Subject(s)
Betacoronavirus/immunology , Coronavirus Infections/immunology , Pneumocystis carinii/immunology , Pneumonia, Pneumocystis/immunology , Pneumonia, Viral/immunology , Pulmonary Surfactant-Associated Proteins/chemistry , Pulmonary Surfactants/chemistry , Spike Glycoprotein, Coronavirus/chemistry , Amino Acid Sequence , Antibodies, Viral/chemistry , Antibodies, Viral/genetics , Betacoronavirus/pathogenicity , COVID-19 , Coronavirus 229E, Human/immunology , Coronavirus Infections/genetics , Coronavirus Infections/pathology , Coronavirus Infections/virology , Coronavirus OC43, Human/immunology , Cross Reactions , Epitopes/chemistry , Epitopes/genetics , Epitopes/immunology , Gene Expression , Host-Pathogen Interactions/genetics , Host-Pathogen Interactions/immunology , Humans , Oligopeptides/chemistry , Oligopeptides/genetics , Oligopeptides/immunology , Pandemics , Pneumocystis carinii/pathogenicity , Pneumonia, Pneumocystis/genetics , Pneumonia, Pneumocystis/pathology , Pneumonia, Pneumocystis/virology , Pneumonia, Viral/genetics , Pneumonia, Viral/pathology , Pneumonia, Viral/virology , Protein Binding , Pulmonary Surfactant-Associated Proteins/genetics , Pulmonary Surfactant-Associated Proteins/immunology , Pulmonary Surfactants/immunology , Pulmonary Surfactants/metabolism , SARS-CoV-2 , Sequence Homology, Amino Acid , Spike Glycoprotein, Coronavirus/genetics , Spike Glycoprotein, Coronavirus/immunologyABSTRACT
OBJECTIVE: Acute respiratory distress syndrome (ARDS) is characterized by quantitative and qualitative changes in surfactant composition, leading to surfactant dysregulation with alveolar collapse and acute respiratory hypoxic failure. Recently, surfactant has been hypothesized to play a relevant role in COVID-19, representing a strong defender against SARS-CoV-2 infection. The aim of our work was the study of immunohistochemical surfactant expression in the lungs of patients died following SARS-CoV-2 ARDS, in order to shed light on a possible therapeutic surfactant administration. PATIENTS AND METHODS: We investigated four patients who died due to ARDS following SARS-COV-2 infection and four patients submitted to lung biopsy, in the absence of SARS-CoV-2 infection. In all 8 cases, lung specimens were immunostained with anti-surfactant protein A (SP-A) and B (SP-B). RESULTS: In control subjects, reactivity for SP-B was restricted to type II alveolar cells. Immunostaining for SP-A was observed on the surface of alveolar spaces. In the COVID-19 positive lungs, immunoreactivity for SP-B was similar to that observed in control lungs; SP-A was strongly expressed along the alveolar wall. Moreover, dense aggregates of SP-A positive material were observed in the alveolar spaces. CONCLUSIONS: Our immunohistochemical data show the dysregulation of surfactant production in COVID-19 patients, particularly regarding SP-A expression. The increased presence of SP-A in condensed masses inside alveolar spaces could invalidate the therapeutic efficacy of the treatment with exogenous surfactant.