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Objective: It has recently been described that circulatory and BAL regulatory T-cells (Tregs), defined as CD4+CD25highCD127low are increased in patients with active sarcoidosis compared with other interstitial lung diseases., Material and Methods: We studied prospectively 17 patients (10 women, 7 men) of median age 39 years (range 27-65) with active granulomatous lung diseases (GLD) (10 patients with sarcoidosis (BBS), and 7 with hypersensitivity pneumonitis (HP), and 9 healthy controls. Bronchoalveolar lavage fluid (BAL) and induced sputum Treg counts, CD4+, CD8+, CD25+ cells were quantified by flow cytometry. Disease activity was measured by ACE serum level. Pulmonary function tests were performed using an Elite DL Medgraphics body box., Results: We found Treg cells count significantly elevated in induced sputum from active GLD (38.3% vs. 7.1% and 5.3% in BBS, HP, and control, respectively). A significantly higher percentage of Treg cells characterized BAL cells from HP patients (2.27%; 9.5%; 2.1%, in BBS, HP and control, respectively). There was a strong correlation with ACE serum level and Treg cell count in BAL fluid of BBS patients, with no such correlation within HP patient group, nor Treg cell count and pulmonary function tests., Conclusions: Our data suggest a potential role of CD4+CD25highCD127low induced sputum and BAL lymphocytes from patients with active granulomatous lung diseases and hypersensitivity pneumonitis. An increased number of Treg cells in active GLD may be involved in immune regulation in active granulomatous lung diseases. The results indicate that analysis of these cells could be useful as markers of disease activity in granulomatous lung diseases.

The aim was to find out how the IL-12 and IL-18 levels in the bronchoalveolar lavage fluid (BALF) correspond to the inflammatory activity of the hypersensitivity pneumonitis (HP). We studied 12 patients with HP and 13 normal subjects. IL-12 and IL-18 levels were measured using ELISA kits. We found a significantly higher plasma angiotensin-converting enzyme (ACE) concentration (55 vs. 34 U/L, P=0.0016), lymphocyte percentage (57 vs. 14%, P<0.001), CD8+ cells (32 vs. 17%, P<0.001) and a lower CD4/CD8 ratio (1.2 vs. 2.0, P<0.0001). The IL-12 and IL-18 levels in BALF were significantly higher in HP patients than in healthy subjects (3.9 vs. 3.2 pg/ml, P=0.003 and 14.2 vs. 6.15 pg/ml, P% 0.0001, respectively). We found a strong positive correlation between IL-12 and the percentage of lymphocytes (r=0.68, P=0.015) and a negative one between IL-12 and the percentage of macrophages in BALF (r=-0.64, P=0.024). We conclude that upregulation of the Th1 cell cytokine profile may play a significant role in the pathogenesis of HP.

We studied prospectively 43 patients with sarcoidosis and 13 normal subjects. IL-12 and IL-18 levels were measured using ELISA kits. Spirometry and body plethysmography were performed using an Elite DL Medgraphics body box. The sarcoidosis group was characterized by significantly higher median range of the plasma angiotensin-converting enzyme (ACE) concentration (72 vs. 34 U/l, P<0.0001), lymphocyte (34 vs. 14%, P<0.0001), CD4+ cells percentages (59 vs. 36%), and CD4/CD8 ratio (4.2 vs. 1.99, P<0.0001). The BALF IL-12 and IL-18 levels were significantly higher in sarcoidosis patients than in healthy subjects (4.1 pg/ml vs. 3.2 pg/ml; P<0.001 and 11.1 pg/ml vs. 6.15 pg/ml, P<0.0001, respectively). A negative correlation between BALF IL-12 and ACE plasma levels (r=-0.33, P<0.05) within the sarcoidosis group was found. Our data suggest a potential role of IL-12 and IL-18 in a local immunologic response in pulmonary sarcoidosis.

In this study we compared the cellular profiles of induced sputum (IS) and BAL in newly diagnosed sarcoidosis patients before and after 6 months of prednisone therapy. The study encompassed 17 untreated patients with stage II pulmonary sarcoidosis. Sputum was induced with hypertonic saline solution, and bronchoscopy was performed in all patients. The results showed a significantly higher percentage of macrophages in BAL (P<0.05), whereas the percentage of neutrophils was higher in IS samples (P<0.01). The percentage of lymphocytes in IS was significantly lower than that in BAL (P<0.05). The TCD4/CD8 ratio was in favor of CD4 in both BAL and IS samples before prednisone therapy and it significantly decreased after therapy; the ratio was 4.8 vs. 1.8 (P=0.009) in BAL and 3.5 vs. 2.0 (P=0.019) in IS, respectively. Positive BAL/IS correlation characterized T cell populations in regards to CD4+ (r=0.59), CD8+ (r=0.34), CD4/CD8 ratio (r= 0.66) and CD3+ HLA-DR+ (r=0.89) cell population. These finding suggest that IS may serve as a valuable alternative to BAL technique.

Unlabelled: This study compares the cellular profiles of induced sputum (IS), bronchial washing (BW), and BAL fluid (BAL) in newly diagnosed sarcoidosis (BBS) and hypersensitivity pneumonitis (HP) patients to COPD group, and examines whether inflammatory cell counts from IS correlated with inflammatory cell counts from BW and BAL in sarcoidosis and HP patients., Methods: We recruited 23 untreated patients with stage II pulmonary sarcoidosis, 15 untreated patients with HP and 17 COPD patients. Sputum was induced with hypertonic saline solution in all individuals. Bronchoscopy was performed on a different occasions in all patients., Results: Mean lymphocyte counts in IS, BW, and BAL fluid from sarcoidosis and HP patients were significantly higher than in COPD subjects (8.9% and 13.8 vs 2.9%, p < 0.05; 11.9% and 30.5 vs 3.2%, p < 0.05; 21.5% and 56 vs 3.4%, p < 0.05, respectively). Moreover we found higher percentage of CD4+, CD3+ CD28+, CD3+ HLADRV+, and gamma delta T cells in IS, BW, and BAL fluid from both BBS and HP groups than in from COPD. Elevated CD4/CD8 ratio characterized IS, BW and BAL fluid in BBS group. Strong correlation IS/BAL and IS/BW of CD3+ CD28+, CD3+ HLADRV+, and CD4/CD8 ratio was found., Conclusions: We demonstrated that, although the relative proportion of inflammatory cells differed in the three samples, lymphocyte counts in IS were high. This finding suggests that IS could be used as a valuable alternative method to more conventional invasive techniques in clinical assessment of interstitial lung diseases patients.