Bronchoalveolar Lavage as a Diagnostic Tool

Keith C. Meyer

doi:10.1055/s-2007-991527

Seminars in Respiratory and Critical Care Medicine, Inhaltsverzeichnis

Semin Respir Crit Care Med 2007; 28(5): 546-560
DOI: 10.1055/s-2007-991527

Bronchoalveolar Lavage as a Diagnostic Tool

Keith C. Meyer¹

¹Department of Medicine, Section of Allergy, Pulmonary, and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin

Abstract

ABSTRACT

Bronchoalveolar lavage (BAL) provides an important diagnostic tool that can facilitate the diagnosis of various diffuse lung diseases. BAL fluid can be analyzed to determine white blood cell (WBC) profiles and to detect respiratory pathogens. Although BAL is seldom useful as a “stand-alone” diagnostic test for the diagnosis of diffuse infiltrative lung disease, when combined with clinical data and high-resolution computed tomography of the chest, BAL WBC profiles can contribute significantly to the diagnosis of specific forms of interstitial lung disease (ILD). Additionally, BAL can play a very important role in the diagnosis of respiratory infection, and it is useful in monitoring the lung allograft and in evaluating pediatric lung disease. Examination of BAL cells or acellular components of BAL via gene microarray technology or proteomic analyses may allow BAL to assume a more prominent role in diagnosis and management of lung disease in the near future.

