Pulmonary surfactant (medication)

Pulmonary surfactant

Carton of beractant (Survanta), surrounded by devices for its application.
Clinical data
Pronunciation	Curosurf, Survanta, others
Other names	Beractant, Poractant alfa, others
AHFS/Drugs.com	Monograph
License data	US  DailyMed:  Poractant_alfa
ATC code	R07AA ( WHO )
Identifiers
CAS Number	129069-19-8  Y
ChemSpider	none
UNII	KE3U2023NP

Pulmonary surfactant is used as a medication to treat and prevent respiratory distress syndrome in newborn babies. ^[1]

Prevention is generally done in babies born at a gestational age of less than 32 weeks. ^[1] It is given by the endotracheal tube. ^[1] Onset of effects is rapid. ^[2] A number of doses may be needed. ^[2]

Side effects may include slow heart rate and low oxygen levels. ^[1] Its use is also linked with intracranial bleeding. ^[1] Pulmonary surfactant may be isolated from the lungs of cows or pigs or made artificially. ^{[1] [3] [4]}

Pulmonary surfactant was discovered in the 1950s and a manufactured version was approved for medical use in the United States in 1990. ^[3] It is on the World Health Organization's List of Essential Medicines. ^[5]

Medical uses

Pulmonary surfactant is used to treat and prevent respiratory distress syndrome in newborn babies. ^[1] Prevention is generally done in babies born less than 32 weeks gestational age. ^[1] Tentative evidence supports use in drowning. ^[6]

Surfactant administration can also be effective in meconium aspiration syndrome where it has been shown to help lower length of stay. ^{[7] [8]}

Types

See also: Pulmonary surfactant § composition

There are a number of types of pulmonary surfactants available. Like their natural counterparts, pulmonary surfactant preparations consist of phospholipids (mainly DPPC) combined with spreading agents such as SP-B and SP-C. ^[9] Ex-situ measurements of surface tension and interfacial rheology can help to understand the functionality of pulmonary surfactants. ^[10]

Synthetic pulmonary surfactants:

• Colfosceril palmitate (Exosurf) – a mixture of DPPC with hexadecanol and tyloxapol added as spreading agents
• Pumactant (Artificial Lung Expanding Compound or ALEC) – a mixture of DPPC and PG
• Lucinactant (KL4, trade name Surfaxin) – composed of DPPC, palmitoyl-oleoyl phosphatidylglycerol, and palmitic acid, combined with a 21 amino acid synthetic peptide (sinapultide) that mimics the C-terminal helical domain of SP-B. ^[11]
• Ventricute - DPPC, rSP-C

Animal-derived surfactants:

• Beractant (Survanta) – extracted from minced cow lung with additional DPPC, palmitic acid and tripalmitin, manufactured by Abbvie
  • (Beraksurf) – extracted from minced cow lung with additional DPPC, palmitic acid and tripalmitin, manufactured by Tekzima
• Calfactant (Infasurf) – extracted from calf lung lavage fluid, manufactured by ONY Biotech.
• Poractant alfa (Curosurf) – extracted from material derived from minced pig lung
• Surfactant TA (Surfacten) – derived from cows, manufactured by Tokyo Tanabe Co. ^[12]
• Bovactant SF-RI (Alveofact) – extracted from cow lung lavage fluid, manufactured by Boehringer Ingelheim

History

Researcher John Clements identified surfactants and their role in the 1950s. Mary Ellen Avery soon after showed that the lungs of premature infants could not produce surfactants. ^[13]

Exosurf, Curosurf, Infasurf, and Survanta were the initial surfactants approved for use in the US. ^[14]

In 2012, the US Food and Drug Administration approved an additional synthetic surfactant, lucinactant (Surfaxin). ^[15]

Research

Surfactant may be beneficial in those with COVID-19 associated acute respiratory distress syndrome. ^{[16] [17]}

