Protein content and biophysical properties of tracheal aspirates form neonates with respiratory failure[1]

Abstract

Background: We aimed at assessing the quality and quantity of protein-leakage across the alveolar-capillary membrane and its influence on surfactant function during the early neonatal period in preterm infants compared to newborns both with respiratory failure.

Patients and methods: We therefore prospectively analyzed total protein, elastase-α₁-proteinase inhibitor complex (E-α₁-PI) and α₂-macroglobulin concentrations in tracheal aspirates from 31 infants ≤ 32 weeks gestational age (group 1 : 29.3 ± 2 weeks, 1214 ± 410 g [means ± SEM]) and from 21 neonates > 32 weeks (group 2 : 37.5 ± 3 weeks, 2890 ± 600 g [means ± SEM]) and measured their surface activity in the pulsating bubble surfactometer.

Results: Day 1 total protein and α₂-macroglobulin levels indicated an initial high leakage that declined to day 3 in both groups (from 1652 ± 241 to 708 ± 227 mg/l; p < 0.05; resp. from 28 ± 6 to 12 ± 4 mg/l [means ± SEM]). In group 2 E-α₁-PI concentrations were significantly elevated at day 1 compared to group 1 (15 754 ± 5766 versus 3320 ± 1056 μg/l [means ± SEM]). In both groups a high minimum surface tension (15 - 30 mN/m) was recorded from day 1 - 4.

Conclusions: These results suggest in larger newborns a secondary surfactant deficiency due to protein-leakage to play an important role in the pathogenesis of respiratory failure. The increased alveolar-capillary membrane permeability might be caused by inflammatory ARDS-like mechanisms.

Zusammenfassung

Hintergrund: Ziel der Studie ist es, das Ausmaß und die Qualität des Proteineinstroms in den Alveolarraum durch die alveolokapilläre Membran bei sehr unreifen Frühgeborenen und reiferen Früh- und Neugeborenen zu vergleichen.

Patienten und Methoden: Im Rahmen einer prospektiven Studie wurde die Elastase-α₁-Proteinaseinhibitorkomplex- (E-α₁-PI) und α₂-Makroglobulinkonzentration in den Trachealaspiraten von 31 Frühgeborenen eines Gestationsalters ≤ 32 Wochen (Gruppe 1: 29,3 ± 2 Wochen; 1214 ± 410 g [MW ± SEM]) und von 21 reiferen Neugeborenen (Gruppe 2: 37,5 ± 3 Wochen; 2890 ± 600 g [MW ± SEM]) gemessen. Zusätzlich wurden die oberflächenaktiven Eigenschaften der Trachealaspirate am „Pulsating Bubble Surfactometer” gemessen.

Ergebnisse: Die am ersten Lebenstag gemessenen Gesamtprotein- und α₂-Makroglobulinwerte zeigen eine initial hohe Leckage, die in beiden Gruppen bis zum 3. Tag signifikant abfällt (von 1652 ± 241 auf 708 ± 227 mg/l; p < 0,05; bzw. von 28 ± 6 auf 12 ± 4 mg/l [MW ± SEM]). In Gruppe 2 fanden sich am ersten Lebenstag signifikant höhere E-α₁-PI-Konzentrationen als in Gruppe 1 (15 754 ± 5766 μg/l bzw. 3320 ± 1056 [means ± SEM]). In beiden Gruppen wurden innerhalb der ersten 4 Lebenstage hohe Oberflächenspannungswerte gemessen (γ_min nach 150 Zyklen: 1530 mN/m).

Schlussfolgerung: Diese Ergebnisse weisen auf einen durch surfactantinhibierende Plasmaproteine bedingten sekundären Surfactantmangel bei reiferen Früh- und Neugeborenen hin. Eine inflammatorisch induzierte Läsion könnte die erhöhte Durchlässigkeit der alveolokapillären Membran in dieser Gruppe erklären.

Surfactant - alveolar-capillary membrane - elastase - RDS

Surfactant - alveolokapilläre Membran - Elastase - ANS

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1 This research was supported in part by Boehringer-Ingelheim, Biberach/Riss, Germany.