• Nicola Lanzarone, Francesco Gentili, Valerio Alonzi, Laura Bergantini, Miriana d'Alessandro, Paola Rottoli, Rosa Metella Refini, Maria Pieroni, Lucia Vietri, Francesco Bianchi, Maria Antonietta Mazzei, Luca Volterrani, Anna Perrone, Paolo Cameli, Elena Bargagli, and Piersante Sestini.
• Respiratory Diseases and Lung Transplant Unit, Department of Medical and Surgical Sciences and Neurosciences, Siena University Hospital, 53100, Siena, Italy.
• Intern Emerg Med. 2020 Oct 1; 15 (7): 1247-1254.

AbstractChronic hypersensitivity pneumonitis (cHP) is a fibrotic interstitial lung disease (ILD) resulting from inhalation of different organic substances and chemical compounds determining an inflammatory and immunological response in sensitized individuals. KL-6, a human mucin protein expressed by type 2 pneumocytes, has been proposed as a prognostic biomarker of cHP. Assessment of usefulness KL-6 in ILD has been investigated primarily in Asiatic population. The aim of this study was to evaluate clinical utility of KL-6 in serum and bronchoalveolar lavage (BAL). In this study, we retrospectively analysed clinical, radiological and immunological data of a cohort of 42 patients affected by cHP: KL-6 concentrations were collected from serum and BAL. KL-6 clinical value was assessed through the analysis of association between KL-6 concentrations and clinical, functional, immunological and radiological features. KL-6 serum concentration results increased in 28/34 patients (82%). A positive direct correlation was observed between KL-6 concentrations in BAL and serum (r = 0.62, p < 0.05). In our study population we found that patients with extensive presence of ground glass opacities and centrilobular nodules at high-resolution computed tomography (HRCT) showed the highest concentrations of KL-6 in BAL and a predominantly CD3+ CD8+ BAL lymphocytosis. BAL lymphocytosis and KL-6 concentrations showed a direct correlation. BAL KL-6, a result of alveolar damage, caused in cHP by CD3+ CD8+ mediated flogosis and suggested by radiological evidence of ground-glass opacities and centrilobular nodules, can be considered a useful biomarker to assess, along with BAL cellular analysis and HRCT findings, disease activity.

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