Surfactant replacement therapy as promising treatment for COVID-19: an updated narrative review

Khaled Khudadah; Alaa Ramadan; Ahmed Othman; Neveen Refaey; Amr Elrosasy; Ayoub Rezkallah; Toka Heseba; Mostafa Hossam El Din Moawad; Ammar Mektebi; Sewar A Elejla; Mohamed Abouzid; Basel Abdelazeem

doi:10.1042/BSR20230504

Surfactant replacement therapy as promising treatment for COVID-19: an updated narrative review

Biosci Rep. 2023 Aug 31;43(8):BSR20230504. doi: 10.1042/BSR20230504.

Authors

Khaled Khudadah^#¹, Alaa Ramadan^#², Ahmed Othman^#¹, Neveen Refaey³, Amr Elrosasy⁴, Ayoub Rezkallah^{5

6}, Toka Heseba⁷, Mostafa Hossam El Din Moawad^{8

9}, Ammar Mektebi¹⁰, Sewar A Elejla¹¹, Mohamed Abouzid^{12

13}, Basel Abdelazeem^{14

15}

Affiliations

¹ Kuwait Oil Company Ahmadi Hospital, Al Ahmadi, Kuwait.
² Faculty of Medicine, South Valley University, Qena, Egypt.
³ Women's Health department, Faculty of Physical Therapy, Cairo University, Cairo, Egypt.
⁴ Faculty of Medicine, Cairo University, Cairo, Egypt.
⁵ Faculty of Medicine, University of Algeirs, Algeirs, Algeria.
⁶ Department of Hematology Laboratory and Blood Transfusion, Hospital Center University Lamine Debaghine, Algeirs, Algeria.
⁷ Faculty of Medicine, Assuit University, Assuit, Egypt.
⁸ Faculty of Pharmacy, Clinical Department, Alexandria University, Egypt.
⁹ Faculty of Medicine, Suez Canal University, Ismailia, Egypt.
¹⁰ Faculty of Medicine, Kutahya Health Sciences University, Kutahya, Turkey.
¹¹ Faculty of Medicine, Alquds University, Jerusalem, Palestine.
¹² Department of Physical Pharmacy and Pharmacokinetics, Faculty of Pharmacy, Poznan University of Medical Sciences, Rokietnicka 3 St., 60-806 Poznan, Poland.
¹³ Doctoral School, Poznan University of Medical Sciences, 60-812 Poznan, Poland.
¹⁴ McLaren Health Care, Flint, Michigan, U.S.A.
¹⁵ Michigan State University, East Lansing, Michigan, U.S.A.

^# Contributed equally.

Abstract

Patients with COVID-19 exhibit similar symptoms to neonatal respiratory distress syndrome. SARS-CoV-2 spike protein has been shown to target alveolar type 2 lung cells which synthesize and secrete endogenous surfactants leading to acute respiratory distress syndrome in some patients. This was proven by post-mortem histopathological findings revealing desquamated alveolar type 2 cells. Surfactant use in patients with COVID-19 respiratory distress syndrome results in marked improvement in respiratory parameters but not mortality which needs further clinical trials comparing surfactant formulas and modes of administration to decrease the mortality. In addition, surfactants could be a promising vehicle for specific drug delivery as a liposomal carrier, which requires more and more challenging efforts. In this review, we highlight the current reviews and two clinical trials on exogenous surfactant therapy in COVID-19-associated respiratory distress in adults, and how surfactant could be a promising drug to help fight the COVID-19 infection.

Keywords: Acute respiratory distress syndrome; Alveolar cells type 2; COVID-19; SARS-CoV-2; pulmonary surfactant.

Publication types

Review
Research Support, Non-U.S. Gov't

MeSH terms

Adult
COVID-19*
Humans
Infant, Newborn
Pulmonary Surfactants* / therapeutic use
Respiratory Distress Syndrome*
Respiratory Distress Syndrome, Newborn* / drug therapy
SARS-CoV-2
Surface-Active Agents / therapeutic use

Substances

spike protein, SARS-CoV-2
Pulmonary Surfactants
Surface-Active Agents