[A case of pulmonary alveolar proteinosis associated with fibrotic changes and alveolitis]

A 62-year-old male, who had worked for 20 years as a farmer and who had been exposed to respirable agricultural chemicals apart from silica, was admitted in April, 1987, because of progressed exertional dyspnea. The chest X-ray film on admission showed irregularly-distributed infiltrative shadows in both lung fields. The chest CT also revealed irregular increase of densities in lung fields. Though the TBLB specimen from right B8 indicated only fibrotic changes, the tissues obtained by open lung biopsy from right S3 and S8 revealed PAS-positive proteinaceous deposits in the alveoli as well as alveolitis or fibrotic change of alveolar septum. Bronchoalveolar lavage fluid (BALF) contained phospholipids composed mainly of lecithin. According to these findings, the case was diagnosed as pulmonary alveolar proteinosis associated with alveolitis and patchy fibrotic changes. It is not completely clear whether fibrotic changes are induced by pulmonary alveolar proteinosis itself or fibrosis and proteinosis result coincidentally from direct response to fibrogenic agents. Inhaled agricultural chemicals may play a role for the pathogenesis of this case, for which further studies are required.

Increased levels of bombesin-like peptides in the lower respiratory tract of asymptomatic cigarette smokers

Bombesin-related peptides are growth factors for a variety of cells, including normal human bronchial epithelial cells. An ELISA for bombesin-like peptides (BLP) has been devised using the MAb BBC353, which is specific for the biologically active carboxy-terminal fragment shared by all known BLP. Using this ELISA, we measured bronchoalveolar lavage (BAL) fluid levels of BLP in normal cigarette smokers (n = 15) and normal nonsmokers (n = 18). Smokers' BAL fluid contained increased levels of BLP, whether expressed in terms of BAL fluid volume (P = 0.0001) or protein content (P less than 0.05). BLP levels did not correlate with any cellular constituent in the BAL fluid but immunostaining of lung tissue with BBC353 revealed an intense specific staining of neuroendocrine cells, implying these as a potential source. Two peaks of bombesin-like immunoreactivity were purified using sequential reverse phase and gel filtration HPLC. Both BLP have apparent molecular weights similar to gastrin-releasing peptide on gel filtration HPLC analysis. However, the amino acid composition of these BLP is different from that of gastrin-releasing peptide or neuromedin B, the only known mammalian forms of BLP, suggesting either incomplete purification or novel peptides. Sequence analysis could not be performed due to blocking groups at the amino terminus of these peptides. Our data demonstrate that cigarette smoking is associated with increased levels of pulmonary BLP and imply a potential role for these neuropeptides in the lung's response to tobacco smoke.

[Usefulness of determining 2 cell membrane enzymes in bronchial aspirate and lung tissue in patients with cancer of the lung]

The cell membrane enzymes, Alkaline Phosphatase and Gamma Glutamyl Transferase, have been studied in lung aspirates from healthy subjects and lung cancer patients. These enzymes were studied, in the latter, both in healthy and in neoplastic tissue. The enzymatic activity both in the lung aspirate and in the neoplastic tissue was significantly lower in poorly differentiated cancers when compared to well or moderately differentiated tumors. Similarly, analysis revealed that there was a statistically significant decrease in the activity of both enzymes in lung aspirates from patients with bronchogenic tumors when compared to healthy controls. The results obtained in this present work, together with the easiness of obtaining a lung aspirate suggest that these enzymes should be determined in order to obtain further information about the histological origin of lung cancer. These enzymatic changes could be explained with the "fatalism" theory for neoplastic tissue as we explain in this work.

The effects of aminophylline and pentoxifylline on multiple organ damage after Escherichia coli sepsis

We studied the effects of the methylxanthines, aminophylline (AMPH) and pentoxifylline (PTXF), on multiple organ damage following Escherichia coli sepsis in guinea pigs. To assess multiple organ damage, 125I-labeled albumin accumulation was measured in bronchoalveolar lavage (BAL) fluid, lung, kidneys, liver, heart, adrenal glands, and spleen and expressed as a ratio of BAL fluid or tissue to 125I-labeled albumin plasma (albumin index: Al). Wet-to-dry lung weight (W/D) ratios were also measured. The methylxanthines were administered by a bolus injection followed by a continuous infusion. The seven experimental groups included: saline-control, AMPH-control, PTXF-control, E. coli septic-control, E. coli septic-AMPH high dose, E coli septic-AMPH low dose, and E. coli septic-PTXF. The AI of the BAL fluid and all examined organs significantly increased in the septic-control group compared to those in the saline-, AMPH-, and PTXF-control groups, In all septic-methylxanthine groups, the AI of the BAL fluid and all organs, except for the spleen, were significantly lower than those of the septic-control group. Compared to the saline-, AMPH-, and PTXF-control groups, the septic-control group revealed a significant increase in lung W/D ratios, whereas the septic-AMPH high and low dose groups and the septic-PTXF group did not. Of importance, the septic-PTXF group did not cause a significant decrease in mean arterial pressure (MAP) as compared to the control groups, whereas the septic-AMPH groups did cause a significant decrease in MAP compared to the septic-control group. Therefore, the data from this experiment demonstrate that both AMPH and PTXF attenuate the multiple organ albumin leak seen in septic guinea pigs. However, PTXF exerted this protective effect with no discernible effect on the MAP whereas the MAP of AMPH-treated guinea pigs was significantly decreased.

Comparison of pulmonary defense mechanisms in Rocky Mountain bighorn (Ovis canadensis canadensis) and domestic sheep

Alveolar macrophages were obtained from Rocky Mountain bighorn sheep (Ovis canadensis canadensis) and domestic sheep for the purpose of comparing pulmonary host defense mechanisms in the two species. Specific variables studied included (1) characterization of the cell types present in the lung, (2) alveolar macrophage phagocytic and bactericidal functions, (3) measurement of protein levels in lavage fluid, and (4) measurement of cortisol levels in lavage fluid. While phagocytic cell populations were similar between bighorn and domestic sheep, a significantly higher percentage of lymphocytes were present in bighorns than domestics (20% in bighorn versus 6% in domestic sheep). Significant differences were not observed in the phagocytic or bactericidal functions of macrophages between the two species. Significant differences were not observed in either lavage fluid protein levels or in cortisol levels.

Setting and monitoring of high-frequency jet ventilation in severe respiratory distress syndrome

High-frequency jet ventilation (HFJV) is used in respiratory distress syndrome (RDS) to avoid high airway pressures and barotrauma. This study was designed to find rational strategies to regulate oxygenation and alveolar ventilation at HFJV and to determine appropriate monitoring methods. Seven dogs were subjected to total lung lavage with saline to induce RDS. PEEP was increased at conventional intermittent positive-pressure ventilation until re-expansion was indicated by a PaO2 of 300 torr at an FIO2 of 1.0 HFJV at 4 and 15 Hz was each tried at 0 and 10 cm H2O PEEP. Intermittent low-frequency inflations were also added to HFJV at 0 PEEP. Lung expansion was maintained without circulatory depression by adjustment of minute ventilation (VE) delivered by the HFJ ventilator; external PEEP was a useful complement. PaCO2 was controlled by frequency adjustment. HFJV at 4 Hz resulted in hypocapnia; intermittent low-frequency inflations had no effect. VE monitoring, CO2 elimination monitoring, and PEEP adjustment was done with a standard ventilator during HFJV. This study illustrates that HFJV is efficient in RDS; VE and external PEEP strongly influence oxygenation and may be used to regulate this factor, and frequency affects CO2 elimination, thus suggesting a method of PaCO2 control.

