Irremovable Blood Stain in Lung: Air-to-Interface Transport of Albumin and Its Mechanical Response to Biaxial Compression/Expansion

Serum proteins are believed to trigger a sudden failure of lung function, but to date the mechanism remains elusive. Most studies have focused on the transport of the proteins from the subphase to the lung surfactant interface, although the opposite direction of transport, i.e., from air-to-interface, could be equally important. Here, we report that physiological concentrations of serum droplets can rapidly form a film upon exposure to air, and the entire film can be transferred to the lung surfactant interface upon coalescence, displacing it. This film was mechanically stable and remains intact even for multiple biaxial compression/expansion cycles. Our findings provide a mechanism of lung surfactant replacement by serum proteins that is fundamentally different from the subphase-to-interface transport and demonstrate that it is nearly impossible to remove the film from the interface where the lung surfactant should be, thus impairing the lung in a permanent way.