Rationale: The presence of inflammatory cells on bronchoalveolar lavage is often used to predict disease activity and the need for therapy in systemic sclerosis-associated interstitial lung disease. Objectives: To evaluate whether lavage cellularity identifies distinct subsets of disease and/or predicts cyclophosphamide responsiveness. Methods: Patients underwent baseline lavage and/or high-resolution computed tomography as part of a randomized placebo-controlled trial of cyclophosphamide versus placebo (Scleroderma Lung Study) to determine the effect of therapy on forced vital capacity. Patients with 3% or greater polymorphonuclear and/or 2% or greater eosinophilic leukocytes on lavage and/or ground-glass opacification on computed tomography were eligible for enrollment. Measurements and Main Results: Lavage was performed in 201 individuals, including 141 of the 158 randomized patients. Abnormal cellularity was present in 101 of these cases (71.6%) and defined a population with a higher percentage of men (P 5 0.04), more severe lung function, including a worse forced vital capacity (P 5 0.003), worse total lung capacity (P 5 0.005) and diffusing capacity of the lung for carbon monoxide (P 5 0.004), more extensive ground-glass opacity (P 5 0.005), and more extensive fibrosis in the right middle lobe (P 5 0.005). Despite these relationships, the presence or absence of an abnormal cell differential was not an independent predictor of disease progression or response to cyclophosphamide at 1 year (P 5 not significant). Conclusions: The presence of an abnormal lavage in the Scleroderma Lung Study defined patients with more advanced interstitial lung disease but added no additional value to physiologic and computed tomography findings as a predictor of progression or treatment response. Clinical trial registered with www.clinicaltrials.gov (NCT 000004563).

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Temporal and spatial measurements of the toxicity (EC50), chemical speciation, and complexation capacity (Cu-CC) of copper in waters from San Diego Bay suggest control of the Cu-CC over copper bioavailability. While spatial distributions of total copper (CuT) indicate an increase in concentration from the mouth toward the head of San Diego Bay, the distribution of aqueous free copper ion (Cu(II)aq) shows the opposite trend. This suggests that the bioavailability of copper to organisms decreases toward the head of the bay, and is corroborated by the increase in the amount of copper needed to reach an EC50, observed for larval stages of three marine invertebrates (Mediterranean mussel, Mytilus galloprovincialis, sand dollar, Dendraster excentricus, and purple sea urchin, Strongylocentrotus purpuratus), and by the increase in Cu-CC heading into the head of the bay. The amount of Cu(II)aq required to produce a 50% reduction in normal larval development (referred to here as pCuTox,) of the mussel, the most sensitive of the three marine invertebrates, was generally at or above approximately 1 x 10(-11) mol L(-1) equivalents of Cu (i.e., pCuTox approximately 11 = -(log [Cu(II)aq])). These results suggest that the copper complexation capacity in San Diego Bay controls copper toxicity by keeping the concentration of Cu(II)aq at nontoxic levels.

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