Chest, Vol 101, 109-114, Copyright © 1992 by American College of Chest Physicians

ARTICLES

Hyaluronic acid (hyaluronan) in BAL fluid distinguishes farmers with allergic alveolitis from farmers with asymptomatic alveolitis

K Larsson, A Eklund, P Malmberg, L Bjermer, R Lundgren and L Belin
Respiratory Division, National Institute of Occupational Health, Solna, Sweden.

Pulmonary function measurements, bronchoalveolar lavage (BAL), and analyses of precipitating antibodies in blood were performed in 12 farmers wtih no symptoms from the airways and 12 farmers who were admitted to the hospital due to acute symptoms of alveolitis (all nonsmokers). In addition, a bronchial methacholine provocation test was performed in the asymptomatic farmers. In 11 of the 12 symptomatic farmers but in none of the asymptomatic farmers, precipitating antibodies against one or more of the microorganisms which usually occur in a farmer's environment were found. In the farmers with symptomatic alveolitis, a restrictive impairment of pulmonary function was found, while pulmonary function was normal in all asymptomatic farmers. Findings in the BAL fluid showed increased concentrations of total cells, lymphocytes, and neutrophils and elevated levels of albumin, fibronectin, and angiotensin-converting enzyme in asymptomatic farmers compared with our own reference group. The same analyses in BAL fluid from the symptomatic farmers revealed a further increase in all parameters compared with the asymptomatic farmers. The BAL fluid from asymptomatic farmers had normal levels of hyaluronic acid (hyaluronan) and procollagen 3 N-terminal peptide, while these levels were significantly increased in the symptomatic group. We conclude that inflammation in the alveolar space and signs of activation of alveolar macrophages are present in farmers regardless of respiratory symptoms, although these findings are more pronounced in the presence of symptoms of acute alveolitis; however, the findings of impaired pulmonary function and the occurrence of precipitins and elevated levels of hyaluronic acid and procollagen 3 N-terminal peptide in BAL fluid were exclusively found in the farmers with airways symptoms. We postulate the hyaluronic acid, due to its pronounced ability to immobilize water, may be of importance in the development of the pulmonary function impairment observed in farmer's lung disease.

This article has been cited by other articles:

				B Sjogren, J Weiner, and K Larsson Ischaemic heart disease among livestock and agricultural workers Occup. Environ. Med., August 1, 2003; 60(8): e1 - 1. [Abstract] [Full Text] [PDF]

				Y Fuji, M Shima, M Ando, M Adachi, and Y Tsunetoshi Effect of air pollution and environmental tobacco smoke on serum hyaluronate concentrations in school children Occup. Environ. Med., February 1, 2002; 59(2): 124 - 128. [Abstract] [Full Text] [PDF]

				R. FORTEZA, T. LIEB, T. AOKI, R. C. SAVANI, G. E. CONNER, and M. SALATHE Hyaluronan serves a novel role in airway mucosal host defense FASEB J, October 1, 2001; 15(12): 2179 - 2186. [Abstract] [Full Text] [PDF]

				T. Takahashi, M. Munakata, Y. Ohtsuka, A. Satoh-Kamachi, R. Sato, Y. Homma, and Y. Kawakami Serum KL-6 Concentrations in Dairy Farmers Chest, August 1, 2000; 118(2): 445 - 450. [Abstract] [Full Text] [PDF]

				M. Schenker Respiratory Health Hazards in Agriculture Am. J. Respir. Crit. Care Med., November 1, 1998; 158(2007): S1 - S76. [Full Text] [PDF]