Attention has recently focused on the critical role of inflammatory responses in the tumor stroma that provide favorable conditions for cancer-cell growth and invasion/metastasis. In particular, macrophages recruited into the tumor stroma and activated, known as tumorassociated macrophages, are suggested to promote tumorigenesis. In this study, we examined the effect of a decrease in the number of monocytes/macrophages in peripheral blood and the tumor stroma on the development of bone and muscle metastases by lung cancer cells. M etastases of several malignant cancers including those of the breast, lung, prostate, and kidney have high affinity for bone. Bone metastasis is often accompanied by serious complications such as pathological fractures, bone pain, spinal cord compression, and hypercalcemia. Organ metastasis, including that affecting bone, is a multistep process mediated through mutual interaction between cancer cells and the host microenvironment. In bone metastasis, cancer cells reach the bone via hematogenous spread, followed by osteoclastic bone resorption, and finally proliferate in the bone matrix.(1,2)Moreover, osteoclast-stimulating cytokines such as PTHrP have been shown to promote bone metastasis. Inflammatory responses in the tumor stroma play an important role by providing favorable conditions for cancer cell growth, invasion/metastasis, and angiogenesis as well as malignant progression.(4-6) In particular, monocytes/macrophages are recruited into the tumor stroma, and activated macrophages known as TAMs produce potent angiogenic factors, as well as inflammatory cytokines, growth factors, and proteases, resulting in a promotion of angiogenesis and invasion/metastasis.(7-9) Infiltrating TAMs are often closely associated with poor prognosis and tumor angiogenesis in patients with various tumor types.(9-11) A preparation of Cl 2 MDP-LIP has been reported to markedly inhibit angiogenesis in corneas in response to inflammatory cytokines through depletion of macrophages.(12) A recent study has demonstrated that administration of clodronate-liposomes depleted TAMs in mouse models resulting in significant inhibition of tumor growth and tumor angiogenesis, whereas free clodronate alone did not.(13) Clodronate-liposomes were also found to inhibit both tumor growth and tumor angiogenesis by lung cancer cells in a xenograft model when stimulated by inflammatory stimuli. (14) Angiogenesis in a tumor microenvironment in bone marrow also played a critical role in the induction of an angiogenic response and invasion/metastasis by cancer cells.(15) Furthermore, monocyte/macrophage precursor cells entered the osteoclastic lineage and expressed the osteoclastic marker TRAP under the influence of the RANK/RNAKL signaling pathway.(16) Tumor burden at bone metastatic sites was markedly decreased in preclinical models on treatment with inhibitors of the RANK/RANKL pathway and neutralizing antibodies against PTHrP as well as bisphosphonate, suggesting a central role for osteoclasts in bone metastasis. (17)(18)(19) ...