Tumour necrosis factor in bronchopulmonary secretions of patients with adult respiratory distress syndrome

Tumour necrosis factor (TNF) concentrations were measured in the bronchopulmonary secretions of 5 patients with the adult respiratory distress syndrome. Each patient underwent fibreoptic bronchoscopy and bronchopulmonary aspiration, and control samples were obtained in an identical manner from 24 patients who underwent bronchoscopy for other reasons (8 had tuberculosis, 6 had sarcoidosis, and 10 had haemoptysis but no abnormal findings). Aspirated fluid was assayed for the presence of TNF by use of an enzyme-linked immunosorbent assay. In the 5 patients with adult respiratory distress syndrome, TNF concentrations exceeded 500 U/ml (12.5 ng/ml), whereas in the control samples no TNF was detected.

Bronchoalveolar lavage desmosine in bleomycin-induced lung injury in marmosets and patients with adult respiratory distress syndrome

Measurement of urinary desmosine in experimental models of emphysema has been used to demonstrate elastin catabolism. In order to evaluate the hypothesis that accelerated elastin degradation also occurs in association with acute lung injury characterized by fibrotic repair, we prepared acid hydrolysates of lung lavage (LL) and used a radioimmunoassay for desmosine to measure concentrations of this elastic-specific cross-link in LL. Lavage desmosine (pmol/100 microliter LL) was measured following bleomycin-induced lung injury in marmosets and was shown to be elevated at 1 week (median 6.0, range 5.1-7.8), 2 weeks (8.4, 6.2-8.7), and 4 weeks (7.6, 4.8-7.8) compared to control levels (1.8, 1.4-3.7). Elevations of lavage desmosine after bleomycin were temporarily associated with remodeling of the lung as indicated by increased total lung collagen, reduced diffusing capacity and lung compliance, and histologic evidence of pulmonary fibrosis. Bronchoalveolar lavage (BAL) desmosine was measured in patients with the Adult Respiratory Distress Syndrome (ARDS) and compared with patients at risk, patients with other interstitial lung diseases, and normal healthy controls. BAL desmosine (pmol/100 microliters) was not significantly different in patients with ARDS (3.2, 2.1-3.0), patients at risk for ARDS (2.8, 2.5-4.4), and those with interstitial lung disease (3.0, 1.7-5.3) compared to normal controls (2.9, 1.9-4.7). There were poor correlations of BAL desmosine with physiologic indices of severity of disease in patients with ARDS and those at risk. Accelerated elastolysis occurred in the lower respiratory tract during the evaluation of bleomycin-induced pulmonary fibrosis in marmosets but was undetectable in BAL of patients studied within the first 3 days of ARDS.

[Experimental model of respiratory distress syndrome by lung lavage with fluorocarbon]

The purpose of this study was to determine how much alveolar surfactant is washed out by lung lavage with fluorocarbon and also to find out whether or not instillation of artificial surfactant can restore pulmonary function after lung lavage in rats. The lung lavage was performed manually, administering a tidal volume 5 mg (2 mg/100g body weight) of fluorocarbon for about eight seconds. This process was repeated more than 40 times. In the study group, 4 ml/kg (120 mg/kg) of artificial surfactant was instilled into the trachea, and the same amount of normal saline was instilled in the control group. The amount of phospholipids extracted in lung lavage was 16.6 +/- 3.6 mg/kg body weight in the control group and 18.9 +/- 3.7 mg/kg body weight in the experimental group. Immediately after instillation of the surfactant, arterial oxygen pressure increased from 84 +/- 17 mmHg to 195.1 +/- 26.7 mmHg, and remained high, at about 170-260 mmHg. In contrast the physiological saline treated group did not show any change. We conclude that lung lavage with fluorocarbon is an adequate ideal experimental model of respiratory distress syndrome and suggests that combination of artificial surfactant treatment after lung lavage with fluorocarbon might be a new pulmonary washing method for severe lung disease.

The use of an indirect fluorescent antibody test for detecting Pneumocystis carinii

Pneumocystis carinii pneumonia is a major cause of morbidity and mortality in immunocompromised patients. An indirect fluorescent antibody (IFA) test has been developed using monoclonal antibodies specific for antigens on the surface of P carinii. We tested the sensitivity and specificity of this IFA test for detecting P carinii in respiratory specimens of immunocompromised patients with pulmonary symptoms undergoing bronchoscopy. Both the bronchial wash and bronchoalveolar lavage specimens of patients with and without P carinii pneumonia were studied. The bronchoalveolar lavage and bronchial wash specimens were examined using modified Wright-Giemsa and methenamine silver stains. In addition, aliquots of the specimen were fixed and stained with IFA and read with a fluorescent microscope. Fifty-nine patients were found to have P carinii organisms. The bronchial wash specimen has been shown to be less sensitive than the bronchoalveolar lavage specimen for detecting the presence of P carinii. In the bronchial wash specimen from these 59 patients, only 60% had positive modified Wright-Giemsa stains, and 70% had positive methenamine silver stains. The IFA stain was positive in 93% of the specimens tested (significantly higher than the other two stains). There was only one false-positive IFA test result among the 54 patients tested with negative results. We found the IFA stain to be superior to conventional stains when examining less-than-adequate specimens, such as those from bronchial washes.

Relationship between inflammatory processes and gas exchanges in pulmonary sarcoidosis

In the present study, we investigated whether the analysis of cells and proteins collected by bronchoalveolar lavage (BAL) could accurately reflect the degree of functional impairment in pulmonary sarcoidosis. Eighteen patients with biopsy-proven sarcoidosis were prospectively evaluated. An inverse relationship was demonstrated between BAL coefficient of excretion relative to albumin (RCE) values of IgG and IgA and diffusion for carbon monoxide (Dco). A similar negative correlation existed with PaO2 at the end of a maximal exercise. Steroid therapy in five patients lowered concomitantly BAL RCE of IgA and IgG while Dco values increased. Immunoperoxidase studies in three lung biopsies revealed numerous Ig-containing cells within the lung parenchyma. We suggest that these BAL Ig values reflected the mononuclear cell infiltration of the bronchiolovascular sheaths and lung interstitium. This cellular infiltration likely induces a distortion of the capillary bed and may affect the gas exchanges in a reversible way.

Serum markers for prediction of pulmonary radiation syndromes. Part I: Surfactant apoprotein

Detection of a biochemical marker indicating radiation lung injury prior to the onset of clinical pathologic events could prove valuable in patient management. An increased level of alveolar surfactant is one of the earliest detectable changes following lung irradiation, starting within hours of irradiation and persisting a maximum of 2-6 weeks. However, because broncho-alveolar lavage is impracticable and endothelial cell damage due to radiation results in changes in permeability of vessel wall with leakage of alveolar proteins into serum, identification of serum markers was sought. A series of experiments in rabbits are described that clearly demonstrate serum surfactant apoprotein is an accurate marker and predictor for later lethal radiation pneumonitis. At 3-7 days after graded single doses to lung, surfactant was found in the serum paralleling the dose response for lethality. Control studies with a physiologic agent such as terbutaline release alveolar surfactant, but no serum surfactant was detected. Monitoring serum surfactant could direct preventive intervention prior to clinicopathologic manifestation of pulmonary radiation syndromes.

