Lipid-laden alveolar macrophage

Lipid-laden alveolar macrophages, also known as pulmonary foam cells,[2] are cells found in bronchoalveolar lavage (BAL) specimens that consist of macrophages containing deposits of lipids (fats).[3] The lipid content of the macrophages can be demonstrated using a lipid targeting stain like Oil Red O or Nile red.[2][4][5][6] Increased levels of lipid-laden alveolar macrophages are associated with various respiratory conditions, including chronic smoking,[3] gastroesophageal reflux, lipoid pneumonia, fat embolism,[7] pulmonary alveolar proteinosis[3][8] and pulmonary aspiration.[2][9] Lipid-laden alveolar macrophages have been reported in cases of vaping-associated pulmonary injury.[10][1][11]

Lipid-laden alveolar macrophages in a case of vaping-associated pulmonary injury. Left: Papanicolaou stain; right: Oil Red O stain.[1]

The lipid-laden macrophage index (LLMI) can be calculated by counting 100 macrophages in a BAL specimen treated with a lipid stain and scoring each macrophage from 0 to 4 based on the amount of lipids present in the cell.[7][12] A LLMI score greater than 100 is considered positive for pulmonary aspiration. However, the test is limited by poor reproducibility[7] and low specificity for pulmonary aspiration, as lipid-laden macrophages occur in many respiratory conditions.[9]

See also

References
  1. Davidson, Kevin; Brancato, Alison; Heetderks, Peter; Mansour, Wissam; Matheis, Edward; Nario, Myra; Rajagopalan, Shrinivas; Underhill, Bailey; Wininger, Jeremy; Fox, Daniel (2019). "Outbreak of Electronic-Cigarette–Associated Acute Lipoid Pneumonia — North Carolina, July–August 2019". MMWR. Morbidity and Mortality Weekly Report. 68 (36). doi:10.15585/mmwr.mm6836e1. ISSN 0149-2195.
  2. Gibeon, D.; Zhu, J.; Sogbesan, A.; Banya, W.; Rossios, C.; Saito, J.; Rocha, J.P.; Hull, J.H.; Menzies-Gow, A.N.; Bhavsar, P.K.; Chung, K.F. (2014). "Lipid-laden bronchoalveolar macrophages in asthma and chronic cough". Respiratory Medicine. 108 (1): 71–77. doi:10.1016/j.rmed.2013.10.005. ISSN 0954-6111. PMID 24172051.
  3. Fessler, Michael B. (2017). "A New Frontier in Immunometabolism. Cholesterol in Lung Health and Disease". Annals of the American Thoracic Society. 14 (Supplement_5): S399–S405. doi:10.1513/AnnalsATS.201702-136AW. ISSN 2329-6933. PMC 5711269.
  4. Sacco, Oliviero; Fregonese, B.; Silvestri, M.; Sabatini, F.; Mattioli, G.; Rossi, G.A. (2000). "Bronchoalveolar lavage and esophageal pH monitoring data in children with ?difficult to treat? respiratory symptoms". Pediatric Pulmonology. 30 (4): 313–319. doi:10.1002/1099-0496(200010)30:4<313::AID-PPUL7>3.0.CO;2-H. ISSN 8755-6863.
  5. Fowler, S D; Greenspan, P (2017). "Application of Nile red, a fluorescent hydrophobic probe, for the detection of neutral lipid deposits in tissue sections: comparison with oil red O." Journal of Histochemistry & Cytochemistry. 33 (8): 833–836. doi:10.1177/33.8.4020099. ISSN 0022-1554.
  6. Augustine S. Lee; James P. Utz. "American Thoracic Society - Bronchoalveolar Lavage". American Thoracic Society. Retrieved 8 September 2019.
  7. K.N. Priftis; M.B. Anthracopoulos; E. Eber; A.C. Koumbourlis; R.E. Wood (6 May 2010). "Bronchoalveolar lavage - indications and application". Paediatric Bronchoscopy. Karger Medical and Scientific Publishers. p. 38. ISBN 978-3-8055-9311-3.
  8. Thomassen, Mary Jane; Barna, Barbara P.; Malur, Achut G.; Bonfield, Tracey L.; Farver, Carol F.; Malur, Anagha; Dalrymple, Heidi; Kavuru, Mani S.; Febbraio, Maria (2007). "ABCG1 is deficient in alveolar macrophages of GM-CSF knockout mice and patients with pulmonary alveolar proteinosis". Journal of Lipid Research. 48 (12): 2762–2768. doi:10.1194/jlr.P700022-JLR200. ISSN 0022-2275. PMID 17848583.
  9. Lahiri, Thomas (2014). "The utility of the lipid-laden macrophage index for the evaluation of aspiration in children". Cancer Cytopathology. 122 (3): 161–162. doi:10.1002/cncy.21365. ISSN 1934-662X. PMID 24302605.
  10. Maddock, Sean D.; Cirulis, Meghan M.; Callahan, Sean J.; Keenan, Lynn M.; Pirozzi, Cheryl S.; Raman, Sanjeev M.; Aberegg, Scott K. (2019). "Pulmonary Lipid-Laden Macrophages and Vaping". New England Journal of Medicine. doi:10.1056/NEJMc1912038. ISSN 0028-4793. PMID 31491073.
  11. Carlos, W. Graham; Crotty Alexander, Laura E; Gross, Jane E; Dela Cruz, Charles S; Keller, Jonathan M; Pasnick, Susan; Jamil, Shazia (September 2019). "Vaping Associated Pulmonary Illness (VAPI)". American Journal of Respiratory and Critical Care Medicine. 200 (7): P13–P14. doi:10.1164/rccm.2007P13. ISSN 1073-449X. PMID 31532695.
  12. Yvan Vandenplas (2017). "Gastroesophageal reflux and cystic fibrosis". Gastroesophageal Reflux in Children: GER in Children. Springer. p. 216. ISBN 978-3-319-60678-1.
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