Surfactant protein-B supplementation improves in vivo function of a modified natural surfactant

Abstract

The effect of the addition of surfactant protein (SP)-B or SP-B plus SP-C (SP-BC) to a surfactant made from bovine lung (Survanta) was evaluated in 27-d-gestation preterm rabbits. The animals were treated with Survanta, Survanta + 2% SP-B, Survanta + 3% SP-BC, or sheep surfactant. They were then ventilated with 3 cm H20 positive end-expiratory pressure and tidal volumes of 8 mL/kg. Survanta + 2% SP-B was prepared by adding SP-B in water to Survanta or by adding SP-B in chloroform [SP-B(Chl)] to lipid-extracted Survanta. Dynamic compliances of the Survanta + 2% SP-B(Chl)- and Survanta + 3% SP-BC-treated rabbits were greater (p < 0.05) than those treated with Survanta or Survanta + 2% SP-B in water and were comparable to sheep surfactant. Postventilation pressure-volume curves for the groups treated with Survanta supplemented with SP-B had significantly larger retained volumes on deflation compared with those treated only with Survanta (p < 0.01). The effects of ventilation style on the responses were assessed by ventilating other groups of rabbits treated with Survanta, Sur-Natural surfactant as recovered by lavage from the air spaces of healthy mammalian lungs is a complex of lipids and specific proteins (1). The lipophilic proteins SP-B and SP-C are critical for surface adsorption and low surface tensions (2-4), and SP-A interacts cooperatively with the other surfactant proteins to influence surface properties (5). In general, lipid-only surfactants are much less effective in preterm surfactant-deficient lungs or surfactant-depleted lungs than natural surfactants that contain SP-B or SP-C (6, 7). Several lines of evidence indicate that SP-B is critical to short-term surfactant efficacy. MAb to SP-B induce severe respiratory failure, and SP-B deficiency in term infants results in pulmonary death (8, 9). Rider et al. (10) recently demonstrated that the addition of SP-B to natural surfactant lipids yielded a surfactant that was as effective as natural sheep surfactant when preterm rabbits were ventilated vanta + 0.5% SP-B(Chl), Survanta + 2% SP-B(Chl), or sheep surfactant with tidal volumes of 10 mL/kg and 0 cm H20 positive end-expiratory pressure. SP-B (2%) augmented the in vivo function of Survanta without positive end-expiratory pressure, and 0.5% SP-B had no effect. Infasurf, a surfactant with more SP-B, was more effective than Survanta when tested in the preterm rabbits. SP-B is a critical factor for optimum immediate surfactant function. © 1994 International Pediatric Research Foundation, Inc.