Untapped therapeutic potential of surfactant proteins: is there a case for recombinant SP-D supplementation in neonatal lung disease?

Whilst pulmonary surfactant therapy has been highly successful in reducing mortality from respiratory distress syndrome of the newborn, a significant proportion of infants born at less than 28 weeks' gestation develop neonatal chronic lung disease. This has a complex pathogenesis but infection, inflammation, oxygen toxicity and ventilator-induced lung injury in the premature infant are all recognised risk factors for its development. Current surfactant therapies in clinical use do not contain all surfactant components and lack the hydrophilic surfactant proteins A and D. These proteins are known to have important roles in surfactant homeostasis and in protecting the lung against inflammation. This review examines the evidence from animal models supporting a role for surfactant protein-D in particular in reducing inflammation in the lung and speculates that supplementation of current surfactant therapies with recombinant forms of surfactant protein-D may help offset the risk of development of chronic lung disease