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    High concentrations of pepsin in bronchoalveolar lavage fluid from children with cystic fibrosis are associated with high interleukin-8 concentrations.

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    Authors
    McNally, P
    Ervine, E
    Shields, M D
    Dimitrov, B D
    El Nazir, B
    Taggart, C C
    Greene, C M
    McElvaney, N G
    Greally, P
    Affiliation
    Respiratory Research Division, Royal College of Surgeons in Ireland, Beaumont, Hospital, Dublin, Ireland. paul.mcnally@olchc.ie
    Issue Date
    2012-02-01T10:01:42Z
    MeSH
    Adolescent
    Biological Markers/analysis
    Bronchoalveolar Lavage Fluid/*chemistry
    Case-Control Studies
    Child
    Child, Preschool
    Cystic Fibrosis/complications/*metabolism
    Female
    Humans
    Infant
    Interleukin-8/*analysis
    Male
    Pepsin A/*analysis
    Respiratory Aspiration/diagnosis/etiology
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    Citation
    Thorax. 2011 Feb;66(2):140-3. Epub 2010 Dec 15.
    Journal
    Thorax
    URI
    http://hdl.handle.net/10147/207197
    DOI
    10.1136/thx.2009.130914
    PubMed ID
    21160087
    Abstract
    BACKGROUND: Gastro-oesophageal reflux is common in children with cystic fibrosis (CF) and is thought to be associated with pulmonary aspiration of gastric contents. The measurement of pepsin in bronchoalveolar lavage (BAL) fluid has recently been suggested to be a reliable indicator of aspiration. The prevalence of pulmonary aspiration in a group of children with CF was assessed and its association with lung inflammation investigated. METHODS: This was a cross-sectional case-control study. BAL fluid was collected from individuals with CF (n=31) and healthy controls (n=7). Interleukin-8 (IL-8), pepsin, neutrophil numbers and neutrophil elastase activity levels were measured in all samples. Clinical, microbiological and lung function data were collected from medical notes. RESULTS: The pepsin concentration in BAL fluid was higher in the CF group than in controls (mean (SD) 24.4 (27.4) ng/ml vs 4.3 (4.0) ng/ml, p=0.03). Those with CF who had raised pepsin concentrations had higher levels of IL-8 in the BAL fluid than those with a concentration comparable to controls (3.7 (2.7) ng/ml vs 1.4 (0.9) ng/ml, p=0.004). Within the CF group there was a moderate positive correlation between pepsin concentration and IL-8 in BAL fluid (r=0.48, p=0.04). There was no association between BAL fluid pepsin concentrations and age, sex, body mass index z score, forced expiratory volume in 1 s or Pseudomonas aeruginosa colonisation status. CONCLUSIONS: Many children with CF have increased levels of pepsin in the BAL fluid compared with normal controls. Increased pepsin levels were associated with higher IL-8 concentrations in BAL fluid. These data suggest that aspiration of gastric contents occurs in a subset of patients with CF and is associated with more pronounced lung inflammation.
    Language
    eng
    ISSN
    1468-3296 (Electronic)
    0040-6376 (Linking)
    ae974a485f413a2113503eed53cd6c53
    10.1136/thx.2009.130914
    Scopus Count
    Collections
    Beaumont Hospital

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