This study will examine the different types of proteins present in the lungs of patients with
pneumonia to explore the causes of different types of the disease. Pneumonia is a condition
that causes lung inflammation AND is often caused by an infection. It is usually diagnosed by
lung x-rays and listening to the chest with a stethoscope. This method can diagnose
pneumonia, but it does not provide information on the cause of the inflammation - information
that might be helpful in guiding treatment. This study will measure proteins in the lungs of
patients to see if certain proteins are associated with specific forms of pneumonia, and can
thus serve as biomarkers for disease.
Patients undergoing diagnostic bronchoscopy at the NIH Clinical Center may participate in
this study. Patients will undergo bronchoscopy and bronchoalveolar lavage as scheduled for
their medical care. For this procedure, the patient's mouth and throat are numbed with
lidocaine; a sedative may be given for comfort. A thin flexible tube called a bronchoscope is
advanced through the nose or mouth into the lung airways to examine the airways carefully.
Saline (salt water) is then injected through the bronchoscope into the air passage, acting as
a rinse. A sample of fluid is then withdrawn for microscopic examination. Researchers in the
current study will use some of the fluid obtained from the lavage to examine for protein
In addition to the bronchoscopy and bronchoalveolar lavage, participants will have about 2
tablespoons of blood drawn to compare blood test results with the results of the lung
washings. Patients' medical records will be reviewed to obtain information on past medical
history, current medical treatment, vital signs, and results of x-ray tests.
The objective of this study is to analyze bronchoalveolar lavage fluid from patients with
lung infiltrates in order to discover new biomarkers and protein expression patterns that are
associated with specific types of pulmonary disease. Bronchoalveolar lavage (BAL) is a
standard method to obtain lower airway samples to evaluate pulmonary infiltrates in order to
diagnose infection, malignancy or non-infectious inflammation. After collecting the lavage,
the clinical microbiology laboratory concentrates the formed elements (i.e. pathogens and
cells) for stains and culture and discards the BAL supernatant. The supernatant however is a
rich source of proteins and other molecules. We hypothesize that BAL fluid supernatant will
be an important source of biomarkers that reflect host-pathogen interactions. The analysis of
protein mass profiles and biomarker identification in BAL fluid supernatant may help develop
new diagnostic methods and extend our understanding of mechanisms of lung inflammation due to
The study population will include all patients undergoing bronchoscopy for clinical
indications at the Clinical Center who provide informed consent for chart review and
proteomic analysis of BAL supernatant, as described in this protocol. We hope to acquire BAL
samples that reflect a spectrum of community-acquired and opportunistic pathogens associated
with pulmonary disease. In addition analysis of a range of non-infectious pulmonary processes
(e.g. acute lung injury, acute respiratory distress syndrome and engraftment syndrome) is
important to develop measures of sensitivity and specificity.
This is a prospective observational study.
The expected outcome is to develop a database of protein mass profiles of BAL fluid linked to
specific microbiologic diagnoses. Our expectation is to acquire 1,000 specimens from the
Clinical Center with a range of clinical diagnoses including bacterial, viral, parasitic and
fungal infections and sterile inflammation. When a sufficient number of samples in an
individual category is collected (approximately 20-30), the samples will be analyzed with
current proteomic techniques.
- INCLUSION CRITERIA:
All eligible patients undergoing diagnostic bronchoscopy who provide consent for proteomic
analysis of BAL fluid supernatant and chart review of patient characteristics will be
included in this study.
Patients undergoing bronchoscopy but not wanting to participate with either the chart
review or the proteomic analysis of BAL fluid supernatant will be excluded.