Immunoregulatory proteins in bronchoalveolar lavage fluid. A comparative analysis of pigeon breeders' disease, sarcoidosis and idiopathic pulmonary fibrosis

Bronchoalveolar lavage fluid (BALF) cell profiles, interleukins 1 and 2, (IL-1 and IL-2) and soluble interleukin 2 receptor (IL-2R) levels from patients with pigeon breeders' disease (PBD) (n = 24) and asymptomatic pigeon breeders (n = 10) were compared with those from patients with active sarcoidosis (n = 11), inactive sarcoidosis (n = 10), idiopathic pulmonary fibrosis (n = 25) and normal subjects (n = 10). BALF total cells, lymphocytes and OKT4 receptor-bearing lymphocytes/ml were higher in PBD and active sarcoidosis compared with normals (P less than 0.02 all comparisons). In the asymptomatic pigeon breeders bronchoalveolar (BA) lymphocyte numbers/ml were higher than controls (P less than 0.01) producing a subclinical lymphocytic "alveolitis" in 80% of subjects, although compared with symptomatics, % OKT4 (helper) cell numbers were lower (P less than 0.05). OKT4/OKT8 ratios in both groups were normal, whereas in active sarcoidosis ratios were higher (P less than 0.05) but with considerable overlap. Mean levels of IL-1 and IL-2 were raised in the BALF from all groups compared with normals (P less than 0.01 all comparisons), IL-2 being higher in active sarcoidosis and IPF compared with PBD (P less than 0.01). There was no significant difference in detectable BALF soluble IL-2R between patient groups, although its levels correlated positively with IL-1 (22 paired samples from all groups (rs = 0.8, P less than 0.02) and negatively with % and T-lymphocytes/ml in PBD (rs = 0.75, P less than 0.02, rs less than 0.8, P less than 0.01). However, when BALF soluble IL-2R is expressed in terms of T lymphocytes/ml of epithelial lining fluid (ELF), asymptomatic pigeon breeders had significantly higher levels than their symptomatic counterparts (P less than 0.01). It is concluded that percentage lymphocytes [corrected] are similar in both groups of pigeon breeders, although those with PBD had increased numbers of OKT4 (helper) cells. Patients with active sarcoidosis could not be reliably differentiated from those with acute PBD on the basis of BAL cell profiles. Our results suggest that IL-1 leads to soluble IL-2R formation and that continued antigenic stimulation, as with inhaled pigeon allergens, results in a down regulation of BALF IL-2. Excess BALF soluble IL-2R on a cellular basis suggests a mechanism by which some pigeon breeders remain asymptomatic.

Pathogenesis of hypersensitivity pneumonitis

Until a few years ago, the pathogenesis of hypersensitivity pneumonitis was based on epidemiological, clinical and histological data. The introduction of bronchoalveolar lavage as a diagnostic tool in pneumology and the use of monoclonal antibodies have afforded considerable advances in pathogenic studies on this clinical entity. In the present work we review the characteristics of bronchoalveolar lavage in patients suffering from hypersensitivity pneumonitis in order to study the mechanisms through which the disease appears after integrating such characteristics with the classical histological, clinical and biochemical data. Bronchoalveolar lavage in these patients demonstrates the following: An elevation in the number of total cells that is higher than in any other interstitial pathology. Morphological, biochemical and functional data suggestive of activation of alveolar macrophages. An elevation in lymphocyte percentages with data characteristic of activation. The rise occurs in the two lymphocyte subpopulations (CD4 and CD8), although there is a predominance, in the rise in C8 lymphocytes, such that the CD4/CD8 ratio decreases. A rise is also observed in "natural killer" cells. Functionally, there are data that reveal an increase in the inducer potential of T lymphocytes together with an increase in cytotoxic capacity, in all their subpopulations. The results on the lymphocyte count vary broadly according to the course of the disease. Varying increases in neutrophils, eosinophils and mast cells. The rises in the first two kinds of cells indicate recent contact with the antigen, while the rise in mast cells seems to be of pathogenic significance. Different biochemical alterations (complement system, immunoglobulins, lipids, etc.).(ABSTRACT TRUNCATED AT 250 WORDS)

Lung compartmentalization of increased TNF releasing ability by mononuclear phagocytes in pulmonary sarcoidosis

The TNF is a monokine with cytotoxic and tumor-necrosing activities; in addition, TNF may play a role in inflammatory processes. The present study evaluates spontaneous and LPS-mediated release of TNF by AMs and autologous peripheral BMs of normal subjects and patients with pulmonary sarcoidosis. A recently developed cytotoxicity assay, specific for detection of TNF activity, was applied. This study demonstrates that (1) unstimulated mononuclear phagocytes released low levels of TNF with no differences between groups; (2) when effector cells were stimulated with LPS, AMs from patients with active pulmonary sarcoidosis released more TNF than AMs recovered from normal subjects and from patients with inactive disease; (3) this increase was compartmentalized to the lungs, since comparisons of TNF production by LPS-stimulated BMs failed to show any difference between study groups. These results suggest that TNF might play a role in the pathogenesis of the alveolitis of pulmonary sarcoidosis.

Early markers of lung injury

The goal of this study was to develop an early marker of lung injury that might change in response to exposure to a mobile source emission. Nitrogen dioxide (NO2)2 was chosen as an example of an atmospheric pollutant that is related to automobile emissions. Since reorganization of the connective tissue matrix of the lung occurs in response to injury, markers of connective tissue metabolism were selected as targets. Hydroxylysine became the marker of choice. It is an amino acid that is virtually exclusive to collagen, although it does occur in minimal amounts in other proteins. Furthermore, it is excreted in the urine, which makes it readily available for analysis using noninvasive techniques. Other markers evaluated as part of the study included angiotensin-converting enzyme as a marker of lung injury, desmosine as a marker of elastin degradation, and hydroxyproline as another marker of collagen metabolism. Male Fischer-344 rats were exposed in whole-body chambers to controlled concentrations of NO2 for various doses and periods of time. The concentrations of NO2 ranged from 0.5 to 30 parts per million (ppm); the rats were exposed for six hours per day for periods of two days to four weeks. Urine and bronchoalveolar lavage samples were collected and analyzed for the appropriate marker. In addition, pulmonary function studies and histologic examinations of the lungs were completed at selected time points. Urinary hydroxylysine concentration increased as a function of NO2 concentration during six-hour-per-day exposures for two days. This short-term exposure required relatively high doses to achieve significant changes in the hydroxylysine output. During one-week exposures to either 25 or 30 ppm NO2, there was an increase in urinary hydroxylysine associated with changes in lavage concentrations of angiotensin-converting enzyme and hydroxylysine. The lungs of these animals demonstrated histologic changes typical of oxidant injury. Four-week exposure protocols using 0.5 and 1 ppm NO2 were most interesting in terms of the sensitivity of the marker. There was minimal damage revealed by the histology and function studies, yet there were significant increases in the excretion of hydroxylysine. It appears that hydroxylysine can be indicative of exposure when other parameters are normal. It will require long-term follow-up of exposed rats to determine whether or not the change in marker concentration is predictive of damage. Hydroxylysine may be an excellent marker of exposure to oxidants in the human population. Controlled studies to establish base-line values are needed, followed by carefully controlled studies in individuals with connective tissue abnormalities of the lung.

