1
|
Bettoni S, Orlandi GL, Salomone F, Boiger R, Ischebeck R, Xue R, Mostacci A. Machine learning based longitudinal virtual diagnostics at SwissFEL. Rev Sci Instrum 2024; 95:015110. [PMID: 38236086 DOI: 10.1063/5.0179712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 12/21/2023] [Indexed: 01/19/2024]
Abstract
The bunch length in a linac driven Free Electron Laser (FEL) is a major parameter to be characterized to optimize the final accelerator performance. In linear machines, this observable is typically determined from the beam imaged on a screen located downstream of a Transverse Deflecting Structure (TDS) used to impinge a time dependent kick along the longitudinal coordinate of the beam. This measurement is typically performed during the machine setup and only sporadically to check the beam duration, but it cannot be continuously repeated because it is time consuming and invasive. A non-invasive method to determine the electron bunch length has already been presented in the past. This method is based on the analysis of the synchrotron radiation light spot emitted by the bunch passing through a magnetic chicane, provided that the energy chirp impinged on the bunch by the upstream radio frequency structures is known. In order to overcome a systematic discrepancy affecting the synchrotron radiation monitor based results compared to the absolute TDS based ones, we implemented and optimized a machine learning approach to predict the bunch length downstream of the two SwissFEL compression stages-from about 10 fs up to about 2 ps-as well as the beam longitudinal profile at the first one.
Collapse
Affiliation(s)
- S Bettoni
- Paul Scherrer Institut, 5232 Villigen, Switzerland
| | - G L Orlandi
- Paul Scherrer Institut, 5232 Villigen, Switzerland
| | - F Salomone
- Paul Scherrer Institut, 5232 Villigen, Switzerland
| | - R Boiger
- Paul Scherrer Institut, 5232 Villigen, Switzerland
| | - R Ischebeck
- Paul Scherrer Institut, 5232 Villigen, Switzerland
| | - R Xue
- Paul Scherrer Institut, 5232 Villigen, Switzerland
| | - A Mostacci
- Sapienza University of Rome, 00161 Rome, Italy
| |
Collapse
|
2
|
Servetto A, Salomone F, Napolitano F, Santaniello A, Formisano L, Bianco R. 59P Assessment of QoL results and correlation with survival outcomes in phase III clinical trials in metastatic NSCLC. J Thorac Oncol 2023. [DOI: 10.1016/s1556-0864(23)00313-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
|
3
|
Salomone F, Napolitano F, Caltavituro A, Buonaiuto R, Pecoraro G, Isernia M, Santaniello A, Formisano L, Bianco R, Servetto A. 65P Correlation of overall survival and surrogate endpoints in advanced non-small cell lung cancer treated with immune checkpoint inhibitors: A trial-level analysis. J Thorac Oncol 2023. [DOI: 10.1016/s1556-0864(23)00319-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
|
4
|
Storti M, Faietti ML, Murgia X, Catozzi C, Minato I, Tatoni D, Cantarella S, Ravanetti F, Ragionieri L, Ciccimarra R, Zoboli M, Vilanova M, Sánchez-Jiménez E, Gay M, Vilaseca M, Villetti G, Pioselli B, Salomone F, Ottonello S, Montanini B, Ricci F. Time-resolved transcriptomic profiling of the developing rabbit's lungs: impact of premature birth and implications for modelling bronchopulmonary dysplasia. Respir Res 2023; 24:80. [PMID: 36922832 PMCID: PMC10015812 DOI: 10.1186/s12931-023-02380-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 03/03/2023] [Indexed: 03/17/2023] Open
Abstract
BACKGROUND Premature birth, perinatal inflammation, and life-saving therapies such as postnatal oxygen and mechanical ventilation are strongly associated with the development of bronchopulmonary dysplasia (BPD); these risk factors, alone or combined, cause lung inflammation and alter programmed molecular patterns of normal lung development. The current knowledge on the molecular regulation of lung development mainly derives from mechanistic studies conducted in newborn rodents exposed to postnatal hyperoxia, which have been proven useful but have some limitations. METHODS Here, we used the rabbit model of BPD as a cost-effective alternative model that mirrors human lung development and, in addition, enables investigating the impact of premature birth per se on the pathophysiology of BPD without further perinatal insults (e.g., hyperoxia, LPS-induced inflammation). First, we characterized the rabbit's normal lung development along the distinct stages (i.e., pseudoglandular, canalicular, saccular, and alveolar phases) using histological, transcriptomic and proteomic analyses. Then, the impact of premature birth was investigated, comparing the sequential transcriptomic profiles of preterm rabbits obtained at different time intervals during their first week of postnatal life with those from age-matched term pups. RESULTS Histological findings showed stage-specific morphological features of the developing rabbit's lung and validated the selected time intervals for the transcriptomic profiling. Cell cycle and embryo development, oxidative phosphorylation, and WNT signaling, among others, showed high gene expression in the pseudoglandular phase. Autophagy, epithelial morphogenesis, response to transforming growth factor β, angiogenesis, epithelium/endothelial cells development, and epithelium/endothelial cells migration pathways appeared upregulated from the 28th day of gestation (early saccular phase), which represents the starting point of the premature rabbit model. Premature birth caused a significant dysregulation of the inflammatory response. TNF-responsive, NF-κB regulated genes were significantly upregulated at premature delivery and triggered downstream inflammatory pathways such as leukocyte activation and cytokine signaling, which persisted upregulated during the first week of life. Preterm birth also dysregulated relevant pathways for normal lung development, such as blood vessel morphogenesis and epithelial-mesenchymal transition. CONCLUSION These findings establish the 28-day gestation premature rabbit as a suitable model for mechanistic and pharmacological studies in the context of BPD.
Collapse
Affiliation(s)
- Matteo Storti
- Department of Experimental Pharmacology and Translational Science, R&D, Chiesi Farmaceutici S.P.A., 43122, Parma, Italy
| | - Maria Laura Faietti
- Department of Analytic and Early Formulations, Chiesi Farmaceutici S.P.A., R&D, 43122, Parma, Italy
| | | | - Chiara Catozzi
- Department of Experimental Pharmacology and Translational Science, R&D, Chiesi Farmaceutici S.P.A., 43122, Parma, Italy
| | - Ilaria Minato
- Laboratory of Biochemistry and Molecular Biology, Department of Chemistry, Life Sciences and Environmental Sustainability, University of Parma, 43124, Parma, Italy.,Interdepartmental Research Centre Biopharmanet-Tec, University of Parma, 43124, Parma, Italy
| | - Danilo Tatoni
- Laboratory of Biochemistry and Molecular Biology, Department of Chemistry, Life Sciences and Environmental Sustainability, University of Parma, 43124, Parma, Italy.,Department of Medical Biotechnologies, University of Siena, 53100, Siena, Italy
| | - Simona Cantarella
- Laboratory of Biochemistry and Molecular Biology, Department of Chemistry, Life Sciences and Environmental Sustainability, University of Parma, 43124, Parma, Italy.,Division of RNA Biology and Cancer, German Cancer Research Center (DKFZ), 69120, Heidelberg, Germany
| | | | - Luisa Ragionieri
- Department of Veterinary Sciences, University of Parma, 43124, Parma, Italy
| | - Roberta Ciccimarra
- Department of Veterinary Sciences, University of Parma, 43124, Parma, Italy
| | - Matteo Zoboli
- Department of Veterinary Sciences, University of Parma, 43124, Parma, Italy
| | - Mar Vilanova
- Institute for Research in Biomedicine (IRB Barcelona), The Barcelona Institute of Science and Technology, Baldiri Reixac, 10, 08028, Barcelona, Spain
| | - Ester Sánchez-Jiménez
- Institute for Research in Biomedicine (IRB Barcelona), The Barcelona Institute of Science and Technology, Baldiri Reixac, 10, 08028, Barcelona, Spain
| | - Marina Gay
- Institute for Research in Biomedicine (IRB Barcelona), The Barcelona Institute of Science and Technology, Baldiri Reixac, 10, 08028, Barcelona, Spain
| | - Marta Vilaseca
- Institute for Research in Biomedicine (IRB Barcelona), The Barcelona Institute of Science and Technology, Baldiri Reixac, 10, 08028, Barcelona, Spain
| | - Gino Villetti
- Department of Experimental Pharmacology and Translational Science, R&D, Chiesi Farmaceutici S.P.A., 43122, Parma, Italy
| | - Barbara Pioselli
- Department of Analytic and Early Formulations, Chiesi Farmaceutici S.P.A., R&D, 43122, Parma, Italy
| | - Fabrizio Salomone
- Department of Experimental Pharmacology and Translational Science, R&D, Chiesi Farmaceutici S.P.A., 43122, Parma, Italy
| | - Simone Ottonello
- Laboratory of Biochemistry and Molecular Biology, Department of Chemistry, Life Sciences and Environmental Sustainability, University of Parma, 43124, Parma, Italy.,Interdepartmental Research Centre Biopharmanet-Tec, University of Parma, 43124, Parma, Italy
| | - Barbara Montanini
- Laboratory of Biochemistry and Molecular Biology, Department of Chemistry, Life Sciences and Environmental Sustainability, University of Parma, 43124, Parma, Italy. .,Interdepartmental Research Centre Biopharmanet-Tec, University of Parma, 43124, Parma, Italy.
| | - Francesca Ricci
- Department of Experimental Pharmacology and Translational Science, R&D, Chiesi Farmaceutici S.P.A., 43122, Parma, Italy. .,Head of Neonatology and Pulmonary Rare Disease, Preclinical Pharmacology, Chiesi Farmaceutici S.P.A., 43122, Parma, Italy.
| |
Collapse
|
5
|
Xu Y, Guo X, Chen M, Ricci F, Salomone F, Murgia X, Sun B. Efficacy of synthetic surfactant (CHF5633) bolus and/or lavage in meconium-induced lung injury in ventilated newborn rabbits. Pediatr Res 2023; 93:541-550. [PMID: 35701606 DOI: 10.1038/s41390-022-02152-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 05/18/2022] [Accepted: 05/26/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND The pathogenesis of neonatal meconium aspiration syndrome (MAS) involves meconium-induced lung inflammation and surfactant inactivation. Bronchoalveolar lavage (BAL) with diluted surfactant facilitates the removal of meconium. CHF5633, one of the most promising synthetic surfactants, is effective in neonatal respiratory distress syndrome. Here we investigated its efficacy via BAL in an experimental MAS model. METHODS Experimental MAS was induced at birth in near-term newborn rabbits by intratracheal instillation of reconstituted human meconium. First, undiluted CHF5633 was compared with a porcine-derived surfactant (Poractant alfa) via intratracheal bolus (200 mg/kg). Second, the efficacy of BAL with diluted CHF5633 (5 mg/mL, 20 ml/kg) alone, or followed by undiluted boluses (100 or 300 mg/kg), was investigated. RESULTS Meconium instillation caused severe lung injury, reduced endogenous surfactant pool, and poor survival. CHF5633 had similar benefits in improving survival and alleviating lung injury as Poractant alfa. CHF5633 BAL plus higher boluses exerted better effects than BAL or bolus alone in lung injury alleviation by reversing phospholipid pools and mitigating proinflammatory cytokine mRNA expression, without fluid retention and function deterioration. CONCLUSIONS CHF5633 improved survival and alleviated meconium-induced lung injury, the same as Poractant alfa. CHF5633 BAL plus boluses was the optimal modality, which warrants further clinical investigation. IMPACT To explore the efficacy of a synthetic surfactant, CHF5633, in neonatal lung protection comparing with Poractant alfa in a near-term newborn rabbit model with meconium-induced lung injury. Similar effects on improving survival and alleviating lung injury were found between CHF5633 and Poractant alfa. Optimal therapeutic effects were identified from the diluted CHF5633 bronchoalveolar lavage followed by its undiluted bolus instillation compared to the lavage or bolus alone regimens. Animals with CHF5633 lavage plus bolus regimen exerted neither substantial lung fluid retention nor lung mechanics deterioration but a trend of higher pulmonary surfactant-associated phospholipid pools.
Collapse
Affiliation(s)
- Yaling Xu
- The Laboratory of Neonatal Diseases of National Commission of Health; National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China
| | - Xiaojing Guo
- The Laboratory of Neonatal Diseases of National Commission of Health; National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China
| | - Meimei Chen
- The Laboratory of Neonatal Diseases of National Commission of Health; National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China
| | - Francesca Ricci
- Neonatology and Pulmonary Rare Disease Unit, Pharmacology & Toxicology Department, Corporate Preclinical R&D, CHIESI, Parma, Italy
| | - Fabrizio Salomone
- Neonatology and Pulmonary Rare Disease Unit, Pharmacology & Toxicology Department, Corporate Preclinical R&D, CHIESI, Parma, Italy
| | | | - Bo Sun
- The Laboratory of Neonatal Diseases of National Commission of Health; National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China.
| |
Collapse
|
6
|
Mielgo V, Gastiasoro E, Salomone F, Ricci F, Gomez-Solaetxe MA, Olazar L, Loureiro B, Rey-Santano C. Structural and haemodynamic evaluation of less invasive surfactant administration during nasal intermittent positive pressure ventilation in surfactant-deficient newborn piglets. PLoS One 2023; 18:e0284750. [PMID: 37115799 PMCID: PMC10146512 DOI: 10.1371/journal.pone.0284750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 04/07/2023] [Indexed: 04/29/2023] Open
Abstract
The most recent approaches to the initial treatment of respiratory distress syndrome (RDS)- involve non-invasive ventilation (NIV) and less-invasive surfactant (SF) administration (LISA). Combining these techniques has been proven a useful treatment option for SF-deficient neonates. The objective of this study was to explore the impact on the brain (using cerebral near infrared spectroscopy, NIRS) of different LISA methods during NIV, using nasal intermittent positive pressure ventilation (NIPPV) for treating neonatal RDS. For this, we used five groups of spontaneously breathing newborn piglets (n = 6/group) with bronchoalveolar lavage (BAL)-induced respiratory distress which received NIPPV only (controls), poractant-alfa using the INSURE-like method (bolus delivery) followed by NIPPV, or poractant-alfa using one of three LISA devices, 1) a nasogastric tube (NT), 2) a vascular catheter (VC) or 3) the LISAcath® catheter. We assessed pulmonary, hemodynamic and cerebral effects, and performed histological analysis of lung and brain tissue. Following BALs, the piglets developed severe RDS (pH<7.2, PaCO2>70 mmHg, PaO2<70 mmHg, dynamic compliance<0.5 ml/cmH2O/kg at FiO2 = 1). Poractant-alfa administration using different LISA techniques during NIPPV was well tolerated and efficacious in newborn piglets. In our study, although all groups showed normal physiological ranges of total lung injury score and biochemical lung analysis, VC and LISAcath® catheters were associated with better values of lung compliance and lower values of lung damage than NIPPV, NT or INSURE-like methods. Moreover, neither of the SF administration methods used (LISA or INSURE-like) had a significant impact on the histological neonatal brain injury score. Of note, the LISAcath® has been recently withdrawn from the market.
Collapse
Affiliation(s)
- Victoria Mielgo
- Animal Research Unit, Biocruces-Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain
| | - Elena Gastiasoro
- Primary Health Care, Biocruces-Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain
| | | | | | | | - Lara Olazar
- Primary Health Care, Biocruces-Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain
| | - Begoña Loureiro
- Animal Research Unit, Biocruces-Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain
| | - Carmen Rey-Santano
- Animal Research Unit, Biocruces-Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain
| |
Collapse
|
7
|
Simonato M, Ricci F, Catozzi C, Storti M, Correani A, Salomone F, Cogo P, Carnielli VP. A novel deuterium-based model for measurement of exogenous surfactant using deuterium-depleted water. Pediatr Pulmonol 2022; 57:2808-2814. [PMID: 35938216 DOI: 10.1002/ppul.26104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 07/29/2022] [Accepted: 08/03/2022] [Indexed: 11/11/2022]
Abstract
Stable isotope tracers, like 13 C, can be used for the measurement of the partition between the endogenous and exogenous pulmonary disaturated-phosphatidylcholine (DSPC). Deuterium labeling methods are still not fully explored. Our aim was to investigate the feasibility of using deuterium-depleted water (DDW) and deuterium-enriched water (DEW) to measure endogenous and exogenous pulmonary DSPC in a rabbit model of surfactant depletion. Data obtained from the 13 C dilution method were used as a reference. We studied 9 adult rabbits: 4 drank DDW and 5 DEW for 5 days. Lung surfactant depletion was induced at Day 5 by repeated saline bronchoalveolar lavages (BAL), which were stored as a pool (BAL pool). After endogenous surfactant depletion, rabbits received exogenous surfactant followed by a second BAL depletion procedure (End-Experiment Pool). DSPC quantity, and palmitic acid (PA)-DSPC 2 H/1 H (δ2 H) and 13 C/12 C ratios (δ13 C) of exogenous surfactant batches and of BAL pools were measured by High-Resolution Mass Spectrometry. The amount of exogenous surfactant recovered from the lungs ranged from 45% to 81% and, it was highly correlated with those obtained with the use of the 13 C (r = 0.9844, p < 0.0001). We demonstrated that commercially available purified DDW and even low doses of DEW can be used to modify the deuterium background of endogenous surfactants with the purpose of measuring the contribution of exogenous surfactants to the endogenous alveolar surfactant pool.
