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Journal of Lipid Research, Vol. 50, 2324-2331, November 2009
Copyright © 2009 by American Society for Biochemistry and Molecular Biology

Patient-Oriented and Epidemiological Research

Metabolic precursors of surfactant disaturated-phosphatidylcholine in preterms with respiratory distress

Paola E. Cogo^1,*, Carlo Ori, Manuela Simonato^*, Giovanna Verlato^*, Ilena Isak^*, Aaron Hamvas and Virgilio P. Carnielli^**

^* Department of Pediatrics, University of Padova, Padova, Italy
Department of Pharmacology and Anaesthesia, University of Padova, Padova, Italy
Division of Newborn Medicine, Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine, St. Louis, MO
^** Division of Neonatology, Institute of Maternal and Infant Sciences, Polytechnic University of Marche, Ancona, Italy

¹ To whom correspondence should be addressed. e-mail: cogo{at}pediatria.unipd.it

Our objective was to study the metabolic precursors of surfactant disaturated-phosphatidylcholine (DSPC) in preterm infants with respiratory distress syndrome (RDS) on mechanical ventilation. We performed 46 DSPC kinetic studies in 23 preterms on fat-free parenteral nutrition and mechanical ventilation (birth weight = 1167 ± 451 g, gestational age = 28.5 ± 2.0 weeks). Eight infants received a simultaneous intravenous infusion of U¹³C-glucose and [16,16,16]²H-palmitate, eight infants received U¹³C-glucose and ²H₂O, and seven received U¹³C-palmitate and ²H₂O. Surfactant DSPC kinetics were calculated from the isotopic enrichments of DSPC-palmitate from sequential tracheal aspirates and its metabolic precursors in plasma or urine. DSPC fractional synthesis rate (FSR) was 17 ± 11, 21 ± 16, and 15 ± 6%/day from glucose, palmitate, and body water, respectively (P = 0.36). DSPC-FSR from U¹³C-glucose and ²H₂O were significantly correlated and yielded similar estimates (difference of –0.1 ± 3%) (P = 0.91). The difference in the 15 infants receiving palmitate versus ²H₂O or palmitate versus glucose was +6.0 ± 12%/day (P = 0.21). There was a significant correlation between DSPC-FSRs from plasma glucose and plasma FFA. The contribution of glucose versus palmitate to DSPC-FSR was 49 ± 20% versus 51 ± 20%, respectively. Plasma glucose and FFA showed similar contributions to DSPC-FSR in infants with RDS and fat-free parenteral nutrition. FSRs from ²H₂O or glucose were highly correlated.

Supplementary key words pulmonary surfactant • isotopes • isotope labeling • lecithins • disaturated • metabolic pathways

Abbreviations: DPPC, dipalmitoyl-phosphatidylcholine; DSPC, disaturated-phosphatidylcholine; FSR, fractional synthesis rate; GC-IRMS, gas-chromatography-combustion interface-isotope ratio mass spectrometry; i.v., intravenous; MPE, mol% excess; RDS, respiratory distress syndrome

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