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. 1992;70(8):637–657. doi: 10.1007/BF00180279

The surfactant system of the adult lung: physiology and clinical perspectives

H Hamm 1, H Fabel 1, W Bartsch 3
PMCID: PMC7095985  PMID: 1392439

Summary

Pulmonary surfactant is synthesized and secreted by alveolar type II cells and constitutes an important component of the alveolar lining fluid. It comprises a unique mixture of phospholipids and surfactant-specific proteins. More than 30 years after its first biochemical characterization, knowledge of the composition and functions of the surfactant complex has grown considerably. Its classically known role is to decrease surface tension in alveolar air spaces to a degree that facilitates adequate ventilation of the peripheral lung. More recently, other important surfactant functions have come into view. Probably most notable among these, surfactant has been demonstrated to enhance local pulmonary defense mechanisms and to modulate immune responses in the alveolar milieu. These findings have prompted interest in the role and the possible alterations of the surfactant system in a variety of lung diseases and in environmental impacts on the lung. However, only a limited number of studies investigating surfactant changes in human lung disease have hitherto been published. Preliminary results suggest that surfactant analyses, e.g., from bronchoalveolar lavage fluids, may reveal quantitative and qualitative abnormalities of the surfactant system in human lung disorders. It is hypothesized that in the future, surfactant studies may become one of our clinical tools to evaluate the activity and severity of peripheral lung diseases. In certain disorders they may also gain diagnostic significance. Further clinical studies will be necessary to investigate the potential therapeutic benefits of surfactant substitution and the usefulness of pharmacologic manipulation of the secretory activity of alveolar type II cells in pulmonary medicine.

Key words: Pulmonary surfactant, Phospholipids, Surfactant proteins, Alveolar stability, Air pollution, Pulmonary defense, Adult respiratory distress syndrome, Surfactant therapy, Bronchoalveolar lavage

Abbreviations

PC

phospatidyleholine

DPPC

dipalmitoylphosphatidylcholine

PG

phosphatidylglycerol

PI

phosphatidylinositol

SP-A, SP-B SP-C, SP-D

surfactant-specific proteins A, B, C, and D

ARDS

adult respiratory distress syndrome

IRDS

infant respiratory distress syndrome

BAL

bronchoalveolar lavage

IPF

idiopathic pulmonary fibrosis

HP

hypersensitivity pneumonitis

DIPD

drug-induced pulmonary disease

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