title: Cholesteryl palmitate crystals in bronchoalveolar lavage fluid smears as a possible prognostic biomarker for chronic interstitial pneumonia: A preliminary study.
abstract: BACKGROUND
  We observed cholesterol-like crystals (Crystal X) in the bronchoalveolar lavage fluid (BALF) smears of patients with diffuse pulmonary disease. We analyzed the clinical data of patients with and without crystals, and elucidated the structure of Crystal X and its concentration in the BALF.
  
  
  METHODS
  Two hundred eighty-nine patients with diffuse pulmonary disease who underwent bronchoalveolar lavage (BAL) were analyzed. The relationships between the presence and number of Crystal X in BALF smears and clinical parameters were investigated. Furthermore, structure determination and quantitative analyses of the crystals were performed.
  
  
  RESULTS
  Seventy-five (26.0%) patients had Crystal X in their BALF. The crystals were frequently observed in patients with chronic interstitial pneumonia (CIP, 60/160=35.3%). Patients with Crystal X exhibited significantly higher serum Kerbs von Lungren 6 antigen and surfactant protein-D levels (P<0.01) and lower percentage vital capacity (P<0.05) than patients without Crystal X. The number of crystals was significantly correlated with these parameters. The presence of crystals was also associated with a lower survival rate at 1 year after the BAL. The interfacial angles of the crystals were 126±2° and 144±2°, different from those of cholesterol monohydrate crystals. Infrared absorption spectrometry showed Crystal X was cholesteryl palmitate. Its concentration was significantly higher in BALF with crystals than in BALF without crystals (P<0.01).
  
  
  CONCLUSIONS
  Crystal X in the BALF of patients with diffuse pulmonary disease was identified as cholesteryl palmitate, which may be a useful prognostic biomarker for CIP.
authors.affiliation: Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, Fukushima 960-1295, Japan. Electronic address: n-naoko@fmu.ac.jp.
authors.forename: Naoko
authors.initials: N
authors.lastname: Fukuhara
authors.affiliation: Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, Fukushima 960-1295, Japan; Department of Pulmonary Medicine, School of Medicine, Kobe University, 1-1 Rokkodai-cho, Nada-ku, Kobe, Hyougo 650-0017, Japan. Electronic address: mt0318@med.kobe-u.ac.jp.
authors.forename: Motoko
authors.initials: M
authors.lastname: Tachihara
authors.affiliation: Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, Fukushima 960-1295, Japan. Electronic address: ytanino@fmu.ac.jp.
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Tanino
authors.affiliation: Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, Fukushima 960-1295, Japan. Electronic address: Junpei@fmu.ac.jp.
authors.forename: Junpei
authors.initials: J
authors.lastname: Saito
authors.affiliation: Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, Fukushima 960-1295, Japan. Electronic address: suguru@fmu.ac.jp.
authors.forename: Suguru
authors.initials: S
authors.lastname: Sato
authors.affiliation: Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, Fukushima 960-1295, Japan. Electronic address: taken@fmu.ac.jp.
authors.forename: Takefumi
authors.initials: T
authors.lastname: Nikaido
authors.affiliation: Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, Fukushima 960-1295, Japan. Electronic address: kmisa@fmu.ac.jp.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Misa
authors.affiliation: Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, Fukushima 960-1295, Japan. Electronic address: fukuhara@fmu.ac.jp.
authors.forename: Atsuro
authors.initials: A
authors.lastname: Fukuhara
authors.affiliation: Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, Fukushima 960-1295, Japan. Electronic address: xintaow@fmu.ac.jp.
authors.forename: Xintao
authors.initials: X
authors.lastname: Wang
authors.affiliation: Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, Fukushima 960-1295, Japan. Electronic address: taku.ishida@nifty.ne.jp.
authors.forename: Takashi
authors.initials: T
authors.lastname: Ishida
authors.affiliation: Department of Chemistry, School of Medicine, Fukushima Medical University, Fukushima City, Fukushima 960-1295, Japan; Symbiotic Systems Science, Fukushima University, Fukushima City, Fukushima 960-1296, Japan. Electronic address: onami98@yahoo.co.jp.
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Onami
authors.affiliation: Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, Fukushima 960-1295, Japan. Electronic address: munakata@fmu.ac.jp.
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Munakata
mesh_terms: D015415:Biomarkers / Q000032:analysis; D001992:Bronchoalveolar Lavage Fluid / Q000737:chemistry*; D002788:Cholesterol Esters / Q000032:analysis*; D002908:Chronic Disease; D003460:Crystallization; D006801:Humans; D017563:Lung Diseases, Interstitial / Q000175:diagnosis*; D011379:Prognosis; D012189:Retrospective Studies; D013057:Spectrum Analysis
chemical_list: D015415:Biomarkers; D002788:Cholesterol Esters; C026651:cholesteryl palmitate
keywords: Bronchoalveolar lavage; Cholesteryl palmitate; Crystal; Interstitial pneumonia; Surfactant