Biochemical responses of rat and mouse lung to inhaled nickel compounds

Nickel subsulfide (Ni3S2), nickel sulfate (NiSO4), and nickel oxide (NiO) are encountered occupationally in the nickel refining and electroplating industries, with inhalation being a common route of exposure. The purposes of this study were to evaluate the biochemical responses of lungs of rats and mice exposed for 13 weeks to occupationally relevant aerosol concentrations of Ni3S2, NiSO4, and NiO, to correlate biochemical responses with histopathologic changes, and to rank the compounds by toxicity. Biochemical responses were measured in bronchoalveolar lavage fluid (BALF) recovered from lungs of exposed animals. Parameters evaluated in BALF were lactate dehydrogenase (LDH), beta-glucuronidase (BG), and total protein (TP). Total and differential cell counts were performed on cells recovered in BALF. All compounds produced an increase in LDH, BG, TP, and total nucleated cells, and an influx of neutrophils, indicating the presence of a cytotoxic and inflammatory response in the lungs of exposed rats and mice. Increases in BG were greater than increases in LDH and TP for both rats and mice. Chronic active inflammation, macrophage hyperplasia, and interstitial phagocytic cell infiltrates were observed histologically in rats and mice exposed to all compounds. Statistically significant increases in BG, TP, neutrophils, and macrophages correlated well with the degree of chronic active inflammation. Results indicated a toxicity ranking of NiSO4 greater than Ni3S2 greater than NiO, based on toxicities of the compounds at equivalent mg Ni/m3 exposure concentrations.

[CEA and CA19-9 in BALF from patients with idiopathic interstitial pneumonia]

Carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) were measured in bronchoalveolar lavage fluid (BALF) in 21 patients with idiopathic interstitial pneumonia (IIP) and 7 healthy volunteers. The concentrations of both CEA and CA19-9 in the BALF were significantly higher in patients with IIP than those in healthy subjects. Significant correlations were present between the concentration of CEA and neutrophil percentage of the total BALF cells and between the concentration of CA19-9 and neutrophil percentage of the total BALF cells in the patients with IIP. Immunohistochemical study of tissue CEA and CA19-9 in the postmortem lungs of patients with IIP showed that CEA staining was present in the epithelia of respiratory bronchioles and alveoli, and it was especially increased in the region of alveoli where type II pneumocytes proliferate. CA19-9 staining was present in the epithelia of the respiratory bronchioles but absent in the epithelia of alveoli. It seems that assay of CEA in BALF may be useful to estimate the degree of pathological change and the activity of IIP.

[A case of pulmonary alveolar proteinosis accompanied with the elevation of CEA (carcinoembryonic antigen) in bronchoalveolar lavage fluid]

A 44-year-old man was admitted with increasing dyspnea and butterfly shadow on his chest roentgenogram. Both the bronchoalveolar lavage and transbronchial lung biopsy (TBLB) led to a diagnosis of pulmonary alveolar proteinosis. CEA level in his bronchoalveolar lavage fluid (BALF) (216.8 ng/ml) was markedly elevated more than that in his serum (50.6 ng/ml). The localization of CEA on TBLB specimen stained by peroxidase-antiperoxidase technique using anti-CEA antibody was investigated and it was found that some alveolar epithelial cells and the material filling the alveoli were positively stained. Functions of alveolar macrophages in BALF were also studied, that is, adherence to glass, cell spreading, the nitroblue tetrazolium reduction, phagocytosis of immunobeads, and the activity of lysosomal enzymes, and found that all of those functions were lower than that of normal smokers. It was suggested that type II alveolar epithelial cells were those which produced and secreted CEA into the alveoli, as they do surfactant-like material in pulmonary alveolar proteinosis, and that the dysfunction of alveolar macrophages was secondary to the overingestion of the proteinaceous material in the alveoli.

Abnormalities of pathways of fibrin turnover in lung lavage of rats with oleic acid and bleomycin-induced lung injury support alveolar fibrin deposition

Alveolar fibrin deposition commonly accompanies acute lung injury, but the nature of the local abnormalities of coagulation and fibrinolysis that support pathologic fibrin deposition are not well understood. The trended abnormalities of procoagulant and fibrinolytic activities occurring in lung lavage fluids of Fischer 344 rats after lung injury induced by intravenous oleic acid (OA) or intratracheal bleomycin were studied. After injury by either agent, bronchoalveolar lavage (BAL) contained increased procoagulant activity and decreased fibrinolytic activity. Lavage procoagulant activity was mainly due to an activator of Factor X attributable to the extrinsic coagulation pathway, and fibrinolytic activity was almost completely plasminogen dependent. Major mechanisms of inhibition of fibrinolytic activity involved both the inhibition of the plasminogen activator (PA) and plasmin. These abnormalities were temporally associated with prominent alveolar fibrin deposition in both models. In OA-treated animals, lavage fibrinolytic activity was absent or profoundly decreased, and antiplasmin and procoagulant activities were increased within 4 hours after the induction of acute lung injury. By 24 hours after OA, lavage PA inhibitor (PAI) activity was elevated with sustained antiplasmin activity. By 3 days after OA, these abnormalities had resolved in association with almost complete resolution of alveolar fibrin deposits. Within 3 days after bleomycin-induced lung injury, lavage procoagulant activity was increased and fibrinolytic activity was depressed due to increased antiplasmin and PAI activities. These conditions persisted for 2 weeks, during which time alveolar fibrin deposition was associated with the development of pulmonary fibrosis. These data indicate that a disruption of the normal balance between procoagulant and fibrinolytic activities occurs in alveolar lining fluids of rats with alveolitis induced by either OA or bleomycin, and that concurrent abnormalities of pathways of fibrin turnover that occur in alveolar lining fluids promote the alveolar fibrin deposition associated with these lung injuries.

Prostaglandin and thromboxane concentrations in plasma and lung lavage fluids during sequential infection of vaccinated and nonvaccinated calves with bovine respiratory syncytial virus

The potential action of immunologic reactions and mediators released during the course of bovine respiratory syncytial virus infection in pathogenesis of the ensuing disease process was examined in an experimental infection study. Prostaglandin (PG) E2, PGF2 alpha 6-keto-PGF1 alpha, and thromboxane B2 (TxB2) concentrations were quantitated in plasma and lung lavage fluid by radioimmunoassay at 3- to 4-day intervals during a primary and secondary virus infection of vaccinated, nonvaccinated, and control (mock-infected) calves. A significant increase in the plasma PGE2 concentration for the nonvaccinated calves was noticed on day 3 after primary infection and on day 7 after secondary infection. The PGF2 alpha plasma concentrations increased significantly for the nonvaccinated groups on day 10 after primary infection. Plasma 6-keto-PGF1 alpha concentrations increased for nonvaccinated and vaccinated calves 3 days after the secondary infection. Plasma TxB2 concentrations during the primary exposure did not vary significantly. However, 14 days after the secondary exposure, both experimental groups had concentrations significantly greater than did the control group. Lung lavage fluid concentrations of TxB2 had peaks of activity 7 days after primary and secondary viral infections for the nonvaccinated group. Increases in plasma PG concentrations corresponded variably with disease expression, whereas plasma TxB2 concentrations did not have any correlation with disease expression. However, there was a significant correlation between TxB2 concentration in lung lavage fluid of the nonvaccinated group with disease expression 7 days after primary and secondary virus infection.(ABSTRACT TRUNCATED AT 250 WORDS)

