Bronchoalveolar lavage and the immunology of lung cancer

Using Bronchoalveolar Lavage to Evaluate Changes in Pulmonary Diseases

Bronchoalveolar lavage (BAL) is a procedure that can be used to collect samples from human and animal lungs to efficiently evaluate the immune response and the potentially pathological changes by examining both the compositions of cells and fluid from lavage. There are observable changes including inflammatory response in human and animal lungs exposed to environmental exposures such as toxic chemicals and microorganisms, or under pathophysiological conditions in respiratory system. The profile of inflammatory cells in BAL provides a qualitative description of inflammatory response, and the secretion in BAL fluid contains secreted proteins of inflammatory mediators and albumin as a quantitative measurement of inflammation and tissue injury in the lungs. Mouse is the most common model system being used for pulmonary disease-related research. A consistent experimental approach on how to lavage mouse lungs and collect samples from mouse lungs is important for a reproducible evaluation of pathological and physiological changes in mouse lung especially for the analysis of inflammation.

A novel diagnostic approach for Pneumocystis jirovecii pneumonia using fine-needle aspiration, electromagnetic navigational bronchoscopy and rapid on-site evaluation

Cavitary lung lesions are common in patients with human immunodeficiency virus infections. Both atypical infections and thoracic malignancies can manifest as a cavitary pulmonary lesion. Standard bronchoscopy is commonly used to evaluate these abnormalities but is limited in its ability to fully assess for cancer and infection. Bronchoalveolar lavage samples are likely to aid in the diagnosis of infection but are less useful in the evaluation of malignancy. In addition, many of these pulmonary lesions are located in the periphery of the lung and are not accessible for tissue sampling by standard bronchoscopy. We present a unique presentation of Pneumocystis jirovecii pneumonia and discuss the utility of electromagnetic navigational bronchoscopy in the evaluation of immunocompromised patients with peripheral cavitary lung lesion.

Assessment of pathological and physiological changes in mouse lung through bronchoalveolar lavage

In animals, environmental exposure such as toxic chemicals and microorganisms or pathophysiological conditions in respiratory system could result in inflammatory response in their lungs. Bronchoalveolar lavage (BAL) is a procedure that can be used to collect samples from animal lungs to efficiently evaluate the immune response by examining both the compositions of cells and fluid from lavage. The profile of inflammatory cells in BAL provides a qualitative description of inflammatory response and the secretion in BAL fluid contains proteins of inflammatory mediators and albumin as a quantitative measurement of inflammation and tissue injury in the lungs. A consistent experimental approach on how to lavage mouse lungs and collect samples is important for a reproducible evaluation of pathological and physiological changes in mouse lung especially for the analysis of inflammation.

Flexible bronchoscopy and its role in the staging of non-small cell lung cancer

Technologic advances in bronchoscopy continue to improve the ability to perform minimally invasive, accurate evaluations of the tracheobronchial tree and to perform an ever-increasing array of diagnostic, staging, therapeutic, and palliative interventions. The role of both old and new diagnostic bronchoscopy will continue to evolve as further improvements are made in bronchoscopes, accessory equipment, and imaging technologies. The major challenge is the adoption of the many new bronchoscopic techniques into routine clinical practice. There is a need for well-designed studies to delineate the appropriate use of these interventions and to better define their limitations and cost effectiveness.

Cytokines in patients with lung cancer

Lung cancer is one of the most common malignant diseases and is amongst the leading causes of death. Cell-mediated immune response and cytokines could play an important role in antitumour immunity. The aim of the study was to evaluate the cytokines', tumour necrosis factor-alpha (TNF-alpha), interleukin-1beta (IL-1beta) and IL-6, releasing capacity in patients with lung carcinoma and benign lung disease. A group of 41 patients were tested for the production of TNF-alpha, IL-1beta and IL-6 in bronchoalveolar lavage (BAL) and blood. The levels of cytokines in the lung cancer patients were: (1) in BAL - IL-6, 173 +/- 85 pg/ml; TNF-alpha, 170 +/- 116 pg/ml; and IL-1beta, 473 +/- 440 pg/ml; (2) in the blood - IL-6, 197 +/- 53 pg/ml; TNF-alpha, 311 +/- 202 pg/ml; and IL-1beta, 915 +/- 239 pg/ml. Alveolar macrophages of the patients with a lung cancer secreted significantly more cytokines, IL-6 (P = 0.0004) and IL-1beta (P = 0.0047), than alveolar macrophages of the patients with a nonmalignant lung cancer. However, significantly lower levels of cytokine production by the BAL cells were found in patients with small cell lung cancer. This production decreased further in phase IV of nonsmall cell lung cancer.

