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Surfactant proteins A and D in pulmonary diseases of preterm infants

Iliana Bersani¹, Christian P Speer, Steffen Kunzmann

¹University Children's Hospital, Würzburg, Germany.

Expert Review of Anti-Infective Therapy

|June 19, 2012

Insights

Immature lung and immune systems in neonates increase risks. Surfactant proteins (SP)-A and SP-D are crucial for lung health and immunity, and enriched surfactants may improve outcomes.

Area of Science:

Neonatology
Pulmonology
Immunology

Background:

Neonatal pulmonary and immune system immaturity are key risk factors for morbidity and mortality.
Surfactant proteins (SP)-A and SP-D link pulmonary and immune systems, regulating lung homeostasis and host defense.
Lower SP-A and SP-D levels in preterm neonates correlate with respiratory distress, infection, and bronchopulmonary dysplasia.

Purpose of the Study:

To investigate the potential of new-generation surfactants enriched with SP-A and/or SP-D to improve neonatal outcomes.
To evaluate the role of SP-A and SP-D in neonatal lung and immune function.

Main Methods:

Analysis of SP-A and SP-D concentrations in preterm neonates with respiratory distress syndrome.
Assessment of exogenous surfactant administration effects on SP secretion.
Evaluation of SP-A and SP-D enriched surfactant formulations in animal models for resistance to plasmatic protein inhibition.

Main Results:

Preterm neonates with respiratory distress syndrome exhibited reduced SP-A and SP-D levels.
Exogenous surfactant administration enhanced SP secretion.
SP-A and SP-D enriched surfactants demonstrated increased resistance to plasmatic protein inhibition in animal models.

Conclusions:

SP-A and SP-D are critical for neonatal lung homeostasis and immune defense.
New-generation surfactants enriched with SP-A and/or SP-D hold promise for enhancing neonatal lung and immune function.
Enriched surfactants may improve clinical outcomes in neonates, particularly those with immature pulmonary and immune systems.

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Abstract:

Immaturity of the pulmonary and immune systems represents an important risk factor for increased morbidity and mortality in neonates. Surfactant protein (SP)-A and SP-D, linking molecules between these two systems, are critical for lung homeostasis as they regulate surfactant metabolism and host immunodefense activities in innate and adaptive immunity. Preterm neonates with respiratory distress syndrome showed lower concentrations of SP-A and SP-D, and the administration of exogenous surfactant was found to strengthen the secretion of SPs. Low levels of SP-A and SP-D also correlated with a higher risk of infection and development of bronchopulmonary dysplasia. Moreover, SP-A- and SP-D-enriched surfactant formulations were more resistant to the inhibitory action of the plasmatic proteins in animal models. Based on these assumptions, new-generation surfactants, enriched with SP-A and/or SP-D, may enhance the function of immune system and lungs in neonates, potentially improving the clinical outcome.

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