Influenza A viruses (IAV) cause respiratory tract infections annually associated with excess mortality and morbidity. Nonspecific, innate immune mechanisms play a key role in protection against viral invasion at early stages of infection. A soluble protein present in mucosal secretions of the lung, surfactant protein D (SP-D), is an important component of this initial barrier that helps to prevent and limit IAV infections of the respiratory epithelium. This collagenous C-type lectin binds IAVs and thereby inhibits attachment and entry of the virus but also contributes to enhanced clearance of SP-D-opsonized virus via interactions with phagocytic cells. In addition, SP-D modulates the inflammatory response and helps to maintain a balance between effective neutralization/killing of IAV, and protection against alveolar damage resulting from IAV-induced excessive inflammatory responses. The mechanisms of interaction between SP-D and IAV not only depend on the structure and binding properties of SP-D but also on strain-specific features of IAV, and both issues will be discussed. SP-D from pigs exhibits distinct anti-IAV properties and is discussed in more detail. Finally, the potential of SP-D as a prophylactic and/or therapeutic antiviral agent to protect humans against infections by IAV is discussed.

1.
Gonzalez S, Gonzalez-Rodriguez AP, Suarez-Alvarez B, Lopez-Soto A, Huergo-Zapico L, Lopez-Larrea C: Conceptual aspects of self and nonself discrimination. Self Nonself 2011;2:19-25.
2.
Voorhout WF, Veenendaal T, Kuroki Y, Ogasawara Y, van Golde LMG, Geuze HJ: Immunocytochemical localization of surfactant protein D (SP-D) in type II cells, Clara cells, and alveolar macrophages of rat lung. J Histochem Cytochem 1992;40:1589-1597.
3.
Madsen J, Kliem A, Tornoe I, Skjodt K, Koch C, Holmskov U: Localization of lung surfactant protein D on mucosal surfaces in human tissues. J Immunol 2000;164:5866-5870.
4.
Bourbon JR, Chailley-Heu B: Surfactant proteins in the digestive tract, mesentery, and other organs: evolutionary significance. Comp Biochem Physiol A Mol Integr Physiol 2001;129:151-161.
5.
Herias MV, Hogenkamp A, van Asten AJ, Tersteeg MH, van Eijk M, Haagsman HP: Expression sites of the collectin SP-D suggest its importance in first line host defence: power of combining in situ hybridisation, RT-PCR and immunohistochemistry. Mol Immunol 2007;44:3324-3332.
6.
Hartshorn KL: Role of surfactant protein A and D (SP-A and SP-D) in human antiviral host defense. Front Biosci (Schol Ed) 2010;2:527-546.
7.
World Health Organization: Influenza (Seasonal); Fact Sheet No. 211. WHO, Geneva, 2009.
8.
Wiley DC, Skehel JJ: The structure and function of the hemagglutinin membrane glycoprotein of influenza virus. Annu Rev Biochem 1987;56:365-394.
9.
Wilson IA, Cox NJ: Structural basis of immune recognition of influenza virus hemagglutinin. Annu Rev Immunol 1990;8:737-771.
10.
Skehel JJ, Wiley DC: Receptor binding and membrane fusion in virus entry: the influenza hemagglutinin. Annu Rev Biochem 2000;69:531-569.
11.
Rogers GN, D'Souza BL: Receptor binding properties of human and animal H1 influenza virus isolates. Virology 1989;173:317-322.
12.
Thompson CI, Barclay WS, Zambon MC, Pickles RJ: Infection of human airway epithelium by human and avian strains of influenza a virus. J Virol 2006;80:8060-8068.
13.
van Riel D, Munster VJ, de Wit E, Rimmelzwaan GF, Fouchier RA, Osterhaus AD, Kuiken T: Human and avian influenza viruses target different cells in the lower respiratory tract of humans and other mammals. Am J Pathol 2007;171:1215-1223.
14.
