Background and Objectives: In immunocytochemical preparations of bronchoalveolar lavage (BAL) cells from patients with extrinsic allergic alveolitis (EAA), we observed the presence of alveolar macrophages with cockade-like structures in their cytoplasm (cockade+ alveolar macrophages). These cockade+ alveolar macrophages may reflect a subpopulation of alveolar macrophages which may show a different predominance in various interstitial lung diseases. In this study we aimed to compare the frequency of cockade+ alveolar macrophages in patients with EAA (n = 14) with the results obtained in patients with sarcoidosis (n = 11), idiopathic interstitial pneumonia (IIP; n = 10) and control subjects (n = 8). We also investigated the expression of the transferrin receptor CD71 on cockade+ alveolar macrophages. Methods: In BAL fluid, the total number of cells and differential counts were determined, and immunocytologic examinations of macrophages and lymphocytes were done using monoclonal antibodies. The percentage of cockade+ alveolar macrophages was determined by counting 300 macrophages in the CD20 field of an immunocytochemical slide. Results: The percentage of cockade+ alveolar macrophages was significantly higher in the EAA group (36 ± 9%) compared to patients with sarcoidosis (12 ± 5%) or IIP (11 ± 10%) and control subjects (3 ± 1%; p < 0.001). The proportion of CD71+ alveolar macrophages was significantly lower in EAA than in the other groups (p < 0.01), and the CD71 antigen was expressed on a significantly lower proportion of cockade+ alveolar macrophages compared to cockade– alveolar macrophages in EAA (p < 0.001). Conclusion: We conclude that cockade+ alveolar macrophages could play a role in the pathogenesis and differential diagnosis EAA.

Semenzato G, Bjermer L, Costabel U, Haslam PL, Olivieri D, Trentin L: Clinical role of bronchoalveolar lavage in extrinsic allergic alveolitis. Eur Respir Rev 1992;2:69–74.
Milburn HJ: Lymphocyte subsets in hypersensitivity pneumonitis. Eur Respir J 1992;5:5–7.
Bourke SJ, Dalphin JC, Boyd G, McSharry C, Baldwin CI, Calvert JE: Hypersensitivity pneumonitis: Current concepts. Eur Respir J 2001;18(suppl 32):81s–92s.
McSharry C, Anderson K, Bourke SJ, Boyd G: Takes your breath away – The immunology of allergic alveolitis. Clin Exp Immunol 2002;128:3–9.
Semenzato G, Adami F, Maschio N, Agostini C: Immune mechanism in interstitial lung diseases. Allergy 2000;55:1103–1120.
Guzman J, Wang YM, Kalaycioglu O, Schoenfeld B, Hamm H, Bartsch H, Costabel U: Increased surfactant protein A content in human alveolar macrophages in hypersensitivity pneumonitis. Acta Cytol 1992;36:668–673.
Costabel U: The alveolitis of hypersensitivity pneumonitis. Eur Respir J 1988;1:5–9.
Costabel U, Bross KJ, Guzman J, Matthys H: Plasmazellen und Lymphozytensubpopulationen in der bronchoalveolaren Lavage bei exogen-allergischer Alveolitis. Prax Klin Pneumol 1985;39:925–926.
Costabel U, Bross KJ, Marxen J, Matthys H: T lymphocytosis in bronchoalveolar lavage fluid of hypersensitivity pneumonitis. Chest 1984;84:514–518.
Costabel U, Bross KJ, Rühle KH, Löhr GW, Matthys H: Ia-like antigens on T-cells and their subpopulations in pulmonary sarcoidosis and in hypersensitivity pneumonitis: Analysis of bronchoalveolar and blood lymphocytes. Am Rev Respir Dis 1985;131:337–342.
Agostini C, Trentin L, Zambello R, Luca M, Masciarelli M, Cipriani A, Marcer G, Semenzato G: Pulmonary alveolar macrophages in patients with sarcoidosis and hypersensitivity pneumonitis: Characterization by monoclonal antibodies. J Clin Immunol 1987;7:64–70.
Haslam PL, Parker DJ, Townsted PJ: Increases in HLA-DQ, DP, DR and transferrin receptors on alveolar macrophages in sarcoidosis and allergic alveolitis compared with fibrosing alveolitis. Chest 1990;97:651–661.
Pforte A, Schiessler A, Gais P, Kress Sv, Beer B, Riethmüller G, Ziegler-Heitbrock HWL: Expression of the adhesion molecule ICAM-1 on alveolar macrophages and in serum in extrinsic allergic alveolitis. Respiration 1993;60:221–226.
Hoogsteden HC, van Hal PT, Wijkhuijs JM, Hop W, Hilvering C: Expression of the CD11/CD18 cell surface glycoprotein family and MHC class II antigen on blood monocytes and alveolar macrophage in interstitial lung disease. Lung 1992;170:221–233.
