Chest
Volume 96, Issue 1, July 1989, Pages 68-73
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New Serum Indicator of Interstitial Pneumonitis Activity: Sialylated Carbohydrate Antigen KL-6

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Serum levels of a high molecular weight circulating antigen KL-6, detected by means of a sandwich assay using a monoclonal antibody KL-6 against a sialylated carbohydrate antigen, were evaluated for usefulness in monitoring the activity of interstitial pneumonitis. Abnormally high levels of KL-6 antigen were observed in the sera of 34 (58 percent) of 59 patients with interstitial pneumonitis. There was no significant correlation between serum values of KL-6 antigen and LDH activity. There was a positive correlation between KL-6 antigen levels and the degree of clinical disease activity as measured by 67Ga-citrate scintigram and the clinical course. Though this is a preliminary study, these observations suggest that the serum level of KL-6 antigen may be a useful indicator of disease activity in patients with interstitial pneumonitis. It does not appear to be useful, however, in the differential diagnosis of interstitial pneumonitis from malignant and nonmalignant diseases. (Chest 1989; 96:68-73)

Section snippets

Clinical Subjects

The clinical sample for this study consisted of 77 patients with interstitial pneumonitis, 21 with alveolar pneumonia, 15 with chronic bronchitis, nine with bronchial asthma, ten with emphysema, five with bronchiectasis, 21 with pulmonary tuberculosis, and ten with diffuse panbronchiolitis. The control groups consisted of 86 men and 74 women, ranging in age from 25 to 63 years, all of whom were in good health. The interstitial pneumonitis group included patients with six different types of

Distribution of KL-6 Antigens in Interstitial Pneumonitis and Normal Lung Tissues

The immunoperoxidase-labeled KL-6 antibody reacted strongly in normal lung tissues with type 2 pneumocytes and respiratory bronchiolar epithelial cells. The reaction was weak with basal cells of the terminal bronchiolar epithelium, a small number of middle layer cells of the bronchial epithelium and serous cells of the bronchial gland. The KL-6 antibody did not react with type 1 pneumocytes, goblet cells or mucous cells of the bronchial gland. The distribution of KL-6 antigens was different

DISCUSSION

At the present time, there are few diagnostic procedures which are of practical value in the evaluation of the clinical activity of patients with IIP.9 Open lung biopsy is traumatic and may result in complications such as pneumothorax or acute exacerbation of IIP. The use of 67Ga-citrate scintigrams is possible only at hospitals which have facilities for employing radioisotopes. Furthermore, frequent 67Ga scintigrams are not advised in order to avoid excess radiation exposure of the patient.

ACKNOWLEDGMENTS

The authors gratefully acknowledge the excellent technical assistance of Kyoko Ozaki, Yoshiko Watanabe, Yoko Mizunoe and Tomoko Hokao. We also wish to thank Professor Shoji Tokuoka, the Second Department of Pathology, Hiroshima University School of Medicine, for providing tissue specimens. Sera were provided by Dr. Masao Kuwabara, Hiroshima Prefectural Hospital; Dr. Hiroshi Fukuda, Mizushima Kyodo Hospital; Dr. Hiroya Egawa, Asa City Hospital; Dr. Mikio Fujita, Yoshijima Hospital; and Dr.

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The Radiation Effects Research Foundation (formerly the Atomic Bomb Casualty Commission) was established in April 1975 as a private, nonprofit Japanese foundation, supported equally by the Government of Japan, through the Ministry of Health and Welfare, and the Government of the United States, through the National Academy of Sciences under contract with the U.S. Department of Energy.

Manuscript received August 8; revision accepted November 24.

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