Pulmonary surfactant (medication)

Pulmonary surfactant

Beractant, surrounded by devices for its application.

Clinical data
Pronunciation| Curosurf, Survanta, others
Other names| Beractant, Poractant alfa, others
AHFS/Drugs.com| Monograph
License data|

* US DailyMed: Poractant_alfa

ATC code|

* R07AA (WHO)

Identifiers
CAS Number|

* 129069-19-8 Y

ChemSpider|

* none

UNII|

* KE3U2023NP

Pulmonary surfactant is used as a medication to treat and prevent respiratory distress syndrome in newborn babies.[1]

Prevention is generally done in babies born at a gestational age of less than 32 weeks.[1] It is given by the endotracheal tube.[1] Onset of effects is rapid.[2] A number of doses may be needed.[2]

Side effects may include slow heart rate and low oxygen levels.[1] Its use is also linked with intracranial bleeding.[1] Pulmonary surfactant may be isolated from the lungs of cows or pigs or made artificially.[1][3][4]

Pulmonary surfactant was discovered in the 1950s and a manufactured version was approved for medical use in the United States in 1990.[3] It is on the World Health Organization's List of Essential Medicines.[5]

## Contents

* 1 Medical uses
* 2 Types
* 3 History
* 4 References
* 5 External links

## Medical uses

Pulmonary surfactant is used to treat and prevent respiratory distress syndrome in newborn babies.[1] Prevention is generally done in babies born less than 32 weeks gestational age.[1] Tentative evidence supports use in drowning.[6]

Surfactant administration can also be effective in meconium aspiration syndrome where it has been shown to help lower length of stay.[7][8]

For patients with acute respiratory distress syndrome (ARDS), surfactant has not been shown to reduce mortality. However, it may be beneficial in those with COVID-19 associated ARDS.[9][10]

## Types

There are a number of types of pulmonary surfactants available. Like their natural counterparts, pulmonary surfactant preparations consist of phospholipids (mainly DPPC) combined with spreading agents such as SP-B and SP-C.[11] Ex-situ measurements of surface tension and interfacial rheology can help to understand the functionality of pulmonary surfactants.[12]

Synthetic pulmonary surfactants:

* Colfosceril palmitate (Exosurf) – a mixture of DPPC with hexadecanol and tyloxapol added as spreading agents
* Pumactant (Artificial Lung Expanding Compound or ALEC) – a mixture of DPPC and PG
* Lucinactant (KL4, trade name Surfaxin) – composed of DPPC, palmitoyl-oleoyl phosphatidylglycerol, and palmitic acid, combined with a 21 amino acid synthetic peptide (sinapultide) that mimics the C-terminal helical domain of SP-B.[13]
* Ventricute - DPPC, rSP-C

Animal-derived surfactants:

* Beractant (Survanta) – extracted from minced cow lung with additional DPPC, palmitic acid and tripalmitin, manufactured by Abbvie
* (Beraksurf) – extracted from minced cow lung with additional DPPC, palmitic acid and tripalmitin, manufactured by Tekzima
* Calfactant (Infasurf) – extracted from calf lung lavage fluid, manufactured by ONY Biotech.
* Poractant alfa (Curosurf) – extracted from material derived from minced pig lung
* Surfactant TA (Surfacten) – derived from cows, manufactured by Tokyo Tanabe Co. [14]
* Bovactant SF-RI (Alveofact) – extracted from cow lung lavage fluid, manufactured by Boehringer Ingelheim

## History

Researcher John Clements identified surfactants and their role in the 1950s. Mary Ellen Avery soon after showed that the lungs of premature infants could not produce surfactants.[15]

Exosurf, Curosurf, Infasurf, and Survanta were the initial surfactants FDA approved for use in the U.S.[16]

In 2012, the US FDA approved an additional synthetic surfactant, lucinactant (Surfaxin).[17]

