1
|
Nakano R, Nakagaki K, Itoh Y, Seino U, Ueda T, Tazawa R, Kitamura N, Tanaka T, Nakata K. Assay system development to measure the concentration of sargramostim with high specificity in patients with autoimmune pulmonary alveolar proteinosis after single-dose inhalation. J Immunol Methods 2018; 460:1-9. [PMID: 30003894 DOI: 10.1016/j.jim.2018.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 05/14/2018] [Accepted: 05/15/2018] [Indexed: 11/18/2022]
Abstract
During a clinical trial of a Saccharomyces cerviciae-derived recombinant human granulocyte-macrophage colony stimulating factor (rhGM-CSF), sargramostim, in patients with autoimmune pulmonary alveolar proteinosis (aPAP), we conducted a pharmacokinetic study of single-dose sargramostim inhalation. Several problems were encountered whereby sargramostim formed an immune-complex with GM-CSF autoantibodies (GMAbs) immediately after entering the body; thus, we could not measure the concentration of sargramostim using a commercial high sensitivity enzyme-linked immunosorbent assay (ELISA). Moreover, the ELISA could not discriminate inhaled sargramostim from intrinsic GM-CSF. To solve these problems, we developed a novel ELISA system with a capture antibody that is specific for sargramostim and a detection antibody capable of binding with GM-CSF. This system quantified the serum sargramostim concentration, but not E. coli-, CHO-, or HEK293T-derived human recombinant GM-CSF. Using this system, serum pharmacokinetics were estimated in five patients after inhalation of 250 μg sargramostim, with a mean Cmax of 9.7 ± 2.85 pg/ml at a Tmax of 2 ± 1.22 h.
Collapse
Affiliation(s)
- Ryu Nakano
- Bioscience Medical Research Center, Niigata University Medical & Dental Hospital Niigata, Japan
| | - Kazuhide Nakagaki
- Bioscience Medical Research Center, Niigata University Medical & Dental Hospital Niigata, Japan
| | - Yuko Itoh
- Bioscience Medical Research Center, Niigata University Medical & Dental Hospital Niigata, Japan
| | - Utako Seino
- Bioscience Medical Research Center, Niigata University Medical & Dental Hospital Niigata, Japan
| | - Takahiro Ueda
- Clinical and Translational Research Center, Niigata University Medical & Dental Hospital Niigata, Japan
| | - Ryushi Tazawa
- Bioscience Medical Research Center, Niigata University Medical & Dental Hospital Niigata, Japan
| | - Nobutaka Kitamura
- Clinical and Translational Research Center, Niigata University Medical & Dental Hospital Niigata, Japan
| | - Takahiro Tanaka
- Clinical and Translational Research Center, Niigata University Medical & Dental Hospital Niigata, Japan
| | - Koh Nakata
- Bioscience Medical Research Center, Niigata University Medical & Dental Hospital Niigata, Japan; Clinical and Translational Research Center, Niigata University Medical & Dental Hospital Niigata, Japan.
| |
Collapse
|
2
|
Ito M, Nakagome K, Ohta H, Akasaka K, Uchida Y, Hashimoto A, Shiono A, Takada T, Nagata M, Tohyama J, Hagiwara K, Kanazawa M, Nakata K, Tazawa R. Elderly-onset hereditary pulmonary alveolar proteinosis and its cytokine profile. BMC Pulm Med 2017; 17:40. [PMID: 28212655 PMCID: PMC5316164 DOI: 10.1186/s12890-017-0382-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 02/07/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pulmonary alveolar proteinosis (PAP) is a rare lung disease characterized by surfactant accumulation, and is caused by disruption of granulocyte/macrophage colony-stimulating factor (GM-CSF) signaling. Abnormalities in CSF2 receptor alpha (CSF2RA) were reported to cause pediatric hereditary PAP. We report here the first case of CSF2RA-mutated, elderly-onset hereditary (h) PAP. CASE PRESENTATION The patient developed dyspnea on exertion, and was diagnosed with PAP at the age of 77 years, based on findings from chest computed tomography scan and bronchoalveolar lavage. She tested negative for GM-CSF autoantibodies, with no underlying disease. Her serum GM-CSF level was elevated (91.3 pg/mL), indicating GM-CSF signaling impairment and genetic defects in the GM-CSF receptor. GM-CSF-stimulated phosphorylation in signal transducer and activator of transcription 5 (STAT5) was not observed, and GM-CSF-Rα expression was defective in her blood cells. Genetic screening revealed a homozygous, single-base C > T mutation at nt 508-a nonsense mutation that yields a stop codon (Q170X)-in exon 7 of CSF2RA. High-resolution analysis of single nucleotide polymorphism array confirmed a 22.8-Mb loss of heterozygosity region in Xp22.33p22.11, encompassing the CSF2RA gene. She was successfully treated with whole lung lavage (WLL), which reduced the serum levels of interleukin (IL)-2, IL-5, and IL-17, although IL-3 and M-CSF levels remained high. CONCLUSIONS This is the first known report of elderly-onset hPAP associated with a CSF2RA mutation, which caused defective GM-CSF-Rα expression and impaired signaling. The analyses of serum cytokine levels during WLL suggested that GM-CSF signaling might be compensated by other signaling pathways, leading to elderly-onset PAP.
Collapse
Affiliation(s)
- Masayuki Ito
- Bioscience Medical Research Center, Niigata University Medical and Dental Hospital, Niigata, 951-8520, Japan
| | - Kazuyuki Nakagome
- Department of Respiratory Medicine, Saitama Medical University, Saitama, Japan
| | - Hiromitsu Ohta
- Department of Respiratory Medicine, Saitama Medical University, Saitama, Japan
| | - Keiichi Akasaka
- Bioscience Medical Research Center, Niigata University Medical and Dental Hospital, Niigata, 951-8520, Japan
| | - Yoshitaka Uchida
- Department of Respiratory Medicine, Saitama Medical University, Saitama, Japan
| | - Atsushi Hashimoto
- Bioscience Medical Research Center, Niigata University Medical and Dental Hospital, Niigata, 951-8520, Japan
| | - Ayako Shiono
- Department of Respiratory Medicine, Saitama Medical University, Saitama, Japan
| | - Toshinori Takada
- Bioscience Medical Research Center, Niigata University Medical and Dental Hospital, Niigata, 951-8520, Japan
| | - Makoto Nagata
- Department of Respiratory Medicine, Saitama Medical University, Saitama, Japan
| | - Jun Tohyama
- National Hospital Organization Nishi-Niigata Chuo Hospital, Niigata, Japan
| | - Koichi Hagiwara
- Department of Respiratory Medicine, Jichi Medical University, Tochigi, Japan
| | - Minoru Kanazawa
- Department of Respiratory Medicine, Saitama Medical University, Saitama, Japan
| | - Koh Nakata
- Bioscience Medical Research Center, Niigata University Medical and Dental Hospital, Niigata, 951-8520, Japan
| | - Ryushi Tazawa
- Bioscience Medical Research Center, Niigata University Medical and Dental Hospital, Niigata, 951-8520, Japan.
| |
Collapse
|