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Eicosanoids in Exhaled Breath Condensate and BAL Fluid of Patients With Sarcoidosis^*

^* From the Division of Pneumonology and Allergy, (Drs. Piotrowski, Antczak, Marczak, and Górski, and Ms. Kurmanowska) and the Department of Pathology (Dr. Nawrocka), Medical University of Lodz, Lodz, Poland.

Correspondence to: Pawel Górski, MD, PhD, Division of Pneumonology and Allergy, Medical University of Lodz, 22 Kopciñskiego Str 90, 153 Lodz, Poland; e-mail: p_gorski{at}toya.net.pl

Abstract

Background: Measurement of inflammatory mediators in exhaled breath condensate (EBC) is an easy and noninvasive diagnostic method, which has gained popularity in the past few years. However, the source of these mediators is not precisely defined. It has been only presumed that inflammatory cells present in the airway lumen are the main source. Therefore, the aim of this study was to verify the relationship between EBC and BAL fluid (BALF) eicosanoids, and the percentage, number, and activity of cells in BALF.

Methods: In 28 sarcoidosis patients and 17 healthy subjects, 8-isoprostane, cysteinyl leukotrienes (CysLTs), and leukotriene B4 (LTB4) were measured in EBC by enzyme immunoassay. Eicosanoids were also examined in BALF in the study group. Cell count, percentage, and superoxide production by BALF cells were estimated.

Results: The mean (± SEM) CysLT and 8-isoprostane concentrations were higher in the sarcoidosis group (6.5 ± 0 vs 27.82 ± 6.65 pg/mL, respectively; and 2.67 ± 0.16 vs 13.95 ± 2.59 pg/mL, respectively). There were positive correlations between EBC and BALF 8-isoprostane concentration (r = 0.68, p < 0.0001) and LTB4 concentration (r = 0.43; p = 0.026). EBC LTB4 levels correlated with the number of lymphocytes per milliliter of BALF. The percentage and number of eosinophils in BALF correlated with EBC 8-isoprostane and BALF CysLT concentrations. No positive correlation was found between concentrations of EBC eicosanoids and percentages BALF lymphocytes, BALF macrophages, or superoxide production.

Conclusions: The levels of 8-isoprostane and CysLT are elevated in EBC in sarcoidosis patients; however, a lack of correlation with BALF lymphocyte percentage does not encourage us to recommend the measurement of eicosanoids as activity markers. The positive correlation of EBC 8-isoprostane and BALF CysLT concentrations with the percentage of eosinophils in BALF, and the higher percentage of eosinophils in BALF from patients with grade 3 sarcoidosis, may suggest the possible prognostic value.

Key Words: BAL fluid • eicosanoids • exhaled breath condensate • 8-isoprostane • leukotrienes • sarcoidosis