- Open Access
Disaturated-phosphatidylcholine and Surfactant protein-B turnover in human acute lung injury and in control patients
© Simonato et al; licensee BioMed Central Ltd. 2011
- Received: 13 October 2010
- Accepted: 24 March 2011
- Published: 1 December 2011
Patients with Adult Respiratory Distress Syndrome (ARDS) and Acute Lung Injury (ALI) have low concentrations of disaturated-phosphatidylcholine and surfactant protein-B in bronchoalveolar lavage fluid. No information is available on their turnover.
To analyze disaturated-phosphatidylcholine and surfactant protein-B turnover in patients with ARDS/ALI and in human adults with normal lungs (controls).
2H2O as precursor of disaturated-phosphatidylcholine-palmitate and 113C-Leucine as precursor of surfactant protein-B were administered intravenously to 12 patients with ARDS/ALI and to 8 controls. Disaturated-phosphatidylcholine and surfactant protein-B were isolated from serial tracheal aspirates, and their fractional synthetic rate was derived from the 2H and 13C enrichment curves, obtained by gas chromatography mass spectrometry. Disaturated-phosphatidylcholine, surfactant protein-B, and protein concentrations in tracheal aspirates were also measured.
1) Surfactant protein-B turned over at faster rate than disaturated-phosphatidylcholine both in ARDS/ALI patients and in controls. 2) In patients with ARDS/ALI the fractional synthesis rate of disaturated-phosphatidylcholine was 3.1 times higher than in controls (p < 0.01), while the fractional synthesis rate of surfactant protein-B was not different. 3) In ARDS/ALI patients the concentrations of disaturated-phosphatidylcholine and surfactant protein-B in tracheal aspirates were markedly and significantly reduced (17% and 40% of the control values respectively).
1) Disaturated-phosphatidylcholine and surfactant protein-B have a different turnover both in healthy and diseased lungs. 2) In ARDS/ALI the synthesis of these two surfactant components may be differently regulated.
- Acute Lung Injury
- Adult Respiratory Distress Syndrome
- Lamellar Body
- Epithelial Line Fluid
- Tracheal Aspirate
Adult Respiratory Distress Syndrome (ARDS) is characterized by bilateral radiographic infiltrates and a ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen (PaO2/FiO2) <200. Acute Lung Injury (ALI) is a less severe form of respiratory distress with a PaO2/FiO2 between 200 and 300 . In both clinical entities reduced lung compliance and surfactant inactivation contributes to the respiratory failure [2–4]. Proposed mechanisms of lung injury include destruction of the air-water interface by alveolar edema, phospholipid degradation by secretory phospholipases, degradation of surfactant proteins by proteases [5, 6], damage by reactive oxygen species and decreased synthesis of surfactant components by damaged type II cells . Moreover, leakage of plasma proteins into the alveoli is thought to decrease alveolar stability . In vitro, proteins have been shown to compete with the lipids for adsorption at the air water interface, leading to the formation of an interfacial film less prone to incorporate surfactant phospholipids .
Pulmonary surfactant is composed by 90% lipids, mostly phospholipids, and 10% of specific proteins . Surfactant Protein B (SP-B) is a small hydrophobic protein synthesized as a preprotein (pro-SP-B) and processed to mature form en route from the Golgi complex to the lamellar bodies . Mature SP-B is secreted as a surfactant component into the alveolar space where it is mainly found as a dimer . Clara cells also express pro-SP-B, but they do not process the protein to the mature form . SP-B enhances the rate of phospholipid adsorption to the alveolar air/water interface , decreases surface tension by interfering with the attractive forces acting between water molecules  and has anti-inflammatory properties [2, 3].
Clinical studies have shown that disaturated-phosphatidylcholine (DSPC) is markedly decreased in bronchoalveolar lavage fluid of adult ARDS patients, whereas the phosphatidylcholine content is only slightly decreased [2, 3]. SP-B has also been reported to be reduced by 25-55% in tracheal aspirates of adult ARDS/ALI patients [2, 6] but in association with normal levels of SP-B mRNA . Conversely a recent study performed in children confirmed a significant decrease of DSPC but no significant changes in SP-B levels in bronchoalveolar lavage fluid of ALI/ARDS children compared with controls. Decreased levels of DSPC and SP-B could be due to increased degradation, decreased synthesis or both. The goal of this investigation was to measure the rate of synthesis of DSPC and SP-B in ARDS/ALI patients and in controls with normal lungs.
