title: Iron laden macrophages in idiopathic pulmonary fibrosis: the telltale of occult alveolar hemorrhage?
abstract: BACKGROUND
  A number of observations suggest that iron accumulates in the lungs of patients with idiopathic pulmonary fibrosis (IPF) with vascular abnormalities, including pulmonary hypertension.
  
  
  OBJECTIVE
  The aim of this study was to determine the prevalence and intensity of accumulation of alveolar epithelial lining fluid (ELF) iron and of alveolar macrophage hemosiderin in IPF and its relationship with disease severity.
  
  
  METHODS
  Forty seven IPF patients and 14 healthy controls were retrospectively evaluated for iron accumulation in the lower respiratory tract using total iron spectrophotometric measures and for hemosiderin accumulation using the Perls' stain with the Golde score.
  
  
  RESULTS
  Total iron levels in ELF were significantly increased in IPF patients compared to non-smoking controls (p < 0.05); there were no differences with healthy smokers (p = 0.2). Hemosiderin accumulation in alveolar macrophages was similar in never smoking and ever smoking IPF patients (p = 0.5), was significantly higher in IPF patients than in both smoking and non-smoking healthy controls (p < 0.05, all comparisons) and was positively correlated with echocardiographic estimates of pulmonary artery systolic pressure (p < 0.05) and with increasing disease severity scores (p < 0.05).
  
  
  CONCLUSIONS
  The data show exaggerated accumulation of iron in IPF broncho-alveolar ELF and alveolar cells with no association with tobacco smoke, thus suggesting, occult pulmonary hemorrhage as a likely cause.
authors.affiliation: Department of Biomedicine and Prevention, Tor Vergata University Hospital, Roma, Italy.
authors.forename: Ermanno
authors.initials: E
authors.lastname: Puxeddu
authors.affiliation: Department of Biomedicine and Prevention, Tor Vergata University Hospital, Roma, Italy.
authors.forename: Alessia
authors.initials: A
authors.lastname: Comandini
authors.affiliation: Postgraduate School in Pulmonary Medicine, Tor Vergata University Hospital, Roma, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Cavalli
authors.affiliation: Pulmonary Fibrosis Clinic, Division of Respiratory Diseases, Tor Vergata University Hospital, Roma, Italy.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Pezzuto
authors.affiliation: Postgraduate School in Pulmonary Medicine, Tor Vergata University Hospital, Roma, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: D'Ambrosio
authors.affiliation: Pulmonary Fibrosis Clinic, Division of Respiratory Diseases, Tor Vergata University Hospital, Roma, Italy.
authors.forename: Lucia
authors.initials: L
authors.lastname: Senis
authors.affiliation: Department of Chemical Science and Technology, University of Rome "Tor Vergata", Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Paci
authors.affiliation: Doctorate School in Medical Sciences, University of Bologna, Bologna, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Curradi
authors.affiliation: Department of Biomedicine and Prevention, Tor Vergata University Hospital, Roma, Italy.
authors.forename: Gian Luigi
authors.initials: GL
authors.lastname: Sergiacomi
authors.affiliation: Department of Biomedicine and Prevention, Tor Vergata University Hospital, Roma, Italy; Postgraduate School in Pulmonary Medicine, Tor Vergata University Hospital, Roma, Italy; Pulmonary Fibrosis Clinic, Division of Respiratory Diseases, Tor Vergata University Hospital, Roma, Italy. Electronic address: cesaresaltini@med.uniroma2.it.
authors.forename: Cesare
authors.initials: C
authors.lastname: Saltini
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D005260:Female; D006470:Hemorrhage / Q000175:diagnosis*; D006485:Hemosiderin / Q000378:metabolism; D006801:Humans; D054990:Idiopathic Pulmonary Fibrosis / Q000503:physiopathology*; D007501:Iron / Q000378:metabolism*; D016676:Macrophages, Alveolar / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D011650:Pulmonary Alveoli / Q000378:metabolism; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012907:Smoking / Q000378:metabolism; D013053:Spectrophotometry
chemical_list: D006485:Hemosiderin; D007501:Iron
keywords: Bronchoalveolar lavage; Hemosiderin and disease severity; Idiopathic pulmonary fibrosis; Total iron