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Background: Cigarette smoke induces bronchial mucus secretion. However, the mechanism of this induction is still unidentified. In this study, we investigated the role of the putative calcium-activated chloride channel 1 (CLCA1) and its blocker, niflumic acid, in cigarette smoke-induced mucin synthesis both in vivo and in vitro., Methods and Results: Sprague-Dawley rats were exposed to cigarette smoke for 4 weeks. The CLCA1, epidermal growth factor receptor (EGFR), and MUC5AC expressions were increased in the trachea and lung tissues. Goblet-cell hyperplasia with marked mucin staining was detected in the tracheal and bronchial epithelium. In the human bronchial epithelial cell line NCI-H292, cigarette smoke solution also induced mucin production as well as the RNA and protein expressions of CLCA1, EGFR, and MUC5AC. Both in vivo and in vitro, the induction of MUC5AC and mucin synthesis were inhibited by niflumic acid, and/or a selective EGFR tyrosine kinase inhibitor, AG-1478. Niflumic acid also blocked the epidermal growth factor-induced MUC5AC and mucin staining in the NCI-H292 cell line., Conclusion: Both EGFR and niflumic acid-sensitive chloride channels (probably CLCA1) are dependently affecting the mucin production as a part of a single complex signaling pathway. CLCA1 may be a key signaling member that can be targeted with pharmacologic interventions to treat mucus hypersecretion.

Epidemiological studies have shown that particulate matter (PM) is associated with adverse respiratory health effects. Although infection in the respiratory organ is one of the most important health risks the association of infection with PM is not fully understood. As we had hypothesized that diesel exhaust particles (DEP), one of the major component of PM, may induce the expression of receptors for viruses and bacteria at invasion sites, we studied the effect of DEP on the mRNA expression of intercellular adhesion molecule-1 (ICAM-1), low-density lipoprotein (LDL) and platelet-activating factor (PAF) receptors, which are invasion sites of virus and bacteria, on rat lung epithelial cells. The real-time quantitative polymerase chain reaction (PCR) method was used for the evaluation. All of these mRNAs were up-regulated by 3, 10, and 30 microg/ml of DEP in a concentration-dependent manner. The up-regulation of each was associated with the mRNA expression of heme oxygenase-1 (HO-1), a marker of oxidative stress. Our present results show that DEP up-regulated the mRNA expression of viral and bacterial receptors. This up-regulation might be associated with DEP-induced oxidative stress. These results thus suggest that DEP may enhance the risk of pneumonia by increasing the density of bacterial and viral invasion sites in the lungs.

Recent studies have demonstrated that Th2 cytokines, such as interleukin-4 and interleukin-13, enhance fibrotic processes by activating fibroblast proliferation and collagen production, whereas interferon-gamma, a Th1 cytokine, inhibits these processes. Th1 and Th2 cells both differentiate from common T precursor cells, with transcription factor GATA-3 a key regulator of Th2 differentiation. In the present study, therefore, we examined the effects of GATA-3 overexpression on the development of pulmonary fibrosis in a mouse model. Wild-type C57BL/6 mice and GATA-3-overexpressing (GATA-3-tg) mice of the same background were intratracheally treated with bleomycin. The survival rate after bleomycin was significantly decreased in GATA-3-tg mice compared with wild-type mice. The degree of pulmonary fibrosis was much greater in GATA-3-tg mice than in wild-type mice 28 days after bleomycin treatment. Lung interferon-gamma concentration was significantly decreased in GATA-3-tg mice compared with wild-type mice by 7 days after either saline or bleomycin treatment. The concentration of transforming growth factor-beta, a fibrogenic cytokine, was significantly higher in GATA-3-tg mice than in wild-type mice. Exogenous administration of interferon-gamma to GATA-3-tg mice improved the degree of pulmonary fibrosis and thus increased survival. These results indicate that overexpression of GATA-3 enhances the development of pulmonary fibrosis, possibly by reducing interferon-gamma levels in the lung.