[Functional activity of the alpha1-proteinase inhibitor in serum and bronchoalveolar lavage fluid in congenital lung emphysema]

Pulmonary emphysema is thought to be due to an elastase-antielastase imbalance which leads to the destruction of alveolar walls. It is generally agreed that cigarette smoking is the major cause of acquired emphysema although many smokers fail to develop overt disease. Cigarette smoke inactivates alpha 1-proteinase inhibitor (alpha 1PI) which is believed to be the major antielastase in the lower respiratory tract. There is, however, controversy regarding the activity of alpha 1PI in smokers compared with nonsmokers. We, therefore, investigated the trypsin inhibitory capacity (TIC), the pancreatic elastase inhibitory capacity (PEIC), and the amount of immunoreactive alpha 1PI in serum and bronchoalveolar lavage fluid (BALF) of 24 individuals (15 smokers, 5 former smokers, 4 non-smokers) with clinical signs of emphysema and 32 persons (15 smokers, 6 former smokers, 11 non-smokers) without emphysema. Pancreatic elastase is known to be inhibited only by non-oxidised alpha 1PI whereas trypsin is inhibited by both native and oxidised alpha 1PI. Serum values of TIC/alpha 1PI and PEIC/alpha 1PI did not differ between the groups of subjects with emphysema (TIC/alpha 1PI: 0.71 +/- 0.12; PEIC/alpha 1PI: 0.44 +/- 0.06) and without emphysema (TIC/alpha 1PI: 0.68 +/- 0.13; PEIC/alpha 1PI: 0.41 +/- 0.07). Both serum-inhibitory capacities were found to be smaller than unit (= 1) indicating inactivation of alpha 1PI. BALF values of TIC/alpha 1PI showed a wide variation. TIC/alpha 1PI was greater than unity in 84% of subjects with emphysema (2.06 +/- 1.28) compared to 61% without emphysema (1.14 +/- 1.07) providing evidence for the presence of additional inhibitor(s) in those lavage fluids.(ABSTRACT TRUNCATED AT 250 WORDS)

Local abnormalities in coagulation and fibrinolytic pathways predispose to alveolar fibrin deposition in the adult respiratory distress syndrome

To determine the possible mechanism(s) promoting alveolar fibrin deposition in the adult respiratory distress syndrome (ARDS), we investigated the initiation and regulation of both fibrinolysis and coagulation from patients with ARDS (n = 14), at risk for ARDS (n = 5), and with interstitial lung diseases (ILD) (n = 8), and normal healthy individuals (n = 13). Bronchoalveolar lavage (BAL) extrinsic pathway inhibitor activity was increased in ARDS BAL compared with patients at risk for ARDS (P = 0.0146) or normal controls (P = 0.0013) but tissue factor-factor VII procoagulant activity was significantly increased in ARDS BAL compared with all other groups (P less than 0.001). Fibrinolytic activity was not detectable in BAL of 10 of the 14 patients with ARDS and low levels of activity were found in BAL of the other four ARDS patients. Depressed fibrinolysis in ARDS BAL was not due to local insufficiency of plasminogen; rather, there was inhibition of both plasmin and plasminogen activator. Plasminogen activator inhibitor 1 was variably detected and low levels of plasminogen activator inhibitor 2 were found in two ARDS BAL samples, but plasminogen activator inhibitor 2 was otherwise undetectable. ARDS BAL antiplasmin activity was, in part, due to alpha 2-antiplasmin. We conclude that abnormalities that result in enhanced coagulation and depressed fibrinolysis, thereby predisposing to alveolar fibrin deposition, occur in the alveolar lining fluids from patients with ARDS.

Type 3 procollagen peptide in bronchoalveolar lavage fluid. Poor indicator of course and prognosis in sarcoidosis

To investigate the role of bronchoalveolar lavage type 3 procollagen peptide as a prognostic indicator in sarcoidosis, we measured type 3 procollagen N-terminal peptide levels in lavage fluids from 84 sarcoidosis patients and monitored disease progress in these patients for a period of 12 months. Lavage procollagen peptide levels were significantly elevated in sarcoidosis patients compared to control subjects (p less than 0.001). No association was observed between lavage type 3 procollagen peptide and disease severity, as assessed by lung function tests. Follow-up monitoring of patients failed to demonstrate any relationship between subsequent functional deterioration and initial lavage type 3 procollagen peptide. These results suggest that elevated lavage type 3 procollagen peptide concentrations in sarcoidosis may reflect increased type 3 collagen synthesis associated with the inflammatory process rather than signal an early event in the development of chronic disease.

Studies on asphyxia: lipids in the alveoli of rats in hypoxic state

Biochemical characterization in alveolar lavage fluids of rats which had inhaled 5% oxygen, carbon dioxide and carbon monoxide was studied in comparison with control rats. The protein content, consisting mainly of serum albumin, markedly increased in the hypoxic states. The phospholipid content also increased one and a half to two times as much as in the control rats. The phospholipids which increased in the alveoli were mainly pulmonary surfactant phospholipids, i.e. phosphatidylcholine and phosphatidylglycerol. The phospholipid profiles did not appear to be affected by the leakage of plasma lipids. These findings indicate that pulmonary surfactant phospholipids accumulate in the alveoli of rats in the hypoxic states examined here.

Essential fatty acid-deficient rats are resistant to oleic acid-induced pulmonary injury

Because leukotrienes and prostaglandins are inflammatory mediators derived from arachidonic acid, their potential role in oleic acid-induced lung injury was evaluated in control and in essential fatty acid-deficient (EFAD) rats depleted of arachidonic acid substrate. In control rats, oleic acid (0.06 ml/kg iv) increased the pulmonary permeability index (measured by scintigraphy) from -10 +/- 13 x 10(-6) s-1 to 217 +/- 20 x 10(-6) s-1 and 118 +/- 13 x 10(-6) s-1 at 5 and 50 min (P less than 0.05), respectively. It also caused arterial hypoxemia at 30 min (P less than 0.05). Compared with saline controls, oleic acid increased bronchoalveolar lavage fluid levels of immunoreactive (i) LTC4/D4, iLTB4, (P less than 0.01), and 6-ketoprostaglandin F1 alpha (6-keto-PGF1 alpha) (P less than 0.05). In EFAD rats, oleic acid failed to significantly increase the lung permeability index at 5 and 50 min. In contrast to control rats, oleic acid failed to cause hypoxemia in the EFAD rats. Bronchoalveolar lavage levels of iLTB4 and i6-keto-PGF1 alpha after oleic acid in EFAD rats were lower compared with oleic acid controls, whereas iLTC4/D4 in the oleic acid EFAD group was not decreased. Treatment with intraperitoneal ethyl arachidonate (400 mg over 2 wk) reversed the resistance of EFAD rats such that the pulmonary edema (P less than 0.05) was evident after oleic acid. This latter group also manifested a significant (P less than 0.05) rise in the bronchoalveolar lavage levels of iLTB4 and i6-keto-PGF1 alpha. These results suggest that arachidonic acid metabolites contribute to oleic acid-induced pulmonary permeability.

