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

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Khudadah K., Ramadan A., Othman A., Refaey N., Elrosasy A., Rezkallah A., ...More

Bioscience reports, vol.43, no.8, 2023 (SCI-Expanded) identifier identifier

  • Publication Type: Article / Article
  • Volume: 43 Issue: 8
  • Publication Date: 2023
  • Doi Number: 10.1042/bsr20230504
  • Journal Name: Bioscience reports
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, Academic Search Premier, BIOSIS, Biotechnology Research Abstracts, CAB Abstracts, Chemical Abstracts Core, EMBASE, Veterinary Science Database, Directory of Open Access Journals
  • Keywords: Acute respiratory distress syndrome, Alveolar cells type 2, COVID-19, pulmonary surfactant, SARS-CoV-2
  • Kütahya Health Sciences University Affiliated: No


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.