Matrosovich MN, Gambaryan AS, Teneberg S, Piskarev VE, Yamnikova SS, Lvov DK, Robertson JS, Karlsson KA: Avian influenza A viruses differ from human viruses by recognition of sialyloligosaccharides and gangliosides and by a higher conservation of the HA receptor-binding site. Virology 1997;233:224-234.
15.
Suzuki Y: Sialobiology of influenza: molecular mechanism of host range variation of influenza viruses. Biol Pharm Bull 2005;28:399-408.
16.
Shinya K, Ebina M, Yamada S, Ono M, Kasai N, Kawaoka Y: Avian flu: influenza virus receptors in the human airway. Nature 2006;440:435-436.
17.
Smith DJ, Lapedes AS, de Jong JC, Bestebroer TM, Rimmelzwaan GF, Osterhaus AD, Fouchier RA: Mapping the antigenic and genetic evolution of influenza virus. Science 2004;305:371-376.
18.
Girard MP, Tam JS, Assossou OM, Kieny MP: The 2009 A (H1N1) influenza virus pandemic: a review. Vaccine 2010;28:4895-4902.
19.
Crouch EC, Persson A, Chang D, Heuser J: Molecular structure of pulmonary surfactant protein D (SP-D). J Biol Chem 1994;269:17311-17319.
20.
Hartshorn KL, White MR, Voelker DR, Coburn J, Zaner K, Crouch EC: Mechanism of binding of surfactant protein D to influenza A viruses: importance of binding to haemagglutinin to antiviral activity. Biochem J 2000;351:449-458.
21.
Tecle T, White MR, Crouch EC, Hartshorn KL: Inhibition of influenza viral neuraminidase activity by collectins. Arch Virol 2007;152:1731-1742.
22.
Hillaire ML, van Eijk M, van Trierum SE, van Riel D, Saelens X, Romijn RA, Hemrika W, Fouchier RA, Kuiken T, Osterhaus AD, Haagsman HP, Rimmelzwaan GF: Assessment of the antiviral properties of recombinant porcine SP-D against various influenza A viruses in vitro. PLoS One 2011;6:e25005.
23.
Brown-Augsburger P, Hartshorn KL, Chang D, Rust K, Fliszar C, Welgus HG, Crouch EC: Site-directed mutagenesis of Cys-15 and Cys-20 of pulmonary surfactant protein D. Expression of a trimeric protein with altered anti-viral properties. J Biol Chem 1996;271:13724-13730.
24.
Hartshorn KL, White MR, Tecle T, Tornoe I, Sorensen GL, Crouch EC, Holmskov U: Reduced influenza viral neutralizing activity of natural human trimers of surfactant protein D. Respir Res 2007;8:9.
25.
Tecle T, White MR, Sorensen G, Gantz D, Kacak N, Holmskov U, Smith K, Crouch EC, Hartshorn KL: Critical role for cross-linking of trimeric lectin domains of surfactant protein D in antiviral activity against influenza A virus. Biochem J 2008;412:323-329.
26.
Hartshorn KL, White MR, Tecle T, Sorensen G, Holmskov U, Crouch EC: Viral aggregating and opsonizing activity in collectin trimers. Am J Physiol Lung Cell Mol Physiol 2010;298:L79-L88.
27.
Hartshorn KL, Crouch EC, White MR, Eggleton P, Tauber AI, Chang D, Sastry K: Evidence for a protective role of pulmonary surfactant protein D (SP-D) against influenza A viruses. J Clin Invest 1994;94:311-319.
28.
Hartshorn KL, White MR, Shepherd V, Reid KBM, Jensenius JC, Crouch EC: Mechanisms of anti-influenza activity of surfactant proteins A and D: comparison with serum collectins. Am J Physiol 1997;273:L1156-L1166.
29.
White MR, Crouch E, Chang D, Hartshorn KL: Increased antiviral and opsonic activity of a highly multimerized collectin chimera. Biochem Biophys Res Commun 2001;286:206-213.
