Pleural Fluid Levels of Vascular Cell Adhesion Molecule-1 Are Elevated in Eosinophilic Pleural Effusions

Interleukin-5-producing malignant pleural mesothelioma with eosinophilic pleural effusion

Malignant tumors are often associated with eosinophilic pleural effusion. Here, we encountered a case of interleukin‐5 (IL‐5)‐producing malignant pleural mesothelioma with eosinophilic pleural effusion. The patient was a 50‐year‐old male. He had a history of a cough for several weeks and had visited a local doctor. Left pleural effusion was noted, and the patient was referred to our hospital. He was diagnosed with malignant pleural mesothelioma by pleural biopsy, with eosinophilic pleural effusion. IL‐5 in the pleural effusion increased, and tumor cells were IL‐5‐positive by immunostaining. There have been few reports of IL‐5‐producing tumors, and this is the first report of IL‐5‐producing malignant pleural mesothelioma. Host‐tumor cell interactions cause eosinophilic pleural effusion. In patients with eosinophilic pleural effusion, malignant pleural effusion should be considered. It is necessary to clarify the pathophysiology of malignant tumors and eosinophils.

Diagnostic and Prognostic Significance of Inflammatory Markers in Lung Cancer-Associated Pleural Effusions

Besides massive expression in inflammatory pleural effusions, inflammatory markers are also present in cancer-induced pleural effusions. Recent advances in cancer biology point to a role of inflammatory signaling in cancer and encourage reconsidering the diagnostic and prognostic value of inflammatory markers. Here an attempt was made to relate protein levels of inflammatory markers to underlying malignant processes in the pleural space.

Pleural effusions from lung cancer patients (n=116) were subjected to a multifactorial analysis covering 13 inflammatory markers. The composition of tumor-associated effusions was compared with that of parainflammatory pleural effusions (n=30), transudates (n=18), and serum values, and evaluated in relation to cancer origin, histology, cytology, pleural involvement, treatment history, and survival time.

Inflammatory markers were significantly expressed in pleural effusions of paraneoplastic origin when compared to transudates and most serum levels. Values in pleura-invading and metastatic tumor-associated effusions were typically higher than those of other tumors. Many markers correlated negatively with survival, most prominently IL-8 (r=–0.36, p=0.001) and VEGF (r=–0.35, p=0.001).

It appears that most inflammatory markers are highly expressed in tumor-associated pleural effusions, reflecting to some extent tumor origin and localization. Despite the lower efficacy of inflammatory markers in the differentiation between exudative pleural effusions, some inflammatory markers may represent potential prognostic markers of malignant processes in the pleural space.

Decreased proinflammatory cytokines production in children with complicated parapneumonic pleural effusion after intrapleural fibrinolytic treatment

Intrapleural fibrinolytic therapy (IFT) provides clinical benefit in the treatment of complicated pleural parapneumonic effusion (CPE). Whether IFT influences the proinflammatory cytokines production and fibrinlytic activity is currently unclear. Therefore, we collected pleural effusion samples from CPE patients with IFT (study group) and patients without IFT (control group). A membrane human inflammatory cytokines array kit was used to compare the difference of targeted cytokine production between these two groups. Enzyme-linked immunosorbent assay (ELISA) methods were used for quantitative analysis of targeted cytokines and fibrinolytic enzymes. The results showed there were no significant differences between the study (n = 16) and control (n = 14) groups in patients' demographic data. After fibrinolytic therapy, the patients in the study group had significant lower plasminogen activator inhibitor (PAI) level (732.36+/-254.09 ng/mL vs 1,509.36+/-1,340.11 ng/mL, p<0.05) and higher urokinase plasminogen activator (u-PA) level (75.56+/-41.70 ng/mL vs 6.87+/-5.07 ng/mL, p<0.05) than they did before treatment. Moreover, the tissue inhibitors of metalloproteinase-2 (TIMP-2) (1,560.03+/-403.49 pg/mL vs 3,686.45+/-1,263.83 pg/mL, p<0.05) and inflammatory chemokine, regulated on activation normal T-cell expressed and secreted/chemokine (C-C motif) ligand 5 (RANTES), (293.58+/-212.93 pg/mL vs 749.27+/-53.79 pg/mL, p<0.05), were also significantly lower in the study group after fibrinolytic therapy, but not in the control group. In conclusion, intrapleural fibrinolytic treatment with urokinase could enhance fibrinolytic activity and decrease TIMP-2 and RANTES production.

Pleural fluid and peripheral eosinophilia from hemothorax: hypothesis of the pathogenesis of EPE in hemothorax and pneumothorax

Blood and air in the pleural space are the most common conditions associated with an eosinophilic pleural effusion. The recruitment of eosinophils is dependent upon stimulation by cytokines, specifically interleukin (IL)-3, IL-5, granulocyte-monocyte cell stimulating factor (GM-CSF), and RANTES (regulated upon activation, normal t-cell expressed and secreted), that cause eosinophil proliferation in the bone marrow, movement into the circulation, and adhesion and migration across endothelial barriers into tissues. There are several possible mechanisms that can explain eosinophilic pleural effusions. We report a case of an eosinophilic pleural effusion after spontaneous hemothorax that illustrates the course of pleural fluid and blood eosinophilia in following hemothorax and describe the different pathophysiology of eosinophil trafficking in the pleural space and serum following hemothorax and pneumothorax.

