1
|
Lettieri S, Bonella F, Marando VA, Franciosi AN, Corsico AG, Campo I. Pathogenesis-driven treatment of primary pulmonary alveolar proteinosis. Eur Respir Rev 2024; 33:240064. [PMID: 39142709 PMCID: PMC11322829 DOI: 10.1183/16000617.0064-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 05/28/2024] [Indexed: 08/16/2024] Open
Abstract
Pulmonary alveolar proteinosis (PAP) is a syndrome that results from the accumulation of lipoproteinaceous material in the alveolar space. According to the underlying pathogenetic mechanisms, three different forms have been identified, namely primary, secondary and congenital. Primary PAP is caused by disruption of granulocyte-macrophage colony-stimulating factor (GM-CSF) signalling due to the presence of neutralising autoantibodies (autoimmune PAP) or GM-CSF receptor genetic defects (hereditary PAP), which results in dysfunctional alveolar macrophages with reduced phagocytic clearance of particles, cholesterol and surfactant. The serum level of GM-CSF autoantibody is the only disease-specific biomarker of autoimmune PAP, although it does not correlate with disease severity. In PAP patients with normal serum GM-CSF autoantibody levels, elevated serum GM-CSF levels is highly suspicious for hereditary PAP. Several biomarkers have been correlated with disease severity, although they are not specific for PAP. These include lactate dehydrogenase, cytokeratin 19 fragment 21.1, carcinoembryonic antigen, neuron-specific enolase, surfactant proteins, Krebs von Lungen 6, chitinase-3-like protein 1 and monocyte chemotactic proteins. Finally, increased awareness of the disease mechanisms has led to the development of pathogenesis-based treatments, such as GM-CSF augmentation and cholesterol-targeting therapies.
Collapse
Affiliation(s)
- Sara Lettieri
- Pneumology Unit, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Francesco Bonella
- Center for interstitial and rare lung diseases, Ruhrlandklinik, University of Essen, Essen, Germany
| | | | | | - Angelo Guido Corsico
- Pneumology Unit, IRCCS San Matteo Hospital Foundation, Pavia, Italy
- Department of Internal Medicine, University of Pavia, Pavia, Italy
| | - Ilaria Campo
- Pneumology Unit, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| |
Collapse
|
2
|
Sakagami T. Advancements in pulmonary alveolar proteinosis treatment: A journey from discovery to GM-CSF inhalation therapy. Respir Investig 2024; 62:375-376. [PMID: 38437758 DOI: 10.1016/j.resinv.2024.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 02/18/2024] [Accepted: 02/23/2024] [Indexed: 03/06/2024]
Affiliation(s)
- Takuro Sakagami
- Department of Respiratory Medicine, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto City, Kumamoto, 860-8556, Japan.
| |
Collapse
|
3
|
Lund-Palau H, Juarez-Molina CI, Meng C, Bhargava A, Pilou A, Aziz K, Clarke N, Atsumi N, Ashek A, Wilson MR, Takata M, Padley S, Gill DR, Hyde SC, Morgan C, Alton EWFW, Griesenbach U. Correction of a chronic pulmonary disease through lentiviral vector-mediated protein expression. Mol Ther Methods Clin Dev 2022; 25:382-391. [PMID: 35573048 PMCID: PMC9065048 DOI: 10.1016/j.omtm.2022.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 04/10/2022] [Indexed: 11/16/2022]
Abstract
We developed a novel lentiviral vector, pseudotyped with the F and HN proteins from Sendai virus (rSIV.F/HN), that produces long-lasting, high-efficiency transduction of the respiratory epithelium. Here we addressed whether this platform technology can secrete sufficient levels of a therapeutic protein into the lungs to ameliorate a fatal pulmonary disease as an example of its translational capability. Pulmonary alveolar proteinosis (PAP) results from alveolar granulocyte-macrophage colony-stimulating factor (GM-CSF) insufficiency, resulting in abnormal surfactant homeostasis and consequent ventilatory problems. Lungs of GM-CSF knockout mice were transduced with a single dose of rSIV.F/HN-expressing murine GM-CSF (mGM-CSF; 1e5-92e7 transduction units [TU]/mouse); mGM-CSF expression was dose related and persisted for at least 11 months. PAP disease biomarkers were rapidly and persistently corrected, but we noted a narrow toxicity/efficacy window. rSIV.F/HN may be a useful platform technology to deliver therapeutic proteins for lung diseases requiring long-lasting and stable expression of secreted proteins.
Collapse
Affiliation(s)
- Helena Lund-Palau
- National Heart and Lung Institute, Gene Therapy Group, Imperial College London, Faculty of Medicine, Manresa Road, London SW3 6LR, UK.,UK Respiratory Gene Therapy Consortium, London SW3 6LR, UK
| | - Claudia Ivette Juarez-Molina
- National Heart and Lung Institute, Gene Therapy Group, Imperial College London, Faculty of Medicine, Manresa Road, London SW3 6LR, UK.,UK Respiratory Gene Therapy Consortium, London SW3 6LR, UK
| | - Cuixiang Meng
- National Heart and Lung Institute, Gene Therapy Group, Imperial College London, Faculty of Medicine, Manresa Road, London SW3 6LR, UK
| | - Anushka Bhargava
- National Heart and Lung Institute, Gene Therapy Group, Imperial College London, Faculty of Medicine, Manresa Road, London SW3 6LR, UK.,UK Respiratory Gene Therapy Consortium, London SW3 6LR, UK
| | - Aikaterini Pilou
- National Heart and Lung Institute, Gene Therapy Group, Imperial College London, Faculty of Medicine, Manresa Road, London SW3 6LR, UK.,UK Respiratory Gene Therapy Consortium, London SW3 6LR, UK
| | - Kiran Aziz
- National Heart and Lung Institute, Gene Therapy Group, Imperial College London, Faculty of Medicine, Manresa Road, London SW3 6LR, UK.,UK Respiratory Gene Therapy Consortium, London SW3 6LR, UK
| | - Nora Clarke
- National Heart and Lung Institute, Gene Therapy Group, Imperial College London, Faculty of Medicine, Manresa Road, London SW3 6LR, UK.,UK Respiratory Gene Therapy Consortium, London SW3 6LR, UK
| | - Naoko Atsumi
- National Heart and Lung Institute, Gene Therapy Group, Imperial College London, Faculty of Medicine, Manresa Road, London SW3 6LR, UK.,UK Respiratory Gene Therapy Consortium, London SW3 6LR, UK
| | - Ali Ashek
- National Heart and Lung Institute, Gene Therapy Group, Imperial College London, Faculty of Medicine, Manresa Road, London SW3 6LR, UK
| | - Michael R Wilson
- Division of Anesthetics, Pain Medicine, and Intensive Care, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Masao Takata
- Division of Anesthetics, Pain Medicine, and Intensive Care, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Simon Padley
- Royal Brompton Hospital & Harefield Hospitals, London, UK
| | - Deborah R Gill
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK.,UK Respiratory Gene Therapy Consortium, London SW3 6LR, UK
| | - Stephen C Hyde
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK.,UK Respiratory Gene Therapy Consortium, London SW3 6LR, UK
| | - Cliff Morgan
- Royal Brompton Hospital & Harefield Hospitals, London, UK
| | - Eric W F W Alton
- National Heart and Lung Institute, Gene Therapy Group, Imperial College London, Faculty of Medicine, Manresa Road, London SW3 6LR, UK.,UK Respiratory Gene Therapy Consortium, London SW3 6LR, UK
| | - Uta Griesenbach
- National Heart and Lung Institute, Gene Therapy Group, Imperial College London, Faculty of Medicine, Manresa Road, London SW3 6LR, UK.,UK Respiratory Gene Therapy Consortium, London SW3 6LR, UK
| |
Collapse
|
4
|
McCarthy C, Carey BC, Trapnell BC. Autoimmune Pulmonary Alveolar Proteinosis. Am J Respir Crit Care Med 2022; 205:1016-1035. [PMID: 35227171 PMCID: PMC9851473 DOI: 10.1164/rccm.202112-2742so] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 02/24/2022] [Indexed: 01/23/2023] Open
Abstract
Autoimmune pulmonary alveolar proteinosis (PAP) is a rare disease characterized by myeloid cell dysfunction, abnormal pulmonary surfactant accumulation, and innate immune deficiency. It has a prevalence of 7-10 per million; occurs in individuals of all races, geographic regions, sex, and socioeconomic status; and accounts for 90% of all patients with PAP syndrome. The most common presentation is dyspnea of insidious onset with or without cough, production of scant white and frothy sputum, and diffuse radiographic infiltrates in a previously healthy adult, but it can also occur in children as young as 3 years. Digital clubbing, fever, and hemoptysis are not typical, and the latter two indicate that intercurrent infection may be present. Low prevalence and nonspecific clinical, radiological, and laboratory findings commonly lead to misdiagnosis as pneumonia and substantially delay an accurate diagnosis. The clinical course, although variable, usually includes progressive hypoxemic respiratory insufficiency and, in some patients, secondary infections, pulmonary fibrosis, respiratory failure, and death. Two decades of research have raised autoimmune PAP from obscurity to a paradigm of molecular pathogenesis-based diagnostic and therapeutic development. Pathogenesis is driven by GM-CSF (granulocyte/macrophage colony-stimulating factor) autoantibodies, which are present at high concentrations in blood and tissues and form the basis of an accurate, commercially available diagnostic blood test with sensitivity and specificity of 100%. Although whole-lung lavage remains the first-line therapy, inhaled GM-CSF is a promising pharmacotherapeutic approach demonstrated in well-controlled trials to be safe, well tolerated, and efficacious. Research has established GM-CSF as a pulmonary regulatory molecule critical to surfactant homeostasis, alveolar stability, lung function, and host defense.
Collapse
Affiliation(s)
- Cormac McCarthy
- Department of Respiratory Medicine, St. Vincent’s University Hospital, Dublin, Ireland
- University College Dublin, Dublin, Ireland
| | - Brenna C. Carey
- Translational Pulmonary Science Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio; and
- University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Bruce C. Trapnell
- Translational Pulmonary Science Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio; and
- University of Cincinnati College of Medicine, Cincinnati, Ohio
| |
Collapse
|
5
|
Liu S, Cui X, Xia K, Wang D, Han J, Yao X, Liu X, Bian L, Zhang J, Li G. A Bibliometric Analysis of Pulmonary Alveolar Proteinosis From 2001 to 2021. Front Med (Lausanne) 2022; 9:846480. [PMID: 35391885 PMCID: PMC8980592 DOI: 10.3389/fmed.2022.846480] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 02/28/2022] [Indexed: 12/05/2022] Open
Abstract
Background Pulmonary alveolar proteinosis (PAP) is a rare syndrome first described by Rosen et al. in 1958. Despite our considerably evolved understanding of PAP over the past decades, no bibliometric studies have been reported on this field. We aimed to analyze and visualize the research hotspots and current trends of the PAP research field using a bibliometric analysis to help understand the future development of basic and clinical research. Methods The literature regarding PAP was culled from the Web of Science Core Collection (WoSCC) database. Data were extracted from the relevant articles and visually analyzed using CiteSpace and VOSviewer software. Results Nine hundred and nine qualifying articles were included in the analysis. Publications regarding PAP increased over time. These articles mainly come from 407 institutions of 57 countries. The leading countries were the USA and Japan. University of Cincinnati (USA) and Niigata University (Japan) featured the highest number of publications among all institutions. Bruce C Trapnell exerts a significant publication impact and has made the most outstanding contributions in the field of PAP. American Journal of Physiology-Lung Cellular and Molecular Physiology was the journal with the most publications, and American Journal of Respiratory and Critical Care Medicine was the most commonly cited journal. All the top 5 co-cited journals belong to Q1. Keyword citation bursts revealed that inflammation, deficiency, tissue resident macrophage, classification, autoimmune pulmonary alveolar proteinosis, sarcoidosis, gm csf, high resolution ct, and fetal monocyte were the emerging research hotspots. Conclusion Research on PAP is prosperous. International cooperation is also expected to deepen and strengthen in the future. Our results indicated that the etiology and pathogenesis of PAP, current and emerging therapies, especially the novel pathogenesis-based options will remain research hotspots in the future.