Collapse
Affiliation(s)
- Manuela Simonato
- PCare laboratory, Department of Women's and Children's Health, University of Padova, Padova, Italy.,Fondazione Istituto di Ricerca Pediatrica, "Citta' della Speranza", Padova, Italy
| | - Francesca Ricci
- Pharmacology & Toxicology Department, Neonatology and Pulmonary Rare Disease Unit, Corporate Preclinical R&D, Parma, Chiesi, Italy
| | - Chiara Catozzi
- Pharmacology & Toxicology Department, Neonatology and Pulmonary Rare Disease Unit, Corporate Preclinical R&D, Parma, Chiesi, Italy
| | - Matteo Storti
- Department of Chemical & Life Sciences and Environmental Sustainability, University of Parma, Parma, Italy
| | - Alessio Correani
- Division of Neonatology, Polytechnic University of Marche and "G. Salesi" Children's Hospital, Ancona, Italy
| | - Fabrizio Salomone
- Pharmacology & Toxicology Department, Neonatology and Pulmonary Rare Disease Unit, Corporate Preclinical R&D, Parma, Chiesi, Italy
| | - Paola Cogo
- Department of Medicine, University Hospital S Maria della Misericordia, University of Udine, Udine, Italy
| | - Virgilio P Carnielli
- Division of Neonatology, Polytechnic University of Marche and "G. Salesi" Children's Hospital, Ancona, Italy
| |
Collapse
|
8
|
Nord A, Bianco F, Salomone F, Ricci F, Schlun M, Linner R, Cunha-Goncalves D. Nebulization of High-Dose Poractant Alfa in Newborn Piglets on Nasal Continuous Positive Airway Pressure Yields Therapeutic Lung Doses of Phospholipids. Am J Perinatol 2022; 39:1001-1007. [PMID: 33242911 DOI: 10.1055/s-0040-1721392] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE It is not known how much surfactant must be nebulized to reach a lung dose of phospholipids equivalent to that obtained by the instillation of 200 mg/kg of surfactant. We aimed to assess the feasibility of nebulizing a high-dose of poractant alfa with the eFlow-Neos investigational vibrating-membrane nebulizer in newborn piglets on nasal continuous positive airway pressure (nCPAP) and to determine whether this intervention would yield therapeutic lung doses of phospholipids. STUDY DESIGN Twelve 1-day-old piglets on nCPAP received 600 mg/kg of poractant alfa admixed with technetium-99m via nebulization. Six piglets receiving 200 mg/kg of instilled synthetic surfactant served as controls. Lung deposition (percentage of the nominal dose) was determined by gamma scintigraphy, and the phospholipids' lung dose was calculated. RESULTS The lung dose of phospholipids (mean ± standard deviation [SD]) was 138 ± 96 mg/kg with nebulization, and 172 ± 24 mg/kg with instillation (p = 0.42). Nebulization took 58 ± 12 minutes. The arterial partial pressure of carbon dioxide increased from 6.7 ± 1.1 to 7.2 ± 1.1 kPa during nebulization (p = 0.04). Cerebral oximetry remained stable, and there was no hemodynamic instability. CONCLUSION Nebulization was well tolerated, and the mean lung dose of phospholipids was above 100 mg/kg, that is, not different from the instillation group. These experimental findings suggest that it may be feasible to reach therapeutic lung doses of phospholipids by surfactant nebulization during nCPAP. KEY POINTS · It is not known if effective lung doses of surfactant can be delivered by nebulization.. · Nebulization of high-dose surfactant in newborn piglets on nCPAP was well tolerated.. · A high-dose of nebulized poractant alfa yielded therapeutic lung doses of phospholipids..
Collapse
Affiliation(s)
- Anders Nord
- Pediatric Anesthesia and Intensive Care, Skåne University Hospital, Lund, Sweden.,Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Federico Bianco
- Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici S.p.A., Parma, Italy
| | - Fabrizio Salomone
- Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici S.p.A., Parma, Italy
| | - Francesca Ricci
- Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici S.p.A., Parma, Italy
| | | | - Rikard Linner
- Cardiothoracic Anesthesia and Intensive Care, Skåne University Hospital, Lund, Sweden.,Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Doris Cunha-Goncalves
- Pediatric Anesthesia and Intensive Care, Skåne University Hospital, Lund, Sweden.,Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| |
Collapse
|
9
|
Ricci F, Mersanne A, Storti M, Nutini M, Pellicelli G, Carini A, Milesi I, Lombardini M, Dellacà RL, Thomson MA, Murgia X, Lavizzari A, Bianco F, Salomone F. Preclinical Assessment of Nebulized Surfactant Delivered through Neonatal High Flow Nasal Cannula Respiratory Support. Pharmaceutics 2022; 14:pharmaceutics14051093. [PMID: 35631679 PMCID: PMC9146271 DOI: 10.3390/pharmaceutics14051093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/16/2022] [Accepted: 05/18/2022] [Indexed: 11/16/2022] Open
Abstract
High-flow nasal cannula (HFNC) is a non-invasive respiratory support (NRS) modality to treat premature infants with respiratory distress syndrome (RDS). The delivery of nebulized surfactant during NRS would represent a truly non-invasive method of surfactant administration and could reduce NRS failure rates. However, the delivery efficiency of nebulized surfactant during HFNC has not been evaluated in vitro or in animal models of respiratory distress. We, therefore, performed first a benchmark study to compare the surfactant lung dose delivered by commercially available neonatal nasal cannulas (NCs) and HFNC circuits commonly used in neonatal intensive care units. Then, the pulmonary effect of nebulized surfactant delivered via HFNC was investigated in spontaneously breathing rabbits with induced respiratory distress. The benchmark study revealed the surfactant lung dose to be relatively low for both types of NCs tested (Westmed NCs 0.5 ± 0.45%; Fisher & Paykel NCs 1.8 ± 1.9% of a nominal dose of 200 mg/kg of Poractant alfa). The modest lung doses achieved in the benchmark study are compatible with the lack of the effect of nebulized surfactant in vivo (400 mg/kg), where arterial oxygenation and lung mechanics did not improve and were significantly worse than the intratracheal instillation of surfactant. The results from the present study indicate a relatively low lung surfactant dose and negligible effect on pulmonary function in terms of arterial oxygenation and lung mechanics. This negligible effect can, for the greater part, be explained by the high impaction of aerosol particles in the ventilation circuit and upper airways due to the high air flows used during HFNC.
Collapse
Affiliation(s)
- Francesca Ricci
- Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici S.p.A., 15739 Parma, Italy; (F.R.); (A.M.); (M.S.); (M.N.); (G.P.); (A.C.); (I.M.); (M.L.); (F.B.)
| | - Arianna Mersanne
- Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici S.p.A., 15739 Parma, Italy; (F.R.); (A.M.); (M.S.); (M.N.); (G.P.); (A.C.); (I.M.); (M.L.); (F.B.)
| | - Matteo Storti
- Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici S.p.A., 15739 Parma, Italy; (F.R.); (A.M.); (M.S.); (M.N.); (G.P.); (A.C.); (I.M.); (M.L.); (F.B.)
| | - Marcello Nutini
- Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici S.p.A., 15739 Parma, Italy; (F.R.); (A.M.); (M.S.); (M.N.); (G.P.); (A.C.); (I.M.); (M.L.); (F.B.)
| | - Giulia Pellicelli
- Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici S.p.A., 15739 Parma, Italy; (F.R.); (A.M.); (M.S.); (M.N.); (G.P.); (A.C.); (I.M.); (M.L.); (F.B.)
| | - Angelo Carini
- Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici S.p.A., 15739 Parma, Italy; (F.R.); (A.M.); (M.S.); (M.N.); (G.P.); (A.C.); (I.M.); (M.L.); (F.B.)
| | - Ilaria Milesi
- Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici S.p.A., 15739 Parma, Italy; (F.R.); (A.M.); (M.S.); (M.N.); (G.P.); (A.C.); (I.M.); (M.L.); (F.B.)
| | - Marta Lombardini
- Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici S.p.A., 15739 Parma, Italy; (F.R.); (A.M.); (M.S.); (M.N.); (G.P.); (A.C.); (I.M.); (M.L.); (F.B.)
| | - Raffaele L. Dellacà
- TechRes Lab, Dipartimento di Elettronica, Informazione e Bioingegneria (DEIB), Politecnico di Milano University, 20133 Milan, Italy;
| | | | | | - Anna Lavizzari
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
| | - Federico Bianco
- Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici S.p.A., 15739 Parma, Italy; (F.R.); (A.M.); (M.S.); (M.N.); (G.P.); (A.C.); (I.M.); (M.L.); (F.B.)
| | - Fabrizio Salomone
- Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici S.p.A., 15739 Parma, Italy; (F.R.); (A.M.); (M.S.); (M.N.); (G.P.); (A.C.); (I.M.); (M.L.); (F.B.)
- Correspondence:
| |
Collapse
|
10
|
Campion S, Inselman A, Hayes B, Casiraghi C, Joseph D, Facchinetti F, Salomone F, Schmitt G, Hui J, Davis-Bruno K, Van Malderen K, Morford L, De Schaepdrijver L, Wiesner L, Kourula S, Seo S, Laffan S, Urmaliya V, Chen C. The benefits, limitations and opportunities of preclinical models for neonatal drug development. Dis Model Mech 2022; 15:275112. [PMID: 35466995 PMCID: PMC9066504 DOI: 10.1242/dmm.049065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Increased research to improve preclinical models to inform the development of therapeutics for neonatal diseases is an area of great need. This article reviews five common neonatal diseases – bronchopulmonary dysplasia, retinopathy of prematurity, necrotizing enterocolitis, perinatal hypoxic–ischemic encephalopathy and neonatal sepsis – and the available in vivo, in vitro and in silico preclinical models for studying these diseases. Better understanding of the strengths and weaknesses of specialized neonatal disease models will help to improve their utility, may add to the understanding of the mode of action and efficacy of a therapeutic, and/or may improve the understanding of the disease pathology to aid in identification of new therapeutic targets. Although the diseases covered in this article are diverse and require specific approaches, several high-level, overarching key lessons can be learned by evaluating the strengths, weaknesses and gaps in the available models. This Review is intended to help guide current and future researchers toward successful development of therapeutics in these areas of high unmet medical need. Summary: This article reviews and analyzes the available preclinical models for five common neonatal diseases to direct therapeutic development in these areas of high unmet medical need.
Collapse
Affiliation(s)
- Sarah Campion
- Pfizer Worldwide Research, Development, and Medical, Groton, CT 06340, USA
| | - Amy Inselman
- U.S. Food and Drug Administration, National Center for Toxicological Research, Division of Systems Biology, Jefferson, AR 72079, USA
| | - Belinda Hayes
- U.S. Food and Drug Administration, Center for Drug Evaluation and Research, Office of New Drugs, Silver Spring, MD 20993, USA
| | - Costanza Casiraghi
- Department of Experimental Pharmacology and Translational Science, Chiesi Farmaceutici S.p.A., 43122 Parma, Italy
| | - David Joseph
- U.S. Food and Drug Administration, Center for Drug Evaluation and Research, Office of New Drugs, Silver Spring, MD 20993, USA
| | - Fabrizio Facchinetti
- Department of Experimental Pharmacology and Translational Science, Chiesi Farmaceutici S.p.A., 43122 Parma, Italy
| | - Fabrizio Salomone
- Department of Experimental Pharmacology and Translational Science, Chiesi Farmaceutici S.p.A., 43122 Parma, Italy
| | - Georg Schmitt
- Pharma Research and Early Development, Roche Innovation Center Basel, Pharmaceutical Sciences, F. Hoffmann-La Roche, 4070 Basel, Switzerland
| | - Julia Hui
- Bristol Myers Squibb, Nonclinical Research and Development, Summit, NJ 07901, USA
| | - Karen Davis-Bruno
- U.S. Food and Drug Administration, Center for Drug Evaluation and Research, Office of New Drugs, Silver Spring, MD 20993, USA
| | - Karen Van Malderen
- Federal Agency for Medicines and Health Products (FAMHP), Department DG PRE authorization, 1210 Brussels, Belgium
| | - LaRonda Morford
- Eli Lilly, Global Regulatory Affairs, Indianapolis, IN 46285, USA
| | | | - Lutz Wiesner
- Federal Institute for Drugs and Medical Devices, Clinical Trials, 53175 Bonn, Germany
| | - Stephanie Kourula
- Janssen R&D, Drug Metabolism & Pharmacokinetics, 2340 Beerse, Belgium
| | - Suna Seo
- U.S. Food and Drug Administration, Center for Drug Evaluation and Research, Office of New Drugs, Silver Spring, MD 20993, USA
| | - Susan Laffan
- GlaxoSmithKline, Non-Clinical Safety, Collegeville, PA 19406, USA
| | | | - Connie Chen
- Health and Environmental Sciences Institute, Washington, DC 20005, USA
| |
Collapse
|
11
|
Simonato M, Ricci F, Catozzi C, Storti M, Giambelluca S, Correani A, Salomone F, Cogo P, Carnielli V. Deuterium-depleted water: A new tracer to label pulmonary surfactant lipids in adult rabbits. J Mass Spectrom 2022; 57:e4808. [PMID: 35060656 PMCID: PMC9285457 DOI: 10.1002/jms.4808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 12/20/2021] [Indexed: 06/14/2023]
Abstract
Stable isotope tracing can be safely used for metabolic studies in animals and humans. The endogenous biosynthesis of lipids (lipogenesis) is a key process throughout the entire life but especially during brain and lung growth. Adequate synthesis of pulmonary surfactant lipids is indispensable for life. With this study, we report the use of deuterium-depleted water (DDW), suitable for human consumption, as metabolic precursor for lipogenesis. We studied 13 adult rabbits for 5 days. Four rabbits drank tap water (TW) and served as controls; in four animals, DDW was substituted to drinking water, whereas five drank deuterium-enriched water (DEW). After 5 days, a blood sample and a bronchoalveolar lavage (BAL) sample were collected. The 2 H/1 H (δ2 H) of BAL palmitic acid (PA) desaturated phosphatidylcholine (DSPC), the major phospholipid of pulmonary surfactant, and of plasma water was determined by high-resolution mass spectrometry. We found that the δ2 H values of DDW, DEW and TW were -984 ± 2‰, +757 ± 2‰ and -58 ± 1‰, respectively. After 5 days, plasma water values were -467 ± 87‰, +377 ± 56‰ and -53 ± 6‰, and BAL DSPC-PA was -401 ± 27‰, -96 ± 38‰ and -249 ± 9‰ in the DDW, DEW and TW, respectively. With this preliminary study, we demonstrated the feasibility of using DDW to label pulmonary surfactant lipids. This novel approach can be used in animals and in humans, and we speculate that it could be associated with more favourable study compliance than DEW in human studies.
Collapse
Affiliation(s)
- Manuela Simonato
- PCare LaboratoryFondazione Istituto di Ricerca Pediatrica, ‘Città della Speranza’PaduaItaly
- Department of Women's and Children's HealthUniversity of PaduaPaduaItaly
| | - Francesca Ricci
- Neonatology and Pulmonary Rare Disease Unit, Pharmacology & Toxicology Department Corporate Preclinical R&DChiesiParmaItaly
| | - Chiara Catozzi
- Neonatology and Pulmonary Rare Disease Unit, Pharmacology & Toxicology Department Corporate Preclinical R&DChiesiParmaItaly
| | - Matteo Storti
- Department of Chemical & Life Sciences and Environmental SustainabilityUniversity of ParmaParmaItaly
| | - Sonia Giambelluca
- PCare LaboratoryFondazione Istituto di Ricerca Pediatrica, ‘Città della Speranza’PaduaItaly
- Department of Women's and Children's HealthUniversity of PaduaPaduaItaly
| | - Alessio Correani
- Division of NeonatologyPolytechnic University of Marche and ‘G. Salesi’ Children's HospitalAnconaItaly
| | - Fabrizio Salomone
- Neonatology and Pulmonary Rare Disease Unit, Pharmacology & Toxicology Department Corporate Preclinical R&DChiesiParmaItaly
| | - Paola Cogo
- Department of Medicine, University Hospital Santa Maria della MisericordiaUniversity of UdineUdineItaly
| | - Virgilio Carnielli
- Division of NeonatologyPolytechnic University of Marche and ‘G. Salesi’ Children's HospitalAnconaItaly
| |
Collapse
|
12
|
Ferrini E, Leo L, Corsi L, Catozzi C, Salomone F, Ragionieri L, Pennati F, Stellari FF. A new anesthesia protocol enabling longitudinal lung function measurements in neonatal rabbits by micro-CT. Am J Physiol Lung Cell Mol Physiol 2021; 321:L1206-L1214. [PMID: 34786984 DOI: 10.1152/ajplung.00328.2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Micro-CT imaging is an emerging technology with many applications in small animals, e.g. the study of pulmonary diseases, although clear guidelines and critical mass of evidence are still missing in the preclinical literature. The neonatal rabbit is a valuable model for studying pulmonary development. However, the longitudinal monitoring of lung function by micro-CT can be challenging. Distinctive datasets corresponding to the end-inspiration and end-expiration phases need to be generated and analyzed to derive lung functional parameters. The quality of CT scans and the reliability of parameters obtained remains highly dependent on the anesthesia protocol used. Three different anesthetic protocols were tested. The combination of dexmedetomidine 0.25 mg/kg injected intraperitoneally followed by 1% isoflurane was found to facilitate CT imaging at 4 and 11 days after birth. Contrarily, isoflurane and ketamine plus xylazine were found unsuitable, and thus not investigated further. Total lung volumes significantly increased at day 11 compared to baseline in both respiratory phases, while lung tissue remained constant. As expected, functional residual capacity, air/tissue ratio and minute ventilation were significantly increased at day 11 in each animal. Those parameters were correlated with inspiratory capacity, compliance, elastance and resistance of both respiratory system and tissue component, as measured by flexiVent. Lung development was also evaluated by histomorphometric analyses. In conclusion, we have identified a safe and suitable anesthesia protocol for micro-CT imaging in neonatal rabbits. Moreover, the possibility to longitudinally measure lung function in the same subject dramatically reduced the intra-experimental variability.
Collapse
Affiliation(s)
- Erica Ferrini
- Department of Veterinary Science, University of Parma, Parma, Italy
| | - Ludovica Leo
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Luisa Corsi
- Chiesi Farmaceutici S.p.A., Corporate Pre-Clinical R&D, Parma, Italy
| | - Chiara Catozzi
- Chiesi Farmaceutici S.p.A., Corporate Pre-Clinical R&D, Parma, Italy
| | - Fabrizio Salomone
- Chiesi Farmaceutici S.p.A., Corporate Pre-Clinical R&D, Parma, Italy
| | - Luisa Ragionieri
- Department of Veterinary Science, University of Parma, Parma, Italy
| | - Francesca Pennati
- Department of Electronics, Information, and Bioengineering, Politecnico di Milano, Milan, Italy
| | | |
Collapse
|
13
|
Mühlfeld C, Schulte H, Jansing JC, Casiraghi C, Ricci F, Catozzi C, Ochs M, Salomone F, Brandenberger C. Design-Based Stereology of the Lung in the Hyperoxic Preterm Rabbit Model of Bronchopulmonary Dysplasia. Oxid Med Cell Longev 2021; 2021:4293279. [PMID: 34659632 PMCID: PMC8514964 DOI: 10.1155/2021/4293279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 09/03/2021] [Indexed: 11/17/2022]
Abstract
Bronchopulmonary dysplasia (BPD) is a complex condition frequently occurring in preterm newborns, and different animal models are currently used to mimic the pathophysiology of BPD. The comparability of animal models depends on the availability of quantitative data obtained by minimally biased methods. Therefore, the aim of this study was to provide the first design-based stereological analysis of the lungs in the hyperoxia-based model of BPD in the preterm rabbit. Rabbit pups were obtained on gestation day 28 (three days before term) by cesarean section and exposed to normoxic (21% O2, n = 8) or hyperoxic (95% O2, n = 8) conditions. After seven days of exposure, lung function testing was performed, and lungs were taken for stereological analysis. In addition, the ratio between pulmonary arterial acceleration and ejection time (PAAT/PAET) was measured. Inspiratory capacity and static compliance were reduced whereas tissue elastance and resistance were increased in hyperoxic animals compared with normoxic controls. Hyperoxic animals showed signs of pulmonary hypertension indicated by the decreased PAAT/PAET ratio. In hyperoxic animals, the number of alveoli and the alveolar surface area were reduced by one-third or by approximately 50% of control values, respectively. However, neither the mean linear intercept length nor the mean alveolar volume was significantly different between both groups. Hyperoxic pups had thickened alveolar septa and intra-alveolar accumulation of edema fluid and inflammatory cells. Nonparenchymal blood vessels had thickened walls, enlarged perivascular space, and smaller lumen in hyperoxic rabbits in comparison with normoxic ones. In conclusion, the findings are in line with the pathological features of human BPD. The stereological data may serve as a reference to compare this model with BPD models in other species or future therapeutic interventions.
