Rozprawy doktorskie na temat „Pulmonary surfactant”

SP-B and SP-C are two pulmonary surfactant proteins. They were isolated in the tear film in 2006 (Lukovic et al. 2006). The molecular mechanism governing lipid spreading in the tear film is not well understood and, along with their production in yeast (as an alternative to animal derived material) provide the motives for this research. To investigate the involvement of SP-B and SP-C in lipid spreading, SP-B and SP-C have been produced as recombinant proteins in Pichia pastoris yeast. SP-B and SP-C are cleaved from their proproteins to produce mature active proteins and both forms were produced recombinantly. The proteins were extracted with detergents, polymers and organic solvents to determine the best method of protein isolation and purification. Purified proteins were subsequently tested for surface activity using a Langmuir trough; proSP-C10 and SP-B demonstrated surface tension activity. The mechanism of SP-B and SP-C was examined through generation of ab initio structural models. The behaviour of SP-B and SP-C was observed in membranes based on phospholipid compositions surrounding the SP-B and SP-C in the yeast plasma membrane using mass spectrometry analysis. Computational modelling then demonstrated that SP-B induces lipid curvature, whilst SP-C may help to stabilise lipid vesicles by forming a molecular bridge between the membrane and vesicle. SP-B is thought to help remodel the lung lipid layer on compression through the formation of vesicles that are connected to the membrane by SP-C.

Thesis advisor: Mary F. Roberts<br>Thesis advisor: Eranthie Weerapana<br>Peripheral proteins from mammals often exhibit multi-domain structures and require metal ions such as calcium as co-factors. This dissertation investigates two types of such proteins -- pulmonary collectins (surfactant proteins A and D) and phosphatidylinositol-specific phospholipase C (PLC) delta1 -- and their interactions with model membranes. One approach to work around the complexity brought upon by such multi-domain protein structure is to use a truncated construct or an isolated single domain. For pulmonary collectins, homotrimers consisting of the neck domain and the carbohydrate recognition domain were used in a novel NMR assay for better understanding of their lipid-specific interactions with the membranes. For PLC delta1, we were particularly interested in the role of the EF-hand domain. The isolated EF-hand domain of PLC delta1 was first used to characterize its interactions with membranes and identify key residues responsible for such interactions. These key residues in the N terminal lobe of the EF-hand domain, either cationic or hydrophobic, were then found to affect the hydrolysis activity of the full-length enzyme. A common role for this region of the PLC in facilitating proper membrane association was thus proposed<br>Thesis (PhD) — Boston College, 2013<br>Submitted to: Boston College. Graduate School of Arts and Sciences<br>Discipline: Chemistry

Abstract Pulmonary surfactant is a lipid-protein mixture that lines the inner surface of the lung. The main function of surfactant is to reduce surface tension at the air-liquid interface, thus preventing alveolar collapse at the end of expiration. Lack of surfactant is the main cause of respiratory distress syndrome (RDS) in preterm infants. Very preterm babies are at risk of developing a lung disease called bronchopulmonary dysplasia (BPD). The surfactant proteins SP-A, -B, -C and -D have important functions in surfactant structure, homeostasis and innate immunity of the lung. The genes of these proteins have been studied as candidates for several multifactorial lung diseases both in adults and in children. The aim of the present study was to examine the genetic variation in SP genes and to evaluate the role of SP gene polymorphism in the etiology of severe pulmonary infantile diseases, including RDS, BPD and severe respiratory syncytial virus (RSV) infection among the Finnish population. Conventional allelic association methods in combination with multiparameter analysis and family-based transmission disequilibrium test (TDT) were used. The SP-D Met11 allele was associated with a risk for severe RSV bronchiolitis in a matched case-control setting of 84 infants with severe RSV infection and 93 control infants. The variants of the SP-C gene had no detectable association with BPD. However, a modest association of SP-C Asn138 and Asn186 alleles with RDS was found. A length variation in the SP-B gene was associated with BPD among very preterm infants born before 32 weeks of gestation. The SP-B intron 4 deletion variant allele increased the risk for BPD especially in very low birth weight infants. The association was confounded by birth order, being evident only among presenting infants, who are more prone to ascending infections during a preterm birth process. The present study provides new evidence about the significance of SP gene polymorphisms in the etiology of complex infantile pulmonary diseases, including RDS, BPD and severe RSV bronchiolitis. The results help us to understand the molecular mechanisms underlying these diseases and may, in the long run, enable better treatment of these life-threatening diseases<br>Tiivistelmä Keuhkosurfaktantti on keuhkon sisäpintaa peittävä kalvomainen rasva-proteiinikompleksi, jonka tärkein ominaisuus on pintajännityksen vähentäminen keuhkorakkuloissa. Surfaktantin puutos ennenaikaisesti syntyneillä lapsilla aiheuttaa hengitysvaikeusoireyhtymän, RDS-taudin (respiratory distress syndrome). Alle 30 raskausviikon iässä syntyneistä, useimmiten RDS-taudin saaneista keskosista n. 30 % sairastuu vakavaan krooniseen keuhkotautiin, BPD-tautiin (bronchopulmonary dysplasia). Surfaktanttiproteiineilla SP-A, -B, -C ja -D on osoitettu olevan tärkeä tehtävä surfaktantin toiminnassa ja keuhkon synnynnäisessä immuniteetissa. Tämän tutkimuksen tavoitteena oli selvittää surfaktanttiproteiineissa esiintyvän geneettisen muuntelun määrää ja merkitystä keskosten RDS- ja BPD-taudeissa sekä pienten lasten vakavassa respiratory syncytial -viruksen (RSV) aiheuttamassa keuhkotulehduksessa. Tutkimuksen laajin osa keskittyi tutkimaan keskosten BPD-tautia ja surfaktanttiproteiinien geenien osuutta siinä. Geneettisen muuntelun merkitystä tarkasteltiin populaatiogeneettisin keinoin tapaus-verrokkiasetelmissa ja perheaineistojen avulla. Yhteensä analysoitiin noin tuhannen lapsen ja yli kahdensadan vanhemman DNA-näytteet. Tutkimuksessa havaittiin SP-D-geenissä olevan metioniini11-geenimuodon liittyvän pienten lasten vakavaan RSV-infektioon. Lisäksi saatiin uutta tietoa SP-C-geenin populaatiotason yleisestä muuntelusta ja todettiin SP-C:n asparagiini138 ja asparagiini186 -geenimuotojen yhteys keskosten RDS-taudin esiintymiseen. Merkittävin löydös oli SP-B-geenissä olevan deleetiovariantin kytkeytyminen alle 32-viikkoisina syntyneiden keskosten BPD-tautiin. Geneettisen altistuksen lisäksi BPD-tautiin sairastumiseen vaikuttivat lukuisat keskosuudelle ominaiset seikat, kuten alhainen syntymäpaino, RDS-tauti ja syntymähetkellä todettu hapenpuute. Geneettisen tekijän vaikutus oli voimakkain erittäin pienipainoisilla keskosilla. Tutkimuksen tulokset ovat tuoneet arvokasta lisätietoa surfaktanttiproteiinien geenien osuudesta keskosten RDS- ja BPD-taudeissa sekä pienten lasten vakavassa RSV-infektiossa. Ne auttavat ymmärtämään näiden molekyylibiologisia syntymekanismeja ja voivat ajan mittaan olla edistämässä uusien hoitomuotojen kehittämistä

La Thérapie par Substitution de Surfactant (TSS), qui opère par instillation d’une solution de surfactant directement dans l’arbre bronchique, est un traitement essentiel chez les nouveau-nés souffrant de syndrome de détresse respiratoire (SDRN). Cette procédure s’est révélée remarquablement efficace chez les grands prématurés, contribuant à la division par cinq de leur mortalité depuis les années 1980. À l’inverse, son utilisation s’est avérée décevante chez l’adulte dans le traitement du syndrome de détresse respiratoire aigu (SDRA), se soldant par un échec après des premiers essais pourtant prometteurs.Dans cette thèse, nous présentons un modèle mathématique et numérique de la propagation de bouchons liquides dans le système pulmonaire aérien de mammifères. Dans ce but, nous commençons par créer des modèles d’arbres trachéobronchiques chez le rat, le cochon ou l’homme. Ces modèles sont définis non seulement par leurs propriétés d’échelle mais également par leur structure tridimensionnelle indispensable à la simulation du transport liquidien. Les géométries ainsi créées sont comparées aux données morphométriques de la littérature.Nous présentons ensuite le modèle mathématique du transport liquidien. La principale propriété de ce modèle réside dans la décomposition de la propagation de bouchons liquides en deux étapes élémentaires fondamentales : (1) le dépôt de liquide sur les parois bronchiques lors de la propagation d’un bouchon, et (2) la division du bouchon liquide à chaque bifurcation de