Lung Surfactants: Basic Science and Clinical Applications

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ISBN: 9780824704018 | 0824704010
Cover: Hardcover
Copyright: 7/18/2000

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Integrating basic and clinical research on the biophysical and physiological functions of pulmonary surfactants, this practical reference presents thorough, cutting-edge coverage on surfactant-related lung disease. Manage neonatal respiratory distress syndrome (RDS), acute respiratory distress syndrome (ARDS), and acute lung injury more effectively!

Introduction

iii

Claude Lenfant

Preface

Introduction

(6)

Summary of Chapter Organization

(1)

Introduction to Surface Tension and Surfactants

(38)

Overview

(1)

Interfaces

(2)

Surface Tension

(3)

Surface Active Agents: Definition and Behavior

(2)

Surface Films (Surfactant Monolayers)

(2)

Behavior of Surfactant Films at the Air-Water Interface

(16)

Langmuir-Blodgett Multilayers

(1)

Wetting, Contact Angles, and Spreading

(2)

Adsorption and Behavior of Surfactants Suspended in the Liquid Phase

(5)

Chapter Summary

(6)

Phospholipids: Introduction to Structure and Biophysics

(28)

Overview

(1)

Phospholipids as Lung Surfactant Constituents

(1)

Phospholipid Classes and Their Molecular Structure

(2)

Distribution of Phospholipid Classes in Cell Membranes and Lung Surfactant

(2)

Fatty Chains in Individual Compounds Within a Phospholipid Class

(1)

Biophysical Importance of Phospholipid Fatty Chains

(2)

Phospholipid Surface Films and Their Characteristics

(3)

Dynamic versus Equilibrium Surface Tension Lowering in Compressed Phospholipid Films

(3)

Phospholipid Bilayers and Their Properties

(5)

Effects of Cholesterol in Phospholipid Films and Bilayers

(1)

Phospholipid Aggregates in the Aqueous Phase

(3)

Phospholipid Adsorption

(2)

Chapter Summary

(3)

Physicochemical Methods for Studying Lung Surfactants

(22)

Overview

(1)

Overview of Analytical and Preparatory Methods Used with Lung Surfactants

(2)

Methods of Measuring Surface Tension

(3)

Methods of Measuring the Surface Active Properties of Surfactants

(1)

Wilhelmy Surface Balance

(4)

Adsorption with Minimized Diffusion Resistance

(2)

The Pulsating Bubble Surfactometer

(3)

Captive Bubble Apparatus

(2)

Molecular Biophysical Methods Used in Lung Surfactant Research

(3)

Chapter Summary

(3)

Lung Surfactant Materials, Research Complexities, and Interdisciplinary Correlations

(24)

Overview

(1)

Complexities in Lung Surfactant Research and the Need for Correlated Measurements

(2)

Multidisciplinary Approaches in Lung Surfactant Research

(1)

Overview of Materials Used in Lung Surfactant Research

(19)

Categories of Animal Models for Studying the Physiological Activity of Lung Surfactants

116

(2)

Chapter Summary

118

(1)

Discovery of Endogenous Lung Surfactant and Overview of Its Metabolism and Actions

119

(32)

Overview

119

(1)

Pulmonary Surface Area

119

(2)

The Alveolar Hypophase and Surface Tension

121

(1)

Importance of surface Tension Forces in Lung Mechanics

121

(1)

Alveolar Stability and the Laplace Equation

122

(3)

Pulmonary Surface Tension Is Much Less Than That of Water

125

(2)

Discovery of Pulmonary Surfactant

127

(2)

Overview of the Composition of Endogenous Lung Surfactant

129

(1)

The Pulmonary Surfactant System: Lung Surfactant and the Type II Pneumocyte

130

(2)

Alveolar Type I and Type II Epithelial Cells

132

(3)

Overview of Lung Surfactant Synthesis and Metabolism in Type II Cells

135

(8)

Lung Surfactant Microstructure and Subtypes

143

(1)

Tubular Myelin and Lung Surfactant Adsorption

143

(1)

Summary of Physiological Actions of Lung Surfactant

144

(2)

Summary of the Biophysical Properties of Active Lung Surfactant

146

(2)

Correlating Composition, Surface Activity, and Physiological Activity in Lung Surfactants

148

(1)

Chapter Summary

149

(2)

Analyses of Surfactant Activity and Its Contribution to Lung Mechanics and Stability

151

(20)

Overview

151

(1)

Relationships Between Surface Tension-Area and Pulmonary P-V Behavior

151

(4)

Experiments Correlating Surface Active Properties with Effects on Mechanics

155

(4)

Theories and Experiments on Minimum Surface Tensions ≤1 Mn/M in Dynamically Compressed Lung Surfactant Films

159

(4)

Theoretical Modeling of Lung Surfactant Adsorption and Dynamic Film Behavior

163

(2)

Theoretical Analyses of the Role of Lung Surfactant in Alveolar Stability

165

(1)

The Alveolar Hypophase and Theories of Lung Surfactant Action

166

(1)

Theoretical Roles of Lung Surfactant in the Airways

167

(1)

Chapter Summary

168

(3)

Functional Composition and Component Biophysics of Endogenous Lung Surfactant

171

(36)

Overview

171

(1)

Overview of Materials and Methods Used in Studying Functional Composition

171

(1)

Concept of Functional Composition

172

(2)

Lung Surfactant Phospholipids and Their Contributions to Surface Activity

174

(8)

Lung Surfactant Neutral Lipids and Their Contributions to Surface Active Biophysics

182

(1)

Lung Surfactant Proteins and Their Molecular Biophysical Characteristics

183

(14)

