The ultrastructure of epithelial cells of the distal lung

This review has focused on the structural and functional characteristics of those epithelial cells that line the walls of the lower respiratory bronchioles, alveolar ducts, and alveoli. In all, five cells types were considered: Clara cells, types I, II, and III pneumocytes, and alveolar macrophages. In addition, a very brief mention of the structure and influence of the basement membrane in alveolar development and repair was included, as well as a brief review of the role of epithelial cells in response to selected deleterious influences. No attempt was made to extend this review to cover the structure and functions of the epithelial lining of the conducting portions of the respiratory system, or the exciting and expanding complexities and interrelationships of the septal stroma. Since the volume of literature encircling this subject has virtually exploded during the last 15 years, it becomes almost impossible to review all reports. However, attempts were made to be selective in citations. Insofar as future developments are concerned, much remains to be understood concerning (1) the responses of all cell types to cytotoxic influences, including their respective abilities to repair induced damage, (2) cell-cell and cell-extracellular matrix relationships in response to injury, (3) the uniqueness of the basement membrane in the lung in controlling permeability and gaseous exchange, (4) the role(s) of alveolar macrophages in response to injury and their relationships to the septal macrophage population, (5) the aberrations in the respective cell types that can give rise to neoplastic growth, and (6) the role of the immune system in responding to the general defense of the lung. Indeed much has been learned in the past 2 decades, and it is expected that a review of this sort 1 or 2 decades hence will elucidate many of the functions and structural modifications of the lung.