1
|
Silva LC, Angrimani DS, Regazzi FM, Lúcio CF, Veiga GA, Fernandes CB, Vannucchi CI. Exogenous surfactant replacement immediately at birth as preventive therapy for lung prematurity in neonatal lambs. Theriogenology 2021; 171:14-20. [PMID: 34000686 DOI: 10.1016/j.theriogenology.2021.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 05/04/2021] [Accepted: 05/05/2021] [Indexed: 11/26/2022]
Abstract
Surfactant treatment is a manner to reduce alveolar superficial tension and increase pulmonary compliance in premature neonates. Thus, we aimed to analyze the effect of exogenous surfactant treatment in combination with manual ventilation for preterm lambs. We used 15 ewes and their lambs (n = 16), prematurely born at 135 days. At birth, lambs were submitted to orotracheal intubation attached to a handheld resuscitation device and randomly allocated to: Control Group (n = 5; only manual ventilation), Single Surfactant Group (n = 5; manual ventilation coupled by intratracheal administration of 100 mg/kg surfactant) and Double Surfactant Group (n = 6; surfactant volume was divided into two doses (50 mg/kg + 50 mg/kg) administrated at birth and 30 min thereafter). A complete physical exam, arterial gas analysis, blood glucose, urea and creatinine concentration and chest radiographic assessment were performed at fixed times. All lambs had decreased body temperature until 20 min after birth. However, control and double surfactant groups reached a thermic plateau after 30 min. Regardless of the time-point, control lambs had higher heart rate in comparison to treated neonates, including bradycardia in Single Surfactant Group. Single instillation led to lower oxygenation degree, compared to the Double Surfactant Group, suggesting that surfactant treatment was not able to adequately spread within the alveoli. Lambs treated with surfactant had severe impairment of aerobic activity, leading to anaerobic metabolism. All groups had hypercapnia, which can be explained by inadequate respiratory pattern and pulmonary opacity (89% of the lambs had severe or moderate lung content). In conclusion, exogenous surfactant therapy in association with manual ventilation is ineffective in reverting pulmonary immaturity of the preterm lamb, leading to less vitality, hypoxemia, delayed pulmonary clearance and high mortality rate.
Collapse
Affiliation(s)
- Liege Cg Silva
- Department of Animal Reproduction, School of Veterinary Medicine and Animal Science, University of São Paulo, Rua Prof. Dr. Orlando Marques de Paiva, 87, São Paulo, SP, 05508-270, Brazil
| | - Daniel Sr Angrimani
- Department of Animal Reproduction, School of Veterinary Medicine and Animal Science, University of São Paulo, Rua Prof. Dr. Orlando Marques de Paiva, 87, São Paulo, SP, 05508-270, Brazil
| | - Fernanda M Regazzi
- Department of Animal Reproduction, School of Veterinary Medicine and Animal Science, University of São Paulo, Rua Prof. Dr. Orlando Marques de Paiva, 87, São Paulo, SP, 05508-270, Brazil
| | - Cristina F Lúcio
- Department of Animal Reproduction, School of Veterinary Medicine and Animal Science, University of São Paulo, Rua Prof. Dr. Orlando Marques de Paiva, 87, São Paulo, SP, 05508-270, Brazil
| | - Gisele Al Veiga
- Department of Animal Reproduction, School of Veterinary Medicine and Animal Science, University of São Paulo, Rua Prof. Dr. Orlando Marques de Paiva, 87, São Paulo, SP, 05508-270, Brazil
| | - Claudia B Fernandes
- Department of Animal Reproduction, School of Veterinary Medicine and Animal Science, University of São Paulo, Rua Prof. Dr. Orlando Marques de Paiva, 87, São Paulo, SP, 05508-270, Brazil
| | - Camila I Vannucchi
- Department of Animal Reproduction, School of Veterinary Medicine and Animal Science, University of São Paulo, Rua Prof. Dr. Orlando Marques de Paiva, 87, São Paulo, SP, 05508-270, Brazil.
