Significance of Elevated Procollagen-III-Peptide and Transforming Growth Factor-b Levels of
Bronchoalveolar Lavage Fluids from Idiopathic Pulmonary Fibrosis Patients
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NANAKO HIWATARI, SANAE
SHIMURA, KOHEI YAMAUCHI,
MASAYUKI NARA, WATARU HIDA
and KUNIO SHIRATO
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The First Department of Internal Medicine, Tohoku University School of Medicine, Sendai 980 - 77
Although both procollagen III aminopeptide (P-III-P) and transforming growth factor-b (TGF-b) are
reported to be present in lung tissue and/or elevated in bronchoalveolar lavage fluid (BALF) from idiopathic
pulmonary fibrosis (IPF) patients, we have little knowledge concerning the clinical significance of elevated
P-III-P and TGF-b levels in BALF. Using a radioimmunoassay, we measured P-III-P and TGF-b in
BALF from 48 IPF patients ( 16F and 32M, 59+/-2 years, mean+/-S.E.) who received BAL in our clinic over
the past 13 years before glucocorticosteroid treatment. Among them, we could detect a significant amount of
P-III-P (2.2+/-1.0 U/ml; range 0.03 to 16.5 U/ml) in BALF in 18 of the patients (5F and 13M, 58+/-3 years)
(group B), but not (0.03 U/ml or less) in the other 30 patients (11F and 19M, 59 +/-2 years) (group A).
Lymphocyte (%) and basophil (%) in BALF from group B was much larger than that from group A (33% vs.
8%. p < 0.01). Group B showed a longer duration of onset to BAL (36 months vs. 23 months, p < 0.05).
TGF-b levels were obtained using an ELISA system kit from the same BALF samples. TGF-b was not
detected in 10 patients ( 100 pg/ml or less) (3F and 7M, 59+/-4 years) (group I), while the remaining 38
patients showed a significant amount of TGF-b (329+/-44 Pg/ml, range 100 to 1,360 pg/ml). The latter
patients were further divided into two groups; group II 100 to 300 pg/ml (10F and 14M, 56+/-3 years) and
group III 350 or more (3F and 11M, 63+/-2 years). Group III showed significantly better values in
PaO2, Aa-DO2, %VC and %DLCO, and smaller percentage of
basophils in BALF than did groups I and/or II, whereas survival after BAL in group III was significantly
shorter than in group I (31 vs. 19 months, p < 0.05). There was no significant relationship between P-III-P
and TGF-b levels in BALF. These findings suggest that elevated P-III-P level is accompanied by an increase
in lymphocyte population in BALF from IPF patients, resulting in a longer duration of the disease, while
elevated TGF-b level reflects alveolar inflammation at an earlier stage of the disease which induces a
progression of the disease, resulting in a shorter survival in IPF patients.
Key words---
idiopathic pulmonary fibrosis; BALF; P-III-P and TGF-b
Tohoku J. Exp. Med., 1997, 181, 285-295
Address for reprints:
Kunio Shirato, M.D. Professor and Chairman, The First Department of Internal Medicine, Tohoku University
School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-77, Japan.
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