Collapse
Affiliation(s)
- Christian Mühlfeld
- Institute of Functional and Applied Anatomy, Hannover Medical School, 30625 Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Research (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - Henri Schulte
- Institute of Functional and Applied Anatomy, Hannover Medical School, 30625 Hannover, Germany
| | | | - Costanza Casiraghi
- Corporate R&D Preclinical Department, Chiesi Farmaceutici S.p.A, Via Palermo 26/a, 43122 Parma, Italy
| | - Francesca Ricci
- Corporate R&D Preclinical Department, Chiesi Farmaceutici S.p.A, Via Palermo 26/a, 43122 Parma, Italy
| | - Chiara Catozzi
- Corporate R&D Preclinical Department, Chiesi Farmaceutici S.p.A, Via Palermo 26/a, 43122 Parma, Italy
| | - Matthias Ochs
- Institute of Functional and Applied Anatomy, Hannover Medical School, 30625 Hannover, Germany
- Institute of Functional Anatomy, Charité-Universitätsmedizin Berlin, Philippstr. 11, 10115 Berlin, Germany
- German Center for Lung Research (DZL), Berlin, Germany
| | - Fabrizio Salomone
- Corporate R&D Preclinical Department, Chiesi Farmaceutici S.p.A, Via Palermo 26/a, 43122 Parma, Italy
| | - Christina Brandenberger
- Institute of Functional and Applied Anatomy, Hannover Medical School, 30625 Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Research (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
| |
Collapse
|
14
|
Pioselli B, Salomone F, Mazzola G, Amidani D, Sgarbi E, Amadei F, Murgia X, Catinella S, Villetti G, De Luca D, Carnielli V, Civelli M. Pulmonary surfactant: a unique biomaterial with life-saving therapeutic applications. Curr Med Chem 2021; 29:526-590. [PMID: 34525915 DOI: 10.2174/0929867328666210825110421] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 06/26/2021] [Accepted: 06/29/2021] [Indexed: 11/22/2022]
Abstract
Pulmonary surfactant is a complex lipoprotein mixture secreted into the alveolar lumen by type 2 pneumocytes, which is composed by tens of different lipids (approximately 90% of its entire mass) and surfactant proteins (approximately 10% of the mass). It is crucially involved in maintaining lung homeostasis by reducing the values of alveolar liquid surface tension close to zero at end-expiration, thereby avoiding the alveolar collapse, and assembling a chemical and physical barrier against inhaled pathogens. A deficient amount of surfactant or its functional inactivation is directly linked to a wide range of lung pathologies, including the neonatal respiratory distress syndrome. This paper reviews the main biophysical concepts of surfactant activity and its inactivation mechanisms, and describes the past, present and future roles of surfactant replacement therapy, focusing on the exogenous surfactant preparations marketed worldwide and new formulations under development. The closing section describes the pulmonary surfactant in the context of drug delivery. Thanks to its peculiar composition, biocompatibility, and alveolar spreading capability, the surfactant may work not only as a shuttle to the branched anatomy of the lung for other drugs but also as a modulator for their release, opening to innovative therapeutic avenues for the treatment of several respiratory diseases.
Collapse
Affiliation(s)
| | | | | | | | - Elisa Sgarbi
- Preclinical R&D, Chiesi Farmaceutici, Parma. Italy
| | | | - Xabi Murgia
- Department of Biotechnology, GAIKER Technology Centre, Zamudio. Spain
| | | | | | - Daniele De Luca
- Division of Pediatrics and Neonatal Critical Care, Antoine Béclère Medical Center, APHP, South Paris University Hospitals, Paris, France; Physiopathology and Therapeutic Innovation Unit-U999, South Paris-Saclay University, Paris. France
| | - Virgilio Carnielli
- Division of Neonatology, G Salesi Women and Children's Hospital, Polytechnical University of Marche, Ancona. Italy
| | | |
Collapse
|
15
|
Loi B, Casiraghi C, Catozzi C, Storti M, Lucattelli M, Bartalesi B, Yousef N, Salomone F, De Luca D. Lung ultrasound features and relationships with respiratory mechanics of evolving BPD in preterm rabbits and human neonates. J Appl Physiol (1985) 2021; 131:895-904. [PMID: 34292788 DOI: 10.1152/japplphysiol.00300.2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Evolving broncho-pulmonary dysplasia (BPD) is a regionally heterogeneous disorder characterized by impaired alveolarization leading to lung aeration inhomogeneities. Hyperoxia-exposed preterm rabbits have been proposed to mimic evolving BPD and we aim to verify if this model has the same lung ultrasound and mechanical features of evolving BPD in human neonates. Twenty-five preterm rabbits and twenty-five neonates with evolving BPD were enrolled and subjected to semi-quantitative lung ultrasound and lung mechanics measurement. A modified rabbit lung ultrasound score (rLUS), the previously validated neonatal lung ultrasound score (LUS) and classical mechanics measurements were obtained. Lung ultrasound images were also recorded and evaluated by two independent observers with different expertise blinded to each other's evaluation. Lung ultrasound findings were equally heterogeneous both in rabbits as in human neonates: images were very similar and encompassed all the classical lung ultrasound semiology. The inter-rater absolute agreement for the evaluation of lung ultrasound images in rabbits was very high (ICC: 0.989 (95%CI: 0.975-0.995); p<0.0001) and there was no difference between the two observers. Lung mechanics parameters were similarly altered both in rabbits and human neonates. There were significant correlations between airway resistances and lung ultrasound scores both in rabbits (r=0.519; p=0.008) and in neonates (r=0.409; p=0.042). No significant correlation between rLUS, LUS and any other mechanics parameter. Lung ultrasound was easy to be performed and accurate even in these small animals and with a short training. In conclusion, the preterm rabbit model fairly reproduces the lung ultrasound and mechanical characteristics of preterm neonates with evolving BPD.
Collapse
Affiliation(s)
- Barbara Loi
- Division of Pediatrics and Neonatal Critical Care, "A.Béclère" Medical Centre, Paris Saclay University Hospitals, APHP, Paris, France
| | - Costanza Casiraghi
- Neonatology and Pulmonary Rare Disease Unit. Pharmacology and Toxicology Dept. Corporate Preclinical R&D, Chiesi, Parma, Italy
| | - Chiara Catozzi
- Neonatology and Pulmonary Rare Disease Unit. Pharmacology and Toxicology Dept. Corporate Preclinical R&D, Chiesi, Parma, Italy
| | - Matteo Storti
- Department of Chemical and Life Sciences and Environmental Sustainability, University of Parma, Parma, Italy
| | - Monica Lucattelli
- Department of Molecular and Developmental Medicine, University of Siena, Italy
| | - Barbara Bartalesi
- Department of Molecular and Developmental Medicine, University of Siena, Italy
| | - Nadya Yousef
- Division of Pediatrics and Neonatal Critical Care, "A.Béclère" Medical Centre, Paris Saclay University Hospitals, APHP, Paris, France
| | - Fabrizio Salomone
- Neonatology and Pulmonary Rare Disease Unit. Pharmacology and Toxicology Dept. Corporate Preclinical R&D, Chiesi, Parma, Italy
| | - Daniele De Luca
- Division of Pediatrics and Neonatal Critical Care, "A.Béclère" Medical Centre, Paris Saclay University Hospitals, APHP, Paris, France.,Physiopathology and Therapeutic Innovation Unit-INSERM U999, Paris Saclay University, Paris, France
| |
Collapse
|
16
|
Rey-Santano C, Mielgo V, Gastiasoro E, Bianco F, Salomone F, Gomez-Solaetxe MA. Surfactant nebulization therapy during NIPPV ventilation in surfactant-deficient newborn piglets. Pediatr Pulmonol 2021; 56:2125-2135. [PMID: 33960742 PMCID: PMC8252521 DOI: 10.1002/ppul.25425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/07/2021] [Accepted: 04/09/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND In recent years, nasal intermittent positive pressure ventilation (NIPPV) has been growing in popularity as a form of noninvasive ventilation for respiratory support in the initial treatment of neonates with surfactant (SF) deficiency. The combination of this type of ventilation with noninvasive SF administration (by nebulization) is an attractive treatment option for respiratory distress syndrome (RDS)-associated pathophysiology of the neonatal lungs. In this study, we aimed to test the tolerability and efficacy of SF nebulization during NIPPV for the treatment of neonatal RDS. METHODS Spontaneously-breathing newborn piglets (n = 6/group) with bronchoalveolar lavage (BAL)-induced RDS were assigned to receive during NIPPV (180 min): poractant alfa (400 mg/kg) via an investigational customized vibrating-membrane nebulizer (eFlow-Neos) or poractant alfa (200 mg/kg) as a bolus using the Insure method or no surfactant (controls). MEASUREMENT AND RESULTS We assessed pulmonary, hemodynamic and cerebral effects and performed histological analysis of lung and brain tissue. After repeated BAL, newborn piglets developed severe RDS (FiO2 : 1, pH < 7.2, PaCO2 > 70 mmHg, PaO2 < 70 mmHg, Cdyn < 0.5 ml/cmH2 O/kg). In both SF-treated groups, we observed rapid improvement in pulmonary status and also similar hemodynamic, cerebral behavior, and lung and brain injury scores. CONCLUSION Our results in newborn piglets with severe BAL-induced RDS show the administration of nebulized poractant alfa using the eFlow-Neos nebulizer during NIPPV to be well tolerated and efficacious, suggesting that this noninvasive SF administration option should be explored further.
Collapse
Affiliation(s)
- Carmen Rey-Santano
- Animal Research Unit and Experimental Research Department, Biocruces-Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain
| | - Victoria Mielgo
- Animal Research Unit and Experimental Research Department, Biocruces-Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain
| | - Elena Gastiasoro
- Primary Health Care Department, Biocruces-Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain
| | | | | | | |
Collapse
|
17
|
Bianco F, Salomone F, Milesi I, Murgia X, Bonelli S, Pasini E, Dellacà R, Ventura ML, Pillow J. Aerosol drug delivery to spontaneously-breathing preterm neonates: lessons learned. Respir Res 2021; 22:71. [PMID: 33637075 PMCID: PMC7908012 DOI: 10.1186/s12931-020-01585-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 11/23/2020] [Indexed: 02/07/2023] Open
Abstract
Delivery of medications to preterm neonates receiving non-invasive ventilation (NIV) represents one of the most challenging scenarios for aerosol medicine. This challenge is highlighted by the undersized anatomy and the complex (patho)physiological characteristics of the lungs in such infants. Key physiological restraints include low lung volumes, low compliance, and irregular respiratory rates, which significantly reduce lung deposition. Such factors are inherent to premature birth and thus can be regarded to as the intrinsic factors that affect lung deposition. However, there are a number of extrinsic factors that also impact lung deposition: such factors include the choice of aerosol generator and its configuration within the ventilation circuit, the drug formulation, the aerosol particle size distribution, the choice of NIV type, and the patient interface between the delivery system and the patient. Together, these extrinsic factors provide an opportunity to optimize the lung deposition of therapeutic aerosols and, ultimately, the efficacy of the therapy. In this review, we first provide a comprehensive characterization of both the intrinsic and extrinsic factors affecting lung deposition in premature infants, followed by a revision of the clinical attempts to deliver therapeutic aerosols to premature neonates during NIV, which are almost exclusively related to the non-invasive delivery of surfactant aerosols. In this review, we provide clues to the interpretation of existing experimental and clinical data on neonatal aerosol delivery and we also describe a frame of measurable variables and available tools, including in vitro and in vivo models, that should be considered when developing a drug for inhalation in this important but under-served patient population.
Collapse
Affiliation(s)
- Federico Bianco
- Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici S.P.A., 43122, Parma, Italy.
| | - Fabrizio Salomone
- Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici S.P.A., 43122, Parma, Italy
| | - Ilaria Milesi
- Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici S.P.A., 43122, Parma, Italy
| | | | - Sauro Bonelli
- Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici S.P.A., 43122, Parma, Italy
| | - Elena Pasini
- Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici S.P.A., 43122, Parma, Italy
| | - Raffaele Dellacà
- TechRes Lab, Dipartimento Di Elettronica, Informazione E Bioingegneria (DEIB), Politecnico Di Milano University, Milano, Italy
| | | | - Jane Pillow
- School of Human Sciences, University of Western Australia, Perth, Australia
| |
Collapse
|
18
|
Ricci F, Bresesti I, LaVerde PAM, Salomone F, Casiraghi C, Mersanne A, Storti M, Catozzi C, Tigli L, Zecchi R, Franceschi P, Murgia X, Simonato M, Cogo P, Carnielli V, Lista G. Surfactant lung delivery with LISA and InSurE in adult rabbits with respiratory distress. Pediatr Res 2021; 90:576-583. [PMID: 33452472 PMCID: PMC7809896 DOI: 10.1038/s41390-020-01324-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 11/02/2020] [Accepted: 11/22/2020] [Indexed: 01/29/2023]
Abstract
BACKGROUND In preterm infants, InSurE (Intubation-Surfactant-Extubation) and LISA (less invasive surfactant administration) techniques allow for exogenous surfactant administration while reducing lung injury associated with mechanical ventilation. We compared the acute pulmonary response and lung deposition of surfactant by LISA and InSurE in surfactant-depleted adult rabbits. METHODS Twenty-six spontaneously breathing surfactant-depleted adult rabbits (6-7 weeks old) with moderate RDS and managed with nasal continuous positive airway pressure were randomized to 3 groups: (1) 200 mg/kg of surfactant by InSurE; (2) 200 mg/kg of surfactant by LISA; (3) no surfactant treatment (Control). Gas exchange and lung mechanics were monitored for 180 min. After that, surfactant lung deposition and distribution were evaluated monitoring disaturated-phosphatidylcholine (DSPC) and surfactant protein C (SP-C), respectively. RESULTS No signs of recovery were found in the untreated animals. After InSurE, oxygenation improved more rapidly compared to LISA. However, at 180' LISA and InSurE showed comparable outcomes in terms of gas exchange, ventilation parameters, and lung mechanics. Neither DSPC in the alveolar pool nor SP-C signal distributions in a frontal lung section were significantly different between InSurE and LISA groups. CONCLUSIONS In an acute setting, LISA demonstrated efficacy and surfactant lung delivery similar to that of InSurE in surfactant-depleted adult rabbits. IMPACT Although LISA technique is gaining popularity, there are still several questions to address. This is the first study comparing LISA and InSurE in terms of gas exchange, ventilation parameters, and lung mechanics as well as surfactant deposition and distribution. In our animal study, three hours post-treatment, LISA method seems to be as effective as InSurE and showed similar surfactant lung delivery. Our findings provide some clarifications on a fair comparison between LISA and InSurE techniques, particularly in terms of surfactant delivery. They should reassure some of the concerns raised by the clinical community on LISA adoption in neonatal units.
Collapse
Affiliation(s)
- Francesca Ricci
- grid.467287.80000 0004 1761 6733Neonatology and Pulmonary Rare Disease Unit, Pharmacology & Toxicology, Dept. Corporate Preclinical R&D, CHIESI, Parma, Italy
| | - Ilia Bresesti
- Neonatal Intensive Care Unit, “V. Buzzi” Children’s Hospital, ASST-FBF-Sacco, Milan, Italy
| | | | - Fabrizio Salomone
- grid.467287.80000 0004 1761 6733Neonatology and Pulmonary Rare Disease Unit, Pharmacology & Toxicology, Dept. Corporate Preclinical R&D, CHIESI, Parma, Italy
| | - Costanza Casiraghi
- grid.467287.80000 0004 1761 6733Neonatology and Pulmonary Rare Disease Unit, Pharmacology & Toxicology, Dept. Corporate Preclinical R&D, CHIESI, Parma, Italy
| | - Arianna Mersanne
- grid.467287.80000 0004 1761 6733Neonatology and Pulmonary Rare Disease Unit, Pharmacology & Toxicology, Dept. Corporate Preclinical R&D, CHIESI, Parma, Italy
| | - Matteo Storti
- grid.467287.80000 0004 1761 6733Neonatology and Pulmonary Rare Disease Unit, Pharmacology & Toxicology, Dept. Corporate Preclinical R&D, CHIESI, Parma, Italy
| | - Chiara Catozzi
- grid.467287.80000 0004 1761 6733Neonatology and Pulmonary Rare Disease Unit, Pharmacology & Toxicology, Dept. Corporate Preclinical R&D, CHIESI, Parma, Italy
| | - Laura Tigli
- grid.467287.80000 0004 1761 6733Neonatology and Pulmonary Rare Disease Unit, Pharmacology & Toxicology, Dept. Corporate Preclinical R&D, CHIESI, Parma, Italy
| | - Riccardo Zecchi
- grid.8404.80000 0004 1757 2304Mass Spectrometry Service Center (CISM), University of Florence, Florence, Italy
| | - Pietro Franceschi
- grid.424414.30000 0004 1755 6224Unit of Computational Biology, Research and Innovation Centre, Fondazione Edmund Mach, S. Michele all’Adige (TN), Italy
| | | | - Manuela Simonato
- grid.5608.b0000 0004 1757 3470Anesthesiology and Intensive Care Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy ,PCare Laboratory, Fondazione Istituto di Ricerca Pediatrica, “Citta’ della Speranza”, Padova, Italy
| | - Paola Cogo
- grid.5390.f0000 0001 2113 062XDivision of Pediatrics, Department of Medicine, Udine University, Udine, Italy
| | - Virgilio Carnielli
- grid.411490.90000 0004 1759 6306Division of Neonatology, Department of Clinical Sciences, Polytechnic University of Marche and Azienda-Ospedaliero Universitaria Ospedali Riuniti, Ancona, Italy
| | - Gianluca Lista
- Neonatal Intensive Care Unit, "V. Buzzi" Children's Hospital, ASST-FBF-Sacco, Milan, Italy.
| |
Collapse
|
19
|
Hillman NH, Abugisisa L, Royse E, Fee E, Kemp MW, Kramer BW, Schmidt AF, Salomone F, Clarke MW, Musk GC, Jobe AH. Dose of budesonide with surfactant affects lung and systemic inflammation after normal and injurious ventilation in preterm lambs. Pediatr Res 2020; 88:726-732. [PMID: 32066138 PMCID: PMC8717708 DOI: 10.1038/s41390-020-0809-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 01/30/2020] [Accepted: 02/07/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND The addition of budesonide (Bud) 0.25 mg/kg to surfactant decreased the lung and systemic responses to mechanical ventilation in preterm sheep and the rates and severity of bronchopulmonary dysplasia (BPD) in preterm infants. We hypothesized that lower budesonide concentrations in surfactant will decrease injury while decreasing systemic corticosteroid exposure. METHODS Preterm lambs received either (1) protective tidal volume (VT) ventilation with surfactant from birth or (2) injurious VT ventilation for 15 min and then surfactant treatment. Lambs were further assigned to surfactant mixed with (i) Saline, (ii) Bud 0.25 mg/kg, (iii) Bud 0.1 mg/kg, or (iv) Bud 0.04 mg/kg. All lambs were then ventilated with protective VT for 6 h. RESULTS Plasma Bud levels were proportional to the dose received and decreased throughout ventilation. In both protective and injurious VT ventilation, <4% of Bud remained in the lung at 6 h. Some of the improvements in physiology and markers of injury with Bud 0.25 mg/kg were also found with 0.1 mg/kg, whereas 0.04 mg/kg had only minimal effects. CONCLUSIONS Lower doses of Bud were less effective at decreasing lung and systemic inflammation from mechanical ventilation. The plasma Bud levels were proportional to dose given and the majority left the lung.