Collapse
Affiliation(s)
- Shixu Liu
- Guanganmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Graduate School of China Academy of Chinese Medical Sciences, Beijing, China
| | - Xiangning Cui
- Guanganmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Kun Xia
- Guanganmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Dandan Wang
- Guanganmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Graduate School of China Academy of Chinese Medical Sciences, Beijing, China
| | - Jing Han
- Affilated Hospital of Weifang Medical University, Weifang, China
| | - Xiaoyan Yao
- Guanganmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xiaohong Liu
- Guanganmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Graduate School of China Academy of Chinese Medical Sciences, Beijing, China
| | - Lingjie Bian
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Jinzhi Zhang
- Guanganmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Graduate School of China Academy of Chinese Medical Sciences, Beijing, China
| | - Guangxi Li
- Guanganmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- *Correspondence: Guangxi Li
| |
Collapse
|
6
|
Iftikhar H, Nair GB, Kumar A. Update on Diagnosis and Treatment of Adult Pulmonary Alveolar Proteinosis. Ther Clin Risk Manag 2021; 17:701-710. [PMID: 34408422 PMCID: PMC8364424 DOI: 10.2147/tcrm.s193884] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 06/19/2021] [Indexed: 01/15/2023] Open
Abstract
Pulmonary alveolar proteinosis (PAP) is a rare pulmonary surfactant homeostasis disorder resulting in buildup of lipo-proteinaceous material within the alveoli. PAP is classified as primary (autoimmune and hereditary), secondary, congenital and unclassifiable type based on the underlying pathogenesis. PAP has an insidious onset and can, in some cases, progress to severe respiratory failure. Diagnosis is often secured with bronchoalveolar lavage in the setting of classic imaging findings. Recent insights into genetic alterations and autoimmune mechanisms have provided newer diagnostics and treatment options. In this review, we discuss the etiopathogenesis, diagnosis and treatment options available and emerging for PAP.
Collapse
Affiliation(s)
- Hira Iftikhar
- Division of Pulmonary and Critical Care, Beaumont Health, OUWB School of Medicine, Royal Oak, MI, USA
| | - Girish B Nair
- Division of Pulmonary and Critical Care, Beaumont Health, OUWB School of Medicine, Royal Oak, MI, USA
| | - Anupam Kumar
- Division of Pulmonary and Critical Care, Baylor College of Medicine, Houston, TX, USA
| |
Collapse
|
7
|
Vahdatpour C, Khasawneh M, Zayed Y, Ataya A. Emerging Medical Therapies for Pulmonary Alveolar Proteinosis. Am J Respir Crit Care Med 2021; 203:1566-1568. [PMID: 33891826 DOI: 10.1164/rccm.202011-4260rr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Cyrus Vahdatpour
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Florida, Gainesville, Florida
| | - Majd Khasawneh
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Florida, Gainesville, Florida
| | - Yazan Zayed
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Florida, Gainesville, Florida
| | - Ali Ataya
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Florida, Gainesville, Florida
| |
Collapse
|
8
|
Trapnell BC, Inoue Y, Bonella F, Morgan C, Jouneau S, Bendstrup E, Campo I, Papiris SA, Yamaguchi E, Cetinkaya E, Ilkovich MM, Kramer MR, Veltkamp M, Kreuter M, Baba T, Ganslandt C, Tarnow I, Waterer G, Jouhikainen T. Inhaled Molgramostim Therapy in Autoimmune Pulmonary Alveolar Proteinosis. N Engl J Med 2020; 383:1635-1644. [PMID: 32897035 PMCID: PMC8083051 DOI: 10.1056/nejmoa1913590] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Autoimmune pulmonary alveolar proteinosis (aPAP) is a rare disease characterized by progressive surfactant accumulation and hypoxemia. It is caused by disruption of granulocyte-macrophage colony-stimulating factor (GM-CSF) signaling, which pulmonary alveolar macrophages require to clear surfactant. Recently, inhaled GM-CSF was shown to improve the partial pressure of arterial oxygen in patients with aPAP. METHODS In a double-blind, placebo-controlled, three-group trial, we randomly assigned patients with aPAP to receive the recombinant GM-CSF molgramostim (300 μg once daily by inhalation), either continuously or intermittently (every other week), or matching placebo. The 24-week intervention period was followed by an open-label treatment-extension period. The primary end point was the change from baseline in the alveolar-arterial difference in oxygen concentration (A-aDo2) at week 24. RESULTS In total, 138 patients underwent randomization; 46 were assigned to receive continuous molgramostim, 45 to receive intermittent molgramostim, and 47 to receive placebo. Invalid A-aDo2 data for 4 patients (1 in each molgramostim group and 2 in the placebo group) who received nasal oxygen therapy during arterial blood gas measurement were replaced by means of imputation. For the primary end point - the change from baseline in the A-aDo2 at week 24 - improvement was greater among patients receiving continuous molgramostim than among those receiving placebo (-12.8 mm Hg vs. -6.6 mm Hg; estimated treatment difference, -6.2 mm Hg; P = 0.03 by comparison of least-squares means). Patients receiving continuous molgramostim also had greater improvement than those receiving placebo for secondary end points, including the change from baseline in the St. George's Respiratory Questionnaire total score at week 24 (-12.4 points vs. -5.1 points; estimated treatment difference, -7.4 points; P = 0.01 by comparison of least-squares means). For multiple end points, improvement was greater with continuous molgramostim than with intermittent molgramostim. The percentages of patients with adverse events and serious adverse events were similar in the three groups, except for the percentage of patients with chest pain, which was higher in the continuous-molgramostim group. CONCLUSIONS In patients with aPAP, daily administration of inhaled molgramostim resulted in greater improvements in pulmonary gas transfer and functional health status than placebo, with similar rates of adverse events. (Funded by Savara Pharmaceuticals; IMPALA ClinicalTrials.gov number, NCT02702180.).
Collapse
Affiliation(s)
- Bruce C Trapnell
- From the Translational Pulmonary Science Center, Cincinnati Children's Hospital Medical Center, Cincinnati (B.C.T.); National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka (Y.I.), Aichi Medical University Hospital, Nagakute, Aichi (E.Y.), and Kanagawa Cardiovascular and Respiratory Center, Yokohama (T.B.) - all in Japan; Outpatients Clinic for Interstitial and Rare Lung Disease, Ruhrlandklinik University Hospital, Essen (F.B.), and Center for Interstitial and Rare Lung Diseases, Pulmonology, Thoraxklinik, Heidelberg University Hospital, and German Center for Lung Research, Heidelberg (M.K.) - all in Germany; the Departments of Critical Care and Respiratory Medicine, Royal Brompton Hospital, London (C.M.); Respiratory Diseases Department, Pontchaillou Hospital, IRSET UMR 1085, Rennes 1 University, Rennes, France (S.J.); the Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus (E.B.), and Savara, Horsholm (C.G., I.T.) - both in Denmark; the Pneumology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy (I.C.); the 2nd Pulmonary Medicine Department, General University Hospital "Attikon," Medical School, National and Kapodistrian University of Athens, Athens (S.A.P.); University of Health Sciences Turkey, Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, Istanbul (E.C.); Pulmonary Clinic of St. Petersburg Pavlov State Medical University, St. Petersburg, Russia (M.M.I.); Institute of Pulmonary and Allergy Medicine, Rabin Medical Center, Petah Tikva, Israel (M.R.K.); ILD Center of Excellence, Department of Pulmonology, St. Antonius Hospital, Nieuwegein, the Netherlands (M.V.); the University of Western Australia, Royal Perth Hospital, Perth, Australia (G.W.); and Savara, Austin, TX (T.J.)
| | - Yoshikazu Inoue
- From the Translational Pulmonary Science Center, Cincinnati Children's Hospital Medical Center, Cincinnati (B.C.T.); National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka (Y.I.), Aichi Medical University Hospital, Nagakute, Aichi (E.Y.), and Kanagawa Cardiovascular and Respiratory Center, Yokohama (T.B.) - all in Japan; Outpatients Clinic for Interstitial and Rare Lung Disease, Ruhrlandklinik University Hospital, Essen (F.B.), and Center for Interstitial and Rare Lung Diseases, Pulmonology, Thoraxklinik, Heidelberg University Hospital, and German Center for Lung Research, Heidelberg (M.K.) - all in Germany; the Departments of Critical Care and Respiratory Medicine, Royal Brompton Hospital, London (C.M.); Respiratory Diseases Department, Pontchaillou Hospital, IRSET UMR 1085, Rennes 1 University, Rennes, France (S.J.); the Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus (E.B.), and Savara, Horsholm (C.G., I.T.) - both in Denmark; the Pneumology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy (I.C.); the 2nd Pulmonary Medicine Department, General University Hospital "Attikon," Medical School, National and Kapodistrian University of Athens, Athens (S.A.P.); University of Health Sciences Turkey, Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, Istanbul (E.C.); Pulmonary Clinic of St. Petersburg Pavlov State Medical University, St. Petersburg, Russia (M.M.I.); Institute of Pulmonary and Allergy Medicine, Rabin Medical Center, Petah Tikva, Israel (M.R.K.); ILD Center of Excellence, Department of Pulmonology, St. Antonius Hospital, Nieuwegein, the Netherlands (M.V.); the University of Western Australia, Royal Perth Hospital, Perth, Australia (G.W.); and Savara, Austin, TX (T.J.)
| | - Francesco Bonella
- From the Translational Pulmonary Science Center, Cincinnati Children's Hospital Medical Center, Cincinnati (B.C.T.); National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka (Y.I.), Aichi Medical University Hospital, Nagakute, Aichi (E.Y.), and Kanagawa Cardiovascular and Respiratory Center, Yokohama (T.B.) - all in Japan; Outpatients Clinic for Interstitial and Rare Lung Disease, Ruhrlandklinik University Hospital, Essen (F.B.), and Center for Interstitial and Rare Lung Diseases, Pulmonology, Thoraxklinik, Heidelberg University Hospital, and German Center for Lung Research, Heidelberg (M.K.) - all in Germany; the Departments of Critical Care and Respiratory Medicine, Royal Brompton Hospital, London (C.M.); Respiratory Diseases Department, Pontchaillou Hospital, IRSET UMR 1085, Rennes 1 University, Rennes, France (S.J.); the Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus (E.B.), and Savara, Horsholm (C.G., I.T.) - both in Denmark; the Pneumology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy (I.C.); the 2nd Pulmonary Medicine Department, General University Hospital "Attikon," Medical School, National and Kapodistrian University of Athens, Athens (S.A.P.); University of Health Sciences Turkey, Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, Istanbul (E.C.); Pulmonary Clinic of St. Petersburg Pavlov State Medical University, St. Petersburg, Russia (M.M.I.); Institute of Pulmonary and Allergy Medicine, Rabin Medical Center, Petah Tikva, Israel (M.R.K.); ILD Center of Excellence, Department of Pulmonology, St. Antonius Hospital, Nieuwegein, the Netherlands (M.V.); the University of Western Australia, Royal Perth Hospital, Perth, Australia (G.W.); and Savara, Austin, TX (T.J.)
| | - Cliff Morgan
- From the Translational Pulmonary Science Center, Cincinnati Children's Hospital Medical Center, Cincinnati (B.C.T.); National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka (Y.I.), Aichi Medical University Hospital, Nagakute, Aichi (E.Y.), and Kanagawa Cardiovascular and Respiratory Center, Yokohama (T.B.) - all in Japan; Outpatients Clinic for Interstitial and Rare Lung Disease, Ruhrlandklinik University Hospital, Essen (F.B.), and Center for Interstitial and Rare Lung Diseases, Pulmonology, Thoraxklinik, Heidelberg University Hospital, and German Center for Lung Research, Heidelberg (M.K.) - all in Germany; the Departments of Critical Care and Respiratory Medicine, Royal Brompton Hospital, London (C.M.); Respiratory Diseases Department, Pontchaillou Hospital, IRSET UMR 1085, Rennes 1 University, Rennes, France (S.J.); the Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus (E.B.), and Savara, Horsholm (C.G., I.T.) - both in Denmark; the Pneumology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy (I.C.); the 2nd Pulmonary Medicine Department, General University Hospital "Attikon," Medical School, National and Kapodistrian University of Athens, Athens (S.A.P.); University of Health Sciences Turkey, Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, Istanbul (E.C.); Pulmonary Clinic of St. Petersburg Pavlov State Medical University, St. Petersburg, Russia (M.M.I.); Institute of Pulmonary and Allergy Medicine, Rabin Medical Center, Petah Tikva, Israel (M.R.K.); ILD Center of Excellence, Department of Pulmonology, St. Antonius Hospital, Nieuwegein, the Netherlands (M.V.); the University of Western Australia, Royal Perth Hospital, Perth, Australia (G.W.); and Savara, Austin, TX (T.J.)
