“…On the basis of these observations, the present study is directed at evaluating the hypothesis that neutrophils accumulate in the alveolar structures of these individuals at least in part because they are attracted by chemotactic signals released by alveolar macrophages. This hypothesis is based on three concepts, including: (a) alveolar macrophages are capable, when activated by surface stimuli, of releasing chemotactic mediators for neutrophils (13)(14)(15)(16)(17)(18)(19); (b) alveolar macrophages have surface receptors for neutrophil elastase (20)(21)(22); and (c) individuals with a I AT deficiency have insufficient alAT in the lower respiratory tract to inhibit the burden ofNE in the local milieu and thus likely have free NE in the alveolar structures (7,23). Putting these concepts together, they lead to a scenario of amplification of normal inflammatory processes, in which free NE resulting from insufficient a 1 AT binds to the NE receptors in alveolar macrophages, causing the macrophages to release mediators with neutrophil chemotactic activity, thus causing an increased number of neutrophils to accumulate in the alveolar structures.…”