The role of persisting infections in the pathogenesis of pulmonary emphysema. Electron microscopy reveals a probable bacterial colonization of the alveolar space and the bronchioles.
Lung volume reduction surgery (LVRS) yields resection specimens from patients with advanced pulmonary emphysema. Regarding the development of lung function parameters, recent results obtained by light microscopy revealed an unfavorable prognosis in patients with remarkable inflammation, particularly in the bronchioli. Tissue from ten patients (alpha1-antitrypsin level in the normal range) was furthermore investigated by electron microscopy. Scanning electron microscopy shows 0.4-0.6 micron spherical bodies variably densely arranged in the whole alveolar space and in the bronchioles of all patients. These bodies are mostly seen on the microvilli of type II pneumocytes. An immunological reaction with activation of macrophages and granulocytes occurs simultaneously. Macrophages show cytoplasmic extensions to the spherical bodies, which exhibit a cellular membrane but no cellular wall. This favors the diagnosis of bacterial colonization of the alveolar space and the bronchioles by mycoplasmas or L-forms of other bacteria. As patients undergoing lung volume reduction surgery are under optimal medical treatment and without any infection clinically, these findings appear to be relevant for the pathogenesis and/or progression of pulmonary emphysema.
Theegarten
D
D
Department of Pathology, Ruhr-University, Bochum, Germany. Dirk.Theegarten@ruhr-uni-bochum.de
Stamatis
G
G
Morgenroth
K
K
D000208:Acute Disease; D001402:B-Lymphocytes / Q000276:immunology; D001424:Bacterial Infections / Q000382:microbiology* / Q000473:pathology / Q000601:surgery; D001980:Bronchi / Q000382:microbiology* / Q000648:ultrastructure; D002908:Chronic Disease; D018549:Cryptogenic Organizing Pneumonia / Q000382:microbiology* / Q000473:pathology / Q000601:surgery; D006801:Humans; D008855:Microscopy, Electron, Scanning; D008871:Microvilli / Q000648:ultrastructure; D011013:Pneumonectomy; D011650:Pulmonary Alveoli / Q000382:microbiology* / Q000648:ultrastructure; D011656:Pulmonary Emphysema / Q000382:microbiology* / Q000473:pathology / Q000601:surgery; D013601:T-Lymphocytes / Q000276:immunology; D000515:alpha 1-Antitrypsin / Q000032:analysis
D000515:alpha 1-Antitrypsin