Jerzy Marczak

Publications of Jerzy Marczak

• Somatostatin receptor scintigraphy in sarcoidosis: relation to selected clinical and laboratory markers.

  Authors: Wojciech J Piotrowski, Małgorzata Bieńkiewicz, Izabella Frieske, Jerzy Marczak, Adam Antczak, Paweł Górski, Jacek Kuśmierek, Anna Płachcińska

  Polskie Archiwum Medycyny Wewnetrznej. 01/2012;

  INTRODUCTION: Differentiation between active and inactive sarcoidosis may be problematic. Several biochemical markers have been proposed for this purpose. Somatostatin receptor scintigraphy with theINTRODUCTION: Differentiation between active and inactive sarcoidosis may be problematic. Several biochemical markers have been proposed for this purpose. Somatostatin receptor scintigraphy with the use of 99mTc Tectreotide as a radiotracer may be used for estimation of disease activity. OBJECTIVES: To estimate the value of traditional biomarkers (serum angiotensin converting enzyme - SACE, C-reactive protein - CRP, markers of calcium metabolism, bronchoalveolar lavage fluid - BALF - lymphocytes) and a novel biomarker 8-isoprostane (8-IP) in exhaled breath condensate (EBC) for estimation of disease activity in relation to somatostatin receptor scintigraphy results. PATIENTS AND METHODS: 32 patients with sarcoidosis were included. 99mTc-HYNIC-TOC was used as a tracer, planar and SPECT/CT images were performed. Patients were divided into a subgroup with positive radiotracer uptake (n=20) and lack of visible uptake (n=12). 8-IP was measured in EBC by EIA method. RESULTS: We found a significant difference between the positive and negative uptake group in EBC 8-IP (19.119.8 vs 5.43.5 pg/ml, p=0.02). The concentration of SACE and % of BALF lymphocytes were also elevated, but did not reach the statistical significance. In the group of patients with positive scintigraphy results, a positive correlation was found between the uptake ratio and SACE (r=0.44, p=0.041). We show examples of practical application of somatostatin receptor scintigraphy for estimation of disease activity. CONCLUSIONS: The study shows low value of biochemical markers in clinical monitoring of sarcoidosis, but indicates the potential usefulness of somatostatin receptor scintigraphy in the monitoring of sarcoidosis.

• Correlation between eicosanoids in bronchoalveolar lavage fluid and in exhaled breath condensate.

  Authors: Adam Antczak, Wojciech Piotrowski, Jerzy Marczak, Maciej Ciebiada, Pawel Gorski, Peter J Barnes

  Disease markers. 01/2011; 30(5):213-20.

  Exhaled breath condensate (EBC) has been increasingly used as a new and non-invasive method to study airway inflammation. In this study we have compared the concentrations of lipid mediators in EBCExhaled breath condensate (EBC) has been increasingly used as a new and non-invasive method to study airway inflammation. In this study we have compared the concentrations of lipid mediators in EBC with concentrations in bronchoalveolar lavage fluid (BALF). We included 37 patients undergoing bronchoscopy (12 sarcoidosis, 12 COPD, 6 lung cancer, 5 chronic cough, 1 Wegener's granulomatosis, 1 sclerodermia). Patients were not allowed to have exacerbation or any change in concomitant medication for at least 4 weeks prior to the study. In all patients, EBC was collected immediately prior to the bronchoscopy. The levels of cys-LTs, LTB _{4} , 8-isoprostane were significantly higher in BALF compared to EBC (p < 0.0001, p< 0.001, p< 0.0001 for cys-LTs, LTB4, 8-isoprostane respectively). Moreover, there was a strong positive correlation between both leukotriene B _{4} and 8-isoprostane in BALF and EBC (r=0.53 and r=0.79, p< 0.01, respectively) in patients with sarcoidosis and COPD but there was no correlation between eicosanoids BALF and EBC in patients with chronic cough and lung cancer. This is the first study to compare EBC and BALF in different lung diseases which demonstrated significant correlations between the levels of eicosanoids in BALF and EBC in patients with COPD and sarcoidosis. EBC may be useful in measuring inflammation in several inflammatory lung diseases.

• Exhaled 8-isoprostane in sarcoidosis: relation to superoxide anion production by bronchoalveolar lavage cells.

  Authors: Wojciech J Piotrowski, Zofia Kurmanowska, Adam Antczak, Jerzy Marczak, Maciej Ciebiada, Paweł Górski

  Inflammation research : official journal of the European Histamine Research Society ... [et al.]. 12/2010; 59(12):1027-32.