| | - Stéphane Jouneau
- From the Translational Pulmonary Science Center, Cincinnati Children's Hospital Medical Center, Cincinnati (B.C.T.); National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka (Y.I.), Aichi Medical University Hospital, Nagakute, Aichi (E.Y.), and Kanagawa Cardiovascular and Respiratory Center, Yokohama (T.B.) - all in Japan; Outpatients Clinic for Interstitial and Rare Lung Disease, Ruhrlandklinik University Hospital, Essen (F.B.), and Center for Interstitial and Rare Lung Diseases, Pulmonology, Thoraxklinik, Heidelberg University Hospital, and German Center for Lung Research, Heidelberg (M.K.) - all in Germany; the Departments of Critical Care and Respiratory Medicine, Royal Brompton Hospital, London (C.M.); Respiratory Diseases Department, Pontchaillou Hospital, IRSET UMR 1085, Rennes 1 University, Rennes, France (S.J.); the Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus (E.B.), and Savara, Horsholm (C.G., I.T.) - both in Denmark; the Pneumology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy (I.C.); the 2nd Pulmonary Medicine Department, General University Hospital "Attikon," Medical School, National and Kapodistrian University of Athens, Athens (S.A.P.); University of Health Sciences Turkey, Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, Istanbul (E.C.); Pulmonary Clinic of St. Petersburg Pavlov State Medical University, St. Petersburg, Russia (M.M.I.); Institute of Pulmonary and Allergy Medicine, Rabin Medical Center, Petah Tikva, Israel (M.R.K.); ILD Center of Excellence, Department of Pulmonology, St. Antonius Hospital, Nieuwegein, the Netherlands (M.V.); the University of Western Australia, Royal Perth Hospital, Perth, Australia (G.W.); and Savara, Austin, TX (T.J.)
| | - Elisabeth Bendstrup
- From the Translational Pulmonary Science Center, Cincinnati Children's Hospital Medical Center, Cincinnati (B.C.T.); National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka (Y.I.), Aichi Medical University Hospital, Nagakute, Aichi (E.Y.), and Kanagawa Cardiovascular and Respiratory Center, Yokohama (T.B.) - all in Japan; Outpatients Clinic for Interstitial and Rare Lung Disease, Ruhrlandklinik University Hospital, Essen (F.B.), and Center for Interstitial and Rare Lung Diseases, Pulmonology, Thoraxklinik, Heidelberg University Hospital, and German Center for Lung Research, Heidelberg (M.K.) - all in Germany; the Departments of Critical Care and Respiratory Medicine, Royal Brompton Hospital, London (C.M.); Respiratory Diseases Department, Pontchaillou Hospital, IRSET UMR 1085, Rennes 1 University, Rennes, France (S.J.); the Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus (E.B.), and Savara, Horsholm (C.G., I.T.) - both in Denmark; the Pneumology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy (I.C.); the 2nd Pulmonary Medicine Department, General University Hospital "Attikon," Medical School, National and Kapodistrian University of Athens, Athens (S.A.P.); University of Health Sciences Turkey, Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, Istanbul (E.C.); Pulmonary Clinic of St. Petersburg Pavlov State Medical University, St. Petersburg, Russia (M.M.I.); Institute of Pulmonary and Allergy Medicine, Rabin Medical Center, Petah Tikva, Israel (M.R.K.); ILD Center of Excellence, Department of Pulmonology, St. Antonius Hospital, Nieuwegein, the Netherlands (M.V.); the University of Western Australia, Royal Perth Hospital, Perth, Australia (G.W.); and Savara, Austin, TX (T.J.)
| | - Ilaria Campo
- From the Translational Pulmonary Science Center, Cincinnati Children's Hospital Medical Center, Cincinnati (B.C.T.); National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka (Y.I.), Aichi Medical University Hospital, Nagakute, Aichi (E.Y.), and Kanagawa Cardiovascular and Respiratory Center, Yokohama (T.B.) - all in Japan; Outpatients Clinic for Interstitial and Rare Lung Disease, Ruhrlandklinik University Hospital, Essen (F.B.), and Center for Interstitial and Rare Lung Diseases, Pulmonology, Thoraxklinik, Heidelberg University Hospital, and German Center for Lung Research, Heidelberg (M.K.) - all in Germany; the Departments of Critical Care and Respiratory Medicine, Royal Brompton Hospital, London (C.M.); Respiratory Diseases Department, Pontchaillou Hospital, IRSET UMR 1085, Rennes 1 University, Rennes, France (S.J.); the Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus (E.B.), and Savara, Horsholm (C.G., I.T.) - both in Denmark; the Pneumology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy (I.C.); the 2nd Pulmonary Medicine Department, General University Hospital "Attikon," Medical School, National and Kapodistrian University of Athens, Athens (S.A.P.); University of Health Sciences Turkey, Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, Istanbul (E.C.); Pulmonary Clinic of St. Petersburg Pavlov State Medical University, St. Petersburg, Russia (M.M.I.); Institute of Pulmonary and Allergy Medicine, Rabin Medical Center, Petah Tikva, Israel (M.R.K.); ILD Center of Excellence, Department of Pulmonology, St. Antonius Hospital, Nieuwegein, the Netherlands (M.V.); the University of Western Australia, Royal Perth Hospital, Perth, Australia (G.W.); and Savara, Austin, TX (T.J.)
| | - Spyros A Papiris
- From the Translational Pulmonary Science Center, Cincinnati Children's Hospital Medical Center, Cincinnati (B.C.T.); National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka (Y.I.), Aichi Medical University Hospital, Nagakute, Aichi (E.Y.), and Kanagawa Cardiovascular and Respiratory Center, Yokohama (T.B.) - all in Japan; Outpatients Clinic for Interstitial and Rare Lung Disease, Ruhrlandklinik University Hospital, Essen (F.B.), and Center for Interstitial and Rare Lung Diseases, Pulmonology, Thoraxklinik, Heidelberg University Hospital, and German Center for Lung Research, Heidelberg (M.K.) - all in Germany; the Departments of Critical Care and Respiratory Medicine, Royal Brompton Hospital, London (C.M.); Respiratory Diseases Department, Pontchaillou Hospital, IRSET UMR 1085, Rennes 1 University, Rennes, France (S.J.); the Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus (E.B.), and Savara, Horsholm (C.G., I.T.) - both in Denmark; the Pneumology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy (I.C.); the 2nd Pulmonary Medicine Department, General University Hospital "Attikon," Medical School, National and Kapodistrian University of Athens, Athens (S.A.P.); University of Health Sciences Turkey, Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, Istanbul (E.C.); Pulmonary Clinic of St. Petersburg Pavlov State Medical University, St. Petersburg, Russia (M.M.I.); Institute of Pulmonary and Allergy Medicine, Rabin Medical Center, Petah Tikva, Israel (M.R.K.); ILD Center of Excellence, Department of Pulmonology, St. Antonius Hospital, Nieuwegein, the Netherlands (M.V.); the University of Western Australia, Royal Perth Hospital, Perth, Australia (G.W.); and Savara, Austin, TX (T.J.)
| | - Etsuro Yamaguchi
- From the Translational Pulmonary Science Center, Cincinnati Children's Hospital Medical Center, Cincinnati (B.C.T.); National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka (Y.I.), Aichi Medical University Hospital, Nagakute, Aichi (E.Y.), and Kanagawa Cardiovascular and Respiratory Center, Yokohama (T.B.) - all in Japan; Outpatients Clinic for Interstitial and Rare Lung Disease, Ruhrlandklinik University Hospital, Essen (F.B.), and Center for Interstitial and Rare Lung Diseases, Pulmonology, Thoraxklinik, Heidelberg University Hospital, and German Center for Lung Research, Heidelberg (M.K.) - all in Germany; the Departments of Critical Care and Respiratory Medicine, Royal Brompton Hospital, London (C.M.); Respiratory Diseases Department, Pontchaillou Hospital, IRSET UMR 1085, Rennes 1 University, Rennes, France (S.J.); the Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus (E.B.), and Savara, Horsholm (C.G., I.T.) - both in Denmark; the Pneumology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy (I.C.); the 2nd Pulmonary Medicine Department, General University Hospital "Attikon," Medical School, National and Kapodistrian University of Athens, Athens (S.A.P.); University of Health Sciences Turkey, Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, Istanbul (E.C.); Pulmonary Clinic of St. Petersburg Pavlov State Medical University, St. Petersburg, Russia (M.M.I.); Institute of Pulmonary and Allergy Medicine, Rabin Medical Center, Petah Tikva, Israel (M.R.K.); ILD Center of Excellence, Department of Pulmonology, St. Antonius Hospital, Nieuwegein, the Netherlands (M.V.); the University of Western Australia, Royal Perth Hospital, Perth, Australia (G.W.); and Savara, Austin, TX (T.J.)
| | - Erdogan Cetinkaya
- From the Translational Pulmonary Science Center, Cincinnati Children's Hospital Medical Center, Cincinnati (B.C.T.); National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka (Y.I.), Aichi Medical University Hospital, Nagakute, Aichi (E.Y.), and Kanagawa Cardiovascular and Respiratory Center, Yokohama (T.B.) - all in Japan; Outpatients Clinic for Interstitial and Rare Lung Disease, Ruhrlandklinik University Hospital, Essen (F.B.), and Center for Interstitial and Rare Lung Diseases, Pulmonology, Thoraxklinik, Heidelberg University Hospital, and German Center for Lung Research, Heidelberg (M.K.) - all in Germany; the Departments of Critical Care and Respiratory Medicine, Royal Brompton Hospital, London (C.M.); Respiratory Diseases Department, Pontchaillou Hospital, IRSET UMR 1085, Rennes 1 University, Rennes, France (S.J.); the Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus (E.B.), and Savara, Horsholm (C.G., I.T.) - both in Denmark; the Pneumology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy (I.C.); the 2nd Pulmonary Medicine Department, General University Hospital "Attikon," Medical School, National and Kapodistrian University of Athens, Athens (S.A.P.); University of Health Sciences Turkey, Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, Istanbul (E.C.); Pulmonary Clinic of St. Petersburg Pavlov State Medical University, St. Petersburg, Russia (M.M.I.); Institute of Pulmonary and Allergy Medicine, Rabin Medical Center, Petah Tikva, Israel (M.R.K.); ILD Center of Excellence, Department of Pulmonology, St. Antonius Hospital, Nieuwegein, the Netherlands (M.V.); the University of Western Australia, Royal Perth Hospital, Perth, Australia (G.W.); and Savara, Austin, TX (T.J.)
| | - Mikhail M Ilkovich
- From the Translational Pulmonary Science Center, Cincinnati Children's Hospital Medical Center, Cincinnati (B.C.T.); National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka (Y.I.), Aichi Medical University Hospital, Nagakute, Aichi (E.Y.), and Kanagawa Cardiovascular and Respiratory Center, Yokohama (T.B.) - all in Japan; Outpatients Clinic for Interstitial and Rare Lung Disease, Ruhrlandklinik University Hospital, Essen (F.B.), and Center for Interstitial and Rare Lung Diseases, Pulmonology, Thoraxklinik, Heidelberg University Hospital, and German Center for Lung Research, Heidelberg (M.K.) - all in Germany; the Departments of Critical Care and Respiratory Medicine, Royal Brompton Hospital, London (C.M.); Respiratory Diseases Department, Pontchaillou Hospital, IRSET UMR 1085, Rennes 1 University, Rennes, France (S.J.); the Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus (E.B.), and Savara, Horsholm (C.G., I.T.) - both in Denmark; the Pneumology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy (I.C.); the 2nd Pulmonary Medicine Department, General University Hospital "Attikon," Medical School, National and Kapodistrian University of Athens, Athens (S.A.P.); University of Health Sciences Turkey, Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, Istanbul (E.C.); Pulmonary Clinic of St. Petersburg Pavlov State Medical University, St. Petersburg, Russia (M.M.I.); Institute of Pulmonary and Allergy Medicine, Rabin Medical Center, Petah Tikva, Israel (M.R.K.); ILD Center of Excellence, Department of Pulmonology, St. Antonius Hospital, Nieuwegein, the Netherlands (M.V.); the University of Western Australia, Royal Perth Hospital, Perth, Australia (G.W.); and Savara, Austin, TX (T.J.)
