aaProtease-antiprotease imbalance theory has been a central theme for the last 30 years in the study of the pathogenesis of pulmonary emphysema [1,2]. Although smoking is a major exogenous cause of pulmonary emphysema, only a small percentage of smokers develop clinically apparent pulmonary emphysema. Numerous studies have examined the effect of cigarette smoking on the proteaseantiprotease balance in body fluids, but few have focused on individual differences in the susceptibility to pulmonary emphysema. Most studies have simply compared smokers and nonsmokers [3,4] or healthy subjects and patients with chronic obstructive pulmonary disease (COPD), mostly clinically diagnosed through pulmonary function tests [5]. However, the data from subjects with established COPD could be influenced by possible concomitant infections of the respiratory tract.It was previously demonstrated that neutrophil elastase (NE) complexed with α 1 -protease inhibitor (α 1 -PI; NE-α 1 -PI complex) in bronchoalveolar lavage (BAL) fluid was significantly increased in community-based older volunteers who had subclinical emphysema, as evidenced by lung computed tomographic (CT) scans, compared with those who had a comparable smoking history but no evidence of emphysema [6]. In addition, the releasability of NE from alveolar macrophages (AM) was shown to be high in those subjects with emphysema [7]. FINLAY et al. [8] recently reported that the levels of collagenase and gelatinase B in BAL fluid from subjects with clinically apparent emphysema were significantly higher than in healthy subjects.Another important class of proteases which is a candidate for causing chronic pulmonary destruction consists of the cysteine proteases, one of which, cathepsin L, has potent elastolytic activity at acidic pH [9,10] and is capable of inactivating α 1 -PI catalytically [11]. The expression of cathepsin L messenger ribonucleic acid (mRNA), as well as the activity of cathepsin L, was reported to be higher in BAL cells from smokers than in nonsmokers [12]. It is also possible that chronic smoking may decrease the level of cystatin C, an inhibitor of cathepsin L in the lungs, so that emphysematous changes are more likely to occur [13]. However, to our knowledge, there have been no reports on the levels of cathepsin L and cystatin C in BAL fluid from subjects with subclinical emphysema.In this study, the activities and immunological quantities of cathepsin L and cystatin C in BAL fluid from asymptomatic community-based older volunteers were evaluated and the releasability of cathepsin L from AM was examined in vitro. Cathepsin B was also measured in BAL fluid, which has little elastolytic activity. In particular, the Cysteine proteinases and cystatin C in bronchoalveolar lavage fluid from subjects with subclinical emphysema. K. Takeyabu, T. Betsuyaku, M. Nishimura, A. Yoshioka, M. Tanino, K. Miyamoto, Y. Kawakami. ©ERS Journals Ltd 1998. ABSTRACT: This study examined the role of cysteine proteinases and their inhibitor in the development of emphysema in com...