Increased lung epithelial permeability in HIV-infected patients with isolated cytotoxic T-lymphocytic alveolitis.
HIV-related lymphocytic alveolitis is common in HIV-seropositive patients without lung infection or tumor. In some of them a fraction of alveolar lymphocytes are HIV-specific cytotoxic T-lymphocytes (CTL) bearing the CD8 and D44 cell surface markers and capable of killing HIV-infected alveolar macrophages. In order to evaluate the in vivo effect of these CTL on lung function, we measured the pulmonary clearance of aerosolized 99mTc-diethylene triamine penta-acetate (DTPA-CI) on 24 occasions in 22 patients with lymphocytic alveolitis. DTPA-CI has been selected as a highly sensitive test to detect injury of the lung epithelium. In 13 of the patients, we found a high DTPA-CI of 4.56 +/- 2.54%.min-1 (mean +/- SD), suggesting an increase of the epithelial permeability. The lymphocytic alveolitis was then characterized by a high cellularity, a high proportion of lymphocytes (59 +/- 18%), mainly composed of CD8+D44+ T-lymphocytes (149 +/- 109 cells/mm3), which spontaneously exhibited a cytolytic activity against the autologous alveolar macrophages in a standard 51Cr release assay. In the remaining 11 patients, DTPA-CI was normal (less than 1.78%.min-1), lymphocytic alveolitis being characterized by a low number or an absence of CD8+D44+ alveolar lymphocytes (9 +/- 13 cells/mm3) with no significant cytolytic activity. In the whole group, a significant correlation (r = 0.74, p = 0.0004) was found between the DTPA-CI and the number of CD8+D44+ lymphocytes and their cytotoxic activity against alveolar macrophages. Altogether, these results suggest that an injury of the lung epithelium could result from a HIV-specific CTL-induced immunologic conflict.
Meignan
M
M
Service de Médecine Nucléaire, Hôpital Henri Mondor, Créteil, France.
Guillon
J M
JM
Denis
M
M
Joly
P
P
Rosso
J
J
Carette
M F
MF
Baud
L
L
Parquin
F
F
Plata
F
F
Debre
P
P
D000328:Adult; D015703:Antigens, CD; D000943:Antigens, Differentiation; D000945:Antigens, Differentiation, T-Lymphocyte; D016827:CD8 Antigens; D004848:Epithelium / Q000378:metabolism; D005710:Gallium Radioisotopes; D015658:HIV Infections / Q000150:complications* / Q000276:immunology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015609:Organotechnetium Compounds; D004369:Pentetic Acid; D010539:Permeability; D011014:Pneumonia / Q000209:etiology / Q000503:physiopathology*; D011650:Pulmonary Alveoli / Q000503:physiopathology*; D016201:Receptors, Lymphocyte Homing; D012129:Respiratory Function Tests; D013602:T-Lymphocytes, Cytotoxic / Q000276:immunology*; D016284:Technetium Tc 99m Pentetate
D015703:Antigens, CD; D000943:Antigens, Differentiation; D000945:Antigens, Differentiation, T-Lymphocyte; D016827:CD8 Antigens; D005710:Gallium Radioisotopes; D015609:Organotechnetium Compounds; D016201:Receptors, Lymphocyte Homing; D004369:Pentetic Acid; D016284:Technetium Tc 99m Pentetate