KEYWORDS

Bronchoalveolar lavage (BAL) - interstitial lung disease (ILD) - bronchoscopy

Volltext

Referenzen

REFERENCES

1 Klech H, Pohl W Technical recommendations and guidelines for bronchoalveolar lavage (BAL): report of the European Society of Pneumology Task Group on BAL. Eur Respir J 1989 2: 561-585
2 Klech H, Hutter C Clinical guidelines and indications for bronchoalveolar lavage (BAL): report of the European Society of Pneumology Task Group on BAL. Eur Respir J 1990 3: 937-969
3 The BAL Co-operative Group Steering Committee . Bronchoalveolar lavage constituents in healthy individuals, idiopathic pulmonary fibrosis, and selected comparison groups. Am Rev Respir Dis. 1990; 141(Suppl 5) S169-S202
4 Klech H, Hutter C, Costabel U Clinical guidelines and indication for bronchoalveolar lavage (BAL): report of the European Society of Pneumology Task Group on BAL. Eur Respir Rev 1992 2: 47-127
5 Haslam PL, Baughman RP Guidelines for the measurement of acellular components and recommendations for standardization of bronchoalveolar lavage (BAL). Eur Respir Rev 1999 9: 25-157
6 American Thoracic Society . Clinical role of bronchoalveolar lavage in adults with pulmonary disease. Am Rev Respir Dis. 1990; 142 481-486
7 Martin T R, Raghu G, Maunder R J et al.. The effects of chronic bronchitis and chronic air-flow obstruction on lung cell populations recovered by bronchoalveolar lavage. Am Rev Respir Dis. 1985; 132 254-260
8 Baughman R P, Spencer R E, Kleykamp B O, Rashkin M C, Douthit M M. Ventilator associated pneumonia: quality of nonbronchoscopic bronchoalveolar lavage sample affects diagnostic yield. Eur Respir J. 2000; 16 1152-1157
9 Dhillon D P, Haslam P L, Townsend P J et al.. Bronchoalveolar lavage in patients with interstitial lung diseases: side effects and factors affecting fluid recovery. Eur J Respir Dis. 1986; 68 342-350
10 Costabel U, Guzman J. Effect of smoking on bronchoalveolar lavage constituents. Eur Respir J. 1992; 5 776-779
11 Meyer K C. Neutrophils and low-grade inflammation in the seemingly normal aging human lung. Mech Ageing Dev. 1998; 104 169-181
12 Meyer K C, Soergel P. Bronchoalveolar lymphocyte phenotypes change in the normal aging human lung. Thorax. 1999; 54 697-700
13 Lee B E, Robinson J L, Khurana V, Pang X L, Preiksaitis J, Fox J D. Enhanced identification of viral and atypical bacterial pathogens in lower respiratory tract samples with nucleic acid amplification tests. J Med Virol. 2006; 78 702-710
14 Hohenthal U, Itälä M, Salonen J et al.. Bronchoalveolar lavage in immunocompromised patients with haematological malignancy: value of new microbiological methods. Eur J Haematol. 2005; 74 203-211
15 Palacios G, Quan P-L, Jabado O J et al.. Panmicrobial oligonucleotide array for diagnosis of infectious diseases. Emerg Infect Dis 2007 [12 Jan 2006] Available from http://www.cdc.gov/EID/13/1/73/htm
16 Chen N H, Liu Y C, Tsao T C et al.. Combined bronchoalveolar lavage and polymerase chain reaction in the diagnosis of pulmonary tuberculosis in smear-negative patients. Int J Tuberc Lung Dis. 2002; 6 350-355
17 Peikert T, Rana S, Edell E S. Safety, diagnostic yield, and therapeutic imiplications of flexible bronchoscopy in patients with febrile neutropenia and pulmonary infiltrates. Mayo Clin Proc. 2005; 80 1414-1420
18 Ninane V. Bronchoscopic invasive diagnostic techniques in the cancer patient. Curr Opin Oncol. 2001; 13 236-241
19 Joos L, Chhajed P N, Wallner J et al.. Pulmonary infections diagnosed by BAL: a 12-year experience in 1066 immunocompromised patients. Respir Med. 2007; 101 93-97
20 Jain P, Sandur S, Meli Y, Arroliga A C, Stoller J K, Mehta A C. Role of flexible bronchoscopy in immunocompromised patients with lung infiltrates. Chest. 2004; 125 712-722
21 Boersma W G, Erjavec Z, van der Werf T S, de Vries-hosper H G, Gouw A SH, Manson W L. Bronchoscopic diagnosis of pulmonary infiltrates in granulocytopenic patients with hematologic malignancies: BAL versus PSB and PBAL. Respir Med. 2007; 101 317-325
22 Sternberg R I, Baughman R P, Dohn M N, First M R. Utility of bronchoalveolar lavage in assessing pneumonia in immunosuppressed renal transplant recipients. Am J Med. 1993; 95 358-364
