Unraveling the Enigma: The Emerging Significance of Pulmonary Surfactant Proteins in Predicting, Diagnosing, and Managing COVID-19

Overview

Journal Immun Inflamm Dis

Specialties Allergy & Immunology
Infectious Diseases

Date 2024 Jun 11

PMID 38860749

Authors

Mohammad Navid Bastani

Shahram Jalilian

Affiliations

Soon will be listed here.

Abstract

Background: Severe cases of COVID-19 often lead to the development of acute respiratory syndrome, a critical condition believed to be caused by the harmful effects of SARS-CoV-2 on type II alveolar cells. These cells play a crucial role in producing pulmonary surfactants, which are essential for proper lung function. Specifically focusing on surfactant proteins, including Surfactant protein A (SP-A), Surfactant protein B, Surfactant protein C, and Surfactant protein D (SP-D), changes in the levels of pulmonary surfactants may be a significant factor in the pathological changes seen in COVID-19 infection.

Objective: This study aims to gain insights into surfactants, particularly their impacts and changes during COVID-19 infection, through a comprehensive review of current literature. The study focuses on the function of surfactants as prognostic markers, diagnostic factors, and essential components in the management and treatment of COVID-19.

Finding: In general, pulmonary surfactants serve to reduce the surface tension at the gas-liquid interface, thereby significantly contributing to the regulation of respiratory mechanics. Additionally, these surfactants play a crucial role in the innate immune system within the pulmonary microenvironment. Within the spectrum of COVID-19 infections, a compelling association is observed, characterized by elevated levels of SP-D and SP-A across a range of manifestations from mild to severe pneumonia. The sudden decline in respiratory function observed in COVID-19 patients may be attributed to the decreased synthesis of surfactants by type II alveolar cells.

Conclusion: Collectin proteins such as SP-A and SP-D show promise as biomarkers, offering potential avenues for predicting and monitoring pulmonary alveolar injury in the context of COVID-19. This clarification enhances our understanding of the molecular complexities contributing to respiratory complications in severe COVID-19 cases, providing a foundation for targeted therapeutic approaches using surfactants and refined clinical management strategies.

Citing Articles

Update prognostic potency of surfactant protein D (SP-D) in the COVID-19 landscape: an In-depth meta-analytical exploration.

Bastani M, Jalilian S, Bahreiny S, Makvandi M, Aghaei M, Mansouri Z Biomark Med. 2024; 18(24):1135-1148.

PMID: 39618167 PMC: 11654819. DOI: 10.1080/17520363.2024.2432325.

References

Yang F, Zhang J, Yang Y, Ruan F, Chen X, Guo J . Regulatory Roles of Human Surfactant Protein B Variants on Genetic Susceptibility to Pseudomonas Aeruginosa Pneumonia-Induced Sepsis. Shock. 2019; 54(4):507-519. PMC: 10336628. DOI: 10.1097/SHK.0000000000001494. View

Sehlmeyer K, Ruwisch J, Roldan N, Lopez-Rodriguez E . Alveolar Dynamics and Beyond - The Importance of Surfactant Protein C and Cholesterol in Lung Homeostasis and Fibrosis. Front Physiol. 2020; 11:386. PMC: 7213507. DOI: 10.3389/fphys.2020.00386. View

Labarrere C, Kassab G . Pattern Recognition Proteins: First Line of Defense Against Coronaviruses. Front Immunol. 2021; 12:652252. PMC: 8494786. DOI: 10.3389/fimmu.2021.652252. View

Freundt K, Herzmann C, Biedziak D, Scheffzuk C, Gaede K, Stamme C . Surfactant Protein A Enhances the Degradation of LPS-Induced TLR4 in Primary Alveolar Macrophages Involving Rab7, β-arrestin2, and mTORC1. Infect Immun. 2021; 90(2):e0025021. PMC: 8853680. DOI: 10.1128/IAI.00250-21. View

El Saleeby C, Li R, Somes G, Dahmer M, Quasney M, DeVincenzo J . Surfactant protein A2 polymorphisms and disease severity in a respiratory syncytial virus-infected population. J Pediatr. 2009; 156(3):409-14. DOI: 10.1016/j.jpeds.2009.09.043. View

