Translational Research in Pediatrics III: Bronchoalveolar Lavage

Abstract

The role of flexible bronchoscopy and bronchoalveolar lavage (BAL) for the care of children with airway and pulmonary diseases is well established, with collected BAL fluid most often used clinically for microbiologic pathogen identification and cellular analyses. More recently, powerful analytic research methods have been used to investigate BAL samples to better understand the pathophysiological basis of pediatric respiratory disease. Investigations have focused on the cellular components contained in BAL fluid, such as macrophages, lymphocytes, neutrophils, eosinophils, and mast cells, as well as the noncellular components such as serum molecules, inflammatory proteins, and surfactant. Molecular techniques are frequently used to investigate BAL fluid for the presence of infectious pathologies and for cellular gene expression. Recent advances in proteomics allow identification of multiple protein expression patterns linked to specific respiratory diseases, whereas newer analytic techniques allow for investigations on surfactant quantification and function. These translational research studies on BAL fluid have aided our understanding of pulmonary inflammation and the injury/repair responses in children. We review the ethics and practices for the execution of BAL in children for translational research purposes, with an emphasis on the optimal handling and processing of BAL samples.

Flexible bronchoscopy contribution in the approach of diagnosis and treatment of children’s respiratory diseases: the experience of a unique pediatric unit in Tunisia

“…The BAL microbiological contribution is well established 3,12 . In a recent prospective study of 56 children with non-cystic fibrosis bronchiectasis, FB and BAL have contributed to changing the therapeutic management in 25 cases 13 .…”

“…The BAL is considered as a key exam in various conditions such as chronic interstitial lung diseases. FB also helps in the treatment of some pathologies such as a foreign body granuloma by cryotherapy, or pulmonary alveolar proteinosis (PAP) by a therapeutic BAL 3,4 .…”

Aspiration techniques for bronchoalveolar lavage in translational respiratory research: Paving the way to develop novel therapeutic moieties

“…Radhakrishnan et al briefed a translational research on BALf which have provided a detailed information on the identification of clinically relevant microbiologic pathogen and cellular analysis in pediatric respiratory diseases [54]. Also, a candidate molecular biomarkers in idiopathic pulmonary fibrosis (IPF) namely, S100A9 protein is been identified in the BALf proteins [55].…”

Pediatric Pulmonology year in review 2014: Part 1

“…The median response was 50 procedures; the actual number of flexible bronchoscopies done during training averaged around 90 per trainee but ranged widely (10–200). Suggested standards for various aspects of bronchoalveolar lavage in children for translational research purposes were published by Radhakrishnan and colleagues …”