A recent study has indicated that alveolar macrophages from smokers incubated with lipopolysaccharide (LPS) secrete much more IL-1b and TNF-a than those from healthy nonsmokers, but the mechanisms underlying this augmented secretion by cigarette smoke (CS) remain unknown. CS and LPS reportedly promote macrophages' secreting substance P (SP) that could up-regulate these cytokines' secretion from macrophages by acting on neurokinin 1 receptor (NK1R). Moreover, NF-kB from macrophages participates in NK1R intracellular signaling and synthesis of these cytokines. The present in vitro study was undertaken to examine whether CS is able to synergize these cytokines' response to LPS in macrophages, and if so, whether an amplified SP secretion is responsible for this synergistic cytokines' response via a NK1R-driven NF-kB pathway. THP-1-derived and MH-S macrophages were exposed to control medium and CS condensate (CSC) without or with LPS. We found that LPS, CSC, and CSC1LPS significantly increased IL1b, TNF-a, and SP secretion and that SP secretion markedly preceded cytokines' secretion. CSC1LPS-induced responses were markedly greater than the sum of the responses to CSC and LPS alone, suggesting a synergistic effect. Blocking NK1R reduced the responses of IL-1b, TNF-a, and NF-kB activation to CSC1LPS by 41, 40, and 46%, respectively. NF-kB inhibitors decreased the CSC1LPS-induced cytokines' responses by 70%. Our findings suggest that CS amplifies the LPS-induced macrophages' secretion of IL-1b and TNF-a through synergizing SP secretion, which activates NF-kB via binding with NK1R.Keywords: cytokines; infection; emphysema; signal pathway of NF-kB IL-1b and TNF-a are important cytokines participating in the pathogenesis of multiple pulmonary diseases, such as pulmonary infection, fibrosis, cancer, and emphysema (1-4). For example, cigarette smoke (CS)-induced emphysema was diminished up to 83% in mice that were null of receptors for IL1b and TNF-a (4). Macrophages are one of the important sources these cytokines (5), especially during infection (6). It was reported that pulmonary infection induced by intratracheal instillation of lipopolysaccharide (LPS) substantially promoted cytokine secretion from macrophages (7). A recent study has further indicated that alveolar macrophages from smokers incubated with LPS secrete much more IL-1b and TNF-a than those from healthy nonsmokers (8). This finding, along with a higher secretion of these cytokines in smokers with pulmonary infection than in those without infection (6), implies a synergistic effect of CS exposure on macrophage secretion of these cytokines induced by LPS. However, the exact mechanisms underlying this CS augmented effect on cytokine secretion have not been investigated.There is evidence demonstrating synergistic impacts of CS on the receptors' expression or mucin secretion. We have observed that alveolar macrophages from mice exposed to CS express more neurokinin 1 receptors (NK1R) in response to substance P (SP) compared with those from control mice (9). Moreo...