluidization). In contrast, the addition of the longer PFA, F8H11OH, reduces the disordered LE/ordered liquid-condensed (LC) phase transition pressure and promotes the growth of ordered domains (solidification). Furthermore, compression-expansion cycles suggest that F8H5OH, when incorporated in the PS model preparation, undergoes an irreversible elimination into the subphase, whereas F8H11OH enhances the squeeze-out phenomenon of the SP-B mimicking peptide, which is important in pulmonary functions and is related to the formation of a solid-like monolayer at the surface and of a surface reservoir just below the surface. F8H11OH particularly reinforces the effectiveness of DPPC in terms of minimum reachable surface tension, and of preservation of the integrated hysteresis area between compression and expansion isotherms, the two latter parameters being generally accepted indices for assessing PS efficacy. We suggest that PFA amphiphiles may be useful potential additives for synthetic PS preparations destined for treatment of RDS in premature infants and in adults.

Effects of surfactant replacement on alveolar overdistension and plasma cytokines in ventilator-induced lung injury

BACKGROUND

Overdistension of the lung causes ventilator-induced lung injury (VILI) accompanied by surfactant abnormalities and inflammatory changes. We investigated the effects of surfactant replacement on overdistension of the terminal airspaces and plasma cytokine levels in VILI.

METHODS

VILI was induced by high-pressure ventilation (HPV) in rats anesthetized with pentobarbital, followed by ventilation for 2 h in the maintenance mode (tidal volume=10 ml/kg, positive end-expiratory pressure = 7.5 cmH(2)O) with or without surfactant replacement. The sizes of the terminal airspaces were determined after fixing the lungs at an airway pressure of 10 cmH(2)O on deflation. Cytokine levels were assessed by enzyme-linked immunosorbent assay.

RESULTS

The mean ratio of the largest terminal airspace size class (> or = 64,000 microm(2)) was increased from 13.4% to 32.0% by HPV (P<0.05). After maintenance-mode ventilation, the ratio decreased to 16.1% with surfactant replacement (P<0.05), but increased to 44.6% without surfactant replacement (P<0.05). Mean macrophage inflammatory protein-2 (MIP-2) levels in the plasma increased from <0.02 to 6.9 ng/ml with HPV (P<0.05), and further increased to > or = 11.8 ng/ml, regardless of surfactant replacement after maintenance-mode ventilation. Similar tendencies were observed in the interleukin (IL)-6 and IL-10 levels. Tumor necrosis factor-alpha levels were almost negligible during the experiment.

CONCLUSION

In rats with VILI, surfactant replacement reversed overdistension of the terminal airspaces that may induce barotrauma, but not upregulation of MIP-2, IL-6, and IL-10 within 2 h.

The effect of fetal tracheal occlusion on lung tissue mechanics and tissue composition

Fetal tracheal occlusion (TO) is currently used to treat severe cases of congenital diaphragmatic hernia (DH). Clinical and experimental studies suggest an improved postnatal outcome, but lung tissue mechanics after TO have not been studied. We determined the effect of TO on mechanical impedance and lung tissue components in a rabbit model for DH. At 23 days of gestation (term = 31 days) either a sham thoracotomy or a diaphragmatic defect was induced. DH fetuses were randomly assigned to undergo 5 days later TO. Fetuses were delivered by term cesarean section to determine lung to body weight ratio (LBWR), dynamic lung mechanics and lung impedance. Airway resistance (R(aw)), elastance (H(L)), tissue damping (G(L)) and hysteresivity (G(L)/H(L)) were calculated from impedance data. Collagen I and III and elastin were quantified histologically. LBWR was significantly increased by TO compared to DH (P < 0.001) and resistance and compliance of the respiratory system (R(rs), C(rs)) were improved as well. TO resulted in a significant decrease of R(aw) comparable to observations in sham-fetuses, without effect on lung tissue mechanics H(L), G(L) and hysteresivity. This coincides with a significant decrease of collagen I, III and elastin in comparison to DH fetuses. In this first report on lung tissue mechanics in a rabbit model of DH, TO had a substantial effect on tissue morphology yet this was not mirrored in lung mechanics. We conclude that the effect of TO on lung mechanics without in utero reversal of occlusion, is dominated by airway remodeling.

Effects of surfactant replacement on irregular overdistension of meconium-injured lungs in rats

BACKGROUND

Overdistension of the lungs is a cause of ventilator-induced lung injury. In meconium aspiration syndrome, irregular overdistension of the lungs often occurs.

OBJECTIVES

We investigated whether surfactant replacement could restore the terminal airspaces in the lungs that had been distended after meconium aspiration.

METHODS

Meconium aspiration was induced by injecting meconium (50 mg x kg(-1)) into the airways of adult rats anesthetized with pentobarbital and ventilated with pressure-preset mode. The animals were further ventilated with or without surfactant replacement (100 mg x kg(-1)), and the sizes of the terminal airspaces were determined after fixing the lungs at an airway pressure of 10 cm H2O on deflation.

RESULTS

Approximately 75 min after aspiration (early analysis point), alveolar ducts were widened and the mean ratio of the largest terminal airspace size class (> or =63,000 microm(2)) was 38.7% (n = 7), which was significantly higher than that of controls (6%, n = 7). Three hours after the early analysis point, the ratio increased to 50.2% (n = 7, p < 0.05), but surfactant replacement reversed the ratio to 18.8% (n = 7, p < 0.05).

CONCLUSIONS

In rats with meconium aspiration, surfactant replacement restored the distended terminal airspaces of the lungs and kept the spaces from irregular overdistension.