Level of Eosinophil Cationic Protein in Sputum of Chemical Warfare Victims

Document Type: Original Article

Authors

1 Department of Pulmonary Medicine, Islamic Azad University- Mashhad Branch, Mashhad, Iran

2 Department of Pulmonary Medicine, Ardabil University of Medical Science, Ardabil, Iran

3 Department of Immunology, Islamic Azad University-Mashhad Branch, Mashhad, Iran

4 Department of Pulmonary Medicine, Lung Diseases and TB Research Center Mashhad University of Medical Science, Mashhad, Iran

5 Department of Epidemiology, Mashhad University of Medical Science, Mashhad, Iran

6 Department of Pathology, Mashhad University of Medical Science, Mashhad, Iran

Abstract

Objective(s)
Considering fair response to inhaled corticosteroids and reports of severe air way hyper responsiveness in chemical warfare victims (CWV), a role for eosinophilic inflammation (i.e. asthma) was postulated. The objective of this study was to determine the presence of eosinophilic inflammation in CWV by evaluation of Sputum cellularity and eosinophil cationic protein (ECP).
Materials and Methods
Forty CWV and 15 control subjects entered this cross sectional study. Demographic data, dyspnea severity scale, spirometry results and 6 min walk test were determined. Sputum was collected with inducing by nebulizing hypertonic saline and analyzed for total inflammatory cell count, the cellular differential count and ECP level. Control group was normal volunteers with PC20 more than 8 mg/ml.
Results
Mean±SD of eosinophil percentage (11.7±11.1%) and ECP level in sputum of CWV (46.1±19.5 ng/ml) were significantly more than control group. Regression analysis showed significant correlation between ECP level and percentage of eosinophils in sputum (r= +0.43, P< 0.01). ECP level of CWV subjects with obstructive pattern did not show any significant difference from CWV with normal spirometry. ECP level in CWV subjects who revealed more than 12% improvement in forced expiratory volume in one second  (FEV1) was significantly higher than CWV who had improvement less than 12% (P= 0.01). BO and asthma as final clinical diagnosis of CWV did not show any significant difference of sputum ECP.
Conclusion
Bronchial inflammation in different types of pulmonary complication of CWV is eosinophil dependent. ECP level of sputum in CWV could guide physician to select CWV who would respond to corticosteroids.

Keywords


1.  Balali-Mood M, Hefazi M, Mahmoudi M, Jalali E, Attaran D, Maleki M, et al. Long-term complications of sulphur mustard poisoning in severely intoxicated Iranian veterans. Fundam Clin Pharmacol  2005; 19:713-721.

2.   Hefazi M, Attaran D, Mahmoudi M, Balali-Mood M. Late respiratory complications of mustard gas poisoning in Iranian veterans. Inhal Toxicol 2005; 17:587-592.

3. Khateri S, Ghanei M, Keshavarz S, Soroush M, Haines D. Incidence of lung, eye, and skin lesions as late complications in 34,000 Iranians with wartime exposure to mustard agent. J Occup Environ Med 2003; 45:1136-1143.

4. Ghanei M, Mokhtari M, Mohammad MM, Aslani J. Bronchiolitis obliterans following exposure to sulfur mustard: chest high resolution computed tomography Eur J Radiol 2004; 52:164-169

5. Ghanei M, Fathi H, Mohammad MM, Aslani J, Nematizadeh F. Long-term respiratory disorders of claimers with subclinical exposure to chemical warfare agents. Inhal Toxicol 2004; 16:491-495.

6. Ghanei M, Khalili AR, Arab MJ, Mojtahedzadeh M, Aslani J, Lessan-Pezeshki M, et al. Diagnostic and therapeutic value of short-term corticosteroid therapy in exacerbation of mustard gas-induced chronic bronchitis. Basic Clin Pharmacol Toxicol 2005; 97:302-305.

7. Mirsadraee M, Attaran D, Boskabady MH, Towhidi M. Airway hyper responsiveness to methacholine in chemical warfare victims. Respiration  2005; 72:523-528.

8. American Thoracic Society. Standardization of spirometry: 1994 Update. Official Statement of American Thoracic Society. Am J Respir Crit Car Med  1995; 152:1107-1136.

9. American  Thoracic  Society.  Lung  Function  Testing:  Selection  of  Reference  Values  and  Interpretative Strategies. Am Rev Respir Dis 1991; 144:1202–1218.

10. Clark T, Busse W, Bousquet J, Holgate ST, Lenfant C, O Byrne P, et al. Global Initiative for asthma. Pocket guide for asthma management and prevention. Naional Institude of Health National Heart, Lung and blood Institude; publication 96-3659B 20021-29.

11. Simpson JL,Timmins NL, Fakes K, Talbot PI, Gibson PG. Effect of saliva contamination on induced sputum cell counts, IL-8 and eosinophil cationic protein levels. Eur Respir J 2004; 23 759–762.

12. Backman KS, Greenberger PA, Patterson R. Airway obstruction in pattern with long term asthma consistent with "Irreversible asthma". Chest 1997; 112:1234:1240.

13. Yilmaz S, Ekici A, Ekici M, Keles H. High-resolution computed tomography findings in elderly patients with asthma. Eur J Radiol  2006; 59:238-243.

14. Little SA, Sproule MW, Cowan MD, Macleod KJ, Robertson M, Love JG, et al. High resolution computed tomographic assessment of airway wall thickness in chronic asthma: reproducibility and relationship with lung function and severity. Thorax 2002; 57:247-253.

15. Bizeto L, Mazolini AB, Riberio M, Stelmac R, Cukier A, Nunes MPT. Interrelationship between serum and sputum inflammatory mediators in chronic obstructive pulmonary disease. Braz J Med Biol Res 2008; 41:193-198.

16.   Birring SS, Parker D, McKenna S, Hargadons B, Brightling CE, Pavrod ID, et al. Sputum eosinophilia in idiopathic pulmonary fibrosis. Inflamm Res  2005; 54:51-56.

17.  Vanaudenaerde  BM,  Meyts  I,  Vos R, Geudens N, De Wever W, Verbeken EK, et al. A dichotomy in bronchiolitis obliterans syndrome after lung transplantation revealed by azithromycin therapy. Eur Respir J 2008; 32:832-843.

18. Verleden GM. Bronchiolitis obliterans syndrome after lung transplantation: medical treatment. Monaldi Arch Chest Dis  2000; 55:140-145.