Clinical and ultrastructural spectrum of diffuse lung disease associated with surfactant protein C mutations

Donatella Peca, Renata Boldrini, Jan Johannson, Joseph T. Shieh, Arianna Citti, Stefania Petrini, Teresa Salerno, Salvatore Cazzato, Raffaele Testa, Francesco Messina, Alfredo Onofri, Giovanna Cenacchi, Per Westermark, Nicola Ullman, Paola Cogo, Renato Cutrera, Olivier Danhaive

Research output: Contribution to journalArticlepeer-review


Genetic defects of surfactant metabolism are associated with a broad range of clinical manifestations, from neonatal respiratory distress syndrome to adult interstitial lung disease. Early therapies may improve symptoms but diagnosis is often delayed owing to phenotype and genotype variability. Our objective was to characterize the cellular/ultrastructural correlates of surfactant protein C (SP-C) mutations in children with idiopathic diffuse lung diseases. We sequenced SFTPC-the gene encoding SP-C-SFTPB and ABCA3, and analyzed morphology, ultrastructure and SP expression in lung tissue when available. We identified eight subjects who were heterozygous for SP-C mutations. Median age at onset and clinical course were variable. None of the mutations were located in the mature peptide-encoding region, but were either in the pro-protein BRICHOS or linker C-terminal domains. Although lung morphology was similar to other genetic surfactant metabolism disorders, electron microscopy studies showed specific anomalies, suggesting surfactant homeostasis disruption, plus trafficking defects in the four subjects with linker domain mutation and protein misfolding in the single BRICHOS mutation carrier in whom material was available. Immunolabeling studies showed increased proSP-C staining in all cases. In two cases, amyloid deposits could be identified. Immunochemistry and ultrastructural studies may be useful for diagnostic purposes and for genotype interpretation.

Original languageEnglish
Pages (from-to)1033-1041
Number of pages9
JournalEuropean Journal of Human Genetics
Issue number8
Publication statusPublished - Aug 21 2015

ASJC Scopus subject areas

  • Genetics(clinical)
  • Genetics


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