Reviewer #2 (Public review):
Summary:
In this manuscript, Porras-Gómez et al. analyse the lipid composition and biophysical properties of pulmonary surfactant obtained by bronchoalveolar lavage (BAL) from a group of bottlenose dolphins (Tursiops truncatus), including two healthy individuals and five affected by pneumonia. Through lipidomic analysis, the authors report an exacerbated presence of cardiolipin species in the BAL lipid extracts from diseased dolphins compared to healthy ones. Structural analyses using electron microscopy, atomic force microscopy, and X-ray scattering on rehydrated membrane samples reveal that lipids from diseased animals form membranes with a more pronounced Lβ phase and reduced fluidity. Moreover, the membranes from affected lungs appear more interconnected and less hydrated, as indicated by the X-ray scattering data. These findings provide valuable and convincing insights into how pulmonary disease alters the lipid composition and structural properties of surfactant in diving mammals, and may have broader implications for understanding surfactant dysfunction in marine mammals.
Strengths:
The study is well designed, and the experimental techniques were applied in a logical and coherent manner. The results are thoroughly analysed and discussed, and the manuscript is clearly written and well organized, making it both easy to follow and scientifically robust. Although the number of samples is limited, the rarity and logistical challenges of obtaining bronchoalveolar lavage material, particularly from animals affected by respiratory disease, make this study especially valuable and relevant.
Weaknesses:
In my opinion, the main issue lies in the treatment of the samples. Pulmonary surfactant is a lipoprotein complex produced by type II pneumocytes of the alveolar epithelium in the form of compact and highly dehydrated structures known as tubular myelin. Once secreted, these structures unfold and, upon contact with the air-liquid interface, form an interfacial monolayer connected to surfactant membranes in the subphase, thereby facilitating respiratory dynamics throughout the breathing cycle.
When bronchoalveolar lavages are treated using the Bligh and Dyer method to extract the hydrophobic fraction of these samples, the structural complexity of the surfactant is disrupted, and this organization cannot be completely restored once the lipids are rehydrated. Although these extracts contain the hydrophobic proteins SP-B and SP-C, the hydrophilic protein SP-A may play an essential role in the formation of pulmonary surfactant structures. It is well established that SP-A is crucial for the formation of tubular myelin, an intermediate structure between the lamellar bodies newly secreted by type II cells and the interfacial surfactant layers.
Moreover, and more importantly, bronchoalveolar lavage fluid may contain cells, tissue debris, and even bacteria that can alter the lipid composition of the samples used in the study after extraction by the Bligh and Dyer method. For this reason, most studies include a density gradient centrifugation step to isolate the surfactant membranes. Consequently, the samples used may be contaminated with phospholipids originating from other cells, such as macrophages, pneumocytes, or bacterial cells, particularly in lavages obtained from diseased animals.
Although the techniques employed provide valuable information about the behaviour of surfactant membranes and allow certain inferences regarding their functionality, no functional studies of these samples have been conducted using methods such as the constrained drop surfactometer or the captive bubble surfactometer. The observed alterations do not necessarily demonstrate that surfactant modulates its properties, as claimed by the authors, but rather indicate that it is altered by the presence of other lipids.
The spin-coating technique used to form lipid films for analysis by atomic force microscopy is not the most suitable approach to reproduce the structures generated by pulmonary surfactant. However, the results obtained may still provide valuable insights into the biophysical behaviour of its components. The analysis of lung tissue shown in Supplementary Figure S3 presents the same limitation, as the samples were embedded in a cutting compound, and the measurements may have been taken from different regions of the tissue. Therefore, it cannot be ensured that the analysed structures correspond to those generated by pulmonary surfactant.
The finding that the structures formed in samples obtained from diseased animals are more tightly packed and dehydrated than those derived from the surfactant of healthy animals contrasts with the notion that the high efficiency of lamellar bodies in generating interfacial structures is related to their high degree of packing and dehydration. The formation of these structures involves the participation of the ABCA3 protein, which pumps phospholipids into the interior of lamellar bodies, and SP-B, which facilitates the formation of close membrane contacts.
While the results are interesting from a comparative perspective, the implications for surfactant performance and respiratory dynamics should be interpreted with caution.