Abstract
Current concepts of the pathogenesis of Sarcoidosis suggest that the alveolitis in this disorder is related to increased numbers of helper T-cells within the lungs. However, the mechanism of this accumulation of lymphocytes is not known. We have reported that proliferation of alveolar lymphocytes induced by P. acnes is increased in patients with active sarcoidosis. To determine whether the response of alveolar lymphocytes would be useful in staging the activity of pulmonary sarcoidosis, we studied 34 untreated patients with this disorder, and correlated the response of alveolar lymphocytes with clinical, roentgenographic, physiologic, and bronchoalveolar lavage findings in these non-smoking patients. There was a significant correlation of the response in the numbers of lymphocytes (p<0.05) and CD4 (+) T-cells (p<0.01) recovered from the lungs of these patients by bronchoalveolar lavage. Furthermore, the response correlated significantly with the activity of Interleukin-2 released by alveolar lymphocytes stimulated by P. acnes (p<0.05). In contrast, no correlation was found between the response and the clinical, roentgenographic, or physiologic data. However, in patients who showed abnormality in all three clinical examinations, i. e. serum angiotensin converting enzyme activity, number of alveolar lymphocytes, and 67Ga scintigraphy of the lung, the response was significantly higher than in controls (p<0.001) or in patients with none of these abnomalities (p<0.01). Also, the response in patients with an abnormality in two of these three examinations was significantly elevated compared to that in normals (p<0.025) or in patients without an abnormal examination (p<0.02). The response in patients without abnormal data in any of the three examinations was in the normal range. These data suggest that the response of alveolar lymphocytes reflects the activity of pulmonary sarcoidosis.
