Increase of Activated T-cells in BAL Fluid of Japanese Patients With Bronchiolitis Obliterans Organizing Pneumonia and Chronic Eosinophilic Pneumonia

doi:10.1378/chest.108.1.123

Chest

Volume 108, Issue 1, July 1995, Pages 123-128

https://doi.org/10.1378/chest.108.1.123 Get rights and content

To study the role of T cells in bronchiolitis obliterans organizing pneumonia (BOOP) and chronic eosinophilic pneumonia (CEP) and to examine the influence of differing racial background, T-cell subsets in bronchoalveolar lavage (BAL) fluid (BALF) and in peripheral blood of 8 Japanese patients with idiopathic BOOP and 5 with CEP were compared with those of 15 normal subjects. The BALF pattern in BOOP was characterized by a significantly high number and percentage of lymphocyte and by a low CD4 to CD8 ratio compared with patients with CEP and healthy volunteers. Patients with CEP showed a significantly higher percentage of BALF eosinophils compared with other groups. There was no significant difference in BALF CD4 to CD8 ratio between patients with CEP and volunteers. Two-color analysis of T-cell subsets revealed that CD3⁺ HLA-DR⁺ cells (activated T cell) in BALF of patients with BOOP and CEP increased significantly compared with volunteers, while BALF CD3⁺ CD25⁺ cells (interleukin 2 receptor⁺ T-cell) did not. In addition, BALF CD8⁺ HLA-DR⁺ cells (activated suppressor/cytotoxic T cell) in patients with BOOP and CD4⁺ HLA-DR⁺ cells (activated helper T cell) in patients with CEP were significantly higher than levels detected in healthy subjects. The percentage of CD8⁺ CD57⁺ cells and the number of CD8⁺ CD11b⁻⁻ cells (cytotoxic T cell) in BALF were significantly higher in patients with BOOP compared with patients with CEP and healthy volunteers. There were no significant differences in the expression of peripheral blood T-lymphocyte surface antigens among the groups. These findings indicate that cytotoxic T cells in Japanese patients with idiopathic BOOP and helper T cells in CEP appear in the lungs is consistent with a previous report in Caucasians, supporting the hypothesis that T cells may play an important role in the pathogenesis of these diseases.

Section snippets

Subjects

We studied 8 Japanese patients with BOOP (6 women and 2 men, aged 63.1 ± 11.8 years, mean±SD), 5 with CEP (2 women and 3 men, aged 65.6 ± 9.5 years), and 15 healthy volunteers (2 women and 13 men, aged 27.3 ± 8.5 years). At the time of the investigation, one patient with BOOP, one with CEP, and five volunteers were smokers. The diagnosis of BOOP was based on clinicopathologic evaluation (four patients by open lung biopsy specimens and four patients by transbronchial lung biopsy specimens).

Characteristics of BALF Cells

The characteristics of cells recovered by BAL are summarized in Table 1. The total number of cells was highest in patients with BOOP, but the volume recovered and percentage of alveolar macrophages were significantly lower in patients with BOOP and CEP compared with healthy volunteers. Patients with BOOP had a significantly higher percentage of lymphocytes compared with other subjects. The percentage of neutrophils was higher, although insignificantly, in patients with BOOP and CEP compared

Discussion

Results of the present study confirmed the presence of a high number of BALF lymphocytes in idiopathic BOOP and eosinophils in CEP, and a significantly low BALF CD4 to CD8 ratio in BOOP, confirming those reported previously.9, 10, 11 However, our results demonstrated no difference in the number or percentage of lymphocytes or CD4 to CD8 ratio between patients with CEP and healthy volunteers. Thus, the differences are observed in T-cell subsets between idiopathic BOOP and CEP, while eosinophilia

Acknowledgments

We thank Drs. M. Senju, K. Fukushima, O. Sakito, S. Kusano, T. Morikawa, and N. Morikawa for helpful advice and Mr. A. Yokoyama for his technical assistance. We also thank the staff at Word-Medex for their assistance in editing the manuscript.

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Neutrophilic alveolitis was the predominant feature. Neutrophils ( $P < 0.0001$ ) and eosinophils ( $P = 0.0006$ ) were the predominant cell types in the BAL fluid of patients with PF. CD8 lymphocytes expressed as percentage or absolute number were significantly higher in patients with PF than in healthy controls (22.96±7.48% vs. 14.16±7.73%, respectively; $P = 0.0006$ ; and 2.28±0.84 vs. 1.10±0.55×10³ cells/ml, respectively; $P < 0.0001$ ). The CD4/CD8 ratio was significantly lower in patients with PF than in healthy controls (0.73±0.25 vs. 1.58±0.67; $P < 0.0001$ ). Except for the percentage and the absolute number of the BAL fluid neutrophils ( $r = 0.70$ , $P = 0.001$ : $r = - 0.62$ , $P = 0.005$ ; respectively), no correlation was found between DLCO% and the other BAL cells. A significant negative correlation was observed between the percentage of DLCO and both the percentage and the absolute number of CD8 lymphocytes in BAL fluid in patients with PF ( $r = - 0.81$ , $P = 0.0003$ ; $r = - 0.61$ , $P = 0.006$ ; respectively). A significant correlation was also seen between the percentage of DLCO and the CD4/CD8 ratio ( $r = - 0.60$ , $P = 0.006$ ) in our patients.
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Chest

Clinical InvestigationsIncrease of Activated T-cells in BAL Fluid of Japanese Patients With Bronchiolitis Obliterans Organizing Pneumonia and Chronic Eosinophilic Pneumonia

Section snippets

Subjects

Characteristics of BALF Cells

Discussion

Acknowledgments

Chest

Chest

Chest

Chest

J Allergy Clin Immunol

J Allergy Clin Immunol

Am J Med

J Allergy Clin Immunol

Blood

J Allergy Clin Immunol

Bronchiolitis obliterans organizing pneumonia

N Engl J Med

Differential diagnosis of bronchiolitis obliterans organizing pneumonia

Chest

Lung biopsy in rheumatoid arthritis

Am Rev Respir Dis

Bronchiolitis obliterans organizing pneumonia in a patient with ulcerative colitis

Thorax

Chronic eosinophilic pneumonia

N Engl J Med

Bronchoalveolar lavage cell findings in patients with BOOP and related diseases

Chest

Bronchiolitis obliterans organizing pneumonia (BOOP): the cytological and immunocytological profile of bronchoalveolar lavage

Eur Respir J

Bronchoalveolar lavage in chronic eosinophilic pneumonia: analysis of six cases in comparison with other interstitial lung diseases

Respiration

Clinical Investigations
Increase of Activated T-cells in BAL Fluid of Japanese Patients With Bronchiolitis Obliterans Organizing Pneumonia and Chronic Eosinophilic Pneumonia