Surfactant Protein A, Phosphatidylcholine, and Surfactant Inhibitors in Epithelial Lining Fluid: Correlation with Surface Activity, Severity of Respiratory Distress Syndrome, and Outcome in Small Premature Infants

Hallman, Mikko; Merritt, T. Allen; Akino, Toyoaki; Bry, Kristina

doi:10.1164/ajrccm/144.6.1376

Cited by 162 publications

(102 citation statements)

References 17 publications

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“…Phosphatidylserine is exposed in the outer membrane of cells undergoing apoptosis (32), and the phosphatidylserine receptor mediates the phagocytosis of apoptotic cells (45). The enhanced phagocytosis by surfactant may be compromised in BPD because the surfactant from baboons developing BPD is deficient in SP-A and SP-D (46,47). Increased apoptosis or necrosis of monocytes was not the reason for the reduced phagocytosis of apoptotic thymocytes.…”

Section: Discussionmentioning

confidence: 99%

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Monocyte Function in Preterm, Term, and Adult Sheep

2003

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Section: Discussionmentioning

confidence: 99%

“…Dexamethasone may not increase the clearance of bacteria or apoptotic cells in preterm lungs. The low amounts of surfactant and SP-A in preterm lungs and lungs developing BPD may also adversely affect phagocytosis (46,47).…”

Section: Discussionmentioning

confidence: 99%

Monocyte Function in Preterm, Term, and Adult Sheep

2003

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“…Albumin was measured with a single radi al immunodiffusion using LC-P artigen and VLC-Partigen (Behrin gwerke AG, Marburg, Germany). The concentration of PC and saturated PC in AS was measured as described elsewhere (20). The lecithin to sphingomyelin ratio and phosphatidylglycerol were isolated by a two-dimensional thin-l ayer chromatograph y and quantitated by planimetry (21).…”

Section: Surfactant Therapy and Management Ofrespiratory Failurementioning

confidence: 99%

“…The concentrations of PC, SPC, SP-A, nonsedimentable protein, and nonsedim entable albumin in ELF were calculated using urea as a marker of the extracellular space (20,23). Urea was quantified in plasma (recovered within 24 h from the AS) and in the nonsedim entable fraction of AS using an enzymatic method (Unimate5 urea, Roche, Basel, Switzerland).…”

Section: Surfactant Therapy and Management Ofrespiratory Failurementioning

confidence: 99%

Prenatal Dexamethasone and Exogenous Surfactant Therapy: Surface Activity and Surfactant Components in Airway Specimens

1995

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To explain som e of the effects of prenatal glucocorticoid treatment on lung function, surfactant paramet ers in the airway specimens of ventil ator-dependent preterm infants were analyzed . In this double -blind study, the mother s of these infants had received dexam ethasone (DEX) or placebo prenatally. Human surfactant was give n for the treatment of moderate to severe respiratory distress syndrom e. Seventy-six preterm infants with mean gestational age of 29 wk and mean birth weight of 1137 g wer e studied. The concentrations of surfactant comp onents in epithelial lining fluid (ELF) were analyz ed, and the surfac e activity was measured using a pulsating bubble meth od. Prenat al DEX treatment increased the responsiveness to exogenous surfactant and decreased the seve rity of respiratory failure durin g the first day of life. The treatment had no effect on the concentrations of surfactant phospholipid s that were generally high. Prenat al DEX treatment incr eased the association between phospholipid conc entration in ELF and the degre e of respir atory failure . Prenatal DEX improved the surface activity of surfactant isolated from airway speci mens and tended to increase the ratio of surfactant protein A to phosph atidylcholin e among recipients of exogenous surfactant. A subgro up of infants , offspring of Several randomized studies have shown that prenatal glucocorticoid treatment before preterm delivery improves survival and decreases the incidence of RDS in preterm infants (1). Likewise, treatment with both natural and synthetic surfactants decreases the mortality of very low birth weight infants and the severity of RDS (2). In newborn infants with RDS, exogenous surfactant therapy improves gas exchange, functiona l recidual capacity, and dynamic compliance (3). A retrospective analysis of surfact ant trials suggests that the combination therapy of prenatal glucocorticoid and exogenous Received December 27, 1994; accepted May 9, 1995 676 moth ers with severe hypert ension had an abnormally low concentration of surfactant protein A and a poor outcome, despite prenat al DEX treatm ent or surfactant sub stitution. Prenatal DEX decreased the concentration of nonsedim entable proteins in ELF and decreased the inhibition of surface activity by these protein s. Our results indicate that imp roved surfactant function during the first day of life explains some of the beneficial pulm onary effects of prenatal glucocorticoid treatment in preterm infants who are ven tilator-depe ndent. (Pediatr Res 38: 676-684, 1995)

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“…This protein has been shown to counteract the inhibitory effects of some proteins and may be critical for improvement of infants with severe respiratory failure (18). Lotze et al (19) have found that surfactant protein A concentrations in tracheal aspirate fluid increase as infants receiving extracorporeal membrane oxygenation improve.…”

Section: Total Scorementioning

confidence: 99%

Surfactant Therapy and High-Frequency Jet Ventilation in the Management of a Piglet Model of the Meconium Aspiration Syndrome

et al. 1994

Pediatr Res

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California 9581 7 (T.A.M.]In vitro data have shown a concentration-dependent inhibition of surfactant by meconium, while anecdotal reports demonstrate improved oxygenation after surfactant replacement in babies with meconium aspiration syndrome, particularly in conjunction with high-frequency jet ventilation. We randomized 70 newborn piglets to either conventional or high-frequency jet ventilation, followed by insufiation of 3 m W g of a 33% meconium solution. Each group was further randomized to one of five surfactant therapies: 1) control, 2) 4 m u g Survanta, 3) 8 m u g Survanta, 4) 5 m u g Exosurf, or 5) 10 m W g Exosurf. We followed arterial blood gases and ventilator requirements over 6 h of ventilation. Aspirates of airway fluids were obtained for surface tension measurements, as well as total protein and phospholipid concentrations. Using a previously established scoring system, a pathologist blinded to treatment evaluated four sections of lung per animal for histologic changes of meconium aspiration syndrome. There were no differences noted between groups in any physiologic parameter measured (mean airway pressure, arterial partial pressure of oxygenlalveolar partial pressure of oxygen ratio, etc.) during the 6 h of ventilation. Airway fluid aspirate total protein concentrations increased significantly after meconium instillation (4-to 5-fold,p < 0.007) and remained elevated in spite of surfactant therapy. There was an initial decline in airway phospholipid concentraThe MAS is a major cause of respiratory distress among neonates (20 000-30 000 babies are affected annu-

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Surfactant Protein A, Phosphatidylcholine, and Surfactant Inhibitors in Epithelial Lining Fluid: Correlation with Surface Activity, Severity of Respiratory Distress Syndrome, and Outcome in Small Premature Infants

Cited by 162 publications

References 17 publications

Monocyte Function in Preterm, Term, and Adult Sheep

Monocyte Function in Preterm, Term, and Adult Sheep

Prenatal Dexamethasone and Exogenous Surfactant Therapy: Surface Activity and Surfactant Components in Airway Specimens

Surfactant Therapy and High-Frequency Jet Ventilation in the Management of a Piglet Model of the Meconium Aspiration Syndrome

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