Idiopathic pulmonary fibrosis (IPF) is a progressive scarring disorder characterized by the proliferation of interstitial fibroblasts and the deposition of extracellular matrix causing impaired gas exchange. Spiruchostatin A (SpA) is a histone deacetylase inhibitor (HDI) with selectivity toward Class I enzymes, which distinguishes it from other nonspecific HDIs that are reported to inhibit (myo)fibroblast proliferation and differentiation. Because the selectivity of HDIs may be important clinically, we postulated that SpA inhibits the proliferation and differentiation of IPF fibroblasts. Primary fibroblasts were grown from lung biopsy explants obtained from patients with IPF or from normal control subjects, using two-dimensional or threedimensional culture models. The effect of SpA on fibroproliferation in serum-containing medium 6 transforming growth factor (TGF)-b 1 was quantified by methylene blue binding. The acetylation of histone H3, the expression of the cell-cycle inhibitor p21 waf1 , and the myofibroblast markers a-smooth muscle actin (a-SMA) and collagens I and III were determined by Western blotting, quantitative RT-PCR, immunofluorescent staining, or colorimetry. SpA inhibited the proliferation of IPF or normal fibroblasts in a time-dependent and concentration-dependent manner (concentration required to achieve 50% inhibition ¼ 3.8 6 0.4 nM versus 7.8 6 0.2 nM, respectively; P , 0.05), with little cytotoxicity. Western blot analyses revealed that SpA caused a concentration-dependent increase in histone H3 acetylation, paralleling its antiproliferative effect. SpA also increased p21 waf1 expression, suggesting that direct cell-cycle regulation was the mechanism of inhibiting proliferation. Although treatment with TGF-b 1 induced myofibroblast differentiation associated with increased expression of a-SMA, collagen I and collagen III and soluble collagen release, these responses were potently inhibited by SpA. These data support the concept that bicyclic tetrapeptide HDIs merit further investigation as potential treatments for IPF.Keywords: pulmonary fibrosis; histone deacetylase inhibitor; spiruchostatin A; myofibroblast; proliferation Interstitial lung diseases (ILDs) are among the most difficult respiratory diseases to manage and treat effectively. One of the most common and important ILDs is idiopathic pulmonary fibrosis (IPF) (1), with an estimated incidence of 6.8-14 cases per 100,000, and a frequency that is slightly higher in the male population (2). It is a progressive disease that causes significant morbidity and mortality (3). The etiology of IPF is unknown, and its prognosis is as dismal as that of lung cancer (a median 2-4 years of survival from time of diagnosis) (4). Currently no effective treatment exists and, to make matters worse, available therapies that include corticosteroids and other immunosuppressive agents frequently cause unpleasant and sometimes dangerous side effects. The histologic hallmark of IPF is a heterogeneous appearance with areas of normal lung alternating with fibro...