Lee Y-S. Mesenchymal stem cell-conditioned media recovers lung fibroblasts from cigarette smoke-induced damage. Am J Physiol Lung Cell Mol Physiol 302: L891-L908, 2012. First published February 3, 2012 doi:10.1152/ajplung.00288.2011.-Cigarette smoking causes apoptotic death, senescence, and impairment of repair functions in lung fibroblasts, which maintain the integrity of alveolar structure by producing extracellular matrix (ECM) proteins. Therefore, recovery of lung fibroblasts from cigarette smoke-induced damage may be crucial in regeneration of emphysematous lung resulting from degradation of ECM proteins and subsequent loss of alveolar cells. Recently, we reported that bone marrow-derived mesenchymal stem cell-conditioned media (MSC-CM) led to angiogenesis and regeneration of lung damaged by cigarette smoke. In this study, to further investigate reparative mechanisms for MSC-CM-mediated lung repair, we attempted to determine whether MSC-CM can recover lung fibroblasts from cigarette smoke-induced damage. In lung fibroblasts exposed to cigarette smoke extract (CSE), MSC-CM, not only inhibited apoptotic death, but also induced cell proliferation and reversed CSE-induced changes in the levels of caspase-3, p53, p21, p27, Akt, and p-Akt. MSC-CM also restored expression of ECM proteins and collagen gel contraction while suppressing CSE-induced expression of cyclooxygenase-2 and microsomal PGE 2 synthase-2. The CSE-opposing effects of MSC-CM on cell fate, expression of ECM proteins, and collagen gel contraction were partially inhibited by LY294002, a phosphatidylinositol 3-kinase (PI3K) inhibitor. In rats, MSC-CM administration also resulted in elevation of p-Akt and restored proliferation of lung fibroblasts, which was suppressed by exposure to cigarette smoke. Taken together, these data suggest that MSC-CM may recover lung fibroblasts from cigarette smoke-induced damage, possibly through inhibition of apoptosis, induction of proliferation, and restoration of lung fibroblast repair function, which are mediated in part by the PI3K/Akt pathway. cigarette smoking; chronic obstructive pulmonary disease; emphysema CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD), a leading cause of death worldwide, is most often caused by cigarette smoking. COPD is characterized by expiratory airflow limitation that is not fully reversible, accompanying inflammation, and emphysematous destruction of the lung (39). Irrespective of the high incidence and mortality rates for COPD, most current therapies for this disease are supportive, and regenerative therapies to cure emphysema are not available.As a pathophysiological mechanism, proteolytic degradation of extracellular matrix (ECM) by protease activities overwhelming antiprotease activities has long been suspected to be responsible for the emphysematous change seen in patients with COPD (45). Lung fibroblasts are considered crucial for maintenance of the integrity of alveolar structure by producing ECM proteins, including collagen, elastin, and fibronectin, which are required for attach...