23 Lehto J T, Anttila V J, Lommi J et al.. Clinical usefulness of bronchoalveolar lavage in heart transplant recipients with suspected lower respiratory tract infection. J Heart Lung Transplant. 2004; 23 570-576
24 Meduri G U, Wunderink R G, Leeper Jr K V, Beals D H. Management of bacterial pneumonia in ventilated patients: protected bronchoalveolar lavage as a diagnostic tool. Chest. 1992; 101 500-508
25 Ioanas M, Ferrer R, Angrill J, Ferrer M, Torres A. Microbial investigation in ventilator-associated pneumonia. Eur Respir J. 2001; 17 791-801
26 Clec'h C, Jauréguy F, Hamza L et al.. Agreement between quantitative cultures of postintubation tracheal aspiration and plugged telescoping catheter, protected specimen brush, or BAL for the diagnosis of nosocomial pneumonia. Chest. 2006; 130 956-961
27 The Canadian Critical Care Trials Group . A randomized trial of diagnostic techniques for ventilator-associated pneumonia. N Engl J Med. 2006; 355 2619-2630
28 Baughman R P, Drent M. Role of bronchoalveolar lavage in interstitial lung disease. Clin Chest Med. 2001; 22 331-341
29 Meyer K C. The role of bronchoalveolar lavage in interstitial lung disease. Clin Chest Med. 2004; 25 637-649
30 Baughman R P. Is bronchoalveolar lavage clinically useful for everyday practice in interstitial lung disease? Con: bronchoalveolar lavage. J Bronchology. 1999; 6 211-216
31 Raghu G. Is bronchoalveolar lavage clinically useful for everyday practice in interstitial lung disease? Con: bronchoalveolar lavage. J Bronchology. 1999; 6 217-221
32 Costabel U, Guzman J. Bronchoalveolar lavage in interstitial lung disease. Curr Opin Pulm Med. 2001; 7 255-261
33 Costabel U, Guzman J. Bronchoalveolar lavage. In: Schwartz MI, King TE Jr Interstitial Lung Disease. Hamilton, ON; BC Decker 2003: 114-133
34 Welker L, Jorres R A, Costabel U, Magnussen H. Predictive value of BAL cell differentials in the diagnosis of interstitial lung diseases. Eur Respir J. 2004; 24 1000-1006
35 Drent M, Jacobs J A. Bronchoalveolar lavage. In: Baughman RP, Du Bois RM, Lynch JP III, Wells AU Diffuse Lung Disease: A Practical Approach. New York; Oxford University Press 2004: 56-64
36 Hunninghake G W, Crystal R G. Pulmonary sarcoidosis: a disorder mediated by excess helper T-lymphocyte activity at sites of disease activity. N Engl J Med. 1981; 305 429-432
37 Costabel U, Zaiss A W, Guzman J. Sensitivity and specificity of BAL findings in sarcoidosis. Sarcoidosis. 1992; 9(Suppl 1) 211-214
38 Winterbauer R H, Lammert J, Selland M et al.. Bronchoalveolar lavage cell populations in the diagnosis of sarcoidosis. Chest. 1993; 104 352-361
39 Kantrow S P, Meyer K C, Kidd P et al.. The CD4/CD8 ratio in BAL fluid is highly variable in sarcoidosis. Eur Respir J. 1997; 10 2716-2721
40 Auerswald U, Barth J, Magnussen H. Value of CD1 positive cells in bronchoalveolar lavage fluid for the diagnosis of pulmonary histiocytosis X. Lung. 1991; 169 305-309
41 Allen J N, Davis W B. Eosinophilic lung diseases. Am J Respir Crit Care Med. 1994; 150 1423-1438
42 Pope-Harman A L, Davis W B, Allen E D et al.. Acute eosinophilic pneumonia: a summary of 15 cases and review of the literature. Medicine (Baltimore). 1996; 75 334-342
43 Fontenot A P, Schwarz M I. Diffuse alveolar hemorrhage. In: Schwartz MI, King TE Jr Interstitial Lung Disease. Hamilton, ON; BC Decker 2003: 632-656
44 Martin R J, Coalson J J, Rogers R M et al.. Pulmonary alveolar proteinosis: the diagnosis by segmental lavage. Am Rev Respir Dis. 1980; 121 819-825
45 Joint Statement of the American Thoracic Society (ATS) . Idiopathic pulmonary fibrosis: diagnosis and treatment: international consensus statement. Am J Respir Crit Care Med. 2000; 161 646-664
46 Hunninghake G W, Lynch D A, Galvin J R et al.. Radiologic findings are strongly associated with a pathologic diagnosis of usual interstitial pneumonia. Chest. 2003; 124 1215-1223
47 Lynch D A, Godwin Jr D, Safrin S et al.. High-resolution computed tomography in idiopathic pulmonary fibrosis: diagnosis and prognosis. Am J Respir Crit Care Med. 2005; 172 488-493
48 Shah P L, Hansell D, Lawson P R, Reid K B, Morgan C. Pulmonary alveolar proteinosis: clinical aspects and current concepts on pathogenesis. Thorax. 2000; 55 67-77
