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Club cell
Club cell
Club cell
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Club cell
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Identifiers
Latinexocrinocytus bronchiolaris
THH3.05.02.0.00008
Anatomical terms of microanatomy

Club cells, also known as bronchiolar exocrine cells,[1] are low columnar/cuboidal cells with short microvilli, found in the small airways (bronchioles) of the lungs.[2] They were formerly known as Clara cells.

Club cells are found in the ciliated simple epithelium. These cells may secrete glycosaminoglycans to protect the bronchiole lining. Bronchiolar cells gradually increase in number as the number of goblet cells decrease.

One of the main functions of club cells is to protect the bronchiolar epithelium. They do this by secreting a small variety of products, including club cell secretory protein uteroglobin, and a solution similar in composition to pulmonary surfactant. They are also responsible for detoxifying harmful substances inhaled into the lungs. Club cells accomplish this with cytochrome P450 enzymes found in their smooth endoplasmic reticulum. Club cells also act as a stem cell, multiplying and differentiating into ciliated cells to regenerate the bronchiolar epithelium.[3]

Function

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The respiratory bronchioles represent the transition from the conducting portion to the respiratory portion of the respiratory system. The narrow channels are usually less than 2 mm in diameter and they are lined by a simple cuboidal epithelium, consisting of ciliated cells and non-ciliated club cells, which are unique to bronchioles. In addition to being structurally diverse, club cells are also functionally variable. One major function they carry out is the synthesis and secretion of the material lining the bronchiolar lumen. This material includes glycosaminoglycans, proteins such as lysozymes, and conjugation of the secretory portion of IgA antibodies. These play an important defensive role, and they also contribute to the degradation of the mucus produced by the upper airways. The heterogeneous nature of the dense granules within the club cell's cytoplasm suggests that they may not all have a secretory function. Some of them may contain lysosomal enzymes, which carry out a digestive role, either in defense: Club cells engulf airborne toxins and break them down via their cytochrome P-450 enzymes (particularly CYP4B1, which is only present in the club cells) present in their smooth endoplasmic reticulum; or in the recycling of secretory products. Club cells are mitotically active. They divide and differentiate to form both ciliated and non-ciliated epithelial cells.

Clinical significance

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Club cells contain tryptase, which is believed to be responsible for cleaving the hemagglutinin surface protein of influenza A virus, thereby activating it and causing the symptoms of flu.[4] When the l7Rn6 protein is disrupted in mice, these mice display severe emphysema at birth as a result of disorganization of the Golgi apparatus and formation of aberrant vesicular structures within club cells.[5] Malignant club cells are also seen in bronchioalveolar carcinoma of the lung. Serum club cell proteins are used as a biomarker of lung permeability. Exposure to particulate air pollution may compromise the integrity of the lung epithelium and lead to rapid increase in epithelial barrier permeability, as reflected by increased serum club cell concentrations.[6]

History

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Name change

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Club cells were previously called Clara cells, as they were first described by Max Clara (1899–1966), in 1937. Clara was an active member of the Nazi Party and used tissue taken from executed victims of Nazi Germany for his research—including the work that led to his discovery of Clara cells.[7] In May 2012, the editorial boards of most of the major respiratory journals (including the journals of the American Thoracic Society, the European Respiratory Society and the American College of Chest Physicians) concluded that the continued use of Clara's eponym would be equivalent to honoring him; they therefore introduced a name-change policy, which went into effect beginning January 1, 2013.[8] The term "Clara" was used parenthetically after "club cell" for a 2-year period, after which "Clara cell" and "Clara cell secretory protein" were conclusively replaced with "club cell" and "club cell secretory protein", respectively.[9]

See also

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References

[edit]
[edit]
Revisions and contributorsEdit on WikipediaRead on Wikipedia

Club cell

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from Grokipedia
Club cells are non-ciliated, dome-shaped epithelial cells primarily residing in the terminal and respiratory bronchioles of the , where they function as progenitors for epithelial repair, metabolize xenobiotics, and secrete protective proteins to modulate and maintain airway . Formerly known as Clara cells—named after Max Clara, whose involved controversial human tissue studies without explicit consent—the term "club cell" was adopted in 2013 by the Anatomy Society to prioritize descriptive nomenclature over eponyms. These cells produce club cell secretory protein (CC16), a key with anti-, immunomodulatory, and effects that protect against and environmental toxins, though CC16 levels decline in chronic diseases such as COPD and , correlating with disease severity. In addition to their defensive roles, club cells contribute to alveolar maintenance and can transdifferentiate into other cell types during injury or in pathological states like , highlighting their significance in both physiological resilience and oncogenesis.