A method for isolating human lung macrophages and observations of fluorescent phagocytes from the lungs of habitual cigarette smokers

We report the development of a simple, efficient, expedient, and inexpensive procedure for isolating a large and relatively pure population of macrophages (Mphi) from residual (i.e., non-tumor) lung tissue obtained from lung cancer patients undergoing either a lobectomy or pneumonectomy. The proposed technique was founded on observations by fluorescent microscopy of fresh, non-fixed, and non-stained human lung tissue. Examinations of 74 specimens from different patients revealed that most of the Mphi reside as non-adherent cells within the sponge-like lung stroma. Very few Mphi were observed in the lungs of nonsmokers. In contrast, many Mphi were visible in the lungs of habitual smokers. For most specimens from smokers, a few of the Mphi were present as randomly distributed single cells; the majority of the Mphi, however, were in clusters that ranged from a dozen to several hundred cells. The Mphi could be released readily by different mechanical techniques. In the procedure reported herein, pulmonary leukocytes (> 75% Mphi) were dislodged easily from lung tissue with the use of an inexpensive, hand-operated, tissue grinder. The grinder consisted of a glass mortar and Teflon pestle that provided sufficient clearance between the mortar and pestle so as to avert damaging the displaced leukocytes. The leukocytes were then segregated by centrifugation on a density gradient. Further purification was achieved by harvesting Mphi that had been allowed to adhere to serum-coated polystyrene culture dishes (> 90% Mphi). In most experiments, the Mphi yield (approximately 5 x 10(6) Mphi /gr of lung) and Mphi viability (> 85%) were good. A significant advantage of this technique is that it avoids jeopardizing the cells to the hazards associated with enzymes that have been used in techniques employed previously for isolating Mphi from the lung and other organs. Thus, the proposed method provides numerous lung Mphi for detailed studies of their morphology, phenotype, and function. Moreover, lung Mphi were cultured as non-adherent, single cells in a serum- and cytokine-free tissue culture medium for more than 6 weeks. Lung Mphi from habitual smokers displayed a high level of fluorescence that was readily apparent when viewed with a fluorescence microscope that had been configured with either a fluorescein or rhodamine filter. Serial sections of single, living Mphi obtained with the use of a confocal laser scanning microscope revealed that the fluorescence originated from cytoplasmic inclusions. Relative fluorescence intensity was measured by cytometry.(ABSTRACT TRUNCATED AT 400 WORDS)

Pulmonary lymphangitic metastasis from breast cancer. Lymphocytic alveolitis is associated with favorable prognosis

BACKGROUND

More than 20 percent of patients with breast cancer have pulmonary lymphangitic spread at death. Previous reports have indicated that some patients may respond to aggressive chemotherapy that includes corticosteroids.

METHODS

Bronchoscopy with bronchoalveolar lavage (BAL) was used to assess pulmonary infiltrates in 14 patients with infiltrating ductal breast cancer. All patients had received prior cytotoxic or hormonal therapy. Following a diagnosis of pulmonary metastasis by BAL or biopsy specimen, all patients received prednisone and chemotherapy.

RESULTS

BAL confirmed the diagnosis of metastatic tumor in 10 of 14 patients. The conditions of the remaining patients were diagnosed by one or more other bronchoscopy specimens. Patients were divided into two groups based on BAL lymphocyte percentage (10 percent is the upper limit of normal in our laboratory). Seven patients had > 10 percent lymphocytes (high lymphs: 26 +/- 11.6 percent [mean +/- SD]) compared with seven patients with normal lymphocyte percentage (low lymphs: 4 +/- 1.9 percent, p < 0.01). Six of seven patients with low lymphs died within three months of BAL compared with one in seven patients with high lymphs (p < 0.01). Within six months, all patients with low lymphs were dead whereas five of seven patients with high lymphs were alive, (p < 0.01). Comparing the two groups, there was no significant difference in percentage of BAL neutrophils, patient age, duration of disease prior to diagnosis, or arterial-alveolar oxygen gradient.

CONCLUSION

In breast cancer patients with pulmonary lymphangitic metastasis, a lymphocytic alveolitis is associated with a better overall prognosis.