Collapse
Affiliation(s)
- Noah H Hillman
- Division of Neonatology, Cardinal Glennon Children's Hospital, Saint Louis University, Saint Louis, MO, 63104, USA.
| | - Leenah Abugisisa
- Division of Neonatology, Cardinal Glennon Children’s Hospital, Saint Louis University, Saint Louis, MO 63104
| | - Emily Royse
- Division of Neonatology, Cardinal Glennon Children’s Hospital, Saint Louis University, Saint Louis, MO 63104
| | - Erin Fee
- School of Women’s and Infants’ Health, University of Western Australia, Perth, WA, Australia 6009
| | - Matthew W Kemp
- School of Women’s and Infants’ Health, University of Western Australia, Perth, WA, Australia 6009
| | | | - Augusto F Schmidt
- Department of Pediatrics, Univ. Miami Miller School of Medicine, Miami, FL 33136
| | - Fabrizio Salomone
- Department of Preclinical Pharmacology R&D, Chiesi Farmaceutici S.p.A, Parma, Italy
| | - Michael W Clarke
- Metabolomics Australia, Centre for Microscopy, Characterisation and Analysis, The University of Western Australia, Perth, WA 6009, Australia
| | - Gabrielle C Musk
- School of Women’s and Infants’ Health, University of Western Australia, Perth, WA, Australia 6009,Animal Care Services, University of Western Australia, Perth, WA, Australia 6009
| | - Alan H Jobe
- Division of Pulmonary Biology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, OH 45229,School of Women’s and Infants’ Health, University of Western Australia, Perth, WA, Australia 6009
| |
Collapse
|
20
|
Autilio C, Echaide M, Shankar-Aguilera S, Bragado R, Amidani D, Salomone F, Pérez-Gil J, De Luca D. Surfactant Injury in the Early Phase of Severe Meconium Aspiration Syndrome. Am J Respir Cell Mol Biol 2020; 63:327-337. [PMID: 32348683 DOI: 10.1165/rcmb.2019-0413oc] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
No in vivo data are available regarding the effect of meconium on human surfactant in the early stages of severe meconium aspiration syndrome (MAS). In the present study, we sought to characterize the changes in surfactant composition, function, and structure during the early phase of meconium injury. We designed a translational prospective cohort study of nonbronchoscopic BAL of neonates with severe MAS (n = 14) or no lung disease (n = 18). Surfactant lipids were analyzed by liquid chromatography-high-resolution mass spectrometry. Secretory phospholipase A2 subtypes IB, V, and X and SP-A (surfactant protein A) were assayed by ELISA. SP-B and SP-C were analyzed by Western blotting under both nonreducing and reducing conditions. Surfactant function was assessed by adsorption test and captive bubble surfactometry, and lung aeration was evaluated by semiquantitative lung ultrasound. Surfactant nanostructure was studied using cryo-EM and atomic force microscopy. Several changes in phospholipid subclasses were detected during MAS. Lysophosphatidylcholine species released by phospholipase A2 hydrolysis were increased. SP-B and SP-C were significantly increased together with some shorter immature forms of SP-B. Surfactant function was impaired and correlated with poor lung aeration. Surfactant nanostructure was significantly damaged in terms of vesicle size, tridimensional complexity, and compactness. Various alterations of surfactant phospholipids and proteins were detected in the early phase of severe meconium aspiration and were due to hydrolysis and inflammation and a defensive response. This impairs both surfactant structure and function, finally resulting in reduced lung aeration. These findings support the development of new surfactant protection and antiinflammatory strategies for severe MAS.
Collapse
Affiliation(s)
- Chiara Autilio
- Department of Biochemistry and Molecular Biology and Research Institute "Hospital 12 de Octubre (imas12)", Complutense University, Madrid, Spain
| | - Mercedes Echaide
- Department of Biochemistry and Molecular Biology and Research Institute "Hospital 12 de Octubre (imas12)", Complutense University, Madrid, Spain
| | - Shivani Shankar-Aguilera
- Division of Pediatrics and Neonatal Critical Care, A. Béclère Medical Center, Paris Saclay University Hospitals, APHP, Paris, France
| | - Rafael Bragado
- Research Institute "Instituto de Investigación Sanitaria-Fundación Jiménez Díaz (IIS FJD)", Madrid, Spain
| | - Davide Amidani
- Pharmacology and Toxicology Department Preclinical R&D, Chiesi Farmaceutici, Parma, Italy; and
| | - Fabrizio Salomone
- Pharmacology and Toxicology Department Preclinical R&D, Chiesi Farmaceutici, Parma, Italy; and
| | - Jesús Pérez-Gil
- Department of Biochemistry and Molecular Biology and Research Institute "Hospital 12 de Octubre (imas12)", Complutense University, Madrid, Spain
| | - Daniele De Luca
- Division of Pediatrics and Neonatal Critical Care, A. Béclère Medical Center, Paris Saclay University Hospitals, APHP, Paris, France.,Physiopathology and Therapeutic Innovation Unit, INSERM U999, Paris-Saclay University, Paris, France
| |
Collapse
|
21
|
Gie AG, Regin Y, Salaets T, Casiraghi C, Salomone F, Deprest J, Vanoirbeek J, Toelen J. Intratracheal budesonide/surfactant attenuates hyperoxia-induced lung injury in preterm rabbits. Am J Physiol Lung Cell Mol Physiol 2020; 319:L949-L956. [PMID: 32903026 DOI: 10.1152/ajplung.00162.2020] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Recent clinical trials have shown improvements in neonatal outcomes after intratracheal administration of a combination of budesonide/surfactant (ITBS) in infants at risk of bronchopulmonary dysplasia. However, the effect of ITBS on lung function and alveolar structure is not known. We aimed to determine the effect of ITBS on lung function, parenchymal structure, and inflammatory cytokine expression in a relevant preterm animal model for bronchopulmonary dysplasia. Premature neonatal rabbits were administered a single dose of ITBS on the day of delivery and exposed to 95% oxygen. Following 7 days of hyperoxia, in vivo forced oscillation and pressure-volume maneuvers were performed to examine pulmonary function. Histological and molecular analysis was performed to assess alveolar and extracellular matrix (ECM) morphology, along with gene expression of connective tissue growth factor (CTGF), IL-8, and CCL-2. ITBS attenuated the functional effect of hyperoxia-induced lung injury and limited the change to respiratory system impedance, measured using the forced oscillation technique. Treatment effects were most obvious in the small airways, with significant effects on small airway resistance and small airway reactance. In addition, ITBS mitigated the decrease in inspiratory capacity and static compliance. ITBS restricted alveolar septal thickening without altering the mean linear intercept and mitigated hyperoxia-induced remodeling of the ECM. These structural changes were associated with improved inspiratory capacity and lung compliance. Gene expression of CTGF, IL-8, and CCL-2 was significantly downregulated in the lung. Treatment with ITBS shortly after delivery attenuated the functional and structural consequences of hyperoxia-induced lung injury to day 7 of life in the preterm rabbit.
Collapse
Affiliation(s)
- Andre G Gie
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Yannick Regin
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Thomas Salaets
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | | | | | - Jan Deprest
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium.,Institute for Women's Health, University College London Hospital, London, United Kingdom
| | - Jeroen Vanoirbeek
- Department of Public Health and Primary Care, Centre for Environment and Health, KU Leuven, Leuven, Belgium
| | - Jaan Toelen
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| |
Collapse
|
22
|
Das P, Curstedt T, Agarwal B, Prahaladan VM, Ramirez J, Bhandari S, Syed MA, Salomone F, Casiraghi C, Pelizzi N, Bhandari V. Small Molecule Inhibitor Adjuvant Surfactant Therapy Attenuates Ventilator- and Hyperoxia-Induced Lung Injury in Preterm Rabbits. Front Physiol 2020; 11:266. [PMID: 32327998 PMCID: PMC7160647 DOI: 10.3389/fphys.2020.00266] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 03/09/2020] [Indexed: 12/15/2022] Open
Abstract
Background Invasive mechanical ventilation (IMV) has become one of the mainstays of therapy in NICUs worldwide, as a result of which premature babies with extremely low birth weight have been able to survive. Although lifesaving, IMV can result in lung inflammation and injury. Surfactant therapy is considered a standard of care in preterm infants with immature lungs. Recently, small molecule inhibitors like siRNAs and miRNAs have been used for therapeutic purposes. Ddit3 (CHOP), Ang2 and miR34a are known to be upregulated in experimental lung injury. We wanted to test whether inhibitors for these molecules (CHOP siRNA, Ang2 siRNA, and miR34a antagomir) if used alone or with a combination with surfactant (Curosurf®) would help in reducing ventilation and hyperoxia-induced injury in an experimental lung injury model. Methods Preterm rabbits born by cesarean section were intratracheally instilled with the three small molecule inhibitors with or without Curosurf® prior to IMV and hyperoxia exposure. Prior to testing the inhibitors in rabbits, these small molecule inhibitors were transfected in mouse lung epithelial cells (MLE12 and AECII) and delivered to neonatal mouse pups intranasally as a proof of concept that surfactant (Curosurf®) could be used as an effective vehicle for administration of such drugs. Survival, pulmonary function tests, histopathology, immunostaining, quantitative PCR and western blotting were done to see the adjuvant effect of surfactant with these three small molecule inhibitors. Results Our data shows that Curosurf® can facilitate transfection of small molecules in MLE12 cells with the same and/or increased efficiency as Lipofectamine. Surfactant given alone or as an adjuvant with small molecule inhibitors increases survival, decreases IMV and hyperoxia-induced inflammation, improves pulmonary function and lung injury scores in preterm rabbit kits. Conclusion Our study shows that Curosurf® can be used successfully as an adjuvant therapy with small molecule inhibitors for CHOP/Ang2/miR34a. In this study, of the three inhibitors used, miR34a inhibitor seemed to be the most promising compound to combat IMV and hyperoxia-induced lung injury in preterm rabbits.
Collapse
Affiliation(s)
- Pragnya Das
- Department of Pediatrics, Drexel University, Philadelphia, PA, United States
| | - Tore Curstedt
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | | | - Varsha M Prahaladan
- Department of Pediatrics, Drexel University, Philadelphia, PA, United States
| | - John Ramirez
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT, United States
| | - Shreya Bhandari
- Department of Pediatrics, Drexel University, Philadelphia, PA, United States
| | - Mansoor A Syed
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT, United States
| | | | | | | | - Vineet Bhandari
- Department of Pediatrics, Drexel University, Philadelphia, PA, United States.,Department of Pediatrics, Yale University School of Medicine, New Haven, CT, United States
| |
Collapse
|
23
|
Bianco F, Pasini E, Nutini M, Murgia X, Stoeckl C, Schlun M, Hetzer U, Bonelli S, Lombardini M, Milesi I, Pertile M, Minocchieri S, Salomone F, Bucholski A. Extended Pharmacopeial Characterization of Surfactant Aerosols Generated by a Customized eFlow Neos Nebulizer Delivered through Neonatal Nasal Prongs. Pharmaceutics 2020; 12:pharmaceutics12040319. [PMID: 32252349 PMCID: PMC7238214 DOI: 10.3390/pharmaceutics12040319] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 03/06/2020] [Accepted: 03/31/2020] [Indexed: 12/17/2022] Open
Abstract
The delivery of nebulized medications to preterm infants during Non-Invasive Ventilation (NIV) remains an unmet clinical need. In this regard, the effective delivery of nebulized surfactant has been particularly investigated in preclinical and clinical studies. In this work, we investigated the feasibility of delivering nebulized surfactant through various commercially available nasal prong types. We first performed a compendial characterization of surfactant aerosols generated by the eFlow Neos nebulizer, customized to be used in neonates, determining the amount of surfactant delivered by the device as well as the aerodynamic characteristics of surfactant aerosols. Additionally, we extended the compendial characterization by testing the effect of different nasal prong types on the estimated lung dose using a realistic Continuous Positive Airway Pressure (CPAP) circuit that included a cast of the upper airways of a preterm neonate. The compendial characterization of surfactant aerosols delivered through different nasal prongs achieved relatively high delivered surfactant doses (in the range 63-74% of the nominal dose), with aerodynamic characteristics displaying mass median aerodynamic diameters ranging between 2.52 and 2.81 µm. Nevertheless, when using a representative in vitro setup mimicking NIV in a clinical setting, significant differences were observed in terms of the estimated lung dose accounting for up to two-fold differences (from 10% to 20% estimated lung deposition of the nominal dose) depending on the chosen nasal prong type. Considering that surfactant lung deposition rates are correlated with therapeutic efficacy, this study points out the relevance of choosing the appropriate NIV interface to maximize the lung dose of nebulized medications.
Collapse
Affiliation(s)
- Federico Bianco
- Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici S.p.A., 43122 Parma, Italy; (E.P.); (M.N.); (S.B.); (M.L.); (I.M.); (M.P.); (F.S.)
- Correspondence: ; Tel.: +390521279035
| | - Elena Pasini
- Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici S.p.A., 43122 Parma, Italy; (E.P.); (M.N.); (S.B.); (M.L.); (I.M.); (M.P.); (F.S.)
| | - Marcello Nutini
- Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici S.p.A., 43122 Parma, Italy; (E.P.); (M.N.); (S.B.); (M.L.); (I.M.); (M.P.); (F.S.)
| | | | - Carolin Stoeckl
- PARI Pharma GmbH, 82319 Starnberg, Germany; (C.S.); (M.S.); (U.H.); (A.B.)
| | - Martin Schlun
- PARI Pharma GmbH, 82319 Starnberg, Germany; (C.S.); (M.S.); (U.H.); (A.B.)
| | - Uwe Hetzer
- PARI Pharma GmbH, 82319 Starnberg, Germany; (C.S.); (M.S.); (U.H.); (A.B.)
| | - Sauro Bonelli
- Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici S.p.A., 43122 Parma, Italy; (E.P.); (M.N.); (S.B.); (M.L.); (I.M.); (M.P.); (F.S.)
| | - Marta Lombardini
- Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici S.p.A., 43122 Parma, Italy; (E.P.); (M.N.); (S.B.); (M.L.); (I.M.); (M.P.); (F.S.)
| | - Ilaria Milesi
- Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici S.p.A., 43122 Parma, Italy; (E.P.); (M.N.); (S.B.); (M.L.); (I.M.); (M.P.); (F.S.)
| | - Marisa Pertile
- Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici S.p.A., 43122 Parma, Italy; (E.P.); (M.N.); (S.B.); (M.L.); (I.M.); (M.P.); (F.S.)
| | - Stephan Minocchieri
- Division of Neonatology, Cantonal Hospital Winterthur, 8401 Winterthur, Switzerland;
| | - Fabrizio Salomone
- Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici S.p.A., 43122 Parma, Italy; (E.P.); (M.N.); (S.B.); (M.L.); (I.M.); (M.P.); (F.S.)
| | - Albert Bucholski
- PARI Pharma GmbH, 82319 Starnberg, Germany; (C.S.); (M.S.); (U.H.); (A.B.)
| |
Collapse
|
24
|
Guo X, Luo S, Amidani D, Rivetti C, Pieraccini G, Pioselli B, Catinella S, Murgia X, Salomone F, Xu Y, Dong Y, Sun B. In vitro characterization and in vivo comparison of the pulmonary outcomes of Poractant alfa and Calsurf in ventilated preterm rabbits. PLoS One 2020; 15:e0230229. [PMID: 32168331 PMCID: PMC7069639 DOI: 10.1371/journal.pone.0230229] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 02/12/2020] [Indexed: 11/18/2022] Open
Abstract
Poractant alfa and Calsurf are two natural surfactants widely used in China for the treatment of neonatal respiratory distress syndrome, which are extracted from porcine and calf lungs, respectively. The purpose of this experimental study was to compare their in vitro characteristics and in vivo effects in the improvement of pulmonary function and protection of lung injury. The biophysical properties, ultrastructure, and lipid composition of both surfactant preparations were respectively analysed in vitro by means of Langmuir-Blodgett trough (LBT), atomic force microscopy (AFM), and liquid-chromatography mass-spectrometry (LC-MS). Then, as core pharmacological activity, both head-to-head (100 and 200 mg/kg for both surfactants) and licensed dose comparisons (70 mg/kg Calsurf vs. 200 mg/kg Poractant alfa) between the two surfactants were conducted as prophylaxis in preterm rabbits with primary surfactant deficiency, assessing survival time and rate and dynamic compliance of the respiratory system (Cdyn). Intrapulmonary surfactant pools, morphometric volume density as alveolar expansion (Vv), and lung injury scores were determined post mortem. AFM and LC-MS analysis revealed qualitative differences in the ultrastructure as well as in the lipid composition of both preparations. Calsurf showed a longer plateau region of the LBT isotherm and lower film compressibility. In vivo, both surfactant preparations improved Cdyn at any dose, although maximum benefits in terms of Vv and intrapulmonary surfactant pools were seen with the 200 mg/kg dose in both surfactants. The group of animals treated with 200 mg/kg of Poractant alfa showed a prolonged survival time and rate compared to untreated but ventilated controls, and significantly ameliorated lung injury compared to Calsurf at any dose, including 200 mg/kg. The overall outcomes suggest the pulmonary effects to be dose dependent for both preparations. The group of animals treated with 200 mg/kg of Poractant alfa showed a significant reduction of mortality. Compared to Calsurf, Poractant alfa exerted better effects if licensed doses were compared, which requires further investigation.
