Study of Lung Proteins in Patients With Pneumonia
Study of Lung Proteins in Patients With Pneumonia
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 A sample of fluid is then withdrawn for microscopic examination.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
 content.

 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.
OBJECTIVE:

 The objective of this study is to analyze bronchoalveolar lavage (BAL) fluid from patients
 with lung infiltrates in order to discover new biomarkers and protein/peptide expression
 patterns that are associated with specific types of pulmonary diseases and infections.
 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 BAL (during a clinically indicated brochoscopy), samples
 are routinely sent to the clinical microbiology laboratory for stains, cultures and molecular
 analysis. We have recently developed a rapid, culture-independent method to identify unique
 peptide markers in BAL that identify specific bacterial species. We are expanding the scope
 of 04-CC-0119 that was based originally on collection of BAL supernatant only, to now
 collect, analyze and store whole (unprocessed) BAL. The availabilty of new methods of
 analyzing BAL will broaden the scope of the study to analyze BAL proteins, lung cells, and
 microbial pathogens. This will allow improved characterization of the host response to lung
 inflammation and infection and help to assess the feasibility of using the
 culture-independent approach on clinical BAL samples to identify specific pathogens.

 POPULATION:

 The study population will include all patients undergoing bronchoscopy for clinical
 indications at the Clinical Center who provide informed consent for chart review blood draw
 (optional), and analysis of BAL, as described in this protocol. We plan 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.

 DESIGN:

 This is a prospective observational study.

 OUTCOME:

 The expected outcome is to:

 Develop a database of protein mass profiles of BAL fluid linked to specific microbiologic
 diagnoses.

 To collect, analyze and store BAL to validate the usefulness of the genoproteomic
 culture-independent method of microbial identification.

 To analyze lung cells associated with infectious or inflammatory pulmonary condidtions.

 Our plan 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.

 -  A parent/guardian may provide consent for a child age 17 or under.

 EXCLUSION CRITERIA:

 Patients undergoing bronchoscopy but not wanting to participate with either the chart
 review or the proteomic analysis of BAL fluid supernatant will be excluded.