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Archives de pédiatrie
Volume 15, n° S1
pages 42-46 (juin 2008)
Doi : 10.1016/S0929-693X(08)73946-0
Une nouvelle génération de surfactants de synthèse
Exogenous surfactant therapy: new synthetic surfactants
 

Th. Lacaze-Masmonteil
Department of Pediatrics, Stollery Childrenʼs Hospital, Women and Childrenʼs Health Research Institute, Edmonton, Alberta, Canada 

Résumé

Le développement et la mise sur le marché de surfactants d’origine bovine ou porcine, comprenant un mélange de phospholipides et protéines hydrophobes spécifiques SP-B et SP-C, ont révolutionné le traitement de la maladie des membranes hyalines du grand prématuré. Une nouvelle génération de surfactants synthétiques, constituée de phospholipides et d’analogues peptidiques des protéines spécifiques, a récemment émergé. Lucinactant (Surfaxin®), un surfactant de synthèse constitué par l’addition d’un analogue de la protéine SP-B à des phospholipides, a été évalué par des essais cliniques contrôlés avec des résultats prometteurs. L’impact de l’émergence de cette nouvelle classe de surfactants est potentiellement majeur. Ces surfactants disponibles en quantité illimitée et à moindre coût ont le potentiel de profondément modifier la prise en charge de la maladie des membranes hyalines dans les 10 prochaines années.

The full text of this article is available in PDF format.
Summary

There are numerous pulmonary conditions in which qualitative or quantitative anomalies of the surfactant system have been demonstrated. In premature newborns with immature lungs, a functional deficit in surfactant is the main physiopathologic mechanism of the neonatal respiratory distress syndrome (RDS). Since the landmark pilot study of Fujiwara, published more than 20 years ago, the efficacy of exogenous surfactant for the treatment of neonatal RDS has been established by numerous controlled studies and meta-analyses. Enlightened by a growing insight into both the structure and function of the different surfactant components, a new generation of synthetic surfactants has been developed. Various complementary approaches have confirmed the fundamental role of the two hydrophobic proteins, SP-B and SP-C, in the surfactant system, thus opening the way to the design of analogues, either by chemical synthesis or expression in a prokaryotic system. An example of these peptide-containing synthetic surfactant preparations, lucinactant (Surfaxin®), has been recently tested in comparison to a synthetic surfactant that does not contain protein as well as to animal derived surfactant preparations. Major clinical outcomes between lucinactant and animal-derived surfactant preparations were fund similar in two randomized controlled trials, opening the way to a new generation of synthetic surfactants in the near future.

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Mots clés : Surfactant, Prématurité, Maladie des membranes hyalines




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