Composition, structure and mechanical properties define performance of pulmonary surfactant membranes and films

• Alveolar stability along the respiratory cycles is ensured by the special mechanics of pulmonary surfactant layers.
• A whole network of interconnected membranes between the interfacial monolayer and reservoirs provides stability.
• Its unique lipid–protein composition determines surfactant mechanics.
• The effect of membrane-associated proteins SP-A, SP-B and SP-C and cholesterol content are crucial in surfactant mechanics.
• Surfactant deficiencies or inactivation are responsible for different respiratory dysfunctions and pathologies.

The respiratory surface in the mammalian lung is stabilized by pulmonary surfactant, a membrane-based system composed of multiple lipids and specific proteins, the primary function of which is to minimize the surface tension at the alveolar air–liquid interface, optimizing the mechanics of breathing and avoiding alveolar collapse, especially at the end of expiration. The goal of the present review is to summarize current knowledge regarding the structure, lipid–protein interactions and mechanical features of surfactant membranes and films and how these properties correlate with surfactant biological function inside the lungs. Surfactant mechanical properties can be severely compromised by different agents, which lead to surfactant inhibition and ultimately contributes to the development of pulmonary disorders and pathologies in newborns, children and adults. A detailed comprehension of the unique mechanical and rheological properties of surfactant layers is crucial for the diagnostics and treatment of lung diseases, either by analyzing the contribution of surfactant impairment to the pathophysiology or by improving the formulations in surfactant replacement therapies. Finally, a short review is also included on the most relevant experimental techniques currently employed to evaluate lung surfactant mechanics, rheology, and inhibition and reactivation processes.

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