Lymphocyte dynamics in the pulmonary microenvironment: implications for the pathophysiology of pulmonary sarcoidosis

It is generally accepted that lymphocytes play a role in sarcoidosis. Lymphocyte numbers and in particular certain subsets are increased in the bronchoalveolar lavage fluid, and these parameters have been used as indicators for prognosis. To understand the pathophysiology of sarcoidosis the localisation and kinetics of lymphocytes in the normal lung have to be known. Lymphocytes are found in different compartments of the lung: the pulmonary vascular bed with the marginal lymphocyte pool, intraepithelial lymphocytes, the lamina propria of the bronchial tree, at a young age and under certain pathological conditions the bronchus-associated lymphoid tissue, the interstitial lymphocyte pool and the lymphocytes in the bronchoalveolar space as recovered by bronchoalveolar lavage. The lymphocyte subsets differ in these compartments. The number and subset composition are influenced by the balance of immigration, regulated by adhesion molecules, local proliferation, apoptosis and migration. In sarcoidosis lymphocyte proliferation and cell death in the bronchoalveolar space are increased several fold in the lung. More studies on regulatory factors of lymphocyte kinetics are needed in the lung of sarcoidosis patients before new therapeutic strategies can be tested.