Klinische Wochenschrift

, Volume 61, Issue 7, pp 349–356 | Cite as

Pulmonary sarcoidosis: Assessment of disease activity by lung lymphocyte subpopulations

  • U. Costabel
  • K. J. Bross
  • H. Matthys
Originalien
Received:
Accepted:

Summary

The aim of this study was to determine the value of the destination of T-lymphocyte subpopulations in bronchoalveolar lavage (BAL) fluid for the assessment of disease activity in pulmonary sarcoidosis in comparison with other tests of activity, i.e., lung function tests, angiotensin-converting enzyme (ACE), and gallium lung scan. According to clinical and roentgenographic data, 20 patients with biopsy-proven sarcoidosis were classified as having either active (nine patients) or inactive (11 patients) disease. Helper and suppressor T-lymphocyte subsets in BAL were identified by the peroxidase-antiperoxidase method performed on glass slides using murine monoclonal antibodies (OKT 3 for pan T-, OKT 4 for helper, and OKT 8 for suppressor T-lymphocytes). Patients with active sarcoidosis had significantly higher proportions of lung helper cells (90±5% of T-lymphocytes) than did patients with inactive sarcoidosis (65±11%) or control patients (63±7%),P<0.001. The proportion of lung helper cells correlated significantly with vital capacity (r=−0.72,P<0.001), with total lung capacity (r=−0.60,P<0.01), with PaO2 at rest (r=−0.46,P<0.05) and during exercise (r=−0.54,P<0.05), and with CO-diffusing capacity/1 lung volume (r=−0.53,P<0.05). There was, however, no correlation between lung lymphocyte subsets and serum ACE or gallium lung scan, nor between ACE and gallium scan. Although ACE and gallium uptake were higher in active sarcoidosis than in inactive disease, considerable overlap existed between groups, and the difference was not significant. Thus, the proportion of helper cells in BAL fluid appears to be a most useful parameter to assess activity of pulmonary sarcoidosis.

Key words

Pulmonary sarcoidosis Immunology Lung T-lymphocytes Immunoenzyme technology Bronchoalveolar lavage 
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References

