Abstract

BackgroundRespiratory Distress Syndrome (RDS) is a prematurity-related breathing disorder caused by a quantitative deficiency of pulmonary surfactant. Surfactant replacement therapy is effective for RDS newborns, although treatment failure has been reported. The aim of this study is to trace exogenous surfactant by 13C variation and estimate the amount reaching the lungs at different doses of the drug.MethodsForty-four surfactant-depleted rabbits were obtained by serial bronchoalveolar lavages (BALs), that were merged into a pool (BAL pool) for each animal. Rabbits were in nasal continuous positive airway pressure and treated with 0, 25, 50, 100 or 200 mg/kg of poractant alfa by InSurE. After 90 min, rabbits were depleted again and a new pool (BAL end experiment) was collected. Disaturated-phosphatidylcholine (DSPC) was measured by gas chromatography. DSPC-Palmitic acid (PA) 13C/12C was analyzed by isotope ratio mass spectrometry. One-way non-parametric ANOVA and post-hoc Dunn’s multiple comparison were used to assess differences among experimental groups.ResultsBased on DSPC-PA 13C/12C in BAL pool and BAL end experiment, the estimated amount of exogenous surfactant ranged from 61 to 87% in dose-dependent way (p < 0.0001) in animals treated with 25 up to 200 mg/kg. Surfactant administration stimulated endogenous surfactant secretion. The percentage of drug recovered from lungs did not depend on the administered dose and accounted for 31% [24–40] of dose.ConclusionsWe reported a risk-free method to trace exogenous surfactant in vivo. It could be a valuable tool for assessing, alongside the physiological response, the delivery efficiency of surfactant administration techniques.

Highlights

  • Respiratory Distress Syndrome (RDS) is a prematurity-related breathing disorder caused by a quantitative deficiency of pulmonary surfactant

  • We recently developed a new method to estimate the contribution of exogenous surfactant to the alveolar pool in a rabbit model of RDS based on carbon stable isotope natural abundance of the disaturatedphosphatidylcholine palmitic acid (DSPC-Palmitic acid (PA)) [13], the main phospholipid component of pulmonary surfactant

  • We further investigated the efficacy and the reliability of our method in lung-lavaged adult rabbits managed with a nasal continuous positive airway pressure [16] and treated with increasing doses of poractant alfa in a dose-ranging study

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Summary

Introduction

Respiratory Distress Syndrome (RDS) is a prematurity-related breathing disorder caused by a quantitative deficiency of pulmonary surfactant. Surfactant replacement therapy is effective for RDS newborns, treatment failure has been reported. The aim of this study is to trace exogenous surfactant by 13C variation and estimate the amount reaching the lungs at different doses of the drug. RDS is a respiratory disorder that mostly affects preterm infants and it is characterised by lung immaturity and critically low amounts of pulmonary surfactant [1, 2]. To overcome pulmonary surfactant deficiency, exogenous surfactant replacement therapy represents a crucial achievement in the care of the preterm newborn [3], reducing death and pneumothorax [4]. The possibility of estimating the amount of drug reaching the target organ could improve treatment dosing

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