Published ahead of print on November 16, 2006, doi:10.1164/rccm.200601-107OC
Am. J. Respir. Crit. Care Med., Volume 175, Number 3, February 2007, 222-227
A more recent version of this article appeared on February 1, 2007
Submitted on January 24, 2006
Accepted on November 10, 2006
Comparison of Biomarkers in Exhaled Breath Condensate and Broncho-Alveolar Lavage
Abigail S Jackson1, Alessandra Sandrini1, Charlotte Campbell1, Sharron Chow2, Paul S Thomas2, and Deborah H Yates1*
1 Department of Thoracic Medicine, St. Vincent's Hospital, Darlinghurst, Sydney, New South Wales, Australia,
2 University of NSW, Randwick, Sydney, New South Wales, Australia
* To whom correspondence should be addressed. E-mail: deborahy88{at}hotmail.com.
Rationale: Exhaled breath condensate (EBC) is increasingly studied as a non-invasive research method of sampling the lungs, measuring several biomarkers. The exact site
of origin of substances measured in EBC is unknown, as is the clinical applicability of the technique. Special techniques might be needed to measure EBC biomarkers.
Objectives: To assess biomarker concentrations in clinical disease and investigate the site of origin of EBC, we compared EBC and BAL biomarkers in 49 patients
undergoing bronchoscopy for clinical indications.
Measurements: We measured exhaled nitric oxide (eNO), 8-isoprostane, hydrogen peroxide, total nitrogen oxides (NOx), pH, total protein, and phospholipid (n=33) and
keratin (n=15) to assess alveolar and mucinous compartments respectively. EBC was collected over 10 minutes using a refrigerated condenser according to ERS/ATS recommendations, and BAL performed immediately thereafter.
Results: 8-isoprostane, NOx and pH were significantly higher in EBC than in BAL (3,844.8 pg/ml vs 26.5 pg/ml; 28.4 vs 3.8 µM; 7.35 vs 6.4 respectively; p<0.001).
Hydrogen peroxide showed no difference between EBC and BAL (17.5 µM vs 20.6 µM; p=NS) whereas protein was significantly higher in BAL (33.8 vs 183.2 µg/ml;
p<0.001). Total phospholipid was also higher in EBC, but keratin showed no difference. No significant correlation was found between EBC and BAL for any of the biomarkers evaluated either before or after correction for dilution.
Conclusions: In clinical disease, markers of inflammation and oxidative stress are easily measurable in EBC using standard laboratory techniques and EBC is readily
obtained. However, EBC and BAL markers do not correlate.
Key words: Exhaled breath condensate (EBC), broncho-alveolar lavage (BAL), biomarkers, oxidative stress, inflammation
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