5). Within about one week, many of these cells become elongated and large. They stopped internalizing foreign materials regardless of the presence or absence of SP-D or GM-CSF (Figure 5). Some of the cells formed elongated fibers and connected with each other whereas others migrated to a common location and formed granulomatous structures. It is logical to consider that defective surfactant homeostasis [1-7,22-26,42,57-62,65-68], accumulation of dead/dying cells [30] and foamy macrophages [21,25,26,69], and increased granulomas [39] would reduce lung function in the patients with PAP and LPI. Here, SFTPD is linked to Granuloma.