References

1. British National Formulary: BNF 69 (69 ed.). British Medical Association. 2015. p. 217. ISBN   9780857111562.
2. Martin RJ, Crowley MA (2013). "Respiratory Problems". In Fanaroff AA, Fanaroff JM (eds.). Klaus and Fanaroff's Care of the High-Risk Neonate, Expert Consult - Online and Print,6: Klaus and Fanaroff's Care of the High-Risk Neonate. Elsevier Health Sciences. p. 252. ISBN   978-1416040019. Archived from the original on 9 January 2017.
3. Lantos JD, Meadow WL (2006). "The Era of Exposed Ignorance, 1982-1992". Neonatal Bioethics: The Moral Challenges of Medical Innovation. JHU Press. pp. 54–56. ISBN   9780801883446. Archived from the original on 9 January 2017.
4. Wratney AT, Cheifetz IM (2006). "Gases and Drugs Used in Support of the Respiratory System". In Slonim AD, Pollack MM (eds.). Pediatric Critical Care Medicine. Lippincott Williams & Wilkins. pp. 724–725. ISBN   9780781794695. Archived from the original on 9 January 2017.
5. World Health Organization (2023). The selection and use of essential medicines 2023: web annex A: World Health Organization model list of essential medicines: 23rd list (2023). Geneva: World Health Organization. hdl: 10665/371090 . WHO/MHP/HPS/EML/2023.02.
6. Ferguson JD, De Guzman J (2012). "Cardiac Arrest in Special Populations". In Brady B, Charlton NP, Lawner BJ, Sutherland SF (eds.). Cardiac Arrest, An Issue of Emergency Medicine Clinics. Elsevier Health Sciences. p. 175. ISBN   978-1455742769. Archived from the original on 9 January 2017.
7. El Shahed AI, Dargaville PA, Ohlsson A, Soll R (December 2014). "Surfactant for meconium aspiration syndrome in term and late preterm infants". The Cochrane Database of Systematic Reviews. 2014 (12): CD002054. doi:10.1002/14651858.CD002054.pub3. PMC   7027383 . PMID   25504256.
8. Walsh B (2019). Neonatal and Pediatric Respiratory Care. Elsevier. pp. 244–261. ISBN   978-0-323-47947-9.
9. Nkadi PO, Merritt TA, Pillers DA (June 2009). "An overview of pulmonary surfactant in the neonate: genetics, metabolism, and the role of surfactant in health and disease". Molecular Genetics and Metabolism. 97 (2): 95–101. doi:10.1016/j.ymgme.2009.01.015. PMC   2880575 . PMID   19299177.
10. Bertsch P, Bergfreund J, Windhab EJ, Fischer P (August 2021). "Physiological fluid interfaces: Functional microenvironments, drug delivery targets, and first line of defense". Acta Biomaterialia. 130: 32–53. doi: 10.1016/j.actbio.2021.05.051 . hdl: 20.500.11850/498803 . PMID   34077806. S2CID   235323337.
11. "KL4 Surfactant Technology". Windtree Therapeutics, Inc. Archived from the original on 29 July 2018. Retrieved 29 November 2017.
12. "T 0723/94 (Surfactant composition/TOKYO TANABE CO) of 18.2.1999". European Patent Office. Retrieved 30 April 2022.
13. Palca J (3 August 2015). "How A Scientist's Slick Discovery Helped Save Preemies' Lives". NPR . Archived from the original on 3 August 2015. Retrieved 3 August 2015.
14. Taeusch HW, Lu K, Ramierez-Schrempp D (2002). "Improving pulmonary surfactants" (PDF). Acta Pharmacologica Sinica. 23 Suppl: 11–5. Archived (PDF) from the original on 1 March 2015.
15. "Surfaxin (lucinactant) Intratracheal Suspension". U.S. Food and Drug Administration (FDA). Archived from the original on 13 November 2014. Retrieved 30 April 2022.
16. Davidson WJ, Dorscheid D, Spragg R, Schulzer M, Mak E, Ayas NT (2006). "Exogenous pulmonary surfactant for the treatment of adult patients with acute respiratory distress syndrome: results of a meta-analysis". Critical Care. 10 (2) R41. doi: 10.1186/cc4851 . PMC   1550886 . PMID   16542488.
17. Heching M, Lev S, Shitenberg D, Dicker D, Kramer MR (July 2021). "Surfactant for the Treatment of ARDS in a Patient With COVID-19". Chest. 160 (1): e9 –e12. doi:10.1016/j.chest.2021.01.028. PMC   7825915 . PMID   33493441.