key: cord-0752499-8byyx25p
authors: Ghati, Amit; Dam, Paulami; Tasdemir, Didar; Kati, Ahmet; Sellami, Hanen; Sezgin, Gulten Can; Ildiz, Nilay; Franco, Octavio L.; Mandal, Amit Kumar; Ocsoy, Ismail
title: Exogenous pulmonary surfactant: a review focused on adjunctive therapy for SARS CoV-2 including SP-A and SP-D as added clinical marker
date: 2020-12-29
journal: Curr Opin Colloid Interface Sci
DOI: 10.1016/j.cocis.2020.101413
sha: 027a18f69c2109c46172846db63288d2d4a30440
doc_id: 752499
cord_uid: 8byyx25p

Type I and Type II pneumocytes are two forms of epithelial cells found lining the alveoli in the lungs. Type II pneumocytes exclusively secrete ‘pulmonary surfactants’, a lipo-protein complex made up of 90% lipids (mainly phospholipids) and 10% surfactant proteins (SP-A, SP-B, SP-C, and SP-D). Respiratory diseases like influenza, SARS-CoV and SARS-CoV-2 are reported to preferentially attack type II pneumocytes of the lungs. After viral invasion, consequent viral propagation and destruction of type II pneumocytes causes altered surfactant production, resulting in dyspnea and Acute respiratory distress syndrome (ARDS) in COVID-19 patients. Exogenous animal-derived or synthetic pulmonary surfactant therapy has already shown immense success in the treatment of neonatal respiratory distress syndrome (RDS) and has the potential to contribute efficiently to repairing damaged alveoli and preventing SARS-CoV-2-associated respiratory failure. Furthermore, the early detection of surfactant collectins (SP-A and SP-D) in the circulatory system can be a significant clinical marker for disease prognosis in the near future.

Nevertheless, such force of attraction is not fully compensated resulting in a net attractive force 83 toward the interior of the liquid. A tiny layer of water covers up the lung epithelium, and these 84 forces provide mechanical and structural stability to the lungs while breathing. The failing to 85 limit these forces during exhalation causes smallest alveoli more susceptible to collapse. The 86 area exposed to the air reduced due to γ which subsequently reduces the area accessible for raised concern on the use of steroid as drug which may increases viral shedding 320 and lead to higher mortality rate. 

Did 362 reduced alveolar delivery of surfactant contribute to negative results in adults 363 with acute respiratory distress syndrome?

How should aerosols be delivered during invasive mechanical 367 ventilation?

Restoring pulmonary surfactant 370 membranes and films at the respiratory surface

Surfactant and the adult respiratory distress syndrome

Exogenous pulmonary surfactant for the treatment of adult patients with acute 378 respiratory distress syndrome: results of a meta-analysis

Surfactant 382 replacement therapy: From biological basis to current clinical practice

Massachusetts General Hospital, Surfactant worth studying as treatment for 386 covid-19-related ARDS

London's Exogenous Surfactant Study for COVID19 (LESSCOVID)

A Clinical Trial of Nebulized Surfactant for the Treatment of Moderate to 395 Severe COVID-19 (COVSurf)

Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, 400 China: a descriptive study

Serum surfactant protein D (SP-D) is a prognostic marker of 406 poor outcome in patients with A/H1N1 virus infection