A Comparative Study of Bronchoscopic Microsample Probe versus Bronchoalveolar Lavage in Patients with Burns-Related Inhalational Injury, Acute Lung Injury and Chronic Stable Lung Disease

Abstract

Background and Objectives: The bronchoscopic microsample (BMS) probe allows direct epithelial lining fluid (ELF) level measurement without saline lavage. We investigated whether cytokine levels in ELF from a BMS differed from those obtained by bronchoalveolar lavage (BAL) in stable and acute lung disease. Methods: In a single-centre, prospective observational cohort study of 45 patients, a sequential BMS probe procedure and BAL were performed on patients with stable chronic obstructive lung disease, interstitial lung disease, acute lung injury (ALI), burns-related inhalational injury or controls. ELF samples were assayed for IL-1β, IL-6, IL-8, TNF-α and G-CSF. Results: Both bronchoscopic microsampling and BAL showed significantly higher cytokine levels in the ELF from patients with ALI and burns-related inhalational injury than from those with chronic stable lung disease. The BMS method detected cytokine levels approximately 20- to 80-fold higher than the corresponding BAL (uncorrected for dilution). The ratio of BMS and BAL cytokine levels was as follows: the ratio for IL-1β [mean 55, 95% confidence interval (CI) 34-88] was higher than that for IL-6 (mean 16, 95% CI 10-23, p = 0.015) and IL-8 (mean 13, 95% CI -5 to 36, p = 0.03). The ratio for G-CSF (mean 43, 95% CI 24-75) was higher than that for IL-6 (mean 16, 95% CI 10-23, p = 0.008). Conclusions: The BMS probe safely collects ELF with higher equivalent inflammatory cytokine concentrations than via BAL from patients with both acute and chronic lung disease and can be an alternative to saline BAL. Variations in cytokine concentrations between BMS and BAL and sampling-site differences warrant further study.

Tubeimoside I attenuates inflammation and oxidative damage in a mice model of PM2.5‑induced pulmonary injury

“…To investigate whether the protective effect of TBMS1 against PM 2.5 -induced pulmonary injury was associated with inflammation, TNF-α and IL-6 levels were measured. These proinflammatory cytokines are known to be elevated in the BALF of lung disease patients (23). The present study revealed that TBMS1 treatment significantly decreased TNF-α and IL-6 protein in BALF.…”

Anti-TNFα therapy in inflammatory lung diseases

“…Increased levels of TNFα have been detected in BAL, serum and epithelial lining fluid from patients with ALI and ARDS (Antonelli et al, 1994; Bauer et al, 2000; Hamacher et al, 2002; Li et al, 2010; Reper and Heijmans, 2015; Roten et al, 1991; Singh et al, 2015; Suter et al, 1992; Vaillant et al, 1996). Higher serum levels of TNFα during early stages of ALI are associated with increased mortality at 2–3 months (Makabe et al, 2012).…”

Biomarkers for patients with trauma associated acute respiratory distress syndrome

“…Second, for a specific biomarker, the best way to collect an ideal biological sample should be verified. For example, several studies have reported that bronchoscopic microsampling yields a much higher concentration of inflammatory mediators than traditional bronchoalveolar lavage (BAL) methods [ 50 ]. Third, panels of biomarkers seem to be a more practical choice than a single marker.…”