Cholesteryl palmitate crystals in bronchoalveolar lavage fluid smears as a possible prognostic biomarker for chronic interstitial pneumonia: A preliminary study

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• 作者：Naoko Fukuhara^a ; ^{n-naoko@fmu.ac.jp" class="auth_mail" title="E-mail the corresponding author} ; Motoko Tachihara^a ; ^b ; ^{mt0318@med.kobe-u.ac.jp" class="auth_mail" title="E-mail the corresponding author} ; Yoshinori Tanino^a ; ^{ytanino@fmu.ac.jp" class="auth_mail" title="E-mail the corresponding author} ; Junpei Saito^a ; ^{Junpei@fmu.ac.jp" class="auth_mail" title="E-mail the corresponding author} ; Suguru Sato^a ; ^{suguru@fmu.ac.jp" class="auth_mail" title="E-mail the corresponding author} ; Takefumi Nikaido^a ; ^{taken@fmu.ac.jp" class="auth_mail" title="E-mail the corresponding author} ; Kenichi Misa^a ; ^{kmisa@fmu.ac.jp" class="auth_mail" title="E-mail the corresponding author} ; Atsuro Fukuhara^a ; ^{fukuhara@fmu.ac.jp" class="auth_mail" title="E-mail the corresponding author} ; Xintao Wang^a ; ^{xintaow@fmu.ac.jp" class="auth_mail" title="E-mail the corresponding author} ; Takashi Ishida^a ; ^{taku.ishida@nifty.ne.jp" class="auth_mail" title="E-mail the corresponding author} ; Tetsuo Onami^c ; ^d ; ^{onami98@yahoo.co.jp" class="auth_mail" title="E-mail the corresponding author} ; Mitsuru Munakata^a ; ^{munakata@fmu.ac.jp" class="auth_mail" title="E-mail the corresponding author}
• 关键词：ABCA ; ATP-binding cassette transporter A ; BALF ; bronchoalveolar lavage fluid ; CIP ; chronic interstitial pneumonia ; Crystal X ; cholesterol-like crystal ; Elovl 6 ; elongation of very long chain fatty acid member 6 ; IIP ; idiopathic interstitial pneumonia ; IP ; interstitial pneumonia ; IP-CTD ; interstitial pneumonia associated with connective tissue disease ; IPF ; idiopathic pulmonary fibrosis.
• 刊名：Respiratory Investigation
• 出版年：2016
• 出版时间：March 2016
• 年：2016
• 卷：54
• 期：2
• 页码：109-115
• 全文大小：828 K

文摘

We observed cholesterol-like crystals (Crystal X) in the bronchoalveolar lavage fluid (BALF) smears of patients with diffuse pulmonary disease. We analyzed the clinical data of patients with and without crystals, and elucidated the structure of Crystal X and its concentration in the BALF.

Methods

Two hundred eighty-nine patients with diffuse pulmonary disease who underwent bronchoalveolar lavage (BAL) were analyzed. The relationships between the presence and number of Crystal X in BALF smears and clinical parameters were investigated. Furthermore, structure determination and quantitative analyses of the crystals were performed.

Results

Seventy-five (26.0%) patients had Crystal X in their BALF. The crystals were frequently observed in patients with chronic interstitial pneumonia (CIP, 60/160=35.3%). Patients with Crystal X exhibited significantly higher serum Kerbs von Lungren 6 antigen and surfactant protein-D levels (P<0.01) and lower percentage vital capacity (P<0.05) than patients without Crystal X. The number of crystals was significantly correlated with these parameters. The presence of crystals was also associated with a lower survival rate at 1 year after the BAL. The interfacial angles of the crystals were 126±2° and 144±2°, different from those of cholesterol monohydrate crystals. Infrared absorption spectrometry showed Crystal X was cholesteryl palmitate. Its concentration was significantly higher in BALF with crystals than in BALF without crystals (P<0.01).

Conclusions

Crystal X in the BALF of patients with diffuse pulmonary disease was identified as cholesteryl palmitate, which may be a useful prognostic biomarker for CIP.