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Comparison of techniques for obtaining lower airway epithelial cells from children

¹ Institute of Child Health, Royal Liverpool Children's Hospital, Liverpool, UK, ² Dept of Respiratory Medicine, Princess Margaret Hospital for Children, Perth, ³ School of Paediatrics and Child Health, The University of Western Australia, Nedlands, and ⁴ Telethon Institute for Child Health Research, Subiaco, Australia.

CORRESPONDENCE: P. S. McNamara, Institute of Child Health, Royal Liverpool Children's Hospital; Eaton Rd, Liverpool, L12 2AP, UK, Fax: 44 1512525456. E-mail: mcnamp{at}liv.ac.uk

Keywords: Airway epithelial cells, bronchoscopy, brush biopsy, child

Received: December 3, 2007
Accepted March 25, 2008

Airway epithelial cells (AECs) are important in asthma as they are the first cells to encounter pathogens/allergens. In children, AECs can be obtained using a "blind" nonbronchoscopic technique through an endotracheal tube. However, due to the increasing use of laryngeal masks the number of children in whom this technique is applicable has become limited. Recently, the present authors began to use a portable "bronchoscope-directed" technique to sample AECs. The current study compares both techniques in both asthmatic and nonasthmatic children.

A total of 81 children undergoing elective surgery, were grouped according to atopic status and respiratory symptoms. Cellular yield of blind and bronchoscope-directed brushings were compared and immunocytochemistry performed. AECs were cultured and cytokine analysis of culture supernatant undertaken.

Both techniques were equally well-tolerated, with the only adverse effect being a cough in 10% of the subjects. The mean±SD cell yield was higher in bronchoscope-directed than blind brushings (5.1±2.4 versus 3.1±1.4x10⁶ cells). Immunocytochemistry confirmed an epithelial cell lineage. Culture supernatant cytokine concentrations were similar regardless of sampling technique with patterns preserved between asthmatic and healthy nonatopic phenotypes.

Compared with blind brushing portable bronchoscope-directed brushing is well-tolerated, yields significantly more cells and is a potentially quick and useful technique for obtaining airway epithelial cells for research into childhood respiratory disease, specifically asthma.