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Surfactant Protein A in Exhaled Endogenous Particles Is Decreased in Chronic Obstructive Pulmonary Disease (COPD) Patients: A Pilot Study

Journal article
Authors Mona Lärstad
Ann-Charlotte Almstrand
Per Larsson
Björn Bake
Sven Larsson
Evert Ljungström
Ekaterina Mirgorodskaya
Anna-Carin Olin
Published in Plos One
Volume 10
Issue 12
Pages e0144463
ISSN 1932-6203
Publication year 2015
Published at Institute of Medicine, School of Public Health and Community Medicine
Institute of Medicine
Department of Chemistry and Molecular Biology
Institute of Medicine, Department of Internal Medicine and Clinical Nutrition
Pages e0144463
Language en
Keywords bronchoalveolar lavage, airway-obstruction, oxidative stress, healthy, smokers, lung-disease, breath, biomarkers, asthma, progression, expression
Subject categories Environmental Health and Occupational Health


Background Exhaled, endogenous particles are formed from the epithelial lining fluid in small airways, where surfactant protein A (SP-A) plays an important role in pulmonary host defense. Based on the knowledge that chronic obstructive pulmonary disease (COPD) starts in the small airway epithelium, we hypothesized that chronic inflammation modulates peripheral exhaled particle SP-A and albumin levels. The main objective of this explorative study was to compare the SP-A and albumin contents in exhaled particles from patients with COPD and healthy subjects and to determine exhaled particle number concentrations. Patients with stable COPD ranging from moderate to very severe (n = 13), and healthy nonsmoking subjects (n = 12) were studied. Subjects performed repeated breath maneuvers allowing for airway closure and re-opening, and exhaled particles were optically counted and collected on a membrane using the novel PExA1 instrument setup. Immunoassays were used to quantify SP-A and albumin. COPD patients exhibited significantly lower SP-A mass content of the exhaled particles (2.7 vs. 3.9 weight percent, p = 0.036) and lower particle number concentration (p<0.0001) than healthy subjects. Albumin mass contents were similar for both groups. Decreased levels of SP-A may lead to impaired host defense functions of surfactant in the airways, contributing to increased susceptibility to COPD exacerbations. SP-A in exhaled particles from small airways may represent a promising non-invasive biomarker of disease in COPD patients.

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