title: The significance of caspase-cleaved cytokeratin 18 in pleural effusion.
abstract: BACKGROUND
  Apoptosis plays a role in the development of pleural effusion. Caspase-cleaved cytokeratin 18, a marker for epithelial cell apoptosis, was evaluated in pleural effusion.
  
  
  METHODS
  A total of 79 patients with pleural effusion were enrolled. The underlying causes were lung cancer (n=24), parapneumonic effusion (n=15), tuberculous effusion (n=28), and transudates (n=12). The levels of M30, an epitope of caspase-cleaved cytokeratin 18, were measured in blood and pleural fluids using enzyme-linked immunosorbent assay along with routine cellular and biochemical parameters. The expression of M30 was evaluated in the pleural tissues using immunohistochemistry for M30.
  
  
  RESULTS
  The M30 levels in pleural fluid were significantly higher in patients with tuberculosis (2,632.1±1,467.3 U/mL) than in patients with lung cancer (956.5±618.5 U/mL), parapneumonic effusion (689.9±413.6 U/mL), and transudates (273.6±144.5 U/mL; all p<0.01). The serum levels were not significantly different among the disease groups. Based on receiver operating characteristics analysis, the area under the curve of M30 for differentiating tuberculous pleural effusion from all other effusions was 0.93. In the immunohistochemical analysis of M30, all pathologic types of cancer cells showed moderate to high expression, and the epithelioid cells in granulomas showed high expression in tuberculous pleural tissues.
  
  
  CONCLUSIONS
  Caspase-cleaved cytokeratin 18 was most prominently observed in tuberculous pleural effusion and showed utility as a clinical marker. The main source of M30 was found to be the epithelioid cells of granulomas in tuberculous pleural tissues.
authors: Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, Suwon, Korea.
authors: Keu Sung
authors: KS
authors: Lee
authors: Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, Suwon, Korea.
authors: Joo Yang
authors: JY
authors: Chung
authors: Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, Suwon, Korea.
authors: Yun Jung
authors: YJ
authors: Jung
authors: Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, Suwon, Korea.
authors: Wou Young
authors: WY
authors: Chung
authors: Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, Suwon, Korea.
authors: Joo Hun
authors: JH
authors: Park
authors: Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, Suwon, Korea.
authors: Seung Soo
authors: SS
authors: Sheen
authors: Department of Pathology, Ajou University School of Medicine, Suwon, Korea.
authors: Kyi Beom
authors: KB
authors: Lee
authors: Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, Suwon, Korea.
authors: Kwang Joo
authors: KJ
authors: Park
keywords: Apoptosis; Cytoskeleton; Epithelioid Cells; Pleural Effusion; Tuberculosis, Pleural