Patients were studied from 2003 to 2006. ARDS and ALI cases were defined by the AECC criteria . Twelve patients were recruited within 72 hours from the onset of the respiratory failure. Causes of ARDS/ALI were pneumonia in 6 patients, polytrauma in 4, pancreatitis in 1 and aspiration of gastric contents in 1. Eight patients without lung disease, who needed mechanical ventilation after major surgery or for neurological failure, were enrolled as controls. Exclusion criteria were: presence of liver failure, defined as transaminases (GOT, GPT) >3 times normal values, renal failure (creatinine >2 times normal values), burns >30% body surface area, bone marrow or lung transplantation. The local ethical committee approved the study, and informed consent was obtained for all the patients.
Clinical data, ventilator parameters, arterial blood gas analysis and trascutaneous saturation were recordered at the start of the study and then every 6 hours during the study period. Routine blood tests performed at the admission to the ICU and during the study according to the standard unit practice were also recorded in order to detect signs of nosocomial infection or of organ failure. For each patient SAPSII score was calculated at study entry.
Methods and study design
All patients received a constant intravenous infusion of 1 g 1-13C Leucine (Cambridge Isotope Laboratories, Andover, MA) dissolved in saline for 24 h. 2H2O (Cambridge Isotope Laboratories, Andover, MA) was administered as a 25 ml bolus at the study start and then, every 12 hours over the next 36 hours, as intermittent boluses corresponding to 0.0625% of fluid intake, to maintain steady state of deuterium enrichment in body water .
Blood (0.6 ml), urine (1 ml) and tracheal aspirates  were collected at times 0, 6, 12, 18, 24, 30, 36, 42, 48 hours and then every 12 hours until extubation. Tracheal aspirates and blood samples were centrifuged at 400 g and 1300 g respectively and supernatants were stored at -80°C.
Tracheal aspirates protein and phopholipid analysis
Total proteins from tracheal aspirates were determined at time 0 or within the first 24 hours . Phospholipid phosphorous was measured in tracheal aspirate samples till 48 hours  from the start of the study.
DSPC, SP-B and protein concentrations in aspirates, were normalized to alveolar lining fluid using the urea method (BioAssay Systems, Hayward, CA) .
Isolation of SP-B from tracheal aspirates
SP-B was isolated from tracheal aspirates and hydrolyzed as previously published . Briefly, SP-B was isolated from lipid extract with Bond Elute NH2 containing 100 mg resin (Supelco, Milano, Italy) preconditioned with 3-5 ml of chloroform. After loading the sample, the columns were eluted sequentially with 3 ml of the following chloroform/methanol/acetic acid mixtures: 20:1:0; 9:1:0; 4:1:0; 4:1:0.025; 3:2:0; 1:4:0; 1:9:0. SP-B fraction (4:1:0 and 4:1:0.025) were pooled together, dried under nitrogen and hydrolysed to free amino acids by 0.5 ml of HCl 6 N for 24 h at 110°C. Individual amino acids were derivatized into their N-acetyl-n-propyl derivatives  and the 13C enrichment of leucine measured by mass spectrometry (GC-MS Voyager, Thermoquest, Milan, Italy).
Plasma leucine enrichment
One hundred μl of plasma were deproteinized with sulphosalicilic acid (6% w/v) and plasma amino acids were derivatized according to Husek . Free plasma leucine enrichment was measured by gas chromatography mass spectrometry. Results were expressed as Mole Percent Excess with reference to a calibration curve for 1-13C Leucine.
Urine deuterium enrichment
One hundred μl of urine were deproteinized with sulphosalicilic acid (6% w/v) and diluted 1:10 with local distilled reference water. Urine deuterium enrichment was analysed by a High Temperature Conversion Elemental Analyser coupled with an Isotope Ratio-Mass Spectrometer (TC-EA-IRMS, Thermo Scientific, Bremen, Germany) . Enrichment was expressed as delta ‰.