Morphology and Distribution

Structural Characteristics

Club cells are non-ciliated, dome-shaped epithelial cells primarily residing in the terminal and respiratory bronchioles, exhibiting a characteristic club-like morphology due to a prominent apical bulge projecting into the airway lumen. These cells measure approximately 10–20 μm in diameter and adopt a cuboidal to low columnar shape, with a smooth apical surface bearing short, blunt microvilli that enhance secretory efficiency without the motile cilia found in neighboring ciliated cells. The lateral surfaces form tight junctions with adjacent epithelial cells, contributing to the airway barrier integrity. Under light , club cells appear pale-staining with a centrally positioned, round nucleus featuring a prominent and euchromatic , reflecting high transcriptional activity. The is and granular, owing to abundant organelles visible at higher resolution. Electron reveals extensive rough and smooth concentrated in the apical , supporting robust protein synthesis and ; numerous mitochondria provide for these processes; and a supranuclear Golgi apparatus facilitates packaging of secretory products into dense, electron-opaque granules, including those containing club cell secretory protein (CCSP, also known as SCGB1A1). These granules, often 0.5–1 μm in diameter, cluster apically and may include lamellar-like bodies, though distinct from the surfactant-containing structures in alveolar type II cells. This ultrastructural profile underscores the cells' specialization for and , with the apical dome and microvilli optimizing luminal interactions while the anchors the cell to the underlying via hemidesmosomes. Variations in density can occur across species or in response to injury, but the core features remain conserved in mammalian lungs.

Location in the Respiratory Tract

Club cells, also known as Clara cells, are nonciliated epithelial cells predominantly located in the small airways of the human respiratory tract, specifically the terminal and respiratory bronchioles. In these distal bronchiolar regions, club cells form a major component of the secretory epithelium, comprising approximately 11–22% of the total epithelial cell population in respiratory bronchioles and serving as the primary secretory cell type. Unlike in rodents, where club cells exhibit broader distribution across intrapulmonary airways, human club cells are largely confined to the bronchiolar epithelium of small airways and are scarce or absent in larger bronchi, trachea, or alveoli under normal conditions. This localization positions them at the interface between conducting airways and gas-exchange regions, where they line the luminal surface without cilia or mucus secretion, often appearing as dome-shaped protrusions into the airway lumen. While club cells can transiently appear in alveoli following injury or with aging, their baseline distribution remains restricted to small airway bronchioles, reflecting species-specific adaptations in architecture.

Physiological Functions

Secretory and Metabolic Roles

Club cells serve as the primary secretory cells in the small-airway , constituting approximately 20% of these cells and producing a range of proteins and essential for airway . Their secretions occur via and mechanisms, often stimulated by adrenergic fibers, and include the club cell secretory protein (CCSP, also known as CC16 or SCGB1A1), a 16 kDa homodimeric protein resistant to proteases, low temperatures, and pH variations. CCSP exhibits anti-inflammatory effects by inhibiting , interferon-γ signaling, activation, and p38 MAPK pathways, thereby reducing pro-inflammatory cytokines such as IL-1β, IL-8, TNF-α, and IL-6. Additional secretory products encompass surfactant-binding proteins (SP-A, SP-B, SP-D) for binding and physical protection, antiproteases including secretory leukocyte protease inhibitor (SLPI), WFDC2, (CST3), SERPINB3, and α-1-antitrypsin (SERPINA1), as well as glycoproteins, , and KL-6 protein. Club cells also express the polymeric immunoglobulin receptor (pIgR), facilitating transport of secretory IgA to maintain mucosal immune barriers. In metabolic functions, club cells play a critical role in detoxification, expressing high levels of enzymes such as CYP2F1, CYP4B1, and in humans (and Cyp2f2 in mice), which biotransform environmental toxins including , , tobacco smoke components, and benzo[α]pyrene. These monooxygenases, along with flavin-containing monooxygenases, enable phase I metabolism, converting lipophilic into more polar forms for , though this can generate reactive intermediates leading to cellular damage if not balanced by phase II conjugation. Complementary enzymes like S-transferases, dehydrogenases, and aldo-keto reductases further mitigate by neutralizing and facilitating . CCSP contributes to this process by binding polychlorinated biphenyls and modulating metabolism, while club cell secretions collectively regulate distal airway fluid and support production to prevent alveolar collapse. These metabolic activities position club cells as key guardians against occupational and environmental hazards, with structural alterations such as mitochondrial swelling observable within 1 hour of toxin exposure and formation after 24 hours.