l’arbre. Les équations du processus de séparation sont déduites de la conservation de l’impulsion, pour tout type de bifurcation asymétrique. Cette décomposition en deux étapes élémentaires nous permet de calculer de manière efficace et rapide la propagation du surfactant dans l’intégralité de l’arbre aérien, fournissant ainsi un véritable outil de conception en génie biomédical.Ce modèle numérique est tout d’abord exploité pour calculer l’administration de surfactant chez le rat. Les rôles respectifs du volume initial, du débit et de l’injection multiple sont examinés. Nos résultats de simulations se révèlent être en bon accord avec les données de la littérature. En particulier, nous mettons en évidence le rôle joué par l’architecture monopodiale du rat qui contribue à la faible homogénéité de la distribution finale de surfactant. On observe également la forte non linéarité de la quantité de surfactant distribuée dans les acini en fonction du volume initial, en raison du dépôt d’une fraction de ce volume sur les parois bronchiques (le coût de dépôt). Des simulations de l’administration chez le cochon font apparaître les mêmes propriétés, avec cette fois une sensibilité accrue à la taille du poumon. Les effets respectifs de la gravité et de la tension de surface ne varient en effet pas suivant les mêmes lois d’échelle, ce qui se traduit par une distribution extrêmement inhomogène à bas débit ou à faible volume.Enfin, chez l’homme, notre modèle montre que l’origine de l’échec de la TSS chez l’adulte est possiblement à chercher dans la mécanique des fluides, l’accroissement du coût de dépôt aggravant la non-linéarité de l’administration. Cet effet peut être contré soit en instillant le surfactant à plus faible débit (mais au prix d’une distribution finale fortement inhomogène), soit en augmentant le volume initial. Nos résultats montrent en outre que, même pour des tailles comparables, les géométries très différentes de l’homme et du cochon ne permettent pas de traduire directement pour le premier les résultats obtenus chez le second. Un modèle fiable de l’administration est donc indispensable pour prédire l’efficacité de la TSS à partir de modèles animaux.En conclusion, cette thèse propose un nouvel outil permettant de prédire l’administration de surfactant chez l’animal et chez l’homme, de comprendre le rôle éventuel des modèles animaux, et en définitive de concevoir et d’optimiser de manière individualisée la TSS pour le patient<br>Surfactant Replacement Therapy (SRT), which involves instillation of a liquid-surfactant mixture directly into the lung airway tree, is a major therapeutic treatment in neonatal patients with respiratory distress syndrome (NRDS). This procedure has proved to be remarkably effective in premature newborns, contributing to a five-fold decrease of mortality since the 1980s. Disappointingly, its use in adults for treating acute respiratory distress syndrome (ARDS) experienced initial success followed by failures.In this PhD thesis, we present a mathematical and numerical model for the propagation of a liquid plug into the pulmonary airway system of mammals. To that intent, we first create realistic geometrical models of the tracheobronchial trees of mammals, rat, pig, and human, defined not only by their scaling properties but also by their 3D spatial embedding (i.e., branching and rotation angles), a description necessary for simulating liquid transport. The resulting geometries are compared with the available quantitative morphometric measurements found in the literature.We then introduce the mathematical model describing liquid plug transport. The main feature of this model is to decompose the propagation of liquid plugs in two fundamental elementary steps: (1) liquid deposition onto the airway walls during the propagation of a plug into a single airway, and (2) plug splitting at each bifurcation between two consecutive generations. The equations for the splitting process are derived from momentum conservation considerations, for any type of asymmetric bifurcation and any orientation with respect to gravity. The decomposition of the transport of liquid plugs into these essential steps allows us to compute efficiently and rapidly the propagation of surfactant into the entire airway tree, thus creating a truly biomedical engineering design tool.This mathematical and numerical model is first used to compute surfactant delivery into realistic asymmetric conducting airway trees of rat lung. The roles of dose volume, flow rate, and multiple aliquot deliveries are investigated. We find that our simulations of surfactant delivery in rat lungs are in good agreement with experimental data. In particular, we show that the monopodial architecture of the rat airway trees plays a major role in surfactant delivery, contributing to the poor homogeneity of the end distribution of surfactant. We also observe that increasing the initial dose volume increases in a nonlinear way the amount of surfactant delivered to the acini after losing a portion to coating the involved airways, the coating cost volume. Simulations of delivery in pig lungs exhibit the same general features, but our model demonstrates that SRT is very sensitive to the lung size. Surface tension and gravity effects do not scale similarly, and the end distribution can become highly nonhomogeneous at smaller flow rates or small dose volumes.Finally, in the human lung, our model shows that the failure of SRT in adults could, in fact, have a fluid mechanical origin that is potentially reversible. The coating cost is predicted to increase in adult lungs, enhancing the nonlinearity of the delivery process. This effect can be countered either by instilling the surfactant mixture at a smaller flow rate (but then the distribution is highly nonhomogeneous) or by using a larger dose volume. In addition, our results show that, even if sizes are comparable, the very different geometrical structures of pig and human lungs do not permit a direction translation of experimental results in pigs to humans, and that a reliable mathematical model of the delivery is absolutely crucial if one wants to predict the efficacy of SRT from animal models.In conclusion, this thesis provides a tool for predicting surfactant delivery in animals and humans, for understanding how to build animals models of SRT, and finally for engineering and optimizing patient-specific surfactant delivery in complex situations

Pulmonary surfactant is a complex mixture of lipids and proteins that lowers surface tension, increases lung compliance, and prevents the adhesion of respiratory surfaces and pulmonary oedema. Pressure can have an enormous impact on respiratory function, by mechanically compressing tissues, increasing gas tension resulting in increased gas absorption and by increasing dissolved gas tensions during diving, resulting in the formation of bubbles in the blood and tissues. The lungs of diving mammals have a huge range of morphological adaptations to enable them to endure the extremely high pressures associated with deep diving. Here, I hypothesise that surfactant will also be modified, to complement the morphological changes and enable more efficient lung function during diving. Molecular adaptations to diving were examined in surfactant protein C (SP-C) using phylogenetic analyses. The composition and function of pulmonary surfactant from several species of diving mammals was examined using biochemical assays, mass spectrometry and captive bubble surfactometry. The development of surfactant in one species of diving mammal (California sea lion), and the control of surfactant secretion using chemical and mechanical stimuli were also determined. Diving mammals showed modifications to SP-C, which are likely to lead to stronger binding to the monolayer, thereby increasing its fluidity. Phospholipid molecular species concentrations were altered to increase the concentration of more fluid species. There was also an increase in the percentage of alkyl molecular species, which may increase the stability of the monolayer during compression and facilitate rapid respreading. Levels of SP-B were much lower in the diving species, and cholesterol was inversely proportional to the maximum dive depth of the three species. Surface activity of surfactant from diving mammals was very poor compared to surfactant from terrestrial mammals. The newborn California sea lion surfactant was similar to terrestrial mammal surfactant, suggesting that these animals develop the diving-type of surfactant after they first enter the water. The isolated cells of California sea lions also showed a similar response to neuro-hormonal stimulation as terrestrial mammals, but were insensitive to pressure. These findings showed diving mammal surfactant to have a primarily anti-adhesive function that develops after the first entry into the water, with a surfactant monolayer, which would be better suited to repeated collapse and respreading.<br>Thesis (Ph.D.)--School of Earth and Environmental Sciences, 2005.