Collapse
Affiliation(s)
- Xiaojing Guo
- Departments of Pediatrics and Neonatology, Children’s Hospital of Fudan University, Shanghai, China
| | - Siwei Luo
- Departments of Pediatrics and Neonatology, Children’s Hospital of Fudan University, Shanghai, China
| | - Davide Amidani
- Department of Research and Development, Chiesi Farmaceutici, Parma, Italy
| | - Claudio Rivetti
- Department of Chemistry, Life Sciences and Environmental Sustainability, University of Parma, Parma, Italy
| | - Giuseppe Pieraccini
- CISM Mass Spectrometry Centre, Department of Health Sciences, University of Florence, Firenze, Italy
| | - Barbara Pioselli
- Department of Research and Development, Chiesi Farmaceutici, Parma, Italy
| | - Silvia Catinella
- Department of Research and Development, Chiesi Farmaceutici, Parma, Italy
| | - Xabi Murgia
- Department of Drug Delivery, Helmholtz Institute for Pharmaceutical Research, Saarbrücken, Saarland, Germany
| | - Fabrizio Salomone
- Department of Research and Development, Chiesi Farmaceutici, Parma, Italy
| | - Yaling Xu
- Departments of Pediatrics and Neonatology, Children’s Hospital of Fudan University, Shanghai, China
| | - Ying Dong
- Departments of Pediatrics and Neonatology, Children’s Hospital of Fudan University, Shanghai, China
| | - Bo Sun
- Departments of Pediatrics and Neonatology, Children’s Hospital of Fudan University, Shanghai, China
- * E-mail: ,
| |
Collapse
|
25
|
Nord A, Linner R, Salomone F, Bianco F, Ricci F, Murgia X, Schlun M, Cunha-Goncalves D, Perez-de-Sa V. Lung deposition of nebulized surfactant in newborn piglets: Nasal CPAP vs Nasal IPPV. Pediatr Pulmonol 2020; 55:514-520. [PMID: 31833668 DOI: 10.1002/ppul.24603] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 11/26/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND Nasal continuous positive airway pressure support (nCPAP) is the standard of care for prematurely born infants at risk of neonatal respiratory distress syndrome (nRDS). However, nasal intermittent positive pressure ventilation (NIPPV) may be an alternative to nCPAP in babies requiring surfactant, and in conjunction with surfactant nebulization, it could theoretically reduce the need for invasive mechanical ventilation. We compared lung deposition of nebulized poractant in newborn piglets supported by nCPAP or NIPPV. METHODS Twenty-five sedated newborn piglets (1.2-2.2 kg) received either nCPAP (3 cmH2 O, n = 12) or NIPPV (3 cmH2 O positive end expiratory pressure+3 cmH2 O inspiratory pressure, n = 13) via custom-made nasal prongs (FiO2 0.4, Servo-i ventilator). Piglets received 200 mg kg-1 of technetium-99m-surfactant mixture continuously nebulized with a customized eFlow-Neos investigational vibrating-membrane nebulizer system. Blood gases were taken immediately before, during, and after nebulization. The deposition was estimated by gamma scintigraphy. RESULTS Mean surfactant deposition in the lungs was 15.9 ± 11.9% [8.3, 23.5] (mean ± SD [95% CI]) in the nCPAP group and 21.6 ± 10% [15.6, 27.6] in the NIPPV group (P = .20). Respiratory rates were similar in both groups. Minute volume was 489 ± 203 [360, 617] in the nCPAP group and 780 ± 239 [636, 924] mL kg-1 min-1 in the NIPPV group (P = .009). Blood gases were comparable in both groups. CONCLUSION Irrespective of the noninvasive ventilatory support mode used, relatively high lung deposition rates of surfactant were achieved with nebulization. The amounts of deposited surfactant might suffice to elicit a pulmonary function improvement in the context of nRDS.
Collapse
Affiliation(s)
- Anders Nord
- Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Rikard Linner
- Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | | | - Federico Bianco
- Corporate Preclinical R&D, Chiesi Farmaceutici S.p.A., Parma, Italy
| | - Francesca Ricci
- Corporate Preclinical R&D, Chiesi Farmaceutici S.p.A., Parma, Italy
| | - Xabi Murgia
- Department of Drug Delivery, Helmholtz Institute for Pharmaceutical Research Saarland, Saarbrucken, Germany
| | | | | | - Valeria Perez-de-Sa
- Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| |
Collapse
|
26
|
Hillman NH, Kothe TB, Schmidt AF, Kemp MW, Royse E, Fee E, Salomone F, Clarke MW, Musk GC, Jobe AH. Surfactant plus budesonide decreases lung and systemic responses to injurious ventilation in preterm sheep. Am J Physiol Lung Cell Mol Physiol 2020; 318:L41-L48. [PMID: 31617728 PMCID: PMC6985873 DOI: 10.1152/ajplung.00203.2019] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 09/09/2019] [Accepted: 09/30/2019] [Indexed: 11/22/2022] Open
Abstract
Mechanical ventilation from birth with normal tidal volumes (VT) causes lung injury and systemic responses in preterm sheep. The addition of budesonide to surfactant therapy decreases these injury markers. Budesonide and surfactant will decrease the injury from injurious VT ventilation in preterm sheep. Lambs at 126 ± 1 day gestational age were ventilated from birth with either: 1) Normal VT [surfactant 200 mg/kg before ventilation, positive end expiratory pressure (PEEP) 5 cmH2O, VT 8 mL/kg] or 2) Injury VT (high pressure, 100% oxygen, no PEEP) for 15 min, then further randomized to surfactant + saline or surfactant + 0.25 mg/kg budesonide with Normal VT for 6 h. Lung function and lung, liver, and brain tissues were evaluated for indicators of injury. Injury VT + saline caused significant injury and systemic responses, and Injury VT + budesonide improved lung physiology. Budesonide decreased lung inflammation and decreased pro-inflammatory cytokine mRNA in the lung, liver, and brain to levels similar to Normal VT + saline. Budesonide was present in plasma within 15 min of treatment in both ventilation groups, and less than 5% of the budesonide remained in the lung at 6 h. mRNA sequencing of liver and periventricular white matter demonstrated multiple pathways altered by both Injury VT and budesonide and the combination exposure. In lambs receiving Injury VT, the addition of budesonide to surfactant improved lung physiology and decreased pro-inflammatory cytokine responses in the lung, liver, and brain to levels similar to lambs receiving Normal VT.
Collapse
Affiliation(s)
- Noah H Hillman
- Division of Neonatology, Cardinal Glennon Children's Hospital, Saint Louis University, St. Louis, Missouri
| | - T Brett Kothe
- Division of Neonatology, Cardinal Glennon Children's Hospital, Saint Louis University, St. Louis, Missouri
| | - Augusto F Schmidt
- Division of Pulmonary Biology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | - Matthew W Kemp
- School of Women's and Infants' Health, University of Western Australia, Perth, Western Australia, Australia
| | - Emily Royse
- Division of Neonatology, Cardinal Glennon Children's Hospital, Saint Louis University, St. Louis, Missouri
| | - Erin Fee
- School of Women's and Infants' Health, University of Western Australia, Perth, Western Australia, Australia
| | - Fabrizio Salomone
- Department of Preclinical Pharmacology R&D, Chiesi Farmaceutici S.p.A, Parma, Italy
| | - Michael W Clarke
- Metabolomics Australia, Centre for Microscopy, Characterisation and Analysis, The University of Western Australia, Perth, Western Australia, Australia
| | - Gabrielle C Musk
- School of Women's and Infants' Health, University of Western Australia, Perth, Western Australia, Australia
- Animal Care Services, University of Western Australia, Perth, Western Australia, Australia
| | - Alan H Jobe
- Division of Pulmonary Biology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
- School of Women's and Infants' Health, University of Western Australia, Perth, Western Australia, Australia
| |
Collapse
|
27
|
Cunha-Goncalves D, Nord A, Bianco F, Salomone F, Ricci F, Schlun M, Linner R, Perez-de-Sa V. Impact of Body Position on Lung Deposition of Nebulized Surfactant in Newborn Piglets on Nasal Continuous Positive Airway Pressure. Neonatology 2020; 117:467-473. [PMID: 32604091 DOI: 10.1159/000508349] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 04/26/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The ideal body position during surfactant nebulization is not known. OBJECTIVE The aim of this study was to determine whether body positioning during surfactant nebulization influences surfactant distribution and deposition in the lungs. METHODS Twenty-four 12- to 36-h-old full-termpiglets (1.3-2.2 kg) on nasal continuous positive airway pressure (nCPAP) were randomized into four groups: lateral decubitus with right or left side up, prone or supine positions (n = 6 each). All animals received 200 mg kg-1 of poractant alfa mixed with 200 MBq of 99mtechnetium-nanocolloid via a customized eFlow-Neos investigational vibrating-membrane nebulizer. Surfactant deposition (percentage of the administered dose) was measured by gamma scintigraphy. RESULTS Comparing all groups, the mean total lung surfactant deposition was significantly higher in the prone position (32.4 ± 7.7%, p = 0.03). The deposition in this group was higher in the right lung (21.0 ± 8.6 vs. 11.3 ± 5.7%, p = 0.04). When nebulization was performed in the lateral decubitus, most of the surfactant was found in the dependent lung, regardless of which side the piglet lay on (right side up 15.3 ± 1.0 vs. 3.4 ± 1.0%, p = 0.06, and left side up 11.2 ± 9.8 vs. 1.8 ± 0.7%, p = 0.04). CONCLUSIONS In spontaneously breathing animals on nCPAP, the prone position yielded the highest lung dose. Higher deposition rates in the dependent lung while on lateral decubitus indicates that deposition was also influenced by gravity.
Collapse
Affiliation(s)
- Doris Cunha-Goncalves
- Department of Cardiothoracic Anesthesia and Intensive Care, Skåne University Hospital, Lund, Sweden, .,Department of Clinical Sciences, Lund University, Lund, Sweden,
| | - Anders Nord
- Department of Pediatric Anesthesia and Intensive Care, Skåne University Hospital, Lund, Sweden.,Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Federico Bianco
- Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici SpA, Parma, Italy
| | - Fabrizio Salomone
- Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici SpA, Parma, Italy
| | - Francesca Ricci
- Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici SpA, Parma, Italy
| | | | - Rikard Linner
- Department of Cardiothoracic Anesthesia and Intensive Care, Skåne University Hospital, Lund, Sweden.,Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Valeria Perez-de-Sa
- Department of Pediatric Anesthesia and Intensive Care, Skåne University Hospital, Lund, Sweden.,Department of Clinical Sciences, Lund University, Lund, Sweden
| |
Collapse
|
28
|
Zecchi R, Franceschi P, Tigli L, Ricci F, Boscaro F, Pioselli B, Mileo V, Murgia X, Bianco F, Salomone F, Schmidt AF, Hillman NH, Kemp MW, Jobe AH. Mass spectrometry imaging as a tool for evaluating the pulmonary distribution of exogenous surfactant in premature lambs. Respir Res 2019; 20:175. [PMID: 31382955 PMCID: PMC6683365 DOI: 10.1186/s12931-019-1144-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 07/24/2019] [Indexed: 01/29/2023] Open
Abstract
Background The amount of surfactant deposited in the lungs and its overall pulmonary distribution determine the therapeutic outcome of surfactant replacement therapy. Most of the currently available methods to determine the intrapulmonary distribution of surfactant are time-consuming and require surfactant labelling. Our aim was to assess the potential of Mass Spectrometry Imaging (MSI) as a label-free technique to qualitatively and quantitatively evaluate the distribution of surfactant to the premature lamb. Methods Twelve preterm lambs (gestational age 126-127d, term ~150d) were allocated in two experimental groups. Seven lambs were treated with an intratracheal bolus of the synthetic surfactant CHF5633 (200 mg/kg) and 5 lambs were managed with mechanical ventilation for 120 min, as controls. The right lung lobes of all lambs were gradually frozen while inflated to 20 cmH2O pressure for lung cryo-sections for MSI analysis. The intensity signals of SP-C analog and SP-B analog, the two synthetic peptides contained in the CHF5633 surfactant, were used to locate, map and quantify the intrapulmonary exogenous surfactant. Results Surfactant treatment was associated with a significant improvement of the mean arterial oxygenation and lung compliance (p < 0.05). Nevertheless, the physiological response to surfactant treatment was not uniform across all animals. SP-C analog and SP-B analog were successfully imaged and quantified by means of MSI in the peripheral lungs of all surfactant-treated animals. The intensity of the signal was remarkably low in untreated lambs, corresponding to background noise. The signal intensity of SP-B analog in each surfactant-treated animal, which represents the surfactant distributed to the peripheral right lung, correlated well with the physiologic response as assessed by the area under the curves of the individual arterial partial oxygen pressure and dynamic lung compliance curves of the lambs. Conclusions Applying MSI, we were able to detect, locate and quantify the amount of exogenous surfactant distributed to the lower right lung of surfactant-treated lambs. The distribution pattern of SP-B analog correlated well with the pulmonary physiological outcomes of the animals. MSI is a valuable label-free technique which is able to simultaneously evaluate qualitative and quantitative drug distribution in the lung. Electronic supplementary material The online version of this article (10.1186/s12931-019-1144-5) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Riccardo Zecchi
- Mass Spectrometry Service Center (CISM), University of Florence, Florence, Italy
| | - Pietro Franceschi
- Computational Biology, Research and Innovation Centre, Fondazione Edmund Mach, S. Michele all'Adige, TN, Italy
| | - Laura Tigli
- Preclinical R&D, Chiesi Farmaceutici, Largo Francesco Belloli, 11/A, 43122, Parma, Italy
| | - Francesca Ricci
- Preclinical R&D, Chiesi Farmaceutici, Largo Francesco Belloli, 11/A, 43122, Parma, Italy
| | - Francesca Boscaro
- Mass Spectrometry Service Center (CISM), University of Florence, Florence, Italy
| | - Barbara Pioselli
- Preclinical R&D, Chiesi Farmaceutici, Largo Francesco Belloli, 11/A, 43122, Parma, Italy
| | - Valentina Mileo
- Preclinical R&D, Chiesi Farmaceutici, Largo Francesco Belloli, 11/A, 43122, Parma, Italy
| | | | - Federico Bianco
- Preclinical R&D, Chiesi Farmaceutici, Largo Francesco Belloli, 11/A, 43122, Parma, Italy
| | - Fabrizio Salomone
- Preclinical R&D, Chiesi Farmaceutici, Largo Francesco Belloli, 11/A, 43122, Parma, Italy.
| | - Augusto F Schmidt
- Division of Neonatology and Pulmonary Biology, Cincinnati Children's Hospital, Cincinnati, USA
| | - Noah H Hillman
- Division of Neonatology, Cardinal Glennon Children's Hospital, Saint Louis University, Saint Louis, USA
| | - Matthew W Kemp
- Division of Obstetrics and Gynecology, University of Western Australia, Perth, WA, Australia
| | - Alan H Jobe
- Division of Neonatology, Cardinal Glennon Children's Hospital, Saint Louis University, Saint Louis, USA.,Division of Obstetrics and Gynecology, University of Western Australia, Perth, WA, Australia
| |
Collapse
|
29
|
Giambelluca S, Ricci F, Simonato M, Vedovelli L, Traldi U, Correani A, Casiraghi C, Storti M, Mersanne A, Cogo P, Salomone F, Carnielli VP. Tracing exogenous surfactant in vivo in rabbits by the natural variation of 13C. Respir Res 2019; 20:158. [PMID: 31319861 PMCID: PMC6637643 DOI: 10.1186/s12931-019-1124-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 07/03/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Respiratory Distress Syndrome (RDS) is a prematurity-related breathing disorder caused by a quantitative deficiency of pulmonary surfactant. Surfactant replacement therapy is effective for RDS newborns, although treatment failure has been reported. The aim of this study is to trace exogenous surfactant by 13C variation and estimate the amount reaching the lungs at different doses of the drug. METHODS Forty-four surfactant-depleted rabbits were obtained by serial bronchoalveolar lavages (BALs), that were merged into a pool (BAL pool) for each animal. Rabbits were in nasal continuous positive airway pressure and treated with 0, 25, 50, 100 or 200 mg/kg of poractant alfa by InSurE. After 90 min, rabbits were depleted again and a new pool (BAL end experiment) was collected. Disaturated-phosphatidylcholine (DSPC) was measured by gas chromatography. DSPC-Palmitic acid (PA) 13C/12C was analyzed by isotope ratio mass spectrometry. One-way non-parametric ANOVA and post-hoc Dunn's multiple comparison were used to assess differences among experimental groups. RESULTS Based on DSPC-PA 13C/12C in BAL pool and BAL end experiment, the estimated amount of exogenous surfactant ranged from 61 to 87% in dose-dependent way (p < 0.0001) in animals treated with 25 up to 200 mg/kg. Surfactant administration stimulated endogenous surfactant secretion. The percentage of drug recovered from lungs did not depend on the administered dose and accounted for 31% [24-40] of dose. CONCLUSIONS We reported a risk-free method to trace exogenous surfactant in vivo. It could be a valuable tool for assessing, alongside the physiological response, the delivery efficiency of surfactant administration techniques.
