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Blood Test Could Identify Severity of Idiopathic Pulmonary Fibrosis PITTSBURGH -- February 3, 2010 -- A simple blood test could predict which patients with idiopathic pulmonary fibrosis (IPF) will become severely ill and can hopefully help researchers and physicians influence their treatment, according a study published online in PLoS One. “If we knew who was in the gravest danger from this illness, we could direct them to lung transplantation or experimental therapy immediately,” said Steven R. Duncan, MD, Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. “Also, we could possibly avoid prescribing grueling treatments for people whose disease is fairly stable.” Dr. Duncan and colleagues collected blood samples from 89 patients with IPF at various stages of disease severity, as well as 32 healthy individuals for comparison, and examined CD4 T-cells. The cells, which typically respond to infectious threats, normally carry a surface protein called CD28. The CD4 T-cells still bore their CD28 markers among patients whose disease was relatively stable, but, as a patient’s disease got worse, the CD4 T-cells lost their CD28 protein markers and the cells were unusually “revved up,” as Dr. Duncan put it. The greater the proportion of these distinctly abnormal cells in the blood, the greater the likelihood that the patient would quickly become gravely ill. In the study group, these patients were the ones who were most likely to require a lung transplant or to die within 12 months. “We suspect that as these CD4 cells repeatedly multiply, subsequent generations become abnormal,” Dr. Duncan said. “The altered cells send out signals that promote inflammatory processes, which perhaps could lead to the fibrosis of the lung tissue that characterizes IPF.” “What is remarkable about this result is that it suggests that we may be able to develop a screening test for patients with idiopathic pulmonary fibrosis, much like cholesterol levels in the case of atherosclerosis, that identifies the patients at greatest need for referral for life-saving lung transplantation,” said Mark T. Gladwin, MD, Division of Pulmonary, Allergy and Critical Care Medicine, at the Pittsburgh School of Medicine. “In addition, it provides new insights into how the immune system is dysfunctional in this disease.” SOURCE: University of Pittsburgh School of Medicine E-mail this page to a friend or colleague! To print, use this version