30.
Rust K, Grosso L, Zhang V, Chang D, Persson A, Longmore WJ, Cai GZ, Crouch EC: Human surfactant protein D: SP-D contains a C-type lectin carbohydrate recognition domain. Arch Biochem Biophys 1991;290:116-126.
31.
Crouch EC, Smith K, McDonald B, Briner D, Linders B, McDonald J, Holmskov U, Head J, Hartshorn K: Species differences in the carbohydrate binding preferences of surfactant protein D. Am J Respir Cell Mol Biol 2006;35:84-94.
32.
Crouch E, Hartshorn K, Horlacher T, McDonald B, Smith K, Cafarella T, Seaton B, Seeberger PH, Head J: Recognition of mannosylated ligands and influenza A virus by human surfactant protein D: contributions of an extended site and residue 343. Biochemistry 2009;48:3335-3345.
33.
van Eijk M, White MR, Crouch EC, Batenburg JJ, Vaandrager AB, van Golde LMG, Haagsman HP, Hartshorn KL: Porcine pulmonary collectins show distinct interactions with influenza A viruses; role of the N-linked oligosaccharides in the carbohydrate recognition domain. J Immunol 2003;171:1431-1440.
34.
Soerensen CM, Nielsen OL, Willis A, Heegaard PM, Holmskov U: Purification, characterization and immunolocalization of porcine surfactant protein D. Immunology 2005;114:72-82.
35.
Wilson IA, Skehel JJ, Wiley DC: Structure of the haemagglutinin membrane glycoprotein of influenza virus at 3 A resolution. Nature 1981;289:366-373.
36.
Reading PC, Morey LS, Crouch EC, Anders EM: Collectin-mediated antiviral host defense of the lung: evidence from influenza virus infection of mice. J Virol 1997;71:8204-8212.
37.
Das SR, Hensley SE, David A, Schmidt L, Gibbs JS, Puigbo P, Ince WL, Bennink JR, Yewdell JW: Fitness costs limit influenza A virus hemagglutinin glycosylation as an immune evasion strategy. Proc Natl Acad Sci USA 2011;108:E1417-E1422.
38.
Reading PC, Miller JL, Anders EM: Involvement of the mannose receptor in infection of macrophages by influenza virus. J Virol 2000;74:5190-5197.
39.
Reading PC, Pickett DL, Tate MD, Whitney PG, Job ER, Brooks AG: Loss of a single N-linked glycan from the hemagglutinin of influenza virus is associated with resistance to collectins and increased virulence in mice. Respir Res 2009;10:117.
40.
Tate MD, Job ER, Brooks AG, Reading PC: Glycosylation of the hemagglutinin modulates the sensitivity of H3N2 influenza viruses to innate proteins in airway secretions and virulence in mice. Virology 2011;413:84-92.
41.
Tate MD, Brooks AG, Reading PC: Specific sites of N-linked glycosylation on the hemagglutinin of H1N1 subtype influenza A virus determine sensitivity to inhibitors of the innate immune system and virulence in mice. J Immunol 2011;187:1884-1894.
42.
Qi L, Kash JC, Dugan VG, Jagger BW, Lau YF, Sheng ZM, Crouch EC, Hartshorn KL, Taubenberger JK: The ability of pandemic influenza virus hemagglutinins to induce lower respiratory pathology is associated with decreased surfactant protein D binding. Virology 2011;412:426-434.
43.
Job ER, Deng YM, Tate MD, Bottazzi B, Crouch EC, Dean MM, Mantovani A, Brooks AG, Reading PC: Pandemic H1N1 influenza A viruses are resistant to the antiviral activities of innate immune proteins of the collectin and pentraxin superfamilies. J Immunol 2010;185:4284-4291.
44.
Vigerust DJ, Ulett KB, Boyd KL, Madsen J, Hawgood S, McCullers JA: N-linked glycosylation attenuates H3N2 influenza viruses. J Virol 2007;81:8593-8600.