Lung cancer is a major cause of death in the world. Cancer chemotherapy is limited by adverse toxicities to normal tissues. Targeted delivery of anticancer drugs to lung cancer by inhalation would help to reduce these toxicities. Lipid based delivery systems have been shown to be effective in improving the delivery of a number of drugs and the potential of using non-ionic surfactant vesicles (NIV) to improve the delivery of Gemcitabine (Gem) was studied in this project. NIV were used to encapsulate Gem (Gem-NIV) for delivery by the pulmonary route. NIV were prepared using different concentrations of lipid (30, 60 and 150 mM) and characterised on the basis of size, drug entrapment efficiency and zeta potential. In vitro pulmonary delivery of Gem-NIV was compared with Gem solution using a multistage liquid impinger (MSLI). In vivo pulmonary delivery of Gem-NIV was also compared with Gem solution using two rodent models (Sprague-Dawley rats and BALB/c mice). The cytotoxicity of Gem formulations was assessed in in vitro studies using the B16-F0 luciferase melanoma cell line and in in vivo studies using lung cancer bearing BALB/c mice. Gem-NIV composed of 60 mM lipid exhibited the highest entrapment efficacy (80 ± 4%), nebulization efficiency (87 ± 6%) and physicochemical stability over a three-month period. Gem-NIV (60mM) were more effective at reaching the lower stages of the MSLI compared to Gem solution with significantly (P < 0.01) greater amounts of the drug being present in stage 1 and 2 of the MSLI, whereas Gem solution had a higher deposition in the mouth piece (P <0.01). In vivo drug delivery studies showed that there was a greater accumulation of Gem in the lungs of rats when administered as a NIV formulation prepared with 30 or 60 mM lipid at a dose of Gem of 15 or 6 mg/kg in comparison with free drug treatment. In lung cancer bearing mice, the Gem lung level was higher for Gem-NIV (60 mM) treated mice at dose 14 mg/ml (0.5ml) compared with the same dose of Gem solution. Gem-NIV prepared with 60 mM lipid were significantly (P < 0.01) more cytotoxic (IC50 0.87 ± 0.01 mg/ml) than Gem solution (IC50 4.45 ± 0.03 mg/ml) against the B16 F0 cell line. In this study, male mice had a significantly (P<0.05) higher severity of lung cancer than female mice according to lung weight data. On treatment with Gem-NIV (60 mM), a dose of 7 mg/ml was more effective in reducing the tumour burden in lungs than Gem solution in male BALB/c mice. The results of these studies indicate that Gem-NIV show significant potential to improve delivery of Gem for the treatment of lung cancer using pulmonary administration compared with Gem solution alone.

A imunização transcutânea (TCI) é uma via atrativa para o desenvolvimento de vacinação livre de agulhas, atuando nas APCs da pele, podendo substituir algumas das imunizações convencionais, em termos de facilidade, segurança e eficácia. O presente estudo avaliou a resposta imune da TCI com proteína recombinante de leptospira LipL32, uma proteína altamente conservada em cepas patogênicas e potente candidata vacinal. A TCI com a LipL32 na região abdominal de C57BL-6 foi capaz de primar o sistema imune, suscitando resposta sistêmica com altos níveis de anticorpos contra o antígeno, após reforços subimunizantes, ID e Tc. O padrão de citocinas em cultivo de células do sangue total dos grupos imunizados indicou que a imunização Tc foi capaz de primar o sistema imune, tanto inato quanto adaptativo. O tratamento local ou a coadministração com surfactantes ou PEG não evidenciou ação emoliente ou adjuvante. A coadministração Tc da LipL32 com MPL-A levou a efeito moderador da reação pro-inflamatória, redirecionando a resposta adaptativa, tanto humoral quanto celular.<br>Transcutaneous immunization (TCI) offers an attractive pathway for the development of needle-free vaccination by acting on APCs of the skin, showing potential to replace conventional immunization, in terms of safety and efficacy. In this study we evaluated the immune response by TCI with recombinant protein of leptospira LipL32, a highly conserved protein among pathogenic strains, a potential vaccine candidate. TCI with LipL32 was evaluated in C57BL-6 mice abdominal region and was able to confer systemic response with high levels of antibodies after subimmunizing ID and Tc boosters. The pattern of cytokines in cell cultures from whole blood of immunized groups indicated that the TCI was able to prime the immune system, for both innate and adaptive response. Local treatment of the skin or coadministration with surfactants and PEG did not show an emollient and an adjuvant action. Co-administration of LipL32 with MPL-A influenced the antibody response as well as showed a moderating effect of the pro-inflammatory reaction, redirecting the adaptive response.

Overwhelming inflammatory responses leading to neutrophil invasion are hypothesised to be the main cause of mortality in influenza virus induced acute respiratory distress syndrome (ARDS). Previously, pulmonary surfactant has been shown to modulate inflammatory responses to bacterial agents. The aim of the present study was to investigate the effect of pulmonary surfactant on innate immune responses in an in vitro model of influenza virus infected human airway epithelial cells. Human lung type II alveolar epithelial cells A549 and BEAS-2B human bronchial epithelial cells were infected with influenza A virus H1N1 strains A/Swine/1976/31, A/WSN/33 and A/PR/8/34. Poly I:C, Escherichia coli Ol 11 :B4 LPS and measles virus strain Edmonston were used as cytokine stimulation controls. The effect of pulmonary surfactant was compared to that of dexamethasone. This in vitro study showed that physiological concentrations (up to 500 ug/ml) of clinically approved SP-A and SP-D depleted surfactant preparations (i) were non-toxic in BEAS-2B cells, (ii) had no effect on influenza virus infectivity, and (iii) reduced influenza virus induced cytokine production comparable to dexamethasone. Porcine Curosurf* significantly inhibited IL-8 and RANTES production in A/WSN/33 infected cells, by 30 and 35% respectively (p&lt;0.05). Bovine Survanta* had a less pronounced effect. In luciferase reporter assays pulmonary surfactant, in contrast to dexamethasone, non-specifically inhibited both TLR3/RIG-I mediated NF-kappaB promoter activation and IFN-beta promoter activation. Our results indicate that SP-A and SP-D depleted surfactant preparations attenuate pro-inflammatory responses in influenza A virus infected human airway epithelial cells, but inhibitory effects on IFN-beta promoter activity were also observed. This suggests that pulmonary surfactant may be of clinical benefit in reducing pro-inflammatory responses in virus induced ARDS, however, a weakening of IFN-beta mediated anti-viral responses can not be excluded.

