Fibrinopeptide A reactive peptides and procoagulant activity in bronchoalveolar lavage: relationship to rheumatoid interstitial lung disease.
Extravascular, primarily, alveolar fibrin deposition is commonly associated with the alveolitis of many interstitial lung diseases including the interstitial lung disease associated with rheumatoid arthritis (RA). We therefore hypothesized that coagulation pathways, which promote fibrin formation, would be activated in the alveolar lining fluids of patients with rheumatoid interstitial lung disease. To test this hypothesis, we studied the bronchoalveolar lavage (BAL) fluids from patients with rheumatoid interstitial lung disease (n = 7) and patients with RA unassociated with interstitial lung disease (n = 10) to characterize and quantitatively compare the BAL procoagulant material and levels of fibrinopeptide A (FPA), which is cleaved from fibrinogen by thrombin. FPA reactive peptide concentrations were significantly greater in rheumatoid interstitial lung disease than RA when normalized per ml of concentrated BAL fluid (p = 0.02), per mg BAL total protein (p = 0.01) or BAL albumin content (p = 0.03) and correlated with BAL antigenic neutrophil elastase concentrations (r = 0.87). Procoagulant activity was present in similar concentration of BAL of patients with RA and rheumatoid interstitial lung disease and was mainly attributable to tissue factor associated with factor VII (or VIIa). Our results demonstrate that tissue factor and factor VII are endogenous in the alveoli of subjects with RA and interstitial lung disease and could interact with distal coagulation substrates which may enter the alveoli in interstitial lung disease to locally promote fibrin deposition.(ABSTRACT TRUNCATED AT 250 WORDS)
Idell
S
S
Department of Medicine, University of Texas Health Center, Tyler 75710.
Garcia
J G
JG
Gonzalez
K
K
McLarty
J
J
Fair
D S
DS
D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000378:metabolism*; D001779:Blood Coagulation Factors / Q000378:metabolism*; D001992:Bronchoalveolar Lavage Fluid / Q000378:metabolism*; D005167:Factor VII / Q000378:metabolism; D005170:Factor X / Q000378:metabolism; D005340:Fibrinogen / Q000378:metabolism*; D005344:Fibrinopeptide A / Q000378:metabolism*; D006801:Humans; D008875:Middle Aged; D009504:Neutrophils / Q000201:enzymology; D010447:Peptide Hydrolases / Q000378:metabolism; D011658:Pulmonary Fibrosis / Q000378:metabolism*; D013925:Thromboplastin / Q000378:metabolism
D001779:Blood Coagulation Factors; C045071:leukocyte procoagulant activity; D005344:Fibrinopeptide A; D005167:Factor VII; D005170:Factor X; D005340:Fibrinogen; D013925:Thromboplastin; D010447:Peptide Hydrolases