Immune Defense and Xenobiotic Detoxification

Club cells contribute to pulmonary immune defense through secretion of club cell secretory protein (CCSP), also designated CC16 or CC10, which exerts and immunomodulatory effects by inhibiting phospholipase A2 activity, sequestering pro-inflammatory mediators, and suppressing production such as IL-1β and IL-8 via blockade of activation. In experimental models of (RSV) infection, CCSP modulates immune responses by reducing infiltration, T-cell activation, and Th2-skewed , thereby limiting excessive pulmonary damage. Additionally, CCSP promotes phagocytic activity in alveolar s while decreasing oxidative stress-induced , enhancing clearance of pathogens and debris during acute lung injury. Beyond CCSP, club cells release and support epithelial barrier integrity, maintaining homeostasis against microbial challenges in the distal airways. In , club cells serve as the principal site of metabolic processing for inhaled toxins, expressing elevated levels of (CYP) monooxygenases—particularly isoforms like CYP2F2 in and analogous human variants—that catalyze phase I oxidation of environmental pollutants, tobacco smoke constituents, and volatile organic compounds. This enzymatic activity facilitates conjugation and elimination of xenobiotics, preventing accumulation and in alveolar regions, as evidenced by heightened susceptibility to naphthalene-induced injury in club cell-deficient models. Club cells' metabolic capacity extends to oxidative defense, where CYP enzymes mitigate reactive intermediates from or exposure, underscoring their role in protecting against occupational and ambient hazards. Disruption of this function, as in , correlates with reduced CC16 levels and impaired , exacerbating tissue vulnerability.

Developmental and Regenerative Roles

Involvement in Lung Development

Club cells, non-ciliated secretory cells of the bronchiolar , emerge during the late pseudoglandular and canalicular stages of lung development in mammals. In models, their differentiation begins around embryonic day 16.5 (E16.5), coinciding with the onset of expression for the marker secretoglobin family 1A member 1 (SCGB1A1), which intensifies by E17.5 in both large and small airways. Earlier expression of related secretoglobins like SCGB3A2 appears at E14.5, suggesting a preparatory role in airway epithelial specialization prior to full club cell maturation. Differentiation of club cells arises from multipotent airway progenitors expressing transcription factors such as Id2, Sox9, and Sox2, which drive their exit from branching regions and activation of secretory programs. Key signaling pathways, including β-catenin stabilization for intercellular connections and Notch signaling for balancing secretory versus ciliated cell fates, regulate this process; high Notch activity favors club cell specification while inhibiting ciliogenesis. In human fetal lungs, club cell-specific protein (CC10, also known as SCGB1A1) aligns with epithelial maturation, supporting an inductive role in airway development. In the perinatal period, club cells function as progenitors capable of differentiating into type I and type II alveolar pneumocytes as well as ciliated cells, contributing to the establishment of functional respiratory epithelium in newborns. Their secretions, including CC10 and surfactant-binding proteins (A, B, D), aid in stabilizing pulmonary structures and protecting against early oxidative stress, with deficiencies linked to heightened vulnerability in developing lungs. Ex vivo studies of fetal rat lungs exposed to mesenchymal stromal cell-conditioned media demonstrate significant upregulation of club cell secretory protein, correlating with enhanced branching morphogenesis—increasing terminal buds from 46.7 ± 5.7 to 73.5 ± 6.1 (P < 0.05)—and accelerated surface area expansion. These findings underscore club cells' paracrine contributions to alveolarization and overall lung architecture formation.

