Bronchoalveolar lavage fluid in scleroderma interstitial lung disease: technical aspects and clinical correlations: review of the literature.

Bronchoalveolar lavage (BAL) has been used for clinical and research purposes in scleroderma interstitial lung disease (SSc-ILD). However, inconsistencies regarding technical aspects of BAL are obstacles in the reproducibility and interpretation of BAL results. This review summarizes clinical correlations and methodological issues of using BAL in the assessment of patients with SSc-ILD. In addition, we review the investigational use of BAL in SSc-ILD. The PubMed database from inception through May 2008 was searched using the following keywords: "systemic sclerosis, scleroderma, interstitial lung disease, and bronchoalveolar lavage." The search was limited to English-language studies that included at least 15 SSc patients that had BAL. An increased percentage of neutrophils, eosinophils, and/or lymphocytes, often referred to as "alveolitis," was reported in a significant percentage of SSc patients (range, 38 to 100%) irrespective of patient selection criteria, cytological cutoff values, or technical aspects of BAL processing. Alveolitis is associated with more severe lung impairment as defined by lung function tests and overall lung high-resolution computed tomography scores, but there is insufficient evidence at this time to recommend BAL cytology as an independent predictor of outcome in SSc-ILD patients. Myofibroblasts have been cultured from BAL fluid, and inflammatory and fibrogenic mediators can be measured in the supernatant of BAL fluid from patients with SSc-ILD. Further studies using standardized BAL protocols are required to establish the role of BAL fluid in the clinical evaluation of SSc-ILD. When performed for research purposes, BAL has provided valuable insight into the pathogenesis of SSc-ILD.

Kowal-Bielecka O ，Kowal K ，Highland KB ，Silver RM ... -  《-》

Bronchoalveolar lavage cellular profiles in patients with systemic sclerosis-associated interstitial lung disease are not predictive of disease progression.

Goh NS ，Veeraraghavan S ，Desai SR ，Cramer D ，Hansell DM ，Denton CP ，Black CM ，du Bois RM ，Wells AU ... -  《ARTHRITIS AND RHEUMATISM》

Induced sputum in systemic sclerosis interstitial lung disease: comparison to healthy controls and bronchoalveolar lavage.

Induced sputum (IS) is a noninvasive tool, which can be used to collect cellular and soluble materials from lung airways. To evaluate if IS may be a useful and safe tool for the detection of airway inflammation in patients with interstitial lung disease (ILD) in systemic sclerosis (SSc). Sixty-eight patients with SSc and ILD as well as 18 healthy individuals (controls) were selected and submitted to IS examination. In 34 of 68 patients with SSc, bronchoalveolar lavage (BAL) was also performed. Safety of IS was assessed by comparison of forced expiratory volume in the first second (FEV(1)), FEV(1)/forced vital capacity ratio and peak expiratory flow before and after the IS procedure. Cell composition in samples collected by BAL and IS was correlated, and IS total and differential cell count in SSc patients and controls were compared. The total number of cells was significantly higher in IS samples of SSc patients compared to those of healthy controls. Mean percentage of neutrophils was also higher in SSc patients (41.79 +/- 23.89 vs. 27.37 +/- 17.90), as well as lymphocytes (17.42 +/- 19.70 vs. 3.13 +/- 2.28) and eosinophils (2.35 +/- 4.43 vs. 0.41 +/- 0.46). On the other hand, mean percentage of macrophages was higher in healthy individuals (69.10 +/- 19.15 vs. 36.96 +/- 20.68). In fluid recovered by BAL, the most frequent cells were macrophages (67.89% +/- 17.26), while neutrophils (14.77 +/- 17.18%) and lymphocytes (15.62 +/- 13.46%) were less frequent and eosinophils (1.66 +/- 2.08%) were rare. A similar pattern of cell composition was found in IS samples (41.15 +/- 21.67% of macrophages, 39.72 +/- 23.15% of neutrophils, 15.28 +/- 19.46% of lymphocytes and 2.56 +/- 5.03% of eosinophils). Strength of correlation between BAL and IS was significant for macrophages and neutrophils. After IS procedure was performed, improvement of FEV(1) (mean value before IS was 85.09 +/- 14.44 and 88.93 +/- 16.40 after IS) and FEV(1)/forced vital capacity (mean value before IS was 98.53 +/- 12.11 and 105.22 +/- 10.78 after IS) was observed. The IS method may allow a noninvasive assessment of cell composition in airway fluid and may contribute to the better understanding of upper/medium airway inflammation in SSc. Future studies are needed to verify whether IS can replace invasive procedures for the detection and monitoring of lung inflammation in SSc.

Damjanov N ，Ostojic P ，Kaloudi O ，Alari S ，Guiducci S ，Stanflin N ，Nestorovic B ，Knezevic J ，Camiciottoli G ，Porta F ，Pistolesi M ，Ibba-Manneschi L ，Conforti ML ，Candelieri A ，Matucci Cerinic M ... -  《-》

Eosinophilic globules in bronchoalveolar lavage fluid of patients with systemic sclerosis-related interstitial lung disease: a diagnostically useful, previously unreported finding in a retrospective and prospective study, including differential diagnosis

Rossi G ，Andreani A ，Morandi P ，Marchioni A ，Corradini P ，Cappiello G ，Bortolotti M ，Qosja A ，Manzini C ，Ferri C ，Richeldi L ，Cavazza A ... -  《-》

Bronchoalveolar matrix metalloproteinase 9 relates to restrictive lung function impairment in systemic sclerosis.

Andersen GN ，Nilsson K ，Pourazar J ，Hackett TL ，Kazzam E ，Blomberg A ，Waldenström A ，Warner J ，Rantapää-Dahlqvist S ，Mincheva-Nilsson L ，Sandström T ... -  《RESPIRATORY MEDICINE》