Bronchoalveolar Lavage and Alveolar Macrophage Function in Acute Lung Injury

Riyami, Bazdawi Mohammed S (1988) Bronchoalveolar Lavage and Alveolar Macrophage Function in Acute Lung Injury. PhD thesis, University of Glasgow.

Abstract

Acute lung injury was studied in community-acquired pneumonia (CAP), smoke inhalation injury in fire victims and radiation injury following radiotherapy for bronchial carcinoma. In vitro methods for processing broncho-alveolar lavage (BAL) specimens and for studying alveolar macrophage (AM) function were developed, assessed and used in comparing these patient groups with control subjects (CS). The AM was the predominant cell in BAL samples from radiogically clear areas (RCA) in CAP patients and in CS. The proportion of AM subgroups in BAL fluid from RCA as determined by macrophage markers was similar to CS apart from NA1/34 (T6) positive (Langerhans) cells which was lower in specimens from RCA. Furthermore BAL fluid from CS and RCA in CAP were similar in their levels of albumin, complement components and products of complement activation. Both unstimulated and stimulated migration of AM from RCA in CAP towards zymosan activated (ZAS), casein and f-met-leu-phe was impaired. The impaired migration was associated with reduced generation of the respiratory burst by AM from RCA. This impairment of AM function could not be attributed to an inhibiting factor in the BAL fluid from these areas. Examination of peripheral blood cells did not reveal similar functional impairment thus making it unlikely to be due to a systemic effect of pneumonia. Neutrophils were the predominant cells in BAL fluid obtained from areas of consolidation (AOC) in CAP patients. AOC also contained significantly higher proportions of UCHM1 positive cells (monocytes) and RFD7 positive cells. In addition BAL fluid from these lung areas showed significantly high chemotatic activity to neutrophils, along with very high levels of albumin, components of complement and products of complement activation. Due to technical difficulties limited information was obtained on function of AM from AOC. This suggested depression of generation of the respiratory burst. The cell composition in BAL fluid from patients with smoke inhalation injury alone or with burns showed significantly higher proportions of neutrophils than CS. This increase in neutrophils was not seen in patients with burns only. There was a significant increase in the proportion of RFD9 positive cells in patients with smoke inhalation only and UCHM1 positive cells in those with smoke and burns injury. AM from patients with smoke inhalation injury showed increased migration compared to those from CS. This was most marked in AM obtained from patients with combined smoke inhalation and burns injury. They showed significantly higher AM unstimulated and stimulated migration towards casein, ZAS and f-met-leu- phe. Again patients with burns only did not show such increase in AM migration. Furthermore, BAL fluid from patients with combined injury showed significantly higher functional chemotatic activity than those from CS; associated with significantly higher levels of albumin, complement components and products of complement activation. BAL fluid from patients with burns only did not show any chemotatic activity. BAL samples from patients with bronchial carcinoma before radiotherapy showed similar proportions of cells to CS. However, BAL from tumour areas following radiotherapy contained significantly lower proportions of macrophages and significantly higher proportion of neutrophils than CS. There were no significant differences in the proportions of macrophage subgroups between CS and patients with bronchial carcinoma before or after radiotherapy. There was functional impairment of AM from patients with bronchial carcinoma and this was more marked in samples obtained from tumour areas. Some improvement in AM function appeared to occur following radiotherapy.

• Item Type: Thesis (PhD)
• Qualification Level: Doctoral
• Keywords: Medicine
• Date of Award: 1988
• Depositing User: Enlighten Team
• Unique ID: glathesis:1988-77771
• Copyright: Copyright of this thesis is held by the author.
• Date Deposited: 14 Jan 2020 11:53
• Last Modified: 14 Jan 2020 11:53
• URI: https://theses.gla.ac.uk/id/eprint/77771