title: Bronchoalveolar lavage cell pattern from healthy human lung.
abstract: Bronchoalveolar lavage (BAL) is widely accepted as a key diagnostic procedure in interstitial lung diseases (ILD). We performed a study to obtain reference intervals of differential cell patterns in BAL fluid with special attention to the origin of lavage fluid, e.g. bronchial/alveolar, to atopy and smoking status and to age of the healthy people. We performed bronchoalveolar lavage in 55 healthy subjects with known atopy status (age: 18-64 years, non-smokers/smokers: 34/21) and determined differential cell counts and lymphocyte subsets in BAL fluid and blood. Moreover, in a subgroup of non-smoking healthy individuals we measured the expression of the regulatory T cell marker forkhead box protein 3 (FoxP3) on blood and BAL fluid lymphocytes in addition to a comprehensive set of activation markers. Differential cell counts from the alveolar lavage fraction differed significantly from calculated pooled fractions (n = 11). In contrast, marginal differences were found between atopic and non-atopic subjects. Interestingly, the BAL fluid CD4(+) /CD8(+) ratio correlated strongly with age (r(2) = 0·50, P < 0·0001). We consider the bronchial and alveolar fraction to be lavage fluid from fundamentally different compartments and recommend analysis of the alveolar fraction in diagnostic work-up of ILD. In addition, our data suggest that age corrected BAL fluid CD4(+) /CD8(+) ratios should be used in the clinical evaluation of patients with interstitial lung diseases.
authors.affiliation: Department of Pulmonology, Center for Interstitial Lung Diseases, St Antonius Hospital, Nieuwegein, the Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Heron
authors.forename: J C
authors.initials: JC
authors.lastname: Grutters
authors.forename: K M
authors.initials: KM
authors.lastname: ten Dam-Molenkamp
authors.forename: D
authors.initials: D
authors.lastname: Hijdra
authors.forename: A
authors.initials: A
authors.lastname: van Heugten-Roeling
authors.forename: A M E
authors.initials: AM
authors.lastname: Claessen
authors.forename: H J T
authors.initials: HJ
authors.lastname: Ruven
authors.forename: J M M
authors.initials: JM
authors.lastname: van den Bosch
authors.forename: H
authors.initials: H
authors.lastname: van Velzen-Blad
mesh_terms: D000293:Adolescent; D000328:Adult; D001992:Bronchoalveolar Lavage Fluid / Q000737:chemistry / Q000166:cytology* / Q000276:immunology; D016516:CD4-CD8 Ratio; D005260:Female; D051858:Forkhead Transcription Factors / Q000097:blood / Q000378:metabolism; D006801:Humans; D006969:Hypersensitivity, Immediate / Q000276:immunology / Q000378:metabolism / Q000473:pathology; D007958:Leukocyte Count; D008168:Lung / Q000166:cytology*; D017563:Lung Diseases, Interstitial / Q000175:diagnosis / Q000276:immunology / Q000378:metabolism / Q000473:pathology; D008213:Lymphocyte Activation; D016131:Lymphocyte Subsets / Q000166:cytology / Q000276:immunology / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D012016:Reference Values; D012907:Smoking / Q000378:metabolism / Q000473:pathology; D055815:Young Adult
chemical_list: C418974:FOXP3 protein, human; D051858:Forkhead Transcription Factors