  This study was designed to examine the mutual relationship between 8-isoprostane in exhaled breath condensate (EBC) and superoxide anion generation by bronchoalveolar lavage fluid (BALF) cells inThis study was designed to examine the mutual relationship between 8-isoprostane in exhaled breath condensate (EBC) and superoxide anion generation by bronchoalveolar lavage fluid (BALF) cells in patients with sarcoidosis. About 29 patients with sarcoidosis, 34 healthy never smokers (control group for EBC) and 15 healthy never smokers (control group for BAL) were examined. EBC was collected directly before bronchoscopy. 8-Isoprostane was measured by ELISA, and superoxide anion by colorimetry. Exhaled breath condensate 8-isoprostane is increased in sarcoidosis (median, 25-75 percentile): 2.50; 2.50-3.90 versus 6.20; 2.50-16.95 pg/ml, p ≤ 0.05). Spontaneous superoxide anion release from BALF cells was significantly elevated only in patients with a high percentage of lymphocytes in BALF (6.42 ± 1.24 vs. 23.52 ± 4.30 nmol/10(6) cells, p ≤ 0.01). There were no correlations between 8-isoprostane and spontaneous or stimulated superoxide anion release. We confirmed higher concentrations of EBC 8-isoprostane in sarcoidosis and higher spontaneous release of superoxide anion from BALF cells in patients with sarcoidosis. The increase of EBC 8-isoprostane is not directly related to superoxide anion released from BALF cells.

• Rhinosinusitis in COPD: symptoms, mucosal changes, nasal lavage cells and eicosanoids.

  Authors: Violetta M Piotrowska, Wojciech J Piotrowski, Zofia Kurmanowska, Jerzy Marczak, Paweł Górski, Adam Antczak

  International journal of chronic obstructive pulmonary disease. 01/2010; 5:107-17.

  The coexistence of upper airways disease with chronic obstructive pulmonary disease (COPD) is not well documented. The aim of this research was to assess sino-nasal inflammation in COPD by variousThe coexistence of upper airways disease with chronic obstructive pulmonary disease (COPD) is not well documented. The aim of this research was to assess sino-nasal inflammation in COPD by various tools, and look for the impact on quality of life, relation to smoking, disease severity and systemic inflammation. Current and ex-smokers with COPD (n = 42) and healthy never-smokers (n = 21) were included in this study. COPD severity was assessed by GOLD criteria and BODE index. Markers of systemic inflammation were measured. Nasal symptoms and general quality of life were assessed using the questionnaires; sino-nasal questionnaire (SNAQ-11) and St. George's Respiratory Questionnaire (SGRQ). Nasal endoscopy and saccharine test were performed. Nasal lavages were collected for cytological examination and eicosanoids (cysteinyl leukotrienes, leukotriene B4, 8-isoprostane). Symptoms and endoscopic scores were higher in COPD (P < or = 0.0001). Only SGRQ symptoms subscore correlated with SNAQ-11 (r = 0.34, P = 0.035). Mucociliary clearance was impaired only in current smokers (9.91 +/- 0.49 versus 13.12 +/- 0.68 minutes, P < or = 0.001). 8-isoprostane was higher in COPD smokers compared to the controls (0.17 +/- 0.04 versus 0.34 +/- 0.09 pg/g protein, P < 0.05). Endoscopic score and mucociliary of impairment patients who currently smoked cigarettes correlated with concentrations of 8-isoprostane. None of the parameters correlated with disease severity and markers of systemic inflammation. We provide evidence of upper airways disease in COPD, which appears to be related more to patients who currently smoke than to disease severity.

• Exhaled 8-isoprostane as a prognostic marker in sarcoidosis. A short term follow-up.

  Authors: Wojciech J Piotrowski, Zofia Kurmanowska, Adam Antczak, Jerzy Marczak, Paweł Górski

  BMC pulmonary medicine. 01/2010; 10:23.