Sputum induction for diagnosis of Pneumocystis carinii pneumonia

51 patients infected with the human immunodeficiency virus (HIV) and with suspected Pneumocystis carinii pneumonia underwent sputum induction. Sputum specimens from 18 patients were positive for P carinii and patients were treated appropriately 25 of the 33 patients with negative specimens underwent bronchoscopy and bronchoalveolar lavage within 4 days of sputum induction, only 1 of whom had evidence of Pneumocystis infection. For diagnosis of Pneumocystis carinii pneumonia, sputum induction according to a strict protocol had a sensitivity of 94.7% and a negative predictive value of 96%, compared with bronchoalveolar lavage.

[Use of precipitins in the diagnosis of bird fancier's lung: apropos of 2 cases]

Bird breeder's disease is a frequent diagnosis among the forms of extrinsic allergic alveolitis seen in the urban environment. We report two illustrative cases and discuss the respective roles of broncho-alveolar lavage cells and precipitating antibodies against avian antigens in the diagnostic work-up and the pathogenesis of the disease. In 1988 we evaluated over 100 sera from all over Switzerland with clinical suspicion of bird breeder's disease. In this cohort preliminary results show sensitivity of 85% and specificity of 92% for the presence of precipitins against avian antigens in the diagnosis of bird breeder's disease. The results suggest that this non-invasive test deserves revaluation as a diagnostic tool in bird breeder's disease.

Detection of leukotrienes B4, C4 and of their isomers in arterial, mixed venous blood and bronchoalveolar lavage fluid from ARDS patients

Seven patients with the adult respiratory distress syndrome (ARDS) were studied. As a control group we used 6 surgical patients who underwent minor surgical operation (inguinal hernia). For both groups the same sample collection and analysis was used. The presence of leuktorienes (LTs) B4 and C4 and of their isomers 11-trans LTC4 and delta 6-trans-12-epi LTB4 was determined in arterial, mixed venous blood and in bronchoalveolar lavage (BAL) fluid. The samples, analysed by reverse phase high performance liquid chromatography (RP-HPLC), showed a similar chromatographic picture among ARDS patients, while the control group showed no detectable amounts of LTs in BAL or blood. The distribution of these arachidonic acid metabolites in mixed venous blood, arterial blood and BAL seems to suggest pulmonary metabolism and/or inactivation. It is suggested that these mediators act as humoral factors in pathogenesis of the ARDS.

O2- and pneumonia-induced lung injury. II. Properties of pulmonary surfactant

Pulmonary surfactant was isolated from the lavage fluids of animals during the course of exposure to 100% O2, 80% O2, 40% O2, or 80% O2 plus 10(8) Pseudomonas aeruginosa instilled intratracheally and analyzed for its phospholipid composition. After 4-5 days of exposure to 100% O2, disaturated phophatidylcholine (DSPC) decreased to 87% of control, whereas the ratio of phosphatidylglycerol to phosphatidylinositol (PG/PI) was 37% of control. Longer periods of ventilation with 100% O2 resulted in DSPC falling to less than 40% of control. The injury was not reversed by reducing the O2 to 50%; rather, a progressive deterioration ensued. Acute respiratory failure (ARF) induced by 5 days of bacterial infection was very similar to that seen after 5 days of exposure to 100% O2. Ventilation with 80% O2 for 6 days resulted in smaller changes in DSPC but with differences in PG/PI comparable to those seen with 100% O2 or infection. We conclude that the ability of the type II cell to synthesize surfactant of normal composition is significantly impaired in these models of ARF. The earliest index of biochemical modification is the substantial change in PG/PI, which may be predictive of early lung injury. Further exacerbation of the injury could result in the reduction of DSPC content, with subsequent changes in lung mechanics and gas exchange.

[The effect of ozone on the bronchoalveolar lavage fluid and Fe receptor in rats]

The effects of ozone (O3) on the cellular and biochemical responses in bronchoalveolar lavage fluid (BALF, and the functional activity of Fc receptor of alveolar macrophage (AM) in rats were studied. The results showed that the functional activity of AM Fc receptor was decreased in the rats when exposed to 0.08 ppm O3 which concentration is approximately equal to the current National Ambient Air Quality Standard (the second grade). As the concentration of O3 was increased, the obvious changes in the cellular composition and biochemical indices occurred.

Changes in the relative concentrations of surfactant phospholipids in young pigs with experimental pneumonia

Lung lavage fluids of 23 young pigs were investigated prior to and after experimental infection with Pasteurella multocida. Comparison of the phospholipid patterns showed an increase in the relative concentration of phosphatidylinositol and a decrease in that of phosphatidylglycerol in the diseased animals. The phosphatidylcholine-to-phosphatidylinositol and phosphatidylglycerol-to-phosphatidylethanolamine ratios were used as parameters to characterize the changing patterns. The reductions in these ratios following infection were found to be useful indicators of bacterial pneumonia. Immunization did not affect the characteristic variations. A rapid screening procedure involving solid-phase extraction, one-dimensional thin-layer chromatography and densitometric scanning of the plates was used.

Chemotactic factor generation and cell accumulation in acute lung injury induced by endotracheal acid instillation

We studied the time course of chemotactic factor generation and inflammatory cell accumulation in the rabbit aspiration pneumonia model. Two major potent chemotactic factors, leukotriene B4 (LTB4) and C5a, in bronchoalveolar lavage fluid (BALF) were measured by radioimmunoassay, and cell analysis was also done. The level of LTB4 increased only in the early phase (2-6 h) after endotracheal acid instillation. The level of C5a increased gradually almost in parallel with the total protein level in BALF, and reached a maximum at 24 h. Neutrophil accumulation occurred early and reached a maximum at 24 h. In contrast, the number of alveolar macrophages increased from days 1 to 7. These findings suggest that the increases in LTB4 and C5a are responsible for accumulation of neutrophils and that C5a may be an important chemotactic factor for alveolar macrophage.

Clinical utility of bronchoalveolar lavage in a general hospital

Although bronchoalveolar lavage (BAL) performed through a fiberoptic bronchoscope is a valuable research tool, its clinical utility has been established in only two specific populations-the acquired immunodeficiency syndrome and immunosuppressed hosts with diffuse pulmonary infiltrates. We questioned whether BAL would be helpful in decision making in a general hospital setting. Eighteen patients, none of whom had the combination of immunosuppression and diffuse roentgenographic infiltrates and none of whom had acquired immunodeficiency syndrome, underwent BAL without any complications. The BAL fluid was analyzed in a hospital clinical laboratory using only stains that are generally used for bronchial washings. Retrospective analysis showed that in 9 cases (50%), the BAL analysis resulted in a significant alteration of therapy that would not have occurred using bronchial washings alone. Therefore, it appears that BAL can be safely performed in a general hospital on various patient populations, and that analysis in a nonresearch laboratory can yield clinically useful results.