Paradoxalement, la sécurité routière est assurée entre autre par la production de particules d’usure ! Ainsi, près de 20 000 tonnes de garnitures de frein sont usées par an en France, dont 9 000 tonnes sous forme de particules d’usure aéroportées. Ces particules posent des problèmes de santé car leur composition chimique et leur morphologie font qu’elles interagissent avec la paroi alvéolaire entrainant des pathologies. Au cours de ces pathologies la phase la plus étudiée est la phase inflammatoire qui s’installe une fois que la particule a passé la première barrière de protection qui est le film de surfactant pulmonaire. En revanche, très peu d’études portent sur l’interaction directe des particules aéroportées avec le film de surfactant pulmonaire à cause de difficultés liées aux résolutions des moyens d’investigations cliniques. Alors-que ces études sont d’un intérêt fondamental puisque, de par ses propriétés physicochimiques de surfactant, ce film contrôle la mécanique respiratoire donc la capacité pulmonaire. Dans ce contexte, cette thèse analyse les mécanismes d’action de particules d’usure aéroportées modèles sur les propriétés physicochimiques et mécaniques des parois alvéolaires et plus particulièrement du film de surfactant pulmonaire. Pour cela, un modèle ex vivo de paroi alvéolaire reproduisant la composition, la microstructure du surfactant ainsi que les sollicitations mécaniques pendant les cycles respiratoires, a été mis au point. L’utilisation de ce modèle et les mesures associées ont permis d’élaborer une démarche d’identification des paramètres significatifs des particules qui déterminent leurs interactions avec le film de surfactant pulmonaire. Cela a permis de montrer que l’électronégativité des particules aéroportées est l’un des paramètres significatifs qui induit des changements couplés à différentes échelles, qui vont de la conformation moléculaire (nano), à la microstructure (micro) et aux propriétés mécaniques (macro) de la paroi alvéolaire, conduisant à la diminution de la capacité respiratoire. Ce modèle et les premiers résultats permettront à court terme, d’identifier les autres paramètres significatifs qui caractérisent les actions de particules d’usure aéroportées sur les propriétés mécaniques et physicochimiques des parois alvéolaires. Ceci permettra de connaitre leurs effets sur la capacité pulmonaire. Par conséquent, à plus long terme, cette connaissance permettra de modifier les matériaux en contact et leurs conditions de frottement pour générer des particules satisfaisant les exigences tribologiques et biologiques, donc tribo-bio-compatibles<br>Paradoxically, road safety is assured among others by the production of wear particles! Thus, almost 20 000 tons of brake linings are worn each year in France. 9000 tons are airborne wear particles. Due to their size, chemical composition and morphology these particles will interact with the alveolar wall causing pathologies. In these pathologies the most studied is the inflammatory phase that appear after the particle has passed the first protective barrier which is the pulmonary surfactant film. However, very few studies have examined the direct interaction of airborne wear particles with pulmonary surfactant film. These studies are of fundamental interest because, by its physicochemical properties, the pulmonary surfactant film control the respiratory mechanics, hence the pulmonary capacity. In this context, this thesis analyzes the interaction mechanism of model airborne wear particles on the physicochemical and mechanical properties of the alveolar wall and more particularly of pulmonary surfactant film. For this, an ex vivo model of alveolar wall reproducing the composition of the surfactant, its microstructure and the mechanical stresses during the breathing cycles has been developed. This model and the associated measures allowed to develop a method for identifying significant parameters of the particles that determine their interaction with the pulmonary surfactant film. The results showed that the electronegativity of airborne particles is one of the significant parameters which induces changes at different scales ranging from molecular conformation (nano), microstructure (micro) and mechanical properties (macro) of the alveolar wall, leading to the diminution of the pulmonary capacity. This model and the first results will allow, at short term, to identify other significant parameters which characterize the actions of airborne wear particles on mechanical and physicochemical properties of alveolar walls, allowing to know their effects on lung capacity. Therefore, at longer term, this knowledge will permit to change the materials in contact and their friction conditions to generate wear particles satisfying tribological and biological requirements, so tribo-bio-compatibles

Cystic fibrosis (CF) is a single gene Mendelian disorder characterized by pulmonary disease and pancreatic insufficiency. Pulmonary disease is the major cause of death in CF patients. Although some cystic fibrosis transmembrane conductance regulator (CFTR) genotypes are associated with less severe disease, patients possessing the same genotype show great variation in pulmonary disease severity and progression. Genes involved in modulating the inflammatory response and genes increasing susceptibility to infection are proposed as modifiers of pulmonary disease severity. Polymorphisms selected for based on evidence that they affect the function of the gene and prevalence of the putative risk allele: 1) antiprotease gene alpha-1-antitrypsin (alpha-1-AT), 2) innate immunity genes: mannose binding lectin (MBL2) (promoter [G→C] at -221 and codon 52 (Arg52Cys, D allele), 54 (Gly54Asp, B allele), and 57 (Gly57Glu, C allele), and pulmonary surfactant genes SPA-1 (Arg219Trp), SPA-2 (Thr9Asn, Lys223Gln) and SPD (Thr11Met), 3) antioxidant genes GSTM1 and T1 (gene deletion polymorphisms), GSTP1 (Ile105Val) and GCLC repeats, 4) mucin genes (MUC2 and MUC5B). Pulmonary disease progression and survival in patients with chronic Burkholderia cepacia complex (BCC) infection were also investigated controlling for genomovar and RAPD type of the organism. BCC infection was associated with more severe pulmonary disease progression and worse survival. Alpha-1-AT genotype was not a major contributor to variability of pulmonary disease severity, but the results suggest that alpha-1-AT plasma levels during pulmonary infections may be affected by poor nutritional status. We showed similar pulmonary disease progression and MBL2 genotype. Contrary to the previous literature, wild-type MBL2 genotype was associated with steeper decline in pulmonary disease over time following chronic infection with BCC, but genotype was not associated with increased susceptibility to BCC infection. We showed inconsistant results for the pulmonary surfactant gene polymorphisms, GSTM1, T1 and GSTP1 polymorphisms, and number of repeats for GCLC and MUC5B depending on the phenotype investigated. We conclude that some of the variability in pulmonary disease severity and progression in CF is explained by polymorphisms in secondary genes.

