The Role of Surface in the Pathogenesis and Treatment of COVID-19

Round 1

Reviewer 1 Report

This hypothesis paper contributes to the discussion of the  the COVID-19 patho-mechanism. The potentially essential role of Surfactant Protein-D in the host immune defense to respiratory inflammation and infections has been researched and discussed in the past two decades. The SARS-Cov-2 infection triggered the research of SP-D in that condition too. There is one clinical study with rhSP-D in Covid-19 running right now.

 

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 2 Report

Dear authors

Please consider the following comments when revising the manuscript.

Lines 28-32. This part should be rewritten in a correct and concise style. 

Line 31. "And because SARS-CoV-2 is a virus naïve to 31 man [8], that defense must be innate."

What do you mean by this sentence that should be corrected. 

Lines 45-46. "it appears COVID-19 is a disease process limited primarily to the pulmonary epithelial surface."

Although I do not agree totally with the authors, I think this conclusion should be further justified and explained. 

Lines 60-61.   "Given both the dose dependence and the certain existence of an innate defense, symptomatic SARS-CoV-2 infection must be a consequence of a viral dose that exceeds temporally the capacity of the innate defense."

This should be further developed and justified using references. 

Lines 62 -64. "And because available evidence suggests symptomatic COVID-19 involves engagement of TLR4 on pulmonary epithelium, the innate defense operating to prevent engagement likely involves an effector native to the pulmonary epithelial surface."

I did not understand the relationship and how this conclusion was achieved?This should be further clarified. 

Lines 76-98. Although I understand that higher serum SP-D level are considered as potential biomarker for the severity of COVID-19, the relationships you gave in this part should be further clarified and the text should be corrected and rewritten in a direct and concise style. 

The closing notes should be revised. Please avoid conclusions not discussed or referenced. 

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Round 2

Reviewer 2 Report

Dear authors

Many thanks for the answers