Synthetic surfactants: where are we? Evidence from randomized, controlled clinical trials

Moya, Fernando

doi:10.1038/jp.2009.26

Cited by 16 publications

(10 citation statements)

References 26 publications

(37 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In the history of artificial surfactant development, early commercial synthetic surfactants included Exosurf® (GlaxoSmithKline, Brentford, UK) and Surfaxin® (Discovery Laboratories, Warrington, PA, USA). Exosurf® contains DPPC only without SP, while Surfaxin® has the synthetic peptide KL4 as an analogue of human SP-B 12. However, animal derived (bovine and porcine) natural SP has been found to be clinically superior to synthetic surfactant.…”

Section: Discussionmentioning

confidence: 99%

A Combination of Short and Simple Surfactant Protein B and C Analogues as a New Synthetic Surfactant: In Vitro and Animal Experiments

2017

View full text Add to dashboard Cite

PurposePulmonary surfactants for preterm infants contain mostly animal-derived surfactant proteins (SPs), which are essential for lowering surface tension. We prepared artificial pulmonary surfactants using synthetic human SP analogs and performed in vitro and in vivo experiments.Materials and MethodsWe synthesized peptide analogues that resemble human SP-B (RMLPQLVCRLVLRCSMD) and SP-C (CPVHLKRLLLLLLLLLLLLLLLL). Dipalmitoylphosphatidylcholine (DPPC), phosphatidylglycerol (PG), and palmitic acid (PA) were added and mixed in lyophilized to render powdered surfactant. Synsurf-1 was composed of DPPC:PG:PA:SP-B (75:25:10:3, w/w); Synsurf-2 was composed of DPPC:PG:PA:SP-C (75:25:10:3, w/w); and Synsurf-3 was composed of DPPC:PG:PA:SP-B:SP-C (75:25:10:3:3, w/w). We performed in vitro study to compare the physical characteristics using pulsating bubble surfactometer and modified Wilhelmy balance test. Surface spreading and adsorption test of the surfactant preparations were measured. In vivo test was performed using term and preterm rabbit pups. Pressure-volume curves were generated during the deflation phase. Histologic findings were examined.ResultsPulsating bubble surfactometer readings revealed following minimum and maximum surface tension (mN/m) at 5 minutes: Surfacten® (5.5±0.4, 32.8±1.6), Synsurf-1 (16.7±0.6, 28.7±1.5), Synsurf-2 (7.9±1.0, 33.1±1.6), and Synsurf-3 (7.1±0.8, 34.5±1.0). Surface spreading rates were as follows: Surfacten® (27 mN/m), Synsurf-1 (43 mN/m), Synsurf-2 (27 mN/m), and Synsurf-3 (27 mN/m). Surface adsorption rate results were as follows: Surfacten® (28 mN/m), Synsurf-1 (35 mN/m), Synsurf-2 (29 mN/m), and Synsurf-3 (27 mN/m). The deflation curves were best for Synsurf-3; those for Synsurf-2 were better than those for Surfacten®. Synsurf-1 was the worst surfactant preparation. Microscopic examination showed the largest aerated area of the alveoli in the Synsurf-3 group, followed by Synsurf-1 and Surfacten®; Synsurf-2 was the smallest.ConclusionSynsurf-3 containing both SP-B and SP-C synthetic analogs showed comparable and better efficacy than commercially used Surfacten® in lowering surface tension, pressure-volume curves, and tissue aerated area of the alveoli.

show abstract

Section: Discussionmentioning

confidence: 99%

A Combination of Short and Simple Surfactant Protein B and C Analogues as a New Synthetic Surfactant: In Vitro and Animal Experiments

2017

View full text Add to dashboard Cite

show abstract

“…Also, these surfactants contain foreign proteins that may be potentially immunogenic and infectious. 6 Synthetic surfactants, which are free of animal proteins, may have advantages over animal-derived surfactants due to their lack of immune reactions, proinflammatory mediators causing bronchopulmonary dysplasia (BPD), and animal-borne infectious agents. 6 They are also reproducible and have fewer production limitations than animal-derived surfactants.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Surfactant-TA, Calfactant and Poractant Alfa for Preterm Infants with Respiratory Distress Syndrome: A Retrospective Study

