Surfactant replacement: immunological considerations

We sought to analyse the potential immunogenicity of human alveolar surfactant as it is currently used in the treatment of neonatal respiratory distress syndrome (RDS). An enzyme linked immunosorbant assay capable of detecting specific immune complexes between surfactant and antibodies directed to surfactant was developed. Premature infants with RDS were divided into groups: one group received surfactant replacement and one received conventional therapy. Plasma samples obtained from these infants at birth and thereafter were examined for specific circulating immune complexes between surfactant and anti-surfactant antibodies. All babies were also examined for clinical and serological evidence of immune complex-mediated tissue damage. We found that almost all infants with RDS, regardless of their therapy, showed evidence of circulating surfactant-anti-surfactant immune complexes. Plasma samples from infants without RDS showed no such complexes. Immune complexes appeared early in postnatal life, usually within the first week, and diminished thereafter. We detected no evidence of altered plasma complement levels or end organ damage attributable to these immune complexes. Thus, circulating immune complexes between surfactant and antibodies to surfactant are common in neonatal respiratory distress syndrome, though they do not appear to cause injury. Since not only human but heterologous surfactants are now used in treating RDS, we feel that cautious evaluation of potential immune reactions to the administered materials should be undertaken.