Neste trabalho foram estudadas algumas propriedades de sistemas miméticos de tensoativos pulmonares (TP) constituídos de dipalmitoilfosfatidilcolina (DPPC) e DPPC/colesterol e suas interações com o material particulado (MP) proveniente da queima da palha da cana-de-açúcar, reconhecido por meio de estudos clínicos como agente agravador de diversas patologias respiratórias. O MP utilizado neste trabalho foi analisado por meio de uma série de técnicas: espalhamento dinâmico de luz (DLS), microscopia eletrônica de varredura acrescida do uso de análise de energia dispersiva de raios X (MEV e MEV-EDX) e espectroscopia de absorção na região do infravermelho. Os valores médios de tamanho e potencial zeta das partículas foram 250 nm e -27 mV, respectivamente. Isotermas de pressão superficial versus área por molécula de DPPC e DPPC/colesterol foram estudadas na ausência e presença de partículas e trouxeram informações a respeito da inserção das partículas nas monocamadas. O sistema DPPC/colesterol apresentou variações menores de área mínima por molécula com o aumento da concentração de MP, indicando que o colesterol atua como agente organizador da monocamada. Reologia superficial dilatacional dinâmica foi estudada pelo método de oscilação harmônica da gota pendente. Concentrações pequenas de MP aumentam a fluidez das monocamadas, enquanto concentrações mais elevadas aumentam a rigidez das mesmas. A presença de colesterol potencializa o efeito provocado pelo MP. Os dados de módulo de compressibilidade obtidos das isotermas se mostraram próximos daqueles obtidos nos estudos reológicos em frequências elevadas. As monocamadas foram transferidas para substratos sólidos por meio da técnica de Langmuir-Blodgett (LB). Os filmes LB resultantes foram analisados por meio de microscopia de força atômica (AFM) e microscopia do tempo de vida de fluorescência (FLIM). Ambas as técnicas mostraram que as partículas se depositam juntamente com o filme e que o sistema DPPC/colesterol dispõe de um arranjo mais homogêneo para as partículas. Imagens de FLIM mostraram que provavelmente esse arranjo se dá devido à preferência do colesterol em se alocar em regiões periféricas às partículas, conferindo estabilidade às mesmas na interface. O trabalho permitiu concluir que o MP proveniente da cana-de-açúcar possui efeito sobre algumas propriedades superficiais estudadas nos sistemas modelos de TP e que essas propriedades devem ter o potencial de interferir no perfeito funcionamento desses sistemas nos meios biológicos.<br>This work presents some of the properties of mimetic systems of pulmonary surfactants (PS) composed of dipalmitoylphosphatidylcholine (DPPC) and DPPC/cholesterol and their interactions with particulate material (PM) originated from the burning of sugar cane leaves which is known by clinical studies as an injurious agent of the respiratory airways. The PM described in the present work was analyzed by different techniques: Dynamic Light Scattering (DLS), Scanning Electron Microscopy (SEM) with EDS (Energy Dispersive Spectrometry) and Fourier Transformed Infrared Spectroscopy (FTIR). The average values of size and zeta potential were 250 nm and -27 mV, respectively. DPPC and DPPC/cholesterol -A isotherms were studied in the absence and presence of particles and it brought some information about the particle insertion in the monolayers. The DPPC/cholesterol system showed smaller changes in the minimum area per molecule with the increase of PM concentration which indicates the cholesterol acts as an organizer in the monolayer. Dilatational surface rheology data indicated that smaller PM concentrations increase the fluidity of the monolayers while the higher PM concentrations increase their rigidity. Cholesterol enhances the effects provoked by PM. Compressional modulus data obtained from the isotherms showed to be very close to those obtained from the rheological studies performed at higher frequencies. The transferred monolayers, using Langmuir-Blodgett technique, to solid supports were analyzed by Atomic Force Microscopy (AFM) and Fluorescence Lifetime Imaging Microscopy (FLIM) which showed that the particles are deposited together with the film and the DPPC/cholesterol system presents a more homogeneous particle arrangement. FLIM images showed that most likely this arrangement is due to the preference of cholesterol to allocate in regions surround the particles, granting stability to them in the monolayers. The study allowed concluding that PM originate from burned sugar cane leaves has an effect over some features of PS model systems and those properties have the potential to interfere in the perfect performance of these systems in biological environments.

The fetal lung undergoes extensive physiological and biochemical maturation prior to birth in preparation for its postnatal function as an organ for gas exchange. Pulmonary surfactant, a substance that reduces surface tension and prevents alveolar collapse, is produced by type II pneumocytes within the lung. Reduced ability to produce surfactant leads to neonatal respiratory distress syndrome. Synthesis of the phospholipid component of surfactant, phosphatidylcholine (PC), is stimulated by fibroblast-pneumocyte factor (FPF), a protein expressed by fibroblast cells within the fetal lung. Although its function is well known, the identity of this important protein has remained a mystery. Recent research has suggested that FPF may be neuregulin-1, a growth factor found in many tissues during development. Enhanced synthesis of PC (and therefore detection of FPF) is measured using a tissue culture-based method. Primary cultures of lung fibroblasts and type II pneumocytes are prepared, and fibroblast-conditioned medium (FCM) is exposed to the type II cells. Resultant PC synthesis is measured using radioisotope-labeled PC-precursor and a chloroform-based lipid extraction method. Initial results using this method were very inconsistent, so a study was undertaken to determine which parts of the method could be contributing to this inconsistency. Cell density of type II cultures (measured in μg DNA.plate-1) was shown to have a significant effect on results. Treatment of fibroblasts with 100 nM dexamethasone and exposure of type II cultures to the resultant FCM caused a mean 9.17% increase in PC synthesis, but when only type II cultures with a cell density below 25 μg DNA.plate-1 were analyzed, this value increased to 17.56%. Type II cultures with cell density above this threshold value showed a mean increase in synthesis of only 3.39%. The consistent application of [3H]-choline chloride also had a significant effect on results. Experiments utilizing phorbol 12-myristate 13-acetate to stimulate fibroblasts were very inconsistent. The mean activity of the initial [3H]-choline chloride solution prepared for these experiments was found to be 2.04 μCi.mL-1, compared to a mean of 4.79 μCi.mL-1 for all other experiments. Observations from this section of the study led to considerable revision of the method used to measure PC synthesis. Quadrupolar ion trap mass spectrometry (MS) was used to analyze FCM and determine if neuregulin-1 (NRG1) could be FPF. A mass spectrum was obtained for recombinant NRG1, with predominant ions of 1068, 1142 and 1246 m/z. All three of these ions were also detected in both control and dexamethasone-treated FCM. Partial fragmentation of 1068 m/z of NRG1 was achieved using MS2, and generated a base peak of 1047 m/z. This fragmentation was also observed in 1068 m/z from FCM. LC/MS was utilized to quantify NRG1 in FCM, using a standard curve generated using recombinant NRG1. Control FCM had a NRG1 concentration of 19.85 μg.mL-1, while the concentration in dexamethasone treated FCM was 41.59 μg.mL-1. FCM which had given no positive response to dexamethasone when tested using the indirect cultured cell system had a control NRG1 concentration of 20.85 μg.mL-1, and a dexamethasone treated concentration of 22.84 μg.mL-1. These values were not significantly different from the control value for FCM in those fibroblast cultures that had generated a positive response to dexamethasone. Results of this section of the study have provided strong evidence that NRG1 is a major component of FPF, and a review of the NRG1 signaling pathway further supports this conclusion. Insulin-like growth factors (IGFs) are functionally related to neuregulins and are known to be important in fetal development. The effect of IGF-II on synthesis of surfactant PC and its subsequent secretion from type II pneumocytes was studied. In terms of PC synthesis, IGF-II was tested at concentrations of 0.4, 0.6 and 0.8 μM. The mean increase in synthesis was found to be 6.00, 6.15 and 6.91%, respectively. These values were not significantly different from control values. Secretion of PC was tested over the concentration range of 0.1 to 1.6 μM, with no significant effect observed. Possible inhibition by IGF-II was also studied, using the known stimulants of secretion, neuromedin C and isoproterenol. No significant effect on the enhanced level of secretion was observed when IGF-II was added with either secretagogue. Lack of an appropriate receptor and/or the possibility that cultured cells may not exactly mimic the situation in vivo are probably the reasons IGF-II has no effect on either synthesis or secretion.

