Clinical features of 125 patients with sarcoidosis: Okayama University Hospital review of a recent 10-year period.

Clinical features were studied in 125 patients with sarcoidosis (72 females and 53 males) diagnosed at Okayama University Hospital during a recent 10-year period. The age distribution had two peaks in patients in their 20s and the 50s. Over half of the patients were detected at health screening check and were asymptomatic, while the remaining were symptomatic. Twelve patients were in stage 0, 41 were in stage I, 54 were in stage II, 16 were in stage III, and 2 were in stage IV according to the chest x-ray findings. Serum angiotensin converting enzyme levels and serum lysozyme levels were elevated in 60% and 76% of the patients, respectively. The bronchoalveolar lavage fluid showed lymphocytosis, especially of helper T-cells. The clinical features of sarcoidosis appear to depend on the duration of the disease.</p

Studies on alveolar macrophage function in interstitial lung disease Part 2. Abnormalities of alveolar macrophages in sarcoidosis and the correlations with clinical findings

Several abnormalities of alveolar macrophage function were found in patients with sarcoidosis, and such abnormalities reflected the recruitment of immature macrophages to the local sites. In this study, alveolar macrophage function was compared with the disease activity in patients with sarcoidosis. The alveolar macrophage phagocytic index correlated closely with the spleen index obtained by ultrasonography, but not with serum angiotensin converting enzyme levels, lung function tests, or the cell differentiations of bronchoalveolar lavage fluid. The patients who had a positive uptake of 67-gallium scintigram showed a higher phagocytic index and a higher percentage of CD15-positive alveolar macrophages than those with negative scintigrams. Acid phosphatase activity and the percentage of CD15-positive alveolar macrophages were increased in patients with negative PPD skin tests compared to those with positive tests. We previously reported that alveolar lymphocytes in patients with sacroidosis are sensitized to Propionibacterium acnes (P. acnes), which may play a significant role in the induction of alveolitis in these patients. There was a significant correlation between the blastogenesis of alveolar lymphocytes induced by P. acnes and beta-galactosidase activity as well as the percentage of CD14-positive alveolar macrophages. These findings suggest that alveolar macrophages play an important role in the pathogenesis of sarcoidosis, in which the clinical abnormalities may reflect abnormal alveolar macrophage function

Studies on alveolar macrophage function in interstitial lung disease Part 1. Abnormalities of alveolar macrophage functions

Interstitial lung diseases comprise a heterogeneous group of disorders that are characterized by the chronic accumulation of inflammatory and immune effector cells within the alveoli, where they produce alveolitis, granulomas, or fibrosis. To investigate the pathogenesis of these diseases, the fucntions of alveolar macrophages recovered from bronchoalveolar lavage were evaluated in patients with interstitial lung disease in comparison to healthy controls. Thirty six patients were investigated : 18 with sarcoidosis, 6 with idiopathic interstitial pneumonia (IIP), 5 with interstitial pneumonia associated with collagen vascular disease (IP-CVD), and 7 with hypersensitivity pneumonitis (HP). Both the chemotactic and phagocytic indices were significantly higher in the patients with sarcoidosis, IIP, and HP than in the healthy subjects. However, the patients with IP-CVD had a lower phagocytic index than the normal subjects. Acid phosphatase activity was lower in patients with IIP, IP-CVD, and HP compared with the healthy subjects, while beta-galactosidase activity was lower in patients with sarcoidosis and IP-CVD compared with the normal controls. Analysis of surface markers showed that CD15-positive macrophages were increased in patients with sarcoidosis, IIP, and HP, but there were no differences in CD14- and HLA-DR-positive macrophages in these patients when compared to the healthy subjects. These findings indicate that the recruitment of peripheral blood monocytes to the lungs is increased in patients with sarcoidosis, IIP, and HP. Alveolar macrophages may play an important role in the pathogenesis of intersitial lung disease