RDS Therapies

Over the last decade there has been an impressive surge of scientific interest in the pathophysiology, diagnosis and treatment of RDS. While the use of surfactant replacement therapy in the newborn has reduced mortality in the premature infant by an impressive 30%, the treatment and prevention of RDS is a continuous challenge.

There are two main types of therapeutic surfactants preparations: those obtained from natural sources and those of an entirely synthetic composition. Although all the preparations contain phospholipids , not all contain hydrophobic peptides or proteins and there are important structural and functional differences.

Preparation and administration

Composition

Natural surfactant preparations

Curosurf® (poractant alfa) by Chiesi Farmaceutici S.p.A.
It is obtained from porcine lungs and contains phospholipids (DPPC, PC, PG, PI) isolated from the native surface-active surfactant fraction (large aggregates) plus the two hydrophobic surfactant-associated proteins (SP-B, SP-C) and a number of neutral lipids such as cholesterol. No exogenous substances are added, as Curosurf doesn’t require synthetic additives for optimal function.

Alveofact® (SF-RI1) by Boehringer Ingelheim Inc.
Phospholipids are extracted from bovine lungs.
Composition: 4% cholesterol 88% phospholipids 8% other lipids suspended in 45 mg/ml 1% Sp-B, Sp-C

Infasurf® (calfactant) by Forest Laboratories, Inc.
It is an extract of natural surfactant from calf lungs which includes phospholipids, neutral lipids, and hydrophobic surfactant-associated proteins B and C (SP-B and SP-C). It contains no preservatives.
Infasurf is an off-white suspension of calfactant in 0.9% aqueous sodium chloride solution

Natural and synthetic surfactant preparations

Survanta® (beractant) by Ross Products Division, Abbott Laboratories Inc.
It is obtained from bovine lungs. The final concentration of active principles is increased by the addition of synthetic lipids: colfosceril palmitato (DPPC, hexadecanol and tyloxapol, tripalmitin and palmitic acid.
Composition: Phospholipids 25mg/ml; Triglycerides 0.5 - 1.75 mg/ml; Free fatty acids 1.4- 3.5 mg/ml; Protein 0.1 - 1.0 mg/ml

Synthetic surfactant preparations

Exosurf neonatal® (Colfosceril Palmitate ) by GlaxoSmithKline UK
Exosurf neonatal (colfosceril palmitate, cetyl alcohol, tyloxapol) is a protein-free synthetic lung surfactant. Each 10-mL vial contains 108 mg colfosceril palmitate (1,2-Dipalmitoyl-sn-glycero(3)phosphocholine), 12 mg cetyl alcohol, 8 mg tyloxapol, and 47 mg sodium chloride. Sodium hydroxide or hydrochloric acid may have been added to adjust pH.

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