Abstract
A hypothesis concerning the potential utility of surfactant supplementation for the treatment of critically ill patients with COVID-19 is proposed, along with a brief summary of the data in the literature supporting this idea. It is thought that surfactant, which is already approved by the Food and Drug Administration for intratracheal administration to treat neonatal respiratory distress syndrome in pre-term infants, could benefit COVID-19-infected individuals by: (1) restoring surfactant damaged by lung infection and/or decreased due to the virus-induced death of the type II pneumocytes that produce it and (2) reducing surface tension to decrease the work of breathing and limit pulmonary edema. In addition, a constituent of surfactant, phosphatidylglycerol, could mitigate COVID-19-induced lung pathology by: (3) decreasing excessive innate immune system stimulation via its inhibition of toll-like receptor-2 and -4 activation by microbial components and cellular proteins released by damaged cells, thereby limiting inflammation and the resultant pulmonary edema, and (4) possibly blocking spread of the viral infection to non-infected cells in the lung. Therefore, it is suggested that surfactant preparations containing phosphatidylglycerol be tested for their ability to improve lung function in critically ill patients with COVID-19.
【저자키워드】 acute respiratory distress syndrome, Toll-like receptor, interleukin, secretory phospholipase A2, ARDSacute respiratory distress syndrome, ILInterleukin, nuclear factor kappa-light-chain-enhancer of activated B cells, TLRToll-like receptor, DAMPdanger- or damage-associated molecular pattern, danger- or damage-associated molecular pattern, NFκBnuclear factor kappa-light-chain-enhancer of activated B cells, PAMPpathogen-associated molecular pattern, pathogen-associated molecular pattern, PGphosphatidylglycerol, phosphatidylglycerol, sPLA2secretory phospholipase A2, TNFαtumor necrosis factor-alpha, tumor necrosis factor-alpha, 【초록키워드】 Treatment, Inflammation, viral infection, lung, Lung infection, drug, Type II pneumocyte, innate immune system, Spread, Protein, Infants, Lung function, death, Pulmonary edema, utility, Lung pathology, cellular, food, Hypothesis, administration, distress, Neonatal, microbial, Critically ill patient, Activation, individual, syndrome, treat, component, damaged cells, tension, Work of breathing, mitigate, benefit, limit, decrease, IMPROVE, thought, tested, addition, approved, reducing, suggested, released, concerning, damaged, non-infected cell, with COVID-19, 【제목키워드】 Potential treatment,