| | - Mordechai R Kramer
- From the Translational Pulmonary Science Center, Cincinnati Children's Hospital Medical Center, Cincinnati (B.C.T.); National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka (Y.I.), Aichi Medical University Hospital, Nagakute, Aichi (E.Y.), and Kanagawa Cardiovascular and Respiratory Center, Yokohama (T.B.) - all in Japan; Outpatients Clinic for Interstitial and Rare Lung Disease, Ruhrlandklinik University Hospital, Essen (F.B.), and Center for Interstitial and Rare Lung Diseases, Pulmonology, Thoraxklinik, Heidelberg University Hospital, and German Center for Lung Research, Heidelberg (M.K.) - all in Germany; the Departments of Critical Care and Respiratory Medicine, Royal Brompton Hospital, London (C.M.); Respiratory Diseases Department, Pontchaillou Hospital, IRSET UMR 1085, Rennes 1 University, Rennes, France (S.J.); the Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus (E.B.), and Savara, Horsholm (C.G., I.T.) - both in Denmark; the Pneumology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy (I.C.); the 2nd Pulmonary Medicine Department, General University Hospital "Attikon," Medical School, National and Kapodistrian University of Athens, Athens (S.A.P.); University of Health Sciences Turkey, Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, Istanbul (E.C.); Pulmonary Clinic of St. Petersburg Pavlov State Medical University, St. Petersburg, Russia (M.M.I.); Institute of Pulmonary and Allergy Medicine, Rabin Medical Center, Petah Tikva, Israel (M.R.K.); ILD Center of Excellence, Department of Pulmonology, St. Antonius Hospital, Nieuwegein, the Netherlands (M.V.); the University of Western Australia, Royal Perth Hospital, Perth, Australia (G.W.); and Savara, Austin, TX (T.J.)
| | - Marcel Veltkamp
- From the Translational Pulmonary Science Center, Cincinnati Children's Hospital Medical Center, Cincinnati (B.C.T.); National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka (Y.I.), Aichi Medical University Hospital, Nagakute, Aichi (E.Y.), and Kanagawa Cardiovascular and Respiratory Center, Yokohama (T.B.) - all in Japan; Outpatients Clinic for Interstitial and Rare Lung Disease, Ruhrlandklinik University Hospital, Essen (F.B.), and Center for Interstitial and Rare Lung Diseases, Pulmonology, Thoraxklinik, Heidelberg University Hospital, and German Center for Lung Research, Heidelberg (M.K.) - all in Germany; the Departments of Critical Care and Respiratory Medicine, Royal Brompton Hospital, London (C.M.); Respiratory Diseases Department, Pontchaillou Hospital, IRSET UMR 1085, Rennes 1 University, Rennes, France (S.J.); the Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus (E.B.), and Savara, Horsholm (C.G., I.T.) - both in Denmark; the Pneumology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy (I.C.); the 2nd Pulmonary Medicine Department, General University Hospital "Attikon," Medical School, National and Kapodistrian University of Athens, Athens (S.A.P.); University of Health Sciences Turkey, Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, Istanbul (E.C.); Pulmonary Clinic of St. Petersburg Pavlov State Medical University, St. Petersburg, Russia (M.M.I.); Institute of Pulmonary and Allergy Medicine, Rabin Medical Center, Petah Tikva, Israel (M.R.K.); ILD Center of Excellence, Department of Pulmonology, St. Antonius Hospital, Nieuwegein, the Netherlands (M.V.); the University of Western Australia, Royal Perth Hospital, Perth, Australia (G.W.); and Savara, Austin, TX (T.J.)
| | - Michael Kreuter
- From the Translational Pulmonary Science Center, Cincinnati Children's Hospital Medical Center, Cincinnati (B.C.T.); National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka (Y.I.), Aichi Medical University Hospital, Nagakute, Aichi (E.Y.), and Kanagawa Cardiovascular and Respiratory Center, Yokohama (T.B.) - all in Japan; Outpatients Clinic for Interstitial and Rare Lung Disease, Ruhrlandklinik University Hospital, Essen (F.B.), and Center for Interstitial and Rare Lung Diseases, Pulmonology, Thoraxklinik, Heidelberg University Hospital, and German Center for Lung Research, Heidelberg (M.K.) - all in Germany; the Departments of Critical Care and Respiratory Medicine, Royal Brompton Hospital, London (C.M.); Respiratory Diseases Department, Pontchaillou Hospital, IRSET UMR 1085, Rennes 1 University, Rennes, France (S.J.); the Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus (E.B.), and Savara, Horsholm (C.G., I.T.) - both in Denmark; the Pneumology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy (I.C.); the 2nd Pulmonary Medicine Department, General University Hospital "Attikon," Medical School, National and Kapodistrian University of Athens, Athens (S.A.P.); University of Health Sciences Turkey, Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, Istanbul (E.C.); Pulmonary Clinic of St. Petersburg Pavlov State Medical University, St. Petersburg, Russia (M.M.I.); Institute of Pulmonary and Allergy Medicine, Rabin Medical Center, Petah Tikva, Israel (M.R.K.); ILD Center of Excellence, Department of Pulmonology, St. Antonius Hospital, Nieuwegein, the Netherlands (M.V.); the University of Western Australia, Royal Perth Hospital, Perth, Australia (G.W.); and Savara, Austin, TX (T.J.)
| | - Tomohisa Baba
- From the Translational Pulmonary Science Center, Cincinnati Children's Hospital Medical Center, Cincinnati (B.C.T.); National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka (Y.I.), Aichi Medical University Hospital, Nagakute, Aichi (E.Y.), and Kanagawa Cardiovascular and Respiratory Center, Yokohama (T.B.) - all in Japan; Outpatients Clinic for Interstitial and Rare Lung Disease, Ruhrlandklinik University Hospital, Essen (F.B.), and Center for Interstitial and Rare Lung Diseases, Pulmonology, Thoraxklinik, Heidelberg University Hospital, and German Center for Lung Research, Heidelberg (M.K.) - all in Germany; the Departments of Critical Care and Respiratory Medicine, Royal Brompton Hospital, London (C.M.); Respiratory Diseases Department, Pontchaillou Hospital, IRSET UMR 1085, Rennes 1 University, Rennes, France (S.J.); the Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus (E.B.), and Savara, Horsholm (C.G., I.T.) - both in Denmark; the Pneumology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy (I.C.); the 2nd Pulmonary Medicine Department, General University Hospital "Attikon," Medical School, National and Kapodistrian University of Athens, Athens (S.A.P.); University of Health Sciences Turkey, Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, Istanbul (E.C.); Pulmonary Clinic of St. Petersburg Pavlov State Medical University, St. Petersburg, Russia (M.M.I.); Institute of Pulmonary and Allergy Medicine, Rabin Medical Center, Petah Tikva, Israel (M.R.K.); ILD Center of Excellence, Department of Pulmonology, St. Antonius Hospital, Nieuwegein, the Netherlands (M.V.); the University of Western Australia, Royal Perth Hospital, Perth, Australia (G.W.); and Savara, Austin, TX (T.J.)
| | - Cecilia Ganslandt
- From the Translational Pulmonary Science Center, Cincinnati Children's Hospital Medical Center, Cincinnati (B.C.T.); National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka (Y.I.), Aichi Medical University Hospital, Nagakute, Aichi (E.Y.), and Kanagawa Cardiovascular and Respiratory Center, Yokohama (T.B.) - all in Japan; Outpatients Clinic for Interstitial and Rare Lung Disease, Ruhrlandklinik University Hospital, Essen (F.B.), and Center for Interstitial and Rare Lung Diseases, Pulmonology, Thoraxklinik, Heidelberg University Hospital, and German Center for Lung Research, Heidelberg (M.K.) - all in Germany; the Departments of Critical Care and Respiratory Medicine, Royal Brompton Hospital, London (C.M.); Respiratory Diseases Department, Pontchaillou Hospital, IRSET UMR 1085, Rennes 1 University, Rennes, France (S.J.); the Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus (E.B.), and Savara, Horsholm (C.G., I.T.) - both in Denmark; the Pneumology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy (I.C.); the 2nd Pulmonary Medicine Department, General University Hospital "Attikon," Medical School, National and Kapodistrian University of Athens, Athens (S.A.P.); University of Health Sciences Turkey, Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, Istanbul (E.C.); Pulmonary Clinic of St. Petersburg Pavlov State Medical University, St. Petersburg, Russia (M.M.I.); Institute of Pulmonary and Allergy Medicine, Rabin Medical Center, Petah Tikva, Israel (M.R.K.); ILD Center of Excellence, Department of Pulmonology, St. Antonius Hospital, Nieuwegein, the Netherlands (M.V.); the University of Western Australia, Royal Perth Hospital, Perth, Australia (G.W.); and Savara, Austin, TX (T.J.)
| | - Inge Tarnow
- From the Translational Pulmonary Science Center, Cincinnati Children's Hospital Medical Center, Cincinnati (B.C.T.); National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka (Y.I.), Aichi Medical University Hospital, Nagakute, Aichi (E.Y.), and Kanagawa Cardiovascular and Respiratory Center, Yokohama (T.B.) - all in Japan; Outpatients Clinic for Interstitial and Rare Lung Disease, Ruhrlandklinik University Hospital, Essen (F.B.), and Center for Interstitial and Rare Lung Diseases, Pulmonology, Thoraxklinik, Heidelberg University Hospital, and German Center for Lung Research, Heidelberg (M.K.) - all in Germany; the Departments of Critical Care and Respiratory Medicine, Royal Brompton Hospital, London (C.M.); Respiratory Diseases Department, Pontchaillou Hospital, IRSET UMR 1085, Rennes 1 University, Rennes, France (S.J.); the Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus (E.B.), and Savara, Horsholm (C.G., I.T.) - both in Denmark; the Pneumology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy (I.C.); the 2nd Pulmonary Medicine Department, General University Hospital "Attikon," Medical School, National and Kapodistrian University of Athens, Athens (S.A.P.); University of Health Sciences Turkey, Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, Istanbul (E.C.); Pulmonary Clinic of St. Petersburg Pavlov State Medical University, St. Petersburg, Russia (M.M.I.); Institute of Pulmonary and Allergy Medicine, Rabin Medical Center, Petah Tikva, Israel (M.R.K.); ILD Center of Excellence, Department of Pulmonology, St. Antonius Hospital, Nieuwegein, the Netherlands (M.V.); the University of Western Australia, Royal Perth Hospital, Perth, Australia (G.W.); and Savara, Austin, TX (T.J.)
| | - Grant Waterer
- From the Translational Pulmonary Science Center, Cincinnati Children's Hospital Medical Center, Cincinnati (B.C.T.); National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka (Y.I.), Aichi Medical University Hospital, Nagakute, Aichi (E.Y.), and Kanagawa Cardiovascular and Respiratory Center, Yokohama (T.B.) - all in Japan; Outpatients Clinic for Interstitial and Rare Lung Disease, Ruhrlandklinik University Hospital, Essen (F.B.), and Center for Interstitial and Rare Lung Diseases, Pulmonology, Thoraxklinik, Heidelberg University Hospital, and German Center for Lung Research, Heidelberg (M.K.) - all in Germany; the Departments of Critical Care and Respiratory Medicine, Royal Brompton Hospital, London (C.M.); Respiratory Diseases Department, Pontchaillou Hospital, IRSET UMR 1085, Rennes 1 University, Rennes, France (S.J.); the Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus (E.B.), and Savara, Horsholm (C.G., I.T.) - both in Denmark; the Pneumology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy (I.C.); the 2nd Pulmonary Medicine Department, General University Hospital "Attikon," Medical School, National and Kapodistrian University of Athens, Athens (S.A.P.); University of Health Sciences Turkey, Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, Istanbul (E.C.); Pulmonary Clinic of St. Petersburg Pavlov State Medical University, St. Petersburg, Russia (M.M.I.); Institute of Pulmonary and Allergy Medicine, Rabin Medical Center, Petah Tikva, Israel (M.R.K.); ILD Center of Excellence, Department of Pulmonology, St. Antonius Hospital, Nieuwegein, the Netherlands (M.V.); the University of Western Australia, Royal Perth Hospital, Perth, Australia (G.W.); and Savara, Austin, TX (T.J.)
