Electromagnetic navigation bronchoscopy in the European cohort of the prospective, multicenter NAVIGATE study

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Durability of ceramic fibers in the human lung. Preliminary results

International audienceA proper understanding of the pulmonary toxicology of man-made mineral fibres (MMMF) requires information on their durability in the human lung but to date there is little information on this subject. Recently however, we have had the opportunity to document some interesting aspects of the short-term durability of ceramic fibres in human lung by analysing fibres recovered in broncho-alveolar lavage fluid obtained frorn seven men currently employed in the MMMF production industry. Fibres recovered from the lungs by lavage were characterized by analytical transmission electron microscopy. Both normal and highiy-transfonned ceramic fibres were detected. The transformed fibres exhibited a spectrum ofmorphological features and elemental compositions. Some retained a typical ceramic chemistry but were heavily coated with ironcontaining material. Others had a hollow tube morphology, made up offine iron-containing granules without any of the normal major ceramic elements. Such fibres were sometimes found lying under a bed ofsiliceous Seachate. It is hypothesized (hat the transformation process first involves a coating of the ceramic fibres with iron-containing granules, followed by a progressive dissolution of the structural elements. We conclude that some ceraraic fibres are not durable in the human lung

Decreased production of local immunoglobulin IgA to Pneumocystis carinii in bronchoalveolar lavage fluid from human immunodeficiency virus-positive patients

An enzyme-linked immunosorbent assay and a Western blot analysis were developed to study the antibody response to Pneumocystis carinii in serum and bronchoalveolar lavage fluid from 27 human immunodeficiency virus 27 (HIV)-infected patients with P. carinii pneumonia (Pcp), 32 patients without Pcp, and 51 HIV-negative controls. Urea was used for the correct dilution of epithelial lining fluid, and albumin was used to evaluate transudation from plasma for the assessment of local production of antibodies to P. carinii. By contrast with those of immunoglobulin G (IgG), IgA responses to P. carinii were increased in serum from HIV-positive patients compared to negative controls. Local production of antibodies to P. carinii, especially IgA, was decreased in patients with Pcp. In a study of 10 patients of each group, IgG and IgA responses to gp116 from P. carinii were lower in patients with Pcp than in other groups. These results suggest that, in addition to alveolar macrophages, local antibodies may play a role in host defense against P. carinii

Epstein-Barr virus replication within pulmonary epithelial cells in cryptogenic fibrosing alveolitis

BACKGROUND--Cryptogenic fibrosing alveolitis (synonymous with idiopathic pulmonary fibrosis) is a clinically heterogeneous condition in which the precipitating factor is unclear. Both environmental and infective factors have been implicated. An association between Epstein-Barr virus (EBV) and cryptogenic fibrosing alveolitis was suggested over a decade ago by a study based on EBV serology, but the significance of this has been unclear. METHODS--Lung tissue obtained surgically from patients (n = 20) with cryptogenic fibrosing alveolitis was investigated for evidence of EBV replication and compared with lung tissue from 21 control patients. Fourteen of the 20 patients had received no specific therapy for cryptogenic fibrosing alveolitis at the time of biopsy. Monoclonal antibodies directed against the EBV viral antigens, EBV viral capsid antigen (VCA) and gp 340/220 antigen, which are expressed during the lytic phase of the EBV life cycle, were studied. RESULTS--Fourteen (70%) of the 20 patients with cryptogenic fibrosing alveolitis were positive for both EBV VCA and gp 340/220 compared with two (9%) of the 21 controls. In the patients with cryptogenic fibrosing alveolitis viral replication was localised to pulmonary epithelial cells using epithelial cell markers, and immunohistochemical analysis confirmed the staining to be within type II alveolar cells. CONCLUSIONS--This is the first report of in vivo EBV replication within epithelial cells of the lower respiratory tract in an immunocompetent human host. Furthermore, this suggests that EBV may be an immune trigger or contribute to lung injury in cryptogenic fibrosing alveolitis, thus offering a potential new avenue of treatment