Biomarkers and Genetic Factors Related to Emphysema

COPD is a disease in which the lung is damaged and breathing passages become partly
obstructed, making it difficult to breathe. Millions of people in the United States have
COPD, and it is the fourth leading cause of death in the country. Symptoms include coughing,
excess mucus production, shortness of breath and wheezing. Emphysema and chronic bronchitis
are illnesses associated with COPD. Emphysema is usually the result of many years of
cigarette smoking, but it remains unknown exactly how cigarette smoking causes emphysema. The
purpose of this study is to examine current and former smokers who have emphysema and those
who do not have emphysema to determine if certain biomarkers or genetic factors are
associated with an increased risk of developing the disease. Specifically, study researchers
will examine various genes and two proteins, membrane-type-1 matrix metalloproteinase
(MT1-MMP) and extracellular matrix metalloproteinase inducer (EMMPRIN), to determine the role
they play in the development of emphysema.

Participants will attend one study visit, which will include a medical history review, a
blood collection, lung function testing, a 6-minute walk test, and a chest computed
tomography (CT) scan. A portion of blood will be stored for current and future genetic
research. Participants will also complete questionnaires to collect information on
activities, health, and quality of life. Some participants will be invited to return for a
bronchoscopy, which is a procedure that allows a doctor to sample the inside of the lungs.
Study researchers will contact all participants at the end of the study to collect follow-up
medical information.

Inclusion Criteria for All Participants:

- Able to read and write English

- At least 30 pack-year smoking history (the equivalent of smoking a pack a day for 30
years)

- Able to participate in the informed consent process

- Relatively stable clinical status for the past six weeks (i.e., no illness in the 6
weeks before study entry)

Inclusion Criteria for Participants with Emphysema:

- Global Initiative for Chronic Obstructive Lung Disease (GOLD) class II, III, or IV
COPD, as determined by post-bronchodilator spirometry values OR

- More than minimal emphysema on an acceptable-quality chest CT scan

Inclusion Criteria for Participants without Emphysema:

- GOLD class I COPD or GOLD class 0 (2005 classification), as determined
post-bronchodilator spirometry values AND

- No or minimal emphysema on an acceptable-quality chest CT scan

Exclusion Criteria:

- Pregnant

- Prisoner

- Vulnerable populations

- Recent illness (defined as increased cough, sputum production, worsening malaise, or
need for unscheduled physician visit in the 6 weeks prior to enrollment)

- Coexisting active chronic inflammatory or collagen vascular disease, immunodeficiency
of any kind, non-cutaneous malignancy (melanoma is an exclusion), or previous organ
transplant

- Congenital abnormalities of the lung or previous lung surgery

- Known active hepatitis B, hepatitis C, or HIV/AIDS (not prospectively evaluated)

- CT evidence of lung disease other than emphysema (including significant fibrosis,
bronchiectasis, consolidation, or indeterminate nodules)