| | - Taneli Jouhikainen
- From the Translational Pulmonary Science Center, Cincinnati Children's Hospital Medical Center, Cincinnati (B.C.T.); National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka (Y.I.), Aichi Medical University Hospital, Nagakute, Aichi (E.Y.), and Kanagawa Cardiovascular and Respiratory Center, Yokohama (T.B.) - all in Japan; Outpatients Clinic for Interstitial and Rare Lung Disease, Ruhrlandklinik University Hospital, Essen (F.B.), and Center for Interstitial and Rare Lung Diseases, Pulmonology, Thoraxklinik, Heidelberg University Hospital, and German Center for Lung Research, Heidelberg (M.K.) - all in Germany; the Departments of Critical Care and Respiratory Medicine, Royal Brompton Hospital, London (C.M.); Respiratory Diseases Department, Pontchaillou Hospital, IRSET UMR 1085, Rennes 1 University, Rennes, France (S.J.); the Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus (E.B.), and Savara, Horsholm (C.G., I.T.) - both in Denmark; the Pneumology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy (I.C.); the 2nd Pulmonary Medicine Department, General University Hospital "Attikon," Medical School, National and Kapodistrian University of Athens, Athens (S.A.P.); University of Health Sciences Turkey, Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, Istanbul (E.C.); Pulmonary Clinic of St. Petersburg Pavlov State Medical University, St. Petersburg, Russia (M.M.I.); Institute of Pulmonary and Allergy Medicine, Rabin Medical Center, Petah Tikva, Israel (M.R.K.); ILD Center of Excellence, Department of Pulmonology, St. Antonius Hospital, Nieuwegein, the Netherlands (M.V.); the University of Western Australia, Royal Perth Hospital, Perth, Australia (G.W.); and Savara, Austin, TX (T.J.)
| | | |
Collapse
|
9
|
Bush A, Pabary R. Pulmonary alveolarproteinosis in children. Breathe (Sheff) 2020; 16:200001. [PMID: 32684993 PMCID: PMC7341618 DOI: 10.1183/20734735.0001-2020] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 03/01/2020] [Indexed: 12/15/2022] Open
Abstract
Pulmonary alveolar proteinosis (PAP) is an umbrella term for a wide spectrum of conditions that have a very characteristic appearance on computed tomography. There is outlining of the secondary pulmonary lobules on the background of ground-glass shadowing and pathologically, filling of the alveolar spaces with normal or abnormal surfactant. PAP is rare and the common causes in children are very different from those seen in adults; autoimmune PAP is rare and macrophage blockade not described in children. There are many genetic causes of PAP, the best known of which are mutations in the genes encoding surfactant protein (SP)-B, SP-C, thyroid transcription factor 1, ATP-binding cassette protein 3, and the granulocyte-macrophage colony-stimulating factor (GM-CSF) receptor α- and β- chains. PAP may also be a manifestation of rheumatological and metabolic disease, congenital immunodeficiency, and haematological malignancy. Precise diagnosis of the underlying cause is essential in planning treatment, as well as for genetic counselling. The evidence base for treatment is poor. Some forms of PAP respond well to whole-lung lavage, and autoimmune PAP, which is much commoner in adults, responds to inhaled or subcutaneous GM-CSF. Emerging therapies based on studies in murine models of PAP include stem-cell transplantation for GM-CSF receptor mutations. EDUCATIONAL AIMS To understand when to suspect that a child has pulmonary alveolar proteinosis (PAP) and how to confirm that this is the cause of the presentation.To show that PAP is an umbrella term for conditions characterised by alveolar filling by normal or abnormal surfactant, and that this term is the start, not the end, of the diagnostic journey.To review the developmental differences in the spectrum of conditions that may cause PAP, and specifically to understand the differences between causes in adults and children.To discuss when to treat PAP with whole-lung lavage and/or granulocyte-macrophage colony-stimulating factor, and review potential promising new therapies.
Collapse
Affiliation(s)
- Andrew Bush
- Imperial College, London, UK
- Royal Brompton Harefield NHS Foundation Trust, London, UK
| | - Rishi Pabary
- Imperial College, London, UK
- Royal Brompton Harefield NHS Foundation Trust, London, UK
| |
Collapse
|
10
|
Granulocyte-Macrophage Colony-Stimulating Factor Inhalation Therapy for Severe Pulmonary Alveolar Proteinosis. Am J Ther 2020; 28:e171-e178. [PMID: 31513019 DOI: 10.1097/mjt.0000000000001053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Some patients with pulmonary alveolar proteinosis (PAP) still present with high recurrence rate after large-volume whole lung lavage (WLL). Granulocyte-macrophage colony-stimulating factor (GM-CSF) has been proved to be effective for PAP, but clinical research on GM-CSF inhalation therapy combined with WLL for severe PAP is rare in Asia. STUDY QUESTION This study aimed to investigate the clinical efficacy of GM-CSF inhalation combined with WLL in Chinese patients with PAP. STUDY DESIGN We performed regression analysis on 33 patients with severe PAP who underwent WLL alone or WLL combined with GM-CSF inhalation. The patients were put into 2 groups, WLL group and GM-CSF/WLL group. MEASURES AND OUTCOMES Physiologic, serologic, and radiologic features of the 2 groups at different time points after treatment and the recurrence rates at 1-year follow-up were compared. RESULTS There were no significant differences in lung function, blood gas analysis indices, and lung CT between the 2 groups after 1-week treatment (P > 0.05). After 3-month treatment, the GM-CSF/WLL group showed significantly faster improvement in FEV1%Pred (P = 0.028), FVC%Pred (P = 0.014), PaO2 (P = 0.022), PA-aO2 (P = 0.009), PaO2/FiO2 (P = 0.025), 6-minute walking test (P = 0.002), and lung CT parameters (P < 0.05) compared with the WLL group. The recurrence rate at the 1-year follow-up in the GM-CSF/WLL group (5.5%) was significantly higher than that in the WLL group (46.67%; P < 0.05). CONCLUSIONS GM-CSF inhalation therapy combined with WLL is an effective treatment for patients with severe PAP, with further improvement in lung function at the base of WILL as well as reduction on re-WLL incidence.
Collapse
|
11
|
Zhang F, Weng D, Su Y, Yin C, Shen L, Zhang Y, Zhou Y, Li Q, Hu Y, Li H. Therapeutic effect of subcutaneous injection of low dose recombinant human granulocyte-macrophage colony-stimulating factor on pulmonary alveolar proteinosis. Respir Res 2020; 21:1. [PMID: 31898493 PMCID: PMC6941258 DOI: 10.1186/s12931-019-1261-1] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 12/12/2019] [Indexed: 01/15/2023] Open
Abstract
Objective To observe the efficacy of recombinant human granulocyte-macrophage colony-stimulating factor (rhGM-CSF) for pulmonary alveolar proteinosis (PAP). Materials and methods A total of 55 patients with PAP were screened at Shanghai Pulmonary Hospital between May 2014 and May 2018. Among these, 42 were diagnosed with idiopathic PAP, 24 were included in this study, 20 were treated for 6 months, and 17 were followed up for additional 6 months. All patients received a subcutaneous injection of 75μg/d GM-CSF qd for 1 month. The therapeutic dose was adjusted according to the changes in the lesions of chest CT. If the lesions were absorbed, subcutaneous injections of 75μg/d GM- CSF qd and 75μg/d GM-CSF qod were given for 2 and 3 months, otherwise, the dose was increased to 150μg/d GM-CSF qd and 150μg/d qod for 2 and 3 months, respectively. All cases were treated once a day in the first 3 months and once every other day in the last 3 months. The total course of treatment was 6 months. After withdrawal, the patients were followed up for another 6 months. The deadline of follow up was September 30, 2019. Results Twenty patients completed the treatment and efficacy evaluation. One patient was completely cured, 16 cases improved, three cases were noneffective. After 1-month evaluation, 12 patients received an increased dose (150μg) from the second month of treatment. Seventeen patients completed the 12-month follow-up, among which fourteen improved. CT showed the lesions were slightly increased in three cases. Economic burden was the following: RMB 7324–15,190 Yuan were required for the 6-month treatment course, which is significantly lower compared to other treatment methods. Conclusion Subcutaneous injection of rhGM-CSF at low dose (75μg-150μg /d) is effective treatment for patients with idiopathic PAP. Trial registration NCT01983657. Registered 16 April 2013.
Collapse
Affiliation(s)
- Fen Zhang
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, 507 Zheng Min Road, Shanghai, 200433, China
| | - Dong Weng
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, 507 Zheng Min Road, Shanghai, 200433, China
| | - Yiliang Su
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, 507 Zheng Min Road, Shanghai, 200433, China
| | - Chengsheng Yin
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, 507 Zheng Min Road, Shanghai, 200433, China
| | - Li Shen
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, 507 Zheng Min Road, Shanghai, 200433, China
| | - Yuan Zhang
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, 507 Zheng Min Road, Shanghai, 200433, China
| | - Ying Zhou
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, 507 Zheng Min Road, Shanghai, 200433, China
| | - Qiuhong Li
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, 507 Zheng Min Road, Shanghai, 200433, China
| | - Yang Hu
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, 507 Zheng Min Road, Shanghai, 200433, China
| | - Huiping Li
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, 507 Zheng Min Road, Shanghai, 200433, China.
| |
Collapse
|
12
|
Ra SW, Park SE, Lee HK, Han IS, Park SH. Whole lung lavage using a rapid infusion system to treat a patient with pulmonary alveolar proteinosis. Yeungnam Univ J Med 2019; 37:67-72. [PMID: 31661750 PMCID: PMC6986965 DOI: 10.12701/yujm.2019.00360] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 10/08/2019] [Indexed: 11/30/2022] Open
Abstract
Whole lung lavage (WLL) is a therapeutic procedure to remove accumulated material by infusing and draining the lungs with lavage fluid. This procedure has been regarded as the current standard of care to treat pulmonary alveolar proteinosis. However, the WLL protocol has not yet been standardized and the technique has been refined and modified a number of times. A rapid infusion system is a device used to infuse blood or other fluids at precise rates and normothermic conditions. This device is not typically used in WLL, which relies on the passive infusion of fluids using the gravitational force. However, in this study we performed WLL using a rapid infusion system, since we aimed to take advantage of its shorter operation time and greater degree of control over fluid volume and temperature. The patient’s symptoms improved without the occurrence of any complications.