Effects of Lung Surfactant Apoproteins on Phospholipid Surface Activity

197

(6)

Summary of Functional Lung Surfactant Components and Their Actions

203

(3)

Chapter Summary

206

(1)

Lung Surfactant Dysfunction

207

(26)

Overview

207

(1)

Concept of Lung Surfactant Inhibition or Inactivation

207

(1)

Endogenous Compounds Able to Directly Inhibit Lung Surfactant Activity

208

(2)

Characteristic Surface Activity Changes Found During Inactivation of Endogenous Lung Surfactant

210

(4)

Inactivation of Exogenous Lung Surfactants

214

(4)

Clinical Relevance of Concentration-Dependent Surfactant Inactivation

218

(1)

Mechanisms of Lung Surfactant Inactivation

219

(8)

Physiological Correlates of Lung Surfactant Inhibition

227

(4)

Chapter Summary

231

(2)

Diseases of Lung Surfactant Deficiency or Dysfunction

233

(16)

Overview

233

(1)

The Neonatal Respiratory Distress Syndrome (RDS, HMD)

233

(5)

Congenital Deficiency of Functional Surfactant Components (SP-B Deficiency)

238

(1)

Acute Lung Injury and ARDS

239

(8)

Chapter Summary

247

(2)

Lung Surfactant Replacement in Animal Models

249

(32)

Overview

249

(1)

Overview of Animal Models for Evaluating Surfactant Therapy in RDS

249

(1)

Surfactant-Deficient Animal Models Primarily Emphasizing Static P-V Mechanics

250

(6)

General Aspects of Animal Models of Prematurity Emphasizing Lung Functional Responses to Exogenous Surfactants

256

(1)

Studies of Surfactant Replacement in Premature Lambs with RDS

257

(8)

Overview of Animal Models of ARDS-Related Acute Lung Injury with Surfactant Dysfunction

265

(4)

Surfactant Replacement in Animal Models of Acute Lung Injury and ARDS

269

(10)

Chapter Summary

279

(2)

Clinical Surfactant Replacement Therapy for Neonatal RDS

281

(18)

Overview

281

(1)

Mortality in Premature Infants in the Mid-1950's

281

(1)

Hyaline Membrane Disease Before Neonatal Intensive Care

282

(1)

Impact of Mechanical Ventilation and Intensive Care on HMD in Premature Infants

283

(1)

Bronchopulmonary Dysplasia (BPD) in Premature Infants

284

(1)

Initial Unsuccessful Clinical Surfactant Therapy for RDS

285

(1)

Basic Research Leading to Successful Surfactant Therapy for RDS

286

(1)

Initial Positive Uncontrolled or Nonrandomized Surfactant Replacement Studies in RDS in the Early 1980's

287

(1)

Successful Controlled Clinical Studies of Exogenous Surfactant Therapy for RDS

288

(2)

Clinical Endpoints in Trials of Lung Surfactant Replacement Therapy for RDS

290

(1)

Clinical Trials Comparing Different Exogenous Surfactant Preparations

291

(3)

Retrospective Assessments of Clinical Surfactant Trials and Exogenous Surfactants: Meta Analyses

294

(1)

Prophylaxis versus Treatment (Rescue) Strategies for Exogenous Surfactant Therapy

295

(1)

Delivery Methods for Exogenous Surfactant

295

(2)

Follow-up Analyses of Premature Infants and Surfactant Trials

297

(1)

Chapter Summary

298

(1)

Surfactant and Combined-Modality Therapies for Clinical ARDS and Acute Lung Injury

299

(20)

Overview

299

(1)

Overview of ARDS and Its Pathophysiology

299

(1)

Rationale for Surfactant Therapy in Clinical ARDS

300

(1)

Factors Complicating Clinical Assessments of Surfactant Therapy for ARDS

301

(2)

Surfactant Therapy in Full-Term Infants with ARDS-Related Respiratory Failure

303

(1)

Surfactant Therapy in Children with Respiratory Failure

303

(2)

Surfactant Therapy in Adults with ARDS

305

(3)

Summary of Current Status of Clinical Surfactant Therapy for ARDS

308

(1)

Overview of Multimodal Therapy for Clinical ARDS

309

(2)

Inhaled Nitric Oxide (INO) and Other Vasoactive Agents for Use in ARDS

311

(2)

Anti-Inflammatory Agents and Antioxidants for Use in ARDS

313

(3)

Specialized Modes of Ventilation for Treating ARDS

316

(1)

Chapter Summary

317

(2)

Exogenous Lung Surfactants: Current and Future

319

(28)

Overview

319

(1)

Classification and Summary of Current Clinical Exogenous Surfactants

319

(6)

Basic Science Comparisons of Activity in Clinical Exogenous Surfactants

325

(6)

Overview of Approaches for New Surfactant Development or Increasing the Activity of Existing Preparations

331

(1)

Exogenous Surfactants Containing Recombinant Surfactant Apoproteins

332

(1)

Synthetic Exogenous Surfactants Containing Synthetic Peptides

333

(2)

Addition of Recombinant Apoproteins or Synthetic Peptides to Existing Exogenou Surfactants

335

(3)

Phospholipid Components in Synthetic Exogenous Surfactants

338

(2)

Novel Phospholipase-Resistant Phospholipid and Phosphonolipid Analogs in Synthetic Exogenous Surfactants

340

(4)

Additional Strategies in Exogenous Surfactant Development

344

(1)

Chapter Summary

344

(3)

Glossary of Common Terms and Abbreviations

347

(8)

References

355

(76)

Index

431

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Lung Surfactants: Basic Science and Clinical Applications

Summary

Author Biography

Table of Contents

Supplemental Materials