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Altered molecular specificity of surfactant phosphatidycholine synthesis in patients with acute respiratory distress syndrome

Altered molecular specificity of surfactant phosphatidycholine synthesis in patients with acute respiratory distress syndrome
Altered molecular specificity of surfactant phosphatidycholine synthesis in patients with acute respiratory distress syndrome
BackgroundAcute respiratory distress syndrome (ARDS) is a life-threatening critical illness, characterised by qualitative and quantitative surfactant compositional changes associated with premature airway collapse, gas-exchange abnormalities and acute hypoxic respiratory failure. The underlying mechanisms for this dysregulation in surfactant metabolisms are not fully explored. Lack of therapeutic benefits from clinical trials, highlight the importance of detailed in-vivo analysis and characterisation of ARDS patients according to patterns of surfactant synthesis and metabolism.MethodsTen patients with moderate to severe ARDS were recruited. Most (90%) suffered from pneumonia. They had an infusion of methyl-D9-choline chloride and small volume bronchoalveolar lavage fluid (BALF) was obtained at 0,6,12,24,48,72 and 96 hours. Controls were healthy volunteers, who had BALF at 24 and 48 hours after methyl-D9-choline infusion. Compositional analysis and enrichment patterns of stable isotope labelling of surfactant phosphatidylcholine (PC) was determined by electrospray ionisation mass spectrometry.ResultsBALF of patients with ARDS consisted of diminished total PC and fractional PC16:0/16:0 concentrations compared to healthy controls. Compositional analysis revealed, reductions in fractional compositions of saturated PC species with elevated levels of longer acyl chain unsaturated PC species. Molecular specificity of newly synthesised PC fraction showed time course variation, with lower PC16:0/16:0 composition at earlier time points, but achieved near equilibrium with endogenous composition at 48 hours after methyl-D9-choline infusion. The enrichment of methyl-D9-choline into surfactant total PC is nearly doubled in patients, with considerable variation between individuals.ConclusionsThis study demonstrate significant alterations in composition and kinetics of surfactant PC extracted from ARDS patients. This novel approach may facilitate biochemical phenotyping of ARDS patients according to surfactant synthesis and metabolism, enabling individualised treatment approaches for the management of ARDS patients in the future.
acute respiratory distress syndrome, acute lung injury, surfactant, phosphatidylcholine, deuterated choline, stable isotopes, isotope labelling, mass spectrometry
1465-9921
1-11
Dushianthan, Ahilanandan
013692a2-cf26-4278-80bd-9d8fcdb17751
Goss, Victoria
ef02be5d-9318-4f7d-b076-3153555980d0
Cusack, Rebecca
dfb1595f-2792-4f76-ac6d-da027cf40146
Grocott, Michael P.W.
1e87b741-513e-4a22-be13-0f7bb344e8c2
Postle, Anthony D.
0fa17988-b4a0-4cdc-819a-9ae15c5dad66
Dushianthan, Ahilanandan
013692a2-cf26-4278-80bd-9d8fcdb17751
Goss, Victoria
ef02be5d-9318-4f7d-b076-3153555980d0
Cusack, Rebecca
dfb1595f-2792-4f76-ac6d-da027cf40146
Grocott, Michael P.W.
1e87b741-513e-4a22-be13-0f7bb344e8c2
Postle, Anthony D.
0fa17988-b4a0-4cdc-819a-9ae15c5dad66

Dushianthan, Ahilanandan, Goss, Victoria, Cusack, Rebecca, Grocott, Michael P.W. and Postle, Anthony D. (2014) Altered molecular specificity of surfactant phosphatidycholine synthesis in patients with acute respiratory distress syndrome. Respiratory Research, 15 (1), 1-11. (doi:10.1186/s12931-014-0128-8). (PMID:25378080)

Record type: Article

Abstract

BackgroundAcute respiratory distress syndrome (ARDS) is a life-threatening critical illness, characterised by qualitative and quantitative surfactant compositional changes associated with premature airway collapse, gas-exchange abnormalities and acute hypoxic respiratory failure. The underlying mechanisms for this dysregulation in surfactant metabolisms are not fully explored. Lack of therapeutic benefits from clinical trials, highlight the importance of detailed in-vivo analysis and characterisation of ARDS patients according to patterns of surfactant synthesis and metabolism.MethodsTen patients with moderate to severe ARDS were recruited. Most (90%) suffered from pneumonia. They had an infusion of methyl-D9-choline chloride and small volume bronchoalveolar lavage fluid (BALF) was obtained at 0,6,12,24,48,72 and 96 hours. Controls were healthy volunteers, who had BALF at 24 and 48 hours after methyl-D9-choline infusion. Compositional analysis and enrichment patterns of stable isotope labelling of surfactant phosphatidylcholine (PC) was determined by electrospray ionisation mass spectrometry.ResultsBALF of patients with ARDS consisted of diminished total PC and fractional PC16:0/16:0 concentrations compared to healthy controls. Compositional analysis revealed, reductions in fractional compositions of saturated PC species with elevated levels of longer acyl chain unsaturated PC species. Molecular specificity of newly synthesised PC fraction showed time course variation, with lower PC16:0/16:0 composition at earlier time points, but achieved near equilibrium with endogenous composition at 48 hours after methyl-D9-choline infusion. The enrichment of methyl-D9-choline into surfactant total PC is nearly doubled in patients, with considerable variation between individuals.ConclusionsThis study demonstrate significant alterations in composition and kinetics of surfactant PC extracted from ARDS patients. This novel approach may facilitate biochemical phenotyping of ARDS patients according to surfactant synthesis and metabolism, enabling individualised treatment approaches for the management of ARDS patients in the future.

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Published date: 7 November 2014
Keywords: acute respiratory distress syndrome, acute lung injury, surfactant, phosphatidylcholine, deuterated choline, stable isotopes, isotope labelling, mass spectrometry

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Local EPrints ID: 372853
URI: http://eprints.soton.ac.uk/id/eprint/372853
ISSN: 1465-9921
PURE UUID: 737de41f-1760-4e08-8b39-ffb32a66ee25
ORCID for Ahilanandan Dushianthan: ORCID iD orcid.org/0000-0002-0165-3359
ORCID for Michael P.W. Grocott: ORCID iD orcid.org/0000-0002-9484-7581
ORCID for Anthony D. Postle: ORCID iD orcid.org/0000-0001-7361-0756

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Date deposited: 23 Dec 2014 14:39
Last modified: 15 Mar 2024 04:02

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Author: Ahilanandan Dushianthan ORCID iD
Author: Victoria Goss
Author: Rebecca Cusack

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