Study Objectives: An inverse relationship between body mass index (BMI) and the risk of lung cancer, suggesting that leanness is a risk factor for lung cancer, has been reported in previous studies. In order to evaluate the risk of lung cancer associated with lower levels of BMI in preclinical patients, we conducted a case-control study based on the results of community mass screening., Design: The relationship between BMI (at the time of diagnosis, and at 1 to 5 years prior to diagnosis) and lung cancer was investigated in a case-control study of 363 lung cancer cases and 1,089 control subjects conducted between April 1993 and March 2003. Control subjects were selected from mass-screening subjects with no abnormalities on chest radiography and routine laboratory tests., Results: In men, an inverse association between BMI and lung cancer was observed after adjustment for age and smoking (BMI < 20.8; range of the referent group, > or = 22.9 to < 25.0; odds ratio, 1.9; p = 0.0025; 95% confidence interval, 1.3 to 2.9). In women, however, no association was found between BMI and lung cancer (BMI < 20.8, p = 0.3868; and BMI

It is recognized that genetic factors play a role in the susceptibility to COPD. COPD is characterized by airflow limitation. Chronic inflammation causes small airway disease and parenchymal destruction, leading to the airflow limitation. Polymorphisms in pro-inflammatory cytokine genes may confer a risk for the development of COPD. A case-control association study was performed in Japanese population (88 COPD patients and 61 controls) and Egyptian population (106 patients and 72 controls). Genotype and allele frequencies of the TNFalpha -308 G/A and +489 G/A polymorphisms, the IL1beta -511 C/T, -31 T/C, and +3954 C/T polymorphisms, and a VNTR polymorphism in intron 2 of the IL1RN gene were investigated. In addition, pairwise haplotype frequencies were analyzed. When studied independently, none of the polymorphisms were associated with the development of COPD in both populations. However, in the Egyptian population, the distributions of the haplotype (IL1beta -31 T/C : IL1beta +3954 C/T) were significantly different between the COPD patients and the controls (p(corr)=0.0037). Our findings suggest that this haplotype within the IL1beta gene may be involved in the pathogenesis of COPD and that the genetic factors of COPD susceptibility might be different between different populations.

Study Objectives: Interleukin (IL)-4, IL-13, and beta(2)-adrenoceptor (ADRB2) are involved in airway hyperresponsiveness (AHR), and their coding genes are located on chromosome 5q31-q33. AHR is one of the risk factors for COPD. Investigating polymorphisms within these genes may help to pinpoint the genetic susceptibility to COPD., Subjects and Measurements: A case-control association study was conducted on two different ethnic groups: Japanese subjects (88 patients with COPD and 61 control subjects) and Egyptian subjects (106 patients with COPD and 72 control subjects). The following polymorphisms were genotyped: - 589 C/T, - 33 C/T, and variable number of tandem repeat (VNTR) in IL4, - 1111 C/T and + 2044 G/A in IL13, and + 46 A/G and + 79 C/G in ADRB2. Pairwise haplotype frequencies as well as genotype and allele frequencies were analyzed., Results: The distribution of the genotype frequencies of ADRB2 + 79 C/G was significantly different between the COPD and the control groups in the Egyptians (p = 0.002). The distributions of the haplotypes in the Japanese (IL4 - 589 C/T: IL4 VNTR; IL4 - 33 C/T: IL4 VNTR) [corrected p values < 0.001 and 0.022, respectively], and those in the Egyptians (IL4 - 589 C/T: ADRB2 + 79 C/G; IL4 VNTR: ADRB2 + 79 C/G) [corrected p values, 0.033 and 0.001, respectively] showed significant differences between the COPD and the control groups., Conclusions: The ADRB2 + 79 C/G polymorphism and the haplotypes shown in this study may be involved in the pathogenesis of COPD.

Transcription factor Nrf2 regulates the basal and inducible expression of detoxifying and antioxidant genes. Recent studies using nrf2-null mice suggest that Nrf2 dysfunction might be involved in the pathogenesis of human diseases. To gain insight into the relationship between impairment in the NRF2 gene and human diseases, we attempted to identify polymorphisms in the human NRF2 gene. We determined the structure of the NRF2 gene and found three single nucleotide polymorphisms and one triplet repeat polymorphism in its regulatory region. These results provide a molecular basis for the genetic analysis of the NRF2 gene. The frequency of each polymorphism was examined in two groups of patients with systemic lupus erythematosus and chronic obstructive pulmonary disease. This study did not reveal a close connection between the risk of these diseases and the polymorphisms. However, available lines of evidence suggest the importance of examining the link between NRF2 polymorphisms and other oxidative stress-related diseases.