Takahashi H, Kuroki Y, Tanaka H, Saito T, Kurokawa K, Chiba H . Serum levels of surfactant proteins A and D are useful biomarkers for interstitial lung disease in patients with progressive systemic sclerosis. Am J Respir Crit Care Med. 2000; 162(1):258-63. DOI: 10.1164/ajrccm.162.1.9903014. View

Wang G, Umstead T, Hu S, Mikerov A, Phelps D, Floros J . Differential Effects of Human SP-A1 and SP-A2 on the BAL Proteome and Signaling Pathways in Response to and Ozone Exposure. Front Immunol. 2019; 10:561. PMC: 6443908. DOI: 10.3389/fimmu.2019.00561. View

Wang E, Mao T, Klein J, Dai Y, Huck J, Jaycox J . Diverse functional autoantibodies in patients with COVID-19. Nature. 2021; 595(7866):283-288. DOI: 10.1038/s41586-021-03631-y. View

DePietro M, Salzberg M . Commentary: Pattern Recognition Proteins: First Line of Defense Against Coronaviruses. Front Immunol. 2022; 13:815168. PMC: 8826256. DOI: 10.3389/fimmu.2022.815168. View

10.

Chroneos Z, Sever-Chroneos Z, Shepherd V . Pulmonary surfactant: an immunological perspective. Cell Physiol Biochem. 2010; 25(1):13-26. PMC: 3025886. DOI: 10.1159/000272047. View

11.

Weiskirchen R . Severity of Coronavirus Disease 2019 (COVID-19): Does Surfactant Matter?. Front Microbiol. 2020; 11:1905. PMC: 7479844. DOI: 10.3389/fmicb.2020.01905. View

12.

Haagsman H, Diemel R . Surfactant-associated proteins: functions and structural variation. Comp Biochem Physiol A Mol Integr Physiol. 2001; 129(1):91-108. DOI: 10.1016/s1095-6433(01)00308-7. View

13.

Mulugeta S, Nguyen V, Russo S, Muniswamy M, Beers M . A surfactant protein C precursor protein BRICHOS domain mutation causes endoplasmic reticulum stress, proteasome dysfunction, and caspase 3 activation. Am J Respir Cell Mol Biol. 2005; 32(6):521-30. PMC: 2715321. DOI: 10.1165/rcmb.2005-0009OC. View

14.

Jakel A, Clark H, Reid K, Sim R . The human lung surfactant proteins A (SP-A) and D (SP-D) interact with apoptotic target cells by different binding mechanisms. Immunobiology. 2009; 215(7):551-8. DOI: 10.1016/j.imbio.2009.09.005. View

15.

Kerr M, Paton J . Surfactant protein levels in severe respiratory syncytial virus infection. Am J Respir Crit Care Med. 1999; 159(4 Pt 1):1115-8. DOI: 10.1164/ajrccm.159.4.9709065. View

16.

Chitsike L, Duerksen-Hughes P . Keep out! SARS-CoV-2 entry inhibitors: their role and utility as COVID-19 therapeutics. Virol J. 2021; 18(1):154. PMC: 8301738. DOI: 10.1186/s12985-021-01624-x. View

17.

Beers M, Fisher A . Surfactant protein C: a review of its unique properties and metabolism. Am J Physiol. 1992; 263(2 Pt 1):L151-60. DOI: 10.1152/ajplung.1992.263.2.L151. View

18.

King S, Chen S . Recent progress on surfactant protein A: cellular function in lung and kidney disease development. Am J Physiol Cell Physiol. 2020; 319(2):C316-C320. PMC: 7500221. DOI: 10.1152/ajpcell.00195.2020. View

19.

Lopez-Rodriguez E, Pascual A, Arroyo R, Floros J, Perez-Gil J . Human Pulmonary Surfactant Protein SP-A1 Provides Maximal Efficiency of Lung Interfacial Films. Biophys J. 2016; 111(3):524-536. PMC: 4982931. DOI: 10.1016/j.bpj.2016.06.025. View

20.

Kishore U, Greenhough T, Waters P, Shrive A, Ghai R, Kamran M . Surfactant proteins SP-A and SP-D: structure, function and receptors. Mol Immunol. 2005; 43(9):1293-315. DOI: 10.1016/j.molimm.2005.08.004. View