Two-dimensional Analysis of Elements and Mononuclear Cells in Hard Metal Lung Disease

• Published in: American journal of respiratory and critical care medicine Vol. 176; no. 1; pp. 70 - 77
• Main Authors: Moriyama, Hiroshi, Kobayashi, Masayoshi, Takada, Toshinori, Shimizu, Takashi, Terada, Masaki, Narita, Jun-Ichi, Maruyama, Michio, Watanabe, Kouichi, Suzuki, Eiichi, Gejyo, Fumitake
• Format: Journal Article
• Language: English
• Published: New York, NY Am Thoracic Soc 01.07.2007; American Lung Association; American Thoracic Society
• Subjects: Adult; Alloys - adverse effects; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Antigens, CD - immunology; Antigens, Differentiation, Myelomonocytic - immunology; Biological and medical sciences; Biopsy; Blood. Blood and plasma substitutes. Blood products. Blood cells. Blood typing. Plasmapheresis. Apheresis; Bone marrow, stem cells transplantation. Graft versus host reaction; Case-Control Studies; CD8-Positive T-Lymphocytes - immunology; Chemical elements; Cobalt; Cobalt - adverse effects; Cobalt - immunology; Cohort Studies; Dimensional analysis; Electrons; Female; Giant Cells, Foreign-Body - immunology; Giant Cells, Foreign-Body - pathology; Humans; Immunohistochemistry; Intensive care medicine; Lung diseases; Lung Diseases, Interstitial - immunology; Lung Diseases, Interstitial - pathology; Lymphocytes; Macrophages, Alveolar - immunology; Macrophages, Alveolar - pathology; Male; Medical sciences; Middle Aged; Occupational Exposure; Pathogenesis; Patients; Phagocytosis - immunology; Pneumonia; Rap music; Receptors, Cell Surface - immunology; T-Lymphocytes, Cytotoxic - immunology; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Tungsten - adverse effects; Tungsten - immunology; Tungsten Compounds - adverse effects; Tungsten Compounds - immunology; X-rays; Japan; Lung disease; Intensive care; Respiratory disease; Metal; CD163 antigen; electron probe microanalysis; hard metal; Mononuclear cell; interstitial lung disease; T-Lymphocyte; Interstitial pneumonitis; CDB-positive T lymphocytes; Resuscitation
• ISSN: 1073-449X; 1535-4970; 1535-4970
• DOI: 10.1164/rccm.200601-134OC

Hard metal lung disease is caused by exposure to hard metal, a synthetic compound that combines tungsten carbide with cobalt as well as a number of other metals. Interstitial lung disease caused by hard metal is uniquely characterized by giant cell interstitial pneumonia. The pathogenesis of hard metal lung disease is unclear. To elucidate the distribution of inhaled hard metal and reactive inflammatory cells in biopsy lung tissue from patients with hard metal lung disease. Seventeen patients with interstitial lung disease in which tungsten was detected and five control subjects were studied. Detection and mapping of elements were performed with an electron probe microanalyzer equipped with a wavelength dispersive spectrometer. We immunohistochemically stained mononuclear cells, in tissue samples available from five patients, with anti-human CD4, CD8, CD20, CD68, and CD163 antibodies, and compared the distribution of positive cells with hard metal elements. Thirteen of 17 patients were pathologically diagnosed as having giant cell interstitial pneumonia. Tungsten and cobalt were accumulated in the centrilobular fibrotic lesions, but were never found in the control lungs. CD8+ lymphocytes and CD163+ monocyte-macrophages were distributed predominantly in centrilobular fibrotic lesions around the hard metal elements. CD163+ colocalized with tungsten. Small numbers of CD8+ and CD163+ cells were also immunohistochemically shown in peribronchiolar areas and alveolar walls. Macrophages may phagocytose inhaled tungsten via CD163 and play an important role in forming the fibrotic lesion of hard metal lung disease with cytotoxic T lymphocytes.