SURFACTANT

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 PRESENTATION OUTLINE
➢ Overview of Surfactant
➢ Definition and source of secretion
➢ Structure and Composition
➢ Formation of Surfactant
➢ Requirement for its synthesis
➢ Functions
➢ Clinical correlation

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 ➢ Overview of Surfactant

❖ Surfactant is a complex mixture of phospholipids (PL) and

proteins (SP) that reduce surface tension at the air-liquid
interface of the alveolus, thus preventing its collapse during
end-exhalation.
❖ It also participates in innate host defense against inhaled
pathogens
❖ When water forms a surface with water, the water molecules
on the surface of the water have strong attraction for one
another. As a result, water surface is always attempting to
contract. This is what holds raindrops together.
❖ On the inner surfaces of the alveoli the water surface is also
attempting to contract, tending to force air out of the alveoli
through the bronchi causing collapse.
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➢ DEFINITION AND SOURCE OF SECRETION

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➢ Pulmonary Surfactant Structure and Its Composition

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➢ Pulmonary Surfactant Structure and Its Composition

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➢ Pulmonary Surfactant Structure and Its Composition

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➢ Pulmonary Surfactant Structure and Composition

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 ➢ Pulmonary Surfactant Structure and Its Composition

1. Lipids: 90%
•Dipalmitoylphosphatidylcholine (62%)
•Phosphatidylglycerol (5%)
•Other phospholipids (10%)
•Neutral lipids (13%)

2. Proteins: 8%
•Albumin
•Immunoglobulin A (IgA)
•Apoproteins (SP-A, -B, -C, - D)

3. Carbohydrates: 2%

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➢ Regulation of Synthesis and Secretion

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➢ Regulation of Synthesis and Secretion

● Surfactant synthesis is regulated by hormones,

● Concentration of protein in the surfactant,
● Stretching of lung and
● Various pharmacological agents.

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 A. Hormonal factors
1. Glucocorticoid hormones: Cortisol stimulates surfactant synthesis.
Secretion of glucocorticoids increases
toward term. Number of glucocorticoid receptors in
lungs also increases in third trimester of pregnancy.

2. Thyroxine: Thyroxine promotes surfactant synthesis.

Maternal thyroid deficiency and cretinism decrease
surfactant secretion.

3. Insulin: Insulin facilitates surfactant synthesis. Therefore, diabetes

during pregnancy decreases surfactant secretion
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B. Quantity and quality of proteins in surfactant
Formation of phospholipid film of surfactant is greatly
facilitated by proteins present in the surfactant. Surfactant
proteins are albumin, immunoglobulin (IgA) and apoproteins (surfactant
proteins).

1. There are 4 types of surfactant proteins (SP): SP-A,

SP-B, SP-C, and SP-D. SP-B and SP-C control synthesis
of monomolecular film of phospholipid.

2. SP-A controls reuptake of surfactant by type II cells.

3. The protein content of surfactant depends on concen

tration of protein in the plasma. 13
C. Stretching of lungs
•Hyperinflation of lungs like yawning enhances surfactant synthesis.
Yawning and sighing during infancy are effective stimuli for surfactant synthesis.

D. Pharmacological agents
• β adrenergic agonists enhance surfactant secretion
• Calcium stimulates surfactant secretion.

E. Exercise
Practice of regular physical exercise stimulates surfactant
synthesis in both children and adults.
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➢ Formation of Surfactant

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➢ Synthesis and Secretion

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➢ Functions of Surfactant

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➢ Functions of Surfactant

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➢ Functions of Surfactant

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➢ Mechanism of Surfactant

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➢ Mechanism of Surfactant

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 ➢ Clinical correlation

1. Infant respiratory distress syndrome: After birth, the newborn makes

strong inspiratory effort so that the lungs expand. Surfactant helps in lung
inflation and prevents collapse of expanded lung.
• Lung maturation is incomplete in premature infants.
• Also, hormonal disturbances like diabetes during pregnancy interfere
with lung maturation.
• In such conditions, due to lack of surfactant synthesis, lung expansion
becomes difficult after birth. Breathing becomes extremely labored due to
high surface tension.
It becomes difficult to inflate lungs.
•This is called infant respiratory distress syndrome (IRDS) or
hyaline membrane disease. Pulmonary edema and atelectasis develop due
to high surface tension.

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 ➢ Clinical correlation

● Administration of phospholipid by inhalation

● Inhalation of synthetic surfactant (or a surfactant

preparation derived from bovine lungs)

● Glucocorticoid therapy (glucocorticoid promotes

surfactant synthesis)

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 ➢ Clinical correlation

2. Atelectasis following surgery: During deep breathing,

the lungs inflate to a larger volume and new
surfactant molecules spread thoroughly on the alveolar surface, whereas,
during shallow breathing,
the spreading of surfactant is impaired.

● Therefore, patients recovering from anesthesia after surgery

are often encouraged to breathe deeply to enhance
the proper spreading of surfactant on the alveolar
surface.

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➢ Clinical correlation

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➢ Clinical correlation

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References: “To obey is better
1. Guyton and Hall Textbook of
Medical Physiology (Guyton
than sacrifice, and
Physiology) 13th Edition to heed is better
by John E. Hall PhD (Author)
than the fat of rams.”
2. Medical Physiology for
1 Samuel 15:22
Undergraduate Students 1st
edition (January 1, 2011) –
January 1, 2011
by KHURANA (Author)

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