## References

1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 British National Formulary: BNF 69 (69 ed.). British Medical Association. 2015. p. 217. ISBN 9780857111562.
2. ↑ 2.0 2.1 "Respiratory Problems" (in en). Klaus and Fanaroff's Care of the High-Risk Neonate, Expert Consult - Online and Print,6: Klaus and Fanaroff's Care of the High-Risk Neonate. Elsevier Health Sciences. 2013. p. 252. ISBN 978-1416040019. https://books.google.com/books?id=cWXTcL82Q6IC&pg=PA252.
3. ↑ 3.0 3.1 "The Era of Exposed Ignorance, 1982-1992" (in en). Neonatal Bioethics: The Moral Challenges of Medical Innovation. JHU Press. 2006. pp. 54–56. ISBN 9780801883446. https://books.google.com/books?id=5BuWwVAxuZkC&pg=PA56.
4. ↑ "Gases and Drugs Used in Support of the Respiratory System" (in en). Pediatric Critical Care Medicine. Lippincott Williams & Wilkins. 2006. pp. 724–725. ISBN 9780781794695. https://books.google.com/books?id=_XavFllbnS0C&pg=PA725.
5. ↑ World Health Organization model list of essential medicines: 21st list 2019. Geneva: World Health Organization. 2019. WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO.
6. ↑ "Cardiac Arrest in Special Populations" (in en). Cardiac Arrest, An Issue of Emergency Medicine Clinics. Elsevier Health Sciences. 2012. p. 175. ISBN 978-1455742769. https://books.google.com/books?id=NMHztDbemToC&pg=PA175.
7. ↑ "Surfactant for meconium aspiration syndrome in term and late preterm infants". The Cochrane Database of Systematic Reviews 2014 (12): CD002054. December 2014. doi:10.1002/14651858.CD002054.pub3. PMID 25504256.
8. ↑ Neonatal and Pediatric Respiratory Care. Elsevier. 2019. pp. 244–261. ISBN 978-0-323-47947-9.
9. ↑ "Exogenous pulmonary surfactant for the treatment of adult patients with acute respiratory distress syndrome: results of a meta-analysis". Critical Care 10 (2): R41. 2006. doi:10.1186/cc4851. PMID 16542488.
10. ↑ "Surfactant for the Treatment of ARDS in a Patient With COVID-19" (in English). Chest 160 (1): e9–e12. July 2021. doi:10.1016/j.chest.2021.01.028. PMID 33493441.
11. ↑ "An overview of pulmonary surfactant in the neonate: genetics, metabolism, and the role of surfactant in health and disease". Molecular Genetics and Metabolism 97 (2): 95–101. June 2009. doi:10.1016/j.ymgme.2009.01.015. PMID 19299177.
12. ↑ "Physiological fluid interfaces: Functional microenvironments, drug delivery targets, and first line of defense". Acta Biomaterialia 130: 32–53. August 2021. doi:10.1016/j.actbio.2021.05.051. PMID 34077806.
13. ↑ "KL4 Surfactant Technology". http://www.windtreetx.com/kl4-surfactant-technology2/.
14. ↑ "T 0723/94 (Surfactant composition/TOKYO TANABE CO) of 18.2.1999" (in en). European Patent Office. https://www.epo.org/law-practice/case-law-appeals/recent/t940723eu1.html.
15. ↑ "How A Scientist's Slick Discovery Helped Save Preemies' Lives". NPR. 3 August 2015. https://www.npr.org/sections/health-shots/2015/08/03/422620170/how-a-scientists-slick-discovery-helped-save-preemies-lives.
16. ↑ "Improving pulmonary surfactants". Acta Pharmacologica Sinica 23 Suppl: 11–5. 2002. http://www.chinaphar.com/1671-4083/23/11s.pdf.
17. ↑ "Surfaxin (lucinactant) Intratracheal Suspension". Drug Approval Package. U.S. Food and Drug Administration. https://www.accessdata.fda.gov/drugsatfda_docs/nda/2012/021746Orig1s000TOC.cfm.

## External links

* "Poractant alfa". Drug Information Portal. U.S. National Library of Medicine. https://druginfo.nlm.nih.gov/drugportal/rn/129069-19-8.
* "Beractant". Drug Information Portal. U.S. National Library of Medicine. https://druginfo.nlm.nih.gov/drugportal/rn/108778-82-1.
* "Calfactant". Drug Information Portal. U.S. National Library of Medicine. https://druginfo.nlm.nih.gov/drugportal/rn/183325-78-2.

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