Abstract Deficiency of pulmonary surfactant is the main cause of respiratory distress syndrome (RDS) in premature newborn infants, which is often complicated by chronic lung disease (CLD). Preterm birth is often associated with intra-amniotic infection (IUI), which is characterized by increased proinflammatory cytokines, such as interleukin-1 (IL-1) and tumor necrosis factor-α (TNF-α), in the amniotic fluid. In very preterm birth due to IUI, the incidence of RDS is decreased, while the incidence of CLD is increased. Maternal glucocorticoids are used in imminent preterm birth to prevent RDS. This study was designed to clarify the contrasting association of these perinatal pulmonary diseases with IUI and the pathogenesis of these lung diseases using an in vitro rabbit model. IL-1 increased the expression of surfactant protein (SP)-A and SP-B in very immature lung. Contrariwise, in transitional and mature fetal lung as well as in newborn lung, IL-1 additively with TNF-α decreased the expression of SP-B and SP-C. Bacterial lipopolysaccharide (LPS) decreased SP-A, -B and -C mRNAs in mature fetal and newborn lung, but had no effect on SP expression in immature lung. Interferon-γ (IFN-γ) had no effect on SP expression at any gestational age, but it modified the effects of the other cytokines. Dexamethasone (Dx) and IL-1 in combination additively increased SP-A and SP-B mRNAs in immature lung. Dx abolished the inhibitory effect of IL-1 on SP-B and SP-C in mature lung. Dx and IL-1 together tended to stabilize SP mRNAs. The present findings provide additional evidence of the role of the transcription factors nuclear factor-κB (NF-κB) and C/CAAT enhancer-binding protein δ (C/EBPδ) in the upregulation of SP-A by IL-1 in immature lung. Proinflammatory cytokines profoundly influence the expression of surfactant proteins in a manner that is strictly dependent on the length of gestation. The present findings help to explain the differences in the incidence of RDS and CLD in preterm births caused by IUI, and they may clarify further the role of surfactant in the pathogenesesis of lung diseases in neonatal infants<br>Tiivistelmä Keuhkosurfaktantin puute aiheuttaa ennenaikaisesti syntyville keskosille vastasyntyneen hengitysvaikeusoireyhtymää eli RDS-tautia (Respiratory Distress Syndrome). Toinen keskosilla esiintyvä keuhkosairaus on krooninen keuhkosairaus eli CLD (Chronic Lung Disease). Glukokortikoideja käytetään hoitona ennenaikaisen synnytyksen uhatessa, koska niiden tiedetään vähentävän RDS-taudin riskiä. Kohdunsisäinen infektio on huomattava ennenaikaisen synnytyksen aiheuttaja. Infektiossa tulehduksen välittäjäaineet, kuten sytokiinit interleukiini-1 (IL-1) ja tuumorinekroositekijä alfa (TNF-α) lisääntyvät lapsivedessä. Infektiosta aiheutunut ennenaikainen synnytys vähentää RDS-taudin ilmaantumista pienille keskosille ja toisaalta lisää kroonisen keuhkosairauden riskiä. Tutkimuksen oli tavoitteena selvittää, miksi RDS ja CLD ilmaantuvat eriävästi infektion vuoksi ennenaikaisesti syntyneille vauvoille. Viljelemällä eri-ikäisten kanin sikiöiden sekä vastasyntyneiden kanin poikasten keuhkon kappaleita tutkittiin tulehduksen välittäjäaineiden sekä anti-inflammatorisen glukokortikoidin (deksametasonin) vaikutusta surfaktantin toiminnalle tarpeellisten surfaktanttiproteiinien (SP) ilmentymiseen. IL-1 lisäsi SP-A:n ja SP-B:n ilmentymistä erittäin epäkypsässä kanin sikiön keuhkossa. Toisaalta IL-1 ja TNF-α vähensivät SP-B:n ja SP-C:n ilmentymistä kypsemmässä sikiön sekä vastasyntyneen kanin keuhkossa. Interferoni-gamma (IFN-γ) ei vaikuttanut surfaktanttiproteiinien ilmentymiseen missään gestaatioiässä, mutta se muunsi muiden sytokiinien surfaktanttivaikutusta. Gram-negatiivisten bakteerien soluseinän tuote, lipopolysakkaridi (LPS) vähensi SP-A:n, SP-B:n ja SP-C:n ilmentymistä kypsässä kanin sikiön ja vastasyntyneen kanin keuhkossa. IL-1:llä ja deksametasonilla oli positiivinen yhteisvaikutus surfaktanttiproteiinien ilmentymiseen. Tämän surfaktanttiproteiineja lisäävän vaikutuksen mekanismiksi havaittiin pääasiallisesti lisääntynyt mRNA:n stabiliteetti. Lisäksi tutkimus antaa lisätietoa kahden transkriptiofaktorin, NF-κB:n (nuclear factor kappa B) ja C/EBPγ:n (C/CAAT enhancer binding protein delta), osuudesta IL-1:n aiheuttamassa SP-A:n ilmentymisen lisääntymisessä. Sytokiinien vaikutukset surfaktanttiproteiinien ilmentymiseen ovat riippuvaisia gestaatioiästä. Tutkimuksen löydökset auttavat ymmärtämään RDS:n ja CLD:n vastakohtaista esiintymismäärää keskosilla, joiden ennenaikainen synnytys on aiheutunut kohdunsisäisestä tulehduksesta. Edelleen tutkimus selittää glukokortikoidien positiivista vaikutusta hengitysvajaukseen johtavassa keuhkotulehduksessa

In title 12, 22, 11 are in subscript.<br>Thesis (PhD)--Stellenbosch University, 2002.<br>ENGLISH ABSTRACT: The aim of this study was to test a synthetic protein-free surfactant preparation, LPM-l, with the same chemical composition as commercially available Exosurf (Glaxo Wellcome), but containing in addition, a sugar, trehalose (TRE). Towards this end, a study was designed to firstly test the hypothesis that the true difference in acute physiological effects between a mixture of oppe, tyloxapol, hexadecanol and trehalose (LPM-l), and Exosurf, (Oppe, tyloxapol and hexadecanol) is zero, in a surfactantdeficient animal model. A second study addressed the physiological effects of oppe, hexadecanol, tyloxapol and trehalose (LPM-l) compared to treatment with trehalose (TRE) or saline, in order to determine (1) the contribution of TRE to the mixture of oppe, hexadecanol and tyloxapol, and (2) to assess the effect of the LPM-l surfactant replacement on the epithelial lining fluid composition by means of analysing bronchoalveolar lavage fluid. Thirdly, the effects of TRE and / or calcium were studied on the surface properties of oppe suspensions, by in vitro analysis using the ring detachment method of Du Nouy The in vivo research comprised of two studies, performed in randomised controlled fashion. In the first study, 24 New Zealand White adult rabbits were randomised into 4 groups, while in the second study, 15 animals were randomised into 3 groups. In the first in vivo study, three synthetic surfactants, LPM-l, Exosurf and LPM-2, and a saline group were tested. LPM-l is a new formulation that consists ofa mixture of Df'PC, TRE, hexadecanol and tyloxapol. LPM-2 is a formulation with a composition equivalent to that of commercially available Exosurf, prepared on site. In both studies animals were subjected to repeated lavage with large volumes of warm saline (25 ml/kg) in order to establish surfactant deficiency and acute lung injury. Five minutes after the last lavage, vehicle, i.e. surfactants LPM-l, Exosurf, or LPM-2, or saline, in the first in vivo study, and LPM-l, TRE or saline in the second in vivo study, was instilled, and the course of the animals followed over the next 3 hours. Ventilator settings were standardized before and after lavage. The effects of surfactant treatment on