Abstract Suppressed surfactant protein C is a hallmark of respiratory infections. Acute Respiratory Distress Syndrome (ARDS) is a critical condition in pneumonia, COVID-19, and sepsis and involves damaged epithelial lining, cytokine storms, and lung edema. Alveolar type 2 (AT2) epithelial cells are stem cells of the distal lung and are vital for lung repair. AT2 cells secrete surfactant protein C which protects alveoli from collapse and infections. Whether downregulated SP-C affects the re-alveolarization via regulating AT2 fate remains unclear. We used alveolar organoids to compare AT2 lineages in wild-type (wt), sftpc gene mutated L184Q mice, and disrupted sftpc gene (KO) mice. H1N1 infection reduced AT2 cells in KO mice. Sftpc deficiency led to fewer AT2 cells and reduced organoid counts and organoid colony-forming efficiency in KO mice compared to wt controls. Confocal images and western blotting indicated increased AT1 differentiation in sftpc-disrupted organoids. Similarly, L184Q mice also exhibited reduced AT2 yield, organoid count, and organoid formation efficiency. Further, scRNAseq identified differentially expressed genes in sftpc-deficient AT2 cells. This study demonstrated that sftpc could be essential to regulate alveolar regeneration by modulating AT2 lineage. Suppressed surfactant protein C in infected lungs could be a potential druggable target for ARDS and COVID-19.
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