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磷脂酰甘油和表面活性剂:COVID-19 的潜在治疗方法?

Phosphatidylglycerol and surfactant: A potential treatment for COVID-19?

机构信息

Charlie Norwood VA Medical Center, Augusta, GA 30904, United States; Department of Physiology, Medical College of Georgia at Augusta University, Augusta, GA 30912, United States; Department of Dermatology, Medical College of Georgia at Augusta University, Augusta, GA 30912, United States; Department of Medicine, Medical College of Georgia at Augusta University, Augusta, GA 30912, United States.

Department of Medicine, Medical College of Georgia at Augusta University, Augusta, GA 30912, United States.

出版信息

Med Hypotheses. 2020 Nov;144:110277. doi: 10.1016/j.mehy.2020.110277. Epub 2020 Sep 16.

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.

摘要

提出了一个关于表面活性剂补充治疗 COVID-19 危重症患者的潜在效用的假设,并简要总结了支持这一观点的文献数据。人们认为,表面活性剂已经获得美国食品和药物管理局批准,可通过气管内给药治疗早产儿呼吸窘迫综合征,它可能通过以下方式使 COVID-19 感染者受益:(1)修复因肺部感染而受损的表面活性剂和/或因病毒导致产生表面活性剂的 II 型肺泡细胞死亡而减少的表面活性剂;(2)降低表面张力,减少呼吸功并限制肺水肿。此外,表面活性剂的一种成分——磷脂酰甘油,通过以下方式减轻 COVID-19 引起的肺部病变:(3)通过抑制微生物成分和受损细胞释放的细胞蛋白激活 Toll 样受体-2 和 -4,从而减少过度的固有免疫系统刺激,从而限制炎症和由此产生的肺水肿;(4)可能阻止病毒感染向肺部未感染的细胞扩散。因此,建议测试含有磷脂酰甘油的表面活性剂制剂改善 COVID-19 危重症患者的肺功能的能力。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/041a/7493731/c1ca00230c02/gr1_lrg.jpg

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