|Budget Amount *help
¥2,400,000 (Direct Cost : ¥2,400,000)
Fiscal Year 1994 : ¥500,000 (Direct Cost : ¥500,000)
Fiscal Year 1993 : ¥1,900,000 (Direct Cost : ¥1,900,000)
We examined sequential structural changes of the alveoli in diffuse alvolar damage (DAD) by immunohistochemical method. Lung specimens obtained at autopsy in 52 patients with DAD were stained with antibodies to laminin, 7S collagen (7S) and type IV collagen (type IV) for alveolar basement membrane, to von Willebrand factor, CD-31 and thrombomodulin (TM) for the alveolar capillary endothelial cell, and to epithelial membrane antigen and surfactant apoprotein (PE-10) for the alveolar epithelium. Forty-two of the patients had the exudative form of DAD ; ten of the patients had proliferative form of DAD.The results were summarized as follows ; (1) Laminin was most easily impaired both in the epithelial and capillary basement membrane in the early exudative stage, (2) Following laminin, 7S and type IV in the capillary basement membrane were also injured in the early exudative stage, and recovered in the proliferative stage, (3) Subsequently, 7S and type IV in the epithelial basement membrane were also impaired in the late exudative stage, and remained impaired even in the proliferative stage, (4) Alveolar epithelium regenerated almost completely in the late exudative stage, but staining for TM in the alveolar capillary recovered in the proliferative stage. Since the alveolar basement membrane must govern the homeostasis of alveolar tissue architecture, we conclude that its preservation is necessary to avoid the abnormal remodeling of the alveoli in the reparative stage of the DAD,if the patient survives the acute episodes of the disease.