45.
Hawgood S, Brown C, Edmondson J, Stumbaugh A, Allen L, Goerke J, Clark H, Poulain F: Pulmonary collectins modulate strain-specific influenza a virus infection and host responses. J Virol 2004;78:8565-8572.
46.
Hartshorn KL, Webby R, White MR, Tecle T, Pan C, Boucher S, Moreland RJ, Crouch EC, Scheule RK: Role of viral hemagglutinin glycosylation in anti-influenza activities of recombinant surfactant protein D. Respir Res 2008;9:65.
47.
Das SR, Puigbo P, Hensley SE, Hurt DE, Bennink JR, Yewdell JW: Glycosylation focuses sequence variation in the influenza A virus H1 hemagglutinin globular domain. PLoS Pathog 2010;6:e1001211.
48.
Gamblin SJ, Haire LF, Russell RJ, Stevens DJ, Xiao B, Ha Y, Vasisht N, Steinhauer DA, Daniels RS, Elliot A, Wiley DC, Skehel JJ: The structure and receptor binding properties of the 1918 influenza hemagglutinin. Science 2004;303:1838-1842.
49.
Hillaire ML, van Eijk M, Nieuwkoop NJ, Vogelzang-van Trierum SE, Fouchier RA, Osterhaus AD, Haagsman HP, Rimmelzwaan GF: The number and position of N-linked glycosylation sites in the hemagglutinin determine differential recognition of seasonal and 2009 pandemic H1N1 influenza virus by porcine surfactant protein D. Virus Res 2012;169:301-305.
50.
Cohen J: Swine flu pandemic. What's old is new: 1918 virus matches 2009 H1N1 strain. Science 2010;327:1563-1564.
51.
Chen W, Sun S, Li Z: Two glycosylation sites in H5N1 influenza virus hemagglutinin that affect binding preference by computer-based analysis. PLoS One 2012;7:e38794.
52.
Hartshorn KL, Crouch EC, White MR, Colamussi ML, Kakkanatt A, Tauber B, Shepherd V, Sastry KN: Pulmonary surfactant proteins A and D enhance neutrophil uptake of bacteria. Am J Physiol 1998;274:L958-L969.
53.
Cai GZ, Griffin GL, Senior RM, Longmore WJ, Moxley MA: Recombinant SP-D carbohydrate recognition domain is a chemoattractant for human neutrophils. Am J Physiol 1999;276:L131-L136.
54.
Fournier B, Andargachew R, Robin AZ, Laur O, Voelker DR, Lee WY, Weber D, Parkos CA: Surfactant protein D (Sp-D) binds to membrane-proximal domain (D3) of signal regulatory protein alpha (SIRPalpha), a site distant from binding domain of CD47, while also binding to analogous region on signal regulatory protein beta (SIRPbeta). J Biol Chem 2012;287:19386-19398.
55.
Hartshorn KL, Reid KBM, White MR, Jensenius JC, Morris SM, Tauber AI, Crouch EC: Neutrophil deactivation by influenza A viruses: mechanisms of protection after viral opsonization with collectins and hemagglutination-inhibiting antibodies. Blood 1996;87:3450-3461.
56.
White MR, Crouch E, Vesona J, Tacken PJ, Batenburg JJ, Leth-Larsen R, Holmskov U, Hartshorn KL: Respiratory innate immune proteins differentially modulate the neutrophil respiratory burst response to influenza A virus. Am J Physiol Lung Cell Mol Physiol 2005;289:L606-L616.
57.
White MR, Tecle T, Crouch EC, Hartshorn KL: Impact of neutrophils on antiviral activity of human bronchoalveolar lavage fluid. Am J Physiol Lung Cell Mol Physiol 2007;293:L1293-L1299.
58.
Hartshorn KL, White MR, Tecle T, Holmskov U, Crouch EC: Innate defense against influenza A virus: activity of human neutrophil defensins and interactions of defensins with surfactant protein D. J Immunol 2006;176:6962-6972.
