Surfactant disaturated-phosphatidylcholine kinetics in acute respiratory distress syndrome by stable isotopes and a two compartment model.
BACKGROUND
In patients with acute respiratory distress syndrome (ARDS), it is well known that only part of the lungs is aerated and surfactant function is impaired, but the extent of lung damage and changes in surfactant turnover remain unclear. The objective of the study was to evaluate surfactant disaturated-phosphatidylcholine turnover in patients with ARDS using stable isotopes.


METHODS
We studied 12 patients with ARDS and 7 subjects with normal lungs. After the tracheal instillation of a trace dose of 13C-dipalmitoyl-phosphatidylcholine, we measured the 13C enrichment over time of palmitate residues of disaturated-phosphatidylcholine isolated from tracheal aspirates. Data were interpreted using a model with two compartments, alveoli and lung tissue, and kinetic parameters were derived assuming that, in controls, alveolar macrophages may degrade between 5 and 50% of disaturated-phosphatidylcholine, the rest being lost from tissue. In ARDS we assumed that 5-100% of disaturated-phosphatidylcholine is degraded in the alveolar space, due to release of hydrolytic enzymes. Some of the kinetic parameters were uniquely determined, while others were identified as lower and upper bounds.


RESULTS
In ARDS, the alveolar pool of disaturated-phosphatidylcholine was significantly lower than in controls (0.16 +/- 0.04 vs. 1.31 +/- 0.40 mg/kg, p < 0.05). Fluxes between tissue and alveoli and de novo synthesis of disaturated-phosphatidylcholine were also significantly lower, while mean resident time in lung tissue was significantly higher in ARDS than in controls. Recycling was 16.2 +/- 3.5 in ARDS and 31.9 +/- 7.3 in controls (p = 0.08).


CONCLUSIONS
In ARDS the alveolar pool of surfactant is reduced and disaturated-phosphatidylcholine turnover is altered.
Cogo
Paola E
PE
Department of Pediatrics, University of Padova, Padova, Italy. cogo@pediatria.unipd.it
Toffolo
Gianna Maria
GM
Ori
Carlo
C
Vianello
Andrea
A
Chierici
Marco
M
Gucciardi
Antonina
A
Cobelli
Claudio
C
Baritussio
Aldo
A
Carnielli
Virgilio P
VP
D015060:1,2-Dipalmitoylphosphatidylcholine / Q000008:administration & dosage / Q000493:pharmacokinetics; D000328:Adult; D000368:Aged; D002247:Carbon Isotopes; D005260:Female; D006801:Humans; D007322:Instillation, Drug; D008168:Lung / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D011650:Pulmonary Alveoli / Q000378:metabolism*; D011663:Pulmonary Surfactants / Q000737:chemistry* / Q000378:metabolism*; D012128:Respiratory Distress Syndrome / Q000378:metabolism*; D014132:Trachea
D002247:Carbon Isotopes; D011663:Pulmonary Surfactants; D015060:1,2-Dipalmitoylphosphatidylcholine