In Vivo Podcast with David Wild
February 12, 2026
Preterm infants represent one of the most challenging patient populations in drug development. Born before their organs have fully formed, they face life‑threatening complications that have seen little therapeutic innovation in decades. Bronchopulmonary dysplasia—a devastating chronic lung condition that affects a large proportion of the most extremely preterm infants—still has no drug specifically approved to prevent or cure it.
The scientific barriers are formidable: these infants’ lungs have not finished developing, their immune systems are immature and any intervention carries profound risk. Add to that the ethical complexities of obtaining informed consent from parents in crisis, the logistical challenges of enrolling patients across specialized neonatal intensive care units, and the regulatory scrutiny that comes with studying fragile newborns. It’s no wonder pharmaceutical companies have largely avoided the space.
But Airway Therapeutics is betting that a recombinant version of surfactant protein D (a naturally occurring immune regulator that preterm babies lack) can change the equation.
In an early Phase Ib study of zelpultide alfa, the company saw not just safety, but striking exploratory efficacy signals: lower rates of BPD, less time on mechanical ventilation and improvements in comorbidities like retinopathy of prematurity, alongside a notable reduction in steroid use.
Now, backed by a series of private financings, Airway is advancing directly from Phase Ib into a seamless Phase II/III registrational trial across multiple countries. In this episode, CEO and CMO Marc Salzberg explains why his team believes replacement therapy for a missing immune protein makes scientific sense, how they’re navigating the unique ethical and operational challenges of neonatal trials, and why preventing BPD in the smallest patients could open doors to treating respiratory inflammation across much larger adult populations.
It’s a conversation about what it takes to develop medicines for patients who can’t speak for themselves and why the toughest populations sometimes offer the clearest paths to breakthrough therapies.