Covid-19 has led to morbidity in millions of patients, ranging from mild flu-like symptoms to
severe respiratory failure, necessitating oxygen supplementation and mechanical ventilation, and ultimately
death. The SARS-CoV-2 virus reacts with angiotensin-converting enzyme 2 (ACE2) molecules
that are especially found in alveolar epithelial type 2 cells in the lungs and thereby causes a loss in lung
surfactant, a protein-lipid mixture that is crucial for both native immunity and reduction of surface tension
in the lung alveoli. Lung surfactant insufficiency results in atelectasis and loss of functional lung
tissue amid an inflammatory storm and may be countered by treating Covid-19 pneumonia patients with
exogenous lung surfactant, preferably by aerosol delivery of a novel dry powder synthetic lung surfactant.
More research on timing, dosing, and delivery of synthetic lung surfactant in patients with Covid-
19 pneumonia is of crucial importance to implement this approach in clinical practice.
Keywords: lung surfactant, alveolar type 2 cells, respiratory failure, SARS-CoV-2, Covid-19, pneumonia.
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