Strayer D S, Merritt T A, Hallman M
Department of Pathology and Laboratory Medicine, University of Texas, Houston.
Eur Respir J Suppl. 1989 Mar;3:91s-96s.
We sought to analyse the potential immunogenicity of human alveolar surfactant as it is currently used in the treatment of neonatal respiratory distress syndrome (RDS). An enzyme linked immunosorbant assay capable of detecting specific immune complexes between surfactant and antibodies directed to surfactant was developed. Premature infants with RDS were divided into groups: one group received surfactant replacement and one received conventional therapy. Plasma samples obtained from these infants at birth and thereafter were examined for specific circulating immune complexes between surfactant and anti-surfactant antibodies. All babies were also examined for clinical and serological evidence of immune complex-mediated tissue damage. We found that almost all infants with RDS, regardless of their therapy, showed evidence of circulating surfactant-anti-surfactant immune complexes. Plasma samples from infants without RDS showed no such complexes. Immune complexes appeared early in postnatal life, usually within the first week, and diminished thereafter. We detected no evidence of altered plasma complement levels or end organ damage attributable to these immune complexes. Thus, circulating immune complexes between surfactant and antibodies to surfactant are common in neonatal respiratory distress syndrome, though they do not appear to cause injury. Since not only human but heterologous surfactants are now used in treating RDS, we feel that cautious evaluation of potential immune reactions to the administered materials should be undertaken.
我们试图分析目前用于治疗新生儿呼吸窘迫综合征（RDS）的人肺泡表面活性物质的潜在免疫原性。开发了一种酶联免疫吸附测定法，能够检测表面活性物质与针对表面活性物质的抗体之间的特异性免疫复合物。患有RDS的早产儿被分为两组：一组接受表面活性物质替代治疗，另一组接受传统治疗。从这些婴儿出生时及之后采集的血浆样本，检测表面活性物质与抗表面活性物质抗体之间的特异性循环免疫复合物。还对所有婴儿进行了免疫复合物介导的组织损伤的临床和血清学证据检查。我们发现，几乎所有患有RDS的婴儿，无论接受何种治疗，均显示有循环的表面活性物质-抗表面活性物质免疫复合物的证据。未患RDS的婴儿的血浆样本未显示此类复合物。免疫复合物在出生后早期出现，通常在第一周内，此后减少。我们未检测到这些免疫复合物导致血浆补体水平改变或终末器官损伤的证据。因此，表面活性物质与抗表面活性物质抗体之间的循环免疫复合物在新生儿呼吸窘迫综合征中很常见，尽管它们似乎不会造成损伤。由于现在不仅用人源表面活性物质，而且用异源表面活性物质治疗RDS，我们认为应该对所使用材料的潜在免疫反应进行谨慎评估。