Recovery of human immunodeficiency virus and detection of p24 antigen in bronchoalveolar lavage fluid from adult patients with AIDS

Published reports indicate that HIV is recovered from BAL fluid of patients with AIDS who have LIP but not with other AIDS-related pulmonary disease. Our experience has been different. Ten BAL specimens from nine patients with AIDS were cultured directly in peripheral blood mononuclear cells, and all ten cultures were positive for HIV as indicated by examination of the culture supernatant by reverse transcriptase assay and enzyme immunoassay for HIV antigen. Five of the specimens were also positive for Pneumocystis carinii, and other pulmonary diagnoses included histoplasmosis, lymphoma, Kaposi's sarcoma, and aspiration pneumonia. Five additional BAL specimens were cultured after freezing at -70 degrees C, but only two were culture-positive for HIV (p = 0.022; FET). This study indicates that HIV can be recovered from the BAL fluid in most patients with AIDS, unrelated to the type of pulmonary disease. In contrast to cultures, HIV antigen was detected in the BAL fluid of only one patient, and that patient had LIP with noncaseating granulomas. Therefore, HIV culture is not useful in the diagnosis of LIP, but HIV antigen detection should be studied further. All BAL fluids should be considered potentially infectious.

The role of cyclooxygenase products in the acute airway obstruction and airway hyperreactivity of ponies with heaves

Airway obstruction and hyperreactivity are characteristics of human asthma and of "heaves," a naturally occurring respiratory disorder of horses and ponies. To document the role of cyclooxygenase products of arachidonic acid metabolism in the pathogenesis of heaves, we measured plasma and bronchoalveolar lavage (BAL) fluid concentrations of metabolites of thromboxane (TX)A2 and prostaglandins (PG) I2 and D2 in five affected ponies and their age- and gender-matched controls prior to and during acute airway obstruction precipitated by housing the ponies in a barn and exposing them to hay dust. Pulmonary resistance increased significantly and dynamic compliance and arterial oxygen tension decreased significantly in affected ponies that were placed in the barn. At this time, histamine aerosol challenge demonstrated the presence of airway hyperresponsiveness in the affected ponies. Plasma TXB2 was the only metabolite that increased significantly during the acute disease state. In a subsequent experiment, the ponies were treated with flunixin meglumine, a cyclooxygenase inhibitor, to determine if this would alter the onset or development of clinical disease. At a dose of 1.1 mg/kg intramuscularly, 3 times daily, flunixin meglumine inhibited TXB2 production but did not alter the degree of airway obstruction or airway hyperreactivity measured at pasture and in the barn. We conclude that cyclooxygenase products of arachidonic acid metabolism are altered but do not play a role in the airway obstruction and hyperreactivity observed in ponies with heaves.

Role for T lymphocytes in silica-induced pulmonary inflammation

The role of the immune system in modulating pulmonary damage evoked by exposure to silica crystals has been examined in a mouse model of experimental silicosis. Congenitally T cell-deficient mice (Balb/c nu/nu) were compared with T cell sufficient mice (Balb/c nu/+) in the degree of silica-induced cellular inflammation on days 3, 5, 7, 30, and 60 after an intratracheal instillation of silica. Cellular inflammation was assessed by increases in the total number and type of inflammatory cell in lung lavage fluid and in lung tissue. Inflammation and/or injury were also measured in the lavage fluid by increases in total protein, angiotensin-converting enzyme and plasminogen activator. No significant difference existed between the two types of mice in total lavage cell number or total protein. In nu/+ mice, the neutrophil predominated early, followed by the macrophage as the major inflammatory cell. However, in nu/nu mice, the neutrophil remained the predominant inflammatory cell throughout the two months postinjection. In addition, angiotensin-converting enzyme levels remained elevated in the nu/nu animals above those in the nu/+ mice whereas plasminogen activator was elevated early (before day 7) in both, and decreased comparably over time. These data suggest that T cells directly or indirectly influence the maintenance of a macrophage infiltrate and the termination of a neutrophil response after exposure to silica. However, it appears that neither T cells nor the cells they influence affect the ultimate amount of collagen deposition.

Leukotrienes, LTC4 and LTB4, in bronchoalveolar lavage in bronchial asthma and other respiratory diseases

Leukotrienes (LTs) C4 and B4 are potent proinflammatory mediators with a wide variety of biologic activities, including smooth muscle contraction, mucus hypersecretion, and leukocyte activation, which may be of particular relevance to the pathology of asthma and other respiratory diseases. We measured the concentrations of LTC4 and LTB4 in bronchoalveolar lavage fluid from 16 atopic subjects with asthma (eight symptomatic and eight asymptomatic) and from 14 control subjects without asthma (six with hay fever and eight nonatopic). The amounts detected in symptomatic subjects with asthma were significantly higher than in control subjects (LTB4, 0.58 +/- 0.06 versus 0.36 +/- 0.05 pmol/ml, p less than 0.05; LTC4, 0.36 +/- 0.1 versus 0.12 +/- 0.02 pmol/ml, p less than 0.01). LTC4 and LTB4 were also measured in 17 patients: nine with interstitial lung disease of varying etiology (cryptogenic fibrosing alveolitis [CFA] or idiopathic pulmonary fibrosis), three with sarcoidosis, one with extrinsic allergic alveolitis, one with sulphonamide-induced pneumonia, and one patient with eosinophilic granuloma. The concentrations of LTB4 (but not LTC4) were significantly greater in patients with CFA compared with normal control subjects (0.69 +/- 0.3 versus 0.36 +/- 0.05 pmol/ml, p less than 0.01). There was a significant correlation (p less than 0.05) between the percentage of neutrophils and the concentration of LTB4 in the bronchoalveolar lavage fluid) of the group with interstitial lung disease as a whole. This study provides evidence for a role for LTs in the airways of subjects with day-to-day asthma and suggests that LTB4 may also be involved in the recruitment of granulocytes into the lung in patients with CFA.

The release of neutrophil chemoattractant activity by bronchoalveolar macrophages from adult and senescent mice

To assess the effects of advanced age on the release of neutrophil chemoattractant activity by resident bronchoalveolar macrophages (BAM), cells from three strains of pathogen- and disease-free mice were secured by lung lavage and stimulated in vitro with unopsonized zymosan or the calcium ionophore, A23187. Chemoattractant release by BAM from adult (5-8 mos) and senescent (19-26 mos) C57BL/6 and DBA/2 mice in response to both stimulants was comparable; however, the generation of chemoattractant activity by BAM from senescent (18-20 mos) BALB/c mice was greater than that observed with cells from younger (4-6 mos) animals with both zymosan and A23187. In the presence of 50 microM piriprost potassium, a 5-lipoxygenase inhibitor, the release of chemoattractant activity and leukotriene B4 (LTB4) in response to zymosan and A23187 by BAM from both groups of C57BL/6 mice was significantly impaired. With BAM from BALB/c mice, 100 microM piriprost potassium was required to produce changes in A23187-stimulated chemoattractant and LTB4 release; of note, the generation of LTB4 in response to A23187 by BAM from aged BALB/c mice was significantly greater than that observed with cells from the younger animals under all conditions studied. Finally, with BAM from DBA/2 mice, 50 microM piriprost potassium significantly reduced chemoattractant activity in both groups of animals, but the lipoxygenase inhibitor had no effect on LTB4 production. Thus, although these studies revealed substantial age and strain-related differences in the release of neutrophil chemoattractant activity by murine BAM, they did not demonstrate deficiencies that might enhance the susceptibility of the senescent host to infection of the lower respiratory tract.