Collapse
Affiliation(s)
- Sonia Giambelluca
- Department of Women's and Children's Health, University of Padova, Padova, Italy.,PCare Laboratory, Fondazione Istituto di Ricerca Pediatrica Città della Speranza, Corso Stati Uniti, 4F, Padova, 35121, Italy
| | | | - Manuela Simonato
- PCare Laboratory, Fondazione Istituto di Ricerca Pediatrica Città della Speranza, Corso Stati Uniti, 4F, Padova, 35121, Italy. .,Institute of Anesthesiology and Intensive Care, Department of Medicine - DIMED, University of Padova, Padova, Italy.
| | - Luca Vedovelli
- PCare Laboratory, Fondazione Istituto di Ricerca Pediatrica Città della Speranza, Corso Stati Uniti, 4F, Padova, 35121, Italy
| | | | - Alessio Correani
- Division of Neonatology, Department of Clinical Sciences, Polytechnic University of Marche and Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
| | | | | | | | - Paola Cogo
- Department of Medicine, University of Udine, Udine, Italy
| | | | - Virgilio P Carnielli
- Division of Neonatology, Department of Clinical Sciences, Polytechnic University of Marche and Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
| |
Collapse
|
30
|
Bianco F, Ricci F, Catozzi C, Murgia X, Schlun M, Bucholski A, Hetzer U, Bonelli S, Lombardini M, Pasini E, Nutini M, Pertile M, Minocchieri S, Simonato M, Rosa B, Pieraccini G, Moneti G, Lorenzini L, Catinella S, Villetti G, Civelli M, Pioselli B, Cogo P, Carnielli V, Dani C, Salomone F. From bench to bedside: in vitro and in vivo evaluation of a neonate-focused nebulized surfactant delivery strategy. Respir Res 2019; 20:134. [PMID: 31266508 PMCID: PMC6604359 DOI: 10.1186/s12931-019-1096-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 06/12/2019] [Indexed: 01/17/2023] Open
Abstract
Background Non-invasive delivery of nebulized surfactant has been a neonatology long-pursued goal. Nevertheless, the clinical efficacy of nebulized surfactant remains inconclusive, in part, due to the great technical challenges of depositing nebulized drugs in the lungs of preterm infants. The aim of this study was to investigate the feasibility of delivering nebulized surfactant (poractant alfa) in vitro and in vivo with an adapted, neonate-tailored aerosol delivery strategy. Methods Particle size distribution of undiluted poractant alfa aerosols generated by a customized eFlow-Neos nebulizer system was determined by laser diffraction. The theoretical nebulized surfactant lung dose was estimated in vitro in a clinical setting replica including a neonatal continuous positive airway pressure (CPAP) circuit, a cast of the upper airways of a preterm neonate, and a breath simulator programmed with the tidal breathing pattern of an infant with mild respiratory distress syndrome (RDS). A dose-response study with nebulized surfactant covering the 100–600 mg/kg nominal dose-range was conducted in RDS-modelling, lung-lavaged spontaneously-breathing rabbits managed with nasal CPAP. The effects of nebulized poractant alfa on arterial gas exchange and lung mechanics were assessed. Exogenous alveolar disaturated-phosphatidylcholine (DSPC) in the lungs was measured as a proxy of surfactant deposition efficacy. Results Laser diffraction studies demonstrated suitable aerosol characteristics for inhalation (mass median diameter, MMD = 3 μm). The mean surfactant lung dose determined in vitro was 13.7% ± 4.0 of the 200 mg/kg nominal dose. Nebulized surfactant delivered to spontaneously-breathing rabbits during nasal CPAP significantly improved arterial oxygenation compared to animals receiving CPAP only. Particularly, the groups of animals treated with 200 mg/kg and 400 mg/kg of nebulized poractant alfa achieved an equivalent pulmonary response in terms of oxygenation and lung mechanics as the group of animals treated with instilled surfactant (200 mg/kg). Conclusions The customized eFlow-Neos vibrating-membrane nebulizer system efficiently generated respirable aerosols of undiluted poractant alfa. Nebulized surfactant delivered at doses of 200 mg/kg and 400 mg/kg elicited a pulmonary response equivalent to that observed after treatment with an intratracheal surfactant bolus of 200 mg/kg. This bench-characterized nebulized surfactant delivery strategy is now under evaluation in Phase II clinical trial (EUDRACT No.:2016–004547-36). Electronic supplementary material The online version of this article (10.1186/s12931-019-1096-9) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- F Bianco
- Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici S.p.A, Parma, Italy
| | - F Ricci
- Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici S.p.A, Parma, Italy
| | - C Catozzi
- Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici S.p.A, Parma, Italy
| | - X Murgia
- Scientific Consultancy, Saarbrücken, Germany
| | - M Schlun
- PARI Pharma GmbH, Starnberg, Germany
| | | | - U Hetzer
- PARI Pharma GmbH, Starnberg, Germany
| | - S Bonelli
- Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici S.p.A, Parma, Italy
| | - M Lombardini
- Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici S.p.A, Parma, Italy
| | - E Pasini
- Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici S.p.A, Parma, Italy
| | - M Nutini
- Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici S.p.A, Parma, Italy
| | - M Pertile
- Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici S.p.A, Parma, Italy
| | - S Minocchieri
- Division of Neonatology, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - M Simonato
- Pediatric Research Institute "Città della Speranza", Padova, Italy
| | - B Rosa
- Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici S.p.A, Parma, Italy
| | - G Pieraccini
- Mass Spectrometry Center (CISM), Polo Biomedico, Careggi University Hospital of Florence, Florence, Italy
| | - G Moneti
- Mass Spectrometry Center (CISM), Polo Biomedico, Careggi University Hospital of Florence, Florence, Italy
| | - L Lorenzini
- Health Science and Technologies Interdepartmental Center for Industrial Research (HST-ICIR), University of Bologna, Bologna, Italy
| | - S Catinella
- Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici S.p.A, Parma, Italy
| | - G Villetti
- Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici S.p.A, Parma, Italy
| | - M Civelli
- Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici S.p.A, Parma, Italy
| | - B Pioselli
- Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici S.p.A, Parma, Italy
| | - P Cogo
- Division of Pediatrics, Department of Medicine, University of Udine, Udine, Italy
| | - V Carnielli
- Polytechnic University of Marche and Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
| | - C Dani
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence School of Medicine, Careggi University Hospital of Florence, Viale Morgagni, 85, Florence, Italy.
| | - F Salomone
- Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici S.p.A, Parma, Italy
| |
Collapse
|
31
|
Abbandonato G, Polli D, Viola D, Cerullo G, Storti B, Cardarelli F, Salomone F, Nifosì R, Signore G, Bizzarri R. Simultaneous Detection of Local Polarizability and Viscosity by a Single Fluorescent Probe in Cells. Biophys J 2019; 114:2212-2220. [PMID: 29742414 DOI: 10.1016/j.bpj.2018.02.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 02/14/2018] [Accepted: 02/14/2018] [Indexed: 11/29/2022] Open
Abstract
Many intracellular reactions are dependent on the dielectric ("polarity") and viscosity properties of their milieu. Fluorescence imaging offers a convenient strategy to report on such environmental properties. Yet, concomitant and independent monitoring of polarity and viscosity in cells at submicron scale is currently hampered by the lack of fluorescence probes characterized by unmixed responses to both parameters. Here, the peculiar photophysics of a green fluorescent protein chromophore analog is exploited for quantifying and imaging polarity and viscosity independently in living cells. We show that the polarity and viscosity profile around a novel hybrid drug-delivery peptide changes dramatically upon cell internalization via endosomes, shedding light on the spatiotemporal features of the release mechanism. Accordingly, our fluorescent probe opens the way to monitor the environmental effects on several processes relevant to cell biochemistry and nanomedicine.
Collapse
Affiliation(s)
| | - Dario Polli
- IFN-CNR and Dipartimento di Fisica, Politecnico di Milano, Milano, Italy; Center for Nano Science and Technology at Polimi, Istituto Italiano di Tecnologia, Milano, Italy
| | - Daniele Viola
- IFN-CNR and Dipartimento di Fisica, Politecnico di Milano, Milano, Italy
| | - Giulio Cerullo
- IFN-CNR and Dipartimento di Fisica, Politecnico di Milano, Milano, Italy
| | - Barbara Storti
- NEST, Scuola Normale Superiore and NANO-CNR, Pisa, Italy
| | - Francesco Cardarelli
- NEST, Scuola Normale Superiore and NANO-CNR, Pisa, Italy; Center for Nanotechnology Innovation at NEST, Istituto Italiano di Tecnologia, Pisa, Italy
| | | | | | - Giovanni Signore
- NEST, Scuola Normale Superiore and NANO-CNR, Pisa, Italy; Center for Nanotechnology Innovation at NEST, Istituto Italiano di Tecnologia, Pisa, Italy.
| | | |
Collapse
|
32
|
Kothe TB, Kemp MW, Schmidt A, Royse E, Salomone F, Clarke MW, Musk GC, Jobe AH, Hillman NH. Surfactant plus budesonide decreases lung and systemic inflammation in mechanically ventilated preterm sheep. Am J Physiol Lung Cell Mol Physiol 2019; 316:L888-L893. [PMID: 30838863 PMCID: PMC6589588 DOI: 10.1152/ajplung.00477.2018] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 02/14/2019] [Accepted: 02/23/2019] [Indexed: 02/06/2023] Open
Abstract
Mechanical ventilation with normal tidal volumes (VT) causes lung and systemic inflammation in preterm sheep. Mechanical ventilation is associated with bronchopulmonary dysplasia (BPD) in preterm infants, and the addition of budesonide to surfactant decreases BPD in clinical trials. Budesonide with surfactant will decrease the lung injury from mechanical ventilation for 24 h in preterm sheep. Lambs at 126 ± 1 day gestational age were delivered and randomized to either: 1) surfactant (200 mg/kg) or 2) surfactant mixed with budesonide (0.25 mg/kg) before mechanical ventilation with VT of 7-8 ml/kg for 2, 6, or 24 h (n = 6 or 7/group). Lung physiology and budesonide levels in the plasma and the lung were measured. Lung tissue, bronchoalveolar lavage fluid (BALF), liver, and brain tissues were evaluated for indicators of injury. High initial budesonide plasma levels of 170 ng/ml decreased to 3 ng/ml at 24 h. Lung tissue budesonide levels were less than 1% of initial dose by 24 h. Although physiological variables were generally similar, budesonide-exposed lambs required lower mean airway pressures, had higher hyperoxia responses, and had more stable blood pressures. Budesonide decreased proinflammatory mRNA in the lung, liver, and brain. Budesonide also decreased total protein and proinflammatory cytokines in BALF, and decreased inducible nitric oxide synthase activation at 24 h. In ventilated preterm lambs, most of the budesonide left the lung within 24 h. The addition of budesonide to surfactant improved physiology, decreased markers of lung injury, and decreased systemic responses in liver and brain.
Collapse
Affiliation(s)
- T Brett Kothe
- Division of Neonatology, Cardinal Glennon Children's Hospital, Saint Louis University , St. Louis, Missouri
| | - Matthew W Kemp
- School of Women's and Infants' Health, University of Western Australia , Perth, Western Australia , Australia
| | - Augusto Schmidt
- Division of Pulmonary Biology, Cincinnati Children's Hospital Medical Center, University of Cincinnati , Cincinnati, Ohio
| | - Emily Royse
- Division of Neonatology, Cardinal Glennon Children's Hospital, Saint Louis University , St. Louis, Missouri
| | - Fabrizio Salomone
- Department of Preclinical Pharmacology R&D, Chiesi Farmaceutici S.p.A., Parma , Italy
| | - Michael W Clarke
- Metabolomics Australia, Centre for Microscopy, Characterisation and Analysis, The University of Western Australia , Perth, Western Australia , Australia
| | - Gabrielle C Musk
- School of Women's and Infants' Health, University of Western Australia , Perth, Western Australia , Australia
- Animal Care Services, University of Western Australia , Perth, Western Australia , Australia
| | - Alan H Jobe
- School of Women's and Infants' Health, University of Western Australia , Perth, Western Australia , Australia
- Division of Pulmonary Biology, Cincinnati Children's Hospital Medical Center, University of Cincinnati , Cincinnati, Ohio
| | - Noah H Hillman
- Division of Neonatology, Cardinal Glennon Children's Hospital, Saint Louis University , St. Louis, Missouri
| |
Collapse
|
33
|
Rey-Santano C, Mielgo VE, Gomez-Solaetxe MA, Salomone F, Gastiasoro E, Loureiro B. Cerebral oxygenation associated with INSURE versus LISA procedures in surfactant-deficient newborn piglet RDS model. Pediatr Pulmonol 2019; 54:644-654. [PMID: 30775857 PMCID: PMC6593807 DOI: 10.1002/ppul.24277] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 01/20/2019] [Indexed: 11/12/2022]
Abstract
BACKGROUND Nasal continuous-positive airway pressure (nCPAP) with the INSURE (INtubation-SURfactant-Extubation) or LISA (Less-Invasive Surfactant Administration) procedures are increasingly being chosen as the initial treatment for neonates with surfactant deficiency. Our objective was to compare the effects on cerebral oxygenation of different methods for surfactant administration: INSURE and LISA, using a nasogastric tube (NT) or a LISAcath® catheter, in spontaneously breathing SF-deficient newborn piglets. METHODS Eighteen newborn piglets with SF-deficient lung injury produced by repetitive bronchoalveolar lavages were randomly assigned to INSURE, LISA-NT, or LISAcath® groups. We assessed pulmonary (gas exchange, lung mechanics, lung histology) and hemodynamic (mean arterial blood pressure, heart rate) changes, cerebral oxygenation (cTOI) and cerebral fractional tissue extraction (cFTOE), with near-infrared spectroscopy, carotid blood flow and brain histology. RESULTS SF-deficient piglets developed respiratory distress (FiO2 = 1, pH <7.2, PaCO2 >70 mmHg, PaO2 <70 mmHg, Cdyn <0.5 mL/cmH2 O/kg). Rapid improvements in pulmonary status were observed in all surfactant-treated groups without hemodynamic alterations. In the INSURE group, a transient decrease in cTOI occurred during and immediately after surfactant administration, while cTOI only decreased during surfactant administration in the LISA-NT group and did not change significantly in the LISAcath® group. Brain injury scores were low in all surfactant-treated groups. CONCLUSION In spontaneously breathing SF-deficient newborn piglets, short-lasting decreases in cerebral oxygenation are associated with surfactant administration by the INSURE method or LISA using an NT, while no cerebral oxygenation changes occurred with LISA using a LISAcath®. Notably, none of treatments studied seems to have a negative impact on the neonatal brain.
Collapse
Affiliation(s)
- Carmen Rey-Santano
- Animal Research Unit, BioCruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain
| | - Victoria E Mielgo
- Animal Research Unit, BioCruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain
| | | | | | - Elena Gastiasoro
- Animal Research Unit, BioCruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain
| | - Begoña Loureiro
- Neonatal Intensive Care Unit, Cruces University Hospital, Barakaldo, Bizkaia, Spain
| |
Collapse
|
34
|
Salaets T, Gie A, Jimenez J, Aertgeerts M, Gheysens O, Vande Velde G, Koole M, Murgia X, Casiraghi C, Ricci F, Salomone F, Villetti G, Allegaert K, Deprest J, Toelen J. Local pulmonary drug delivery in the preterm rabbit: feasibility and efficacy of daily intratracheal injections. Am J Physiol Lung Cell Mol Physiol 2019; 316:L589-L597. [PMID: 30675804 DOI: 10.1152/ajplung.00255.2018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Recent clinical trials in newborns have successfully used surfactant as a drug carrier for an active compound, to minimize systemic exposure. To investigate the translational potential of surfactant-compound mixtures and other local therapeutics, a relevant animal model is required in which intratracheal administration for maximal local deposition is technically possible and well tolerated. Preterm rabbit pups (born at 28 days of gestation) were exposed to either hyperoxia or normoxia and randomized to receive daily intratracheal surfactant, daily intratracheal saline, or no injections for 7 days. At day 7, the overall lung function and morphology were assessed. Efficacy in terms of distribution was assessed by micro-PET-CT on both day 0 and day 7. Lung function as well as parenchymal and vascular structure were altered by hyperoxia, thereby reproducing a phenotype reminiscent of bronchopulmonary dysplasia (BPD). Neither intratracheal surfactant nor saline affected the survival or the hyperoxia-induced BPD phenotype of the pups. Using PET-CT, we demonstrate that 82.5% of the injected radioactive tracer goes and remains in the lungs, with a decrease of only 4% after 150 min. Surfactant and saline can safely and effectively be administered in spontaneously breathing preterm rabbits. The described model and method enable researchers to evaluate intratracheal pharmacological interventions for the treatment of BPD.
Collapse
Affiliation(s)
- Thomas Salaets
- Department of Development and Regeneration, Cluster Woman and Child, KU Leuven , Leuven , Belgium
| | - André Gie
- Department of Development and Regeneration, Cluster Woman and Child, KU Leuven , Leuven , Belgium
| | - Julio Jimenez
- Department of Development and Regeneration, Cluster Woman and Child, KU Leuven , Leuven , Belgium.,Facultad de Medicina, Universidad del Desarollo, Clínica Alemana, Santiago de Chile, Chile
| | - Margo Aertgeerts
- Department of Development and Regeneration, Cluster Woman and Child, KU Leuven , Leuven , Belgium
| | - Olivier Gheysens
- Department of Imaging and Pathology, KU Leuven , Leuven , Belgium
| | | | - Michel Koole
- Department of Imaging and Pathology, KU Leuven , Leuven , Belgium
| | - Xabi Murgia
- Department of Drug Delivery, Helmholtz Institute for Pharmaceutical Research Saarland , Saarbrücken , Germany
| | | | | | | | | | - Karel Allegaert
- Department of Development and Regeneration, Cluster Woman and Child, KU Leuven , Leuven , Belgium.,Division of Neonatology, Department of Pediatrics, Erasmus MC Sophia Children's Hospital , Rotterdam , The Netherlands
| | - Jan Deprest
- Department of Development and Regeneration, Cluster Woman and Child, KU Leuven , Leuven , Belgium.,Institute for Women's Health, University College London Hospital , London , United Kingdom
| | - Jaan Toelen
- Department of Development and Regeneration, Cluster Woman and Child, KU Leuven , Leuven , Belgium
| |
Collapse
|
35
|
Madsen J, Panchal MH, Mackay RMA, Echaide M, Koster G, Aquino G, Pelizzi N, Perez-Gil J, Salomone F, Clark HW, Postle AD. Metabolism of a synthetic compared with a natural therapeutic pulmonary surfactant in adult mice. J Lipid Res 2018; 59:1880-1892. [PMID: 30108154 PMCID: PMC6168297 DOI: 10.1194/jlr.m085431] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 07/09/2018] [Indexed: 11/24/2022] Open
Abstract
Secreted pulmonary surfactant phosphatidylcholine (PC) has a complex intra-alveolar metabolism that involves uptake and recycling by alveolar type II epithelial cells, catabolism by alveolar macrophages, and loss up the bronchial tree. We compared the in vivo metabolism of animal-derived poractant alfa (Curosurf) and a synthetic surfactant (CHF5633) in adult male C57BL/6 mice. The mice were dosed intranasally with either surfactant (80 mg/kg body weight) containing universally 13C-labeled dipalmitoyl PC (DPPC) as a tracer. The loss of [U13C]DPPC from bronchoalveolar lavage and lung parenchyma, together with the incorporation of 13C-hydrolysis fragments into new PC molecular species, was monitored by electrospray ionization tandem mass spectrometry. The catabolism of CHF5633 was considerably delayed compared with poractant alfa, the hydrolysis products of which were cleared more rapidly. There was no selective resynthesis of DPPC and, strikingly, acyl remodeling resulted in preferential synthesis of polyunsaturated PC species. In conclusion, both surfactants were metabolized by similar pathways, but the slower catabolism of CHF5633 resulted in longer residence time in the airways and enhanced recycling of its hydrolysis products into new PC species.