The 2H enrichment of DSPC-palmitate was analyzed by gas chromatography-IRMS and expressed in delta ‰ after correction for isotopic contribution of the derivative group .
All kinetic measurements were performed assuming a steady state. The assumption was based on the following considerations: 1) in all patients plasma 113C leucine and urine 2H2O enrichments reached steady state within 6 h from the start of the isotope infusion; 2) the slope of the enrichment curve over time did not deviate significantly from zero between time 6 h and time 24 h for plasma leucine and between time 6 h and time 36 h for urine 2H2O; 3) the concentrations of DSPC and SP-B in tracheal aspirates did not change significantly during the first 48 hours of the study.
Clinical and kinetic variables were expressed as mean ± SD or median (interquartile range) as appropriate. Statistical analysis was performed by a non-parametric test (Mann-Whitney test). Significance was defined as p < 0.05. Data were analysed using the statistical package SPSS 15 (SPSS Inc, Chicago, IL).
Clinical characteristics and ventilator parameters of study patients.
ARDS/ALI (N = 11)
CONTROL (N = 8)
53 ± 16
48 ± 24
Body weight (Kg)
80 ± 16
69 ± 19
37 ± 12
37 ± 5
PIP at the start of the study (cm H2O)
25 ± 6
14 ± 4 (4/8)
PIP during the study (cm H2O)
24 ± 6
14 ± 4 (4/8)
PEEP at the start of the study (cm H2O)
9 ± 2
3 ± 1 (4/8)
PEEP during the study (cm H2O)
9 ± 2
3 ± 0.4 (4/8)
PaO2/FiO2 at the start of the study
185 ± 61
365 ± 72
PaO2/FiO2 during the study period
208 ± 46
383 ± 82
AaDO2 at the start of the study (mmHg)
309 ± 111
71 ± 27
AaDO2 during the study (mmHg)
255 ± 84
74 ± 41
Tidal Volume (ml/Kg bw)
7 ± 1
7 ± 1 (4/8)
Surfactant composition of tracheal aspirates
Total phospholipids (mg/ml ELF)
Total protein (mg/ml ELF)
SP-B (μg/ml ELF)
DSPC (mg/ml ELF)
Mean DSPC (%PL)
DSPC, as percentage of total phospholipids, was lower in ARDS/ALI than in controls throughout the study (p < 0.01).
Surfactant DSPC and SP-B kinetics
SP-B turned over at a much faster rate than DSPC both in controls and in patients with ARDS/ALI (Figure 1). In controls SP-B turned over at a rate 28 times faster than DSPC.
This paper provides novel information on the turnover of DSPC and SP-B in normal subjects and in patients with ARDS/ALI, while confirming that patients with ARDS/ALI have decreased levels of DSPC and SP-B and increased protein concentration in tracheal aspirates [2, 4–6, 16, 30, 31].
In agreement with previous animal studies [24, 32], we found that SP-B is turned over at a faster rate than DSPC both in controls and in ARDS/ALI. Since SP-B and DSPC are packaged into lamellar bodies and then are secreted together, their different turnover rate could be explained by partitioning into distinctive alveolar structures (i.e. DSPC could distribute preferentially to the interfacial film or stay there for a longer time), by an intrinsically faster turnover of SP-B in the alveolar space or by the use of different pathways of recycling before packaging into lamellar body membranes. Human studies do not allow to further discriminate among these possibilities, since lung tissue could not be sampled. From animal experiments, though, we can extrapolate that all these mechanisms could be at play [24, 32].
