| Bronchioloalveolar
lung carcinoma (BAC) is a form of lung cancer
for which etiology and pathogenesis are controversial.
While squamous cell carcinomas and small cell
carcinomas have shown an overall decrease in incidence
during the past four decades, BACs and peripheral
adenocarcinomas (PAC) have shown exponential increases
during this same time period. Some of the distinguishing
pathological, biological, epidemiological, and
perhaps etiological features of BAC/PAC include
its peripheral location, its association with
desmoplasia (scarring), its comparatively high
female/male ratio, and its high incidence of multifocality.
These days there is emerging evidence that stem
cells and transformed stem cells are the source
and reservoir of many human cancers. Based on
the multifocality of BAC/PAC, its penchant for
recurring, its penchant for initially responding
to targeted therapies and then relapsing and other
unique biological features, certainly the applicability
of the stem cell hypothesis to human BAC/PAC would
appear real and worthy of study. We recently made
a startling observation in patients who had received
a bone marrow transplant from a different sex
donor for non-Hodgkin’s lymphoma or leukemia
who years later developed lung BAC/PAC. The BAC/PAC
which developed was of donor origin! This could
only have been the case if a stem cell derived
from the bone marrow of the donor was the cell
of origin of the BAC/PAC. We would like to test
this hypothesis further in two experimental mouse
models, so-called transgenics which express certain
genes that cause the mouse to develop BAC/PAC.
If our hypothesis is correct and, in fact, a bone
marrow-derived stem cell gives rise to BAC/PAC
then transplanting the bone marrow from these
transgenic mice into normal recipients (which
do not normally get lung cancer) will result in
the recipient mice getting BAC/PAC. Conversely
transplanting bone marrow from normal donors into
the transgenic mice whose original bone marrow
we destroy by irradiation should result in a decrease
or absence of BAC/PAC. If we can demonstrate experimental
proof for our hypothesis, we should be able to
identify and purify the putative bone marrow stem
cell that gives rise to BAC/PAC because they will
be marked with the causative transgene.
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