First breaths – technology developed at the Technion will help premature babies undergo the soul process

About one tenth of the babies in the world are born prematurely, before their body systems have developed properly. One of these systems is the respiratory system, which reaches full maturity at the age of two and is essential for the survival of the baby. When the fetus is in the womb it receives oxygen from its mother through the umbilical cord, but after birth it must breathe on its own. Therefore preterm infants are often characterized by respiratory distress and need support to breathe. Moreover, the earlier the preterm infant is born the more severe the respiratory distress and the longer the respiration period is expected. Sometimes, respiration is done through a respirator that injects air into the lungs through a tube inserted into the trachea.

Despite the continuous improvement in soul technologies and treatment of preterm infants, the morbidity rates among them are still higher than desired. One of the problems stems from the fact that essential treatments for prematurity, including artificial respiration, do prevent death but create damage and side effects that can affect the patient in the long run. These effects and sources of damage to the artificial soul are not yet fully understood. This is the background to the research conducted in the laboratory of Prof. Joshua Schnittman from the Faculty of Biomedical Engineering at the Technion .

In a previous study, published in Past in Journal of the Royal Society Interface , discovered Prof. Joshua Schnittman And Dr. Eliram Nof is a phenomenon that is not mentioned at all in the medical literature: Lung damage as a result of air jet exiting the tube inserted into the trachea of ​​the preterm infant during artificial respiration. These forces can cause damage that endangers the patient, and all the more so when it comes to prematurity.

In the follow-up study, now published in the journal Bioengineering & Translational Medicine
, the researchers tested the hypothesis in a new model containing artificial human epithelium, led by Prof. Schnittman , Dr. Eliram Nof and Dr. Arbel Artzi-Schnirman. Pediatricians and ENTs are also involved in the study, including Dr. Liron Bornstein, a faculty member at the Rapaport Faculty of Medicine at the Technion and a senior physician in the Department of Tip. The newborn and preterm infants in the Rambam Medical Campus.

The study was conducted using a three-dimensional model of the upper airways – the trachea and the bronchi that branch off from it. Within this model, the researchers grew a layer of epithelial cells – the cells that also cover the natural respiratory system – to track the effect of respiration on them. “Today we already know that artificial respiration, which is a life-saving technology, causes various damages to the respiratory system,” explains Prof. Schnittman. “These damages have so far been attributed to mechanical factors such as the entry of air under pressure that causes the lung tissue to stretch. In recent years, insights into more complex sources of damage have been added. A process underlying lung damage in respiratory preterm infants resulting from airflow and shear forces during respiration. “

In a previous study, Technion researchers found, as mentioned, that air jet exerts strong shear forces on epithelial tissue; They have now discovered that the jet causes a change in the balance of cytokines – proteins that form the basis for communication between immune cells. In other words, beyond the mechanical damage – epithelial erosion – the invasive respiration also triggers an immune response and this can lead to harmful and even life-threatening inflammatory developments.

Following these findings, the researchers examined the possibility of reducing the damage. This is done through medication, and with the help of their colleagues, the doctors chose a common drug called Montelukast, which is used to treat asthma patients. Indeed, in the three-dimensional model, they found that pretreatment with montlocast moderates epithelial cell mortality and the immune response during respiration.

Prof. Schnittman estimates that the use of models of the type developed in his laboratory may improve in-vitro pre-clinical trials. “If preclinical research in laboratories is more efficient and accurate, we can reach the next stage – preclinical animal experiments – when we are much more focused. That way we can not only accelerate research but also reduce harm to experimental animals.”

As mentioned, this is the first study that demonstrates in a model developed in the laboratory the effect of an artificial respiration air jet on the immune system. This study offers a new tool for examining clinical trials in search of a solution that may eliminate or at least mitigate inflammatory damage. Prof. Schnittman estimates that these findings may be useful, in addition to treating preterm infants, also in other contexts such as the treatment of patients with other lung diseases that require artificial respiration, such as COPD and Corona.

The study is supported by the European Commission Research (ERC).

Prof. Joshua Schnittman is a faculty member in the Faculty of Biomedical Engineering, and heads the Bio Lab -Flowing. The laboratory is engaged in the study of the aerodynamics of drugs and particles in the respiratory system. Prof. Schnittman has developed a model of “acinus-on-chip” that allows for the assessment of various health risks and the design of drugs for the respiratory system. Dr. Eliram Nof Appointed a researcher at the Memorial Sloan Kettering Cancer Center in New York a few months ago. Dr. Arbel Artzi – Snirman Recently moderated as head of the Center for Advanced Technologies for Medical Application at Rambam Medical Campus, Haifa.

Article in the journal Bioengineering & Translational Medicine
click here

to a video explaining the study click here

In the video: The simulation of a jet The air inside Respiratory conditions in different respiratory states Imaging is based on PIV – an experimental method for measuring flow fields