| |
Collapse
|
2
|
Silva LCG, Angrimani DSR, Regazzi FM, Lúcio CF, Veiga GAL, Fernandes CB, Vannucchi CI. Pulmonary changes and redox status after fractionalized dose of prophylactic surfactant treatment in preterm neonatal lambs. JOURNAL OF APPLIED ANIMAL RESEARCH 2020. [DOI: 10.1080/09712119.2020.1771344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Liege Cristina Garcia Silva
- Department of Animal Reproduction, School of Veterinary Medicine and Animal Science, University of São Paulo, São Paulo, Brazil
| | - Daniel Souza Ramos Angrimani
- Department of Animal Reproduction, School of Veterinary Medicine and Animal Science, University of São Paulo, São Paulo, Brazil
| | - Fernanda Machado Regazzi
- Department of Animal Reproduction, School of Veterinary Medicine and Animal Science, University of São Paulo, São Paulo, Brazil
| | - Cristina Fátima Lúcio
- Department of Animal Reproduction, School of Veterinary Medicine and Animal Science, University of São Paulo, São Paulo, Brazil
| | - Gisele Almeida Lima Veiga
- Department of Animal Reproduction, School of Veterinary Medicine and Animal Science, University of São Paulo, São Paulo, Brazil
| | - Claudia Barbosa Fernandes
- Department of Animal Reproduction, School of Veterinary Medicine and Animal Science, University of São Paulo, São Paulo, Brazil
| | - Camila Infantosi Vannucchi
- Department of Animal Reproduction, School of Veterinary Medicine and Animal Science, University of São Paulo, São Paulo, Brazil
| |
Collapse
|
3
|
Guo X, Luo S, Amidani D, Rivetti C, Pieraccini G, Pioselli B, Catinella S, Murgia X, Salomone F, Xu Y, Dong Y, Sun B. In vitro characterization and in vivo comparison of the pulmonary outcomes of Poractant alfa and Calsurf in ventilated preterm rabbits. PLoS One 2020; 15:e0230229. [PMID: 32168331 PMCID: PMC7069639 DOI: 10.1371/journal.pone.0230229] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 02/12/2020] [Indexed: 11/18/2022] Open
Abstract
Poractant alfa and Calsurf are two natural surfactants widely used in China for the treatment of neonatal respiratory distress syndrome, which are extracted from porcine and calf lungs, respectively. The purpose of this experimental study was to compare their in vitro characteristics and in vivo effects in the improvement of pulmonary function and protection of lung injury. The biophysical properties, ultrastructure, and lipid composition of both surfactant preparations were respectively analysed in vitro by means of Langmuir-Blodgett trough (LBT), atomic force microscopy (AFM), and liquid-chromatography mass-spectrometry (LC-MS). Then, as core pharmacological activity, both head-to-head (100 and 200 mg/kg for both surfactants) and licensed dose comparisons (70 mg/kg Calsurf vs. 200 mg/kg Poractant alfa) between the two surfactants were conducted as prophylaxis in preterm rabbits with primary surfactant deficiency, assessing survival time and rate and dynamic compliance of the respiratory system (Cdyn). Intrapulmonary surfactant pools, morphometric volume density as alveolar expansion (Vv), and lung injury scores were determined post mortem. AFM and LC-MS analysis revealed qualitative differences in the ultrastructure as well as in the lipid composition of both preparations. Calsurf showed a longer plateau region of the LBT isotherm and lower film compressibility. In vivo, both surfactant preparations improved Cdyn at any dose, although maximum benefits in terms of Vv and intrapulmonary surfactant pools were seen with the 200 mg/kg dose in both surfactants. The group of animals treated with 200 mg/kg of Poractant alfa showed a prolonged survival time and rate compared to untreated but ventilated controls, and significantly ameliorated lung injury compared to Calsurf at any dose, including 200 mg/kg. The overall outcomes suggest the pulmonary effects to be dose dependent for both preparations. The group of animals treated with 200 mg/kg of Poractant alfa showed a significant reduction of mortality. Compared to Calsurf, Poractant alfa exerted better effects if licensed doses were compared, which requires further investigation.
