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Surfactant protein D inhibits lipid-laden foamy macrophages and lung inflammation in chronic obstructive pulmonary disease


Increased levels of surfactant protein D (SP-D) and lipid-laden foamy macrophages (FMs) are frequently found under oxidative stress conditions and/or in patients with chronic obstructive pulmonary disease (COPD) who are also chronically exposed to cigarette smoke (CS). However, the roles and molecular mechanisms of SP-D and FMs in COPD have not yet been determined. In this study, increased levels of SP-D were found in the bronchoalveolar lavage fluid (BALF) and sera of ozone- and CS-exposed mice. Furthermore, SP-D-knockout mice showed increased lipid-laden FMs and airway inflammation caused by ozone and CS exposure, similar to that exhibited by our study cohort of chronic smokers and COPD patients. We also showed that an exogenous recombinant fragment of human SP-D (rfhSP-D) prevented the formation of oxidized low-density lipoprotein (oxLDL)-induced FMs in vitro and reversed the airway inflammation and emphysematous changes caused by oxidative stress and CS exposure in vivo. SP-D upregulated bone marrow-derived macrophage (BMDM) expression of genes involved in countering the oxidative stress and lipid metabolism perturbations induced by CS and oxLDL. Our study demonstrates the crucial roles of SP-D in the lipid homeostasis of dysfunctional alveolar macrophages caused by ozone and CS exposure in experimental mouse emphysema, which may provide a novel opportunity for the clinical application of SP-D in patients with COPD.

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We thank the Laboratory Animal Center, College of Medicine, National Cheng Kung University and Taiwan Animal Consortium for the technical support in IVIS.


This work was supported by the Ministry of Science and Technology (MOST) of Taiwan (grant numbers 103-2321-B-006-030 and 104-2321-B-006-008), funding received in part from the Headquarters of University Advancement at the National Cheng Kung University, which is sponsored by the Ministry of Education in Taiwan, and a research grant (1JA8) from the Center for Allergy, Immunology, and Microbiome (A.I.M.), China Medical University Hospital, Taichung, Taiwan.

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Authors and Affiliations



MHH, LSHW, and JYW developed the study concepts and aims. MHH, HYH, JCL, YSH, SDW, and WSK performed the experiments and data extraction. CWK collected the clinical BALF samples from COPD patients. MHH, WSK, HFK, and ZGL performed the data analysis. MHH, LSHW, and JYW drafted the manuscript. All authors provided important insight into data interpretation and contributed to the final version of the manuscript.

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Correspondence to Lawrence Shih-Hsin Wu or Jiu-Yao Wang.

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The authors declare no competing interests.

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Hsieh, MH., Chen, PC., Hsu, HY. et al. Surfactant protein D inhibits lipid-laden foamy macrophages and lung inflammation in chronic obstructive pulmonary disease. Cell Mol Immunol 20, 38–50 (2023).

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  • Alveolar macrophages
  • Chronic obstructive pulmonary diseases
  • Surfactant protein D
  • Lipid metabolism
  • Ozone
  • Cigarettes


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