Background-Lysozyme is increased in inflammatory reactions and is a component of the extracellular matrix, but its possible role in lung diseases such as emphysema and interstitial fibrosis has not been investigated. Methods-To characterise diVerences in lysozyme content among normal, emphysematous, and fibrotic human lungs, tissue sections obtained from necropsy specimens were immunostained with rabbit polyclonal anti-human lysozyme antibody using the labelled streptavidin-biotin peroxidase method. The immunostained sections were evaluated semiquantitatively (grading the degree of immunostaining on a scale of 0-4). To determine if degradation of the extracellular matrix aVects lysozyme binding, hyaluronidase-treated normal lung tissues were incubated with egg white lysozyme, immunostained with the lysozyme antibody, which crossreacts with egg white lysozyme, and evaluated for degree of staining. Results-Lysozyme immunostaining was significantly increased in lungs with pulmonary emphysema compared with normal or fibrotic tissues (3.4 versus 1.6 and 1.9, respectively; p<0.05) and was preferentially associated with interstitial elastic fibres. Hyaluronidase-treated lung tissues incubated with lysozyme showed increased immunostaining for this protein compared with untreated controls (1.9 versus 1.2; p<0.05). Conclusions-The results suggest that damage to elastic fibres and/or the surrounding extracellular matrix increases lysozyme binding. It is hypothesised that attachment of lysozyme to elastic fibres may interfere with their repair and possibly enhance the progression of pulmonary emphysema. (Thorax 1998;53:193-196) Keywords: lysozyme; pulmonary emphysema; elastic fibres This study examined the possible role of lysozyme in lung injury. The investigation was prompted by earlier studies indicating that lysozyme is increased in a number of inflammatory conditions and is specifically associated with extracellular matrix constituents.1-3 These findings suggested that the amount of lysozyme in the lung might be altered in diseases such as emphysema or interstitial fibrosis where there is damage to various matrix components.To determine if lysozyme is involved in pulmonary disease, tissue sections from normal, fibrotic, and emphysematous human lungs were evaluated for diVerences in lysozyme content. An increase in extracellular lysozyme was specifically observed in lung tissues with pulmonary emphysema, and the protein was preferentially associated with elastic fibres which undergo breakdown in this disease. Since this laboratory and other investigators have previously shown that hyaluronic acid and other polysaccharides surround elastic fibres, 4 5 normal lung tissues were treated with hyaluronidase and examined for their ability to bind exogenously administered lysozyme. Such treatment resulted in increased attachment of lysozyme, suggesting that degradation of extracellular matrix components, as occurs in pulmonary emphysema, may expose binding sites for lysozyme on elastic fibres, possibly altering matri...