Collapse
Affiliation(s)
- Jens Madsen
- Child Health, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Madhuriben H Panchal
- Child Health, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Rose-Marie A Mackay
- Child Health, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Mercedes Echaide
- Department of Biochemistry and Molecular Biology, Faculty of Biology, Hospital 12 de Octubre Research Institute, Complutense University, Madrid, Spain
| | - Grielof Koster
- Child Health, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom.,National Institute for Health Research, Biomedical Research Centre, University Hospital Southampton, Southampton, United Kingdom
| | | | | | - Jesus Perez-Gil
- Department of Biochemistry and Molecular Biology, Faculty of Biology, Hospital 12 de Octubre Research Institute, Complutense University, Madrid, Spain
| | | | - Howard W Clark
- Child Health, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom.,National Institute for Health Research, Biomedical Research Centre, University Hospital Southampton, Southampton, United Kingdom
| | - Anthony D Postle
- Child Health, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom .,National Institute for Health Research, Biomedical Research Centre, University Hospital Southampton, Southampton, United Kingdom
| |
Collapse
|
36
|
Ronda L, Pioselli B, Catinella S, Salomone F, Marchetti M, Bettati S. Quenching of tryptophan fluorescence in a highly scattering solution: Insights on protein localization in a lung surfactant formulation. PLoS One 2018; 13:e0201926. [PMID: 30075031 PMCID: PMC6075776 DOI: 10.1371/journal.pone.0201926] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 07/24/2018] [Indexed: 11/18/2022] Open
Abstract
CHF5633 (Chiesi Farmaceutici, Italy) is a synthetic surfactant developed for respiratory distress syndrome replacement therapy in pre-term newborn infants. CHF5633 contains two phospholipids (dipalmitoylphosphatidylcholine and 1-palmitoyl-2oleoyl-sn-glycero-3-phosphoglycerol sodium salt), and peptide analogues of surfactant protein C (SP-C analogue) and surfactant protein B (SP-B analogue). Both proteins are fundamental for an optimal surfactant activity in vivo and SP-B genetic deficiency causes lethal respiratory failure after birth. Fluorescence emission of the only tryptophan residue present in SP-B analogue (SP-C analogue has none) could in principle be exploited to probe SP-B analogue conformation, localization and interaction with other components of the pharmaceutical formulation. However, the high light scattering activity of the multi-lamellar vesicles suspension characterizing the pharmaceutical surfactant formulation represents a challenge for such studies. We show here that quenching of tryptophan fluorescence and Singular Value Decomposition analysis can be used to accurately calculate and subtract background scattering. The results indicate, with respect to Trp microenvironment, a conformationally homogeneous population of SP-B. Trp is highly accessible to the water phase, suggesting a surficial localization on the membrane of phospholipid vesicles, similarly to what observed for full length SP-B in natural lung surfactant, and supporting an analogous role in protein anchoring to the lipid phase.
Collapse
Affiliation(s)
- Luca Ronda
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Biopharmanet-TEC, University of Parma, Parma, Italy
- * E-mail: (LR); (SB)
| | | | | | | | | | - Stefano Bettati
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Biopharmanet-TEC, University of Parma, Parma, Italy
- Italian National Institute of Biostructures and Biosystems, Rome, Italy
- * E-mail: (LR); (SB)
| |
Collapse
|
37
|
Ricci F, Casiraghi C, Storti M, D’Alò F, Catozzi C, Ciccimarra R, Ravanetti F, Cacchioli A, Villetti G, Civelli M, Murgia X, Carnielli V, Salomone F. Surfactant replacement therapy in combination with different non-invasive ventilation techniques in spontaneously-breathing, surfactant-depleted adult rabbits. PLoS One 2018; 13:e0200542. [PMID: 30001410 PMCID: PMC6042776 DOI: 10.1371/journal.pone.0200542] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 06/28/2018] [Indexed: 12/14/2022] Open
Abstract
Nasal intermittent positive pressure ventilation (NIPPV) holds great potential as a primary ventilation support method for Respiratory Distress Syndrome (RDS). The use of NIPPV may also be of great value combined with minimally invasive surfactant delivery. Our aim was to implement an in vivo model of RDS, which can be managed with different non-invasive ventilation (NIV) strategies, including non-synchronized NIPPV, synchronized NIPPV (SNIPPV), and nasal continuous positive airway pressure (NCPAP). Forty-two surfactant-depleted adult rabbits were allocated in six different groups: three groups of animals were treated with only NIV for three hours (NIPPV, SNIPPV, and NCPAP groups), while three other groups were treated with surfactant (SF) followed by NIV (NIPPV+SF, SNIPPV+SF, and NCPAP+SF groups). Arterial gas exchange, ventilation indices, and dynamic compliance were assessed. Post-mortem the lungs were sampled for histological evaluation. Surfactant depletion was successfully achieved by repeated broncho-alveolar lavages (BALs). After BALs, all animals developed a moderate respiratory distress, which could not be reverted by merely applying NIV. Conversely, surfactant administration followed by NIV induced a rapid improvement of arterial oxygenation in all surfactant-treated groups. Breath synchronization was associated with a significantly better response in terms of gas exchange and dynamic compliance compared to non-synchronized NIPPV, showing also the lowest injury scores after histological assessment. The proposed in vivo model of surfactant deficiency was successfully managed with NCPAP, NIPPV, or SNIPPV; this model resembles a moderate respiratory distress and it is suitable for the preclinical testing of less invasive surfactant administration techniques.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Xabi Murgia
- Department of Drug Delivery, Helmholtz Institute for Pharmaceutical Research Saarland, Saarbrücken, Germany
| | - Virgilio Carnielli
- Division of Neonatology, Polytechnic University of Marche and Salesi Children’s Hospital, Ancona, Italy
| | | |
Collapse
|
38
|
Giambelluca S, Ricci F, Simonato M, Correani A, Casiraghi C, Storti M, Cogo P, Salomone F, Carnielli VP. Estimating the contribution of surfactant replacement therapy to the alveolar pool: An in vivo study based on 13 C natural abundance in rabbits. J Mass Spectrom 2018; 53:560-564. [PMID: 29633450 DOI: 10.1002/jms.4088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 03/22/2018] [Accepted: 03/26/2018] [Indexed: 06/08/2023]
Abstract
Variation of the isotopic abundance of selected nutrients and molecules has been used for pharmacological and kinetics studies under the premise that the administered molecule has a different isotopic enrichment from the isotopic background of the recipient subject. The aim of this study is to test the feasibility of assessing the contribution of exogenous surfactant phospholipids to the endogenous alveolar pool in vivo after exogenous surfactant replacement therapy in rabbits. The study consisted in measuring the consistency of 13 C/12 C ratio of disaturated-phosphatidylcholine palmitate (DSPC-PA) in 7 lots of poractant alfa, produced over a year, and among bronchoalveolar lavages of 20 rabbits fed with a standard chow. A pilot study was performed in a rabbit model of lavage-induced surfactant deficiency: 7 control rabbits and 4 treated with exogenous surfactant. The contribution of exogenous surfactant to the alveolar pool was assessed after intra-tracheal administration of 200 mg/kg of poractant alfa. The 13 C content of DSPC-PA was measured by isotope ratio mass spectrometry. The mean DSPC-PA 13 C/12 C ratio of the 7 lots of poractant alfa was -18.8‰ with a SD of 0.1‰ (range: -18.9‰; -18.6‰). The mean 13 C/12 C ratio of surfactant DSPC recovered from the lung lavage of 20 rabbits was -28.8 ± 1.2‰ (range: -31.7‰; -25.7‰). The contribution of exogenous surfactant to the total alveolar surfactant could be calculated in the treated rabbits, and it ranged from 83.9% to 89.6%. This pilot study describes a novel method to measure the contribution of the exogenous surfactant to the alveolar pool. This method is based on the natural variation of 13 C, and therefore it does not require the use of chemically synthetized tracers. This method could be useful in human research and especially in surfactant replacement studies in preterm infants.
Collapse
Affiliation(s)
- Sonia Giambelluca
- Department of Women's and Children's Health, Padova University Hospital, Padova, Italy
| | | | - Manuela Simonato
- Division of Pediatrics, Department of Medicine, University of Udine, Udine, Italy
| | - Alessio Correani
- Division of Neonatology, Department of Clinical Sciences, Polytechnic University of Marche and Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
| | | | | | - Paola Cogo
- Division of Pediatrics, Department of Medicine, University of Udine, Udine, Italy
| | | | - Virgilio Paolo Carnielli
- Division of Neonatology, Department of Clinical Sciences, Polytechnic University of Marche and Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
| |
Collapse
|
39
|
Kothe TB, Royse E, Kemp MW, Schmidt A, Salomone F, Saito M, Usuda H, Watanabe S, Musk GC, Jobe AH, Hillman NH. Effects of budesonide and surfactant in preterm fetal sheep. Am J Physiol Lung Cell Mol Physiol 2018; 315:L193-L201. [PMID: 29671605 DOI: 10.1152/ajplung.00528.2017] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Mechanical ventilation causes lung injury and systemic inflammatory responses in preterm sheep and is associated with bronchopulmonary dysplasia (BPD) in preterm infants. Budesonide added to surfactant decreased BPD by 20% in infants. We wanted to determine the effects of budesonide and surfactant on injury from high tidal volume (VT) ventilation in preterm lambs. Ewes at 125 ± 1 days gestational age had fetal surgery to expose fetal head and chest with placental circulation intact. Lambs were randomized to 1) mechanical ventilation with escalating VT to target 15 ml/kg by 15 min or 2) continuous positive airway pressure (CPAP) of 5 cmH2O. After the 15-min intervention, lambs were given surfactant 100 mg/kg with saline, budesonide 0.25 mg/kg, or budesonide 1 mg/kg. The fetuses were returned to the uterus for 24 h and then delivered and ventilated for 30 min to assess lung function. Budesonide levels were low in lung and plasma. CPAP groups had improved oxygenation, ventilation, and decreased injury markers compared with fetal VT lambs. Budesonide improved ventilation in CPAP lambs. Budesonide decreased lung weights and lung liquid and increased lung compliance and surfactant protein mRNA. Budesonide decreased proinflammatory and acute-phase responses in lung. Airway thickness increased in animals not receiving budesonide. Systemically, budesonide decreased monocyte chemoattractant protein-1 mRNA and preserved glycogen in liver. Results with 0.25 and 1 mg/kg budesonide were similar. We concluded that budesonide with surfactant matured the preterm lung and decreased the liver responses but did not improve lung function after high VT injury in fetal sheep.
Collapse
Affiliation(s)
- T Brett Kothe
- Division of Neonatology, Cardinal Glennon Children's Hospital, Saint Louis University , Saint Louis, Missouri
| | - Emily Royse
- Division of Neonatology, Cardinal Glennon Children's Hospital, Saint Louis University , Saint Louis, Missouri
| | - Matthew W Kemp
- School of Women's and Infants' Health, University of Western Australia , Perth, Western Australia , Australia
| | - Augusto Schmidt
- Division of Pulmonary Biology, Cincinnati Children's Hospital Medical Center, University of Cincinnati , Cincinnati, Ohio
| | - Fabrizio Salomone
- Department of Preclinical Pharmacology Research and Development, Chiesi Farmaceutici, Parma , Italy
| | - Masatoshi Saito
- Center for Perinatal and Neonatal Medicine, Tohoku University Hospital , Sendai , Japan
| | - Haruo Usuda
- School of Women's and Infants' Health, University of Western Australia , Perth, Western Australia , Australia.,Center for Perinatal and Neonatal Medicine, Tohoku University Hospital , Sendai , Japan
| | - Shimpei Watanabe
- Center for Perinatal and Neonatal Medicine, Tohoku University Hospital , Sendai , Japan
| | - Gabrielle C Musk
- Animal Care Services, University of Western Australia , Perth, Western Australia , Australia
| | - Alan H Jobe
- Division of Pulmonary Biology, Cincinnati Children's Hospital Medical Center, University of Cincinnati , Cincinnati, Ohio.,School of Women's and Infants' Health, University of Western Australia , Perth, Western Australia , Australia
| | - Noah H Hillman
- Division of Neonatology, Cardinal Glennon Children's Hospital, Saint Louis University , Saint Louis, Missouri
| |
Collapse
|
40
|
Beharry KD, Cai CL, Valencia GB, Lazzaro D, Valencia AM, Salomone F, Aranda JV. Human retinal endothelial cells and astrocytes cultured on 3-D scaffolds for ocular drug discovery and development. Prostaglandins Other Lipid Mediat 2018; 134:93-107. [PMID: 28923362 PMCID: PMC5803320 DOI: 10.1016/j.prostaglandins.2017.09.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 09/11/2017] [Accepted: 09/14/2017] [Indexed: 12/20/2022]
Abstract
Topical ocular ketorolac improves the outcomes of severe retinopathy of prematurity and when administered with systemic caffeine, decreases the severity of oxygen-induced retinopathy. We tested the hypothesis that co-cultures of human retinal endothelial cells (HRECs) and human retinal astrocytes (HRAs) on 3-dimensional (3-D) hydrogel scaffolds is a more representative biomimetic paradigm of the blood-retinal-barrier (BRB) than 2-D cultures, and should be utilized for preclinical drug discovery and development. Mono- and co-cultures of HRECs and HRAs were treated with standard doses of ketorolac, ibuprofen, and/or caffeine, and exposed to hyperoxia, intermittent hypoxia (IH), or normoxia on 2-D surfaces or 3-D biodegradable hydrogel scaffolds (AlgiMatrix or Geltrex). Media and cells were collected at 72h post treatment for arachidonic acid metabolites. Cells cultured on 3-D scaffolds exhibited less oxidative stress and variability in drug responses. HRAs enhanced the responses of HRECs to drugs and changes in oxygen environment. PGE2 and PGI2 were the predominant prostanoids produced in response to IH, reflecting COX-2 immunoreactivity. We conclude that HRECs and HRAs co-cultured on 3-D scaffolds may recapitulate drug responses of the dynamic BRB and therefore should be implemented for preclinical ocular drug discovery and development.
Collapse
Affiliation(s)
- Kay D Beharry
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY, USA; Department of Ophthalmology, State University of New York, Downstate Medical Center, Brooklyn, NY, USA; SUNY Eye Institute, NY, NY, USA.
| | - Charles L Cai
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY, USA
| | - Gloria B Valencia
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY, USA
| | - Douglas Lazzaro
- Department of Ophthalmology, State University of New York, Downstate Medical Center, Brooklyn, NY, USA; SUNY Eye Institute, NY, NY, USA
| | | | | | - Jacob V Aranda
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY, USA; Department of Ophthalmology, State University of New York, Downstate Medical Center, Brooklyn, NY, USA; SUNY Eye Institute, NY, NY, USA
| |
Collapse
|
41
|
Ricci F, Catozzi C, Ravanetti F, Murgia X, D'Aló F, Macchidani N, Sgarbi E, Di Lallo V, Saccani F, Pertile M, Cacchioli A, Catinella S, Villetti G, Civelli M, Amadei F, Stellari FF, Pioselli B, Salomone F. In vitro and in vivo characterization of poractant alfa supplemented with budesonide for safe and effective intratracheal administration. Pediatr Res 2017; 82:1056-1063. [PMID: 28723887 DOI: 10.1038/pr.2017.171] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 06/18/2017] [Indexed: 12/29/2022]
Abstract
BackgroundThe intratracheal (IT) administration of budesonide using surfactant as a vehicle has been shown to reduce the incidence of bronchopulmonary dysplasia (BPD) in preterm infants. The objective of this study was to characterize the in vitro characteristics and in vivo safety and efficacy of the extemporaneous combination of budesonide and poractant alfa.MethodsThe stability, minimum surface tension, and viscosity of the preparation were evaluated by means of high-performance liquid chromatography (HPLC), Wilhelmy balance, and Rheometer, respectively. The safety and efficacy of the IT administration of the mixture were tested in two respiratory distress syndrome (RDS) animal models: twenty-seventh day gestational age premature rabbits and surfactant-depleted adult rabbits.ResultsA pre-formulation trial identified a suitable procedure to ensure the homogeneity and stability of the formulation. Wilhelmy Balance tests clarified that budesonide supplementation has no detrimental effect on poractant alfa surface tension activity. The addition of budesonide to poractant alfa did not affect the physiological response to surfactant treatment in both RDS animal models, and was associated to a significant reduction of lung inflammation in surfactant-depleted rabbits.ConclusionOur in vitro and in vivo analysis suggests that the IT administration of a characterized extemporaneous combination of poractant alfa and budesonide is a safe and efficacious procedure in the context of RDS.
Collapse
Affiliation(s)
| | | | | | - Xabier Murgia
- Department of Drug Delivery, Helmholtz Institute for Pharmaceutical Research Saarland, Saarbrücken, Germany
| | | | | | - Elisa Sgarbi
- R&D Department, Chiesi Farmaceutici, Parma, Italy
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Abstract
Nonsteroidal antiinflammatory drugs (NSAIDs) and acetaminophen are used in young infants and newborns for pain and fever control, patent ductus closure, prevention of intraventricular hemorrhage, and potentially for prevention of retinopathy of prematurity. These drugs inhibit cyclooxygenase 1 (COX-1), COX-2, and peroxidases, thus, blocking prostaglandin (PG) synthesis. PGs are eicosanoids that regulate several physiologic, pathologic, and cellular processes, including vasomotor tone, platelet aggregation, sensitization of neurons to pain, and many molecular events critical to physiologic homeostasis. NSAIDs inhibit caspases and cell death. Increasing knowledge of these molecular entities may allow targeted drug development to prevent or minimize neonatal morbidities.