In the present study we used 2H2O as metabolic precursor for DSPC synthesis. This is at variance from other studies by our group where we used other metabolic precursors, such as deuterated palmitate or uniformely labeled 13C glucose [18, 33, 34]. We chose the heavy water for its ease to use and because in preterm and term infants we found that heavy water gives estimates of DSPC synthesis similar to those obtained using other metabolic precursors . ARDS/ALI patients showed an increased synthesis rate of DSPC but not of SP-B. If the increased synthesis rate of DSPC seems a logical compensatory mechanism to increased phospholipid degradation or monolayer inactivation in the injured lungs, the finding that in ARDS/ALI the rate of synthesis of SP-B is comparable to control subjects, is unexpected. Possible explanations are that ARDS/ALI patients cannot mount a compensatory enhanced synthesis of SP-B or conversely that the decrease of airway SP-B in our ARDS patients was not big enough to elicit a homeostatic response. In agreement with the last interpretation, a recent study with a transgenic mouse model expressing human TNF-α in respiratory epithelial cells showed that, after a 36-61% decrease of airway SP-B, the level of SP-B mRNA in lung tissue remained unchanged .
Differently from SP-B, the lung appeared to "sense" the larger decrease in airway DSPC content and increased three fold its fractional rate of synthesis. The mechanism underlying this response remains unclear. A recent article investigating the role of signal transducer and activator of transcription-3 (STAT-3), which is activated by members of IL-6-like group of proinflammatory cytokines , found that in mice treated with LPS the synthesis of DSPC and SP-B increased in a STAT-3 dependent way .
In this study we have measured also DSPC and SP-B concentration in epithelial lining fluid as a proxy of surfactant pool. The estimation of airway surfactant pool by the measurement of individual surfactant components obtained from tracheal aspirates has limitations, since the recovery may vary, in spite of the standardization of the suction technique and the correction for dilution. Therefore the low concentrations of DSPC and SP-B recovered from tracheal aspirates of patients with ARDS/ALI could be due either to decreased surfactant concentration in the airways, or to the fact that collapsed areas may be less prone to release surfactant recoverable by aspiration or even to the sampling technique that could be affected by clinical severity. These observations can partially explain the controversial results reported on surfactant SP-B amount during ARDS/ALI [2, 6, 17].
Kinetic data obtained from tracer studies have the advantage of being independent from recovery. Tracer studies were classically performed in animals using radioactive tracers, and they showed that surfactant specific proteins A, B and C were turned over faster than DSPC [24, 32]. Using stable isotopes we can now perform kinetic studies in humans and even in preterm infants. By this approach we previously measured the rate of synthesis of DSPC and SP-B in newborn infants with and without respiratory failure [18, 26]. Furthermore, by administering DSPC labelled with stable isotopes through the airways, we showed that in a population of patients with ARDS the airway DSPC pool was 10 fold smaller than in controls .
A further limit on the estimation of the airway surfactant composition and pool by tracheal aspirates derives from the fact that the currently available ELISA methods to measure SP-B cannot distinguish between the mature protein and its pro-forms, nor do they recognize modified SP-B, like oxidized SP-B, whose possible pathogenetic role has been recently underlined . In this paper we separated mature SP-B by sorbent chromatography and thus provides kinetic data regarding solely mature SP-B.
Since the concentrations of DSPC and SP-B in the tracheal aspirates of patients with ARDS/ALI did not change significantly during the sampling period, we assumed that patients were at steady state, with synthesis matching degradation for both surfactant components. However, due to the uncertainty about the true dimensions of the alveolar pool of DSPC and SP-B, the present data did not allow us to calculate the absolute rate of synthesis of these compounds .
In conclusion our paper provides original data on DSPC and SP-B turnover "in vivo" in humans. Our results can be summarized as follows: 1) DSPC and SP-B turned over with different kinetics in the airways both in human adults with normal lungs and in patients with ARDS/ALI, 2) in patients with ARDS/ALI in spite of the low concentration of DSPC and SP-B in tracheal aspirates, the fractional synthesis rate of DSPC increased, while that of SP-B did not change significantly.
The authors thanks Paola Bazzan, Diana Bertini, Claudia Montini, Rossella Padovan and all intensive care nurses who contributed to the sample collection.
