Am. J. Respir. Crit. Care Med., Volume 156, Number 5, November 1997, 1586-1592

Sarcoidosis: TNF- Release from Alveolar Macrophages and Serum Level of sIL-2R Are Prognostic Markers

MANFRED W. ZIEGENHAGEN, UDO K. BENNER, GERNOT ZISSEL, PETER ZABEL, MAX SCHLAAK, and JOACHIM MÜLLER-QUERNHEIM

Research Center Borstel, Medical Hospital, Borstel; and Division of Pneumology, Third Department of Internal Medicine, Johannes Gutenberg University, Mainz, Germany

At the time of diagnosis, many sarcoidosis patients have no clinical indication for corticosteroid therapy, and prognostic parameters predicting deterioration are missing. In the present study, we investigated parameters derived from bronchoalveolar lavage (BAL) and serum in 77 patients with recently diagnosed sarcoidosis to test their predictive value. Patients were divided into a group with (Group A, n = 37) and a group without (Group B, n = 40) indications for therapy, and the course of the disease was evaluated after 5.7 ± 0.4 mo. The CD4⁺/CD8⁺ lymphocyte ratio and percentage of BAL lymphocytes were of no predictive value. Release of tumor necrosis factor- (TNF-) from cultured alveolar macrophages (AM) was significantly increased in both groups (Group A = 1,872 ± 428 pg/ml; Group B = 1,561 ± 449 pg/ml) as compared with controls (220 ± 37 pg/ml). In Group B, however, patients with a high level of TNF- release had a significantly greater risk of disease progression than did those with normal TNF- release (43.8% versus 8.3%, respectively). From the serologic parameters investigated, consisting of neopterin, angiotensin converting enzyme (ACE), and soluble interleukin-2 receptor (sIL-2R), only the last was of significant predictive value; 42.1% of sarcoidosis patients in Group B with a high level of sIL-2R experienced disease progression, whereas none of those with a normal level did. We conclude that TNF- release and sIL-2R are suitable parameters for predicting disease progression in sarcoid patients who have no indication for therapy at the time of disease diagnosis.

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