Oral Administration of Surfactant Protein‐A Reduces Pathology in an Experimental Model of Necrotizing Enterocolitis

Objectives: Necrotizing enterocolitis (NEC) frequently results in significant morbidity and mortality in premature infants. Others reported that mice deficient in pulmonary surfactant protein‐A (SP‐A) born and raised in a nonhygienic environment succumb to significant gastrointestinal tract pathology, and enteral administration of purified SP‐A significantly reduced mortality. We hypothesized that oral administration of purified SP‐A can ameliorate pathology in an experimental model of neonatal NEC. Methods: Experimental NEC was induced in newborn Sprague–Dawley rat pups by daily formula gavage and intermittent exposure to hypoxia. Purified human SP‐A (5 μg/day) was administered by oral gavage. After 4 days, surviving pups were sacrificed, and intestinal pathology was assessed by histological examination of distal terminal ileal sections. Intestinal levels of inflammatory cytokines (IL‐1β, IFN‐γ, and TNF‐α) were assessed by enzyme‐linked immunosorbent assay and levels of Toll‐like receptor 4 (TLR4) by Western analysis. Results: Sixty‐one percent of the gavaged rat pups that survived to day 4 met the criteria for experimental NEC after hypoxia, whereas treatment with SP‐A significantly reduced mortality and assessment of NEC. Intestinal levels of proinflammatory cytokines were significantly increased in pups exposed to hypoxia. Administration of SP‐A to pups exposed to hypoxia significantly reduced IL‐1β and TNF‐α levels, but had little effect on elevated levels of IFN‐γ. SP‐A treatment of hypoxia‐exposed pups significantly reduced expression of intestinal TLR4, key in NEC pathogenesis. Conclusions: In a rat model of experimental neonatal NEC, oral administration of SP‐A reduces intestinal levels of proinflammatory cytokines and TLR4 protein and ameliorates adverse outcomes associated with gastrointestinal pathologies.