- Bernard GR, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L, Lamy M, Legall JR, Morris A, Spragg R: The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med. 1994, 149 (3 Pt 1): 818-824.View ArticlePubMedGoogle Scholar
- Gregory TJ, Longmore WJ, Moxley MA, Whitsett JA, Reed CR, Fowler AA, Hudson LD, Maunder RJ, Crim C, Hyers TM: Surfactant chemical composition and biophysical activity in acute respiratory distress syndrome. J Clin Invest. 1991, 88 (6): 1976-1981. 10.1172/JCI115523.View ArticlePubMedPubMed CentralGoogle Scholar
- Schmidt R, Meier U, Yabut-Perez M, Walmrath D, Grimminger F, Seeger W, Gunther A: Alteration of fatty acid profiles in different pulmonary surfactant phospholipids in acute respiratory distress syndrome and severe pneumonia. Am J Respir Crit Care Med. 2001, 163 (1): 95-100.View ArticlePubMedGoogle Scholar
- Gunther A, Siebert C, Schmidt R, Ziegler S, Grimminger F, Yabut M, Temmesfeld B, Walmrath D, Morr H, Seeger W: Surfactant alterations in severe pneumonia, acute respiratory distress syndrome, and cardiogenic lung edema. Am J Respir Crit Care Med. 1996, 153 (1): 176-184.View ArticlePubMedGoogle Scholar
- Baker CS, Evans TW, Randle BJ, Haslam PL: Damage to surfactant-specific protein in acute respiratory distress syndrome. Lancet. 1999, 353 (9160): 1232-1237. 10.1016/S0140-6736(98)09449-5.View ArticlePubMedGoogle Scholar
- Greene KE, Wright JR, Steinberg KP, Ruzinski JT, Caldwell E, Wong WB, Hull W, Whitsett JA, Akino T, Kuroki Y, et al: Serial changes in surfactant-associated proteins in lung and serum before and after onset of ARDS. Am J Respir Crit Care Med. 1999, 160 (6): 1843-1850.View ArticlePubMedGoogle Scholar
- Rodriguez-Capote K, Manzanares D, Haines T, Possmayer F: Reactive oxygen species inactivation of surfactant involves structural and functional alterations to surfactant proteins SP-B and SP-C. Biophys J. 2006, 90 (8): 2808-2821. 10.1529/biophysj.105.073106.View ArticlePubMedPubMed CentralGoogle Scholar
- Frerking I, Gunther A, Seeger W, Pison U: Pulmonary surfactant: functions, abnormalities and therapeutic options. Intensive Care Med. 2001, 27 (11): 1699-1717. 10.1007/s00134-001-1121-5.View ArticlePubMedGoogle Scholar
- Taeusch HW, de la Serna JB, Perez-Gil J, Alonso C, Zasadzinski JA: Inactivation of pulmonary surfactant due to serum-inhibited adsorption and reversal by hydrophilic polymers: experimental. Biophys J. 2005, 89 (3): 1769-1779. 10.1529/biophysj.105.062620.View ArticlePubMedPubMed CentralGoogle Scholar
- Veldhuizen R, Possmayer F: Phospholipid metabolism in lung surfactant. Subcell Biochem. 2004, 37: 359-388.View ArticlePubMedGoogle Scholar
- Brash F, Johnen G, Winn-Brash A, Guttentag SH, Schmiedl A, Kapp N, Suzuki Y, Muller KM, R J, Hawgood S, et al: Surfactant protein B in Type II Pneumocytes and Intra-Alveolar Surfactant Forms of Human Lungs. Am J Respir Cell Mol Biol. 2004, 30: 449-458. 10.1165/rcmb.2003-0262OC.View ArticleGoogle Scholar
- Weaver TE, Conkright JJ: Function of surfactant proteins B and C. Annu Rev Physiol. 2001, 63: 555-578. 10.1146/annurev.physiol.63.1.555.View ArticlePubMedGoogle Scholar
- Zhou L, Lim L, Costa RH, Whitsett J: Thyroid trascription fator-1, hepatocyte nuclear factor-3beta, surfactant protein B, C, and Clara cell secretory protein in developing mouse lung. The journal of histochemistry and cytochemistry. 1996, 44 (10): 1183-1193. 10.1177/44.10.8813084.View ArticlePubMedGoogle Scholar
