TY - JOUR T1 - Inhaled all-trans retinoic acid in an individual with severe emphysema JF - European Respiratory Journal JO - Eur Respir J SP - 1487 LP - 1489 DO - 10.1183/09031936.00105309 VL - 34 IS - 6 AU - M. Frankenberger AU - I. Heimbeck AU - W. Möller AU - S. Mamidi AU - G. Kaßner AU - K. Pukelsheim AU - M. Wjst AU - M. Neiswirth AU - P. Kroneberg AU - D. Lomas AU - D. Halsall AU - P. Iadarola AU - A. Fertl AU - K. Häußinger AU - L. Ziegler-Heitbrock Y1 - 2009/12/01 UR - http://erj.ersjournals.com/content/34/6/1487.abstract N2 - To the Editors: A patient with extensive emphysema was treated with liposomal all-trans retinoic acid (ATRA) using a controlled inhalation manoeuvre. After a gradual increase from 0.1 mg to 3 mg ATRA per day, the patient was treated at a level of 1 mg·day−1 for 4 days per week. Over the 6-month observation period there was an improvement of forced expiratory volume in 1 s (FEV1) from 16% to 21% predicted and an increase from 400 m to 615 m in the 6-min walking test (6MWT), although there was no apparent change in lung morphology with high-resolution computed tomography (HRCT). Biochemical analysis demonstrated a decrease in exhaled isoprostane and a decrease in serum interleukin (IL)-13. In addition, desmosine excretion decreased from 115 μg·g−1 creatinine to <35 μg·g−1 creatinine (normal range 25±4 μg·g−1). The data suggest that inhaled ATRA reduces inflammation and lung destruction processes and may be of benefit in selected cases of emphysema. The patient was a 45-yr-old male never-smoker of Caucasian origin with no family history of lung disease. He had worked in the wood industry and then as an electrician without any known asbestos exposure for 7 yrs until diagnosis. He first developed dyspnoea in 2002 and HRCT analysis revealed extensive basal centrilobular emphysema. Standard inhalation therapy was Spiriva® (tiotropium 18 μg q.d.; Boehringer Ingelheim Pharma, Ingelheim, Germany) and Symbicort® (budesonid 160 μg plus formoterol 4.5 μg … ER -