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22 The absence of ABCA1 or ABCG1 in alveolar type II epithelial cells leads to cholesterol overload, impairing surfactant function, and resulting in severe surfactant protein and lipid accumulation

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Chronic smoking also leads to the formation of atheromatous plaques due to increased expression of matrix metalloproteinases (MMP), particularly MMP-12 and MMP-9 in macrophages, MMP-8 and MMP-9 in endothelial cells, and MMP-2 and MMP-9 in vascular smooth muscle cells ( 35 , 36 )