59.
Ohya M, Nishitani C, Sano H, Yamada C, Mitsuzawa H, Shimizu T, Saito T, Smith K, Crouch E, Kuroki Y: Human pulmonary surfactant protein D binds the extracellular domains of Toll-like receptors 2 and 4 through the carbohydrate recognition domain by a mechanism different from its binding to phosphatidylinositol and lipopolysaccharide. Biochemistry 2006;45:8657-8664.
60.
Yamazoe M, Nishitani C, Takahashi M, Katoh T, Ariki S, Shimizu T, Mitsuzawa H, Sawada K, Voelker DR, Takahashi H, Kuroki Y: Pulmonary surfactant protein D inhibits lipopolysaccharide (LPS)-induced inflammatory cell responses by altering LPS binding to its receptors. J Biol Chem 2008;283:35878-35888.
61.
Imai Y, Kuba K, Neely GG, Yaghubian-Malhami R, Perkmann T, van Loo G, Ermolaeva M, Veldhuizen R, Leung YH, Wang H, Liu H, Sun Y, Pasparakis M, Kopf M, Mech C, Bavari S, Peiris JS, Slutsky AS, Akira S, Hultqvist M, Holmdahl R, Nicholls J, Jiang C, Binder CJ, Penninger JM: Identification of oxidative stress and Toll-like receptor 4 signaling as a key pathway of acute lung injury. Cell 2008;133:235-249.
62.
Kongchanagul A, Suptawiwat O, Boonarkart C, Kitphati R, Puthavathana P, Uiprasertkul M, Auewarakul P: Decreased expression of surfactant protein D mRNA in human lungs in fatal cases of H5N1 avian influenza. J Med Virol 2011;83:1410-1417.
63.
Wang J, Nikrad MP, Phang T, Gao B, Alford T, Ito Y, Edeen K, Travanty EA, Kosmider B, Hartshorn K, Mason RJ: Innate immune response to influenza A virus in differentiated human alveolar type II cells. Am J Respir Cell Mol Biol 2011;45:582-591.
64.
van Eijk M, Haagsman HP, Skinner T, Archibold A, Reid KBM, Lawson PR: Porcine lung surfactant protein D: complementary DNA cloning, chromosomal localization, and tissue distribution. J Immunol 2000;164:1442-1450.
65.
van Eijk M, van de Lest CHA, Batenburg JJ, Vaandrager AB, Meschi J, Hartshorn KL, van Golde LMG, Haagsman HP: Porcine surfactant protein D is N-glycosylated in its carbohydrate recognition domain and is assembled into differently charged oligomers. Am J Respir Cell Mol Biol 2002;26:739-747.
66.
van Eijk M, White MR, Batenburg JJ, Vaandrager AB, van Golde LM, Haagsman HP, Hartshorn KL: Interactions of influenza A virus with sialic acids present on porcine surfactant protein D. Am J Respir Cell Mol Biol 2004;30:871-879.
67.
van Eijk M, Rynkiewicz MJ, White MR, Hartshorn KL, Zou X, Schulten K, Luo D, Crouch EC, Cafarella TR, Head JF, Haagsman HP, Seaton BA: A unique sugar-binding site mediates the distinct anti-influenza activity of pig surfactant protein D. J Biol Chem 2012;287:26666-26677.
68.
Ma W, Lager KM, Vincent AL, Janke BH, Gramer MR, Richt JA: The role of swine in the generation of novel influenza viruses. Zoonoses Public Health 2009;56:326-337.
69.
de Jong JC, Palache AM, Beyer WE, Rimmelzwaan GF, Boon AC, Osterhaus AD: Haemagglutination-inhibiting antibody to influenza virus. Dev Biol (Basel) 2003;115:63-73.
