Institute of Functional and Applied Anatomy, Hannover Medical School, Hannover, Germany.
J Heart Lung Transplant. 2012 Jan;31(1):85-93. doi: 10.1016/j.healun.2011.10.002.
Surfactant inactivation results from ischemia/reperfusion injury and plays a major role in the pathogenesis of primary graft dysfunction after clinical lung transplantation. Thus, prophylactic administration of exogenous surfactant preparations before the onset of ischemia/reperfusion has proven to be effective in preserving pulmonary structure and function. Various natural and synthetic surfactant preparations exhibit differences regarding the biochemical composition and biophysical properties.
In this study we compared the efficacy of preservation of pulmonary structure and function of the natural surfactant preparations Curosurf and Survanta to that of a synthetic surfactant containing an analog of surfactant protein C (SPC-33) in a rat model of ischemia/reperfusion injury. The oxygenation capacity and peak inspiratory pressure during the reperfusion period were recorded. By applying design-based stereology at the light- and electron-microscopic level, pathologic alterations, including alveolar edema, injury of the blood-air barrier and the intra-alveolar as well as intracellular surfactant pools, were quantified.
The best oxygenation and preservation of lung structure was achieved with Curosurf. Survanta treatment was associated with the most severe injury of the blood-air barrier, and SPC-33 demonstrated signs of microatelectasis. The intra-alveolar surfactant pool after Curosurf and SPC-33 was dominated by active surfactant subtypes, whereas Survanta was associated with the highest fraction of inactive surfactant. The intracellular surfactant pool did not show any differences between the treatment groups.
Taken together, Curosurf achieved the best structural and functional lung preservation, whereas Survanta was inferior to both Curosurf and SPC-33.
表面活性剂失活是由缺血/再灌注损伤引起的，在临床肺移植后原发性移植物功能障碍的发病机制中起主要作用。因此，在缺血/再灌注发生之前预防性给予外源性表面活性剂制剂已被证明可有效维持肺结构和功能。各种天然和合成表面活性剂制剂在生化组成和生物物理特性方面存在差异。
在本研究中，我们比较了天然表面活性剂制剂 Curosurf 和 Survanta 与含有表面活性蛋白 C 类似物（SPC-33）的合成表面活性剂制剂在大鼠缺血/再灌注损伤模型中对肺结构和功能的保存效果。记录再灌注期间的氧合能力和吸气峰压。通过应用基于设计的光镜和电镜体视学，定量了包括肺泡水肿、气血屏障损伤以及肺泡内和细胞内表面活性剂池在内的病理改变。
Curosurf 可实现最佳的氧合和肺结构保存。Survanta 治疗与气血屏障损伤最严重相关，而 SPC-33 表现出微肺不张的迹象。Curosurf 和 SPC-33 处理后的肺泡内表面活性剂池以活性表面活性剂亚型为主，而 Survanta 则与最高比例的非活性表面活性剂相关。细胞内表面活性剂池在治疗组之间没有差异。
综上所述，Curosurf 实现了最佳的结构和功能肺保存，而 Survanta 不如 Curosurf 和 SPC-33。
