ABSTRACTare collectins, members of the C-type lectin family (4). The collectins are composed of four domains: a short aminoterminal region with interchain disulfide bonds, a long collagen-like domain, a coiled-coil neck region and a calciumdependent carbohydrate recognition domain. The basic structural unit of each collectin is a trimer based on the collagenlike triple helix, but the arrangement of multiple trimers into higher order oligomers varies (4). The close linkage of the mouse collectin genes on chromosome 14 suggests the collectins arose by ancestral gene duplication (5).It is not known whether the genetic and structural relationships among the collectins lead to related functions. There are variable degrees of evidence for each of the collectins having a role in innate immunity (for review, see ref. 6). Humans with low levels of MBP secondary to gene mutations are predisposed to infections (7,8), and mice deficient in SP-A secondary to gene targeting have delayed clearing of certain intratracheal bacterial challenges (9). Consistent with a possible role in innate immunity, SP-D binds to both microbes and phagocytic cells in vitro (6, 10), yet there is no direct evidence that SP-D has a role in host defense in vivo.Although SP-D was initially called a SP because it was expressed in the alveolar type II cell and had striking biochemical similarities to SP-A (1), a role for SP-D in surfactant homeostasis has not been established. Some surfactant phospholipid is associated with SP-D purified from alveolar lavage (11), and SP-D will interact with surfactant phospholipids in vitro under certain circumstances (12-14). SP-D also binds to both type II cell apical membranes and alveolar macrophages (6), cells that participate in alveolar surfactant metabolism (15). To develop a model to test the role of SP-D, we have produced mice lacking in SP-D secondary to the disruption of the single copy mouse SP-D gene by homologous recombination. Initial characterization of the phenotype demonstrates a progressive alveolar surfactant accumulation and a striking increase in foamy alveolar macrophages and alteration in type II cell morphology. These findings differ markedly from the results of SP-A gene targeting (16,17) and show that deletion of SP-D alters surfactant homeostasis. MATERIALS AND METHODS Generation of SP-D-Deficient Mice.A murine 129 strain genomic library (Stratagene) was screened by using a 1.2-kb full-length SP-D cDNA to obtain a 15-kb genomic fragment containing all but the extreme 3Ј end of the structural gene. A replacement-type targeting vector containing 1.2-kb and 4.3-kb homology regions was constructed by standard methods (Fig. 1a). Pgk-neo (1.8 kb) for positive selection replaced all of exon 2, including the translation start site for murine SP-D, and short segments of flanking intronic sequence (2.8 kb). Pgk-tk was inserted 5Ј to the regions of homology for negative selection. The targeting vector was linearized by using a unique NotI site and electroporated into CB1-4 embryonic stem cells as des...

Surfactant protein B is a small homodimeric protein that is found tightly associated with surfactant lipids in the alveolar space. In this review, we discuss the actions of SP-B on phospholipid membranes using information predominantly obtained from model membrane systems. We try to correlate these model actions with current concepts of SP-B structure and proposed biological functions. These functions may include critical roles in the intracellular assembly of surfactant through a role in lamellar body organogenesis, the structural rearrangement of secreted surfactant lipids into tubular myelin, and the subsequent rapid insertion of secreted surfactant phospholipids into the surface film itself. The relevance of SP-B to human biology is emphasized by the fatal respiratory distress that is associated with a genetic deficiency of SP-B and the important role of SP-B in certain exogenous surfactant formulations in wide clinical use.

