TY - JOUR T1 - Genetic disorders of the surfactant system: focus on adult disease JF - European Respiratory Review JO - EUROPEAN RESPIRATORY REVIEW DO - 10.1183/16000617.0085-2020 VL - 30 IS - 159 SP - 200085 AU - Coline H.M. van Moorsel AU - Joanne J. van der Vis AU - Jan C. Grutters Y1 - 2021/03/31 UR - http://err.ersjournals.com/content/30/159/200085.abstract N2 - Genes involved in the production of pulmonary surfactant are crucial for the development and maintenance of healthy lungs. Germline mutations in surfactant-related genes cause a spectrum of severe monogenic pulmonary diseases in patients of all ages. The majority of affected patients present at a very young age, however, a considerable portion of patients have adult-onset disease. Mutations in surfactant-related genes are present in up to 8% of adult patients with familial interstitial lung disease (ILD) and associate with the development of pulmonary fibrosis and lung cancer.High disease penetrance and variable expressivity underscore the potential value of genetic analysis for diagnostic purposes. However, scarce genotype–phenotype correlations and insufficient knowledge of mutation-specific pathogenic processes hamper the development of mutation-specific treatment options.This article describes the genetic origin of surfactant-related lung disease and presents spectra for gene, age, sex and pulmonary phenotype of adult carriers of germline mutations in surfactant-related genes.Genes involved in monogenic surfactant-related parenchymal lung disease associate with age, ethnicity and pulmonary phenotype but not with sex. High disease penetrance and emerging genotype–phenotype correlations advocate genetic analysis in the clinic. https://bit.ly/2PrjAp6 ER -