Effect of Aspergillus fumigatus sensitization and colonization on lung function and airways inflammation in asthma

The sensitization and exposure to fungal allergens have been reported to be associated with asthma. The importance of Aspergillus fumigatus [AF] sensitization and colonization of the airways in patients with asthma is unclear. To clarify the effect of sensitization and airways colonization of AF on lung function and airways inflammation in asthma. We studied 66 patients with asthma. Patients were classified into two groups according to AF sensitization: [1] AF-sensitized [immediate cutaneous reactivity >3 mm]; and [2] AFnonsensitized. A positive sputum culture for AF confirmed airways colonization by AF. Routine spirometry was performed for all patients. Airways inflammation was assessed by sputum differential inflammatory cell count. Asthma duration was significantly longer in AF-sensitized asthmatics. Significantly higher rates of positive AF-culture were detected in sputum from AF-sensitized asthmatics [63%] in comparison to AF-nonsensitized asthmatics [31%]. FEV1 and FEV1/FVC were more reduced in AF-sensitized asthmatics in comparison to AF-nonsensitized asthmatics. Sputum neutrophils count was significantly higher in AF-sensitized asthmatics in comparison to AF-nonsensitized asthmatics. Sputum eosinophils did not differ between AF-sensitized and AF-nonsensitized asthma groups, concordant with peripheral blood eosinophils, which did not differ significantly between groups. Multilinear regression analysis predicting FEV1% showed that AF sensitization and sputum neutrophil count were the most important predictors of FEV1 [p= 0.016 for both], followed by positive sputum culture for AF and sputum eosinophil count [p= 0.024 and 0.046 respectively]. [p = 0.105]. AF detection in sputum is associated with AF-sensitization, neutrophilic airway inflammation, and reduced lung function. This supports the concept that development of fixed airflow obstruction in asthma is consequent upon the damaging effects of airway colonization with AF

Increased tumor necrosis factor [TNF] level in patients with bronchogenic carcinoma with higher values in patients with bone marrow metastasis

TNF is a protein produced by various cell types, mainly monocytes, and has been originally shown to induce necrosis of tumors in vivo. Serum TNF-alpha levels were demonstrated by radioimmunoassay in 17 patients with bronchogenic carcinoma [9 cases with small cell carcinoma and 8 with squamous cell carcinoma]. TNF level was significantly increased in 14 patients [65 +/- 12 ng/L] in comparison with the control group [19 +/- 6 ng/L]. The highest TNF level was encountered in patients with small cell carcinoma, especially in those with bone marrow metastasis [3 cases]. The variation in the TNF level may be due to a variation in immunogenicity of different pathological types or a variation in the TNF receptor numbers of affinity on different cell types. TNF may have a role in the progress of the disease and the bone marrow Involvement