Protein permeability in the adult respiratory distress syndrome. Loss of size selectivity of the alveolar epithelium

J. F. Holter, J. E. Weiland, E. R. Pacht, J. E. Gadek, W. B. Davis

Research output: Contribution to journalArticle

160 Scopus citations

Abstract

Small amounts of plasma protein normally reach the alveolar epithelial surface by a size-selective process that restricts the passage of very large molecules. Size selectivity may be compromised in the lungs of patients with the adult respiratory distress syndrome (ARDS). To assess this question, bronchoalveolar lavage fluid (BALF) from normal volunteers (n = 11), cardiac edema patients (n = 3), and ARDS patients (n = 8) was compared. Mean total protein in ARDS BALF was >12 times the levels in normals or cardiac edema patients. BALF/plasma total protein ratios and measurements of epithelial lining fluid protein also separated the patient groups. The large proteins IgM and α2-macroglobulin were found in ARDS BALF at >90 times the concentrations of normal or cardiac edema fluid. The relationship of distribution coefficient vs. log molecular weight for seven proteins (54,000-900,000 mol wt) hyperbolically increased in normals but was flat in ARDS patients. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis revealed a paucity of high molecular weight proteins in normal and cardiac edema BALF, but demonstrated the full spectrum of plasma proteins in ARDS BALF. We conclude that normal size selectivity is preserved in cardiac edema but is destroyed by the alveolar-capillary injury of ARDS.

Original languageEnglish (US)
Pages (from-to)1513-1522
Number of pages10
JournalJournal of Clinical Investigation
Volume78
Issue number6
DOIs
StatePublished - 1986

ASJC Scopus subject areas

  • Medicine(all)

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