ALVEOLAR T-CELL SUBSETS IN PULMONARY SARCOIDOSIS - CORRELATION WITH DISEASE-ACTIVITY AND EFFECT OF STEROID TREATMENT

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  • 1 January 1984
    • journal article
    • research article
    • Vol. 129  (4) , 563-568
Abstract
Alveolar lymphocytes, obtained by bronchoalveolar lavage in 35 patients with sarcoidosis, were analyzed with monoclonal antibodies to lymphocyte subsets. Untreated patients had significantly higher percentages of Leu 3a(+) T helper-inducer cells (THI) and significantly lower Leu 2a(+)T cytotoxic-suppressor cells (TCS) with the alveolar lymphocyte population than did normal control subjects (P < 0.002). The mean ratio of alveolar THI to TCS cells was 6.20 .+-. 3.76 vs. 1.44 .+-. 0.54 in control subjects (P < 0.002). Untreated patients had a percentual enrichment of THI cells among alveolar lymphocytes relative to blood (P < 0.0002), whereas TCS cells in percent of lymphocytes were lower in alveolar lavage fluid than in blood (P < 0.002). These shifts were not observed in the control subjects. Patients with high-intensity alveolitis (i.e., T cells constituted 28% or more of alveolar inflammatory cells) had significantly greater proportions of THI cells among alveolar lymphocytes than did those with low-intensity alveolitis (P < 0.01). This percent of alveolar THI cells correlated positively with the number of lymphocytes and T cells in percent of alveolar cells (P < 0.03) which both are indexes of disease activity. In untreated patients who were lavaged at least twice, a decrease in the THI/TCS ratio accompanied or preceded radiologic and clinical improvement but the initial THI/TCS ratio was not predictive of further evolution. Steroid treatment decreased the THI/TCS ratio with a marked increase in the proportion of TCS cells. These changes were independent of an effect on the number of alveolar lymphocytes. In contrast to untreated patients, the steroid-treated patients had a greater proportion of TCS cells (in percent of lymphocytes) in alveolar lavage fluid than in blood (P < 0.03). This could reflect a fundamental mechanism by which steroids tend to influence the disease process, conferring higher suppressor cell function to areas of intense immunologic activity.