Breath of life
Fred Possmayer, PhD’65, nurtures the science of possibilities
By Debora Van Brenk, BA'86, MA'87
Breathe in. Feel those lungs expand in your chest. Consider how remarkable it is your lungs reflexively continue that task – 15 or so breaths a minute, 20,000 a day.
The unheralded hero of that story is a naturally occurring, micro-thin film that lines the tiny air sacs in your lungs and keeps them from collapsing when you exhale. Without this pulmonary surfactant – a slippery combination of proteins and fats that work together to reduce the surface tension of the fluid in the lungs – breathing would exhaust you. You’d be unable to take a deep breath, to draw in life-giving oxygen or to expel its waste product, carbon dioxide.
Mere breathing would be as difficult as trying to inflate a dollar-store balloon.
That’s the life-threatening condition faced by many premature babies, whose little bodies haven’t yet produced enough surfactant for their tiny lungs and who often suffer from life-threatening Infant Respiratory Distress Syndrome (RDS).
Enter Fred Possmayer, an RDS pioneer finding solutions that, since the late 1980s, have saved thousands of lives around the world.
Possmayer, PhD’65 (Biochemistry), conducted all of his surfactant research at Western during a five-decade career that included hundreds of published research papers and scores of invited lectures. His laboratory’s work to sterilize and purify bovine lung surfactant was named among the Top 50 most significant Ontario research discoveries of the century.
Underweight and premature, Possmayer went into respiratory distress soon after birth in 1939. There were no ventilators; no one knew pulmonary surfactant existed, much less that preemies struggling to breathe were lacking in it.
“What they knew was keeping the babies warm and maybe jiggling them once in a while to get them breathing again,” Possmayer said.
It was only in 1954 that scientists Richard Pattle and John Clements first demonstrated lung surfactant (whose existence Swiss scientist Kurt von Neergard had hypothesized in the late 1920s in a paper that was widely ignored for almost three decades). In 1959, American paediatrician Dr. Mary Ellen Avery linked RDS in pre-term babies to a deficiency of surfactant.
In 1963, this syndrome became part of the world’s lexicon when it claimed the life of baby Patrick Bouvier Kennedy, premature infant son of the U.S. President and First Lady.
But that research was far in the future for Possmayer, whose father came to Canada from Romania with a Grade 3 education, an analytical mind and the hope of building a better life for his family.
The young Possmayer excelled in the sciences and earned his PhD in biochemistry from Western in 1965. This was specialized basic science. “I had to be very independent at the time,” he recalled.
After graduation, he pursued postdoctoral training at the University of Cologne and the University of Utrecht. At the University of California, he specialized in plant biochemistry.
In 1971, he returned to Canada, where Western researchers Earl Plunkett and Kenneth P. Strickland, who was Possmayer’s PhD supervisor, hired him to examine the role of fetal insulin on brain development. He was quickly diverted to another problem: developing an amniotic fluid test to determine the maturity of fetal lungs.
That was the genesis of his research into lung surfactants.
He began working with Goran Enhorning in Toronto, and they demonstrated in tests that surfactant helped premature rabbits breathe and survive. But it was a long stretch to translate the success with bunnies to babies. What was needed was a reliable, abundant source of pulmonary surfactant – and a method of extracting, purifying and sterilizing it so it could be administered safely to premature babies.
A small abattoir west of London, Ont., helped solve that issue by providing the lab with lungs for $5 per cow.
“They were interested in helping us for the sake of helping us,” Possmayer said, crediting Western-based research associate Shou-Hwa Yu with developing a method for mass processing the precious surfactant. An organic solvent extraction procedure proved key to eliminating microorganisms and protein contaminants
while also maintaining surfactant efficacy.
They called it Bovine Lipid Extract Surfactant (BLES).
With the assistance of Dr. Graham Chance, Director of the Neonatal Intensive Care Unit, St. Joseph’s Health Care London, they began their attempts to treat premature newborns.
“You need to treat them before the lungs are damaged. You’re buying them time until they can produce their own surfactant,” Possmayer said.
It worked. Testing showed the surfactant needed to be given early, immediately at the first sign of RDS.
“If you give BLES, there’s an improvement in breathing within 10 minutes and usually by 12 hours, surfactant function is normal.”
Possmayer and Enhorning’s 1985 paper – the world’s first randomized, controlled clinical trial – demonstrated surfactant therapy saved premature babies’ lives. This proved a turning point in premature newborn care around the world.
The lab expanded to meet the newfound demand and included virtually every neonatal unit in Canada. “Other hospitals – Ottawa, Alberta, Manitoba, British Columbia, all over Canada – started using this stuff.” Morbidity and mortality rates among premature babies dropped.
Once Health and Welfare Canada approved BLES as a drug therapy, other countries signed on and BLES is now used in 20 countries. About 99 per cent of Canada’s neonatal intensive care units use BLES.
Now the process continues, as it is being investigated for use in adults suffering from acute lung injury. BLES Biochemicals, although no longer owned by Possmayer, continues to process and supply surfactant to hospitals around the world.
Possmayer, now retired but still active in the Western community, is quick to deflect praise to others, including the support of his wife Mary; and to Enhorning, Yu, Chance (now Paediatrics Professor Emeritus), Dr. Paul Harding, Obstetrics and Gynaecology Professor Emeritus and Dr. Victor Han, Western Paediatrics Professor and Canada Research Chair.
In 2009, the Canadian Medical Association Journal and the Canadian Institutes of Health Research recognized Possmayer with the Top Canadian Achievement in Health Research Award. In 2015, he was named one of the Schulich School of Medicine & Dentistry’s Alumni of Distinction. His publication authorship contributions, numbering more than 320, have been cited almost 10,000 times.
Better than all the accolades, though, is the legacy of babies such as Tyler, born in 1988 at 26 weeks. Treated with BLES, then an experimental drug, the tiny infant recovered.
“Last I heard of him, he was a pre-med student.”