Collapse
Affiliation(s)
- Jacob V Aranda
- State University of New York Downstate Medical Center, 450 Clarkson Avenue, Box 49, Brooklyn, NY 11203, USA.
| | - Fabrizio Salomone
- Neonatology and Pulmonary Rare Disease Unit, Corporate Pre-Clinical R and D, Chiesi Farmaceutici S.p.A, Largo Belloli 11/A, Parma IT-43122, Italy
| | - Gloria B Valencia
- State University of New York Downstate Medical Center, 450 Clarkson Avenue, Box 49, Brooklyn, NY 11203, USA
| | - Kay D Beharry
- State University of New York Downstate Medical Center, 450 Clarkson Avenue, Box 49, Brooklyn, NY 11203, USA
| |
Collapse
|
43
|
Maida M, Macaluso FS, Salomone F, Petta S. Non-Invasive Assessment of Liver Injury in Non-Alcoholic Fatty Liver Disease: A Review of Literature. Curr Mol Med 2017; 16:721-737. [PMID: 27719652 DOI: 10.2174/1566524016666161004143613] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 09/06/2016] [Accepted: 09/30/2016] [Indexed: 11/22/2022]
Abstract
NAFLD (Non-Alcoholic Fatty Liver Disease) is an increasingly significant public health issue, regarded as the most relevant liver disease of the twenty-first century. Approximately 20%-30% of NAFLD subjects develop a NASH (Non-Alcoholic Steato-Hepatitis), a condition which can potentially evolve to liver cirrhosis and hepatocellular carcinoma. For these reasons a proper evaluation of liver damage is a key point for diagnosis and prognosis and liver biopsy still remains the "gold standard" procedure both for discrimination between steatosis and steatohepatitis and assessment of the degree of liver fibrosis. Nonetheless, given it is an invasive, painful and costly procedure, a great research efforts have been made in order to develop non-invasive methods for the assessment of NAFLD presence and/or severity by serum markers and imaging techniques. In this review we aimed to perform a comprehensive review of the literature about strengths and weaknesses of the main tools available for the non-invasive assessment of NAFLD patients.
Collapse
Affiliation(s)
| | | | | | - S Petta
- Section of Gastroenterology, DIBIMIS, University of Palermo, P.zza delle Cliniche 2, 90127 Palermo, Italy.
| |
Collapse
|
44
|
Hidalgo A, Salomone F, Fresno N, Orellana G, Cruz A, Perez-Gil J. Efficient Interfacially Driven Vehiculization of Corticosteroids by Pulmonary Surfactant. Langmuir 2017; 33:7929-7939. [PMID: 28738158 DOI: 10.1021/acs.langmuir.7b01177] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Pulmonary surfactant is a crucial system to stabilize the respiratory air-liquid interface. Furthermore, pulmonary surfactant has been proposed as an effective method for targeting drugs to the lungs. However, few studies have examined in detail the mechanisms of incorporation of drugs into surfactant, the impact of the presence of drugs on pulmonary surfactant performance at the interface under physiologically meaningful conditions, or the ability of pulmonary surfactant to use the air-liquid interface to vehiculise drugs to long distances. This study focuses on the ability of pulmonary surfactant to interfacially vehiculize corticosteroids such as beclomethasone dipropionate (BDP) or Budesonide (BUD) as model drugs. The main objectives have been to (a) characterize the incorporation of corticosteroids into natural and synthetic surfactants, (b) evaluate whether the presence of corticosteroids affects surfactant functionality, and (c) determine whether surfactant preparations enable the efficient spreading and distribution of BDP and BUD along the air-liquid interface. We have compared the performance of a purified surfactant from porcine lungs and two clinical surfactants: Poractant alfa, a natural surfactant of animal origin extensively used to treat premature babies, and CHF5633, a new synthetic surfactant preparation currently under clinical trials. Both, natural and clinical surfactants spontaneously incorporated corticosteroids up to at least 10% by mass with respect to phospholipid content. The presence of the drugs did not interfere with their ability to efficiently adsorb into air-liquid interfaces and form surface active films able to reach and sustain very low surface tensions (<2 mN/m) under compression-expansion cycling mimicking breathing dynamics. Furthermore, the combination of clinical surfactant with corticosteroids efficiently promoted the active diffusion of the drug to long distances along the air-liquid interface. This effect could not be mimicked by vehiculisation of corticosteroids in liposomes or in micellar emulsions similar to the formulations currently in use to deliver anti-inflammatory corticosteroids through inhalation.
Collapse
Affiliation(s)
- Alberto Hidalgo
- Department of Biochemistry, Faculty of Biology, and Research Institute Hospital "12 de Octubre", Complutense University , Madrid 28040, Spain
| | | | - Nieves Fresno
- Department of Organic Chemistry, Faculty of Chemistry, Complutense University , Madrid 28040, Spain
| | - Guillermo Orellana
- Department of Organic Chemistry, Faculty of Chemistry, Complutense University , Madrid 28040, Spain
| | - Antonio Cruz
- Department of Biochemistry, Faculty of Biology, and Research Institute Hospital "12 de Octubre", Complutense University , Madrid 28040, Spain
| | - Jesus Perez-Gil
- Department of Biochemistry, Faculty of Biology, and Research Institute Hospital "12 de Octubre", Complutense University , Madrid 28040, Spain
| |
Collapse
|
45
|
Rey-Santano C, Mielgo VE, Murgia X, Gomez-Solaetxe MA, Salomone F, Bianco F, Pelizzi N, Loureiro B, López de Heredia Y Goya J. Cerebral and lung effects of a new generation synthetic surfactant with SP-B and SP-C analogs in preterm lambs. Pediatr Pulmonol 2017; 52:929-938. [PMID: 28221717 DOI: 10.1002/ppul.23685] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 01/13/2017] [Accepted: 02/09/2017] [Indexed: 11/09/2022]
Abstract
BACKGROUND Though natural surfactants (SF) are clinically superior to protein-free synthetic preparations, CHF-5633, a synthetic SF containing SP-B and SP-C analog peptides is a potential alternative to natural SF for treating neonatal respiratory distress syndrome (RDS). Nevertheless, information is lacking regarding the safety of this new treatment for the neonatal brain. We sought to compare the cerebral and pulmonary effects of this new synthetic surfactant (CHF5633) with those of natural porcine surfactant (Cursosurf) in premature lambs with RDS. METHODS Twenty-one preterm lambs were randomly assigned to receive CHF5633, Curosurf, or no treatment (control). Pulmonary (gas exchange, lung mechanics) and cerebral (carotid artery blood flow, cerebral oxygen metabolism) effects were measured every 30 min for 6 h. Pulmonary and cerebral histological analysis were also performed. RESULTS After delivery, lambs developed severe RDS (FIO2 :1, pH < 7.15, PaCO2 > 70 mmHg, PaO2 < 40 mmHg, Cdyn < 0.1 mL/cmH2 O/kg). By 30 min after treatment, animals in both SF-treated groups had consistently better gas exchange and lung mechanics than controls. After CHF5633 administration, PaCO2 , carotid artery blood flow, and cerebral oxygen delivery tended to slowly decrease compared to other groups. By 2 h, SF-treated groups had similar values of all parameters studied, these remaining steady for the rest of the experiment. Lambs administered CHF5633 obtained better lung and brain injury scores than controls. CONCLUSION Intratracheal administration of a bolus of CHF5633 improves pulmonary status in preterm lambs with severe RDS, obtaining better lung and brain injury scores than controls and favorable cerebral hemodynamics, comparable to those with gold standard Curosurf treatment.
Collapse
Affiliation(s)
- Carmen Rey-Santano
- Animal Research Unit, BioCruces Health Research Institute, Barakaldo, Bizkaia, Spain
| | - Victoria E Mielgo
- Animal Research Unit, BioCruces Health Research Institute, Barakaldo, Bizkaia, Spain
| | - Xabier Murgia
- Animal Research Unit, BioCruces Health Research Institute, Barakaldo, Bizkaia, Spain
| | | | | | | | | | - Begoña Loureiro
- Neonatal Intensive Care Unit, Cruces University Hospital, Barakaldo, Bizkaia, Spain
| | | |
Collapse
|
46
|
Todorov R, Exerowa D, Alexandrova L, Platikanov D, Terziyski I, Nedyalkov M, Pelizzi N, Salomone F. Behavior of thin liquid films from aqueous solutions of a pulmonary surfactant in presence of corticosteroids. Colloids Surf A Physicochem Eng Asp 2017. [DOI: 10.1016/j.colsurfa.2016.09.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
|
47
|
Todorov R, Exerowa D, Alexandrova L, Platikanov D, Nedyalkov M, Bianco F, Razzetti R, Salomone F, Pelizzi N. Thin liquid films from a new synthetic pulmonary surfactant preparation. Colloids Surf A Physicochem Eng Asp 2017. [DOI: 10.1016/j.colsurfa.2016.06.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
48
|
Ricci F, Catozzi C, Murgia X, Rosa B, Amidani D, Lorenzini L, Bianco F, Rivetti C, Catinella S, Villetti G, Civelli M, Pioselli B, Dani C, Salomone F. Physiological, Biochemical, and Biophysical Characterization of the Lung-Lavaged Spontaneously-Breathing Rabbit as a Model for Respiratory Distress Syndrome. PLoS One 2017; 12:e0169190. [PMID: 28060859 PMCID: PMC5217971 DOI: 10.1371/journal.pone.0169190] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 12/13/2016] [Indexed: 12/01/2022] Open
Abstract
Nasal continuous positive airway pressure (nCPAP) is a widely accepted technique of non-invasive respiratory support in spontaneously-breathing premature infants with respiratory distress syndrome (RDS). Surfactant administration techniques compatible with nCPAP ventilation strategy are actively investigated. Our aim is to set up and validate a respiratory distress animal model that can be managed on nCPAP suitable for surfactant administration techniques studies. Surfactant depletion was induced by bronchoalveolar lavages (BALs) on 18 adult rabbits. Full depletion was assessed by surfactant component analysis on the BALs samples. Animals were randomized into two groups: Control group (nCPAP only) and InSurE group, consisting of a bolus of surfactant (Poractant alfa, 200 mg/kg) followed by nCPAP. Arterial blood gases were monitored until animal sacrifice, 3 hours post treatment. Lung mechanics were evaluated just before and after BALs, at the time of treatment, and at the end of the procedure. Surfactant phospholipids and protein analysis as well as surface tension measurements on sequential BALs confirmed the efficacy of the surfactant depletion procedure. The InSurE group showed a significant improvement of blood oxygenation and lung mechanics. On the contrary, no signs of recovery were appreciated in animals treated with just nCPAP. The surfactant-depleted adult rabbit RDS model proved to be a valuable and efficient preclinical tool for mimicking the clinical scenario of preterm infants affected by mild/moderate RDS who spontaneously breathe and do not require mechanical ventilation. This population is of particular interest as potential target for the non-invasive administration of surfactant.
Collapse
Affiliation(s)
| | | | - Xabier Murgia
- Department of Drug Delivery, Helmholtz Institute for Pharmaceutical Research Saarland, Saarbrücken, Germany
| | - Brenda Rosa
- Chiesi Farmaceutici, R&D Department, Parma, Italy
| | - Davide Amidani
- Department of Life Sciences, University of Parma, Parma, Italy
| | | | | | - Claudio Rivetti
- Department of Life Sciences, University of Parma, Parma, Italy
| | | | | | | | | | - Carlo Dani
- Department of Neurosciences, Psychology, Drug Research and Child Health, Careggi University Hospital of Florence, Florence, Italy
| | | |
Collapse
|
49
|
Ricci F, Salomone F, Kuypers E, Ophelders D, Nikiforou M, Willems M, Krieger T, Murgia X, Hütten M, Kramer BW, Bianco F. In Vivo Evaluation of the Acute Pulmonary Response to Poractant Alfa and Bovactant Treatments in Lung-Lavaged Adult Rabbits and in Preterm Lambs with Respiratory Distress Syndrome. Front Pediatr 2017; 5:186. [PMID: 28913327 PMCID: PMC5583171 DOI: 10.3389/fped.2017.00186] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 08/15/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Poractant alfa (Curosurf®) and Bovactant (Alveofact®) are two animal-derived pulmonary surfactants preparations approved for the treatment of neonatal respiratory distress syndrome (nRDS). They differ in their source, composition, pharmaceutical form, and clinical dose. How much these differences affect the acute pulmonary response to treatment is unknown. OBJECTIVES Comparing these two surfactant preparations in two different animal models of respiratory distress focusing on the short-term response to treatment. METHODS Poractant alfa and Bovactant were administered in a 50-200 mg/kg dose range to surfactant-depleted adult rabbits with acute respiratory distress syndrome induced by lavage and to preterm lambs (127-129 days gestational age) with nRDS induced by developmental immaturity. The acute impact of surfactant therapy on gas exchange and pulmonary mechanics was assessed for 1 h in surfactant-depleted rabbits and for 3 h in preterm lambs. RESULTS Overall, treatment with Bovactant 50 mg/kg or Poractant alfa 50 mg/kg did not achieve full recovery of the rabbits' respiratory conditions, as indicated by significantly lower arterial oxygenation and carbon dioxide values. By contrast, the two approved doses for clinical use of Poractant alfa (100 and 200 mg/kg) achieved a rapid and sustained recovery in both animal models. The comparison of the ventilation indices of the licensed doses of Bovactant (50 mg/kg) and Poractant alfa (100 mg/kg) showed a superior performance of the latter preparation in both animal models. At equal phospholipid doses, Poractant alfa was superior to Bovactant in terms of arterial oxygenation in both animal models. In preterm lambs, surfactant replacement therapy with Poractant alfa at either 100 or 200 mg/kg was associated with significantly higher lung gas volumes compared to Bovactant treatment with 100 mg/kg. CONCLUSION At the licensed doses, the acute pulmonary response to Poractant alfa was significantly better than the one observed after Bovactant treatment, either at 50 or at 100 mg/kg dose, in two animal models of pulmonary failure.
Collapse
Affiliation(s)
- Francesca Ricci
- Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici S.p.A., Parma, Italy
| | - Fabrizio Salomone
- Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici S.p.A., Parma, Italy
| | - Elke Kuypers
- Department of Paediatrics, Maastricht University Medical Center, Maastricht, Netherlands
| | - Daan Ophelders
- Department of Paediatrics, Maastricht University Medical Center, Maastricht, Netherlands
| | - Maria Nikiforou
- Department of Paediatrics, Maastricht University Medical Center, Maastricht, Netherlands
| | - Monique Willems
- Department of Paediatrics, Maastricht University Medical Center, Maastricht, Netherlands
| | - Tobias Krieger
- Department of Paediatrics, Maastricht University Medical Center, Maastricht, Netherlands
| | - Xabier Murgia
- Department of Drug Delivery, Helmholtz Institute for Pharmaceutical Research Saarland, Saarbrücken, Germany
| | - Matthias Hütten
- Department of Paediatrics, Maastricht University Medical Center, Maastricht, Netherlands
| | - Boris W Kramer
- Department of Paediatrics, Maastricht University Medical Center, Maastricht, Netherlands
| | - Federico Bianco
- Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici S.p.A., Parma, Italy
| |
Collapse
|
50
|
Salomone F, Breton M, Leray I, Cardarelli F, Boccardi C, Bonhenry D, Tarek M, Mir LM, Beltram F. High-Yield Nontoxic Gene Transfer through Conjugation of the CM18-Tat11 Chimeric Peptide with Nanosecond Electric Pulses. Mol Pharm 2014; 11:2466-74. [DOI: 10.1021/mp500223t] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Fabrizio Salomone
- NEST, Scuola Normale Superiore and Istituto Nanoscienze-CNR, Piazza San Silvestro 12, 56127 Pisa, Italy
- Center
for Nanotechnology Innovation
@NEST, Istituto Italiano di Tecnologia, Piazza San Silvestro 12, 56127 Pisa, Italy
| | - Marie Breton
- CNRS, Laboratoire de Vectorologie et Thérapeutiques
Anticancéreuses,
UMR 8203, Orsay F-91405, France
| | - Isabelle Leray
- CNRS, Laboratoire de Vectorologie et Thérapeutiques
Anticancéreuses,
UMR 8203, Orsay F-91405, France
- Université Paris-Sud, Laboratoire de Vectorologie et
Thérapeutiques
Anticancéreuses, UMR 8203, Orsay F-91405, France
- Institute Gustave-Roussy, Laboratoire de
Vectorologie et Thérapeutiques
Anticancéreuses, UMR 8203, Villejuif F-94805, France
| | - Francesco Cardarelli
- Center
for Nanotechnology Innovation
@NEST, Istituto Italiano di Tecnologia, Piazza San Silvestro 12, 56127 Pisa, Italy
| | - Claudia Boccardi
- Center
for Nanotechnology Innovation
@NEST, Istituto Italiano di Tecnologia, Piazza San Silvestro 12, 56127 Pisa, Italy
| | - Daniel Bonhenry
- Université de Lorraine, UMR 7565, Structure et Réactivité
des
Systèmes Moléculaires Complexes, CNRS, Nancy F-54003, France
| | - Mounir Tarek
- Université de Lorraine, UMR 7565, Structure et Réactivité
des
Systèmes Moléculaires Complexes, CNRS, Nancy F-54003, France
| | - Lluis M. Mir
- CNRS, Laboratoire de Vectorologie et Thérapeutiques
Anticancéreuses,
UMR 8203, Orsay F-91405, France
- Université Paris-Sud, Laboratoire de Vectorologie et
Thérapeutiques
Anticancéreuses, UMR 8203, Orsay F-91405, France
- Institute Gustave-Roussy, Laboratoire de
Vectorologie et Thérapeutiques
Anticancéreuses, UMR 8203, Villejuif F-94805, France
| | - Fabio Beltram
- NEST, Scuola Normale Superiore and Istituto Nanoscienze-CNR, Piazza San Silvestro 12, 56127 Pisa, Italy
- Center
for Nanotechnology Innovation
@NEST, Istituto Italiano di Tecnologia, Piazza San Silvestro 12, 56127 Pisa, Italy
| |
Collapse
|