Clare O'Connor, PhD; Kevin Ward, MD...

Clare O'Connor, PhD; Kevin Ward, MD; Alex van Breda, BSc; Ann McIlgorm, BSc; and Muiris X FitzGerald, MD FCCP

To investigate the character of bronchoalveolar lavage type 3 procollagen peptide as a prognostic indicator in sarcoidosis, we measured protoplast 3 procollagen N-terminal peptide flats in lavage fluids from 84 sarcoidosis patients and monitored disease progres in these patients for a period of 12 month Lavage procollagen peptide horizontals were significantly elevated in sarcoidosis patients compared to direct subjects (p<0.001). No association was observ between lavage mark 3 procollagen peptide and disease severity, as assessed by the agency of lung function tests. Follow-up monitoring of patients failed to demonstrate any relationship between succeeding functional deterioration and initial lavage token 3 procollagen peptide. These eventuates suggest that elevated lavage image 3 procollagen peptide concentrations in sarcoidosis may ruminate increased type 3 collagen synthesis associated with the inflammatory proces rather than signal an early adventure in the development of chronic disease.

A proportion (20 percent) of patients who at hand with sarcoidosis develop chronic pulmonary disease, which is characterized by means of impaired pulmonary function and eventual fibrosis. Early identification of these patients could render certain more informed clinical decisions aimed at preventing permanent lung injury. Pulmonary fibrosis is characterized from an increase in fibroblast numbers and altered collagen metabolism in the lung Although end-stage fibrosis is marked through an increased proportion of stamp 1 collagen in the alveolar interstitium, several studies indicate that during the early phase of fibrosis, there is a temporary increase in the production of sign 3 collagen.[1,2] Bateman et al,[3] in a studious mood of lung biopsy samples from patients with cryptogenic fibrosing alveolitis, base that type 3 collagen was associated with active fibrogenesis in this disease. image 3 collagen is produced and shroudeded by fibroblasts in a precursor form. Following secretion, specific N-terminal and C-terminal procollagen peptides are cleaved from the precursor. The mature collagen monad is then deposited in fibrillar form in the extracellular matrix. Several investigators have indicated that evens of procollagen peptides in material substance fluids reflect altered collagen synthesis and that these peptides may be of use to as markers of fibrotic changes in the tissues.[4-6] gentle et al[7] found that concentrations of N-terminal sign 3 procollagen peptide were elevated in bronchoalveolar lavage fluids from patients with idiopathic pulmonary fibrosis and sarcoidosis and indicated that lavage archetype 3 procollagen peptide levels might contemplate changes in collagen production in lung disease. More newly Bjermer et al[8] observed an association between lavage emblem 3 procollagen peptide concentrations and clinical symptoms of lung impairment in patients with sarcoidosis. These authors advise that lavage type 3 procollagen peptide flushs might reflect fibrotic activity in the sarcoid lung and hence, be useful in assessing disease severity and result In the present research we measured type 3 procollagen peptide on a levels in bronchoalveolar lavage fluids from a assign places to of sarcoid patients and monitored disease progres in those patients for a minimum of 12 month to determine whether lavage procollagen peptide on a levels might serve to identify patients who unravel functional impairment and chronic disease.

METHODS

reflection Population

Eighty four patients (37 women 47 men) with sarcoidosis verfied by the agency of biopsy, mean age 33.4 (range 20 to 64) years, underwent bronchoalveolar lavage. Sixty-one were newly presenting at the time of lavage and the median duration of disease from diagnosis in the remaining patients was 33 (range 6 to 126) month None of the patients was receiving cortocosteroid therapy at the time of investigation. Twenty were generally received smokers. Four healthy offers and seven hospitalized patients without lung disease were included in the meditation as a control group, (one woman, ten men; mean age, 303 years). Pulmonary function proofs performed before lavage, indicated normal lung function in the bridle subjects. All subjects gave their informed agreement for lavage.

Bronchoalvelar Lavage

Before bronchoscopy patients were given intramuscular atropine (06 mg) and pethidine (50 mg) and the upper respiratory tract was anesthetized with lignocaine. A fiberoptic bronchoscope was securely wedged in a subsegmental bronchus in the right middle lobe, 180 ml of sterile 09 percent saline solution at 37 [degrees] C infused in three 60 ml aliquots, and tame suction applied after each infusion. The bulk of the aspirated fluid was recorded and the fluid strained within sterile surgical gauze to dislodge mucus. The fluid was then centrifuged at 400 g for 15 minutes and the supernatant stored at -20 [degrees] C for following analysis.

Analysis of Lavage Fluid