CYTOKINES IN BRONCHOALVEOLAR LAVAGE FLUID IN PATIENTS WITH HIGH-ALTITUDE PULMONARY-EDEMA AT MODERATE ALTITUDE IN JAPAN

Background - The precise mechanism of high altitude pulmonary oedema ( HAPE) remains unclear. The purpose of this study was to evaluate the r ole of cytokines and P-selectin in the development of HAPE which occur red at moderate altitude in Japan. Methods - The following cellular an d biochemical markers and chemotactic cytokines were measured in the b ronchoalveolar (BAL) fluid from four patients with HAPE at 2857-3180 m in the Japanese Alps: total proteins, albumin, lactate dehydrogenase (LDH), and interleukin (IL)-1 alpha, IL-1 beta, IL-1 receptor antagoni st (ra), IL-6, IL-8, IL-10, tumour necrosis factor (TNF)-alpha, and th e soluble form of P-selectin. Results - At admission there were signif icant increases in the levels of total cells, especially macrophages a nd neutrophils, total protein, albumin and LDH when compared with 13 h ealthy individuals. Furthermore, the levels of IL-1 beta, IL-6, IL-8, and TNF-alpha were also considerably increased but returned quickly to the normal ranges or were not detected after recovery. The levels of IL-1 alpha, IL-10, and P-selectin did not change. Conclusions - These results suggest that an inflammatory process almost identical with acu te respiratory distress syndrome (ARDS) may occur in HAPE, but that th ese changes are transient and are not associated with any increase in P-selectin levels in the BAL fluid.