Significance of Elevated Procollagen-III-Peptide and Transforming Growth Factor-.BETA. Levels of Bronchoalveolar Lavage Fluids from Idiopathic Pulmonary Fibrosis Patients.
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Although both procollagen III aminopeptide (P-IIl-P) and transforming growth factor-β (TGF-β) are reported to be present in lung tissue and/or elevated in bronchoalveolar lavage fluid (BALF) from idiopathic pulmonary fibrosis (IPF) patients, we have little knowledge concerning the clinical significance of elevated P-III-P and TGF-β levels in BALF. Using a radioimmunoassay, we measured P-III-P and TGF-β in BALF from 48 IPF patients (16F and 32M, 59±2 years, mean± S.E.) who received BAL in our clinic over the past 13 years before glucocorticosteroid treatment. Among them, we could detect a significant amount of P-III-P (2.2± 1.0 U/ml; range 0.03 to 16.5 U/ml) in BALF in 18 of the patients (5F and 13M, 58±3 years) (group B), but not (0.03 U/ml or less) in the other 30 patients (11E and 19M, 59±2 years) (group A). Lymphocyte (%) and basophil (%) in BALF from group B was much larger than that from group A (33% vs. 8%, p<0.01). Group B showed a longer duration of onset to BAL (36 months vs. 23 months, p<0.05). TGF-β levels were obtained using an ELISA system kit from the same BALF samples. TGF-β was not detected in 10 patients (100 pg/ml or less) (3F and 7M, 59±4 years) (group I), while the remaining 38 patients showed a significant amount of TGF-β (329±44 pg/ml, range 100 to 1,360 pg/ml). The latter patients were further divided into two groups; group II 100 to 300 pg/ml (10F and 14M, 56±3 years) and group III 350 or more (3F and 11M, 63±2 years). Group III showed significantly better values in PaO2, Aa-DO2, %VC and %DLco, and smaller percentage of basophils in BALF than did groups I and/or II, whereas survival after BAL in group III was significantly shorter than in group I (31 vs. 19 months, p<0.05). There was no significant relationship between P-III-P and TGF-β levels in BALE. These findings suggest that elevated P-III-P level is accompanied by an increase in lymphocyte population in BALF from IPF patients, resulting in a longer duration of the disease, while elevated TGF-β level reflects alveolar inflammation at an earlier stage of the disease which induces a progression of the disease, resulting in a shorter survival in IPF patients.
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