49 Haslam P L, Dewar A, Butchers P et al.. Mast cells, atypical lymphocytes, and neutrophils in bronchoalveolar lavage in extrinsic allergic alveolitis: comparison with other interstitial lung diseases. Am Rev Respir Dis. 1987; 135 35-47
50 Drent M, van Velzen Blad H, Diamant M et al.. Bronchoalveolar lavage in extrinsic allergic alveolitis: effect of time elapsed since antigen exposure. Eur Respir J. 1993; 6 1276-1281
51 Lynch J PD, Standiford T J, Rolfe M W et al.. Neutrophilic alveolitis in idiopathic pulmonary fibrosis: the role of initerleukin-8. Am Rev Respir Dis. 1992; 145 1433-1439
52 Haslam P L, Turton C W, Lukoszek A et al.. Bronchoalveolar lavage fluid cell counts in cryptogenic fibrosing alveolitis and their relation to therapy. Thorax. 1980; 35 328-339
53 Rudd R M, Haslam P L, Turner-Warwick M. Cryptogenic fibrosing alveolitis: relationships of pulmonary physiology and bronchoalveolar lavage to response to treatment and prognosis. Am Rev Respir Dis. 1981; 124 1-8
54 Watters L C, Schwarz M I, Cherniack R M et al.. Idiopathic pulmonary fibrosis: pretreatment bronchoalveolar lavage cellular constituents and their relationships with lung histopathology and clinical response to therapy. Am Rev Respir Dis. 1987; 135 696-704
55 Peterson M W, Monick M, Hunninghake G W. Prognostic role of eosinophils in pulmonary fibrosis. Chest. 1987; 92 51-56
56 Drent M, Macobs J A, de Vries J et al.. Does the cellular bronchoalveolar lavage fluid profile reflect the severity of sarcoidosis?. Eur Respir J. 1999; 13 1338-1344
57 Schwartz D A, Helmers R A, Galvin J R et al.. Determinants of survival in idiopathic pulmonary fibrosis. Am J Respir Crit Care Med. 1994; 149 450-454
58 Ryu Y J, Chung M P, Han J et al.. Bronchoalveolar lavage in fibrotic idiopathic interstitial pneumonias. Respir Med. 2007; 101 655-660
59 De Vuyst P, Dumortier P, Moulin E et al.. Asbestos bodies in bronchoalveolar lavage reflect lung asbestos body concentration. Eur Respir J. 1988; 1 362-367
60 Dodson R F, Garcia J G, O'Sullivan M, Corn C et al.. The usefulness of bronchoalveolar lavage in identifying past occupational exposure to asbestos: a light and electron microscopy study. Am J Ind Med. 1991; 19 619-628
61 Fireman E, Greif J, Schwarz Y et al.. Assessment of hazardous dust exposure by BAL and induced sputum. Chest. 1999; 115 1720-1728
62 Perna F, Iavarone M, Skrimpas S, Mazzarella G, Sanduzzi A. Detection and qualitative identification of mineral fibers and particles in alveolar macrophages of BAL fluid by SEM and EDXA. Monaldi Arch Chest Dis. 2002; 57 193-195
63 Christman J W, Emerson R J, Graham W G, Davis G S. Mineral dust and cell recovery from the bronchoalveolar lavage of healthy Vermont granite workers. Am Rev Respir Dis. 1985; 132 393-399
64 Michetti G, Mosconi G, Zanelli R et al.. Bronchoalveolar lavage and its role in diagnosing cobalt lung disease. Sci Total Environ. 1994; 150 173-178
65 Rossman M D, Kern J A, Elias J A et al.. Proliferative response of bronchoalveolar lymphocytes to beryllium: a test for chronic beryllium disease. Ann Intern Med. 1988; 108 687-693
66 Lam B, Wong M P, Ooi C et al.. Diagnostic yield of bronchoscopic sampling methods in bronchial carcinoma. Respirology. 2000; 5 265-270
67 Wongsurakiat P, Wongbunnate S, Dejsomritrutai W et al.. Diagnostic value of bronchoalveolar lavage and postbronchoscopic sputum cytology in peripheral lung cancer. Respirology. 1998; 3 131-137
68 Tang C C, Hsiao C J, Chen H et al.. Value of bronchoalveolar lavage combined with transbronchial lung biopsy in the diagnosis of peripheral lung cancer. Chang Gung Med J. 2000; 23 695-700
69 Schwarz M I. Miscellaneous interstitial lung diseases. In: Schwarz MI, King TE Jr Interstitial Lung Disease. Hamilton, ON; BC Decker 2003: 877-916
70 Springmeyer S C, Hackman R, Carlson J J, McClellan J E. Bronchioloalveolar cell carcinoma diagnosed by bronchoalveolar lavage. Chest. 1983; 83 278-279
71 Keicho N, Oka T, Takeuchi K, Yamane A, Yazaki Y, Yotsumoto H. Detection of lymphomatous involvement of the lung by bronchoalveolar lavage: application of immunophenotypic and gene rearrangement analysis. Chest. 1994; 105 458-462
72 Zompi S, Couderc L J, Cadranel J et al.. Clonality analysis of alveolar B lymphocytes contributes to the diagnostic strategy in clinical suspicion of pulmonary lymphoma. Blood. 2004; 103 3208-3215
