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Review Question - QID 106485

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QID 106485 (Type "106485" in App Search)
A 67-year-old man is hospitalized after several days of fever and increasing shortness of breath. Respiratory viral panel returns positive for influenza A and the patient is started on a standard five day course of oseltamivir. Despite therapy, his shortness of breath continues to worsen and his oxygen saturation decreases to the point where ICU transfer and intubation are required. Chest radiograph shows bilateral infiltrates. Clinical criteria are consistent with development of Acute Respiratory Distress Syndrome (ARDS). After several weeks of supportive therapy, the patient improves with lung function returning to near normal. Which of the following processes is involved in the regeneration of alveolar lining after damage to alveoli occurs?

Squamous cell proliferation

2%

4/167

Sweeping of debris out of the alveoli by ciliated cells

2%

3/167

Excess mucus production by goblet cells

1%

2/167

Proliferation of surfactant-secreting cells

88%

147/167

Proliferation of club cells

5%

8/167

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Type II pneumocytes are cuboidal, surfactant-secreting cells that are responsible for the regeneration of alveolar lining following injury.

Gas exchange in the lung takes place primarily in the alveoli. Type I pneumocytes are squamous cells that line the alveoli, comprising 97% of alveolar surfaces. Type II pneumocytes are cuboidal cells that secrete pulmonary surfactant, decreasing alveolar surface tension and preventing airway collapse. Type II pneumocytes proliferate following lung damage to form new type I and type II pneumocytes. (See Illustration A)

Sanguil and Fargo describe the role of type I and type II pneumocytes in the pathophysiology of ARDS. In ARDS, the release of inflammatory mediators within the lung results in the destruction of the type I and type II cells, compromising the integrity of the alveolar lining and leading to decreased surfactant release. Damage to the surrounding vasculature with vessel leakage also occurs, resulting in pulmonary edema. After the insult, type II cells proliferate, reconstituting the alveolar lining. The reconstitution of the alveolar lining is essential for the removal of fluid and debris from the alveoli and return of lung function.

Castranova et al. review the structure and function of alveolar type II pneumocytes. While type II cells cover less than 5% of the alveolar surface, they actually comprise 60% of all alveolar epithelial cells. In addition to forming and secreting surfactant and regenerating alveolar epithelium, type II pneumocytes also play an important role in transepithelial fluid movement and toxin metabolism within the lung.

Illustration A shows type I pneumocytes and type II pneumocytes in the respiratory epithelium. Illustration B shows the branching of a lobular bronchiole into terminal and respiratory bronchioles.

Incorrect Answers:
Answer 1: Type I pneumocytes are squamous cells that comprise the majority of alveolar surfaces but do not proliferate following alveolar injury.
Answer 2: Alveolar cells are non-ciliated. Ciliated cells extend to the end of terminal bronchioles (see Illustration B).
Answer 3: Mucus-producing goblet cells are not present in the alveoli. Goblet cells extend to the end of bronchi where lobular bronchioles branch (see Illustration B).
Answer 5: Club cells (formerly Clara cells) act as reserve cells and do not proliferate following alveolar injury.

ILLUSTRATIONS:
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