- Hawgood S: Surfactant protein B: structure and function. Biol Neonate. 2004, 85 (4): 285-289. 10.1159/000078169.View ArticlePubMedGoogle Scholar
- Kurutz JW, Lee KY: NMR structure of lung surfactant peptide SP-B(11-25). Biochemistry. 2002, 41 (30): 9627-9636. 10.1021/bi016077x.View ArticlePubMedGoogle Scholar
- Ikegami M, Le Cras TD, Hardie WD, Stahlman MT, Whitsett JA, Korfhagen TR: TGF-alpha perturbs surfactant homeostasis in vivo. Am J Physiol Lung Cell Mol Physiol. 2005, 289 (1): L34-43. 10.1152/ajplung.00407.2004.View ArticlePubMedGoogle Scholar
- Todd DA, Marsh MJ, George A, Henderson NG, Barr H, Sebastian S, Clark GT, Koster G, Clark HW, Postle AD: Surfactant phospholipids, surfactant proteins, and inflammatory markers during acute lung injury in children. Pediatr Crit Care Med. 2010, 11 (1): 82-91. 10.1097/PCC.0b013e3181ae5a4c.View ArticlePubMedGoogle Scholar
- Cogo PE, Gucciardi A, Traldi U, Hilkert AW, Verlato G, Carnielli V: Measurement of pulmonary surfactant disaturated-phosphatidylcholine synthesis in human infants using deuterium incorporation from body water. J Mass Spectrom. 2005, 40 (7): 876-881. 10.1002/jms.858.View ArticlePubMedGoogle Scholar
- Cogo PE, Carnielli VP, Bunt JE, Badon T, Giordano G, Zacchello F, Sauer PJ, Zimmermann LJ: Endogenous surfactant metabolism in critically ill infants measured with stable isotope labeled fatty acids. Pediatr Res. 1999, 45 (2): 242-246. 10.1203/00006450-199902000-00015.View ArticlePubMedGoogle Scholar
- Lowry OH, Rosebrough NJ, Farr AL, Randall RJ: Protein measurement with the Folin phenol reagent. J Biol Chem. 1951, 193 (1): 265-275.PubMedGoogle Scholar
- Bartlett GR: Phosphorus assay in column chromatography. J Biol Chem. 1959, 234 (3): 466-468.PubMedGoogle Scholar
- Cogo PE, Giordano G, Badon T, Orzali A, Zimmermann IU, Zacchello F, Sauer PJ, Carnielli VP: Simultaneous measurement of the rates of appearance of palmitic and linoleic acid in critically ill infants. Pediatr Res. 1997, 41 (2): 178-182. 10.1203/00006450-199702000-00004.View ArticlePubMedGoogle Scholar
- Kramer HJ, Schmidt R, Gunther A, Becker G, Suzuki Y, Seeger W: ELISA technique for quantification of surfactant protein B (SP-B) in bronchoalveolar lavage fluid. Am J Respir Crit Care Med. 1995, 152 (5 Pt 1): 1540-1544.View ArticlePubMedGoogle Scholar
- Baritussio A, Alberti A, Quaglino D, Pettenazzo A, Dalzoppo D, Sartori L, Pasquali-Ronchetti I: SP-A, SP-B and SP-C in surfactant subtypes around birth: reexamination of alveolar life cycle of surfactant. Am J Physiol. 1994, 266 (4 Pt 1): L436-437.PubMedGoogle Scholar
- Dargaville PA, South M, Vervaart P, McDougall PN: Validity of markers of dilution in small volume lung lavage. Am J Respir Crit Care Med. 1999, 160 (3): 778-784.View ArticlePubMedGoogle Scholar
- Cogo P, Baritussio A, Rosso F, Gucciardi A, Moretti V, Badon T, Duner E, Zimmernann L, Carnielli VP: Surfactant-associated protein B kinetics in vivo in newborn infants by stable isotopes. Pediatr Res. 2005, 57 (4): 519-522. 10.1203/01.PDR.0000155755.27716.04.View ArticlePubMedGoogle Scholar
- Corr LT, Berstan R, Evershed RP: Optimisation of derivatisation procedures for the determination of delta13C values of amino acids by gas chromatography/combustion/isotope ratio mass spectrometry. Rapid Commun Mass Spectrom. 2007, 21 (23): 3759-3771. 10.1002/rcm.3252.View ArticlePubMedGoogle Scholar