  8-Isoprostane (8-IP) is a marker of lipid peroxidation. Elevated concentrations have been reported in BAL fluid and exhaled breath condensate (EBC) in sarcoidosis (S). To validate the prognostic8-Isoprostane (8-IP) is a marker of lipid peroxidation. Elevated concentrations have been reported in BAL fluid and exhaled breath condensate (EBC) in sarcoidosis (S). To validate the prognostic value of this marker we tested whether: 1. high initial EBC 8-IP predispose to more severe disease; 2. low initial concentrations increase a chance of early remission; 3. remissions are connected with the decrease of EBC 8-IP. 40 patients (S) have been examined initially (V1) and after 8.5 +/- 0.5 months (V2). EBC 8-IP concentrations were measured by ELISA. Chest X-ray, lung function test, serum ACE and Ca2+ concentrations, 24 hrs Ca2+loss, abdominal ultrasonography, symptoms evaluation were performed. We confirmed higher concentrations of 8-IP in EBC of patients with sarcoidosis (p = 0.001). Relative risk (RR) of persistence of disease at V2 when initial 8-IP was above 20 pg/mL was 1.04, and the frequency distributions estimated by chi2 test were not significantly different. A chance (RR) of early complete remission when V1 8-IP was below DL, was 3.33 (p = 0.04 by chi2 test). A significant decrease of 8-IP at V2 was observed only in patients who received treatment (p = 0.03), but not in those with spontaneous remission. We come to the conclusion, that low initial 8-IP may be a positive prognostic factor. A decrease of 8-IP in treated patients reflects a non-specific effect of treatment and is not related to mere regression of disease.

• Hepatocyte growth factor in exhaled breath and BAL fluid in sarcoidosis.

  Authors: Wojciech J Piotrowski, Zofia Kurmanowska, Adam Antczak, Jerzy Marczak, Paweł Górski

  Pneumonologia i alergologia polska : organ Polskiego Towarzystwa Ftyzjopneumonologicznego, Polskiego Towarzystwa Alergologicznego, i Instytutu Gruźlicy i Chorób Płuc. 01/2010; 78(3):187-91.

  Hepatocyte growth factor (HGF) is a strong mitogen stimulating lung epithelial cell growth. Elevated levels of HGF have been reported in various biological materials of patients with acuteHepatocyte growth factor (HGF) is a strong mitogen stimulating lung epithelial cell growth. Elevated levels of HGF have been reported in various biological materials of patients with acute respiratory distress syndrome and in patients recovering from pneumonia or pneumonectomy. Sarcoidosis may be complicated by lung fibrosis. Consequently, HGF could be considered a new biomarker identifying patients with a higher risk of lung fibrosis. The aim of the study was to verify whether: 1. HGF is measurable in bronchoalveolar lavage fluid (BALF) and exhaled breath condensate (EBC); 2. HGF in BALF or EBC is impaired in sarcoidosis; and 3. HGF correlates with chosen activity and prognostic markers. Sixty-four EBC and 30 BALF of sarcoid patients, and 15 and 9 of healthy controls, respectively, were collected for the measurement of HGF using an ELISA test. HGF was detectable in 62% of EBC samples (56% sarcoidosis and 87% of controls) and in all the BALF samples. EBC and BALF concentrations were not different in comparison to the controls. Moreover, no correlation was found between EBC/BALF concentrations and radiological stage, lung function tests, duration of disease, number of relapses, BALF lymphocytes, serum ACE, or serum and urine calcium concentrations. HGF is detectable in BAL and EBC. However, it does not distinguish sarcoidosis patients from healthy subjects. The above, as well as the lack of correlations with various parameters of disease activity and severity rule out EBC/ /BALF HGF as a biomarker for sarcoidosis monitoring.

• Superoxide anion production by bronchoalveolar lavage cells in relation to cellular composition and lung function in sarcoidosis and chronic bronchitis.

  Authors: Wojciech J Piotrowski, Zofia Kurmanowska, Adam Antczak, Jerzy Marczak, Sebastian Majewski, Paweł Górski

  Polskie archiwum medycyny wewnȩtrznej. 12/2009; 119(12):777-84.

  INTRODUCTION: Increased generation of superoxide anion (O2 -.) by bronchoalveolar lavage (BAL) cells has been reported in various inflammatory disorders. However, the clinical relevance of thisINTRODUCTION: Increased generation of superoxide anion (O2 -.) by bronchoalveolar lavage (BAL) cells has been reported in various inflammatory disorders. However, the clinical relevance of this phenomenon is unclear. OBJECTIVES: The aim of the study was to investigate whether production of O2-. is enhanced in smoking-related chronic bronchitis and sarcoidosis, and to assess a relationship between O2-. generation and lung function impairment and changes in BAL cellular pattern. PATIENTS AND METHODS: Forty-two patients with sarcoidosis, 24 smokers with chronic bronchitis, and 17 controls were examined. A number/percentage of BAL cells was calculated. Spontaneous and phorbol myristate acetate (PMA)-stimulated O2-. production was measured in BAL cells. Spirometry was performed. RESULTS: Patients with smoking-related chronic bronchitis produced more O2 -. spontaneously (6.42 -/+1.24 vs. 15.39 -/+2.47 nmol/106 cells, P = 0.003) and after stimulation (3.73 -/+1.32 vs. 14.76 -/+2.79 nmol/106 cells; P = 0.001). PMA-stimulated excess production correlated with the percentage of neutrophils (r = 0.66, P = 0.0005). In sarcoidosis, only spontaneous production of O2 -. was higher (vs. 18.07 -/+2.49 nmol/106 cells, P = 0.004) and correlated with the percentage of BAL lymphocytes. There was no correlation between O2-. production and lung function parameters. CONCLUSIONS: Patients with smoking-related chronic bronchitis produce more O2-., and this phenomenon is related to BAL neutrophils. In sarcoidosis, spontaneous release of O2-. from BAL cells is related to the extent of lymphocytic alveolitis. Higher O2-. generation did not impair lung function.