73 Tiroke A H, Bewig B, Haverich A. Bronchoalveolar lavage in lung transplantation. Clin Transplant. 1999; 13 131-157
74 Meyer K C. The role of neutrophils in transplantation. In: Wilkes DS, Burlingham WJ Immunobiology of Organ Transplantation. New York; Kluwer/Plenum 2004: 493-507
75 Meyer K C, Nunley D R, Dauber J et al.. Neutrophils, unopposed neutrophil elastase and alpha-1-antiprotease defenses following human lung transplantation. Am J Respir Crit Care Med. 2001; 164 97-102
76 Bowdish M E, Arcasoy S M, Wilt J S et al.. Surrogate markers and risk factors for chronic lung allograft dysfunction. Am J Transplant. 2004; 4 1171-1178
77 Lu B S, Yu A D, Zhu X, Garrity Jr E R, Vigneswaran W T, Bhorade S M. Sequential gene expression profiling in lung transplant recipients with chronic rejection. Chest. 2006; 130 847-854
78 Zhang Y, Wroblewski M, Hertz M I, Wendt C H, Cervenka T M, Nelsestuen G L. Analysis of chronic lung transplant rejection by MALDI-TOF profiles of bronchoalveolar lavage fluid. Proteomics. 2006; 6 1001-1010
79 Gimino V J, Lande J D, Berryman T R, King R A, Hertz M I. Gene expression profiling of bronchoalveolar lavage cells in acute lung rejection. Am J Respir Crit Care Med. 2003; 168 1237-1242
80 Valentine V G, Taylor D E, Dhillon G S et al.. Success of lung transplantation without surveillance bronchoscopy. J Heart Lung Transplant. 2002; 21 319-326
81 Palmer S M, Miralles A P, Howell D N et al.. Gastroesophageal reflux as a reversible cause of allograft dysfunction after lung transplantation. Chest. 2000; 118 1214-1217
82 Farrell S, McMaster C, Gibson D, Shields M D, McCallion W A. Pepsin in bronchoalveolar lavage fluid: a specific and sensitive method of diagnosing gastro-oesophageal reflux-related pulmonary aspiration. J Pediatr Surg. 2006; 41 289-293
83 Ratjen F, Bredendick M, Brendel M et al.. Differential cytology of bronchoalveolar lavage fluid in normal children. Eur Respir J. 1994; 7 1865-1870
84 Ratjen F, Bredendick M, Zheng L et al.. Lymphocyte subsets in bronchoalveolar lavage fluid of children without bronchopulmonary disease. Am J Respir Crit Care Med. 1995; 152 174-178
85 Midulla F, Villani A, Merolla R et al.. Bronchoalveolar lavage studies in children without parenchymal lung disease: cellular constituents and protein levels. Pediatr Pulmonol. 1995; 20 112-118
86 Ratjen F, Bruch J. Adjustment of bronchoalveolar lavage volume to body weight in children. Pediatr Pulmonol. 1996; 21 184-188
87 Fan L L, Lum Lung M C, Wagener J S. The diagnostic value of bronchoalveolar lavage in immunocompetent children with chronic diffuse pulmonary infiltrates. Pediatr Pulmonol. 1997; 23 8-13
88 Colombo J L, Hallberg T K. Recurrent aspiration in children: lipid-laden alveolar macrophage quantitation. Pediatr Pulmonol. 1987; 3 86-89
89 Ahrens P, Noll C, Kitz R et al.. Lipid-laden alveolar macrophages (LLAM): a useful marker of silent aspiration in children. Pediatr Pulmonol. 1999; 28 83-88
90 Bauer M L, Lyrene R K. Chronic aspiration in children: evaluation of the lipid-laden macrophage index. Pediatr Pulmonol. 1999; 28 94-100
91 Chang A B, Cox N C, Purcell J et al.. Airway cellularity, lipid laden macrophages and microbiology of gastric juice and airways in children with reflux oesophagitis. Respir Res. 2005; 15 72
92 Meyer K C, Sharma A. Regional lung inflammation in cystic fibrosis. Am J Respir Crit Care Med. 1997; 156 1536-1540
93 Konstan M W, Hilliard K A, Norvell T M, Berger M. Bronchoalveolar lavage findings in cystic fibrosis patients with stable, clinically mild lung disease suggest ongoing infection and inflammation. Am J Respir Crit Care Med. 1994; 150 448-454
94 Khan T Z, Wagener J S, Bost T, Martinez J, Accurso F J, Riches D WH. Early pulmonary inflammation in infants with cystic fibrosis. Am J Respir Crit Care Med. 1995; 151 1075-1082
95 Armstrong D S, Grimwood K, Carzino R, Carlin J B, Olinsky A, Phelan P D. Lower respiratory infection and inflammation in infants with newly diagnosed cystic fibrosis. BMJ. 1995; 310 1571-1572
96 Rosenfeld M, Gibson R, McNamara S et al.. Early pulmonary infection, inflammation, and clinical outcomes in infants with cystic fibrosis. Pediatr Pulmonol. 2001; 32 356-366