Contribution to Tissue Repair and Stem Cell Dynamics

Club cells function as facultative progenitors in the distal airway epithelium, enabling repair of bronchiolar tissue following injury by proliferating and differentiating to replenish the epithelial lining. In models of naphthalene-induced injury, which selectively depletes CYP2F2-expressing club cells, a resistant subpopulation of SCGB1A1-positive variant club cells survives, undergoes self-renewal, and generates both new club cells and ciliated cells to restore epithelial integrity within 2-3 weeks. Lineage-tracing experiments using Scgb1a1-CreER mice confirm that these progenitors contribute over 90% of the regenerated bronchiolar cells, highlighting their essential role in localized tissue homeostasis. Beyond airway repair, certain club cell subsets exhibit plasticity to support alveolar regeneration under severe injury conditions. A quiescent subpopulation comprising approximately 5% of club-like cells, identified as lineage-negative epithelial progenitors (LNEPs) with high H2-K1 (MHC class I) expression, proliferates robustly after bleomycin administration—reaching 11% EdU incorporation compared to 2% in H2-K1-low cells—and differentiates into alveolar type 1 (AEC1) and type 2 (AEC2) cells, aiding functional recovery such as improved oxygenation. These LNEPs differ from mature club cells by showing limited self-differentiation into club lineages (<1%) and unique host-defense signaling, suggesting they represent a specialized reserve for cross-compartmental repair rather than routine airway maintenance. In lung stem cell dynamics, club cells occupy a hierarchical niche as transit-amplifying progenitors in mild distal airway damage, positioned downstream of basal stem cells in proximal regions and upstream of terminally differentiated ciliated or secretory cells. Notch signaling modulates their fate decisions, promoting differentiation into ciliated cells while inhibiting excessive proliferation. However, injury severity reveals stem-like heterogeneity: while most club cells act facultatively, LNEP subsets mobilize as potent regenerators, challenging uniform progenitor models and indicating context-dependent activation in the broader epithelial stem cell network, which includes bronchioalveolar stem cells (BASCs) at airway-alveolar junctions—though BASC contributions remain debated due to marker overlap with AEC2s. This plasticity underscores club cells' role in adaptive repair but also highlights limitations, such as senescence-associated barriers (e.g., Cdkn1a upregulation) that constrain full regenerative output in chronic or aged contexts.

Clinical and Pathological Aspects

Associations with Lung Diseases

Club cells, through their production of club cell secretory protein (CC16, also known as SCGB1A1), exhibit protective functions against inflammation and oxidative stress, but their dysfunction or depletion is implicated in the pathogenesis of several lung diseases. In chronic obstructive pulmonary disease (COPD), club cell numbers are reduced in the small airways of affected individuals, particularly smokers, correlating with subepithelial fibrosis, goblet cell hyperplasia, and airflow obstruction. Serum and airway CC16 levels are inversely associated with disease severity and annual decline in forced expiratory volume in 1 second (FEV1), with Mendelian randomization studies indicating a causal protective role of CC16 against COPD risk and progression via dampening of chronic inflammation and activation. In asthma, fewer CC16-positive epithelial cells are observed in small airways, accompanied by lower serum and bronchoalveolar lavage fluid (BALF) CC16 concentrations, particularly in cases of longer disease duration. Genetic polymorphisms in the CC16 gene, such as A38G, increase asthma susceptibility and are linked to reduced plasma CC16, while CC16 inhibits Th2 cytokine expression and eosinophilic inflammation, suggesting a modulatory role in airway hyperresponsiveness. Club cells contribute to pulmonary fibrosis, including idiopathic pulmonary fibrosis (IPF), where they undergo phenoconversion—acquiring proliferative and migratory properties—and migrate to sites of injury, promoting fibrotic remodeling. CC16 knockout mice show heightened susceptibility to bleomycin-induced fibrosis, yet human IPF patients exhibit elevated serum and BALF CC16 levels reflective of epithelial damage and barrier permeability; depletion of club cells in experimental models attenuates lung injury and fibrosis progression. In lung adenocarcinoma, club cells serve as progenitor cells capable of forming tumors, particularly in response to oncogenic drivers like KRAS mutations, with their maintenance of alveolar structures also implicated in premalignant states. Reduced serum uteroglobin (CC16) concentrations in smokers correlate with increased lung cancer mortality, underscoring a potential anticarcinogenic role disrupted in chronic lung injury. Other associations include acute respiratory distress syndrome (ARDS), where elevated serum CC16 in non-survivors indicates leakage from damaged epithelium and predicts mortality, contrasting with lower BALF levels; and cystic fibrosis, where CC16 deficits compound inflammation and lung function decline. Occupational exposures and cigarette smoke further deplete club cells, exacerbating interstitial lung diseases through impaired xenobiotic detoxification.

