Diagnostic Values Of Neopterin In Serum And Bronchoalveolar Lavage Samples In Pulmonary Sarcoidosis
Volume 2 - Issue 11, November 2018 Edition
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Deniz Dogan, Canturk Tascı, Seyfettin Gumus, Ergun Ucar, Arzu Balkan, Omer Deniz, Ergun Tozkoparan, Metin Ozkan, Halil Yaman, Hayati Bilgic
bronchoalveolar lavage, neopterin, sarcoidosis, tuberculosis.
Neopterin (NP), an marker of cellular immunity, is emitted from monocyte and macrophages through interferon-γ stimulation. Sarcoidosis is a systemic granulomatous disease and mainly involves lungs and lymphoid tissue. In this study we aimed to evaluate the diagnostic value of serum and Bronchoalveolar lavage (BAL) NP levels in lung sarcoidosis and its correlation through clinical parameters. Serum measurements were performed in 26 patients with sarcoidosis and 16 healty patients. Serum and BAL NP levels were significantly higher in the group with sarcoidosis (17.42±6.91 nmol/L and 1.50±1.46 mcmol/g-prt) than the group with non-sarcoidosis lung disease (12.38±7.46 nmol/L and 0.62±0.75 mcmol/g-prt) and the healthy group (8.12±4.20 nmol/L 0.42±0.22 mcmol/g-prt). In sarcoidosis BAL NP measurement was determined as 92%, 35%, 75% and 68% in means of specifity, sensitivity, PPD and NPD, respectively. In assessing sarcoidosis and tuberculosis differential diagnosis, BAL NP measurements were detected as 89%, 53%, 90% and 50% in means of specifity, sensitivity, PPD and NPD, respectively. BAL NP levels expressively proved correlation with radiological stage (r=0.879), FVC (r=-0.645), DLCO (r=-0.611) and DLCO/VA (r=-0.615). Serum NP levels just expressively showed correlation with FVC (r=-0.481) and FEV1 (r=0.507) values. It has been concluded that serum and BAL NP levels increased in sarcoidosis cases compared to healthy individuals and the other disease cases and these parameters are correlated with radiological stage, FVC and DLCO parameters, which are fundamental determinants in pulmonary sarcoidosis prognosis and treatment decision. We consider high BAL and serum NP levels may support sarcoidosis diagnosis in case invasive diagnostic applications cannot be made.
 C. Prior, RA. Knight, M. Herold, G. Ott, MA. Spiteri, “Pulmonary sarcoidosis: patterns of cytokine release in vitro,” European Respiratory Journal, IX (1), pp. 47-53.1996.
 P. Beirne, P. Pantelidis, P. Charles, AU. Wells, DJ. Abraham, CP. Denton, KI. Welsh, PL. Shah, RM. du Bois, P. Kelleher, “Multiplex immune serum biomarker profiling in sarcoidosis and systemic sclerosis,” European Respiratory Journal XXXIV (6), pp. 1376-1382, 2009.
 MW. Ziegenhagen, ME. Rothe, M. Schlaak, J. Muller-Quernheim, “Bronchoalveolar and serological parameters reflecting the severity of sarcoidosis,” European Respiratory Journal XXI (3), pp. 407-413, 2003.
 A. Planck, A. Eklund, J. Grunewald, “Markers of activity in clinically recovered human leukocyte antigen-DR17-positive sarcoidosis patients,” European Respiratory Journal XXI (1), pp. 52-57, 2003.
 A. Berdowska, K. Zwirska-Korczala, “Neopterin measurement in clinical diagnosis,” Journal of Clinical Pharmacy and Therapeutics,” XXVI (5), pp. 319-329, 2001.
 JL. Dhondt, A. Darras, P. Mulliez, JM. Hayte, J. Crinquette, “Unconjugated pteridines in bronchoalveolar lavage as indicators of alveolar macrophage activation,” Chest Journal XCV (2), pp. 348-351, 1989.
 KH. Mohamed, AA. Mobasher, AR. Yousef, A. Salah, IZ. El-Naggar, AH. Ghoneim, RW. Light, “BAL neopterin: a novel marker for cell-mediated immunity in patients with pulmonary tuberculosis and lung cancer,” Chest Journal CXIX (3) pp. 776-780, 2001.
 N. Turgan, S. Habif, Z. Parildar, D. Ozmen, I. Mutaf, D. Erdener, O. Bayindir, “Association between homocysteine and neopterin in healthy subjects measured by a simple HPLC-fluorometric method,” Journal of Clinical Biochemistry,” XXXIV (4), pp. 271-275, 2001.
 MF. Baganha, A. Mota-Pinto, MA. Pego, MA. Marques, MA. Rosa, AJ. Cordeiro, “Neopterin in tuberculous and neoplastic pleural fluids. Lung CLXX (2), pp. 155–161, 1992.
 J. Muller-Quernheim, “Sarcoidosis: immunopathogenetic concepts and their clinical application,” European Respiratory Journal, XXII (3), pp. 716-738, 1998.
 MW. Ziegenhagen, S. Schrum, G. Zissel, PF. Zipfel, M. Schlaak, J. Muller-Quernheim, “Increased expression of proinflammatory chemokines in bronchoalveolar lavage cells of patients with progressing idiopathic pulmonary fibrozis and sarcoidosis,” Journal of Investigative Medicine, XLVI (5), pp. 223-231, 1998.
 BD. Car, F. Meloni, M. Luisetti, G. Semenzato, G. Gialdroni-Grassi, A. Walz, “Elevated IL-8 and MCP-1 in the bronchoalveolar lavage fluid of patients with idiopathic pulmonary fibrozis and pulmonary sarcoidosis,” American Journal of Respiratory and Critical Care Medicine, CXLIX (3), pp. 655-659, 1994.
 M. Drent, JA. Jacobs, J. de Vries, RJ. Lamers, IH. Liem, EF. Wouters, “Does the cellular bronchoalveolar lavage fluid profile reflect the severity of sarcoidosis?,” European Respiratory Journal XIII (6), pp. 1338-1344, 1999.
 A. Eklund, E. Blaschke, “Elevated serum neopterin levels in sarcoidosis,” Lung, CLXV (6), pp. 325-332, 1986.