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  3. Cholesteryl palmitate crystals in bronchoalveolar lavage fluid smears as a possible prognostic biomarker for chronic interstitial pneumonia: A preliminary study

Cholesteryl palmitate crystals in bronchoalveolar lavage fluid smears as a possible prognostic biomarker for chronic interstitial pneumonia: A preliminary study

  • Respir Investig. 2016 Mar;54(2):109-15. doi: 10.1016/j.resinv.2015.09.003.
Naoko Fukuhara 1,  Motoko Tachihara 2,  Yoshinori Tanino 3,  Junpei Saito 4,  Suguru Sato 5,  Takefumi Nikaido 6,  Kenichi Misa 7,  Atsuro Fukuhara 8,  Xintao Wang 9,  Takashi Ishida 10,  Tetsuo Onami 11,  Mitsuru Munakata 12
Affiliations

Affiliations

  • 1 Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, Fukushima 960-1295, Japan. Electronic address: [email protected].
  • 2 Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, Fukushima 960-1295, Japan; Department of Pulmonary Medicine, School of Medicine, Kobe University, 1-1 Rokkodai-cho, Nada-ku, Kobe, Hyougo 650-0017, Japan. Electronic address: [email protected].
  • 3 Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, Fukushima 960-1295, Japan. Electronic address: [email protected].
  • 4 Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, Fukushima 960-1295, Japan. Electronic address: [email protected].
  • 5 Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, Fukushima 960-1295, Japan. Electronic address: [email protected].
  • 6 Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, Fukushima 960-1295, Japan. Electronic address: [email protected].
  • 7 Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, Fukushima 960-1295, Japan. Electronic address: [email protected].
  • 8 Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, Fukushima 960-1295, Japan. Electronic address: [email protected].
  • 9 Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, Fukushima 960-1295, Japan. Electronic address: [email protected].
  • 10 Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, Fukushima 960-1295, Japan. Electronic address: [email protected].
  • 11 Department of Chemistry, School of Medicine, Fukushima Medical University, Fukushima City, Fukushima 960-1295, Japan; Symbiotic Systems Science, Fukushima University, Fukushima City, Fukushima 960-1296, Japan. Electronic address: [email protected].
  • 12 Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, Fukushima 960-1295, Japan. Electronic address: [email protected].
PMID: 26879480 DOI: 10.1016/j.resinv.2015.09.003
Abstract

Background: We observed cholesterol-like crystals (Crystal X) in the bronchoalveolar lavage fluid (BALF) smears of patients with diffuse pulmonary disease. We analyzed the clinical data of patients with and without crystals, and elucidated the structure of Crystal X and its concentration in the BALF.

Methods: Two hundred eighty-nine patients with diffuse pulmonary disease who underwent bronchoalveolar lavage (BAL) were analyzed. The relationships between the presence and number of Crystal X in BALF smears and clinical parameters were investigated. Furthermore, structure determination and quantitative analyses of the crystals were performed.

Results: Seventy-five (26.0%) patients had Crystal X in their BALF. The crystals were frequently observed in patients with chronic interstitial pneumonia (CIP, 60/160=35.3%). Patients with Crystal X exhibited significantly higher serum Kerbs von Lungren 6 antigen and surfactant protein-D levels (P<0.01) and lower percentage vital capacity (P<0.05) than patients without Crystal X. The number of crystals was significantly correlated with these parameters. The presence of crystals was also associated with a lower survival rate at 1 year after the BAL. The interfacial angles of the crystals were 126±2° and 144±2°, different from those of Cholesterol monohydrate crystals. Infrared absorption spectrometry showed Crystal X was cholesteryl palmitate. Its concentration was significantly higher in BALF with crystals than in BALF without crystals (P<0.01).

Conclusions: Crystal X in the BALF of patients with diffuse pulmonary disease was identified as cholesteryl palmitate, which may be a useful prognostic biomarker for CIP.

Keywords

Bronchoalveolar lavage; Cholesteryl palmitate; Crystal; Interstitial pneumonia; Surfactant.

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