Study Objective: Cytokeratin 19 fragment (CYFRA) is a specific tumor marker in patients with lung cancer; however, it has been reported that serum CYFRA levels are elevated in some patients with nonmalignant respiratory diseases such as interstitial pulmonary fibrosis (IPF) and collagen disease-associated pulmonary fibrosis (CDPF). To investigate the serum CYFRA levels in nonmalignant respiratory diseases in detail, we studied 413 patients with respiratory diseases., Design: Retrospective study., Setting: University hospital., Patients: Four hundred thirteen patients with nonmalignant respiratory diseases and lung cancer., Measurements and Results: Serum CYFRA levels were measured with a commercially available enzyme immunoassay kit. Immunohistochemical study was performed using monoclonal antibody Ks 19.1 (Rosch Diagnosica; Bern, Switzerland) on surgically resected or autopsied lung specimens. Gel electrophoresis and immunoblotting was performed with serum samples. In 149 patients with nonmalignant diseases except IPF and CDPF, the ratio of patients with > 3.5 ng/mL of serum CYFRA was 13.4%. In 13 of 30 patients (43.3%) with IPF and CDPF, the serum CYFRA levels were abnormally elevated. The 95th percentile serum CYFRA level of the patients with nonmalignant respiratory diseases was 6.2 ng/mL, and none of them had CYFRA levels > 20.3 ng/mL. Survival in patients with IPF and CDPF with elevated serum CYFRA levels were significantly lower than in those with normal range (p = 0.0335). Western blotting using serum from nonmalignant lung diseases and patients with lung cancer showed no apparent difference between them. An immunohistochemical study indicated CYFRA was selectively expressed in the pulmonary epithelial cells that covered the remodeling alveolar septi in nonmalignant respiratory disease., Conclusion: Serum CYFRA was elevated in some nonmalignant respiratory diseases, especially in IPF and CDPF. The value of serum CYFRA would reflect the severity of lung injury in nonmalignant respiratory diseases and might be related to the prognosis in patients with IPF and CDPF.

Study Objective: To study the role of orexins in regulating body composition in patients with COPD., Design: Prospective study., Patients and Measurements: We measured the plasma concentration of orexin-A in 20 patients with COPD and compared the results to those obtained from 10 age-matched control subjects. Patients with COPD were classified into two groups based on their body mass index (BMI): a normal weight (NW) group (BMI > 20) and an underweight (UW) group (BMI < 20)., Results: The plasma orexin-A level was significantly lower in patients with COPD than in control subjects. In patients with COPD, the level was significantly lower in the UW group than in the NW group. Plasma orexin-A levels significantly correlated with BMI and fat mass values, but there was no significant relationship between plasma orexin-A levels and the fat-free mass of patients with COPD., Conclusion: These results suggest that orexin-A levels are altered with weight loss and changes in body composition in patients with COPD.

Study Objectives: The purpose of this study was to investigate the effect of heavy-ion radiotherapy on pulmonary function in patients with clinical stage I non-small cell lung cancer (NSCLC) patients., Design: Retrospective study., Setting: Research Center Hospital for Charged Particle Therapy, National Institute of Radiological Sciences, Chiba, Japan., Patients: From a total of 81 patients who were not candidates for surgical resection due to medical reasons or patient refusal, and who were treated with carbon beam radiotherapy from October 1994 to February 1999, the 52 patients who had completed the repeat overall pulmonary function tests at 6 and 12 months after undergoing heavy-ion radiotherapy were examined. The total heavy-ion irradiation dose ranged from 59.4 to 95.4 photon gray equivalents (GyE), with a mean dose of 76.2 GyE. INTERVENTIONS AND MEASUREMENT: Pulmonary function was evaluated prior to heavy-ion radiotherapy and at 6 and 12 months after heavy-ion radiotherapy. Comparisons of all pulmonary function indexes between, before, and at 6 and 12 months after heavy-ion radiotherapy were made using repeated-measures analysis of variance using the Dunnett test for post hoc comparison., Results: A statistically significant decrease in FEV(1) and total lung capacity was detected at both 6 and 12 months after the patient had undergone heavy-ion radiotherapy. No significant decreases in other pulmonary function indexes in patients were observed at either 6 or 12 months after heavy-ion radiotherapy. The magnitude of the decrease in all pulmonary function indexes was < 8% at both 6 and 12 months after heavy-ion radiotherapy., Conclusions: These findings suggest that heavy-ion radiotherapy is feasible for stage I NSCLC patients without a severe loss of pulmonary function.