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Clinical Investigations in Critical Care |

Parathyroid Hormone-Related Protein in Epithelial Lining Fluid in Humans Negatively Correlates With the Severity of Lung Injury*

Jean-Baptiste Stern, MD; Oana Bernard, MD; Catherine Paugam, MD; Caroline Silve, PhD; Jean Mantz, MD, PhD; Michel Aubier, MD, PhD; Bruno Crestani, MD, PhD
Author and Funding Information

*From INSERM U408 (Dr. Stern), INSERM U426 (Dr. Silve), Service de Réanimation Chirurgicale (Drs. Paugam and Mantz), Service de Pneumologie (Drs. Aubier and Crestam), Hôpital Bichat, and Laboratoire de Biologie Endocrinienne (Dr. Bernard), Hôpital Lariboisière (Assistance Publique - Hôpitaux de Paris), Paris, France.

Correspondence to: Bruno Crestani, MD, PhD, Service de Pneumologie, Hôpital Bichat, 46 rue Henri Huchard, 75877 Paris Cedex 18, France; e-mail: bruno.crestani@bch.ap-hop-paris.fr



Chest. 2002;121(3):852-857. doi:10.1378/chest.121.3.852
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Objective: To determine the concentration of parathyroid hormone-related protein (PTHrP; an autocrine/paracrine regulator of type-2 alveolar epithelial cells proliferation and apoptosis) in the epithelial lining fluid (ELF) from patients without pulmonary disease and from patients with acute lung injury (ALI), and to evaluate whether PTHrP concentrations correlated with the intensity of lung injury.

Design: Prospective study.

Setting: An adult trauma/surgical ICU in an urban teaching hospital.

Patients: A total of 20 patients with ALI receiving mechanical ventilation (patients), and 10 patients without pulmonary disease not receiving mechanical ventilation (control subjects).

Interventions: None.

Measurements and main results: PTHrP was detected in all BAL fluids, and ELF PTHrP concentrations (median; 25% to 75% percentiles) tended to be higher in patients (52.2 nmol/mL; 20.8 to 65.6 nmol/mL) than in control subjects (25.4 nmol/mL; 20.5 to 35.4 nmol/mL; p = 0.18). In patients, ELF PTHrP concentration correlated positively with the Pao2/fraction of inspired oxygen ratio (r = 0.53; p = 0.005), and negatively with lung injury score (r = − 0.44; p = 0.02), radiologic score (r = − 0.40; p = 0.04), and BAL albumin concentration (r = − 0.42; p = 0.02).

Conclusion: PTHrP is present in biologically significant concentrations in the alveolar milieu in humans. In patients with ALI, the PTHrP concentration correlates negatively with the degree of lung injury.

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