VITRONECTIN IN BRONCHOALVEOLAR LAVAGE FLU ID - A MARKER OF DISEASE-ACTIVITY IN SARCOIDOSIS

Vitronectin is a multifunctional glycoprotein which is involved in sev eral of the processes of inflammation and repair. In previous studies we demonstrated that increased concentrations of vitronectin can be de tected in bronchoalveolar lavage fluids (BAL) of patients with interst itial lung disease (e.g. sarcoidosis). The outcome of sarcoidosis is g enerally favorable, however, some patients progress to pulmonary fibro sis. There is a need for markers indicating early fibrotic changes in the lung in patients with sarcoidosis. The present study was designed to evaluate the potential of BAL-vitronectin measurements for the asse ssment of disease activity in subjects with sarcoidosis. BAL-vitronect in concentrations were determined in 19 patients with biopsy proven sa rcoidosis and sequential analysis of BAL-vitronectin levels were perfo rmed in 11 patients before and after therapy. Patients with active sar coidosis had higher BAL-vitronectin concentrations (1.56 +/- 0.89 mug/ ml) than patients with inactive disease (0.68 +/- 0.33 mug/ml; p < 0.0 1). Patients with active sarcoidosis received high-dose glucocorticoid treatment for four weeks followed by low-dose glucocorticoid therapy for eleven months. After high-dose medication BAL-vitronectin concentr ations fell significantly (1.08 +/- 0.9 mug/ml; p < 0.0 1). A further decrease in vitronectin levels resulted when therapy was continued for a year (0.75 +/- 0.48 mug/ml). Clinical deterioration correlated with an increase in BAL-vitronectin concentrations. Thus, measurement of B AL-vitronectin levels might be a useful marker for assessing disease a ctivity and response to therapy in patients with sarcoidosis, but does not provide prognostic information.