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Immunologic neutrophil elastase levels in sequential aliquots of bronchoalveolar lavage Elsser, Kimberley Anne


Pulmonary emphysema is a destructive disease of the peripheral lung that causes progressive loss of functional alveoli. It is considered that proteolytic enzymes, particularly neutrophil elastase (NE), play an important pathogenetic role in the development of emphysema. In order to evaluate the contribution of bronchial lining fluid to immunologic NE levels in bronchoalveolar lavage (BAL), NE levels and cell counts in sequential aliquots of BAL in 44 subjects were determined. The subjects were comprised of healthy volunteer smokers (n=20) and smokers, nonsmokers and ex-smokers who were patients undergoing diagnostic bronchoscopy for localized disease (n =24). Lavage was performed through a fiberoptic bronchoscope wedged into a segmental bronchus, using 5 x 50 ml aliquots of saline. The first two aliquots were analyzed separately while aliquots 3 to 5 were pooled for analysis. NE levels in unconcentrated BAL were assayed using a sensitive double-sandwich enzyme linked immunosorbent assay (ELISA). Mean NE levels were highest in aliquot 1 (2.16 ng/ml) and lowest in aliquot 3-5 (0.46 ng/ml). The percentage of neutrophils was highest in the first aliquot of BAL (10.6%) and lowest in the pooled aliquots 3-5 (4.4%). A significant correlation was established between the number of neutrophils present and the NE levels in the first aliquot of BAL in smokers. These data indicate that the number of neutrophils and NE levels are highest in aliquot 1 which reflects bronchial lining fluid, while NE levels in aliquots 3-5 of BAL, which reflect alveolar lining fluid and may be more important in the pathogenesis of emphysema, were lower.

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