Collapse
Affiliation(s)
- Seung Won Ra
- Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Soon Eun Park
- Department of Anesthesiology and Pain Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Hyung Kwan Lee
- Department of Anesthesiology and Pain Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Il Sang Han
- Department of Anesthesiology and Pain Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Se Hun Park
- Department of Anesthesiology and Pain Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| |
Collapse
|
13
|
Tazawa R, Ueda T, Abe M, Tatsumi K, Eda R, Kondoh S, Morimoto K, Tanaka T, Yamaguchi E, Takahashi A, Oda M, Ishii H, Izumi S, Sugiyama H, Nakagawa A, Tomii K, Suzuki M, Konno S, Ohkouchi S, Tode N, Handa T, Hirai T, Inoue Y, Arai T, Asakawa K, Sakagami T, Hashimoto A, Tanaka T, Takada T, Mikami A, Kitamura N, Nakata K. Inhaled GM-CSF for Pulmonary Alveolar Proteinosis. N Engl J Med 2019; 381:923-932. [PMID: 31483963 DOI: 10.1056/nejmoa1816216] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Pulmonary alveolar proteinosis is a disease characterized by abnormal accumulation of surfactant in the alveoli. Most cases are autoimmune and are associated with an autoantibody against granulocyte-macrophage colony-stimulating factor (GM-CSF) that prevents clearing of pulmonary surfactant by alveolar macrophages. An open-label, phase 2 study showed some therapeutic efficacy of inhaled recombinant human GM-CSF in patients with severe pulmonary alveolar proteinosis; however, the efficacy in patients with mild-to-moderate disease remains unclear. METHODS We conducted a double-blind, placebo-controlled trial of daily inhaled recombinant human GM-CSF (sargramostim), at a dose of 125 μg twice daily for 7 days, every other week for 24 weeks, or placebo in 64 patients with autoimmune pulmonary alveolar proteinosis who had a partial pressure of arterial oxygen (Pao2) while breathing ambient air of less than 70 mm Hg (or <75 mm Hg in symptomatic patients). Patients with severe pulmonary alveolar proteinosis (Pao2 <50 mm Hg) were excluded to avoid possible exacerbation of the disease in patients who were assigned to receive placebo. The primary end point was the change in the alveolar-arterial oxygen gradient between baseline and week 25. RESULTS The change in the mean (±SD) alveolar-arterial oxygen gradient was significantly better in the GM-CSF group (33 patients) than in the placebo group (30 patients) (mean change from baseline, -4.50±9.03 mm Hg vs. 0.17±10.50 mm Hg; P = 0.02). The change between baseline and week 25 in the density of the lung field on computed tomography was also better in the GM-CSF group (between-group difference, -36.08 Hounsfield units; 95% confidence interval, -61.58 to -6.99, calculated with the use of the Mann-Whitney U test and the Hodges-Lehmann estimate of confidence intervals for pseudo-medians). Serious adverse events developed in 6 patients in the GM-CSF group and in 3 patients in the placebo group. CONCLUSIONS In this randomized, controlled trial, inhaled recombinant human GM-CSF was associated with a modest salutary effect on the laboratory outcome of arterial oxygen tension, and no clinical benefits were noted. (Funded by the Japan Agency for Medical Research and Development and the Ministry of Health, Labor, and Welfare of Japan; PAGE ClinicalTrials.gov number, NCT02835742; Japan Medical Association Center for Clinical Trials number, JMA-IIA00205.).
Collapse
Affiliation(s)
- Ryushi Tazawa
- From Niigata University Medical and Dental Hospital, Niigata (R.T., T.U., K.A., T.S., A.H., Takahiro Tanaka, T. Takada, N.K., K.N.), the Department of Respirology, Graduate School of Medicine, Chiba University, Chiba (M.A., K. Tatsumi), Kurashiki Municipal Hospital, Kurashiki (R.E., S. Kondoh), the Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki (K.M., Takeshi Tanaka), the Division of Respiratory Medicine and Allergology, Department of Medicine, Aichi Medical University School of Medicine, Aichi (E.Y., A.T.), the Department of Respiratory Medicine, Kyorin University School of Medicine (M.O., H.I.), and the Center Hospital of the National Center for Global Health and Medicine (S.I., H.S., A.M.), Tokyo, Kobe City Medical Center General Hospital, Kobe (A.N., K. Tomii), the Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo (M.S., S. Konno), the Department of Respiratory Medicine and Department of Occupational Health, Tohoku University Graduate School of Medicine, Sendai (S.O., N.T.), the Departments of Advanced Medicine for Respiratory Failure (T. Handa) and Respiratory Medicine (T. Handa, T. Hirai), Graduate School of Medicine, Kyoto University, Kyoto, and the National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka (Y.I., T.A.) - all in Japan
| | - Takahiro Ueda
- From Niigata University Medical and Dental Hospital, Niigata (R.T., T.U., K.A., T.S., A.H., Takahiro Tanaka, T. Takada, N.K., K.N.), the Department of Respirology, Graduate School of Medicine, Chiba University, Chiba (M.A., K. Tatsumi), Kurashiki Municipal Hospital, Kurashiki (R.E., S. Kondoh), the Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki (K.M., Takeshi Tanaka), the Division of Respiratory Medicine and Allergology, Department of Medicine, Aichi Medical University School of Medicine, Aichi (E.Y., A.T.), the Department of Respiratory Medicine, Kyorin University School of Medicine (M.O., H.I.), and the Center Hospital of the National Center for Global Health and Medicine (S.I., H.S., A.M.), Tokyo, Kobe City Medical Center General Hospital, Kobe (A.N., K. Tomii), the Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo (M.S., S. Konno), the Department of Respiratory Medicine and Department of Occupational Health, Tohoku University Graduate School of Medicine, Sendai (S.O., N.T.), the Departments of Advanced Medicine for Respiratory Failure (T. Handa) and Respiratory Medicine (T. Handa, T. Hirai), Graduate School of Medicine, Kyoto University, Kyoto, and the National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka (Y.I., T.A.) - all in Japan
| | - Mitsuhiro Abe
- From Niigata University Medical and Dental Hospital, Niigata (R.T., T.U., K.A., T.S., A.H., Takahiro Tanaka, T. Takada, N.K., K.N.), the Department of Respirology, Graduate School of Medicine, Chiba University, Chiba (M.A., K. Tatsumi), Kurashiki Municipal Hospital, Kurashiki (R.E., S. Kondoh), the Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki (K.M., Takeshi Tanaka), the Division of Respiratory Medicine and Allergology, Department of Medicine, Aichi Medical University School of Medicine, Aichi (E.Y., A.T.), the Department of Respiratory Medicine, Kyorin University School of Medicine (M.O., H.I.), and the Center Hospital of the National Center for Global Health and Medicine (S.I., H.S., A.M.), Tokyo, Kobe City Medical Center General Hospital, Kobe (A.N., K. Tomii), the Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo (M.S., S. Konno), the Department of Respiratory Medicine and Department of Occupational Health, Tohoku University Graduate School of Medicine, Sendai (S.O., N.T.), the Departments of Advanced Medicine for Respiratory Failure (T. Handa) and Respiratory Medicine (T. Handa, T. Hirai), Graduate School of Medicine, Kyoto University, Kyoto, and the National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka (Y.I., T.A.) - all in Japan
| | - Koichiro Tatsumi
- From Niigata University Medical and Dental Hospital, Niigata (R.T., T.U., K.A., T.S., A.H., Takahiro Tanaka, T. Takada, N.K., K.N.), the Department of Respirology, Graduate School of Medicine, Chiba University, Chiba (M.A., K. Tatsumi), Kurashiki Municipal Hospital, Kurashiki (R.E., S. Kondoh), the Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki (K.M., Takeshi Tanaka), the Division of Respiratory Medicine and Allergology, Department of Medicine, Aichi Medical University School of Medicine, Aichi (E.Y., A.T.), the Department of Respiratory Medicine, Kyorin University School of Medicine (M.O., H.I.), and the Center Hospital of the National Center for Global Health and Medicine (S.I., H.S., A.M.), Tokyo, Kobe City Medical Center General Hospital, Kobe (A.N., K. Tomii), the Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo (M.S., S. Konno), the Department of Respiratory Medicine and Department of Occupational Health, Tohoku University Graduate School of Medicine, Sendai (S.O., N.T.), the Departments of Advanced Medicine for Respiratory Failure (T. Handa) and Respiratory Medicine (T. Handa, T. Hirai), Graduate School of Medicine, Kyoto University, Kyoto, and the National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka (Y.I., T.A.) - all in Japan
| | - Ryosuke Eda
- From Niigata University Medical and Dental Hospital, Niigata (R.T., T.U., K.A., T.S., A.H., Takahiro Tanaka, T. Takada, N.K., K.N.), the Department of Respirology, Graduate School of Medicine, Chiba University, Chiba (M.A., K. Tatsumi), Kurashiki Municipal Hospital, Kurashiki (R.E., S. Kondoh), the Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki (K.M., Takeshi Tanaka), the Division of Respiratory Medicine and Allergology, Department of Medicine, Aichi Medical University School of Medicine, Aichi (E.Y., A.T.), the Department of Respiratory Medicine, Kyorin University School of Medicine (M.O., H.I.), and the Center Hospital of the National Center for Global Health and Medicine (S.I., H.S., A.M.), Tokyo, Kobe City Medical Center General Hospital, Kobe (A.N., K. Tomii), the Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo (M.S., S. Konno), the Department of Respiratory Medicine and Department of Occupational Health, Tohoku University Graduate School of Medicine, Sendai (S.O., N.T.), the Departments of Advanced Medicine for Respiratory Failure (T. Handa) and Respiratory Medicine (T. Handa, T. Hirai), Graduate School of Medicine, Kyoto University, Kyoto, and the National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka (Y.I., T.A.) - all in Japan
| | - Shotaro Kondoh
- From Niigata University Medical and Dental Hospital, Niigata (R.T., T.U., K.A., T.S., A.H., Takahiro Tanaka, T. Takada, N.K., K.N.), the Department of Respirology, Graduate School of Medicine, Chiba University, Chiba (M.A., K. Tatsumi), Kurashiki Municipal Hospital, Kurashiki (R.E., S. Kondoh), the Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki (K.M., Takeshi Tanaka), the Division of Respiratory Medicine and Allergology, Department of Medicine, Aichi Medical University School of Medicine, Aichi (E.Y., A.T.), the Department of Respiratory Medicine, Kyorin University School of Medicine (M.O., H.I.), and the Center Hospital of the National Center for Global Health and Medicine (S.I., H.S., A.M.), Tokyo, Kobe City Medical Center General Hospital, Kobe (A.N., K. Tomii), the Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo (M.S., S. Konno), the Department of Respiratory Medicine and Department of Occupational Health, Tohoku University Graduate School of Medicine, Sendai (S.O., N.T.), the Departments of Advanced Medicine for Respiratory Failure (T. Handa) and Respiratory Medicine (T. Handa, T. Hirai), Graduate School of Medicine, Kyoto University, Kyoto, and the National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka (Y.I., T.A.) - all in Japan
| | - Konosuke Morimoto
- From Niigata University Medical and Dental Hospital, Niigata (R.T., T.U., K.A., T.S., A.H., Takahiro Tanaka, T. Takada, N.K., K.N.), the Department of Respirology, Graduate School of Medicine, Chiba University, Chiba (M.A., K. Tatsumi), Kurashiki Municipal Hospital, Kurashiki (R.E., S. Kondoh), the Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki (K.M., Takeshi Tanaka), the Division of Respiratory Medicine and Allergology, Department of Medicine, Aichi Medical University School of Medicine, Aichi (E.Y., A.T.), the Department of Respiratory Medicine, Kyorin University School of Medicine (M.O., H.I.), and the Center Hospital of the National Center for Global Health and Medicine (S.I., H.S., A.M.), Tokyo, Kobe City Medical Center General Hospital, Kobe (A.N., K. Tomii), the Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo (M.S., S. Konno), the Department of Respiratory Medicine and Department of Occupational Health, Tohoku University Graduate School of Medicine, Sendai (S.O., N.T.), the Departments of Advanced Medicine for Respiratory Failure (T. Handa) and Respiratory Medicine (T. Handa, T. Hirai), Graduate School of Medicine, Kyoto University, Kyoto, and the National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka (Y.I., T.A.) - all in Japan
| | - Takeshi Tanaka
