Evidence of lung surfactant abnormality in respiratory failure. Study of bronchoalveolar lavage phospholipids, surface activity, phospholipase activity, and plasma myoinositol.

Abstract

A B S T R A C T Autopsy findings suggest that lung surfactant is damaged in the adult respiratory distress syndrome. In the present study 225 bronchoalveolar lavage specimens (78 from 36 patients, 1-78 yr old with respiratory failure, 135 from another 128 patients with other respiratory disease, and 12 from healthy controls) were assayed for the lung profile [lecithin/ sphingomyelin (L/S) ratio, saturated lecithin, phosphatidylinositol, and phosphatidylglycerol]. Bronchoalveolar lavage fluid was further analyzed for phospholipids and for phosphatidic acid phosphohydrolase, phospholipase A2, and phosphatidylinositol phosphodiesterase activities. A lipid-protein complex was isolated and analyzed for surface activity, and plasma was measured for myoinositol.There were only small differences seen in the recovery of total phospholipid between respiratory failure patients and normal controls. However, in respiratory failure, phospholipids in bronchoalveolar lavage were qualitatively different from those recovered either from normal controls or from patients with other lung disease: the L/S ratio, phosphatidylglycerol, and disaturated lecithin were low, whereas sphingomyelin and phosphatidylserine were prominent. These abnormalities were present early in respiratory failure A preliminary report of this work was presented at the

Inhibitory Effects of Surfactant Protein A on Surfactant Phospholipid Hydrolysis by Secreted Phospholipases A2

“…Remarkably, hydrolysis of PG occurs as early as 1 h after sPLA 2 -IIA administration, indicating that this enzyme could account for surfactant abnormalities observed at early phases in ARDS (17). In fact, alterations in the relative composition of the surfactant phospholipids are seen in patients with ARDS (17,18,43,44). A decrease in PG levels (by Ͼ80% in three of these studies) and a moderate reduction of PC levels were observed.…”

Surfactant chemical composition and biophysical activity in acute respiratory distress syndrome.

“…In subsequent reports, Petty and colleagues observed a lighter surfactant buoyant density (2) and increased surfactant compressibility (2,3) in bronchoalveolar lavage (BAL) material obtained from the lungs of ARDS patients immediately after their death. Intriguing observations of surfactant composition and functional activity in ARDS patients were made by Hallman et al (4), who reported a decrease in the percentages of disaturated phosphatidylcholine and phosphatidylglycerol in BAL samples obtained from ARDS patients. In addition, they observed an increase in the minimum surface tension in the surfactant lavaged from ARDS patients.…”

“…tress Syndrome) (1)(2)(3)(4). However, because of the difficulty in obtaining surfactant from these patients, the available data are incomplete.…”

Lung Surfactant and Its Use in Lung Diseases

“…Наряду со снижением содержания основных классов ФЛ на блюдается относительное увеличение содержания минорных компонентов ФЛ, ненасыщенных ЖК в составе ФЛ [8,[90][91][92]. Обнаружено также уменьшение содержания САБ: SP А, SP В и SP С, но не SP D [8, 91 93].…”