Barbara Pioselli*, Fabrizio Salomone, Giuseppe Mazzola, Davide Amidani, Elisa Sgarbi, Francesco Amadei, Xabi Murgia, Silvia Catinella, Gino Villetti, Daniele De Luca, Virgilio Carnielli and Maurizio Civelli Pages 526 - 590 ( 65 )
Pulmonary surfactant is a complex lipoprotein mixture secreted into the alveolar lumen by type 2 pneumocytes, which is composed by tens of different lipids (approximately 90% of its entire mass) and surfactant proteins (approximately 10% of the mass). It is crucially involved in maintaining lung homeostasis by reducing the values of alveolar liquid surface tension close to zero at end-expiration, thereby avoiding the alveolar collapse, and assembling a chemical and physical barrier against inhaled pathogens. A deficient amount of surfactant or its functional inactivation is directly linked to a wide range of lung pathologies, including the neonatal respiratory distress syndrome. This paper reviews the main biophysical concepts of surfactant activity and its inactivation mechanisms, and describes the past, present and future roles of surfactant replacement therapy, focusing on the exogenous surfactant preparations marketed worldwide and new formulations under development. The closing section describes the pulmonary surfactant in the context of drug delivery. Thanks to its peculiar composition, biocompatibility, and alveolar spreading capability, the surfactant may work not only as a shuttle to the branched anatomy of the lung for other drugs but also as a modulator for their release, leading to innovative therapeutic avenues for the treatment of several respiratory diseases.
Pulmonary surfactant, surface tension, respiratory distress syndrome, surfactant replacement therapy, exogenous surfactant preparations, drug delivery
Preclinical R&D, Chiesi Farmaceutici, Parma, Preclinical R&D, Chiesi Farmaceutici, Parma, Portfolio Management R&D, Chiesi Farmaceutici, Parma, Preclinical R&D, Chiesi Farmaceutici, Parma, Preclinical R&D, Chiesi Farmaceutici, Parma, Preclinical R&D, Chiesi Farmaceutici, Parma, Department of Biotechnology, GAIKER Technology Centre, Zamudio, Preclinical R&D, Chiesi Farmaceutici, Parma, Preclinical R&D, Chiesi Farmaceutici, Parma, Division of Pediatrics and Neonatal Critical Care, Antoine Béclère Medical Center, APHP, South Paris University Hospitals, Paris, France; Physiopathology and Therapeutic Innovation Unit-U999, South Paris-Saclay University, Paris, Division of Neonatology, G Salesi Women and Children’s Hospital, Polytechnical University of Marche, Ancona, Preclinical R&D, Chiesi Farmaceutici, Parma