  1. 1.
    Beaumont D, Larzul JJ, Herry JY, Sapène M, Kernec J, Delaval P, de Labarthe B (1981) Angiotensin-converting enzyme, gallium scanning, and bronchoalveolar lavage in evaluation of sarcoidosis. Bull Eur Physiopath Respir 17:58 pGoogle Scholar
  2. 2.
    Böyum A (1968) Isolation of mononuclear cells and granulocytes from human blood. Scand J Clin Lab Invest 21 [Suppl 97]:77–89Google Scholar
  3. 3.
    Brambilla C, Chavez L, Groslambert P, Maisonneuve D, Vincent M, Morel F, Damak A, Alibeu F, Favre M (1981) Prognosis value of bronchoalveolar lavage and angiotensinconverting enzyme in sarcoidosis. Bull Eur Physiopathol Respir 17:57 pGoogle Scholar
  4. 4.
    Bross KJ, Pangalis GA, Staatz CG, Blume KG (1978) Demonstration of cell surface antigens and their antibodies by the peroxidase-antiperoxidase method. Transplantation 25:331–334Google Scholar
  5. 5.
    Burrows B, Kasik JE, Niden H, Barclay WR (1961) Clinical usefulness of the single-breath pulmonary diffusing capacity test. Am Rev Respir Dis 84:789Google Scholar
  6. 6.
    Cosimi AB, Colvin RB, Burton RC, Rubin RH, Goldstein G, Kung PC, Hansen WP, Delmonico FL, Russell PS (1981) Use of monoclonal antibodies to T-cell subsets for immunologic monitoring and treatment in recipients of renal allografts. N Engl J Med 305:308–314Google Scholar
  7. 7.
    Crystal RG, Gadek JE, Ferrans VJ, Fulmer JD, Line BR, Hunninghake GW (1981) Interstitial lung disease. Current concepts of pathogenesis, staging and therapy. Am J Med 70:542–568Google Scholar
  8. 8.
    Crystal RG, Roberts WC, Hunninghake GW, Gadek JE, Fulmer JD, Line BR (1981) Pulmonary sarcoidosis: a disease characterized and perpetuated by activated lung-T-lymphocytes. Ann Intern Med 94:73–94Google Scholar
  9. 9.
    Daniele RP, Rowlands DT jr (1976) Lymphocyte subpopulations in sarcoidosis: correlation with disease activity and duration. Ann Intern Med 85:593–600Google Scholar
  10. 10.
    Huchon GJ, Berrisoul F, Barritault LG, Venet A, Marsac JH, Roucayrol JC, Chrétien J (1981) Comparison of bronchoalveolar lavage with gallium-67 lung scan to assess activity of thoracic sarcoidosis. Bull Eur Physiopathol Respir 17:59 pGoogle Scholar
  11. 11.
    Hunninghake GW, Fulmer JD, Young RC jr, Gadek JE, Crystal RG (1979) Localization of the immune response in sarcoidosis. Am Rev Respir Dis 120:49–57Google Scholar
  12. 12.
    Hunninghake GW, Crystal RG (1981) Pulmonary sarcoidosis: a disorder mediated by excess helper T-lymphocyte activity at sites of disease activity. N Engl J Med 305:429–434Google Scholar
  13. 13.
    Kazmierowski JA, Aduan RP, Reynolds HY (1977) Pulmonary host defense: coordinated interactions of mechanical, cellular and humoral immune systems of the lung. Bull Eur Physiopathol Respir 13:103–105Google Scholar
  14. 14.
    Koziner B, Denny T, Myskowski PL, Kris M, Safai B (1982) Opportunistic infections and Kaposi's sarcoma in homosexual men. Letter to the editor. N Engl J Med 306:933–934Google Scholar
  15. 15.
    Lieberman J (1975) Elevation of serum angiotensin-converting enzyme level in sarcoidosis. Am J Med 59:365–372Google Scholar
  16. 16.
    Line BR, Hunninghake GW, Keogh BA, Jones AE, Johnston GS, Crystal RG (1981) Gallium-67 scanning to stage the alveolitis of sarcoidosis: correlation with clinical studies, pulmonary function studies, and bronchoalveolar lavage. Am Rev Respir Dis 123:440–446Google Scholar
  17. 17.
    Matthys H, Fischer J, Ulrichs HC, Rühle KH (1979) Functional patterns of different lung diseases for computer-assisted diagnostic procedures. Prog Respir Res 11:188–201Google Scholar
  18. 18.
    Reinherz EL, Kung PC, Goldstein G, Schlossman SF (1979) Separation of functional subsets of human T cells by a monoclonal antibody. Proc Natl Acad Sci USA 76:4061–4065Google Scholar
  19. 19.
    Reinherz EL, Kung PC, Goldstein G, Schlossman SF (1979) Further characterization of the human inducer T cell subset defined by monoclonal antibody. J Immunol 123:2894–2896Google Scholar
  20. 20.
    Reinherz EL, Kung PC, Goldstein G, Schlossman SF (1980) A monoclonal antibody reactive with the human cytotoxic/suppressor T cell subset previously defined by a heteroantiserum termed TH2. J Immunol 124:1301–1307Google Scholar
  21. 21.
    Reinherz EL, Schlossman SF (1980) Regulation of the immune response — inducer and suppressor T-lymphocyte subsets in human beings. N Engl J Med 303:370–373Google Scholar
  22. 22.
    Reinherz EL, Weiner HL, Hauser SL, Cohen JA, Distaso JA, Schlossman SF (1980) Loss of supressor T cells in active multiple sclerosis. Analysis with monoclonal antibodies. N Engl J Med 303:125–129Google Scholar
  23. 23.
    Reynolds HY, Fulmer JD, Kazmierowski JA, Roberts WC, Frank MM, Crystal RG (1977) Analysis of cellular and protein content of broncho-alveolar lavage fluid from patients with idiopathic pulmonary fibrosis and chronic hypersensitivity pneumonitis. J Clin Invest 59:165–175Google Scholar
  24. 24.
    Rossman MD, Dauber JH, Daniele RP (1978) Identification of activated T cells in sarcoidosis. Am Rev Respir Dis 117:713–720Google Scholar
  25. 25.
    Rossman MD, Dauber JH, Cardillo ME, Daniele RP (1982) Pulmonary sarcoidosis: correlation of serum angiotensin-converting enzyme with blood and bronchoalveolar lymphocytes. Am Rev Respir Dis 125:366–369Google Scholar
  26. 26.
    Schoenberger CI, Line BR, Keogh BA, Hunninghake GW, Crystal RG (1982) Lung inflammation in sarcoidosis: comparison of serum angiotensin-converting enzyme levels with bronchoalveolar lavage and gallium-67 scanning assessment of the T-lymphocyte alveolitis. Thorax 37:19–25Google Scholar
  27. 27.
    Sørensen SF, Hardt F, Veien NK (1976) Estimation of lymphocyte subpopulations in the peripheral blood of patients with sarcoidosis. Scand J Immunol 5:1117–1122Google Scholar
  28. 28.
    Weinberger SE, Kelman JA, Elson NA, Young RC, Reynolds HY, Fulmer JD, Crystal RG (1978) Bronchoalveolar lavage in interstitial lung disease. Ann Intern Med 89:459–466Google Scholar

Copyright information

© Springer-Verlag 1983

Authors and Affiliations

  • U. Costabel
    • 1
  • K. J. Bross
    • 1
  • H. Matthys
    • 1
  1. 1.Abtcilung Pulmologie und Abteilung Hämatologie-Onkologie der Medizinischen Universitätsklinik FreiburgGermany

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