Abstract : The mechanisms of pulmonary emphysema, characterized by the destruction of alveolar walls, remain incompletely understood. Our hypothesis is that a deficiency in fibroblast-borne alveolar repair systems accounts partly for the constitution of lesions in this disease. In our experiments, we show that fibroblasts isolated in vitro from human emphysematous lung express the Hepatocyte Growth Factor and the Keratinocyte Growth Factor (KGF), which target alveolar epithelial and endothelial cells, at low or unstimulable levels. Additionally, emphysema fibroblasts did not increase their expression of elastin, the main component of the pulmonary extracellular matrix, in response to retinoic acid, due to a low expression of Cellular Retinoic Acid Binding Protein 2 (CRABP2). The role of KGF In alveolar homeostasis was demonstrated in vivo in the elastase-induced emphysema model: Mice treated with KGF before elastase instillation were protected against emphysema. CRABP2- knockout mice were not protected against emphysema in this model. Our pathophysiological data may help in the identification of novel therapeutic targets for emphysema.