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Am. J. Respir. Crit. Care Med., Volume 160, Number 6, December 1999, 1843-1850

Serial Changes in Surfactant-associated Proteins in Lung and Serum before and after Onset of ARDS

KELLY E. GREENE, JO RAE WRIGHT, KENNETH P. STEINBERG, JOHN T. RUZINSKI, ELLEN CALDWELL, WES B. WONG, WILLIAM HULL, JEFFREY A. WHITSETT, TOYOAKI AKINO, YOSHIO KUROKI, HISATO NAGAE, LEONARD D. HUDSON, and THOMAS R. MARTIN

Harborview Medical Center; The Medical Research Service, Seattle Veterans' Affairs Medical Center; The Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, Washington; The Department of Cell Biology, Duke University Medical Center, Durham, North Carolina; The Children's Hospital Medical Center, Division of Pulmonary Biology, Cincinnati, Ohio; Department of Biochemistry, Sapporo Medical University School of Medicine, Sapporo; and Diagnostic Division, Yamasa Corporation, Choshi, Japan

The goal of this study was to determine the changes that occur in surfactant-associated proteins in bronchoalveolar lavage fluid (BAL) and serum of patients at risk for ARDS and during the course of ARDS. We found that the concentrations of SP-A and SP-B were low in the BAL of patients at risk for ARDS before the onset of clinically defined lung injury, whereas the concentration of SP-D was normal. In patients with established ARDS, BAL SP-A and SP-B concentrations were low during the entire 14-d observation period, but the median SP-D concentrations remained in the normal range. Immunoreactive SP-A and SP-D were not increased in the serum of patients at risk for ARDS, but both increased after the onset of ARDS to a maximum on Day 3 and remained elevated for as long as 14 d. The BAL SP-A concentrations were significantly lower in at-risk patients who developed ARDS, and no patient with a BAL SP-A concentration greater than 1.2 µg/ml developed ARDS. On Days 1 and 3 of ARDS, the BAL SP-D concentration was significantly lower in patients who died, and the BAL SP-D concentration was significantly related to the PIO2/FIO2 ratio. Thus, surfactant protein abnormalities occur before and after the onset of ARDS, and the responses of SP-A, SP-B, and SP-D differ in important ways. The BAL SP-A and SP-D measurements can be used to classify patients as high or low risk for progression to ARDS and/or death after the onset of ARDS. Strategies to increase these surfactant proteins in the lungs of patients with ARDS could be useful to modify the onset or the course of ARDS. Greene KE, Wright JR, Steinberg KP, Ruzinski JT, Caldwell E, Wong WB, Hull W, Whitsett JA, Akino T, Kuroki Y, Nagae H, Hudson LD, Martin TR. Serial changes in surfactant-associated proteins in lung and serum before and after onset of ARDS.




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