[Measurement of small quantities of alpha 2-macroglobulin in bronchoalveolar lavage fluid by enzyme-labelled immunoassay, and its clinical implication in pulmonary disease]

We established an enzyme labelled immunoassay for the determination of alpha 2 macroglobulin (alpha 2M). The assay range was from 2 to 140 ng/ml and the within-assay coefficient of variation (CV) were 5.2% at 31.2 ng/ml and 6.4% at 62.5 ng/ml. Between-day CV ranged from 6.9% to 15.4%. Using this method, alpha 2 M was determined in the bronchoalveolar lavage fluid (BALF) from patients with interstitial lung diseases. Those diseases were active and inactive sarcoidosis, hypersensitivity pneumonitis and idiopathic pulmonary fibrosis (IPF, including collagen disease). We divided the IPF patients into two groups, 'acute type' and 'chronic type', judging from the prognosis. alpha 2 M/Albumin ratio in BALF in the active sarcoidosis and acute type IPF groups is significantly higher than that in the inactive sarcoidosis and chronic type IPF. These findings suggest that alpha 2 M in BALF can be a sensitive marker of the interstitial lung disease.

A PAF antagonist blocks antigen-induced airway hyperresponsiveness and inflammation in sheep

We studied the effects of WEB-2086, a specific antagonist of platelet-activating factor (PAF), on the development of antigen-induced airway hyperresponsiveness and inflammation in sheep (n = 8). For these studies, airway responsiveness was determined from slopes of carbachol dose-response curves (DRC) performed at base line (prechallenge) and 2 h after Ascaris suum antigen challenges in the following three protocols: 1) antigen challenge alone (control trial), 2) WEB-2086 (1 mg/kg iv) given 30 min before antigen challenge (WEB pretreatment), and 3) WEB-2086 given 2 h after antigen challenge, immediately before the postchallenge DRC (WEB posttreatment). Airway inflammation was assessed by bronchoalveolar lavage (BAL) before antigen challenge and after the postchallenge DRC for each trial. A. suum challenge resulted in acute increases in specific lung resistance that were not different among the three trials. Antigen challenge (control trial) caused a 93% increase (P less than 0.05) in the slope of the carbachol DRC when compared with the prechallenge value. WEB pretreatment (1 mg/kg) reduced (P less than 0.05) this antigen-induced hyperresponsiveness, whereas pretreatment with a 3-mg/kg dose completely prevented it. WEB posttreatment was ineffective in blocking this hyperresponsiveness. BAL neutrophils increased after antigen challenge in the control trial and when WEB-2086 was given after antigen challenge (P less than 0.05). Pretreatment with WEB-2086 (1 or 3 mg/kg) prevented this neutrophilia. This study provides indirect evidence for antigen-induced PAF release in vivo and for a role of endogenous PAF in the modulation of airway responsiveness and airway inflammation after antigen-induced bronchoconstriction in sheep.

Local increase of antiprotease and neutrophil elastase-alpha 1-proteinase inhibitor complexes in lung cancer

Tumour progression is dependent on many factors including antiproteases and proteases released by tumour cells or host cells infiltrating the tumour. In the present study, we evaluated the antiprotease content, namely alpha 2-macroglobulin (A2M) and alpha 1-proteinase inhibitor (A1PI) and neutrophil (PMN) elastase complexed with A1PI, in limited and extended lung cancer patients compared to a nonsmoker and smoker control population. Data showed that A2M and A1PI were increased in the involved lung from limited cancer when compared to normals. In extended lung cancer, A2M content was also increased in the uninvolved side. The concentration of PMN elastase-A1PI complex was increased on both sides in lung cancer patients (10.2 ng.ml-1 in the uninvolved side, 8.2 ng.ml-1 in the involved side) when compared to nonsmokers (1.9 ng.ml-1, p less than 0.001) and smokers (3.8 ng.ml-1, p less than 0.005). This increase was not solely due to the smoking habit. We conclude that antiproteases and PMN elastase complexed with antiprotease are increased in lung cancer area. This increase could result in extracellular changes in lung cancer.

Comparison between intra- and extracellular surfactant in respiratory distress induced by oleic acid

The present study compares the phospholipid distribution and protein content in bronchoalveolar lavage, purified extracellular surfactant and lamellar bodies isolated from rabbits killed at intervals of 2.5, 12 and 24 h after oleic acid administration. The data suggest that the alteration of pulmonary surfactant could be partially due to the type II cell response to the injury.

Leukocytes and mediators in bronchoalveolar lavage during allergen-induced late-phase asthmatic reactions

We have measured the total and differential cell counts, histamine, leukotriene (LT) B4 and LTC4, immunoglobulins, complement (C3), eosinophil-derived basic proteins, and monocyte complement rosettes in bronchoalveolar lavage (BAL) 6 h after challenge with either antigen or diluent control in seven patients with antigen-induced single early reactions, and seven with dual (early and late phase) reactions. In both groups, the total cell counts in BAL were similar, irrespective of whether they were challenged with antigen or diluent. However, in the late-phase responders (LPR), there were significant increases in lymphocytes, neutrophils, and eosinophils (p less than 0.05), and significant decreases in the percentage of lung mast cells (p less than 0.05). The eosinophil major basic protein and eosinophil-derived neurotoxin increased in four of five subjects with dual responses and in the majority of single early responders (SER). BAL histamine concentrations increased in five of seven patients with dual responses. There were no consistent changes in LTB4 concentrations in either the LPR or the SER between diluent and antigen days, but a small but significant increase in LTC4 was observed in the LPR. Concentrations of IgG, IgA, IgM, IgE, C3, and albumin did not differ significantly. The percentage of monocyte complement rosettes also increased significantly (p less than 0.05) in LPR, but not in SER. These findings support the hypothesis that eosinophils and their products play a role in tissue injury in LPR and that eosinophil infiltration may be associated with macrophage activation.

Pulmonary involvement in patients with HTLV-I-associated myelopathy: increased soluble IL-2 receptors in bronchoalveolar lavage fluid

A chronic spastic myelopathy associated with HTLV-I infection (HTLV-I-associated myelopathy: HAM) shows subclinical pulmonary involvement with bronchoalveolar T lymphocytosis. In the present study, we investigated 18 patients with HAM: five HTLV-I carriers without myelopathy and 13 normal control subjects seronegative for HTLV-I to determine if soluble IL-2 receptors (IL-2R), a marker of lymphocyte activation, were increased in serum and bronchoalveolar lavage (BAL) fluid from HAM patients. Serum IL-2R levels were significantly increased in patients with HAM as compared to normal control subjects (HAM versus control subjects: 633 +/- 395 versus 278 +/- 53 U/ml, p less than 0.01). There was also an increase of serum IL-2R levels in one of five HTLV-I carriers. BAL levels of soluble IL-2R were low but detectable in four normal control subjects and in one HTLV-I carrier. In HAM patients, however, soluble IL-2R levels in BAL fluid were remarkably elevated (173 +/- 110 U/mg of albumin) and were nearly 13 times higher on average than in serum (BAL fluid/serum ratio: 13 +/- 10). In patients with HAM, lavage IL-2R levels correlated well with the number of T lymphocytes (CD3+ cells) and CD4+ cells in BAL fluid (p less than 0.01). Furthermore, BAL lymphocytes obtained from HAM patients synthesized DNA spontaneously when cultured in vitro. These results suggest that, in HAM, T lymphocytes increased in the lung are activated locally to produce soluble IL-2R. Based on the results of this study, we conclude that immunologic mechanism(s) may play an important role in the development of pulmonary lesions in HAM patients.