title: Increased levels of cell death and proliferation in alveolar wall cells in patients with pulmonary emphysema.
abstract: BACKGROUND
  Pulmonary emphysema, a major component of COPD, is pathologically characterized by destructive alterations in pulmonary architectures as a result of persistent inflammation. However, alterations in the turnover of pulmonary cells are less well understood. This study was designed to examine whether the turnover of alveolar wall cells is altered in patients with emphysema.
  
  
  METHODS
  We obtained lung tissue specimens from patients with emphysema who had undergone lung volume reduction surgery (13 patients) as well as asymptomatic smokers (7 patients) and nonsmokers (9 patients) undergoing lung resections for solitary lung cancers. Paraffin-embedded lung tissue sections were evaluated for apoptosis and proliferation using terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick-end labeling (TUNEL) or immunohistochemistry for Bax, proliferation cell nuclear antigen (PCNA), and topoisomerase IIalpha. Tissue sections were also immunostained for epithelial membrane antigen, surfactant protein A, and CD31.
  
  
  RESULTS
  The percentages of alveolar wall cells undergoing apoptosis and proliferation of the total number of alveolar wall cells were significantly higher in patients with emphysema than in asymptomatic smokers and nonsmokers (p < 0.05). The percentage of TUNEL-positive alveolar wall cells was positively correlated with the percentage of PCNA-positive alveolar wall cells. Most of the TUNEL-positive and PCNA-positive cells were alveolar epithelial cells.
  
  
  CONCLUSIONS
  These results suggest that the turnover of alveolar wall cells is enhanced in emphysematous lungs, compared to healthy lungs. Emphysema may be a dynamic disease process in which alveolar wall cell death and proliferation are repeated.
authors.affiliation: First Department of Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan.
authors.forename: Naoko
authors.initials: N
authors.lastname: Yokohori
authors.forename: Kazutetsu
authors.initials: K
authors.lastname: Aoshiba
authors.forename: Atsushi
authors.initials: A
authors.lastname: Nagai
mesh_terms: D000368:Aged; D017209:Apoptosis / Q000502:physiology*; D016022:Case-Control Studies; D002455:Cell Division / Q000502:physiology*; D002478:Cells, Cultured; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D020287:In Situ Nick-End Labeling; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy; D011336:Probability; D011650:Pulmonary Alveoli / Q000166:cytology* / Q000502:physiology; D011656:Pulmonary Emphysema / Q000209:etiology / Q000473:pathology* / Q000601:surgery; D012016:Reference Values; D012680:Sensitivity and Specificity; D012907:Smoking / Q000009:adverse effects*