- From Niigata University Medical and Dental Hospital, Niigata (R.T., T.U., K.A., T.S., A.H., Takahiro Tanaka, T. Takada, N.K., K.N.), the Department of Respirology, Graduate School of Medicine, Chiba University, Chiba (M.A., K. Tatsumi), Kurashiki Municipal Hospital, Kurashiki (R.E., S. Kondoh), the Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki (K.M., Takeshi Tanaka), the Division of Respiratory Medicine and Allergology, Department of Medicine, Aichi Medical University School of Medicine, Aichi (E.Y., A.T.), the Department of Respiratory Medicine, Kyorin University School of Medicine (M.O., H.I.), and the Center Hospital of the National Center for Global Health and Medicine (S.I., H.S., A.M.), Tokyo, Kobe City Medical Center General Hospital, Kobe (A.N., K. Tomii), the Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo (M.S., S. Konno), the Department of Respiratory Medicine and Department of Occupational Health, Tohoku University Graduate School of Medicine, Sendai (S.O., N.T.), the Departments of Advanced Medicine for Respiratory Failure (T. Handa) and Respiratory Medicine (T. Handa, T. Hirai), Graduate School of Medicine, Kyoto University, Kyoto, and the National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka (Y.I., T.A.) - all in Japan
| | - Etsuro Yamaguchi
- From Niigata University Medical and Dental Hospital, Niigata (R.T., T.U., K.A., T.S., A.H., Takahiro Tanaka, T. Takada, N.K., K.N.), the Department of Respirology, Graduate School of Medicine, Chiba University, Chiba (M.A., K. Tatsumi), Kurashiki Municipal Hospital, Kurashiki (R.E., S. Kondoh), the Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki (K.M., Takeshi Tanaka), the Division of Respiratory Medicine and Allergology, Department of Medicine, Aichi Medical University School of Medicine, Aichi (E.Y., A.T.), the Department of Respiratory Medicine, Kyorin University School of Medicine (M.O., H.I.), and the Center Hospital of the National Center for Global Health and Medicine (S.I., H.S., A.M.), Tokyo, Kobe City Medical Center General Hospital, Kobe (A.N., K. Tomii), the Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo (M.S., S. Konno), the Department of Respiratory Medicine and Department of Occupational Health, Tohoku University Graduate School of Medicine, Sendai (S.O., N.T.), the Departments of Advanced Medicine for Respiratory Failure (T. Handa) and Respiratory Medicine (T. Handa, T. Hirai), Graduate School of Medicine, Kyoto University, Kyoto, and the National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka (Y.I., T.A.) - all in Japan
| | - Ayumu Takahashi
- From Niigata University Medical and Dental Hospital, Niigata (R.T., T.U., K.A., T.S., A.H., Takahiro Tanaka, T. Takada, N.K., K.N.), the Department of Respirology, Graduate School of Medicine, Chiba University, Chiba (M.A., K. Tatsumi), Kurashiki Municipal Hospital, Kurashiki (R.E., S. Kondoh), the Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki (K.M., Takeshi Tanaka), the Division of Respiratory Medicine and Allergology, Department of Medicine, Aichi Medical University School of Medicine, Aichi (E.Y., A.T.), the Department of Respiratory Medicine, Kyorin University School of Medicine (M.O., H.I.), and the Center Hospital of the National Center for Global Health and Medicine (S.I., H.S., A.M.), Tokyo, Kobe City Medical Center General Hospital, Kobe (A.N., K. Tomii), the Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo (M.S., S. Konno), the Department of Respiratory Medicine and Department of Occupational Health, Tohoku University Graduate School of Medicine, Sendai (S.O., N.T.), the Departments of Advanced Medicine for Respiratory Failure (T. Handa) and Respiratory Medicine (T. Handa, T. Hirai), Graduate School of Medicine, Kyoto University, Kyoto, and the National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka (Y.I., T.A.) - all in Japan
| | - Miku Oda
- From Niigata University Medical and Dental Hospital, Niigata (R.T., T.U., K.A., T.S., A.H., Takahiro Tanaka, T. Takada, N.K., K.N.), the Department of Respirology, Graduate School of Medicine, Chiba University, Chiba (M.A., K. Tatsumi), Kurashiki Municipal Hospital, Kurashiki (R.E., S. Kondoh), the Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki (K.M., Takeshi Tanaka), the Division of Respiratory Medicine and Allergology, Department of Medicine, Aichi Medical University School of Medicine, Aichi (E.Y., A.T.), the Department of Respiratory Medicine, Kyorin University School of Medicine (M.O., H.I.), and the Center Hospital of the National Center for Global Health and Medicine (S.I., H.S., A.M.), Tokyo, Kobe City Medical Center General Hospital, Kobe (A.N., K. Tomii), the Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo (M.S., S. Konno), the Department of Respiratory Medicine and Department of Occupational Health, Tohoku University Graduate School of Medicine, Sendai (S.O., N.T.), the Departments of Advanced Medicine for Respiratory Failure (T. Handa) and Respiratory Medicine (T. Handa, T. Hirai), Graduate School of Medicine, Kyoto University, Kyoto, and the National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka (Y.I., T.A.) - all in Japan
| | - Haruyuki Ishii
- From Niigata University Medical and Dental Hospital, Niigata (R.T., T.U., K.A., T.S., A.H., Takahiro Tanaka, T. Takada, N.K., K.N.), the Department of Respirology, Graduate School of Medicine, Chiba University, Chiba (M.A., K. Tatsumi), Kurashiki Municipal Hospital, Kurashiki (R.E., S. Kondoh), the Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki (K.M., Takeshi Tanaka), the Division of Respiratory Medicine and Allergology, Department of Medicine, Aichi Medical University School of Medicine, Aichi (E.Y., A.T.), the Department of Respiratory Medicine, Kyorin University School of Medicine (M.O., H.I.), and the Center Hospital of the National Center for Global Health and Medicine (S.I., H.S., A.M.), Tokyo, Kobe City Medical Center General Hospital, Kobe (A.N., K. Tomii), the Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo (M.S., S. Konno), the Department of Respiratory Medicine and Department of Occupational Health, Tohoku University Graduate School of Medicine, Sendai (S.O., N.T.), the Departments of Advanced Medicine for Respiratory Failure (T. Handa) and Respiratory Medicine (T. Handa, T. Hirai), Graduate School of Medicine, Kyoto University, Kyoto, and the National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka (Y.I., T.A.) - all in Japan
| | - Shinyu Izumi
- From Niigata University Medical and Dental Hospital, Niigata (R.T., T.U., K.A., T.S., A.H., Takahiro Tanaka, T. Takada, N.K., K.N.), the Department of Respirology, Graduate School of Medicine, Chiba University, Chiba (M.A., K. Tatsumi), Kurashiki Municipal Hospital, Kurashiki (R.E., S. Kondoh), the Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki (K.M., Takeshi Tanaka), the Division of Respiratory Medicine and Allergology, Department of Medicine, Aichi Medical University School of Medicine, Aichi (E.Y., A.T.), the Department of Respiratory Medicine, Kyorin University School of Medicine (M.O., H.I.), and the Center Hospital of the National Center for Global Health and Medicine (S.I., H.S., A.M.), Tokyo, Kobe City Medical Center General Hospital, Kobe (A.N., K. Tomii), the Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo (M.S., S. Konno), the Department of Respiratory Medicine and Department of Occupational Health, Tohoku University Graduate School of Medicine, Sendai (S.O., N.T.), the Departments of Advanced Medicine for Respiratory Failure (T. Handa) and Respiratory Medicine (T. Handa, T. Hirai), Graduate School of Medicine, Kyoto University, Kyoto, and the National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka (Y.I., T.A.) - all in Japan
| | - Haruhito Sugiyama
- From Niigata University Medical and Dental Hospital, Niigata (R.T., T.U., K.A., T.S., A.H., Takahiro Tanaka, T. Takada, N.K., K.N.), the Department of Respirology, Graduate School of Medicine, Chiba University, Chiba (M.A., K. Tatsumi), Kurashiki Municipal Hospital, Kurashiki (R.E., S. Kondoh), the Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki (K.M., Takeshi Tanaka), the Division of Respiratory Medicine and Allergology, Department of Medicine, Aichi Medical University School of Medicine, Aichi (E.Y., A.T.), the Department of Respiratory Medicine, Kyorin University School of Medicine (M.O., H.I.), and the Center Hospital of the National Center for Global Health and Medicine (S.I., H.S., A.M.), Tokyo, Kobe City Medical Center General Hospital, Kobe (A.N., K. Tomii), the Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo (M.S., S. Konno), the Department of Respiratory Medicine and Department of Occupational Health, Tohoku University Graduate School of Medicine, Sendai (S.O., N.T.), the Departments of Advanced Medicine for Respiratory Failure (T. Handa) and Respiratory Medicine (T. Handa, T. Hirai), Graduate School of Medicine, Kyoto University, Kyoto, and the National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka (Y.I., T.A.) - all in Japan
| | - Atsushi Nakagawa
- From Niigata University Medical and Dental Hospital, Niigata (R.T., T.U., K.A., T.S., A.H., Takahiro Tanaka, T. Takada, N.K., K.N.), the Department of Respirology, Graduate School of Medicine, Chiba University, Chiba (M.A., K. Tatsumi), Kurashiki Municipal Hospital, Kurashiki (R.E., S. Kondoh), the Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki (K.M., Takeshi Tanaka), the Division of Respiratory Medicine and Allergology, Department of Medicine, Aichi Medical University School of Medicine, Aichi (E.Y., A.T.), the Department of Respiratory Medicine, Kyorin University School of Medicine (M.O., H.I.), and the Center Hospital of the National Center for Global Health and Medicine (S.I., H.S., A.M.), Tokyo, Kobe City Medical Center General Hospital, Kobe (A.N., K. Tomii), the Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo (M.S., S. Konno), the Department of Respiratory Medicine and Department of Occupational Health, Tohoku University Graduate School of Medicine, Sendai (S.O., N.T.), the Departments of Advanced Medicine for Respiratory Failure (T. Handa) and Respiratory Medicine (T. Handa, T. Hirai), Graduate School of Medicine, Kyoto University, Kyoto, and the National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka (Y.I., T.A.) - all in Japan
| | - Keisuke Tomii
- From Niigata University Medical and Dental Hospital, Niigata (R.T., T.U., K.A., T.S., A.H., Takahiro Tanaka, T. Takada, N.K., K.N.), the Department of Respirology, Graduate School of Medicine, Chiba University, Chiba (M.A., K. Tatsumi), Kurashiki Municipal Hospital, Kurashiki (R.E., S. Kondoh), the Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki (K.M., Takeshi Tanaka), the Division of Respiratory Medicine and Allergology, Department of Medicine, Aichi Medical University School of Medicine, Aichi (E.Y., A.T.), the Department of Respiratory Medicine, Kyorin University School of Medicine (M.O., H.I.), and the Center Hospital of the National Center for Global Health and Medicine (S.I., H.S., A.M.), Tokyo, Kobe City Medical Center General Hospital, Kobe (A.N., K. Tomii), the Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo (M.S., S. Konno), the Department of Respiratory Medicine and Department of Occupational Health, Tohoku University Graduate School of Medicine, Sendai (S.O., N.T.), the Departments of Advanced Medicine for Respiratory Failure (T. Handa) and Respiratory Medicine (T. Handa, T. Hirai), Graduate School of Medicine, Kyoto University, Kyoto, and the National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka (Y.I., T.A.) - all in Japan
| | - Masaru Suzuki
- From Niigata University Medical and Dental Hospital, Niigata (R.T., T.U., K.A., T.S., A.H., Takahiro Tanaka, T. Takada, N.K., K.N.), the Department of Respirology, Graduate School of Medicine, Chiba University, Chiba (M.A., K. Tatsumi), Kurashiki Municipal Hospital, Kurashiki (R.E., S. Kondoh), the Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki (K.M., Takeshi Tanaka), the Division of Respiratory Medicine and Allergology, Department of Medicine, Aichi Medical University School of Medicine, Aichi (E.Y., A.T.), the Department of Respiratory Medicine, Kyorin University School of Medicine (M.O., H.I.), and the Center Hospital of the National Center for Global Health and Medicine (S.I., H.S., A.M.), Tokyo, Kobe City Medical Center General Hospital, Kobe (A.N., K. Tomii), the Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo (M.S., S. Konno), the Department of Respiratory Medicine and Department of Occupational Health, Tohoku University Graduate School of Medicine, Sendai (S.O., N.T.), the Departments of Advanced Medicine for Respiratory Failure (T. Handa) and Respiratory Medicine (T. Handa, T. Hirai), Graduate School of Medicine, Kyoto University, Kyoto, and the National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka (Y.I., T.A.) - all in Japan
| | - Satoshi Konno