• Metalloproteinases MMP-9, MMP-2 and their tissue inhibitors TIMP-1, TIMP-2 in peripheral transbronchial lung biopsies of patients with sarcoidosis.

  Authors: Wojciech J Piotrowski, Agnieszka Nawrocka-Kunecka, Adam Antczak, Jerzy Marczak, Romuald Biernacki, Piotr Kordek, Zofia Kurmanowska, Paweł Górski

  Polskie archiwum medycyny wewnȩtrznej. 10/2009; 119(10):628-35.

  INTRODUCTION: The imbalance between metalloproteinases (MMPs) and their tissue inhibitors TIMPs) may be involved in the pathogenesis of lung sarcoidosis, a granulomatous inflammatory disease whichINTRODUCTION: The imbalance between metalloproteinases (MMPs) and their tissue inhibitors TIMPs) may be involved in the pathogenesis of lung sarcoidosis, a granulomatous inflammatory disease which may lead to lung fibrosis. OBJECTIVES: The aim of the study was to verify whether the expression of MMP-9, MMP-2, TIMP-1, and TIMP-2 in peripheral lung biopsies of patients with sarcoidosis correlate with lung function tests, radiological pattern, and bronchoalveolar lavage (BAL) cells. We compared the expression of MMPs and TIMPs between patients with sarcoid-positive vs. - negative biopsy and fibrosing vs. non-fibrosing high-resolution computed tomography (HRCT)pattern. PATIENTS AND METHODS: We examined patients with histologically proven stage II and III sarcoidosis (n = 17). Immunohistochemistry with antibodies against the studied molecules was performed in the lung and bronchial tissue specimens obtained from transbronchial lung biopsies. The radiological pattern was evaluated based on HRCT. The total cell number and percentage of cells were calculated in the BAL samples. RESULTS: MMPs and TIMPs were present in the cells of sarcoid granuloma, and were more prevalent in the parenchyma than in the bronchi. We found no correlation between MMP-9, MMP-2, TIMP-1, TIMP-2 and HRCT pattern or BAL cells. There were inverse associations between MMP-9 and FEV1 (% predicted), and also between MMP-2 and maximal expiratory flow 25-75% (L and % predicted) in patients with sarcoidosis diagnosed by transbronchial lung biopsy. There were no differences in the measured parameters between patients with and without fibrotic changes and between those with negative vs. positive lung biopsy results. CONCLUSIONS: Our study provides an indirect evidence for a potential involvement of MMPs/TIMPs in the sarcoid inflammation of the distal airways.

• Eicosanoids in exhaled breath condensate and BAL fluid of patients with sarcoidosis.

  Authors: Wojciech J Piotrowski, Adam Antczak, Jerzy Marczak, Agnieszka Nawrocka, Zofia Kurmanowska, Pawel Górski

  Chest. 09/2007; 132(2):589-96.

