Serum Type I and Type III Procollagen Peptide Levels in Sarcoidosis
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Eur Respir J, 1996, 9, 1648–1651 Copyright ERS Journals Ltd 1996 DOI: 10.1183/09031936.96.09081648 European Respiratory Journal Printed in UK - all rights reserved ISSN 0903 - 1936 Serum type I and type III procollagen peptide levels in sarcoidosis L. Bacchella*, C. Tinelli**, L.S. Gilè+, V. Peona+, C. Aprile*, M.Gorrini+, L. Pasturenzi+, G. Cetta++, M. Luisetti+ Serum type I and type III procollagen peptide levels in sarcoidosis. L. Bacchella, C. *Servizio di Medicina Nucleare, Fondazione Tinelli, L.S. Gilè, V. Peona, C. Aprile, M.Gorrini, L. Pasturenzi, G. Cetta, M. Luisetti. Clinica del Lavoro, Pavia, Italy. **Unità ERS Journals Ltd 1996. di Statistica and +Istituto di Tisiologia e ABSTRACT: Type I and type III are the most abundant collagens in the lung. Malattie Respiratorie, IRCCS Policlinico ++ The aim of our study was to compare type I and III procollagen peptides in sera San Matteo, Pavia, Italy. Dipartimento of sarcoid patients. di Biochimica, Università di Pavia, Italy. Sixty eight patients with sarcoidosis were studied (19 with newly recognized dis- Correspondence: M. Luisetti, Istituto di ease, 7 with relapsing disease, 15 with chronic disease, and 27 in stable remission). Tisiologia e Malattie Respiratorie, IRCCS Thirty healthy volunteers served as controls. The levels of procollagen I and III Policlinico San Matteo, Università degli peptides were determined by radioimmunoassay. Angiotensin-converting enzyme Studi di Pavia, Via Taramelli 5, 27100 (ACE) level was evaluated by means of a colorimetric assay. Pavia, Italy In patients with newly recognized sarcoidosis, both serum procollagen I and III peptide levels were increased with respect to controls (p=0.0014 and p<0.00001, Keywords: Angiotensin-converting enzyme, respectively). There was a poor correlation between levels of procollagen I and III collagens, granulomata, lung, sarcoidosis activity (r=0.26), whereas there was a closer correlation between procollagen III and ACE (r=0.69). Procollagen I peptide level did not identify patients in roentgenological Received: May 12 1995 stage III. Accepted after revision February 20 1996 In conclusion, in patients with newly recognized sarcoidosis there is a significant increase in the serum level of procollagen I peptide. However, procollagen I pep- This work has been partially supported by tide is not a marker of sarcoid patients with fibrosis, i.e. stage III disease. Its clini- research grants from IRCCS Policlinico San cal usefulness seems to be weaker than that of procollagen III peptide. Matteo (Ricerca Corrente) and from Fonda- Eur Respir J., 1996, 9, 1648–1651. zione Clinica del Lavoro. Sarcoidosis is a multisystem granulomatous disorder developed [11, 12]. PICP is used as a marker of colla- characterized by an enhancement of immune processes gen biosynthesis in bone [11, 13, 14], where type I col- at sites of disease activity [1]. A large variety of mark- lagen accounts for >90% of the organic matrix. ers of disease activity have been proposed [2] for satis- Information about PICP in BAL fluids in interstitial factory assessment and clinical management of the disease. lung disease (ILD) and sarcoidosis is so far very limited Among biochemical markers, particular interest has [15, 16]. Its BAL fluid values increase similarly to those been devoted to the search for indicators of accelerated of PIIINP. However, no information about serum PICP turnover of extracellular matrix, with the purpose of using in sarcoidosis is available. them to assess or predict fibrogenic processes in lung The aim of our study was to evaluate the serum level interstitium during sarcoidosis [3]. The most abundant of PICP, in comparison to that of PIIINP, in well-defined macromolecules in the lung are the interstitial collagens [4]. groups of patients with sarcoidosis. Type I and type III are the most abundant of the lung collagens in normal conditions, with a ratio of 2:1. where- as, in fibrotic lungs there is an excess of type III collagen in Material and methods the early stages and of type I in the late stages [5]. The availability of a radioimmunoassay for the N- Study subjects terminal procollagen III peptide (PIIINP) [6], a cleavage product of the type III procollagen molecule, makes it The study comprised a series of 98 individuals, includ- possible to demonstrate that PIIINP levels are increased ing 68 patients with biopsy proven sarcoidosis consecu- in bronchoalveolar lavage (BAL) fluid [7, 8] and in serum tively examined in our Department from April 1992 until [9, 10] of patients affected by sarcoidosis. However it September 1994. There were 43 females and 25 males is believed that such an elevation represents the expres- and their mean age was 38±16 yrs. The sarcoidosis patients sion of granulomata cell hyperactivity, rather than pre- were divided in four subsets: 1) newly diagnosed patients, dicting fibrogenic processes. 