Pneumothorax-Associated Pleural Eosinophilia in Mice Is Interleukin-5 but Not Interleukin-13 Dependent

STUDY OBJECTIVES

To establish a murine model of pneumothorax-associated pleural eosinophilia and to examine the role of interleukin (IL)-5 and IL-13 in the pathogenesis of this reaction.

DESIGN

An animal study.

INTERVENTIONS

One hundred thirty-seven C57/Bl-6 mice were used in this study. Wild-type animals were injected intrapleurally with 0.4 mL of air and were killed at different time points (30 min to 7 days) after the injection. IL-5 knockout and IL-13 knockout animals were killed 24 h and 48 h after the injection. Pleural inflammation was assessed by pleural lavage (PL).

MEASUREMENTS AND RESULTS

PL cells were significantly increased following the induction of pneumothorax. The peak number of neutrophils, observed at 12 h, was 900 times higher than the control. The peak number of eosinophils, observed at 48 h, was 700 times higher than the control. Lymphocytes and mononuclear cells increased threefold and fourfold, respectively. IL-5 knockout mice had significantly less PL eosinophils than that the wild-type or the IL-13 knockout mice at 24 h (150 +/- 46/microL, 903 +/- 244/microL, and 912 +/- 168/microL, respectively; p = 0.013) and 48 h (181 +/- 45/microL, 1,587 +/- 212/microL, and 1,379 +/- 364/microL, respectively; p = 0.003).

CONCLUSION

Pneumothorax induces an inflammatory reaction of the mouse pleura, mainly characterized by increased neutrophils and eosinophils. IL-5 but not IL-13 is required for pneumothorax-associated pleural eosinophilia.

Eotaxin-3 and interleukin-5 pleural fluid levels are associated with pleural fluid eosinophilia in post-coronary artery bypass grafting pleural effusions

OBJECTIVES

The primary aim of this study was to examine the association between pleural fluid (PF) eosinophilia, and the PF and serum levels of interleukin (IL)-5, eotaxin-2, eotaxin-3, and vascular cell adhesion molecule (VCAM)-1 in patients with post-coronary artery bypass grafting (CABG) pleural effusions.

DESIGN

A prospective observational study.

SETTING

A tertiary teaching hospital.

PATIENTS AND METHODS

Thirty-eight patients with post-CABG pleural effusions were recruited into the study. An effusion that contained at least 10% eosinophils was called "eosinophilic." The PF and serum levels of the cytokines and VCAM-1 were measured using an enzyme-linked immunosorbent assay.

RESULTS

(1) The number of PF eosinophils significantly correlated with the number of blood eosinophils. (2) PF IL-5 levels were significantly higher than the corresponding serum levels, and there was a significant correlation between the PF and serum IL-5 levels. PF IL-5 levels significantly correlated with the PF eosinophil count, and serum IL-5 levels significantly correlated with the number of blood eosinophils. (3) PF eotaxin-3 levels were significantly higher than serum levels, and PF eotaxin-3 levels significantly correlated with the PF eosinophil count. (4) PF VCAM-1 levels were significantly lower than the corresponding serum levels, and PF VCAM-1 levels were significantly higher in eosinophilic pleural effusions (EPEs) than in non-EPEs.

CONCLUSION

In patients with post-CABG pleural effusions, IL-5 and eotaxin-3 are produced preferentially in the pleural cavity, and they are strongly associated with PF eosinophilia.

Lymphocytes in pleural disease

PURPOSE OF REVIEW

Lymphocytic pleural effusions are characterised by divergent cellular responses depending on the etiology of disease. The pathogenic role of lymphocytes in pleural disease, however, remains unclear. This review provides a basic description of the functions of the different lymphocyte subsets within the pleural space and then summarises recent studies of lymphocyte biology in pleural disease.

RECENT FINDINGS

The mechanisms of lymphocyte trafficking into the pleural space have been clarified. Specific adhesion molecules (such as intercellular adhesion molecule-1 and vascular cell adhesion molecule-1) and chemokines (CXCL13, interleukin-8, and monocyte chemotactic protein-1) have been identified as important factors involved in the accumulation of lymphocytes during inflammatory pleuritis. Both cellular and soluble factors may contribute to impaired T-cell immunity in malignant pleural effusions. Studies of natural killer cell and gammadelta T-cell biology indicate that these lymphocyte subsets may also play a role in the pathogenesis of pleural disease. The dominant Th1 response characterised by tuberculous pleuritis may allow for rapid diagnosis of disease. Furthermore, strategies for improving cytotoxic T-cell and natural killer cell function show promise for treatment of malignant pleural disease.

SUMMARY

Recent work has provided insight into the pathogenesis of disease in lymphocytic pleural effusions. Further study of specific cellular responses may offer significant opportunities in the diagnosis and management of these disorders.