Type 3 Procollagen Peptide in Bronchoalveolar Lavage Fluid: Results

20 Nov
2014

Bronchoalveolar Lavage Analysis
Lavage type 3 procollagen peptide levels were above the detection limit of the assay in 45 percent (N = 5) of control subjects and 80 percent (N = 67) of sarcoid patients (Fig 1). Type 3 procollagen peptide levels were significantly elevated in the sarcoid group (p<0.001). However, considerable variation in type 3 procollagen peptide levels were observed among sarcoidosis patients. Lavage fibronectin, ACE, and protein levels were also elevated in the sarcoid group, as were the percentage of T-lymphocytes and the T-cell helper/suppressor ratio of the cells recovered on lavage. In the sarcoid group, lavage type 3 procollagen peptide levels were found to be positively correlated with lavage fibronectin (r=0.66, p<0.001) and lavage ACE (r=0.64, p<0.01). In addition, a weak but significant positive correlation was observed between lavage procollagen peptide and serum ACE levels (r = 0.36, p<0.05). Patients with an elevated recovery of T-lymphocytes on lavage (greater than 30 percent of inflammatory cells) displayed higher type 3 procollagen peptide levels (type 3 procollagen peptide ng/ mg protein: median, 1.39, range, 0 to 51.4) than those with less than 30 percent T-lymphocytes recovered on lavage, (procollagen peptide ng/mg protein: median, 0.69; range, 0 to 11.8; p<0.01). flovent inhalers

Roentgenography
Analysis of variance indicated that type 3 procollagen peptide levels varied according to roentgenographic disease stage—highest levels being observed in patients with stage 2 and stage 3 disease (Fig 2). Lavage type 3 procollagen peptide levels in smokers did not differ from those in nonsmokers.
Disease Presentation
Twenty patients in the study group were lavaged on presentation with erythema nodosum. Chest x-ray films indicated that 11 of these patients had stage 1 disease and nine had stage 2 disease. A further seven patients were lavaged on presentation with acute uveitis. Both these symptoms of acute-onset disease are associated with a good prognosis in sarcoidosis. Although lavage type 3 procollagen peptide levels in these patients did not differ significantly from those observed in patients presenting with other symptoms of disease (Fig 3), very high type 3 procollagen peptide levels were observed in some patients presenting with erythema nodosum or uveitis. No difference in type 3 procollagen peptide levels was observed between newly presenting patients (excluding those presenting with erythema nodosum or uveitis) and patients with established disease.

Figure 1. Type 3 procollagen peptide levels in bronchoalveolar lavage fluid of control subjects and sarcoid patients. Levels are expressed per milligram of lavage fluid protein. Horizontal bars indicate median values for each group.

Figure 1. Type 3 procollagen peptide levels in bronchoalveolar lavage fluid of control subjects and sarcoid patients. Levels are expressed per milligram of lavage fluid protein. Horizontal bars indicate median values for each group.

Figure 2. Lavage type 3 procollagen peptide levels in sarcoidosis patients subgrouped according to roentgenographic disease stage. Horizontal bars indicate median values for each group.

Figure 2. Lavage type 3 procollagen peptide levels in sarcoidosis patients subgrouped according to roentgenographic disease stage. Horizontal bars indicate median values for each group.

Figure 3. Lavage type 3 procollagen peptide levels in sarcoidosis patients subgrouped according to disease presentation. “New” patients are patients with symptoms other than erythema nodosum or uveitis lavaged on first presentation. Old patients are patients lavaged at various times (6 to 126 months) following initial presentation.

Figure 3. Lavage type 3 procollagen peptide levels in sarcoidosis patients subgrouped according to disease presentation. “New” patients are patients with symptoms other than erythema nodosum or uveitis lavaged on first presentation. Old patients are patients lavaged at various times (6 to 126 months) following initial presentation.

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