gas exchange (arterial Pa02, oxygenation index (Ol), arterial-alveolar oxygen (a/A) ratio), percentage calculated shunt, and total dynamic respiratory compliance (CRSdyn), and histopathological changes were compared with changes in saline treated controls. Arterial blood gases in 100% oxygen and CRSdynwere measured before and after lavage, at 15 minute intervals for the first 30 min, then at 60, 90, 120, and 180 min after vehicle instillation. Oxygenation improved to a similar extent after LPM-l and Exosurf instillation, surpassing that of LPM-2 or saline. Overall, intratracheal instillation of both Exosurf and LPM-l, rapidly improved the gas exchange and reduced the intrapulmonary shunt, but did not restore the lung to its pre-lavage condition. From the 2nd in vivo study it was evident that trehalose-only, was inefficient as a lung surfactant, failing to improve oxygenation indices or the calculated percentage shunt, or influencing respiratory compliance. The addition of the sugar, trehalose (TRE), to the on-site 'Exosurf mixture (LPM-2) brought the activity of the resultant LPM-l to the same level as that of commercial Exosurf, but failed to raise the activity above that of Exosurf. These physiological improvements were sustained for up to 3 hours. Saline-treated animals had no improvement in gas exchange despite management with variable PIP (to maintain a tidal volume of -1 0 ml / kg) and constant PEEP of 5 cm H20. In-vitro results, obtained by the Ou Nouy tensiometer, showed higher mean ordinate surface tension values for the OPPC-only and DPPC + TRE mixtures, and the slopes of their respective graphs smaller in magnitude than those of the other formulations, suggesting that these formulations had less surface tension-lowering capability than the other surfactants. At 20°C (20 mg / ml DPPC-surfactants) the mean ordinate values of OPPC and OPPC + TRE, 70.13 and 69.47 dyne / cm, respectively, were not significantly different from each other. The mean ordinate values of LPM-l and the formulation containing OPPC + TRE + tyloxapol + CaCh were lower, but similar, as were the values of LPM-2 (on-site Exosurf) and LPM-2 + CaCho Thus, three internally homogeneous subgroups could be identified which differed significantly, namely: DPPC and DPPC + TRE, LPM-2 and LPM-2 + CaCh, and DPPC + TRE + tyloxapol + CaCh and LPM-l. Similar conclusions apply to the ordinate values of the surfactants at 37°C, and to the mean slope values at 20°C, with the exception that the subgroups, LPM-2 and LPM-2 + CaCh, and LPM-l and OPPC + TRE + tyloxapol + CaCh are not so clearly separated. A similar analysis of mean slope values was performed. Here too a significant difference between substances was found, OPPC alone or in combination with TRE, again being significantly different from the other surfactants. The most prominent light microscopy findings of the lungs of animals included general lymphatic dilatation, congestion and lung polymorphonuclear infiltration, with no difference between study groups. Hyaline membranes were present in all surfactant groups, but significantly more so in the saline treated group. In the first in vivo study, the presence of neutrophils in the lung interstitiwn as well as alveoli, was a common finding in all of the study groups towards the end of the study protocol. A significant increase in the BAL-fluid neutrophil count occurred in all animals, concurrent with a significant decrease in the BAL macrophage count. No significant change occurred in the peripheral neutrophil count during the 3-hour study, suggesting recruitment of neutrophils from storage pools. Treatment with synthetic surfactant (LPM -1) did not have a significant effect on modifying the inflammatory response, since there was no significant difference in the BAL-derived cell counts between the LPM-1 and -saline groups. Epithelial damage was a consistent finding in all groups. The damage was more evident by electron microscopy examination and included hydropic changes, most readily observed in the mitochondria. The airspaces of study subjects showed the presence of oedema fluid. This luminal oedema appeared to be more prominent in the control group and LPM-2 (on site 'Exosurf') group. Organellar debris, probably originating from lysis of epithelial cells, was present, despite treatment with synthetic surfactant. The electron microscopical appearance of the epithelial-lined substance ("hyaline membranes") in the present study showed a marked variability within groups as well as within the same case. The majority of cases showed a mix of membrane types with both granular and fibrillar materials present within the same membrane. In some cases there were layering of the membranes into distinct bands. The instillation of LPM-l resulted in the formation of a slightly different type of epithelial lining fluid after lavage, when compared to the prelavage composition. The most pronounced changes occurred within the fatty acids, whilst the phosphatidylcholine values remained unchanged. Palmitic acid concentrations (C16:0) increased significantly, suggesting enrichment of the epithelial lining fluid after instillation of LPM-l. This increase in C16:0 was concurrent with significant decreases in the percentage C16:1, C18:0, and C18:2. In contrast to previous studies, we describe higher levels for phosphatidyldimethylethanolarnine (PEA). An explanation may be that the lipid identified as PEA, was in fact partly phosphatidylglycerol (PG)-a lipid whose accurate identification was precluded for technical reasons. After surfactant instillation, the PC/SM ratio, a reflection of the lecithin / sphingomyelin (LIS), decreased significantly in the TRE-group between the first and final lavage, but remained statistically unchanged in the animals treated with LPM-l or saline. The change in ratio was mainly accounted for by a decrease in BAL-fluid PC content together with a rise in SM content. A poor correlation existed between the BAL-derived PC/SM ratio and indices reflecting oxygenation status (a/A ratio, Ol), as well as the CRSdynat the time of the final lavage. In conclusion, the primary hypothesis was accepted, LPM-l performed similarly to Exosurf in vivo, improving oxygenation, but not CRSdyn.None was clearly superior to the other. Some questions remain. The reason why LPM-l (LPM-2 + TRE) did not behave in a superior manner, in vivo, to Exosurf, is partly unclear. This finding was somewhat surprising since the chemical composition of Exosurf and LPM-2 did not differ, and the addition of TRE to LPM-2 (on-site Exosurf), did improve the in vivo activity of the resultant LPM-l, above that of LPM-2. A possible explanation for observed differences in performance include methodological issues, i.e. the preparation of the on-site formulations, especially that of LPM-2 (on-site Exosurf), may differ from the way in which true commercial Exosurf is prepared.