Costabel U, Andreesen R, Bross KJ, Matthys H: Transferrin and transferrin receptors on alveolar macrophages in interstitial lung diseases. Am Rev Respir Dis 1985;131:A38.
Stankus RP, Cashner FM, Salvaggio JE: Bronchopulmonary macrophage activation in pathogenesis of hypersensitivity pneumonitis. J Immunol 1978;120:685–688.
Pacheco Y, Fonlupt P, Rey C, Biot N, Vergnon JM, Douss T, Pacheco H, Perrin-Fayolle M: Alveolar macrophage membrane phospholipid methylation in sarcoidosis and hypersensitivity pneumonitis. Bull Eur Physiopathol Respir 1986;22:565–572.
Costabel U, Bross KJ, Matthys H: Pulmonary sarcoidosis: Assessment of disease activity by lung lymphocyte subpopulations. Klin Wochenschr 1983;61:349–356.
Costabel U, Bross KJ, Matthys H: The immunoperoxidase slide assay. A new method for the demonstration of surface antigens on bronchoalveolar lavage cells. Eur Physiopathol Respir 1985;21:381–387.
Semenzato G: Immunology of interstitial lung disease: Cellular events taking place in the lung of sarcoidosis, hypersensitivity pneumonitis and HIV infection. Eur Respir J 1991;4:94–102.
Nakstad B, Lyber T, Skjorten F, Boye NP: Sub-populations of human lung alveolar macrophages: Ultrastructural features. Ultrastruct Pathol 1989;13:1–13.
Reynolds HY: Hypersensitivity pneumonitis: Correlation of cellular and immunologic changes with clinical phases of disease. Lung 1988;166:189–208.
Trentin L, Migone N, Zambello R: Mechanism accounting for lymphocytic alveolitis in hypersensitivity pneumonitis. J Immunol 1990;145:2147–2154.
Dakhama A, Israel-Assayag E, Cormier Y: Role of interleukin-2 in the development and persistence of lymphocytic alveolitis in farmer’s lung. Eur Respir J 1998;11:1281–1286.
Denis M: Proinflammatory cytokines in hypersensitivity pneumonitis. Am J Respir Crit Care Med 1995;151:164–169.
Gudmundsson G, Monick MM, Hunninghake GW: IL-12 modulates expression of hypersensitivity pneumonitis. J Immunol 1998;161:991–999.
Sugiyama Y, Kasahara T, Mukaida N, Matsushima K, Kitamura S: Chemokines in bronchoalveolar lavage fluid in summer-type hypersensitivity pneumonitis. Eur Respir J 1995;8:1084–1090.
Schuyler M, Gott K, Cherne A: Mediators of hypersensitivity pneumonitis. J Lab Clin Med 2000;136:29–38.
Yamasaki H, Ando M, Brazer W, Center DM, Cruikshank WW: Polarized type 1 cytokine profile in bronchoalveolar lavage T cells of patients with hypersensitivity pneumonitis. J Immunol 1999;163:3516–3523.
Israel-Assayag E, Dakhama A, Lavigne S, Laviolette M, Cormier Y: Expression of costimulatory molecules on alveolar macrophages in hypersensitivity pneumonitis. Am J Respir Crit Care Med 1999;159:1830–1834.
Costabel U, Andreesen R, Bross KJ, Kroegel C, Teschler H, Walter M: Role of cells and mediators for granuloma formation in pulmonary sarcoidosis; in Yoshida T, Torisu M (eds): Basic Mechanism of Granulomatous Inflammation. Amsterdam, Elsevier, 1989, pp 319–343.
Striz I, Pokorna-Sochurkova H, Zheng L, Jaresova M, Guzman J, Costabel U: Calprotectin expression and mononuclear phagocyte subpopulations in peripheral blood and bronchoalveolar lavage. Sarcoidosis Vasc Diffuse Lung Dis 2001;18:57–63.
Hoogsteden HC, van Hal PT, Wijkhuijs JM, Hop W, Hilvering C: Differences in expression of monocytes/macrophage surface antigen in peripheral blood and bronchoalveolar lavage cells in interstitial lung disease. Lung 1993;171:149–160.
Andreesen R, Osterholz J, Bodemann H, Bross KJ, Costabel U, Löhr GW: Expression of transferrin receptors and intracellular ferritin during terminal differentiation of human monocytes. Blut 1984;49:195–202.
Costabel U, Baur R, Guzman J, Matthys H: Surface markers on BAL cells in organic and inorganic dust diseases (abstract). Bull Eur Physiopathol Respir 1987;23(suppl 12):351s.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.