title: Lung preservation in experimental ischemia/reperfusion injury and lung transplantation: a comparison of natural and synthetic surfactants.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  Taken together, Curosurf achieved the best structural and functional lung preservation, whereas Survanta was inferior to both Curosurf and SPC-33.
authors.affiliation: Institute of Functional and Applied Anatomy, Hannover Medical School, Hannover, Germany. knudsen.lars@mh-hannover.de
authors.forename: Lars
authors.initials: L
authors.lastname: Knudsen
authors.forename: Laura
authors.initials: L
authors.lastname: Boxler
authors.forename: Christian
authors.initials: C
authors.lastname: Mühlfeld
authors.forename: Inga-Marie
authors.initials: IM
authors.lastname: Schaefer
authors.forename: Laura
authors.initials: L
authors.lastname: Becker
authors.forename: Christine
authors.initials: C
authors.lastname: Bussinger
authors.forename: Immanuel
authors.initials: I
authors.lastname: von Stietencron
authors.forename: Navid
authors.initials: N
authors.lastname: Madershahian
authors.forename: Joachim
authors.initials: J
authors.lastname: Richter
authors.forename: Thorsten
authors.initials: T
authors.lastname: Wahlers
authors.forename: Thorsten
authors.initials: T
authors.lastname: Wittwer
authors.forename: Matthias
authors.initials: M
authors.lastname: Ochs
mesh_terms: D000818:Animals; D001688:Biological Products / Q000494:pharmacology*; D015824:Blood-Air Barrier / Q000187:drug effects; D004195:Disease Models, Animal; D016040:Lung Transplantation; D008297:Male; D009926:Organ Preservation / Q000379:methods*; D019188:Organ Preservation Solutions / Q000494:pharmacology*; D055031:Primary Graft Dysfunction / Q000378:metabolism / Q000503:physiopathology / Q000517:prevention & control*; D011663:Pulmonary Surfactants / Q000494:pharmacology*; D051381:Rats; D017207:Rats, Sprague-Dawley; D015427:Reperfusion Injury / Q000150:complications / Q000188:drug therapy* / Q000378:metabolism; D012129:Respiratory Function Tests; D016896:Treatment Outcome
chemical_list: D001688:Biological Products; D019188:Organ Preservation Solutions; D011663:Pulmonary Surfactants; C072197:beractant