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Treatment of Acute Respiratory Distress Syndrome with Recombinant Surfactant Protein C Surfactant

Department of Medicine, University of California San Diego School of Medicine and San Diego Veterans Affairs HealthCare System, San Diego, California; Department of Medicine, Lawson Health Research Institute, St. Joseph's Health Centre, University of Western Ontario, London, Ontario, Canada; ALTANA Pharma AG, Konstanz, Germany; Department of Medicine, University of Cincinnati, Cincinnati; and Department of Medicine, Ohio State University, Columbus, Ohio

Correspondence and requests for reprints should be addressed to Dr. Roger G. Spragg, M.D., Veteran's Administration Medical Center, 3350 La Jolla Village Drive, San Diego, CA 92161. E-mail: rspragg{at}ucsd.edu

We performed a phase I/II trial in North America of a recombinant surfactant protein C–based surfactant (Venticute) as treatment for the acute respiratory distress syndrome. Patients were prospectively randomized to receive either standard therapy or standard therapy plus one of two doses of exogenous surfactant given four times over 24 hours. Surfactant administration was well tolerated. No significant treatment benefit was associated with surfactant treatment. Bronchoalveolar lavage of treated patients at 48 hours reflected the presence of exogenous surfactant components, did not show evidence of improved surface tension lowering function, and had interleukin-6 concentrations that were significantly lower than control group values, consistent with an antiinflammatory treatment effect. The presence of exogenous surfactant was not detected in lavage fluid obtained at 120 hours. Future studies might rationally employ larger surfactant doses and a more prolonged dosing schedule.

Key Words: pulmonary surfactant • surfactant apoprotein C • phospholipids • interleukin-6

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