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Low Levels of Exhaled Surfactant Protein A Associated With BOS After Lung Transplantation

Journal article
Authors Petrea Ericson
Ekaterina Mirgorodskaya
Oscar Hammar
Emilia Viklund
Ann-Charlotte Almstrand
Per Larsson
Gerdt C. Riise
Anna-Carin Olin
Published in Transplantation Direct
Volume 2
Issue 9
ISSN 2373-8731
Publication year 2016
Published at Institute of Medicine, School of Public Health and Community Medicine
Institute of Medicine, Department of Public Health and Community Medicine, Section of Occupational and environmental medicine
Core Facilities, Mammalian Protein Expression
Language en
Links 10.1097/txd.0000000000000615
Keywords bronchiolitis obliterans syndrome, innate immunity, particles, inflammation, heart
Subject categories Internal medicine


Background. There is no clinically available marker for early detection or monitoring of chronic rejection in the form of bronchiolitis obliterans syndrome (BOS), the main long-term complication after lung transplantation. Sampling and analysis of particles in exhaled air is a valid, noninvasive method for monitoring surfactant protein A (SP-A) and albumin in the distal airways. Methods. We asked whether differences in composition of exhaled particles can be detected when comparing stable lung transplant recipients (LTRs) (n = 26) with LTRs who develop BOS (n = 7). A comparison between LTRs and a matching group of healthy controls (n = 33) was also conducted. Using a system developed in-house, particles were collected from exhaled air by the principal of inertial impaction before chemical analysis by immunoassays. Results. Surfactant protein A in exhaled particles and the SP-A/albumin ratio were lower (P = 0.002 and P = 0.0001 respectively) in the BOS group compared to the BOS-free group. LTRs exhaled higher amount of particles (P < 0.0001) and had lower albumin content (P < 0.0001) than healthy controls. Conclusions. We conclude that low levels of SP-A in exhaled particles are associated with increased risk of BOS in LTRs. The possibility that this noninvasive method can be used to predict BOS onset deserves further study with prospective and longitudinal approaches.

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