title: Surfactant "fortification"  by topical inhibition of nuclear   factor-kappaB activity in a newborn piglet lavage model.
abstract: OBJECTIVE
  In acute respiratory distress syndrome of term newborn infants, surfactant replacement may be effective because endogenous surfactant is decreased and structurally changed. Inflammation is central to acute respiratory distress syndrome, and hence, attenuation of proinflammatory transcription factor nuclear factor (NF)-[kappa]B activation in the lung might prevent secondary loss of surfactant function. In this study, we tested the hypothesis that the topical use of a NF-[kappa]B inhibitor (I[kappa]B kinase-NF-[kappa]B essential modulator binding domain [IKK-NBD] peptide), together with surfactant as a carrier substance, improves surfactant function by attenuation of pulmonary inflammation during 24 hrs of mechanical ventilation in a neonatal piglet model of acute respiratory distress syndrome by repeated airway lavage.
  
  
  METHODS
  Prospective, randomized, controlled study.
  
  
  METHODS
  Research laboratory of a university children's hospital.
  
  
  METHODS
  A total of 24 anesthetized, mechanically ventilated newborn piglets.
  
  
  METHODS
  After 20 +/- 6 (mean +/- sd) lavages to induce lung failure and inflammation, a porcine surfactant (100 mg/kg) with (S+IKK) or without (S) 1.25 mg of IKK-NBD peptide, or an air bolus (control) was administered into the airways. Lung function was monitored throughout 24 hrs of mechanical ventilation and completed by ex vivo analyses.
  
  
  RESULTS
  Pao2 (S+IKK, 125 +/- 16 mm Hg; S, 105 +/- 33; control, 61 +/- 20), ventilation efficiency index, functional residual capacity, compliance of the respiratory system, and extravascular lung water (S+IKK, 24 +/- 2 mL/kg; S, 30 +/- 7; control, 34 +/- 8) were all significantly improved in S+IKK piglets after 24 hrs. Decreased leukocyte concentrations in bronchoalveolar lavage (S+IKK, 152 +/- 94 cells/microL; S, 202 +/- 100; control, 276 +/- 57) were observed together with reduced acid sphingomyelinase activity, lowered ceramide concentrations, improved surfactant function (minimum surface tension: S+IKK, 10.8 +/- 6.1 mN/m; S, 13.2 +/- 3.9; control, 20.9 +/- 8.5), and decreased NF-[kappa]B activation in lung tissue.
  
  
  CONCLUSIONS
  Supplementation of exogenous surfactant with a NF-[kappa]B inhibitor to create a "fortified" surfactant improves gas exchange, lung function, and pulmonary edema during 24 hrs of mechanical ventilation, without a secondary functional relapse. Inhibition of NF-[kappa]B suppressed acid sphingomyelinase activity and ceramide generation, indicating a novel proinflammatory link of NF-[kappa]B.
authors.affiliation: Department of Pediatrics, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Schwanenweg 20, 24105 Kiel, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: von Bismarck
authors.forename: Karsten
authors.initials: K
authors.lastname: Klemm
authors.forename: Carlos-Francisco García
authors.initials: CF
authors.lastname: Wistädt
authors.forename: Supandi
authors.initials: S
authors.lastname: Winoto-Morbach
authors.forename: Ulrike
authors.initials: U
authors.lastname: Uhlig
authors.forename: Stefan
authors.initials: S
authors.lastname: Schütze
authors.forename: Stefan
authors.initials: S
authors.lastname: Uhlig
authors.forename: Burkhard
authors.initials: B
authors.lastname: Lachmann
authors.forename: Martin F
authors.initials: MF
authors.lastname: Krause
mesh_terms: D000818:Animals; D000831:Animals, Newborn; D006801:Humans; D007231:Infant, Newborn; D047908:Intracellular Signaling Peptides and Proteins / Q000627:therapeutic use*; D016328:NF-kappa B / Q000037:antagonists & inhibitors*; D012127:Respiratory Distress Syndrome, Newborn / Q000188:drug therapy*; D013501:Surface-Active Agents / Q000627:therapeutic use*; D013552:Swine
chemical_list: D047908:Intracellular Signaling Peptides and Proteins; D016328:NF-kappa B; D013501:Surface-Active Agents; C015482:protein kinase modulator