Collapse
Affiliation(s)
- Xiaojing Guo
- Departments of Pediatrics and Neonatology, Children’s Hospital of Fudan University, Shanghai, China
| | - Siwei Luo
- Departments of Pediatrics and Neonatology, Children’s Hospital of Fudan University, Shanghai, China
| | - Davide Amidani
- Department of Research and Development, Chiesi Farmaceutici, Parma, Italy
| | - Claudio Rivetti
- Department of Chemistry, Life Sciences and Environmental Sustainability, University of Parma, Parma, Italy
| | - Giuseppe Pieraccini
- CISM Mass Spectrometry Centre, Department of Health Sciences, University of Florence, Firenze, Italy
| | - Barbara Pioselli
- Department of Research and Development, Chiesi Farmaceutici, Parma, Italy
| | - Silvia Catinella
- Department of Research and Development, Chiesi Farmaceutici, Parma, Italy
| | - Xabi Murgia
- Department of Drug Delivery, Helmholtz Institute for Pharmaceutical Research, Saarbrücken, Saarland, Germany
| | - Fabrizio Salomone
- Department of Research and Development, Chiesi Farmaceutici, Parma, Italy
| | - Yaling Xu
- Departments of Pediatrics and Neonatology, Children’s Hospital of Fudan University, Shanghai, China
| | - Ying Dong
- Departments of Pediatrics and Neonatology, Children’s Hospital of Fudan University, Shanghai, China
| | - Bo Sun
- Departments of Pediatrics and Neonatology, Children’s Hospital of Fudan University, Shanghai, China
- * E-mail: ,
| |
Collapse
|
4
|
Rimensberger PC. Surfactant. PEDIATRIC AND NEONATAL MECHANICAL VENTILATION 2015. [PMCID: PMC7175631 DOI: 10.1007/978-3-642-01219-8_28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Exogenous pulmonary surfactant, widely used in neonatal care, is one of the best-studied treatments in neonatology, and its introduction in the 1990s led to a significant improvement in neonatal outcomes in preterm infants, including a decrease in mortality. This chapter provides an overview of surfactant composition and function in health and disease and summarizes the evidence for its clinical use.
Collapse
Affiliation(s)
- Peter C. Rimensberger
- Service of Neonatology and Pediatric Intensive Care, Department of Pediatrics, University Hospital of Geneva, Geneve, Switzerland
| |
Collapse
|
5
|
Seehase M, Collins JJP, Kuypers E, Jellema RK, Ophelders DRMG, Ospina OL, Perez-Gil J, Bianco F, Garzia R, Razzetti R, Kramer BW. New surfactant with SP-B and C analogs gives survival benefit after inactivation in preterm lambs. PLoS One 2012; 7:e47631. [PMID: 23091635 PMCID: PMC3473048 DOI: 10.1371/journal.pone.0047631] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Accepted: 09/13/2012] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Respiratory distress syndrome in preterm babies is caused by a pulmonary surfactant deficiency, but also by its inactivation due to various conditions, including plasma protein leakage. Surfactant replacement therapy is well established, but clinical observations and in vitro experiments suggested that its efficacy may be impaired by inactivation. A new synthetic surfactant (CHF 5633), containing synthetic surfactant protein B and C analogs, has shown comparable effects on oxygenation in ventilated preterm rabbits versus Poractant alfa, but superior resistance against inactivation in vitro. We hypothesized that CHF 5633 is also resistant to inactivation by serum albumin in vivo. METHODOLOGY/PRINCIPAL FINDINGS Nineteen preterm lambs of 127 days gestational age (term = 150 days) received CHF 5633 or Poractant alfa and were ventilated for 48 hours. Ninety minutes after birth, the animals received albumin with CHF 5633 or Poractant alfa. Animals received additional surfactant if P(a)O(2) dropped below 100 mmHg. A pressure volume curve was done post mortem and markers of pulmonary inflammation, surfactant content and biophysiology, and lung histology were assessed. CHF 5633 treatment resulted in improved arterial pH, oxygenation and ventilation efficiency index. The survival rate was significantly higher after CHF 5633 treatment (5/7) than after Poractant alfa (1/8) after 48 hours of ventilation. Biophysical examination of the surfactant recovered from bronchoalveolar lavages revealed that films formed by CHF 5633-treated animals reached low surface tensions in a wider range of compression rates than films from Poractant alfa-treated animals. CONCLUSIONS For the first time a synthetic surfactant containing both surfactant protein B and C analogs showed significant benefit over animal derived surfactant in an in vivo model of surfactant inactivation in premature lambs.
