The Pulmonary Surfactant System: Biochemical and Clinical Aspects
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© Springer-Verlag New York Inc. 1997
Review The Pulmonary Surfactant System: Biochemical and Clinical Aspects L. A. J. M. Creuwels, L. M. G. van Golde, and H. P. Haagsman Laboratory of Veterinary Biochemistry, Utrecht University, P.O. Box 80176, 3508 TD Utrecht, The Netherlands
Abstract. This article starts with a brief account of the history of research on pulmonary surfactant. We will then discuss the morphological aspects and composition of the pulmonary surfactant system. We describe the hydrophilic surfactant proteins A and D and the hydrophobic surfactant proteins B and C, with focus on the crucial roles of these proteins in the dynamics, metabolism, and functions of pulmonary surfactant. Next we discuss the major disorders of the surfactant system. The final part of the review will be focused on the potentials and complications of surfactant therapy in the treatment of some of these disorders. It is our belief that increased knowledge of the surfactant system and its functions will lead to a more optimal composition of the exogenous surfactants and, perhaps, widen their applicability to treatment of surfactant disorders other than neonatal respiratory distress syndrome. Key words: Surfactant protein—Pulmonary surfactant—Respiratory distress syndrome. History Research on surfactant goes back to 1929 when von Neergaard published the first paper about the difference in pressure needed to inflate lungs with air or with liquid [333]. He found that the pressure necessary for filling the lungs with air was higher than when the lungs were filled with liquid. To explain this result he stated that the alveoli were stabilized by lowering the naturally high surface tension of the air/water interface. In 1946 Thannhauser and co-workers reported that lung tissue has a remarkably high content of the lipid dipalmityl lecithin (current name, dipalmitoylphosphatidylcholine) Offprint requests to: Henk P. Haagsman. Abbreviations: DPPC, dipalmitoylphosphatidylcholine; PG, phosphatidylglycerol; RDS, respiratory distress syndrome; SP-A, SP-B, SP-C, and SP-D, surfactant protein A, B, C, and D; PC, phosphatidylcholine; PE, phosphatidylethanolamine; PI, phosphatidylinositol; PS, phosphatidylserine; CRD, carbohydrate recognition domain; LPS, lipopolysaccharide; HIV, human immunodeficiency virus; ALTE, apparent lifethreatening events; SIDS, sudden infant death syndrome; PEEP, positive end-expiratory pressure.
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[307]. At that time no connection was made between the high content of this lipid and stabilization of the alveoli. Nine years later, in 1955, Pattle proposed that bubbles, made of lung fluid material, obtained their stability through the quantity and quality of the surface-active material [246]. Subsequently, Clements showed, with the help of a modified surface balance, that surface tension dropped to low values upon compression of surface films from lung extracts [41]. This was followed by a theoretical attempt to clarify the role of surfactant in the structural stability of the lung [42]. It wa
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