Pulmonary surfactant is used as a medication to treat and prevent

respiratory distress syndrome Infantile respiratory distress syndrome (IRDS), also called respiratory distress syndrome of newborn, or increasingly surfactant deficiency disorder (SDD), and previously called hyaline membrane disease (HMD), is a syndrome in premature infants ...

in newborn babies. Prevention is generally done in babies born at a gestational age of less than 32 weeks. It is given by the endotracheal tube. Onset of effects is rapid. A number of doses may be needed. Side effects may include slow heart rate and low oxygen levels. Its use is also linked with intracranial bleeding. Pulmonary surfactant may be isolated from the lungs of cows or pigs or made artificially. Pulmonary surfactant was discovered in the 1950s and a manufactured version was approved for medical use in the United States in 1990. It is on the World Health Organization's List of Essential Medicines.

Medical uses

Pulmonary surfactant is used to treat and prevent

in newborn babies. Prevention is generally done in babies born less than 32 weeks gestational age. Tentative evidence supports use in drowning. Surfactant administration can also be effective in meconium aspiration syndrome where it has been shown to help lower length of stay. For patients with

acute respiratory distress syndrome Acute respiratory distress syndrome (ARDS) is a type of respiratory failure characterized by rapid onset of widespread inflammation in the lungs. Symptoms include shortness of breath (dyspnea), rapid breathing (tachypnea), and bluish skin colo ...

(ARDS), surfactant has not been shown to reduce mortality. However, it may be beneficial in those with COVID-19 associated ARDS.

Types

There are a number of types of pulmonary surfactants available. Like their natural counterparts, pulmonary surfactant preparations consist of phospholipids (mainly

DPPC DPPC can stand for: * Disabled Persons Protection Commission at the Commonwealth of Massachusetts * Dipalmitoylphosphatidylcholine, a phospholipid * Disaster Prevention and Preparedness Commission of Ethiopia Ethiopia, , om, Itiyoophiyaa, ...

) combined with spreading agents such as

SP-B Surfactant protein B is an essential lipid-associated protein found in pulmonary surfactant. Without it, the lung would not be able to inflate after a deep breath out. It rearranges lipid molecules in the fluid lining the lung so that tiny air sac ...

and

SP-C Surfactant protein C (SP-C), is one of the pulmonary surfactant proteins. In humans this is encoded by the ''SFTPC'' gene. It is a membrane protein. Structure SFTPC is a 197-residue protein made up of two halves: a unique N-terminal propept ...

. Ex-situ measurements of

surface tension Surface tension is the tendency of liquid surfaces at rest to shrink into the minimum surface area possible. Surface tension is what allows objects with a higher density than water such as razor blades and insects (e.g. water striders) to f ...

and

interfacial rheology Interfacial rheology is a branch of rheology that studies the flow of matter at the interface between a gas and a liquid or at the interface between two immiscible liquids. The measurement is done while having surfactants, nanoparticles or other sur ...

can help to understand the functionality of pulmonary surfactants. Synthetic pulmonary surfactants: *

Colfosceril palmitate Colfosceril palmitate (trade name Exosurf) is a drug used as a pulmonary surfactant. It is a drug that is used in surfactant deficient conditions such as infant respiratory distress syndrome Infantile respiratory distress syndrome (IRDS), also c ...

(Exosurf) – a mixture of DPPC with hexadecanol and tyloxapol added as spreading agents *

Pumactant Pulmonary surfactant is used as a medication to treat and prevent respiratory distress syndrome in newborn babies. Prevention is generally done in babies born at a gestational age of less than 32 weeks. It is given by the endotracheal tube. Ons ...

(Artificial Lung Expanding Compound or ALEC) – a mixture of DPPC and PG *

Lucinactant Lucinactant (trade name Surfaxin) is a liquid medication used to treat infant respiratory distress syndrome. It is a pulmonary surfactant for infants who lack enough natural surfactant in their lungs. Whereas earlier medicines of the class, such a ...

(KL-4) – composed of DPPC, palmitoyl-oleoyl phosphatidylglycerol, and palmitic acid, combined with a 21 amino acid synthetic peptide ( sinapultide) that mimics the C-terminal helical domain of

. * Ventricute - DPPC, rSP-C *

(trade name Surfaxin) is a liquid medication that contains

, POPG as the sodium salt, and palmitic acid. Animal-derived surfactants: *

Beractant Beractant, also known by the trade name of Survanta, is a modified bovine pulmonary surfactant containing bovine lung extract (phospholipids, neutral lipids, fatty acids, and bovine surfactant proteins), to which synthetic DPPC, tripalmitin and p ...

(Survanta) – extracted from minced cow lung with additional DPPC, palmitic acid and tripalmitin, manufactured by Abbvie ** (Beraksurf) – extracted from minced cow lung with additional DPPC, palmitic acid and tripalmitin, manufactured by Tekzima * Calfactant (Infasurf) – extracted from calf lung lavage fluid, manufactured by ONY Biotech. *

Poractant alfa Poractant alfa is a pulmonary surfactant sold under the brand name Curosurf by Chiesi Farmaceutici. Poractant alfa is an extract of natural porcine lung surfactant. As with other surfactants, marked improvement on oxygenation may occur within mi ...

(Curosurf) – extracted from material derived from minced pig lung * Surfactant TA (Surfacten) – derived from cows, manufactured by Tokyo Tanabe Co. * Bovactant SF-RI (Alveofact) – extracted from cow lung lavage fluid, manufactured by

Boehringer Ingelheim C.H. Boehringer Sohn AG & Co. is the parent company of the Boehringer Ingelheim group, which was founded in 1885 by Albert Boehringer in Ingelheim am Rhein, Germany. As of 2018, Boehringer Ingelheim is one of the world's largest pharmaceutical ...

History

Researcher John Clements identified surfactants and their role in the 1950s.

Mary Ellen Avery Mary Ellen Avery (May 6, 1927 – December 4, 2011), also known as Mel, was an American pediatrician. In the 1950s, Avery's pioneering research efforts helped lead to the discovery of the main cause of respiratory distress syndrome (RDS) in prem ...

soon after showed that the lungs of premature infants could not produce surfactants. Exosurf, Curosurf, Infasurf, and Survanta were the initial surfactants FDA approved for use in the U.S. In 2012, the US FDA approved an additional synthetic surfactant,

lucinactant Lucinactant (trade name Surfaxin) is a liquid medication used to treat infant respiratory distress syndrome. It is a pulmonary surfactant for infants who lack enough natural surfactant in their lungs. Whereas earlier medicines of the class, such a ...

(Surfaxin).

References

External links

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