Measurement of Ceruloplasmin in the Lungs of Patients with Acute Respiratory Distress Syndrome: Is Plasma or Local Production the Major Source?

BACKGROUND: Oxidant-induced tissue damage is thought to contribute to the lung injury seen in patients with acute respiratory distress syndrome (ARDS). Ceruloplasmin (CP) is a major circulating antioxidant, increased levels of which have been measured in bronchoalveolar lavage fluid (BALF) taken from such patients. Traditionally, CP detected in these circumstances was thought to be plasma-derived, moving into the alveolar spaces as a consequence of the increased alveolar-capillary permeability that characterises ARDS. However, recent studies in murine models suggest that CP may be synthesised in the airways and even alveoli under physiological conditions. OBJECTIVES: The aims of this investigation were therefore to identify the source of any increased levels of CP detectable in BALF taken from patients with established ARDS. METHODS: Matched BALF and plasma samples taken from patients with ARDS (n = 46) and from controls without lung disease (n = 11) were analysed for CP (132 kD) and plasma specific albumin (ALB, 68 kD) and (alpha(2)-macroglobulin (alpha(2)-M, 820 kD). RESULTS: All three proteins were increased in BALF taken from patients with ARDS compared to controls (p < 0.01, ALB and CP; p < 0.001, alpha(2)-M). When protein levels were expressed as the ratios of BALF: plasma (designated Q), Q(CP) and Q(alpha2)-M increased in parallel to Q(ALB) (p < 0.001), indicating that all increases were primarily plasma-derived. Their relative coefficients of excretion (RCE: Q(CP)/Q(ALB) and Q(alpha2)-M/Q(ALB)) demonstrated that the larger molecular weight protein, alpha(2)-M, gave the best discrimination between patients with ARDS and normal controls (0.85 vs. 0.04; p < 0. 01), indicating that this was the most sensitive marker of alveolar-capillary permeability. CONCLUSIONS: Increased levels of CP in BALF from patients with ARDS are mainly attributable to plasma exudation.