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We evaluated the effect of surfactant therapy in combination with antibiotic polymyxin B (PxB) in double-hit model of neonatal lung injury. Surfactant (poractant alfa, Curosurf) was exposed to smooth (S) LPS without\/with PxB and tested in captive bubble surfactometer. Preterm rabbits received intratracheally saline (control) or S-LPS and were ventilated with 100% oxygen. After 30\u00a0min, LPS-treated animals received no treatment, or surfactant (200\u00a0mg\/kg) without\/with 3% PxB; controls received the same dose of surfactant. Animals were ventilated for further 2\u00a0h. In vitro, addition of 5% S-LPS to surfactant increased minimum surface tension (\u03b3min) and addition of\u00a01\u20133% PxB to surfactant\/S-LPS mixture restored \u03b3min to low values. Animals only given S-LPS had lower lung compliance and lung gas volume (LGV) compared to surfactant groups. Treatment with surfactant\/PxB, but not with surfactant only, restored LGV. Addition of PxB to the surfactant increased the alveolar expansion. S-LPS interferes with surface activity of the pulmonary surfactant and PxB improves the resistance of surfactant to LPS-induced inactivation. In our neonatal model of respiratory distress syndrome surfactant gives positive response even in simultaneous exposure to S-LPS, when enriched with PxB.<\/jats:p>","DOI":"10.1038\/s41598-020-79679-z","type":"journal-article","created":{"date-parts":[[2021,1,8]],"date-time":"2021-01-08T11:13:01Z","timestamp":1610104381000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Restoration of surfactant activity by polymyxin B in lipopolysaccharide-potentiated injury of immature rabbit lungs"],"prefix":"10.1038","volume":"11","author":[{"given":"Andrea","family":"Calkovska","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marie","family":"Haegerstrand-Bj\u00f6rkman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tore","family":"Curstedt","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,1,8]]},"reference":[{"key":"79679_CR1","doi-asserted-by":"publisher","first-page":"1451","DOI":"10.1016\/j.bbalip.2016.10.006","volume":"1862","author":"P Sperandeo","year":"2017","unstructured":"Sperandeo, P., Martorana, A. 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