Delivery and Performance of Surfactant Replacement Therapies to Treat Pulmonary Disorders

Abstract

Lung surfactant is crucial for optimal pulmonary function throughout life. An absence or deficiency of surfactant can affect the surfactant pool leading to respiratory distress. Even if the coupling between surfactant dysfunction and the underlying disease is not always well understood, using exogenous surfactants as replacement is usually a standard therapeutic option in respiratory distress. Exogenous surfactants have been extensively studied in animal models and clinical trials. The present article provides an update on the evolution of surfactant therapy, types of surfactant treatment, and development of newer-generation surfactants. The differences in the performance between various surfactants are highlighted and advanced research that has been conducted so far in developing the optimal delivery of surfactant is discussed.

Antimicrobial and Biophysical Properties of Surfactant Supplemented with an Antimicrobial Peptide for Treatment of Bacterial Pneumonia

“…Pulmonary surfactant contains ca. 10 to 15% acidic phospholipids, mainly phosphatidylglycerol (PG), with which the cathelicidins could electrostatically interact (23). Although surfactant composition is more com- plex than simple lipid mixtures, the idea of the interaction with PG is supported by studies by Sevcsik et al (24).…”

Exogenous Surfactant Treatment in Children with ARDS

“…Using exogenous surfactant in the early stage of ARDS could be associated with lower dosage, better distribution and better efficacy. When lungs are less injured, other ways of administration could also be used, such as simple instillation or aerosolization because some new experimental studies (38)(39)(40) have shown a good distribution of these less invasive tools especially when lungs have not yet deteriorated. Other investigations in exogenous surfactant treatment in ARDS examined the possibility of using different types of synthetic surfactant.…”

Challenges Associated with Route of Administration in Neonatal Drug Delivery

“…The procedure often requires intubation, and atelectasis with collapsed alveoli is a frequent comorbidity which may lead to uneven distribution in the lung. Despite this, there have been several recent (non-invasive) procedures developed for surfactant delivery which have been well-described in a review by El-Gendy et al [99].…”

“…Another developmental concern is the surfactant deficiency often experienced by neonates born at \28 weeks' gestational age that frequently results in respiratory distress syndrome [98,99]. These patients typically receive prophylactic and/or rescue surfactant replacement therapy, which may complicate further drug delivery to the lungs, although some drugs such as antibiotics, anti-inflammatory agents, and bronchodilators may potentially be deliverable using surfactant as a vehicle [100][101][102][103].…”