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BAL Induces an Increase in Peripheral Blood Neutrophils and Cytokine Levels in Healthy Volunteers and Patients With Pneumonia^*

^* From the Department of Internal Medicine (Dr. Terashima and Ms. Matsumaru), Tokyo Dental College Ichikawa General Hospital, Ichikawa, Chiba; Department of Internal Medicine (Drs. Amakawa and Yamaguchi), School of Medicine, Keio University, Shinjuku, Tokyo; and Pulmonary Research Laboratory (Drs. Eeden and Hogg), St. Pauls Hospital, Vancouver, British Columbia, Canada.

Correspondence to: Takeshi Terashima, MD, PhD, Department of Internal Medicine, Tokyo Dental College Ichikawa General Hospital, 5–11-13, Sugano, Ichikawa, Chiba, 272-0824, Japan; e-mail: terasima{at}tdc.ac.jp

Study objectives: To examine the peripheral effects of BAL on the neutrophil counts and cytokine levels in the circulation.

Design and methods: WBC counts and plasma cytokines were measured before and 4 h after fiberoptic bronchoscopy (FOB) without further interventions (n = 6), or combined with BAL in normal volunteer subjects (n = 6), and in patients with bacterial pneumonia (n = 4). The bronchus of the right middle lobe was wedged, and three 50-mL aliquots of sterile saline solution was instilled. There was no endotoxin contamination in the saline solution or the fluid obtained through the working channel of bronchoscope.

Results: In volunteers, peripheral WBC counts and the number of nonsegmented and segmented neutrophils increased after the BAL procedure (p < 0.05) associated with the increase in plasma concentration (mean ± SEM) of interleukin (IL)-6 (0.99 ± 0.32 pg/mL before BAL and 20.38 ± 13.42 pg/mL after BAL; p < 0.05) and granulocyte colony-stimulating factor (G-CSF; 14.1 ± 1.7 pg/mL before BAL and 38.5 ± 9.7 pg/mL after BAL; p < 0.05). The increase in WBC counts and neutrophil counts was positively correlated to the increase in IL-6 (p < 0.05) and the increase in G-CSF (p < 0.05). In patients with pneumonia, IL-6 and G-CSF levels were higher after BAL than in normal volunteer subjects (p < 0.05). There was no increase in plasma concentration of IL-1ß, tumor necrosis factor-, or IL-8 after BAL in normal volunteer subjects or in patients with pneumonia. FOB without BAL did not increase the WBC count, neutrophil count, or plasma cytokine levels.

Conclusion: The BAL procedure increases the number of WBCs, and segmented and nonsegmented neutrophils in the peripheral circulation as well as circulating IL-6 and G-CSF levels.

Key Words: BAL • granulocyte colony-stimulating factor • interleukin-6 • neutrophilia

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