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CD8+ T-cell alveolitis in familial pulmonary alveolar microlithiasis

¹ Depts of Respiratory Medicine, AO Monaldi, and ³ Cellular and Molecular Biology and Pathology, ⁵ Center for Basic and Clinical Immunology (CISI), University Federico II of Naples, and, ² Dept of Respiratory Medicine, AO Monaldi, Second University of Naples, Naples, ⁴ Laboratory of Immunobiology of Cardiovascular Disease, Dept of Medical Sciences and Rehabilitation, IRCCS San Raffaele Pisana, Rome ⁶ Dept of Respiratory Medicine, University of Bari, Bari, Italy

CORRESPONDENCE: G. de Laurentiis, Via L. Bianchi, 80131, Naples, Italy, Fax: 39 0815453213

Keywords: Bronchoalveolar lavage, diffuse lung disease, pulmonary alveolar microlithiasis, T-CD8 lymphocytes, T-receptor repertoire

Received: November 6, 2006
Accepted January 8, 2007

Pulmonary alveolar microlithiasis (PAM) is a rare diffuse lung disease characterised by the accumulation of calcium phosphate microliths within the alveoli.

The causative mechanism of PAM has only recently been discovered, and involves a gene mutation of sodium phosphate co-transporter, which is expressed by alveolar epithelial cells. This mutation may have variable consequences on the clinical phenotype. However, pulmonary cell immune phenotyping in familial PAM has not previously been assessed.

In the present article, the analysis of bronchoalveolar lavage fluid of two siblings with PAM diagnosis revealed a pattern of lymphocytic alveolitis with accumulation of CD8+ T-cells. The clonal complexity of this lymphocyte’s population was assayed by spectratyping, which showed an oligoclonal accumulation of T-cells with a restricted variable beta T-cell receptor (TCR) gene usage. TCR analysis in peripheral blood lymphocytes revealed no abnormal patterns of T-lymphocytes.

In the pulmonary alveolar microlithiasis familial cases reported, CD8-mediated maladaptive immune response may have taken place in the bronchoalveolar compartment. The relationship between this immune dysregulation and genetic background in pulmonary alveolar microlithiasis warrants further investigation.