ACTIVATION OF EOSINOPHILS AND FIBROBLASTS ASSESSED BY EOSINOPHIL CATIONIC PROTEIN AND HYALURONAN IN BAL - ASSOCIATION WITH ACUTE REJECTION IN LUNG-TRANSPLANT RECIPIENTS

Lung transplantation has become an accepted therapy for end-stage lung disease, Acute rejection of the transplanted lung still remains a maj or clinical problem since it decreases graft survival, Eosinophil cati onic protein (ECP) from activated eosinophils, hyaluronan (HYA) from f ibroblasts, and circulating intercellular adhesion molecule 1 (ICAM-1) have been associated with acute rejection in kidney and liver grafts, We investigated whether these, as well as other molecules, were incre ased in acute rejection of lung allografts, Serum and BAL fluid from 3 8 bronchoscopies performed in 9 single lung, 2 bilateral lung, and 4 h eart-lung transplant patients were studied, Differential cell counts w ere made from the BAL fluid, Levels of ECP, myeloperoxidase (MPO), and HYA were used as indirect markers for activation of eosinophils, neut rophils, and fibroblasts, respectively, In addition, levels of circula ting ICAM-1, cVCAM-1, and cE-selectin were analyzed. Twenty-two episod es with acute rejection were diagnosed. Of these, 7 were minimal, 13 w ere mild, and 2 were of moderate character, We found increased levels of ECP and HYA in BAL fluid during mild acute rejection of the allogra ft, Numbers of eosinophils were also increased, Activation of neutroph ils or neutrophil numbers were not significantly increased. Levels of circulating ICAM-1, cVCAM-1, and cE-selectin did not differ between th e groups, This retrospective study shows that measurements of ECP and HYA can give information about the inflammatory process present during acute rejection in patients who have undergone lung transplants, Anal ysis of cCAMS, however, appears to be of limited value as markers for acute rejection.