Collapse
Affiliation(s)
- Matthias Seehase
- Department of Pediatrics, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jennifer J. P. Collins
- Department of Pediatrics, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Elke Kuypers
- Department of Pediatrics, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Reint K. Jellema
- Department of Pediatrics, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - Olga L. Ospina
- Department of Biochemistry, Faculty of Biology, Complutense University, Madrid, Spain
- Department of Physics, Pontificia Universidad Javeriana, Bogota, Colombia
| | - J. Perez-Gil
- Department of Biochemistry, Faculty of Biology, Complutense University, Madrid, Spain
| | - Federico Bianco
- Research and Development Department, Chiesi Farmaceutici SpA, Parma, Italy
| | - Raffaella Garzia
- Research and Development Department, Chiesi Farmaceutici SpA, Parma, Italy
| | - Roberta Razzetti
- Research and Development Department, Chiesi Farmaceutici SpA, Parma, Italy
| | - Boris W. Kramer
- Department of Pediatrics, Maastricht University Medical Center, Maastricht, The Netherlands
| |
Collapse
|
6
|
Rahmel D, Pohlmann G, Iwatschenko P, Volland J, Liebisch S, Kock H, Mecklenburg L, Maurer C, Kemkowski J, Taut F. The non-intubated, spontaneously breathing, continuous positive airway pressure (CPAP) ventilated pre-term lamb: A unique animal model. Reprod Toxicol 2012; 34:204-15. [DOI: 10.1016/j.reprotox.2012.05.089] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Revised: 05/18/2012] [Accepted: 05/21/2012] [Indexed: 11/25/2022]
|
7
|
Shah S. Exogenous surfactant: intubated present, nebulized future? World J Pediatr 2011; 7:11-5. [PMID: 20549420 DOI: 10.1007/s12519-010-0201-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2009] [Accepted: 05/25/2009] [Indexed: 11/29/2022]
Abstract
BACKGROUND exogenous surfactant is currently administered via intra-tracheal instillation, a method which can increase the possibility of clinical instability in the peri-surfactant administration period. Since its introduction, there has been an increase in understanding of the pathology of respiratory distress syndrome and surfactant biology. This includes development of a potential nebulized surfactant which has the potential to increase the number, safety and timely administration of the medication in preterm infants. DATA SOURCES based on recent original publications in the field of surfactant biology, we reviewed our experience with surfactant administration and discussed the available evidence on nebulized surfactant and outlined potential barriers toward widespread introduction of this therapy. RESULTS surfactant has revolutionized modern neonatal management and nebulized surfactant is attractive and a vector for administration. However, issues regarding costeffectiveness, development of nebulizer devices capable of administration, deposition of medication in the airway and dosing strategies remain unresolved. CONCLUSIONS nebulized surfactant has the potential to be a therapeutic breakthrough by eliminating the potent volu-and-baro-traumatic effects of mechanical ventilation in the peri-surfactant period. Nebulization would likely lead to increased administration immediately after birth and more emphasis on noninvasive ventilator strategies. These features will aid clinical implementation of nebulized surfactant as a standard of treatment after introduction.
