PURPOSE: Granuloma formation is a common inflammatory condition in the lungs of patients with sarcoidosis. The underlying mechanism is unknown but several studies suggest that fungi in the environment may be related to the risk of disease.
METHODS: We investigated the reactivity of peripheral blood mononuclear cells (PBMC) among patients with sarcoidosis (n = 22) and healthy controls (n=20). PBMC were isolated and incubated with lipopolysaccharide (LPS). The secretion of tumor necrosis factor α (TNFα), interleukin (IL)6, IL 10 and IL 12 was measured and the values were related to the degree of granuloma infiltration in the lung, using a X-ray based scoring scheme. Domestic exposure to fungi was measured by determining airborne levels of N-acetylhexomsaminidase (NAHA) in the bedrooms of the subjects.
RESULTS: There were significant relationships between the granuloma X-ray scores and the LPS induced secretion of TNFα, IL-6, IL-10, and IL-12 (p = 0.019, 0.018, 0.002 and 0.002 respectively). Among subjects with sarcoidosis the levels of NAHA were related to the spontaneous secretion of IL6, IL-10 and IL-12 (p= 0.027, <0.001, and 0.011 resp) and to the LPS induced secretion of IL-6 and IL-10 (p=0.005 and 0.049 resp) from PBMC.
CONCLUSIONS: The results suggest that the sensitivity of PBMC reflects the inflammatory process related to granuloma formation. The relation between exposure to fungi and the spontaneous and LPS induced secretion of cytokines suggests that fungi induce an inflammatory response closely related to that which is present during granuloma formation.
CLINICAL IMPLICATIONS: The relation between exposure to fungi and the inflammatory reactions present in sarcoidosis suggests that remedial and preventive actions against the disease should focus on the fungal contamination at home and at workplaces.
DISCLOSURE: The following authors have nothing to disclose: Marjeta Tercelj, Sanja Stopinsek, Alojz Ihan, Sasa Simcic, Branka Wraber, Barbara Salobir, Ragnar Rylander
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