  BACKGROUND: Measurement of inflammatory mediators in exhaled breath condensate (EBC) is an easy and noninvasive diagnostic method, which has gained popularity in the past few years. However, theBACKGROUND: Measurement of inflammatory mediators in exhaled breath condensate (EBC) is an easy and noninvasive diagnostic method, which has gained popularity in the past few years. However, the source of these mediators is not precisely defined. It has been only presumed that inflammatory cells present in the airway lumen are the main source. Therefore, the aim of this study was to verify the relationship between EBC and BAL fluid (BALF) eicosanoids, and the percentage, number, and activity of cells in BALF. METHODS: In 28 sarcoidosis patients and 17 healthy subjects, 8-isoprostane, cysteinyl leukotrienes (CysLTs), and leukotriene B4 (LTB4) were measured in EBC by enzyme immunoassay. Eicosanoids were also examined in BALF in the study group. Cell count, percentage, and superoxide production by BALF cells were estimated. RESULTS: The mean (+/- SEM) CysLT and 8-isoprostane concentrations were higher in the sarcoidosis group (6.5 +/- 0 vs 27.82 +/- 6.65 pg/mL, respectively; and 2.67 +/- 0.16 vs 13.95 +/- 2.59 pg/mL, respectively). There were positive correlations between EBC and BALF 8-isoprostane concentration (r = 0.68, p < 0.0001) and LTB4 concentration (r = 0.43; p = 0.026). EBC LTB4 levels correlated with the number of lymphocytes per milliliter of BALF. The percentage and number of eosinophils in BALF correlated with EBC 8-isoprostane and BALF CysLT concentrations. No positive correlation was found between concentrations of EBC eicosanoids and percentages BALF lymphocytes, BALF macrophages, or superoxide production. CONCLUSIONS: The levels of 8-isoprostane and CysLT are elevated in EBC in sarcoidosis patients; however, a lack of correlation with BALF lymphocyte percentage does not encourage us to recommend the measurement of eicosanoids as activity markers. The positive correlation of EBC 8-isoprostane and BALF CysLT concentrations with the percentage of eosinophils in BALF, and the higher percentage of eosinophils in BALF from patients with grade 3 sarcoidosis, may suggest the possible prognostic value.

• [The case of numerous foreign bodies in bronchial tree of both lungs and digestive tract]

  Authors: Szymon Wcisło, Sławomir Jabłoński, Paweł Górski, Jerzy Marczak, Leszek Kutwin, Jacek Kordiak, Edyta Santorek, Marcin Wawrzycki, Marian Brocki

  Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 05/2006; 20(118):424-6.

  The article shows the description of the seldom met case of simultaneous appearing of numerous foreign bodies situated both in air passages and in the alimentary canal at patient of mentallyThe article shows the description of the seldom met case of simultaneous appearing of numerous foreign bodies situated both in air passages and in the alimentary canal at patient of mentally handicapped with the tendency to swallowing of small objects. After observing by guardians of the patients fact of swallowing metallic foreign bodies by him the specified research were made (X-ray pictures, computer tomography) and the presence in the bronchial tree of both lungs and in the upper and lower section of the alimentary canal were confirmed. Swallowed and aspirated objects did not cause no complaints at the patient. Revealed foreign bodies were removed from air passages by using of the bronchofiberoscopy method and the surgical treatment. Foreign bodies of the alimentary canal were voided by patient through natural tract.

• Concentration of TBA-reactive substances in type II pneumocytes exposed to oxidative stress.

  Authors: Wojciech J Piotrowski, Jerzy Marczak, Zofia Kurmanowska, Paweł Górski

  Archivum immunologiae et therapiae experimentalis. 52(6):435-40.

  INTRODUCTION: Oxidative lung damage may be associated with the destruction of alveolar cells. Type II alveolar epithelial cells (AECs),as progenitors of type I cells, are indispensable for theINTRODUCTION: Oxidative lung damage may be associated with the destruction of alveolar cells. Type II alveolar epithelial cells (AECs),as progenitors of type I cells, are indispensable for the renovation of alveolar structure after lung injury. Extensive damage to type II cells could be responsible for unfavorable outcome. However, the susceptibility of type II AECs to oxidative stress is unclear. MATERIAL/METHODS: We investigated the susceptibility of freshly isolated and cultured rat type II AECs to oxidative stress (H2O2 and Fe2+). Thiobarbituric acid reactive substances (TBARS)were measured as indices of lipid peroxidation and cytotoxicity was estimated by the MTT test. Aminotriazol (ATZ), an inhibitor of intracellular catalase, was used to estimate the protective role of catalase. RESULTS: TBARS concentration increased significantly in freshly isolated, oxidant-exposed cells (4.0 +/-1.3 vs.8.3 +/-2.2 nmol/g protein, p=0.0313)and insignificantly in cultured cells (1.7 +/-0.4 vs.4.4 +/-1.7 nmol/g protein).ATZ was toxic even to cells not exposed to oxidants. Inhibition of catalase in cells exposed to oxidants resulted in an insignificant increase in TBARs:4.5 +/-1.5 vs.16.2 +/-3.9 nmol/g protein, p=0.0625,and 4.0 +/-0.8 vs.7.6 +/-4.0 for freshly isolated and cultured cells, respectively. Oxidative stress itself did not increase cytotoxicity. CONCLUSIONS: Type II AECs are not resistant to oxidative stress. We cannot, however, explain why cells with evidence of lipid peroxidation do not show increased cytotoxicity. The toxicity of ATZ is not related to oxidative cell damage. In cells exposed to oxidants, TBARS may fur-ther increase when catalase is inhibited, which suggests an important protective role for catalase.