Surfactant therapy of acute and chronic lung diseases

Abstract

Lung surfactant is a complex of lipids and surfactant-associated proteins which covers the surface of alveoli and the other airways. It is responsible for the mechanics of respiration as well as innate and acquired local immunity. The deficiency and abnormalities of lung surfactant are found in many lung pathologies including RDS in newborns and ARDS in adults, COPD, lung tuberculosis and others. Lung surfactant formulations showed high efficiency in RDS treatment in newborns. Many attempts were made to test them for ARDS therapy. Highly-efficient native formulation of lung surfactant based on nanoliposomes, Surfactant-BL, was developed in RSCRCT. Surfactant-BL had been tested within preclinical and multi-central clinical trials in Russia and was permitted for the treatment of RDS in newborns in 2000 and ARDS in adults in 2003. In December, 2008 Surfactant-BL was approved for use in patients with infiltrative and fibrocavernous lung tuberculosis (TB). Surfactant-BL has been registered in Moldavia and Byelorussia. By June 2009 Surfactant-BL had been used in over 9,000 newborns, 1,000 adults with ARDS and more than 300 lung TB patients. It is well known that mortality rate in RDS can be as high as 10-20% and mortality rate in ARDS is 50-80%. The use of Surfactant-BL causes a significant decrease in CMV duration, a reduction in complication frequency and a 3-4 fold decrease of mortality rate. Two-month inhalation course of Surfactant-BL (together with standard antituberculosis therapy) to lung TB patients including the patients with multi-drug resistance results in abacillarity in 83% patients (62% in control group), resolution of infiltrates in 100% patients (63% in control group) and cavern closing in 73% patients (41% in control group). We believe that surfactant therapy will be used not only in above-mentioned patient groups but also in patients with COPD, bronchial asthma and other lung diseases.