SARS-CoV2 can lead to a severe form of pneumonia, which under certain circumstances can trigger acute lung failure (ARDS, “Acute respiratory distress syndrome”). This is an “excessive” inflammatory reaction: inflammatory cells and fluid accumulate in the lungs. On the one hand, this mechanically impedes breathing, and on the other hand, the inflammatory-aggressive liquid destroys the body’s own protective film (“surfactant”) in the alveoli, which as a result can no longer absorb oxygen. SARS-CoV-2 induces the destruction of type II alveolar cells in COVID-19-associated pneumonia. Type-II- alveolar-cells produce pulmonary surfactant. Surfactant is necessary for the maintenance of the breathing mechanics by reducing surface tension and preventing lung collapse. In addition, the massive release of cytokines from lymphocytopenia is another factor that leads to pulmonary failure and death in severe cases of COVID19 patients.
There is currently intense discussion in the literature as to whether surfactant could be of great use in the treatment of adult respiratory distress syndrome.
Some authors speculate that early administration of a natural pulmonary surfactant could improve lung function to restore lung barrier function in patients with COVID-19 pneumonia, thereby shortening the duration of ventilation therapy and helping patients recover. Indeed, this could easily be accomplished by adding the reconstituted lyophilizate powder to the tracheal tube of the ventilated COVID-19 patient. Another hypothesis argues that surfactants may be effective not only for the treatment but also for the prophylactic protection of SARS-CoV-2. Each theory argues that the pulmonary surfactant is not only beneficial for reducing surface tension or increasing lung compliance, but is also a strong defender against the virus itself. However, none of the theories are actually supported with real experimental evidence. Numerous clinical studies are currently underway to determine whether treatment with surfactant in COVID-19-induced respiratory failure can be considered useful.
It has always been our clear and steadfast focus to follow science in order to achieve the best possible benefit for our patients. With this in mind, we, as a surfactant manufacturer, hope to be able to make our contribution in the fight against COVID-19.
Dr. Dr. Romina Weinhold
Head of Medical Affairs
Lyomark Pharma GmbH