title: BAL induces an increase in peripheral blood neutrophils and cytokine levels in healthy volunteers and patients with pneumonia.
abstract: OBJECTIVE
  To examine the peripheral effects of BAL on the neutrophil counts and cytokine levels in the circulation.
  
  
  METHODS
  WBC counts and plasma cytokines were measured before and 4 h after fiberoptic bronchoscopy (FOB) without further interventions (n = 6), or combined with BAL in normal volunteer subjects (n = 6), and in patients with bacterial pneumonia (n = 4). The bronchus of the right middle lobe was wedged, and three 50-mL aliquots of sterile saline solution was instilled. There was no endotoxin contamination in the saline solution or the fluid obtained through the working channel of bronchoscope.
  
  
  RESULTS
  In volunteers, peripheral WBC counts and the number of nonsegmented and segmented neutrophils increased after the BAL procedure (p < 0.05) associated with the increase in plasma concentration (mean +/- SEM) of interleukin (IL)-6 (0.99 +/- 0.32 pg/mL before BAL and 20.38 +/- 13.42 pg/mL after BAL; p < 0.05) and granulocyte colony-stimulating factor (G-CSF; 14.1 +/- 1.7 pg/mL before BAL and 38.5 +/- 9.7 pg/mL after BAL; p < 0.05). The increase in WBC counts and neutrophil counts was positively correlated to the increase in IL-6 (p < 0.05) and the increase in G-CSF (p < 0.05). In patients with pneumonia, IL-6 and G-CSF levels were higher after BAL than in normal volunteer subjects (p < 0.05). There was no increase in plasma concentration of IL-1beta, tumor necrosis factor-alpha, or IL-8 after BAL in normal volunteer subjects or in patients with pneumonia. FOB without BAL did not increase the WBC count, neutrophil count, or plasma cytokine levels.
  
  
  CONCLUSIONS
  The BAL procedure increases the number of WBCs, and segmented and nonsegmented neutrophils in the peripheral circulation as well as circulating IL-6 and G-CSF levels.
authors.affiliation: Department of Internal Medicine, Tokyo Dental College Ichikawa General Hospital, Ichikawa, Chiba. terasima@tdc.ac.jp
authors.forename: T
authors.initials: T
authors.lastname: Terashima
authors.forename: K
authors.initials: K
authors.lastname: Amakawa
authors.forename: A
authors.initials: A
authors.lastname: Matsumaru
authors.forename: S
authors.initials: S
authors.lastname: van Eeden
authors.forename: J C
authors.initials: JC
authors.lastname: Hogg
authors.forename: K
authors.initials: K
authors.lastname: Yamaguchi
mesh_terms: D000328:Adult; D018893:Bronchoalveolar Lavage; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000097:blood*; D016178:Granulocyte-Macrophage Colony-Stimulating Factor / Q000097:blood; D006801:Humans; D007375:Interleukin-1 / Q000097:blood; D015850:Interleukin-6 / Q000097:blood*; D016209:Interleukin-8 / Q000097:blood; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000166:cytology*; D018410:Pneumonia, Bacterial / Q000097:blood* / Q000175:diagnosis*; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis
chemical_list: D007375:Interleukin-1; D015850:Interleukin-6; D016209:Interleukin-8; D014409:Tumor Necrosis Factor-alpha; D016179:Granulocyte Colony-Stimulating Factor; D016178:Granulocyte-Macrophage Colony-Stimulating Factor