Surfactant and its Role in Chronic Sinusitis

Abstract

Although numerous studies have focused on the nature and defensive role of surfactant in the lower airways, relatively little is known about its role in the upper airways. Decreased levels of the main component of surfactant — phospholipids — have been implicated in atrophic rhinitis. The lamellar body arrangement of phospholipids has now been demonstrated in both normal and diseased sinus tissue, resulting in the implication that these structures may play a crucial role in mucociliary clearance against inhaled pathogens, as well as in the regulation of mucous viscosity. Furthermore, they may be secreted from sinonasal ciliated epithelium. Surfactant proteins (SPs) make up a relatively smaller proportion of surfactant, but appear to have an important role in innate immunity. Altered levels of SPs have been observed in a number of respiratory tract diseases. These SPs may prove to play a significant role in chronic sinusitis. Demonstrated expression of SP-A and SP-D in diseased and normal sinus tissue may mean that these SPs are excreted into the airway-lining fluid of the sinuses. Additionally, initial contact and interaction between pathogens and SP-A and SP-D may occur relatively early after inhalation and deposition into the mucus of the respiratory tract. These findings may lead to potential therapeutic options for difficult-to-treat sinus disease in the future.

Keywords

lamellar body phospholipid surfactant surfactant protein

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References

Woodworth

Smythe

Spicer

Schulte

Schlosser

. Presence of surfactant lamellar bodies in normal and diseased sinus mucosa. ORL J Otorhinolaryngol Relat Spec 2005; 67: 199–202.

Sayed

Abou-Elhamd

Abdel-Kader

Saleem

. Study of surfactant level in cases of primary atrophic rhinitis. J Laryngol Otol 2000; 114: 254–9.

Nogee

. Alterations in SP-B and SP-C expression in neonatal lung disease. Annu Rev Physiol 2004; 66: 601–23.

Augusto

Synguelakis

Johansson

Chaby

. Structural basis for interactions between lung surfactant protein C and bacterial lipopolysaccharide. J Biol Chem 2002; 277: 23484–92.

Augusto

. Synguelakis M, Johansson J, Pedron T, Girard R, Chaby R. Interaction of pulmonary surfactant protein C with CD14 and lipopolysaccharide. Infect Immun 2003; 71: 61–7.

Rubio

. Lacaze-Masmonteil T, Chailley-Heu B, Kahn A, Bourbon JR, Ducroc R. Pulmonary surfactant protein A (SP-A) is expressed by epithelial cells of small and large intestine. J Biol Chem 1995; 270: 12162–9.

Lin

deMello

. Phelps DS, Koltun WA, Page M, Floras J. Both human SP-A1 and SP-A2 genes are expressed in small and large intestine. Pediatr Pathol Mol Med 2001; 20: 367–86.

Madsen

Kliem

Tornoe

Skjodt

Koch

Holmskov

. Localization of lung surfactant protein D on mucosal surfaces in human tissues. J Immunol 2000; 164: 5866–70.

Leth-Larsen

Floridon

Nielsen

Holmskov

. Surfactant protein D in the female genital tract. Mol Hum Reprod 2004; 10: 149–54.

10.

Crouch

Wright

. Surfactant proteins a and d and pulmonary host defense. Annu Rev Physiol 2001; 63: 521–54.

11.

Wright

. Immunoregulatory functions of surfactant proteins. Nat Rev Immunol 2005; 5: 58–68.

12.

Kuroki

Voelker

. Pulmonary surfactant proteins. J Biol Chem 1994; 269: 25943–6.

13.

Crouch

Hartshorn

Ofek

. Collectins and pulmonary innate immunity. Immunol Rev 2000; 173: 52–65.

14.

Davidson

Murphy

Mitchell

Smith

Light

. Management of chronic sinusitis in cystic fibrosis. Laryngoscope 1995; 105: 354–8.

15.

van Rozendaal

van Golde

Haagsman

. Localization and functions of SPA and SP-D at mucosal surfaces. Pediatr Pathol Mol Med 2001; 20: 319–39.

16.

Kishor

Madan

Sarma

Singh

Urban

Reid

. Protective roles of pulmonary surfactant proteins. SP-A and SP-D, against lung allergy and infection caused by Aspergillus fumigatus. Immunobiology 2002; 205: 610–8.

17.

Saxena

Madan

Shah

Muralidhar

Sarma

. Association of polymorphisms in the collagen region of SP-A2 with increased levels of total IgE antibodies and eosinophilia in patients with allergic bronchopulmonary aspergillosis. J Allergy Clin Immunol 2003; 111: 1001–7.

18.

Noah

Murphy

Alink

. Bronchoalveolar lavage fluid surfactant protein-A and surfactant protein-D are inversely related to inflammation in early cystic fibrosis. Am J Respir Crit Care Med 2003; 168: 685–91.

19.

Postle

Mander

Reid

. Deficient hydrophilic lung surfactant proteins A and D with normal surfactant phospholipid molecular species in cystic fibrosis. Am J Respir Cell Mol Biol 1999; 20: 90–8.

20.

Zhang

Ikegami

Dey

Korfhagen

Whitsett

. Reversibility of pulmonary abnormalities by conditional replacement of surfactant protein D (SP-D) in vivo. J Biol Chem 2002; 277: 38709–13.

21.

Strong

Reid

Clark

. Intranasal delivery of a truncated recombinant human SP-D is effective at down-regulating allergic hypersensitivity in mice sensitized to allergens of Aspergillus fumigatus. Clin Exp Immunol 2002; 130: 19–24.

22.

Hohlfeld

Erpenbeck

Krug

. Surfactant proteins SP-A and SP-D as modulators of the allergic inflammation in asthma. Pathobiology 2002–2003; 70: 287–92.

23.

Wang

Shieh

You

Lei

Reid

. Inhibitory effect of pulmonary surfactant proteins A and D on allergen-induced lymphocyte proliferation and histamine release in children with asthma. Am J Respir Crit Care Med 1998; 158: 510–8.