-alkylguanine-DNA alkyltransferase (MGMT) represents the first line of defense against the toxic, mutagenic and carcinogenic effects of O 6 -alkylguanine adducts in DNA. These adducts mediate the biological activity from a series of alkylating agents, such as the tobacco-specific nitrosamines, believed to contribute to the carcinogenicity of tobacco smoke. There have been conflicting reports on the effects of smoking on MGMT activity in lung and other tissues. Here, we investigate MGMT activity in peripheral blood mononuclear cells (PBMC) and lung bronchial epithelial cells (BEC), extracted by lung brushings, from smokers and nonsmokers attending a bronchoscopy clinic. MGMT activity was significantly lower in BECs (geometric mean; 95% confidence interval 1.02; 0.86-1.20 fmol/lg DNA) than in PBMCs (7.86; 6.70-9.59 fmol/lg DNA; p < 0.001), suggesting that bronchial epithelia may be particularly sensitive to alkylation damage. More importantly our results indicate that activity in BECs is significantly decreased in samples from current smokers (0.71; 0.54-0.93 fmol/lg DNA) compared to nonsmokers (1.25; 1.03-1.51 fmol/lg DNA; p 5 0.002). This could represent an important contribution to the carcinogenicity of tobacco smoke. ' 2006 Wiley-Liss, Inc.Key words: expression; bronchoscopy; MGMT; lung cancer; DNA alkylation Lung cancer is one of the most common cancers in industrialized countries and the leading cause of cancer deaths. Exposure to tobacco smoke, the main cause of lung cancer, accounts for at least 85% of all lung cancer deaths. Among the carcinogens in tobacco smoke are the tobacco-specific nitrosamines, such as 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK), 1 compounds which are known to alkylate DNA. It is likely that cigarette smoke constitutes one of the most important sources of human exposure to alkylating agents.1 It has been suggested that exposure to NNK can cause adenocarcinomas of the lung.2 For these and a variety of other alkylating agents, the most important mutagenic and toxic lesions produced are O 6 -alkylguanine adducts.3,4 These types of lesions are corrected by a specific repair protein O 6 -alkylguanine-DNA alkyltransferase (O 6 -methylguanine-DNA methyltransferase; MGMT, E.C.2.1.1.63).5-7 MGMT reverses O 6 -alkylation damage by covalent transfer of the offending alkyl group to a cysteine residue in the active site of the protein. This leads to the inactivation of the protein, which is then ubiquitinated and degraded. [5][6][7] MGMT expression is characterized by a large degree of interindividual heterogeneity, and most studies report in PBMC a 10-fold range of variation.8 Since only 11-24% of all smokers develop the disease, 9 variation of MGMT activity levels may be one of the factors that modulate interindividual differences in susceptibility to cancer in individuals exposed to tobacco smoke. The causes underlying differences in MGMT activity have been the focus of several studies. 8,10,11 Studies attempting to show whether in humans exposure to cigarette smoke causes an incr...