Biomarkers and Diagnostic Implications

Club cell secretory protein (CCSP), also known as CC16 or secretoglobin family 1A member 1 (SCGB1A1), serves as the principal biomarker for club cell function and integrity, detectable in serum, urine, bronchoalveolar lavage fluid, sputum, and other respiratory specimens. Produced abundantly by club cells, CCSP levels reflect epithelial health, with reductions often signaling injury, inflammation, or dysfunction due to its anti-inflammatory and protective roles, such as inhibiting phospholipase A2 activity and neutrophil chemotaxis. Measurement typically employs enzyme-linked immunosorbent assay (ELISA), providing a non-invasive means to assess club cell-derived contributions to lung pathology. In asthma, circulating CC16 deficits are linked to increased disease risk and persistence, with a meta-analysis of three cohorts (Tucson Children’s Respiratory Study, BAMSE, and Manchester Asthma and Allergy Study; n>4,000) showing that each standard deviation decrease in CC16 elevates odds of asthma by 20% (adjusted OR 1.20, 95% CI 1.12–1.28) and frequent symptoms by 40% (adjusted RRR 1.40, 95% CI 1.24–1.57), independent of lung function. Low childhood CC16 predicts persistent adult symptoms (adjusted OR 3.72, 95% CI 1.78–7.76), positioning it as a prognostic tool for risk stratification. For chronic obstructive pulmonary disease (COPD), reduced serum and sputum CC16 correlates with severity, accelerated lung function decline, and chronic bronchitis phenotype, with Mendelian randomization studies indicating a causal protective effect of higher levels. Serum CC16 also holds prognostic value in other conditions; in (IPF), elevated levels in serum and lavage fluid associate with disease severity and club cell proliferation, while models incorporating CC16 predict acute exacerbations and . In , baseline serum CC16 inversely predicts mortality, with each standard deviation decrease raising overall cancer risk by 41% (HR 1.41, 95% CI 1.19–1.67) and mortality in smokers by 52% (HR 1.52, 95% CI 1.14–2.03) in a longitudinal cohort of 1,086 adults followed up to 39 years. Similarly, low CC16 forecasts epithelial damage in , silica-induced , and viral infections like and H1N1, where it tracks inflammation and outcomes. Diagnostic implications include early detection of subclinical airway and epithelial barrier disruption, as serum CC16 sensitively mirrors club cell loss preceding overt symptoms in obstructive diseases. However, levels vary with environmental exposures (e.g., , pollutants) and genetic polymorphisms like G38A (rs3741240), which reduce expression and confound interpretations, necessitating context-specific thresholds. While promising for monitoring therapy response and (e.g., predicting chronic allograft dysfunction), CC16's utility is limited by variability and inconsistent elevations in fibrotic versus obstructive pathologies, underscoring the need for multimodal panels.

Potential Therapeutic Targets

Club cell secretory protein (CCSP), also known as CC16, exhibits properties by dampening leukocyte migration, , and pro-inflammatory production in the , positioning it as a candidate for therapeutic augmentation in (COPD), where CCSP levels are deficient and correlate with disease severity. Recombinant human CCSP (rhCCSP) administered intratracheally has shown potential to reduce and improve outcomes in preclinical models of COPD and acute exacerbations, suggesting its utility in restoring airway protection against oxidative damage. In ischemia-reperfusion injury models relevant to , CCSP pretreatment mitigates endothelial damage and , indicating prophylactic therapeutic value. Subpopulations of club cells function as progenitor cells capable of differentiating into alveolar type 2 (AT2) and type 1 (AT1) cells during injury-induced regeneration, offering targets for stem cell-based therapies to repair damaged alveoli in conditions like or . Specialized club cell subsets, marked by expression profiles distinct from bulk populations, mobilize post-injury to contribute to epithelial renewal, highlighting their potential in engineered progenitor transplantation for enhancing repair efficiency. In (IPF), club cell-specific overexpression of 5 (PDCD5) exacerbates fibrotic remodeling, while its targeted deletion ameliorates disease progression in murine models, implicating PDCD5 as a club cell-restricted therapeutic target to curb activation and deposition. Similarly, inactivation of the TGF-β1/ALK5 signaling axis in club cells boosts their proliferative and differentiative capacity, reversing emphysematous changes in COPD models and supporting pathway inhibitors as adjunct therapies to preserve bronchiolar integrity. For particulate matter-induced , exogenous CC16 administration reduces and promotes epithelial proliferation, underscoring its role in mitigating environmental toxin-driven . In lung adenocarcinoma (LUAD), club cells serve as cells-of-origin for Kras-mutant tumors, with their inactivation preventing aggressive phenotypes, suggesting oncogene-targeted interventions early in tumorigenesis; conversely, radiation-activated club cell secretions, including CCSP, suppress immunosuppressive myeloid cells and enhance anti-tumor immunity, proposing mimics for adjuvant . These targets collectively leverage club cells' secretory, regenerative, and modulatory functions, though clinical translation requires validation of specificity to avoid off-target effects on airway .

