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Pulmonology Procedures |

Is the Serum and Bronchoalveolar Fluid Urokinase Like Plasminogen Activator Elevated in Lung Cancer? A Pilot Study

Jijo John, MD; Kevin O'Neal, MD; Dustin McLemore*, MD; Gary Kinasewitz, MD; Mazen Zouwayhed, MD; Richard Marlar, PhD
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Banner MD Anderson Cancer Center, Gilbert, AZ


Chest. 2012;142(4_MeetingAbstracts):920A. doi:10.1378/chest.1389182
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Abstract

SESSION TYPE: Bronchoscopy and Interventional Procedures Posters

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

PURPOSE: Transbronchial and endobronchial biopsies are associated with a small but significant risk of bleeding. Some of the risk factors associated with increased incidence are presence of malignancy or an immunocompromised state. It has been shown that the Urokinase-type plasminogen activator (uPA) system is capable of stimulating cell migration and invasion. uPA, plasminogen, uPAR, and PAI-1 are all upregulated during normal cell migration with uPA and uPAR, being concentrated at the leading edge. It has also been shown that normal human bronchial epithelial cells exposed to compressive forces have shown upregulation of plasminogen related genes. We suspect that patients with pulmonary malignancy have higher Urokinase-type plasminogen activator (uPA). uPA will increase following the procedure and the rise will be higher in patients with pulmonary malignancy.

METHODS: Patients scheduled for bronchoscopy were enrolled if they fit the inclusion criteria and consented to be enrolled. We obtained blood before and after bronchoscopy. We also obtained bronchoalveolar lavage (BAL) for analysis. Specimens were frozen and stored. Following completion of enrollment, samples were thawed and analyzed using ELISA.

RESULTS: We recruited a total of 10 patients who were scheduled for bronchoscopy with biopses. Five patients with suspected malignancy and five without were enrolled. The BAL uPA in patients with benign disease was 1.2 ±1.5 whereas in patients with malignancy it was 3.4±3.2 (p=0.2).The median serum uPA prior to bronchoscopy was 2.26 (1.49 - 4.35) while post bronchoscopy serum uPA was 4.355 (2.37 - 5.78) with p=0.18.

CONCLUSIONS: There was a trend to elevated BAL uPA in patients with malignant disease. There was also a trend to an increase in serum uPA following biopsies. A larger study will need to be conducted to confirm statistically significant differences.

CLINICAL IMPLICATIONS: If the findings are confirmed,this would explain the cause of bleeding and assist in guiding therapies to prevent/control it during bronchoscopy.

DISCLOSURE: The following authors have nothing to disclose: Jijo John, Kevin O'Neal, Dustin McLemore, Gary Kinasewitz, Mazen Zouwayhed, Richard Marlar

No Product/Research Disclosure Information

Banner MD Anderson Cancer Center, Gilbert, AZ

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