Surfactant-derived proteins as markers of alveolar membrane damage in heart failure

PLoS One. 2014 Dec 16;9(12):e115030. doi: 10.1371/journal.pone.0115030. eCollection 2014.

Abstract

Background: In heart failure (HF) alveolar-capillary membrane is abnormal. Surfactant-derived proteins (SPs) and plasma receptor for advanced-glycation-end-products (RAGE) have been proposed as lung damage markers.

Methods: Eighty-nine chronic HF and 17 healthy subjects were evaluated by echocardiography, blood parameters, carbon monoxide lung diffusion (DLCO) and cardiopulmonary exercise test. We measured immature SP-B, mature SP-B, SP-A, SP-D and RAGE plasma levels.

Results: Immature SP-B (arbitrary units), mature SP-A (ng/ml) and SP-D (ng/ml), but not mature SP-B (ng/ml) and RAGE (pg/ml) levels, were higher in HF than in controls [immature SP-B: 15.6 (13.1, 75th-25th interquartile range) Vs. 11.1 (6.4), p<0.01; SP-A, 29.6 (20.1) Vs. 18.3 (13.5), p = 0.01; SP-D: 125 (90) Vs. 78 (58), p<0.01]. Immature SP-B, SP-A, SP-D and RAGE values were related to DLCO, peak oxygen consumption, ventilatory efficiency, and brain natriuretic peptide (BNP), whereas plasma mature SP-B was not. The DLCO Vs. immature SP-B correlation was the strongest one. At multivariate analysis, RAGE was associated to age and creatinine, SP-A to DLCO and BNP, SP-D to BNP, mature SP-B to DLCO and creatinine, and immature SP-B only but strongly to DLCO.

Conclusions: Immature SP-B is the most reliable biological marker of alveolar-capillary membrane function in HF.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Biomarkers / blood*
  • Carbon Monoxide / metabolism
  • Exercise Test*
  • Female
  • Heart Failure / pathology*
  • Humans
  • Male
  • Middle Aged
  • Mucous Membrane / blood supply*
  • Mucous Membrane / pathology
  • Natriuretic Peptide, Brain / blood
  • Oxygen Consumption
  • Pulmonary Alveoli / blood supply*
  • Pulmonary Alveoli / pathology
  • Pulmonary Surfactant-Associated Protein A / blood
  • Pulmonary Surfactant-Associated Protein B / blood
  • Pulmonary Surfactant-Associated Protein D / blood
  • Receptor for Advanced Glycation End Products / blood
  • Respiratory Function Tests

Substances

  • AGER protein, human
  • Biomarkers
  • Pulmonary Surfactant-Associated Protein A
  • Pulmonary Surfactant-Associated Protein B
  • Pulmonary Surfactant-Associated Protein D
  • Receptor for Advanced Glycation End Products
  • Natriuretic Peptide, Brain
  • Carbon Monoxide

Grants and funding

This study was carried out with the support of a grant from the Italian Ministry of health, Roma, Italy (Current research project 2013, BIO 12, ID 2600721). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.