97 Rosenfeld M, Emerson J, Accurso F et al.. Diagnostic accuracy of oropharyngeal cultures in infants and young children with cystic fibrosis. Pediatr Pulmonol. 1999; 28 321-328
98 Baughman R P, Keeton D, Perez C, Wilmott R. Use of bronchoalveolar lavage semiquantitative cultures in cystic fibrosis. Am J Respir Crit Care Med. 1997; 156 286-291
99 Hilliard T N, Sukhani S, Francis J et al.. Bronchoscopy following diagnosis with Cystic Fibrosis. Arch Dis Child. 2007; 92 898-899
100 Wainwright C. Bronchoalveolar lavage to guide management of lung disease in children with cystic fibrosis. Pediatr Pulmonol. 2006; 29(Suppl) 188-189
101 Agostini C, Miorin M, Semenzato G. Gene expression profile analysis by DNA microarrays: a new approach to assess functional genomics in diseases. Sarcoidosis Vasc Diffuse Lung Dis. 2002; 19 5-9
102 Kaminski N, Rosas I O. Gene expression profiling as a window into idiopathic pulmonary fibrosis pathogenesis: can we identify the right target genes?. Proc Am Thorac Soc. 2006; 3 339-344
103 Bowler R P, Ellison M C, Reisdorph N. Proteomics in pulmonary medicine. Chest. 2006; 130 567-574
104 Lenz A G, Meyer B, Costabel U, Maier K. Bronchoalveolar lavage fluid proteins in human lung disease: analysis by two-dimensional electrophoresis. Electrophoresis. 1993; 14 242-244
105 Uebelhoer M, Bewig B, Oldigs M et al.. Protein profile in bronchoalveolar lavage fluaid from patients with sarcoidosis and idiopathic pulmonary fibrosis as revealed by SDS-PAGE electrophoresis and western blot analysis. Scand J Clin Lab Invest. 1993; 53 617-623
106 Wattiez R, Hermans C, Cruyt C, Bernard A, Falmagne P. Human bronchoalveolar lavage fluid protein two-dimensional database: study of interstitial lung diseases. Electrophoresis. 2000; 21 2703-2712
107 Magi B, Bini L, Perari M G et al.. Bronchoalveolar lavage fluid protein composition in patients with sarcoidosis and idiopathic pulmonary fibrosis: a two-dimensional electrophoretic study. Electrophoresis. 2002; 23 3434-3444
108 Rottoli P, Magi B, Perari M G et al.. Cytokine profile and proteome analysis in bronchoalveolar lavage of patients with sarcoidosis, pulmonary fibrosis associated with systemic sclerosis and idiopathic pulmonary fibrosis. Proteomics. 2005; 5 1423-1430
109 Sabounchi-Schütt F, Mikko M, Eklund A, Grunewald J, Aström J. Serum protein pattern in sarcoidosis analysed by a proteomics approach. Sarcoidosis Vasc Diffuse Lung Dis. 2004; 21 182-190
110 de Torre C, Ying S, Munson P J, Meduri G U, Suffredini A F. Proteomic analysis of inflammatory biomarkers in bronchoalveolar lavage. Proteomics. 2006; 6 3949-3957
111 Cosgrove G P, Brown K K, Schiemann W P et al.. Pigment epithelium-derived factor in idiopathic pulmonary fibrosis: a role in aberrant angiogenesis. Am J Respir Crit Care Med. 2004; 170 242-251
112 Zuo F, Kaminski N, Eugui E et al.. Gene expression analysis reveals matrilysin as a key regulator of pulmonary fibrosis in mice and humans. Proc Natl Acad Sci USA. 2002; 99 6292-6297
113 Pardo A, Gibson K, Cisneros J et al.. Up-regulation and profibrotic role of osteopontin in human idiopathic pulmonary fibrosis. PLoS Med. 2005; 2 e251
114 Thonhofer R, Maercker C, Popper H H. Expression of sarcoidosis related genes in lung lavage cells. Sarcoidosis Vasc Diffuse Lung Dis. 2002; 19 59-65
115 Selman M, Pardo A, Barrera L et al.. Gene expression profiles distinguish idiopathic pulmonary fibrosis from hypersensitivity pneumonitis. Am J Respir Crit Care Med. 2006; 173 188-198
116 Rutherford R M, Kehren J, Staedtler F et al.. Functional genomics in sarcoidosis: reduced or increased apoptosis?. Swiss Med Wkly. 2001; 131 459-470
117 Rutherford R M, Staedtler F, Kehren J et al.. Functional genomics and prognosis in sarcoidosis: the critical role of antigen presentation. Sarcoidosis Vasc Diffuse Lung Dis. 2004; 21 10-18
118 Kadota J, Mizunoe S, Mito K et al.. High plasma concentrations of osteopontin in patients with interstitial pneumonia. Respir Med. 2005; 99 111-117

Keith C MeyerM.D. M.S. F.A.C.P. F.C.C.P.

Department of Medicine, Section of Allergy, Pulmonary, and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health

K4/926 Clinical Science Center, 600 Highland Ave., Madison, WI 53792-9988

eMail: kcm@medicine.wisc.edu

>