Spontaneous interleukin 2 release of bronchoalveolar lavage cells in sarcoidosis is a codeterminator of prognosis.
There is mounting evidence that activated interleukin 2 (IL-2)-releasing lymphocytes play a central role in the immunopathogenesis of sarcoidosis by directing inflammatory reactions and granuloma formation. In the context that a significant proportion of these cells accumulates in the lung and releases mediators, we hypothesized that different immunologically defined stages of sarcoidosis can be identified. A cohort of 89 sarcoidosis patients was allocated to four groups according to the following criteria: stage A, a low number of bronchoalveolar lavage (BAL) lymphocytes (< 20%) without IL-2 release (< 1 unit/ml in BAL cell culture supernatant); stage B, BAL lymphocytes < 20%, with IL-2 release (> or = 1 unit/ml); stage C, BAL lymphocytes > or = 20% with IL-2 release; and stage D, > or = 20% BAL lymphocytes without IL-2 release. Although patients of stages C and D (n = 49) exhibited lymphocytic inflammation, only 20/49 of these patients had activated IL-2-releasing alveolar lymphocytes. BAL of groups A and B showed a low number of lymphocytes, but the lymphocytes were activated in 20/40 patients. Forty-four patients not receiving therapy were reevaluated by pulmonary function tests 8 +/- 1 months after BAL. Progressive disease was found in 9/12 patients of group C and stable or regressing disease in 13/13 patients of group A. These results demonstrate that a combination of BAL parameters can yield prognostic information.
Müller-Quernheim
J
J
Research Institute Borstel, Medical Hospital, Germany.
Pfeifer
S
S
Kienast
K
K
Zissel
G
G
D000328:Adult; D001992:Bronchoalveolar Lavage Fluid / Q000276:immunology; D002478:Cells, Cultured; D016009:Chi-Square Distribution; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007376:Interleukin-2 / Q000032:analysis / Q000378:metabolism*; D008297:Male; D011379:Prognosis; D017565:Sarcoidosis, Pulmonary / Q000276:immunology*; D018709:Statistics, Nonparametric; D013601:T-Lymphocytes / Q000378:metabolism*
D007376:Interleukin-2