<br>AFRIKAANSE OPSOMMING: Die doel van die studie was om 'n sintetiese proteïn vrye surfaktant te ontwikkel en die produk te vergelyk met 'n kunsmatige surfaktant reeds in kliniese gebruik. Die bekende uit die literatuur en die onbekende van die produk wat evalueer sou word, lei op tot die samestelling van die nul hipotese van die PhD naamlik dat geen verskil in longfunksie sou gewys word tussen die toetsproduk en reeds gebruikte kommersiële surfaktant nie. Die hipotese was dat 'n suiker (trehalose), in kombinasie met Dipalmitoiel fosfatidielcholine (DPPC), gaswisseling en longfunksies sal verbeter vir 'n long met 'n lae surfaktant konsentrasie. Vir die studie is jong volwasse wit New Zealand konyne gebruik en is hulle met 'n gestandaardiseerde en menslike manier gebruik in eksperimentele werk. Die diere is onder intraveneuse narkose geplaas en verskillende kardiovaskulêre en pulmonologiese aspekte is gemeet. Die long surfaktant is uitgewas deur middel van fisiologiese soutoplossing wat tot liggaam temperatuur verhit is en daarna is die diere prospektief gerandomiseer tot eksperimentele groepe. Met vooraf bepaalde tydsintervalle is die fisiologiese metings herhaal en was die metings toegespits daarop om longmeganiese funksie en gasoordrag vermoë te evalueer. Lig mikroskopiese en elektron mikroskopiese studies is ook op die longe gedoen en verder is brongoalveolêre vloeistof ook ontleed. Die groepe met ondersoek was: I. oppe, heksadekanol, tyloxapol en trehalose (LPM-I). 2. oppe, heksadekanol, tyloxapol (LPM-2 :. LPM-I sonder trehalose). Hierdie is 'n proteïnvrye surfaktant plaaslik berei ( dieselfde samestelling as Exosurf). 3. Exosurf®. (Kommersiële preperaat reeds in gebruik). Hierdie is 'n proteïnvrye sintetiese surfaktant. 4. Trehalose, 'n non-reduserende disakklaried van glukose. Addisioneel is daar ook in vitro studies gedoen waann die oppervlakte spanmngs aktiwiteite van die verskillende surfaktant oplossings vergelyk is. Die statistiese analise is gedoen in samewerking met Prof. J. Maritz wat 'n unieke metode ontwikkel en gepubliseer het om herhalende veranderlikes op 'n statisties verantwoordbare manier te ontleed. In die eerste van die studies, is LPM-I, Exosurf®, fisiologiese soutoplossing en 'n plaaslik bereide "Exosurf" (LPM-2), met 'n chemiese samestelling identies aan dié van kommersiële Exosurf®, evalueer. In 'n tweede studie is die fisologiese effekte van LPM-I vergelyk met trehalose of fisiologiese soutoplossing om die volgende te ondersoek: 1) Die bydrae van trehalose tot 'n mengsel van oppe, heksadekanol en tyloxapol (LPM-2). 2) Die gevolg van LPM-l surfaktant toediening op die konyn se brongo-alveolêre vloeistof samestelling. 'n Derde, in vitro studie, het die oppervlaktespannings-effekte van trehalose en of kalsiumbyvoegings tot DPPC-oplossings gemeet deur middel van die ring metode van Du Nouy, In die eerste in vivo studie verbeter oksigenasie en persentasie longaftakking tot dieselfde mate na LPM-l en Exosurf® toediening en word die hipotese van die proefskrif bevestig. In die breë gesien, is die tydsprofiele van LPM-l en Exosurf® ten opsigte van oksigenasie en persentasie longaftakking statisties betekenisvol beter en van 'n sneller aard, as die tydsprofiele van dieselfde indekse na die toediening van fisiologiese soutoplossing of LPM-2. Die tydsprofiel van dinamiese longvervormbaarheid, na die toediening van LPM-I of Exosurf®, is dieselfde, maar betekenisvol beter as die vervormbaarheid na toediening van LPM-2 of fisiologiese soutoplossing. Alhoewel die oksigenasie indekse in die geval van LPM-l en Exosurf® betekenisvol verbeter oor die studietydperk, vind volkome herstel tot die basislynwaardes (voor spoeling) nie plaas nie. Bykomend, geen van die surfaktante het na toediening enige noemenswaardige verbetering in longvervormbaarheid tot gevolg gehad nie. Die rede vir die swakker vertoning van LPM-2 en Exosurf is onbekend en sal in opvolg studie ondersoek word. In die tweede in vivo studie is dit duidelik dat trehalose op sy eie, 'n oneffektiewe surfaktant is aangesien die preperaat na toediening geen verbetering teweegbring ten opsigte van oksigenasie indekse, persentasie longaftakking, of long-dinamiese vervormbaarheid nie. Die toevoeging van trehalose tot LPM-2, om LPM-l te lewer, neem wel die aktiwiteit van LPM-l tot dieselfde in vivo vlak as dié van kommersiële Exosurf®, maar slaag nie daarim om 'n hoër fisiologiese in vivo aktiwiteit as dié produk te bereik nie. Die diere wat met fisiologiese soutoplossing behandel is toon geen verbetering in enige fisiologiese parameter nie. Die in vitro resultate wat verkry is deur die Du Nouy tensiometer toon hoër gemiddelde ordinaat oppervlaktespannings waardes vir 'n formule wat slegs uit DPPC bestaan, asook vir 'n mengsel van DPPC + trehalose. Die helling van die grafieke van hierdie oplossings is ook kleiner as die van die ander formulas wat daarop dui dat DPPC op sigself, en DPPC + trehalose, weinig vermoë het om oppervlaktespanning te verminder. Daarteenoor verlaag die volgende oplossings die oppervlaktespanning ten opsigte van gedistilleerde water betekenisvol en wel in In konsentrasie afhanklike manier by beide 21°C en 3rc: LMP-I-, LPM-2-, DPPC + trehalose + tyloxapol + CaCf2-, en LPM-2 + CaCf2. Die prominentste ligmikroskopiese bevindinge van die longe van die diere sluit in: Algemene limfvat dilatasie, stuwing, en long neutrofiel infiltrasie. Betreffende hierdie histologiese bevindinge is daar geen verskille aangetoon tussen die groepe nie. Hialienmembrane was teenwoordig in al die groepe, maar betekenisvol meer in die groep wat fisiologiese soutoplossing ontvang as vervangingsterapie. In die tweede in vivo studie is daar 'n betekenisvolle styging in die neutrofiel- en daling in makrofaagtelling, van die brongoalveolêre vloeistof spoeling in al drie die groep aangetoon. Terselfdertyd vind geen noemenswaardige daling in die perifêre (sistematiese) neutrofieltelling plaas nie. Hierdie bevindinge dui daarop dat die brongoalveolêre selveranderinge toegeskryf kan word aan verwerwing van neutrofiele vanuit 'n longstoringspoel eerder as rekrutering vanuit die sistemiese sirkulatoriese poel. Surfaktant (LPM-l), behandeling het geen betekenisvolle vermindering in long inflammasie teweeggebring nie. Epiteelskade was 'n algemene ligmikroskopiese bevinding in al die groepe. Die samestelling van die brongoalveolêre vloeistof verander na installering van LPM-I. Die prominentste verandering word waargeneem in die vetsuur samestelling terwyl die DPPC waardes onveranderd bly. Die vetsuur, palmitiensuur (palmitic acid), (CI6:0), verhoog betekenisvol na toediening van LPM-l. Daarteenoor verminder die konsentrasie van C16:1, C18:0 en C18:2. In kontras met vorige studies, beskryf die huidige studie hoër konsentrasies van fosfatidieletanolamien, moontlik as gevolg van tegniese verskille in die metingsmetodes. 'n Betekenisvolle verlaging in die fosfatidielcholine:sfingomiëlien (PC/SM) verhouding word waargeneem tussen die eerste en die finale longspoeling van die trehalose-groep, terwyl dit onveranderd bly in die diere wat LPM-1 of fisiologiese soutoplossing ontvang.