By Mary Hearty

Since lack of oxygen is what kills alot of people with COVID-19, there is a possibility that lung surfactant- a soapy substance released by the lungs enabling them to relax and contract easily when breathing in and out- can help increase the patients’ accessibility to oxygen thus, reduce mortality as it increases their level of recovery.

Prof Barack Otieno Abonyo, Medical Physiologist and Registrar Planning Partnership, Research and Innovation at Kibabii University, said during a virtual media briefing with Africa Science Media Centre (AfriSMC) on Efficacy of Lung Surfactant on COVID-19 Induced Acute Respiratory Distress Syndrome (ARDS).

He explained that this was tested in seven COVID-19 PCR positive ARDS patients whereby, they were given lung surfactant and results showed that it reduced their problem compared to the use of ventilation.

However, Prof Abonyo said that this was a small study and proposed that a bigger study needs to be done to show that surfactants are vital in the treatment of COVID-19 patients.

“Without lung surfactant, your lungs will not easily contract and relax when you breathe in and out. As a result, your lung will become dry and crack,” he explained.

Prof Abonyo described that lung surfactant was first discovered on newborn infants that are pre-maturely born with respiratory distress. Those medical practitioners found that they lacked surfactant so, they were not able to survive as their lungs were collapsing. Later on, they found that if they were given lung surfactant, they survived, he said.

“It is with this reason that we believe that if the same is given to COVID-19 patients, then it will increase the patient’s accessibility to oxygen,” Prof. Abonyo reiterated.

Another study he mentioned was Peter Schouboe’s which indicated that patients given surfactant recover to some extent. “They gave them surfactant plus steroids which helps in the production of surfactant,” he stated.

In an X-ray presentation, Prof Abonyo highlighted that normal lungs will appear dark, not translucent. However, with COVID-19 infection, you will end up with pneumonia, in that water will infiltrate the lungs, making it appear translucent and therefore you cannot breathe. Most of the people at this stage die.

According to Prof Abonyo, coronavirus affects the production of lung surfactant, whereby it attaches and penetrates the wall of the cells that are responsible for the production of lung surfactant.

During this process, the coronavirus destroys those cells hence making them incapable of producing lung surfactant. In turn, ARDS is developed. Also, the lungs will be injured in what is referred to as Acute Lung Injury.

In the case of Acute Lung Infection, when patients are given surfactant protein, there is always a reduction of inflammation. They react with other inflammatory products in the lungs and therefore may increase the survival of COVID-19 patients.

“Lung surfactant consists of lipids especially phospholipids, proteins, and ions. The proteins which are known as surfactant proteins are divided in four, and some of them are anti-inflammatory so, when there is an inflammation in the lung, they cover it hence gets destroyed,” he explained.

Prof. Abonyo also acknowledged that surfactants are deactivated in COVID-19 patients due to inflammation induced by the coronavirus.

“Surfactant is almost like soap, it has hydrophilic head meaning it is water-loving and hydrophobic tail means it is not water-loving. And this is the same way soap works. So, when there is dirt, the component that does not love water engulfs the dirt then it releases it out,” he said, observing that it is for this reason that people are always advised to wash their hands thoroughly with soap to wash out the coronavirus.

“When you use surfactant early during infection then it is possible that it can form micelles of the virus and release it out instead of letting it get into the epithelium. So this component of the surfactant is very important for this theory as it can reduce the infectivity of the epithelial cells by the virus,” Prof. Abonyo explained.

Additionally, the Medical physiologist revealed that at the moment, Windtree Therapeutics, a biotechnology and medical device company is studying surfactant therapy known as Lucinactant in adults with ALI with COVID-19 and ARDS. Earlier this year, the company announced that it had begun a phase 2 clinical trial for this therapy.

Therefore, he proposed that COVID-19 patients to continue with steroid treatment to help boost surfactant levels. Also, he said that a comparison of the production of surfactant in those COVID-19 patients should be done to check if it has increased.

Among the recommendations by Prof. Abonyo was that examination should be done to determine which type of surfactant is effective for COVID-19 treatment as they are of different kinds. Also, the timing of administration should be evaluated to determine whether it is effective if the treatment starts late or early.

Again, he encouraged studies on the surfactant level in COVID-19 patients because there is no study that has followed COVID-19 patients from the point of infection to the point of death and looked at surfactant production. “That will give us an idea to know when we can begin the surfactant treatment and when it cannot have an impact when administered,” he said.