19 subjects (11 females and 8 males); 2) patients with More recently, a radioimmunoassay (RIA) able to relapse of the disease (recent worsening of chest radi- determine the carboxyterminal propeptide of human ograph and/or pulmonary function test parameters and/or type I procollagen (PICP) in biological fluids has been dyspnoea, and increase of serum angiotensin converting SERUM PICP IN SARCOIDOSIS 1649 enzyme (s-ACE) level), 7 subjects (6 females and 1 male); mouse, sample PIIINP, and 125I-labelled anti-PIIINP mono- 3) patients with chronic sarcoidosis (persistent, but sta- clonal antibodies raised in mouse. The monoclonal anti- ble, chest radiographic abnormalities), 15 subjects (12 bodies used in this kit are highly specific for Col 1–3 females and 3 males); and 4) patients in remission (per- PIIINP, which accounts for approximately 20% of the total sistent resolution of chest radiographic abnormalities), serum PIIINP level found in patients with IPF, the remain- 27 subjects (14 females and 13 males). The patients had der being Col 1, a Col 1–3 metabolite [18]. The anti- not received corticosteroid treatment for at least 6 months, bodies do not react with PICP. All samples were run in with the exception of three patients with chronic sar- triplicate. The within and between assay variation coef- coidosis, chronically treated with oral prednisone 15 mg ficient was less than 8 %. on alternate day. Thirty healthy volunteers from the clinical staff, 20 Serum ACE determination. The serum ACE level was females and 10 males, mean age 36±12 yrs, served as determined by means of a colorimetric assay (ACE Color; controls. Fujirebio Inc., Tokyo, Japan), using the substrate p- hydroxyhippuryl-histidyl-leucine [19], adjusted to a micro- Study design assay [20]. The study was designed as a cross-sectional investi- Statistical analysis [21] gation. The newly diagnosed patients and patients with relapse of the disease were assessed by chest radiograph, Data are presented as mean±SD. Differences in serum high resolution computed tomography (CT) scan, BAL, mean value of PICP, PIIINP, and ACE (quantitative vari- pulmonary function tests, Ga67 lung scan, abdomen ultra- ables), and roentgenological stage (qualitative variable) sonography and biopsy (either prescalenic, bronchial, trans- among groups were tested by one-way analyses of vari- bronchial, or open lung). Biopsies were not performed ance (ANOVA). Once overall differences were signifi- in patients with relapse of the disease if histological proof cant, least square differences (LSD) test for planned had already been achieved. Subjects in remission and comparisons was used to identify which groups were res- with chronic sarcoidosis were seen as out-patients and ponsible for the significance found. Relationships among enrolled provided their clinical picture, chest radiograph, quantitative variables were investigated by means of and pulmonary function test parameters were unchanged Pearson's correlation coefficient. The difference was taken with respect to the previous examinations. Based on chest as statistically significant at a p-level less than 0.05. This radiograph (independently reviewed by one radiologist analysis was approached as exploratory, rather than con- and two pulmonologists), patients with newly diagnosed firmatory, and no adjustments were made for multiple sarcodiosis, with relapse of the disease or with chronic testing. sarcoidosis were assigned to roentgenological stage I, II, or III, according to DEREMEE [17]. Results Blood samples for determination of PICP, PIIINP, alka- line phosphatase, and s-ACE levels were obtained by veni- The ANOVA showed that values of serum PICP, PIII- puncture in control subjects and at the moment of disease NP and ACE were statistically different among the five assessment in patients with newly diagnosed sarcoidosis groups of subjects studied (F=3.43, p=0.011; F=21.9, and relapse, or during examination in subjects in remis- p<0.0001; F=7.1, p=0.00035, respectively). With refer- sion and with chronic sarcoidosis. ence to the PICP levels, patients with newly diagnosed sarcoidosis were found to be the only group of indivi- Serum PICP, PIIINP and ACE level determination duals with serum PICP levels significantly higher than those of the three other groups: their PICP level was Aliquots of sera were kept at -20˚C for no more than higher than that of controls and patients with chronic or 3 months before the determination of PICP, PIIINP, and resolved sarcoidosis (p=0.0014, p=0.0150 and p=0.0027, ACE levels. A blood sample obtained at the same time respectively) (table 1). PICP level did not significantly had heparin added