Neuroendocrine tumors in the lung fall into four categories: typical carcinoid tumor (TC), atypical carcinoid tumor (AC), large-cell neuroendocrine carcinoma (LCNEC) and small-cell lung carcinoma (SCLC), in ascending order of malignancy. The drs gene was originally isolated as a suppressor against v-src transformation and was shown to induce apoptosis in human cancer cells. The expression of drs was markedly downregulated in various human cancer tissues and cell lines. Furthermore, drs knockout mice showed a tumor-prone phenotype, indicating that drs acts as a tumor suppressor gene in malignant tumor formation. To clarify the role of the drs gene in the development of human pulmonary neuroendocrine tumors, we examined the expression of drs mRNA in tissue specimens from 3 cases of TC, 4 cases of AC, 2 cases of LCNEC, and 11 cases of SCLC by in situ mRNA hybridization. Four cases of normal lung and bronchial epithelia, 8 samples of normal brain tissue, and 2 cases of tumorlets in the lung were also examined. The drs mRNA was definitely expressed in all normal tissues of the lung and brain, and 3 TC and 2 tumorlet tissues. The expression of drs mRNA was also detected in 2 of 2 LCNEC tissues and 3 of 4 AC tissues, although the signals were weak. On the other hand, drs mRNA was not detected in 10 of 11 SCLC tissues. Downregulation of drs mRNA was also observed in 3 of 4 SCLC cell lines that were examined by reverse transcriptase-polymerase chain reaction (RT-PCR). Neither gross deletion nor rearrangement of the drs genome was detected in these cell lines by Southern blot analysis. Our results indicate that the downregulation of drs is correlated with the development of SCLC, a highly malignant pulmonary neuroendocrine tumor.