Hundertmark et al. [1] recently reported that 11-oxo steroids, like their 11-hydroxy isoforms, can stimulate fetal lung maturation due to the expression of 11b-hydroxysteroid dehydrogenase Type 1 (11b HSD 1), the enzyme that converts (inactive) cortisone to (active) cortisol [2]. In a subsequent study, this group has shown that knocking out the 11b HSD 1 gene inhibits lung maturation and surfactant synthesis [3], confirming the biological significance of 11b HSD 1 in lung development. A series of studies performed by my collaborators and myself beginning more than 30 years ago had previously demonstrated the biological activity and significance of 11b HSD 1 in fetal human, rabbit and rat lung development. These studies were the first to elucidate the physiologic role of glucocorticoids in normal fetal lung development [4]. I would like to relate these studies, which were overlooked in the Hundertmark publications.Our laboratory at McGill University was the first to discover why the placenta is a`barrier' to steroids. Hillman and Giroud [5] demonstrated that the placenta quantitatively oxidizes cortisol to cortisone as it passes through from mother to fetus. This was thought to be protective since glucocorticoids are classically considered to be catabolic. By contrast, Burton demonstrated that fetal mouse liver had the capacity to convert 11-dehydrocorticosterone to corticosterone [6,7], setting a precedent for the local tissue activation of glucocorticoids in specific fetal tissues. The discovery by Liggins that glucocorticoids stimulate fetal lung development and reduce the morbidity and mortality of preterm birth catalyzed the then burgeoning interest in fetal steroid metabolism [8]. The presence of 11b HSD 1 activity in human fetal lung cells was first reported by Smith, Torday and Giroud in 1973 [9]. In a subsequent study [10], we showed that cortisol could directly affect fetal rabbit lung cell surfactant phospholipid synthesis, and that cortisol stimulated 11b HSD 1 activity by fetal rabbit lung cells [11]. To determine whether 11b HSD 1 could actively generate cortisol from cortisone in the intact fetal lung, we perfused fetal rabbit lung via the pulmonary artery with 3 H-cortisone, and demonstrated quantitative secretion of 3 H-cortisol from the pulmonary vein [12]; we also reported that 11b HSD 1 activity increased significantly from 23 to 29 days gestation (day 31 = term).The physiological significance of 11b HSD 1 activation by fetal lung fibroblasts was elucidated by in-depth studies on the cellmolecular mechanism of glucocorticoid action on lung maturation. Smith [13] discovered that cortisol stimulated lung fibroblast synthesis of a low molecular-weight paracrine factor he termed fibroblast-pneumonocyte factor (FPF), which was secreted into the extracellular milieu and stimulated surfactant phospholipid synthesis by the alveolar type II cell [14]. My laboratory pursued these observations by demonstrating that the hormonedependent sex difference in fetal lung development was due to the differential ...