Exogenous human surfactant for treatment of severe respiratory distress syndrome: A randomized prospective clinical trial

Hallman, Mikko; Merritt, T. Allen; Järvenpää, Anna‐Liisa; Boynton, Bruce R.; Mannino, Frank L.; Gluck, Louis; Moore, Thomas R.; Edwards, David K.

doi:10.1016/s0022-3476(85)80253-5

Cited by 295 publications

(92 citation statements)

References 12 publications

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“…The importance of these apoproteins, termed SP-B and SP-C (20) in the ability of natural or synthetic surfactants to be able to reduce surface tension at the epithelial air/liquid interface in the lung has been the subject of several recent papers (2,7,10,11,(13)(14)(15)(17)(18)(19)(21)(22)(23). Human surfactant isolated from term amniotic fluid (24)(25)(26), as well as heterologous surfactants consisting of lung mince or airway lavage lipid extracts from calves Sephadex LH-60 (Pharmacia Fine Chemicals, Uppsala, Sweden) column. The column was run at a flow rate of 2.5 mL/h using the acidified chloroform/methanol buffer, and fractions of 0.5 mL were collected.…”

Section: Preparation Ofpurified Sp-b Monomer Dimer and Oligomersmentioning

confidence: 99%

The Use of Synthetic Peptides in the Formation of Biophysically and Biologically Active Pulmonary Surfactants

et al. 1991

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ABSTRACf. Synthetic pulmonary surfactants consisting of mixtures of phospholipids with synthetic peptides based on the amino acid sequence of human surfactant apoprotein SP-B were prepared. These surfactants were analyzed for their ability to lower surface tension on a pulsating bubble surfactometer and for their capacity to improve lung compliance and increase alveolar expansion in a fetal rabbit model of surfactant deficiency. The data demonstrate that several peptides, ranging from 17 to 45 residues in length, matching the carboxy-terminal sequence of the SP-B protein, when appropriately recombined with the phospholipids dipalmitoylphosphatidylcholine and phosphatidylglycerol (3:1), are capable of producing a synthetic surfactant with biophysical and biologicactivity approaching that of human surfactant derived from amniotic fluid. (Pediatr Res 29: 460-465, 1991) Abbreviations DPPC, dipalmitoylphosphatidylcholine lA, iodoacetic acid PG, phosphatidylglycerol PL, phospholipid SP, surfactant protein or swine, or synthetic lipids, generally in combination with SPBand SP-C (7, 10, 11, 13-15, 17-19, 21-23, 27), are being evaluated for their potential use in surfactant replacement therapies.Our previous studies (10) and those of Curstedt et al. (2), and Yu and Possmayer (19), suggested that when recombined with PL, SP-B resulted in greater surface tension lowering and biologic activity than did SP-C. For this reason, we decided to focus our attention on this protein. SP-B, also called SP-18 (4, 10), SPL(Phe) (3), PSP-B (5), and SAP-6-14 (7,16,17,23), has been shown to be a disulfide-linked dimer of two identical polypeptides of approximately 9000 D having an amino terminal sequence of phe-pro-ile-pro-leu-pro-tyr-(human) (3, 5, 10). Data based on amino acid compositions (10) and fast atom bombardment mass spectroscopy (unpublished observations) have led us to conclude that human SP-B is 80-81 residues in length. The sequence is shown in Figure I.To investigate the mechanisms by which SP-B protein augments the surfactant capacity of PL, peptides were synthesized that conform to portions of the native sequence of this protein. These peptides could be combined with PL to reconstitute the biophysical and biologic activities of natural surfactant. We report here the results of studies, using the pulsating bubble surfactometer to measure the capacity of these synthetic surfactants to lower surface tension at an air/liquid interface and the fetal rabbit model to determine their ability to increase lung compliance and alveolar expansion. MATERIALS AND METHODS Preparation ofpurified SP-B monomer, dimer, and oligomers.SP-B was isolated from human amniotic fluid surfactant ad escribed previously (10). One hundred J.Lg of SP-B, in a volume of 206 J.LL methanol, were incubated with 5.14 mg DTT (Sigma Chemical Co, St. Louis, MO) in 17 J.LL methanol, for 1 h at 37°C. Analysis of 2 J.LL on SDS-PAGE showed the SP-B to be approximately 70% reduced as noted by a shift in band position from 18000 D to approximately 9000 D. The SP-B/...

