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Fibroblast-pneumonocyte factor, produced by the fetal lung fibroblast in response to glucocorticoids, was partially purified by column chromatography on Sephadex G-75. The resulting preparation showed two major and two minor bands on sodium dodecylsulfate-polyacrylamide gel electrophoresis. When fetal rats were injected on day 17 of gestation with 1 microgram of this material, they showed on day 20 biochemical evidence of accelerated lung maturation as compared to littermate controls. There were no differences between the two groups in body weights, organ weights, or circulating corticosteroid levels.

The prenatal and postnatal therapeutic management of surfactant insufficiency are reviewed. Prenatal maternal glucocorticoid therapy promotes lung maturation and enhances lung surfactant levels in the neonate, but a minimum of 24 hr treatment is required and the therapy is of limited effectiveness even under optimal conditions. Relatively few women in premature labour are good candidates for glucocorticoid therapy. Research into combinations of glucocorticoids with hormones (e.g. thyroid), and adrenergic agents in progress. The authors are studying the effects of fibroblast-pneumonocyte factor (FPF) on the fetal lung surfactant system. Postnatal therapy with insufflated natural and artificial surfactants has been studied in several centres with varying degrees of success. Currently, the risk:benefit ratios favour attempts to reduce the risks of respiratory distress syndrome (RDS) by both prenatal surfactant induction and postnatal replacement therapy. Greater understanding of the underlying mechanisms should permit the establishment of more satisfactory treatment.

Alveolar type II cells that were isolated from organotypic cultures of fetal rat lung and maintained in primary monolayer culture were analyzed. Morphologically the cells retained many characteristics of type II cells in vivo. Biochemical analysis revealed that the cells contained and synthesized phosphatidylcholine with a high degree of saturation. Furthermore, the cells released saturated phosphatidylcholine and responded to adrenergic stimulation with increased release. The type II cells retained their ability to proliferate and responded to fibroblast-pneumonocyte factor. These data indicate that primary cultures of fetal type II cells will be useful to elucidate mechanisms modulating type II cell proliferation, surfactant synthesis, and surfactant secretion.

The effect of fibroblast-pneumonocyte factor on the formation of surfactant-associated phospholipids was studied in fetal rat lung type II cells in primary culture. Exposure of the cells to fibroblast-pneumonocyte factor enhanced the incorporation of radioactively labelled choline, glycerol and palmitate into total and saturated phosphatidylcholine. Fibroblast-pneumonocyte factor also stimulated the formation of phosphatidylglycerol from labelled glycerol and palmitate but did not significantly affect the synthesis of the other phospholipids. This indicates that fibroblast-pneumonocyte factor specifically stimulates the production of surfactant lipids in fetal lung.

A simplified, single-step shake test has been performed on gastric aspirate samples from 85 preterm infants and a control group of 214 term infants. Respiratory symptoms were seen in 25 of 30 preterm infants with a negative or intermediate test, but in only 2 of 55 infants with a positive test (P less than 0-001). No infant with a positive test developed respiratory distress syndrome (RDS) while RDS developed in 66% of those preterm infants with a negative test. False-negative results were not seen in the preterm group. The gastric aspirate shake test had better sensitivity and selectivity in prediction of clinical outcome than did the amniotic fluid lecithin/sphingomyelin ratio in 37 preterm infants in whom both results were available. Serial shake tests were performed on samples from a number of infants with RDS and the results were seen to change in parallel with clinical recovery. This and other observations suggest that the result of the gastric aspirate shake test depends more upon direct swallowing of fetal lung liquid than on swallowing of amniotic fluid.

Mice with different histocompatibility alleles in otherwise identical backgrounds (congenic inbred strains of H-2a and H-2b haplotypes), were used to study the possible influence of the major histocompatibility complex (MHC) upon glucocorticoid-stimulated pulmonary surfactant synthesis during embryonic and fetal stages of mouse lung development. Pregnant C57BL/10SnJ (H-2b) and congenic B10.A/SnSgJ (H-2a) mice were administered single or consecutive intraperitoneal injections of betamethasone during the period of 14 through 17 days gestation. Assays for incorporation of [3H]choline into total lipid and saturated phosphatidylcholine (an index for pulmonary surfactant synthesis) were conducted, 24 hr following the last treatment, on Days 17 or 18 of gestation. Control mice received injections of phosphate-buffered saline. The H-2 genotype appears to influence the relative responsiveness of glucocorticoid-stimulated surfactant synthesis during fetal lung development. The B10.A strain (H-2a haplotype) was more responsive to glucocorticoid-stimulated pulmonary surfactant synthesis than the H-2b haplotype. Whereas both strains were responsive to glucocorticoid-stimulated [3H]choline incorporation into lung surfactant, the differences in responsiveness at specific fetal stages suggest that genes within or closely linked to the H-2 complex might have a role in pulmonary surfactant biosynthesis during mouse lung development. The results also suggest the possibility that relative susceptibility to congenital pulmonary disorders may be influenced by the H-2 complex.

During lung development type II alveolar epithelial cells produce extracellular pulmonary surfactant. Polyclonal antibodies were produced against nonserum proteins associated with human surfactant. The present studies were designed (i) to determine if mouse surfactant proteins were antigenically cross-reactive with polyclonal antibodies directed against human surfactant proteins; and (ii) to determine surfactant protein localization during fetal, neonatal, and adult mouse lung development. Two-dimensional gel electrophoresis studies in conjunction with immunologic techniques provided evidence that mouse and human surfactant proteins shared antigenic determinants. The major monomeric form of mouse surfactant protein in a glycoprotein of approximately Mr 35,000 under reducing conditions. A less abundant form was identified as a Mr 45,000 polypeptide. Immunohistochemical localization showed that type II cells contain surfactant protein at Theiler stage 26. A gradient of immunostaining was localized within alveolar surfaces. The antigen was not detected in heart, blood vessels, or pulmonary interstitial cells. Surfactant protein was detected lining alveolar surfaces in mature adult lung. The distribution of this protein during fetal and neonatal lung morphogenesis suggests that this extracellular constituent of pulmonary surfactant may be extremely useful as a phenotypic marker with which to evaluate normal and abnormal lung development.