Abstract
BACKGROUND. Systemic steroid therapy, due to its strong anti-inflammatory action, is considered beneficial in interstitial lung disorders. However, its application to pulmonary sarcoidosis (PS) and nonspecific interstitial pneumonia (NSIP) is not regulated by precise algorithm, moreover, its clinical role in idiopathic pulmonary fibrosis (IPF) is questionable.
AIM. Examination of steroids impact on cytological pattern of BAL, including specific features, as alveolar lymphocyte (AL) subsets and cell apoptosis.
METHODS. Examination of BAL from steroid-treated and -naive patients with PS, IPF and NSIP (n=23,17,13): a) cell cycle analysis (sub-G1 phase apoptosis detection); b) TUNEL assay; c) flow cytometry assessment of scatter cell properties; d) AL staining for BCL-2 and death receptor (DRs).
RESULTS. PS and NSIP treated patients presented lower BAL total cell number, eosinophil percentage and CD4/CD8 ratio, as compared to untreated counterparts. AL apoptosis rate was higher in treated patients: 2.5±2.3 vs 0.4±0.4% in PS nonsmokers (p<0.0001), 6,2±4,1 vs 0.7±0.5% in PS smokers (p<0.001) and 4.4±2.1 vs 1.5±1.3% in NSIP nonsmokers (p<0.05). No changes were found in IPF. Serial BAL procedure perfomed in PS (n=7), showed AL apoptosis to increase dramatically during therapy, incl. incidental massive apoptosis (mitotic drama pattern); clinical remission occurred. No changes in DR expression appeared. AL BCL-2+ percentage was lower in treated, as compared to untreated PS patients.
CONCLUSIONS. We provide evidence of 1) local action of steroids in PS and NSIP treated patients; 2) unefectiveness of steroid treatment in IPF.
- © 2013 ERS
