Poractant alfa

Poractant alfa, sold under the brand name Curosurf among others, is a medication used to treat and prevent respiratory distress syndrome (RDS) in premature babies.^[1][2] It decreases the risk of death and pneumothoraces.^[2] It is given into the trachea.^[1]

Common side effects include slow heart rate, low blood pressure, and low oxygen.^[1] Other side effects may include blockage of the endotracheal tube.^[1] It is composed of pulmonary surfactant which is made up of phospholipids and surfactant proteins.^[1]

was approved for medical use in the United States in 1999.^[1] In the United States it costs about 1,000 USD for 3 mL as of 2021.^[3] It is made from pig lungs.^[1]

Medical uses

Side effects

Transient episodes of bradycardia, decreased oxygen saturation, hypotension, or endotracheal tube blockage may occur.

Pharmacology

Each milliliter of poractant alfa contains 80 mg of surfactant (extract) that includes 76 mg of phospholipids and 1 mg of protein of which 0.2 mg is surfactant protein B (SP-B). Depending on local country registration, CUROSURF is available in 1.5mL vials, 3.0mL vials, and/or twin packs containing two 1.5mL vials.

The amount of phospholipids is calculated from the content of phosphorus and contains 55 mg of phosphotidylcholine of which 30 mg is dipalmitoylphosphatidylcholine.

Mechanism of action

Endogenous pulmonary surfactant reduces surface tension at the air-liquid interface of the alveoli during mechanical ventilation and stabilizes the alveoli against collapse at resting transpulmonary pressures.^[4]

A deficiency of pulmonary surfactant in preterm infants results in respiratory distress syndrome. Poractant alfa compensates for the surfactant deficiency and restores surface activity to the lung tissue.

History

Surfactant deficiency was identified as the cause of respiratory distress syndrome (RDS) as long ago as 1959. Trials of surfactant replacement in the 1960s were unsuccessful because the preparations used contained only phospholipids and they were administered inefficiently by nebulization. In the 1970s Bengt Robertson and Göran Enhörning showed that natural surfactant, containing both phospholipids and proteins, could ameliorate the signs of RDS in immature rabbits. In the 1980s Bengt Robertson and Tore Curstedt developed a porcine surfactant, Curosurf (named after their surnames), which was effective in immature animals and was used in a pilot clinical trial beginning in 1983. Subsequent randomized clinical trials were planned a year later by Bengt Robertson, Tore Curstedt and Henry Halliday, and the first trial was begun in 1985. This showed that Curosurf reduced pulmonary air leaks and neonatal mortality in preterm infants with severe RDS. A second trial, coordinated by Christian P. Speer, demonstrated that multiple doses of Curosurf were more effective than a single dose. Subsequent trials conducted by the Collaborative European Multicenter Study Group, which included among others Guilio Bevilacqua, Janna Koppe, Ola Saugstad, Nils Svenningsen and Jean-Pierre Relier, showed that early treatment was more effective than later administration and that infants treated at birth had similar neurodevelopmental status to untreated controls at a corrected age of 2 years. Members of the Collaborative European Multicenter Study Group in Denmark and Sweden performed studies to demonstrate the benefits of a combination of surfactant treatment and early continuous positive airway pressure.^[5]

Society and culture

Other forms of surfactant include SLS (Sheep Lung Surfactant) developed in PersisGen Co.

References

External links