Hyaluronan and type III procollagen peptide concentrations in bronchoalveolar lavage fluid in idiopathic pulmonary fibrosis.

Abstract

The connective tissue components hyaluronan (hyaluronic acid) and type III procollagen peptide were measured in bronchoalveolar lavage fluid in 22 patients with idiopathic pulmonary fibrosis and 21 healthy control subjects. The patients with idiopathic pulmonary fibrosis had higher concentrations of hyaluronan (median 46 Mg/l) and type III procollagen peptide (median 0-45 jg/l) than the healthy controls (9 and < 0-2 yg/l; p < 0001). The patients had normal serum concentrations of hyaluronan and of the procollagen peptide, and albumin concentrations in lavage fluid similar to those of the control subjects. Neutrophil and lymphocyte counts in lavage fluid were increased on average 10 and two fold respectively in the patients with idiopathic pulmonary fibrosis and both correlated with the amount ofhyaluronan recovered (p < 0-05). An inverse correlation was seen between the transfer factor for carbon monoxide and hyaluronan concentrations in lavage fluid in the patients (p < 0-05). Deterioration in lung function and radiographic progression were seen over six months in 12 of the patients. These patients had higher lavage fluid concentrations of hyaluronan and type III procollagen peptide than the patients whose disease was stable (p < 0-01). Increased synthesis of hyaluronan and type III procollagen peptide in lung parenchyma may reflect activation or proliferation (or both) of pulmonary fibroblasts in idiopathic pulmonary fibrosis and seems to be linked to the severity and activity of the lung disease.

Simultaneous measurement of collagen type-VI-related antigen and procollagen type-III-N-propeptide levels in bronchoalveolar lavage

“…Our measurements of PIIINP agree with previous studies indicating elevated PIIINP levels in BAL of patients with diffuse lung diseases, such as IPF, adult respiratory distress syndrome (ARDS), sarcoidosis and farmer's lung [5][6][7][8][10][11][12][13][14][15].…”

“…The first is to evaluate the PIIINP/ C-VI ratio in correlation to physiological parameters, symptoms and X-ray scores. This has been done by others for PIIINP levels in BALF by using the alveolar-arterial oxygen difference (A-aDO 2 ) [15], or by using roentgenographic methods [5]. The second problem involves disease activity.…”

“…Thus, biochemical measurements of the balance between collagen synthesis and degradation would be helpful in monitoring the progress of fibrotic lung disease. In recent years, an assay for the procollagen type-III Nterminal propeptide (PIIINP) [3,4] has been used to assess collagen turnover both in serum and bronchoalveolar lavage fluid (BALF) from patients with idiopathic pulmonary fibrosis [5,6], sarcoidosis [7,8], adult respiratory distress syndrome [9,10], and farmer's lung [11][12][13]. Most of these studies have investigated PIIINP levels either in serum or BALF: In a few studies both PIIINP levels were investigated [10,14,15].…”

Dynamic role of hyaluronan (HYA) in connective tissue activation and inflammation

“…After avoidance of contact with mouldy plant material the increased HYA lavage fluid concentrations fall progressively [21]. The parallel appearance of HYA and type III procollagen peptide in BAL fluid in interstitial lung diseases may reflect the activated or proliferating fibroblast as a common cellular source [17].…”

“…The inflammatory injury to lung parenchymal cells is associated with fibroblast activation and may develop into deposition of increased amounts of collagen in the interstitial space. Analysis of the broncho-alveolar lavage (BAL) fluid from patients with sarcoidosis and idiopathic pulmonary fibrosis has demonstrated an increased broncho-alveolar recovery of HYA related to the intensity of the alveolitis and the clinical severity, as indicated by pulmonary function tests and radiological criteria [16,17,18,19]. During an acute episode of farmer's lung very high amounts of HYA are recovered which are related to the intensity of the alveolitis [20,21].…”