Abstract
BackgroundSerum KL-6 is a useful biomarker for the diagnosis of interstitial lung diseases (ILD). However, KL-6 has not been used to discriminate different types of ILD. Serum KL-6 concentrations can vary depending on antigen exposure levels in patients with hypersensitivity pneumonitis (HP); however, seasonal changes in serum KL-6 concentrations in ILD have not been determined. We hypothesized that seasonal variation of serum KL-6 is greater in HP than for the other ILD. The aim of this study was to determine seasonal variation of serum KL-6 concentrations in various ILD.MethodsSerum KL-6 concentrations in the summer season from June 1 to September 30 and the winter season from November 1 to February 28 were retrospectively analyzed in patients with idiopathic pulmonary fibrosis (IPF, n = 16), non-specific interstitial pneumonia (NSIP, n = 16), collagen vascular disease-associated interstitial pneumonia (CVD-IP, n = 33), house-related HP (House-HP, n = 9), bird-related HP (Bird-HP, n = 9), and combined pulmonary fibrosis and emphysema (CPFE, n = 13).ResultsBird-HP and House-HP showed greater seasonal serum KL-6 variation than the other ILD. Serum KL-6 concentrations in Bird-HP were significantly increased in the winter and KL-6 concentrations in House-HP were significantly increased in the summer. Serum KL-6 variation was significantly greater in acute HP than chronic HP. Receiver operating characteristic curve analysis revealed that greater seasonal variation in serum KL-6 concentrations is diagnostic for Bird-HP.ConclusionHP should be considered in ILD with greater seasonal changes in serum KL-6 concentrations.
Highlights
Serum Krebs von den Lungen-6 (KL-6) is a useful biomarker for the diagnosis of interstitial lung diseases (ILD)
The variation of KL-6 during the summer (Smax/Smin) in patients with House-hypersensitivity pneumonitis (HP) was significantly greater than bird-related HP (Bird-HP) (P = 0.003) and showed a tendency to be greater than Combined pulmonary fibrosis and emphysema (CPFE) (P = 0.004), CVDIP (P = 0.021), idiopathic pulmonary fibrosis (IPF) (P = 0.033), or non-specific interstitial pneumonia (NSIP) (P = 0.037) (Table 1, Figure 1C)
We evaluated seasonal variations in serum KL-6 concentrations in various ILD, including IPF, NSIP, collagen vascular diseaseassociated interstitial pneumonia (CVD-IP), HP, and CPFE, and confirmed that seasonal changes of serum KL-6 concentrations were greater in HP especially Bird-HP than for the other ILD
Summary
Serum KL-6 is a useful biomarker for the diagnosis of interstitial lung diseases (ILD). Regenerating type II pneumocytes in patients with interstitial lung diseases (ILD) highly express KL-6 [1]. Serum concentrations of KL-6 have been reported to serve as a sensitive biomarker for the diagnosis and monitoring of therapeutic responses in various ILD, including idiopathic pulmonary fibrosis (IPF), non-specific interstitial pneumonia (NSIP), collagen vascular diseaseassociated interstitial pneumonia (CVD-IP), hypersensitivity pneumonitis (HP), some types of drug-induced pneumonitis, pulmonary sarcoidosis, Pneumocystis jirovecii pneumonia (PCP), Cytomegalovirus (CMV) pneumonia, and radiation pneumonitis [1,2,3,4,5,6,7,8]. Possible causes of unexpected serum KL-6 elevation in patients with ILD include acute exacerbation of ILD, exacerbation of HP by increased antigen exposure, the development of PCP, CMV pneumonia, drug-induced pneumonitis, or adenocarcinoma of lung, breast, pancreas, ovary, colon and liver
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