Source: Annual Congress 2001 - Interstitial lung disease: BAL in diagnosis and management

Abstract

Wegener's granulomatosis (WG) is a form of systemic vasculitis of presumed auto-immune origin. The disease is closely associated with anti-neutrophil cytoplasmic antibodies directed to proteinase-3 (PR3-ANCA). Bronchoalveolar lavage (BAL) studies in patients with WG are only occasionally reported. In the present study, we evaluated BAL in 14 consecutive patients for local IgG and/or PR3-ANCA production. In 8 patients BAL was performed during active disease, whereas in 6 patients during remission because of a clinically suspected respiratory tract infection. BAL IgG levels were higher in active WG compared to remission (76.4 versus 26.0 mg/dl) whereas serum IgG levels were lower in active WG compared to remission (76.2 versus 121.3 mg/dl). In contrast, albumen BAL levels and serum levels were lower in active WG than in remission. Accordingly, the calculated IgG index (BAL IgG/albumen: serum Ig/albumen) was 1.35 in active WG (suggestive of local production) and 0.92 during remission (suggestive of exudation). PR3-ANCA levels in BAL were significantly higher in patients with active disease compared to remission (p=0.031). BAL PR3-ANCA levels, however, correlated significantly with serum PR3-ANCA levels (p<0.009) suggesting exudation rather than local production of PR3-ANCA. In conclusion, our results demonstrate that in patients with active WG IgG is locally produced in the lungs. Further studies are needed to determine the specificity of this local immune response.

Rating:

Share or cite this content

Citations should be made in the following way:
H. De Jong, J. W. Cohen Tervaert (Maastricht, The Netherlands). Bronchoalveolar lavage studies in Wegener's granulomatosis: local production of IgG and ANCA?. Eur Respir J 2001; 16: Suppl. 31, 3418

Member's Comments

No comment yet.

Related content which might interest you: Neutrophil chemotaxis in granulomatosis with polyangiitis (Wegener’s) and idiopathic pulmonary fibrosis Source: Eur Respir J 2011; 38: 1081-1088 Year: 2011 c-ANCA-induced neutrophil-mediated lung injury: a model of acute Wegener's granulomatosis Source: Eur Respir J 2010; 36: 187-195 Year: 2010 Utility of bronchoalveolar lavage in vasculitis patients Source: International Congress 2014 – Clinical management of interstitial lung diseases and vasculitis Year: 2014 Clinical approach to pulmonary sarcoidosis Source: International Congress 2016 – Long-term oxygen therapy, noninvasive ventilation, and other clinical variables in chronic lung diseases Year: 2016 Refractory severe asthma: Is presence of aspergillus in broncho-alveolar lavage significant? Source: International Congress 2015 – Respiratory infections: from basic science to clinical issues Year: 2015 Bronchoalveolar lavage cytology resembles sarcoidosis in a subgroup of granulomatous CVID Source: Eur Respir J 2014; 43: 922-924 Year: 2014 Bronchoalveolar lavage cytology resembles sarcoidosis in a subgroup of granulomatous CVID Source: Eur Respir J 2014; 43: 924-925 Year: 2014 The impact of smoking on bronchoalveolar lavage fluid (BALf) amyloid A concentration in patients with sarcoidosis Source: Annual Congress 2013 –Sarcoidosis and other granulomatosis Year: 2013 Usefulness of anti-Ro52 antibodies in the BAL of the patients with ILDs. Pilot study Source: International Congress 2016 – ILD pathogenesis Year: 2016 Bronchoalveolar lavage (BAL) in the differential diagnosis of sarcoidosis, extrinsic allergic alveolitis and BOOP Source: Eur Respir J 2003; 22: Suppl. 45, 255s Year: 2003 Serum and bronchoalveolar exosomal miRNAs in pulmonary sarcoidosis Source: International Congress 2015 – Sarcoidosis: pathogenesis Year: 2015 Clinical and immunological parameters in patients with newly diagnosed sarcoidosis Source: Annual Congress 2013 –Diffuse parenchymal lung disease III Year: 2013 Bronchoalveolar lavage findings and disease progression in hypersensitivity pneumonitis Source: International Congress 2017 – ILDs: clinical aspects Year: 2017 Detection of anticentromere antibodies (ACA) in a patient with Wegener Granulomatosis Source: Eur Respir J 2002; 20: Suppl. 38, 65s Year: 2002 Cytologicalfeaturesof bronchoalveolar lavage in different variants of exogenous allergic alveolitis Source: International Congress 2014 – ILDs 5 Year: 2014 Wegener's granulomatosis: our experience Source: Eur Respir J 2001; 18: Suppl. 33, 511s Year: 2001 Bronchoalveolar and serological parameters reflecting the severity of sarcoidosis Source: Eur Respir J 2003; 21: 407-413 Year: 2003 Alveolar haemorrhage syndromes Source: Eur Respir Mon 2011; 54: 15-31 Year: 2011 Clinical, computed tomography, and cytological peculiarities of different variants of exogenic allergic alveolitis (EAA) Source: International Congress 2015 – Interstitial lung diseases I Year: 2015 Bronchoalveolar lavage findings in patients with diffuse interstitial lung disease (DILDs) Source: International Congress 2016 – Clinical aspects of ILD Year: 2016