Blood tumor markers in patients with lung cancer

Over the past years, a number of serum components have been confirmed as useful biological markers of lung cancer. Although none have been sensitive or specific enough to enable early diagnosis, they do seem to facilitate the monitoring and prediction of disease prognosis. We studied tumor markers in 66 patients with lung cancer: serum levels of ferritin, carcinoembryonic antigen (CEA), alpha-fetoprotein (alpha-FP); tissue polypeptide antigen (TPA), cytocheratin fragment 19, 21-1 (CYFRA 21-1) and carbohydrate antigen 125 (CA 125) levels were measured and correlated to tumor stage and histological type. Postulating a specificity of 95% versus benign diseases of the lung, we confirmed the following diagnostic sensitivity for the markers: ferritin = 39.3%; CEA = 42.4%; alpha-FP = 5.1%; TPA = 57.5%; CYFRA 21-1 = 65.1%; CA 125 = 46.9%. CYFRA 21-1 showed significantly higher sensitivity in non small cell lung cancer patients than in those with small cell lung cancer (Wilcoxon, p = 0.02). Moreover since survival time was significantly shorter in patients with high serum CYFRA 21-1, these levels seemed to be correlated with the prognosis

Increased endothelin-like immunoreactive material on broncho-alveolar lavage fluid from patients with bronchial asthma and patients with interstitial lung disease.

Endothelin (ET) is an endothelial regulatory peptide present also in pulmonary tissue where it exerts several biological actions both on bronchial and vascular smooth muscle cells. It has been shown to increase in bronchoalveolar lavage fluid (BALF) from asthmatic patients; but changes in other chronic respiratory disease have not been well studied. We measured by a radioimmunoassay (RIA) ET-immunoreactive (IR) levels on BALF (BALF-ETIR, pg/ml) from 5 normal subjects (NS), 5 patients with chronic extrapulmonary disease (ED) without signs of lung involvement, 5 patients with allergic bronchial asthma (BA), 10 patients with idiopatic lung fibrosis (ILF) and 9 patients with miscellaneous interstitial lung disease (MILD). In 5/5 NS and 4/5 ED BALF-ETIR was lower than sensibility of RIA test used (0.8 pg/ml). BALF-ETIR was dosable in all patients with bronchopulmonary disease; means were 2.45 pg/ml in BA, 12.37 pg/ml in ILF, 2.90 pg/ml in MILD - Wilcoxon's rank test (two tailed) versus NS, p < 0.05. There was an inverse correlation between BALF-ETIR values and the degree of ventilatory impairment (forced vital capacity % of predicted value, r = -0.61 p < 0.01; forced expiratory volume in 1 s % of predicted value, r = -0.71 p < 0.01) and the level of arterial pressure of 02 (PaO2; r = -0.75 p < 0.01); a positive correlation was found with number of neutrophils/ml of BALF (r = 0.52 p < 0.01) - Spearman's rank correlation. Though rarely detected on BALF from normal lungs, ET increases on BALF in patients with bronchopulmonary disease, raising the question of its involvement in pathogenic mechanisms or evolution of bronchial asthma and interstitial lung disease

