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Diffuse Lung Disease |

β-Glucan in BAL Among Patients With Sarcoidosis

Marjeta Tercelj*, MD; Barbara Salobir, MD; Mirjana Zupancic, MD; Branka Wraber, MD; Ragnar Rylander, MD
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University Medical Center, Ljubljana, Slovenia


Chest. 2012;142(4_MeetingAbstracts):436A. doi:10.1378/chest.1365445
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Abstract

SESSION TYPE: ILD Posters

PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM

PURPOSE: Evidence from epidemiological [1, 2] and treatment [3, 4] studies suggest that exposure to mould (fungi) is related to the risk of sarcoidosis. As no infection is present, the mechanism is probably an inflammatory reaction to one or several agents in fungi. A potential such agent is β-glucan which has important immune-modulating effects.The aim of the study was to investigate 1) if β-glucan is present in BAL from patients with sarcoidosis 2) if there is a relation to inflammagenic markers of sarcoidosis.

METHODS: Subjects were 62 non-smoking subjects with sarcoidosis, 34 of which had extra pulmonary manifestations (EPM). They underwent BAL and blood was taken to determine inflammatory cytokines. β-glucan in BAL was analysed using a commercially available automatic analyser (Endosafe PTS, Charles River). Angiotensin converting enzyme (sACE), interleukin (IL)-6, IL-10, and IL-12 were determined using commercial ELISA kits (Milenia Biotec, Germany and Thermo Scientific, USA). Serum samples were also obtained from 18 controls with no pulmonary disease or respiratory symptoms. Fungal exposure at home was determined by measuring the enzyme N-acetylhexosaminidase in air filters.

RESULTS: The evels of IL-6 and IL-12 were higher among subjects with sarcoidosis as compared to controls (p = 0.001 for both). IL-12 was significantly higher among subjects with EPM (p = 0.029). The values of β-glucan in BAL ranged from 100 to 1130 pg/mL (mean 451 pg/mL, SEM 32). There was a significant relation between β-glucan and NAHA values in the home (p = 0.016) There was also a significant relationship between NAHA levels at home and the amount of IL2R and IL-12 (p = 0.042 and 0.012).

CONCLUSIONS: This is the first time that an environmental agent suspected to be related to the pathogenesis of sarcoidosis has been identified in the lung. The range of β-glucan values corresponds to those found in a previous study on eosinophilic pneumonia, another disease where fungal exposure is important [5]. The relation between the domestic exposure to fungi and IL-12 in serum confirms an earlier observation on a relation to the spontaneous secretion of IL-12 among subjects with sarcoidosis. Taken together, the results further support the hypothesis that exposure to fungi is important for the risk of sarcoidosis.

CLINICAL IMPLICATIONS: Measurements of β-glucan in the lung could be a tool for diagnosis and to follow the effect of treatment.

DISCLOSURE: The following authors have nothing to disclose: Marjeta Tercelj, Barbara Salobir, Mirjana Zupancic, Branka Wraber, Ragnar Rylander

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University Medical Center, Ljubljana, Slovenia

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