Reduction of pulmonary surfactant in patients with human immunodeficiency virus infection and Pneumocystis carinii pneumonia.

Important note: Information in this article was accurate in 1993. The state of the art may have changed since the publication date.

Reduction of pulmonary surfactant in patients with human immunodeficiency virus infection and Pneumocystis carinii pneumonia.

Chest. 1992 Dec;102(6):1730-6. Unique Identifier : AIDSLINE MED/93076534
Hoffman AG; Lawrence MG; Ognibene FP; Suffredini AF; Lipschik GY; Kovacs JA; Masur H; Shelhamer JH; Critical Care Medicine Department, Warren G. Magnuson Clinical; Center, National Institutes of Health, Bethesda 20892.

Abstract: We assessed qualitative and quantitative differences in surfactant lipid composition of bronchoalveolar lavage (BAL) fluid in patients with acquired immune deficiency syndrome (AIDS) and Pneumocystis carinii (PC) pneumonia. Five normal volunteers and 27 patients with human immunodeficiency virus (HIV) infection underwent BAL for evaluation of possible pulmonary infection. Bronchoalveolar lavage studies in eight patients were negative for PC organisms, and 19 were positive. Pneumocystis carinii pneumonia was graded (mild vs moderate to severe) by initial alveolar-arterial oxygen gradient. Bronchoalveolar lavage fluid was centrifuged, the lipids were extracted from the supernatant, and total lipid profiles of dephosphorylated glycerolipids were analyzed as trimethylsilylether derivatives by high temperature gas-liquid chromatography. Phospholipase A2 levels were determined using a radiolabeled E coli membrane method. Compared to the normal volunteers (109 +/- 13 micrograms/5 ml) and the PC negative group (107 +/- 13 micrograms/5 ml), total BAL lipid was reduced for both the mild PC pneumonia group (73 +/- 10 micrograms/5 ml) and the moderate to severe PC pneumonia group (46 +/- 4 micrograms/5 ml). There was a parallel reduction of diacylglycerol lipids: normal volunteers, 52 +/- 7 micrograms/5 ml; PC negative, 52 +/- 9 micrograms/5 ml; mild PC pneumonia, 35 +/- 7 micrograms/5 ml; and moderate to severe PC pneumonia, 15 +/- 2 micrograms/5 ml. Phospholipase A2 activity in moderate to severe PC pneumonia was twice that of the PC negative patients, and 30 times that for normals. The data demonstrate a marked diminution in surfactant glycerophospholipid in patients with AIDS and PC pneumonia and suggest a potential role for surfactant abnormality in the pathophysiology of this disease.

Keywords: Adult Bronchoalveolar Lavage Fluid/CHEMISTRY Bronchoscopy Diglycerides/ANALYSIS Fatty Acids, Nonesterified/ANALYSIS Glycerides/ANALYSIS Human HIV Infections/*METABOLISM Lipids/*ANALYSIS Male Middle Age Phosphatidylcholines/ANALYSIS Phospholipases A/*ANALYSIS Phospholipids/ANALYSIS Pneumonia, Pneumocystis carinii/*METABOLISM Pulmonary Surfactants/*CHEMISTRY JOURNAL ARTICLE
930330
M9331071

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