1 Institute of Anesthesiology and 2 Institute of Physiology, University of Zurich Medical School, Zurich, Switzerland; 3 Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan; 4 Department of Surgery and 5 Cardiovascular Research, Institute of Physiology, University of Zurich Medical School, Zurich, Switzerland Submitted 21 October 2004 ; accepted in final form 8 August 2005 Respiratory epithelial cells play a crucial role in the inflammatory response in endotoxin-induced lung injury, an experimental model for acute lung injury. To determine the role of epithelial cells in the upper respiratory compartment in the inflammatory response to endotoxin, we exposed tracheobronchial epithelial cells (TBEC) to lipopolysaccharide (LPS). Expression of inflammatory mediators was analyzed, and the biological implications were assessed using chemotaxis and adherence assays. Epithelial cell necrosis and apoptosis were determined to identify LPS-induced cell damage. Treatment of TBEC with LPS induced enhanced protein expression of cytokines and chemokines (increases of 235–654%, P < 0.05), with increased chemotactic activity regarding neutrophil recruitment. Expression of the intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1) was enhanced by 52–101% ( P < 0.0001). This upregulation led to increased adhesion of neutrophils, with >95% adherence to TBEC after LPS stimulation, which could be blocked by either ICAM-1 (69%) or VCAM-1 antibodies (55%) ( P < 0.05). Enhanced neutrophil-induced necrosis of TBEC was observed when TBEC were exposed to LPS. Reduced neutrophil adherence by ICAM-1 or VCAM-1 antibodies resulted in significantly lower TBEC death (52 and 34%, respectively, P < 0.05). Therefore, tight adherence of neutrophils to TBEC appears to promote epithelial cell killing. In addition to indirect effector cell-induced TBEC death, direct LPS-induced cell damage was seen with increased apoptosis rate in LPS-stimulated TBEC (36% increase of caspase-3, P < 0.01). These data provide evidence that LPS induces TBEC killing in a necrosis- and apoptosis-dependent manner. lipopolysaccharide; inflammatory mediators; leukocytes Address for reprint requests and other correspondence: B. Beck-Schimmer, Institutes of Anesthesiology and Physiology, Univ. of Zurich Medical School, Winterthurerstrasse 190, CH-8057 Zurich, Switzerland (e-mail: Beatrice_Beck.Schimmer{at}access.unizh.ch )