Cytochrome P450 2A13 (CYP2A13), mainly expressed in human respiratory tract, is highly efficient in the metabolic activation of aflatoxin (AF) B1 (AFB1) and is assumed to play a role in human lung tumorigenesis in airborne AFB1 exposure. To validate the assumption, we exposed human bronchial epithelial (BEAS-2B) cells stably expressing CYP2A13 (B-2A13), CYP1A2 (B-1A2) and CYP2A6 (B-2A6) to 0.1-10 nM AFB1 for 30-50 passages. B-2A13 cells showed increased sensitivity to 0.1 nM AFB1-induced neoplastic transformation and the formation of tumors in nude mice were observed at passage 30 (P30) while it occurred at P50 B-1A2 cells. B-2A6, similar to vector control, showed no neoplastic transformation in this condition. Additionally, AFB1-DNA adducts and 8-OHdG significantly increased in transformed P40 B-2A13, in parallel with the upregulation of p-ATR, p-BRCA1, Mre11, Rad50 and Rad51. However, the apoptosis of P40 cells was near normal, while the expression of Bax, C-Caspase 3 and C-PARP increased passage-dependently. Inhibition of ATR (ATR siRNA or NU6027) reversely increased the apoptosis of P40 B-2A13 cells in parallel with the upregulation of Bax, C-Caspase 3 and C-PARP, suggesting that ATR plays an important role in maintaining cell survival via antiapoptosis. Additionally, activation of ATR was necessary to neoplastic transformation since blockage of ATR in P40 cells inhibited DNA damage repair response and anchorage-independent growth. Our data demonstrated that CYP2A13 played a critical role in AFB1-induced neoplastic transformation. ATR-mediated the dysfunction of apoptosis and DNA damage repair might be involved. These results help establish a linkage between airborne AFB1 and human respiratory carcinoma.Aflatoxins (AFs) are primarily produced by the food-borne fungi Aspergillus flavus and Aspergillus parasiticus, which colonize a variety of food commodities, including maize, oilseeds, spices, groundnuts, and tree nuts. Currently, more than 55 million people worldwide suffer from uncontrolled exposure to AFs. 1 In China, corn is the food most seriously contaminated with AFs. 2 Aflatoxin B1 (AFB1) is the main AF found as a contaminant in foods, and high concentrations of AFB1 are commonly found in respirable, airborne dusts in amounts as high as 52 ppm. 3 Furthermore, predicted occupational exposure of AFB1 in a corn-processing plant was 107 ng/m 3 , and the daily exposure to AFB1 was calculated to be 40-856 ng. 4 Research in Denmark found that 7 of 45 animalfeed production plant workers had detectable levels of AFB1 in their blood after working for 4 weeks in the factory or unloading raw materials from ships. 5 AFB1 has been evaluated and classified by the International Agency for Research on Cancer (IARC) as carcinogenic to humans. Epidemiological surveys have revealed a strong statistical correlation between AF ingestion and incidence of hepatocellular carcinoma (HCC) in several areas of the world. 6 AFs may play a causative role in 4.6-28.2% of all global HCC cases. 7 Additionally, lung cancer has been a l...