Preterm infants must establish regular respirations at delivery. Sustained inflations may establish lung volume faster than short inflations. OBJECTIVE To determine whether a ventilation strategy including sustained inflations, compared with standard intermittent positive pressure ventilation, reduces bronchopulmonary dysplasia (BPD) or death at 36 weeks' postmenstrual age without harm in extremely preterm infants. DESIGN, SETTING, AND PARTICIPANTS Unmasked, randomized clinical trial (August 2014 to September 2017, with follow-up to February 15, 2018) conducted in 18 neonatal intensive care units in 9 countries. Preterm infants 23 to 26 weeks' gestational age requiring resuscitation with inadequate respiratory effort or bradycardia were enrolled. Planned enrollment was 600 infants. The trial was stopped after enrolling 426 infants, following a prespecified review of adverse outcomes. INTERVENTIONS The experimental intervention was up to 2 sustained inflations at maximal peak pressure of 25 cm H 2 O for 15 seconds using a T-piece and mask (n = 215); standard resuscitation was intermittent positive pressure ventilation (n = 211). MAIN OUTCOME AND MEASURES The primary outcome was the rate of BPD or death at 36 weeks' postmenstrual age. There were 27 prespecified secondary efficacy outcomes and 7 safety outcomes, including death at less than 48 hours. RESULTS Among 460 infants randomized (mean [SD] gestational age, 25.30 [0.97] weeks; 50.2% female), 426 infants (92.6%) completed the trial. In the sustained inflation group, 137 infants (63.7%) died or survived with BPD vs 125 infants (59.2%) in the standard resuscitation group (adjusted risk difference [aRD], 4.7% [95% CI, −3.8% to 13.1%]; P = .29). Death at less than 48 hours of age occurred in 16 infants (7.4%) in the sustained inflation group vs 3 infants (1.4%) in the standard resuscitation group (aRD, 5.6% [95% CI, 2.1% to 9.1%]; P = .002). Blinded adjudication detected an imbalance of rates of early death possibly attributable to resuscitation (sustained inflation: 11/16; standard resuscitation: 1/3). Of 27 secondary efficacy outcomes assessed by 36 weeks' postmenstrual age, 26 showed no significant difference between groups. CONCLUSIONS AND RELEVANCE Among extremely preterm infants requiring resuscitation at birth, a ventilation strategy involving 2 sustained inflations, compared with standard intermittent positive pressure ventilation, did not reduce the risk of BPD or death at 36 weeks' postmenstrual age. These findings do not support the use of ventilation with sustained inflations among extremely preterm infants, although early termination of the trial limits definitive conclusions.

The innate immune molecule surfactant protein-D (SP-D) plays an important regulatory role in the allergic airway response. In this study, we demonstrate that mice sensitized and challenged with either Aspergillus fumigatus (Af) or OVA have increased SP-D levels in their lung. SP-D mRNA and protein levels in the lung also increased in response to either rIL-4 or rIL-13 treatment. Type II alveolar epithelial cell expression of IL-4Rs in mice sensitized and challenged with Af, and in vitro induction of SP-D mRNA and protein by IL-4 and IL-13, but not IFN-γ, suggested a direct role of IL-4R-mediated events. The regulatory function of IL-4 and IL-13 was further supported in STAT-6-deficient mice as well as in IL-4/IL-13 double knockout mice that failed to increase SP-D production upon allergen challenge. Interestingly, addition of rSP-D significantly inhibited Af-driven Th2 cell activation in vitro whereas mice lacking SP-D had increased numbers of CD4+ cells with elevated IL-13 and thymus- and activation-regulated chemokine levels in the lung and showed exaggerated production of IgE and IgG1 following allergic sensitization. We propose that allergen exposure induces elevation in SP-D protein levels in an IL-4/IL-13-dependent manner, which in turn, prevents further activation of sensitized T cells. This negative feedback regulatory circuit could be essential in protecting the airways from inflammatory damage after allergen inhalation.

Granulysin is an antimicrobial and tumoricidal molecule expressed in granules of CTL and NK cells. In this study, we show that granulysin damages cell membranes based upon negative charge, disrupts the transmembrane potential (Δψ) in mitochondria, and causes release of cytochrome c. Granulysin-induced apoptosis is blocked in cells overexpressing Bcl-2. Despite the release of cytochrome c, procaspase 9 is not processed. Nevertheless, activation of caspase 3 is observed in granulysin-treated cells, suggesting that granulysin activates a novel pathway of CTL- and NK cell-mediated death distinct from granzyme- and death receptor-induced apoptosis.