Collapse
Affiliation(s)
- Shetal Shah
- Department of Pediatrics, State University of New York at Stony Brook, Stony Brook, New York 11791, USA.
| |
Collapse
|
8
|
Almlén A, Walther FJ, Waring AJ, Robertson B, Johansson J, Curstedt T. Synthetic surfactant based on analogues of SP-B and SP-C is superior to single-peptide surfactants in ventilated premature rabbits. Neonatology 2010; 98:91-9. [PMID: 20110733 PMCID: PMC2914361 DOI: 10.1159/000276980] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2009] [Accepted: 08/26/2009] [Indexed: 11/19/2022]
Abstract
BACKGROUND Respiratory distress syndrome (RDS) is currently treated with surfactant preparations obtained from natural sources and attempts to develop equally active synthetic surfactants have been unsuccessful. One difference in composition is that naturally derived surfactants contain the two hydrophobic proteins SP-B and SP-C while synthetic preparations contain analogues of either SP-B or SP-C. It was recently shown that both SP-B and SP-C (or SP-C33, an SP-C analogue) are necessary to establish alveolar stability at end-expiration in a rabbit RDS model, as reflected by high lung gas volumes without application of positive end-expiratory pressure. OBJECTIVES To study the efficacy of fully synthetic surfactants containing analogues of both SP-B and SP-C compared to surfactants with only one protein analogue. METHODS Premature newborn rabbits, treated with synthetic surfactants, were ventilated for 30 min without positive end-expiratory pressure. Tidal volumes as well as lung gas volumes at end-expiration were determined. RESULTS Treatment with 2% Mini-B (a short-cut version of SP-B) and 2% SP-C33, or its C-terminally truncated form SP-C30, in 1,2-dipalmitoyl-sn-glycero-3-phosphocholine/1-palmitoyl-2-oleoyl-sn-glycero-3-phosphoglycerol, 68:31 (w/w) resulted in median lung gas volumes of 8-9 ml/kg body weight, while animals treated with 2% Mini-B surfactant or 2% SP-C33/SP-C30 surfactant had lung gas volumes of 3-4 ml/kg, and those treated with Curosurf, a porcine surfactant, 15-17 ml/kg. In contrast, mixing SP-C33 with peptides with different distributions of positively charged and hydrophobic residues did not improve lung gas volumes. CONCLUSIONS The data indicate that synthetic surfactants containing analogues of both SP-B and SP-C might be superior to single-peptide surfactants in the treatment of RDS.
Collapse
Affiliation(s)
- Andreas Almlén
- Department of Molecular Medicine and Surgery, Section of Clinical Chemistry, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | | | | | | | | | | |
Collapse
|
9
|
Abstract
PURPOSE OF REVIEW To present existing data on the potential use of aerosolized surfactants for treatment of neonatal respiratory distress syndrome in the era of noninvasive ventilatory support. RECENT FINDINGS Current surfactant therapy requires endotracheal intubation and application of positive pressure ventilation. Instillation of the drug itself can be complicated by 'peridosing adverse events' including, but not limited to, desaturations, bradycardias, changes in blood pressure, drug reflux and even the need for reintubations. Increasing use of noninvasive ventilatory support for neonatal respiratory distress syndrome has motivated clinicians and researchers to look for alternate ways of introducing surfactants to patients. Aerosolized surfactants have been tested in animal models of respiratory distress syndrome. In addition, four small clinical studies have been performed to date. The effectiveness of this form of treatment requires further study, however, which will need to include optimizing the dose of aerosolized surfactant, choosing particle size, developing the best delivery system, and using a surfactant formulation that maintains its activity once aerosolized. SUMMARY Aerosolized surfactants for neonatal respiratory distress syndrome may prevent the need for endotracheal intubation. Appropriately designed randomized controlled studies are required to determine if this form of surfactant administration is as effective and safe as tracheal instillation.
Collapse
Affiliation(s)
- Jan Mazela
- Poznan University of Medical Sciences, Poland.
| | | | | |
Collapse
|