Historical Context

Initial Discovery and Description

The non-ciliated secretory cells of the bronchiolar , later termed club cells, were initially observed in 1881 by anatomist , who described them as bronchiolar cells lacking both cilia and mucus in mammalian lungs during histological examinations. Kölliker's observations, based on light microscopy of animal tissues, highlighted their distinct epithelial position in terminal bronchioles but did not elaborate on their or function beyond basic morphology. In 1937, German anatomist Max Clara provided the first detailed characterization of these cells in human lungs, naming them after their prominent secretory features in a study published in the Zeitschrift für mikroskopisch-anatomische Forschung. Clara examined bronchiolar from human samples, identifying the cells as dome-shaped with , a rounded nucleus, and apical secretory granules visible under light after specific techniques. He emphasized their role in producing a surface-active to protect the bronchiolar lining, distinguishing them from ciliated and goblet cells. These findings established the cells' identity as a specialized bronchiolar subtype, though subsequent scrutiny revealed that some samples derived from executed prisoners in Nazi-era facilities, raising ethical concerns about the research context without invalidating the morphological observations.

Nomenclature Evolution and Debates

The bronchiolar secretory cells now termed club cells were first noted in 1881 by as non-ciliated, non-mucous cells in terminal bronchioles, though without an eponym. In 1937, anatomist Max Clara provided a detailed histological description of these dome-shaped, secretory epithelial cells in and animal lungs, leading to their designation as "Clara cells" in subsequent literature. This persisted for decades, reflecting Clara's identification of their , including prominent secretory granules and lack of cilia, which distinguished them from neighboring ciliated and goblet cells. Debates over the nomenclature intensified in the late 2000s, driven by revelations of Clara's active membership from 1937 onward and his unethical use of tissues from executed prisoners—often political dissidents—for , conducted or ethical oversight. Critics, including respiratory scholars, argued that retaining the eponym honored a figure complicit in Third Reich atrocities, aligning with broader efforts to purge of "tainted eponyms" from that , such as those linked to Wegener or Stillingfleet. Proponents of change emphasized that scientific validity of Clara's morphological observations did not justify perpetuating his name, proposing descriptive alternatives like "club cells" (evoking the cells' characteristic apical dome and club-like outline, a term suggested as early as ) or "bronchiolar exocrine cells" to prioritize function and structure over personal association. While some defended eponyms for their historical utility in denoting cell types, the ethical consensus favored avoidance, particularly given Clara's post-war denial of involvement and continued academic career despite scrutiny. In May 2012, the , alongside editors of leading respiratory journals, endorsed replacing "Clara cells" with "club cells" to reflect these concerns and standardize non-eponymous terminology. The shift was formalized by 2013, with "club cell" gaining widespread adoption in peer-reviewed publications for its morphological accuracy and neutrality. Official anatomical nomenclature retains "exocrine bronchiolar cell" for precision, but "club cell" predominates in functional and pathological contexts due to its brevity and alignment with markers like secretoglobin family 1A member 1 (SCGB1A1). Despite the change, "Clara cell" lingers in legacy literature and some databases, complicating searches, though modern reviews consistently favor "club cell" to dissociate from historical baggage without altering empirical understanding of the cell's role in metabolism and airway protection.

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