- Husek P: Amino acid derivatization and analysis in five minutes. FEBS Lett. 1991, 280 (2): 354-356. 10.1016/0014-5793(91)80330-6.View ArticlePubMedGoogle Scholar
- Gucciardi A, Cogo PE, Traldi U, Eaton S, Darch T, Simonato M, Ori C, Carnielli VP: Simplified method for microlitre deuterium measurements in water and urine by gas chromatography-high-temperature conversion-isotope ratio mass spectrometry. Rapid Commun Mass Spectrom. 2008, 22 (13): 2097-2103. 10.1002/rcm.3593.View ArticlePubMedGoogle Scholar
- Nakos G, Kitsiouli EI, Tsangaris I, Lekka ME: Bronchoalveolar lavage fluid characteristics of early intermediate and late phases of ARDS. Alterations in leukocytes, proteins, PAF and surfactant components. Intensive Care Med. 1998, 24 (4): 296-303. 10.1007/s001340050571.View ArticlePubMedGoogle Scholar
- Epaud R, Ikegami M, Whitsett JA, Jobe AH, Weaver TE, Akinbi HT: Surfactant protein B inhibits endotoxin-induced lung inflammation. Am J Respir Cell Mol Biol. 2003, 28 (3): 373-378. 10.1165/rcmb.2002-0071OC.View ArticlePubMedGoogle Scholar
- Ueda T, Ikegami M, Henry M, Jobe AH: Clearance of surfactant protein B from rabbit lungs. Am J Physiol. 1995, 268 (4 Pt 1): L636-641.PubMedGoogle Scholar
- Bunt JE, Zimmermann LJ, Wattimena JL, van Beek RH, Sauer PJ, Carnielli VP: Endogenous surfactant turnover in preterm infants measured with stable isotopes. Am J Respir Crit Care Med. 1998, 157 (3 Pt 1): 810-814.View ArticlePubMedGoogle Scholar
- Cogo PE, Ori C, Simonato M, Verlato G, Isak I, Hamvas A, Carnielli VP: Metabolic precursors of surfactant disaturated-phosphatidylcholine in preterms with respiratory distress. J Lipid Res. 2009, 50 (11): 2324-2331. 10.1194/jlr.M800514-JLR200.View ArticlePubMedPubMed CentralGoogle Scholar
- Akira S: IL-6-regulated transcription factors. Int J Biochem Cell Biol. 1997, 29 (12): 1401-1418. 10.1016/S1357-2725(97)00063-0.View ArticlePubMedGoogle Scholar
- Ikegami M, Falcone A, Whitsett J: STAT-3 regulates surfactant phospholipid homeostasis in normal lung and during endotoxin-mediated lung injury. J Appl Physiol. 2008, 104: 1753-1760. 10.1152/japplphysiol.00875.2007.View ArticlePubMedGoogle Scholar
- Cogo PE, Toffolo GM, Ori C, Vianello A, Chierici M, Gucciardi A, Cobelli C, Baritussio A, Carnielli VP: Surfactant disaturated-phosphatidylcholine kinetics in acute respiratory distress syndrome by stable isotopes and a two compartment model. Respir Res. 2007, 8: 13-10.1186/1465-9921-8-13.View ArticlePubMedPubMed CentralGoogle Scholar
- Manzanares D, Rodriguez-Capote K, Liu S, Haines T, Ramos Y, Zhao L, Doherty-Kirby A, Lajoie G, Possmayer F: Modification of tryptophan and methionine residues is implicated in the oxidative inactivation of surfactant protein B. Biochemistry. 2007, 46 (18): 5604-5615. 10.1021/bi062304p.View ArticlePubMedGoogle Scholar
- Cogo PE, Zimmermann LJ, Verlato G, Midrio P, Gucciardi A, Ori C, Carnielli VP: A dual stable isotope tracer method for the measurement of surfactant disaturated-phosphatidylcholine net synthesis in infants with congenital diaphragmatic hernia. Pediatr Res. 2004, 56 (2): 184-190. 10.1203/01.PDR.0000132665.73234.F6.View ArticlePubMedGoogle Scholar
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.