Open Access Open Badges Research article

Ageing and smoking contribute to plasma surfactant proteins and protease imbalance with correlations to airway obstruction

Helen Ilumets1*, Witold Mazur1, Tuula Toljamo2, Noora Louhelainen1, Pentti Nieminen3, Hideo Kobayashi4, Nobuhisa Ishikawa15 and Vuokko L Kinnula1

Author Affiliations

1 Department of Medicine, Division of Pulmonary Medicine, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland

2 Department of Medicine, Division of Pulmonary Medicine, Lapland Central Hospital, Rovaniemi, Finland

3 Medical informatics and statistics research group, University of Oulu, Oulu, Finland

4 Department of Medicine, Division of Pulmonary Medicine, National Defense Medical College, Tokorozawa, Japan

5 Departments of Molecular and Internal Medicine, Graduate School of Biomedical Science, Hiroshima University, Hiroshima, Japan

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BMC Pulmonary Medicine 2011, 11:19  doi:10.1186/1471-2466-11-19

Published: 19 April 2011



A significant number of young people start smoking at an age of 13-15, which means that serious smoking-evoked changes may have been occurred by their twenties. Surfactant proteins (SP) and matrix metalloproteinases (MMPs) and their tissue inhibitors (TIMPs) have been linked to cigarette smoke induced lung remodelling and chronic obstructive pulmonary disease (COPD). However, the level of these proteins has not been examined during ageing or in young individuals with short smoking histories.


Plasma levels of SP-A, SP-D, MMP-9, and TIMP-1 were measured by EIA/ELISA from young (18-23 years) non-smoking controls (YNS) (n = 36), smokers (YS) (n = 51), middle aged/elderly (37-77 years) non-smoking controls (ONS) (n = 40), smokers (OS) (n = 64) (FEV1/FVC >0.7 in all subjects) and patients with COPD (n = 44, 35-79 years).


Plasma levels of SP-A increased with age and in the older group in relation to smoking and COPD. Plasma SP-D and MMP-9 levels did not change with age but were elevated in OS and COPD as compared to ONS. The TIMP-1 level declined with age but increased in chronic smokers when compared to ONS. The clearest correlations could be detected between plasma SP-A vs. age, pack years and FEV1/FVC. The receiver operating characteristic (ROC) curve analysis revealed SP-A to be the best marker for discriminating between patients with COPD and the controls (area under ROC curve of 0.842; 95% confidence interval, 0.785-0.899; p < 0.001).


Age has a significant contribution to potential markers related to smoking and COPD; SP-A seems to be the best factor in differentiating COPD from the controls.