70.
de Jong JC, Smith DJ, Lapedes AS, Donatelli I, Campitelli L, Barigazzi G, Van Reeth K, Jones TC, Rimmelzwaan GF, Osterhaus AD, Fouchier RA: Antigenic and genetic evolution of swine influenza A (H3N2) viruses in Europe. J Virol 2007;81:4315-4322.
71.
Zhang M, Gaschen B, Blay W, Foley B, Haigwood N, Kuiken C, Korber B: Tracking global patterns of N-linked glycosylation site variation in highly variable viral glycoproteins: HIV, SIV, and HCV envelopes and influenza hemagglutinin. Glycobiology 2004;14:1229-1246.
72.
Igarashi M, Ito K, Kida H, Takada A: Genetically destined potentials for N-linked glycosylation of influenza virus hemagglutinin. Virology 2008;376:323-329.
73.
van Riel D, den Bakker MA, Leijten LM, Chutinimitkul S, Munster VJ, de Wit E, Rimmelzwaan GF, Fouchier RA, Osterhaus AD, Kuiken T: Seasonal and pandemic human influenza viruses attach better to human upper respiratory tract epithelium than avian influenza viruses. Am J Pathol 2010;176:1614-1618.
74.
Botas C, Poulain F, Akiyama J, Brown C, Allen L, Goerke J, Clements JA, Carlson E, Gillespie AM, Epstein C, Hawgood S: Altered surfactant homeostasis and alveolar type II cell morphology in mice lacking surfactant protein D. Proc Natl Acad Sci USA 1998;95:11869-11874.
75.
Zhang L, Hartshorn KL, Crouch EC, Ikegami M, Whitsett JA: Complementation of pulmonary abnormalities in SP-D (-/-) mice with a SP-D/conglutinin fusion protein. J Biol Chem 2002;277:22453-22459.
76.
LeVine AM, Whitsett JA, Hartshorn KL, Crouch EC, Korfhagen TR: Surfactant protein D enhances clearance of influenza A virus from the lung in vivo. J Immunol 2001;167:5868-5873.
77.
Bright RA, Medina MJ, Xu X, Perez-Oronoz G, Wallis TR, Davis XM, Povinelli L, Cox NJ, Klimov AI: Incidence of adamantane resistance among influenza A (H3N2) viruses isolated worldwide from 1994 to 2005: a cause for concern. Lancet 2005;366:1175-1181.
78.
Deyde VM, Xu X, Bright RA, Shaw M, Smith CB, Zhang Y, Shu Y, Gubareva LV, Cox NJ, Klimov AI: Surveillance of resistance to adamantanes among influenza A(H3N2) and A(H1N1) viruses isolated worldwide. J Infect Dis 2007;196:249-257.
79.
World Health Organization: Influenza A (H1N1) Virus Resistance to Oseltamivir - 2008/2009 Influenza Season, Northern Hemisphere. Geneva, WHO, 2011.
80.
Hickling TP, Bright H, Wing K, Gower D, Martin SL, Sim RB, Malhotra R: A recombinant trimeric surfactant protein D carbohydrate recognition domain inhibits respiratory syncytial virus infection in vitro and in vivo. Eur J Immunol 1999;29:3478-3484.
81.
Crouch E, Nikolaidis N, McCormack FX, McDonald B, Allen K, Rynkiewicz MJ, Cafarella TM, White M, Lewnard K, Leymarie N, Zaia J, Seaton BA, Hartshorn KL: Mutagenesis of surfactant protein D informed by evolution and x-ray crystallography enhances defenses against influenza A virus in vivo. J Biol Chem 2011;286:40681-40692.
82.
Veldhuizen EJ, van Eijk M, Haagsman HP: The carbohydrate recognition domain of collectins. FEBS J 2011;278:3930-3941.
83.
Xu R, McBride R, Nycholat CM, Paulson JC, Wilson IA: Structural characterization of the hemagglutinin receptor specificity from the 2009 H1N1 influenza pandemic. J Virol 2012;86:982-990.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.