Penetrating missile pulmonary embolisation.

Collagen 1 promotes epithelial-to-mesenchymal transition in lung cancer cells via transforming growth factor-b signalling. Inflammatory markers are associated with ventilatory limitation and muscle dysfunction in obstructive lung disease in well functioning elderly subjects. Usefulness of C-reactive protein and interleukin-6 as predictors of outcomes in chronic obstructive pulmonary disease receiving pravastatin. We thank R. Young and co-workers for their constructive comments on our review [1] and we fully agree with them on the potential benefits of statins in chronic obstructive pulmonary disease (COPD) patients. The new information they provide about the potential for statins in reducing lung cancer is particularly important, as this is one of the most common causes of death amongst COPD patients, particularly in those with severe disease. The potential anti-inflammatory effects of statins highlighted in our review might account for the reduction in cancer, although it is possible that statins have additional effects on the signalling pathways which lead to epithelial cancers [1]. For example, lovastatin inhibits the growth of lung cancer cell lines in vitro, in part, by increasing activity of the tumour suppressor protein p53 and the cell-cycle checkpoint inhibitors p21 WAF and p27 KIP [2]. Although the pleiotropic effects of statins provide a convincing scientific rationale for their potential benefit in COPD patients, a note of caution should be applied as the evidence for the benefits of statins is derived solely from observational studies that may have a selection bias. For example, patients with a better prognosis or who receive more intense medical attention may be more likely to be selected for statin therapy. What is needed now is a large, long-term, randomised placebo-controlled study investigating the addition of statins to usual therapy across a range of COPD disease severity; measuring disease progression, exacerbations, comorbidities and all-cause mortality. However, the high costs of such a study and the availability of generic statins mean that such a trial may be difficult to fund. In the meantime, further research investigating the molecular mechanisms of action of statins may be useful in identifying novel targets for the development of new treatments for COPD and its comorbidities [3]. It should also be remembered that there are differences between statins in the range of pleiotropic effects, thus it may not be appropriate to analyse all statins together. In vitro mechanisms of lovastatin on lung cancer cell lines as a potential chemopreventive agent. We read with interest the review by …