Pulmonary Surfactant: A Unique Biomaterial with Life-saving Therapeutic
Applications

Barbara       Pioselli; Fabrizio       Salomone; Giuseppe       Mazzola; Davide       Amidani; Elisa       Sgarbi; Francesco       Amadei; Xabi       Murgia; Silvia       Catinella; Gino       Villetti; Daniele       De Luca; Virgilio       Carnielli; Maurizio       Civelli
Abstract

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.
Keywords: Pulmonary surfactant, surface tension, respiratory distress syndrome, surfactant replacement therapy, exogenous surfactant preparations, drug delivery
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DOI https://dx.doi.org/10.2174/0929867328666210825110421	Print ISSN 0929-8673
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