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Disaturated phosphatidylcholine (DSPC) is the predominate phospholipid component of lung surfactant. In the alveolar type II cell, the cytidine diphosphocholine (CDP-choline) pathway is the major biosynthetic pathway for DSPC. To investigate the hypothesis that phosphocholine cytidylyltransferase (CT) is the rate-limiting enzyme in the CDP-choline pathway, rat alveolar type II cells or lung tumor-derived cell lines (A549 or H441) with type II cell features were transfected with CT complementary DNA (cDNA). Cell fractions were subsequently assayed for CT protein and activity, and cell rates of DSPC synthesis were determined. In all cases, cell CT protein and activity were increased after transfection with CT cDNA but not after control transfection. Rat type II cells, but not A549 or H441 cells, increased the rate of DSPC synthesis after transfection with CT cDNA. Exposure of type II cells transfected with CT cDNA to palmitic acid resulted in a further increase in CT protein and activity. Exposure to dexamethasone resulted in increased CT protein and activity and increased synthesis of DSPC. The results confirm that CT has a rate-limiting and regulatory role in the synthesis of type II cell DSPC, and raise possibilities for novel therapeutic interventions.