EVALUATION OF THE EFFICIENCY OF CORTICOSTEROID (BECLOMETIIASONE-DIPROPRIONATE) USE IN ATOPIC PATIENTS WITH MILD ASTHMA

The most commonly adopted therapy for chronic asthma is actually repre¬sented by inhaled corticosteroids; these drugs act at several levels of the inflammatory process in the asthmatics' airways. The aim of our study, therefore, was that to evaluate the efficacy of short term (2 months) use of beclomethasone-dipropionate (1000 jig) taken on a daily basis in mild asthmatics. The evaluation was based upon several criteria: clinical, func¬tional, biological and morphological. We observed a clear improvement of the clinical pattern (cough, wheeze, dyspnoea), and a neat increase of the bronchial hyperresponsitivity thresh¬old (PD15/FEV 1=368.6 compared to 827.1 jig methacholine after therapy, p<0.05) was found. The antiinflammatory effect of the drug was confirmed by a lower cytokine- [IL-1|3 (p=0.02), IL-6 (p=0.03), IL-8 (p=0.003)] and chemical mediators [PAF (p=0.01), TXB2 (p=0.01), LTB4 (p=0007)] release in BAL, and by the evidence of a reduced activation of alveolar macrophages, as documented by flow-cytofluorimetry [HLA-DR (p=0.01), CD23 (p=0.02), CD44 (p=0.01), CD54 (p=0.05)]. Light microscopy evidenciated the histological improvement of basal mem¬brane thickening, as well as repair processes of the bronchial epithelium, and a marked decrease in mucus secretion, goblet cells and mucosecretory glands volume. We therefore can conclude that the use of inhaled beclomethasone- dipropionate is indicated for the therapy of mild asthma

Inhaled beclomethasone dipropionate (BDP) prevents seasonal changes in atopic asthmatics.

Inhaled corticosteroids are most effective drugs currently available for the treatment of bronchial asthma. They have been shown to reduce airway inflammation and hyperresponsiveness. The aim of this study was to assess the preventive effect of inhaled steroid therapy in seasonal asthma. In a double-blind study, two groups of 10 allergic asthmatics were randomly assigned to receive inhaled beclomethasone dipropionate (BDP), 500 micrograms b.i.d., or a matched placebo, two puffs b.i.d. The patients used inhaled salbutamol as needed. At the beginning of the study, and every month between February and June, the following parameters were assessed: lung function (forced expiratory volume in one second (FEV1); airway responsiveness (provocative dose of methacholine producing a 20% fall in forced expiratory volume in one second (PD20)), serum eosinophil cationic protein (ECP); and blood eosinophil count. All subjects recorded daily asthma symptoms, beta 2-agonist consumption and peak expiratory flow (PEF) values. In the placebo group, all parameters except FEV1 worsened significantly during the pollen season compared with preseasonal values (p < 0.001). BDP produced complete protection, although a slight change from baseline was found for symptom score (p < 0.01), beta 2-agonist consumption (p < 0.01), and eosinophil number (p < 0.05) in May, when the pollen load was highest. These data provide evidence that beclomethasone dipropionate treatment is able to inhibit the seasonal changes occurring during natural exposure in asthmatics. This preventive effect is probably due to the anti-inflammatory action of beclamethasone dipropionate, as documented by its effect on serum markers of airway inflammation

Serum eosinophil cationic protein (ECP) as a marker of disease activity and treatment efficacy in seasonal asthma.

This study was carried out to determine whether serum eosinophil cationic protein (ECP) represents a sensitive marker for disease activity in atopic asthmatic patients during the pollen season. The study, in double-blind fashion, was performed between February and June 1994. Two groups of 10 seasonal asthmatic patients randomly received two different treatments. The first group was treated with inhaled beclomethasone dipropionate (BDP) 500 mu g bid; the second received a matched placebo (P). At the beginning and every month, blood samples for determination of ECP and eosinophil count were collected and lung function (FEV(1)) and methacholine responsiveness (PD20) were performed. Subjects recorded daily symptoms of asthma, salbutamol consumption, and peak expiratory flow (PEF) values. In the P group, all indices, except FEV(1), showed significant changes during the pollen season (P < 0.001). In the BDP group, significant changes were detected for symptom score (P < 0.01), salbutamol consumption (P < 0.01), and eosinophil number (P < 0.05). Between the two groups, significant differences for symptom score (P < 0.001), salbutamol consumption (P < 0.001), ECP levels (P < 0.05), eosinophil count (P < 0.02), PD20 methacholine (P < 0.02), and PEF values (P < 0.01) were detected. Changes in serum ECP significantly correlated with changes in other parameters (P < 0.001), except FEV(1). Our results provide evidence that serum ECP is a sensitive marker for monitoring of the disease activity in seasonal asthma. Furthermore, it may offer a useful tool for estimating treatment efficacy