Surfactant-based therapy against COVID-19: A review

Abstract

The coronavirus disease 2019 (COVID-19) has led to serious health and economic damage to all over the world, and it still remains unstoppable. The SARS-CoV-2, by using its S-glycoprotein, binds with an angiotensin-converting enzyme 2 receptor, mostly present in alveolar epithelial type II cells. Eventually pulmonary surfactant depletion occurs. The pulmonary surfactant is necessary for maintaining the natural immunity as well as the surface tension reduction within the lung alveoli during the expiration. Its insufficiency results in the reduction of blood oxygenation, poor pulmonary regeneration, lung fibrosis, and finally the respiratory system collapses. Exogenous surfactants have previously shown great promise in the treatment of infant respiratory distress syndrome, and they may also aid in the healing of damaged alveolar cells and the prevention of respiratory failure. Surfactant based therapy has been advised for the prevention of COVID-19, and the trials have begun around the world. Furthermore, greater research on the timing, dose, and the distribution of surfactant to the COVID-19 patients is required before this technique can be implemented in clinical practice.

Molecular Pathogenesis of Fibrosis, Thrombosis and Surfactant Dysfunction in the Lungs of Severe COVID-19 Patients

“…The SP-A and SP-D proteins, commonly referred to as collectins, are hydrophilic and are crucial for sustaining lung immunity by eliminating viruses and bacteria. The surfactant proteins SP-B and SP-C are hydrophobic and are essential in reducing the surface tension at the respiratory air–liquid interface [ 35 , 36 , 37 ]. Various novel surfactant-related proteins (SFTAs) that exhibit similar properties to standard SP have been recently described, namely, SFTA2, which is a hydrophilic protein and exhibits similar functions to SP-A and SP-D. Additionally, the SFTA3, an amphiphilic protein, improves phagocytosis in macrophage cell lines.…”

“…Moreover, in patients infected with SARS-CoV-2, impaired pulmonary surfactant function disturbs the air–liquid interphase. Alveolar cell loss results in a decrease in blood oxygen levels, contributes to pulmonary fibrosis, hinders regeneration, and causes edema, all of which can lead to respiratory system failure [ 23 , 35 , 49 ]. The specific sequence of changes in the lungs of COVID-19 patients evaluated by transmission electron microscopy includes epithelial cell damage at the outset, which is further accompanied by surfactant dysfunction, alveolar instability, and microatelectasis.…”

“…From the abovementioned information, it appears clear that one of the major risk factors for severe COVID-19 complications is the reduction or qualitative change in pulmonary surfactant. Since the PS serves a protective and defensive role to viral infection, various researchers have suggested that administering an exogenous “natural” surfactant to COVID-19 pneumonia patients at an early stage of disease could improve lung function, shorten mechanical ventilation time, and enhance patient recovery [ 29 , 35 ].…”

The paradigm of prophylactic viral outbreaks measures by microbial biosurfactants

“…Recent research studies have described surfactant therapy as a considerate symbolic treatment against COVID-19 infection and mortality because of respiratory failure [18] . Exogenic surfactants have already been approved against neonatal respiratory disease syndrome and are also being used to treat COVID-19 infection [19] .…”

Study of Cationic Surfactants Raw Materials for COVID-19 Disinfecting Formulations by Potentiometric Surfactant Sensor

“…Cationic surfactants are known to interact with DNA–RNA molecules, proteins, and lipids from viruses, resulting in virus disintegration [ 8 ]. Because of this specific interaction, they are also used in surfactant-based therapy against the COVID-19 disease [ 5 , 9 , 10 ]. For these reasons, the demand for cationic surfactants has rapidly increased [ 11 ].…”