Jeon

Sin

2015

Yonsei Med J

View full text Add to dashboard Cite

PurposeTo compare the efficacy of the new drug calfactant with the commonly used drugs surfactant-TA and poractant alfa.Materials and MethodsA total of 332 preterm infants at 24-31 weeks' gestation with respiratory distress syndrome (RDS) were enrolled and allocated to three groups according to the surfactant instilled; Group 1 (n=146, surfactant-TA), Group 2 (n=96, calfactant), and Group 3 (n=90, poractant alfa). The diagnosis of RDS and the decision to replace the pulmonary surfactant were left to the attending physician and based on patient severity determined by chest radiography and blood gas analysis. Data were collected and reviewed retrospectively using patient medical records.ResultsDemographic factors including gestational age, birth weight, Apgar score, clinical risk index for babies II score, and maternal status before delivery were not different between the study groups. Instances of surfactant redosing and pulmonary air leaks, as well as duration of mechanical ventilation, were also not different. Rates of patent ductus arteriosus, intraventricular hemorrhage (≥grade III), periventricular leukomalacia, high stage retinopathy of prematurity, necrotizing enterocolitis (≥stage II), and mortality were also similar, as was duration of hospital stay. Cases of pulmonary hemorrhage and moderate to severe bronchopulmonary dysplasia were increased in Group 3.ConclusionCalfactant is equally as effective as surfactant-TA and poractant alfa. This was the first study comparing the efficacy of surfactant-TA, calfactant, and poractant alfa in a large number of preterm infants in Korea. Further randomized prospective studies on these surfactants are needed.

show abstract

“…It had been shown that its therapeutic effect was inferior to that of natural surfactant. The rise of protein-containing synthetic surfactant, such as lucinactant (Surfaxin ® ), has offered scientists a new avenue to further expand upon our advancement in surfactant as its action has been hypothesised to be as effective as, or even better than, natural surfactant [15,16]. The purpose of this review is to identify the key components of surfactant analogues, discuss the trials comparing surfactant types, analyse the methods of surfactant administration, and highlight recent developments.…”

Section: Introductionmentioning

confidence: 99%

The Role of Surfactant in Respiratory Distress Syndrome

Cheng-Hwa¹

2012

TORMJ

View full text Add to dashboard Cite

The key feature of respiratory distress syndrome (RDS) is the insufficient production of surfactant in the lungs of preterm infants. As a result, researchers have looked into the possibility of surfactant replacement therapy as a means of preventing and treating RDS. We sought to identify the role of surfactant in the prevention and management of RDS, comparing the various types, doses, and modes of administration, and the recent development. A PubMed search was carried out up to March 2012 using phrases: surfactant, respiratory distress syndrome, protein-containing surfactant, protein-free surfactant, natural surfactant, animal-derived surfactant, synthetic surfactant, lucinactant, surfaxin, surfactant protein-B, surfactant protein-C.Natural, or animal-derived, surfactant is currently the surfactant of choice in comparison to protein-free synthetic surfactant. However, it is hoped that the development of protein-containing synthetic surfactant, such as lucinactant, will rival the efficacy of natural surfactants, but without the risks of their possible side effects. Administration techniques have also been developed with nasal continuous positive airway pressure (nCPAP) and selective surfactant administration now recommended; multiple surfactant doses have also reported better outcomes. An aerosolised form of surfactant is being trialled in the hope that surfactant can be administered in a non-invasive way. Overall, the advancement, concerning the structure of surfactant and its mode of administration, offers an encouraging future in the management of RDS.

show abstract

Synthetic surfactants: where are we? Evidence from randomized, controlled clinical trials

Cited by 16 publications

References 26 publications

A Combination of Short and Simple Surfactant Protein B and C Analogues as a New Synthetic Surfactant: In Vitro and Animal Experiments

A Combination of Short and Simple Surfactant Protein B and C Analogues as a New Synthetic Surfactant: In Vitro and Animal Experiments

Efficacy of Surfactant-TA, Calfactant and Poractant Alfa for Preterm Infants with Respiratory Distress Syndrome: A Retrospective Study

The Role of Surfactant in Respiratory Distress Syndrome

Contact Info

Product

Resources

About