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Section: Preparation Ofpurified Sp-b Monomer Dimer and Oligomersmentioning

confidence: 99%

The Use of Synthetic Peptides in the Formation of Biophysically and Biologically Active Pulmonary Surfactants

et al. 1991

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“…The use of surfactant has greatly improved survival and decreased complications, such as air leak and chronic lung disease, in the last several years. [1][2][3][4][5][6][7][8][9] Published outcomes have come from either single-center academic institutions [10][11][12][13][14][15] or elaborate multi-academic center collaborative studies, [16][17][18][19][20][21][22][23] analyzing thousands of tiny survivors from many NICU's showing extreme variation in outcomes. 21 Recent studies focus on the earliest gestational age (GA) infants 16,18,19 or infants less than 1000 g, also called extremely low birth weight (ELBW).…”

Section: Introductionmentioning

confidence: 99%

“…Testing was carried out at 24 months corrected age and analyzed as: (1) 'normal', which we define as within 1 standard deviation (s.d.) of the mean on both the Mental Developmental Index (MDI) and Psychomotor Developmental Index (PDI) portions of the BSID, which can be compared with 60% of the 24-month normal standardization sample on the BSID (M Pinon, Research Director, The Psychological Corporation, 10 September 2003, personal communication), (2) MDI only score more than 84, which is within 1 s.d.…”

Section: Introductionmentioning

confidence: 99%

Surfactant era (1990–2002) 2-year outcomes of infants less than 1500 g from a Community Level 3 Neonatal Intensive Care Unit

et al. 2006

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“…[5][6][7][8][9][10][11][12] The main case-control studies investigating the prophylactic or therapeutic use of surfactants were reviewed in two meta-analyses. 13,14 They summarized the evident beneficial effects of surfactant therapy on the natural clinical outcome of RDS.…”

Section: Introductionmentioning

confidence: 99%

Terapia com surfactante pulmonar exógeno em pediatria

Freddi

Filho²,

Fiori³

2003

J. Pediatr. (Rio J.)

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Objective: To review current knowledge about the use of exogenous surfactants in the treatment of different lung diseases causing acute respiratory failure in children. Sources of data:This review is based on the authors' experience and on recent data retrieved from ONIA, Mdconsult, Medline and the Cochrane Database Library. Summary of the findings:In spite of the success of the use of exogenous surfactants in Respiratory Distress Syndrome (RDS) of the newborn, some questions remain unanswered, such as the optimal administration timing -either very early (prophylactic), based on gestational age or on quick tests of lung maturity, or later, when the clinical picture becomes unequivocal. In other severe diseases requiring ventilatory support, the use of surfactants is still controversial, and data in the literature are limited and conflicting. However, successful use in several other diseases has been reported. Recent studies have focused on surfactant inactivation by substances that can be found in the airways. New surfactants with the addition of substances to control inhibition, such as polyethyleneglycol, are being tested for diseases in which inactivation seems to be a significant factor. Conclusions:Therapy with exogenous surfactants, even as a treatment for RDS, has not been thoroughly investigated. Further studies should be conducted to improve surfactants -mainly their resistance to inhibition -and the treatment of diseases other than RDS.J Pediatr (Rio J) 2003;79 (Suppl 2):S205-S12: Exogenous surfactant, respiratory failure, intensive care, respiratory distress syndrome.

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Exogenous human surfactant for treatment of severe respiratory distress syndrome: A randomized prospective clinical trial

Cited by 295 publications

References 12 publications

The Use of Synthetic Peptides in the Formation of Biophysically and Biologically Active Pulmonary Surfactants

The Use of Synthetic Peptides in the Formation of Biophysically and Biologically Active Pulmonary Surfactants

Surfactant era (1990–2002) 2-year outcomes of infants less than 1500 g from a Community Level 3 Neonatal Intensive Care Unit

Terapia com surfactante pulmonar exógeno em pediatria

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