Torday, J. S., and V. K. Rehan. Stretch-stimulated surfactant synthesis is coordinated by the paracrine actions of PTHrP and leptin. Am J Physiol Lung Cell Mol Physiol 283: L130-L135, 2002. First published February 22, 2002; 10.1152/ajplung.00380.2001.-Intrauterine lung development, culminating in physiological pulmonary surfactant production by epithelial type II (TII) cells, is driven by fluid distension through unknown mechanisms. Differentiation of alveolar epithelial and mesenchymal cells is mediated by soluble factors like parathyroid hormone-related protein (PTHrP), a stretch-sensitive TII cell product. PTHrP stimulates pulmonary surfactant production by a paracrine feedback loop mediated by leptin, a soluble product of the mature lipofibroblast (LF). When LFs and TIIs are stretched in coculture, there is a fivefold increase in surfactant phospholipid synthesis that can be "neutralized" by inhibitors of PTHrP or leptin, implicating a paracrine feedback loop in this mechanism. Stretching LFs stimulates PTHrP binding (2.5-fold) and downstream stimulation of triglyceride uptake quantitatively (15-25%) due to upregulation of adipose differentiation-related protein expression. Stretching TII cells increases leptin stimulation of their surfactant phospholipid synthesis threefold, suggesting that retrograde signaling by leptin to TII cells is also stretch sensitive. We conclude that the effect of stretch on alveolar LF and TII differentiation is coordinated by PTHrP, leptin, and their receptors.lipofibroblast; parathyroid hormone-related protein; leptin; adipose differentiation-related protein INTRAUTERINE LUNG DEVELOPMENT is driven by lung fluid secretion, which distends the alveolar acinus, forming a "bubblelike" template for its structure and function (2, 16). Stretch stimulates the growth and differentiation of both the epithelial and mesenchymal cells of the alveolar septal wall in preparation for air breathing at the time of birth. Of particular importance to the transition from intrauterine to extrauterine adaptation is the synthesis and secretion of pulmonary surfactant by alveolar type II cells. The surfactant reduces surface tension of the lung lining layer, preventing atelectasis of the air-filled lung. The surfactant is a complex of both proteins and phospholipids, the latter being responsible for the lowering of surface tension.It has previously been shown that stretching stimulates the growth of cultured mixed lung cells (15) and the secretion of pulmonary surfactant phospholipid by epithelial type II (TII) cells (38). It has subsequently been shown that stretch increases the expression of surfactant proteins (27). However, there is no information regarding how stretch stimulates surfactant phospholipid synthesis. Developing TII cell surfactant phospholipid synthesis is controlled by a wide variety of growth factors (13), cytokines (41), and eicosanoids (10), which mediate the paracrine regulation of fetal lung development. Among these, prostaglandin E 2 (PGE 2 ) and parathyroid hormone-related p...