- From Niigata University Medical and Dental Hospital, Niigata (R.T., T.U., K.A., T.S., A.H., Takahiro Tanaka, T. Takada, N.K., K.N.), the Department of Respirology, Graduate School of Medicine, Chiba University, Chiba (M.A., K. Tatsumi), Kurashiki Municipal Hospital, Kurashiki (R.E., S. Kondoh), the Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki (K.M., Takeshi Tanaka), the Division of Respiratory Medicine and Allergology, Department of Medicine, Aichi Medical University School of Medicine, Aichi (E.Y., A.T.), the Department of Respiratory Medicine, Kyorin University School of Medicine (M.O., H.I.), and the Center Hospital of the National Center for Global Health and Medicine (S.I., H.S., A.M.), Tokyo, Kobe City Medical Center General Hospital, Kobe (A.N., K. Tomii), the Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo (M.S., S. Konno), the Department of Respiratory Medicine and Department of Occupational Health, Tohoku University Graduate School of Medicine, Sendai (S.O., N.T.), the Departments of Advanced Medicine for Respiratory Failure (T. Handa) and Respiratory Medicine (T. Handa, T. Hirai), Graduate School of Medicine, Kyoto University, Kyoto, and the National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka (Y.I., T.A.) - all in Japan
| | - Shinya Ohkouchi
- From Niigata University Medical and Dental Hospital, Niigata (R.T., T.U., K.A., T.S., A.H., Takahiro Tanaka, T. Takada, N.K., K.N.), the Department of Respirology, Graduate School of Medicine, Chiba University, Chiba (M.A., K. Tatsumi), Kurashiki Municipal Hospital, Kurashiki (R.E., S. Kondoh), the Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki (K.M., Takeshi Tanaka), the Division of Respiratory Medicine and Allergology, Department of Medicine, Aichi Medical University School of Medicine, Aichi (E.Y., A.T.), the Department of Respiratory Medicine, Kyorin University School of Medicine (M.O., H.I.), and the Center Hospital of the National Center for Global Health and Medicine (S.I., H.S., A.M.), Tokyo, Kobe City Medical Center General Hospital, Kobe (A.N., K. Tomii), the Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo (M.S., S. Konno), the Department of Respiratory Medicine and Department of Occupational Health, Tohoku University Graduate School of Medicine, Sendai (S.O., N.T.), the Departments of Advanced Medicine for Respiratory Failure (T. Handa) and Respiratory Medicine (T. Handa, T. Hirai), Graduate School of Medicine, Kyoto University, Kyoto, and the National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka (Y.I., T.A.) - all in Japan
| | - Naoki Tode
- From Niigata University Medical and Dental Hospital, Niigata (R.T., T.U., K.A., T.S., A.H., Takahiro Tanaka, T. Takada, N.K., K.N.), the Department of Respirology, Graduate School of Medicine, Chiba University, Chiba (M.A., K. Tatsumi), Kurashiki Municipal Hospital, Kurashiki (R.E., S. Kondoh), the Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki (K.M., Takeshi Tanaka), the Division of Respiratory Medicine and Allergology, Department of Medicine, Aichi Medical University School of Medicine, Aichi (E.Y., A.T.), the Department of Respiratory Medicine, Kyorin University School of Medicine (M.O., H.I.), and the Center Hospital of the National Center for Global Health and Medicine (S.I., H.S., A.M.), Tokyo, Kobe City Medical Center General Hospital, Kobe (A.N., K. Tomii), the Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo (M.S., S. Konno), the Department of Respiratory Medicine and Department of Occupational Health, Tohoku University Graduate School of Medicine, Sendai (S.O., N.T.), the Departments of Advanced Medicine for Respiratory Failure (T. Handa) and Respiratory Medicine (T. Handa, T. Hirai), Graduate School of Medicine, Kyoto University, Kyoto, and the National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka (Y.I., T.A.) - all in Japan
| | - Tomohiro Handa
- From Niigata University Medical and Dental Hospital, Niigata (R.T., T.U., K.A., T.S., A.H., Takahiro Tanaka, T. Takada, N.K., K.N.), the Department of Respirology, Graduate School of Medicine, Chiba University, Chiba (M.A., K. Tatsumi), Kurashiki Municipal Hospital, Kurashiki (R.E., S. Kondoh), the Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki (K.M., Takeshi Tanaka), the Division of Respiratory Medicine and Allergology, Department of Medicine, Aichi Medical University School of Medicine, Aichi (E.Y., A.T.), the Department of Respiratory Medicine, Kyorin University School of Medicine (M.O., H.I.), and the Center Hospital of the National Center for Global Health and Medicine (S.I., H.S., A.M.), Tokyo, Kobe City Medical Center General Hospital, Kobe (A.N., K. Tomii), the Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo (M.S., S. Konno), the Department of Respiratory Medicine and Department of Occupational Health, Tohoku University Graduate School of Medicine, Sendai (S.O., N.T.), the Departments of Advanced Medicine for Respiratory Failure (T. Handa) and Respiratory Medicine (T. Handa, T. Hirai), Graduate School of Medicine, Kyoto University, Kyoto, and the National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka (Y.I., T.A.) - all in Japan
| | - Toyohiro Hirai
- From Niigata University Medical and Dental Hospital, Niigata (R.T., T.U., K.A., T.S., A.H., Takahiro Tanaka, T. Takada, N.K., K.N.), the Department of Respirology, Graduate School of Medicine, Chiba University, Chiba (M.A., K. Tatsumi), Kurashiki Municipal Hospital, Kurashiki (R.E., S. Kondoh), the Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki (K.M., Takeshi Tanaka), the Division of Respiratory Medicine and Allergology, Department of Medicine, Aichi Medical University School of Medicine, Aichi (E.Y., A.T.), the Department of Respiratory Medicine, Kyorin University School of Medicine (M.O., H.I.), and the Center Hospital of the National Center for Global Health and Medicine (S.I., H.S., A.M.), Tokyo, Kobe City Medical Center General Hospital, Kobe (A.N., K. Tomii), the Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo (M.S., S. Konno), the Department of Respiratory Medicine and Department of Occupational Health, Tohoku University Graduate School of Medicine, Sendai (S.O., N.T.), the Departments of Advanced Medicine for Respiratory Failure (T. Handa) and Respiratory Medicine (T. Handa, T. Hirai), Graduate School of Medicine, Kyoto University, Kyoto, and the National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka (Y.I., T.A.) - all in Japan
| | - Yoshikazu Inoue
- From Niigata University Medical and Dental Hospital, Niigata (R.T., T.U., K.A., T.S., A.H., Takahiro Tanaka, T. Takada, N.K., K.N.), the Department of Respirology, Graduate School of Medicine, Chiba University, Chiba (M.A., K. Tatsumi), Kurashiki Municipal Hospital, Kurashiki (R.E., S. Kondoh), the Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki (K.M., Takeshi Tanaka), the Division of Respiratory Medicine and Allergology, Department of Medicine, Aichi Medical University School of Medicine, Aichi (E.Y., A.T.), the Department of Respiratory Medicine, Kyorin University School of Medicine (M.O., H.I.), and the Center Hospital of the National Center for Global Health and Medicine (S.I., H.S., A.M.), Tokyo, Kobe City Medical Center General Hospital, Kobe (A.N., K. Tomii), the Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo (M.S., S. Konno), the Department of Respiratory Medicine and Department of Occupational Health, Tohoku University Graduate School of Medicine, Sendai (S.O., N.T.), the Departments of Advanced Medicine for Respiratory Failure (T. Handa) and Respiratory Medicine (T. Handa, T. Hirai), Graduate School of Medicine, Kyoto University, Kyoto, and the National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka (Y.I., T.A.) - all in Japan
| | - Toru Arai
- From Niigata University Medical and Dental Hospital, Niigata (R.T., T.U., K.A., T.S., A.H., Takahiro Tanaka, T. Takada, N.K., K.N.), the Department of Respirology, Graduate School of Medicine, Chiba University, Chiba (M.A., K. Tatsumi), Kurashiki Municipal Hospital, Kurashiki (R.E., S. Kondoh), the Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki (K.M., Takeshi Tanaka), the Division of Respiratory Medicine and Allergology, Department of Medicine, Aichi Medical University School of Medicine, Aichi (E.Y., A.T.), the Department of Respiratory Medicine, Kyorin University School of Medicine (M.O., H.I.), and the Center Hospital of the National Center for Global Health and Medicine (S.I., H.S., A.M.), Tokyo, Kobe City Medical Center General Hospital, Kobe (A.N., K. Tomii), the Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo (M.S., S. Konno), the Department of Respiratory Medicine and Department of Occupational Health, Tohoku University Graduate School of Medicine, Sendai (S.O., N.T.), the Departments of Advanced Medicine for Respiratory Failure (T. Handa) and Respiratory Medicine (T. Handa, T. Hirai), Graduate School of Medicine, Kyoto University, Kyoto, and the National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka (Y.I., T.A.) - all in Japan
| | - Katsuaki Asakawa
- From Niigata University Medical and Dental Hospital, Niigata (R.T., T.U., K.A., T.S., A.H., Takahiro Tanaka, T. Takada, N.K., K.N.), the Department of Respirology, Graduate School of Medicine, Chiba University, Chiba (M.A., K. Tatsumi), Kurashiki Municipal Hospital, Kurashiki (R.E., S. Kondoh), the Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki (K.M., Takeshi Tanaka), the Division of Respiratory Medicine and Allergology, Department of Medicine, Aichi Medical University School of Medicine, Aichi (E.Y., A.T.), the Department of Respiratory Medicine, Kyorin University School of Medicine (M.O., H.I.), and the Center Hospital of the National Center for Global Health and Medicine (S.I., H.S., A.M.), Tokyo, Kobe City Medical Center General Hospital, Kobe (A.N., K. Tomii), the Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo (M.S., S. Konno), the Department of Respiratory Medicine and Department of Occupational Health, Tohoku University Graduate School of Medicine, Sendai (S.O., N.T.), the Departments of Advanced Medicine for Respiratory Failure (T. Handa) and Respiratory Medicine (T. Handa, T. Hirai), Graduate School of Medicine, Kyoto University, Kyoto, and the National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka (Y.I., T.A.) - all in Japan
| | - Takuro Sakagami
- From Niigata University Medical and Dental Hospital, Niigata (R.T., T.U., K.A., T.S., A.H., Takahiro Tanaka, T. Takada, N.K., K.N.), the Department of Respirology, Graduate School of Medicine, Chiba University, Chiba (M.A., K. Tatsumi), Kurashiki Municipal Hospital, Kurashiki (R.E., S. Kondoh), the Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki (K.M., Takeshi Tanaka), the Division of Respiratory Medicine and Allergology, Department of Medicine, Aichi Medical University School of Medicine, Aichi (E.Y., A.T.), the Department of Respiratory Medicine, Kyorin University School of Medicine (M.O., H.I.), and the Center Hospital of the National Center for Global Health and Medicine (S.I., H.S., A.M.), Tokyo, Kobe City Medical Center General Hospital, Kobe (A.N., K. Tomii), the Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo (M.S., S. Konno), the Department of Respiratory Medicine and Department of Occupational Health, Tohoku University Graduate School of Medicine, Sendai (S.O., N.T.), the Departments of Advanced Medicine for Respiratory Failure (T. Handa) and Respiratory Medicine (T. Handa, T. Hirai), Graduate School of Medicine, Kyoto University, Kyoto, and the National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka (Y.I., T.A.) - all in Japan
| | - Atsushi Hashimoto
- From Niigata University Medical and Dental Hospital, Niigata (R.T., T.U., K.A., T.S., A.H., Takahiro Tanaka, T. Takada, N.K., K.N.), the Department of Respirology, Graduate School of Medicine, Chiba University, Chiba (M.A., K. Tatsumi), Kurashiki Municipal Hospital, Kurashiki (R.E., S. Kondoh), the Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki (K.M., Takeshi Tanaka), the Division of Respiratory Medicine and Allergology, Department of Medicine, Aichi Medical University School of Medicine, Aichi (E.Y., A.T.), the Department of Respiratory Medicine, Kyorin University School of Medicine (M.O., H.I.), and the Center Hospital of the National Center for Global Health and Medicine (S.I., H.S., A.M.), Tokyo, Kobe City Medical Center General Hospital, Kobe (A.N., K. Tomii), the Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo (M.S., S. Konno), the Department of Respiratory Medicine and Department of Occupational Health, Tohoku University Graduate School of Medicine, Sendai (S.O., N.T.), the Departments of Advanced Medicine for Respiratory Failure (T. Handa) and Respiratory Medicine (T. Handa, T. Hirai), Graduate School of Medicine, Kyoto University, Kyoto, and the National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka (Y.I., T.A.) - all in Japan
| | - Takahiro Tanaka
- From Niigata University Medical and Dental Hospital, Niigata (R.T., T.U., K.A., T.S., A.H., Takahiro Tanaka, T. Takada, N.K., K.N.), the Department of Respirology, Graduate School of Medicine, Chiba University, Chiba (M.A., K. Tatsumi), Kurashiki Municipal Hospital, Kurashiki (R.E., S. Kondoh), the Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki (K.M., Takeshi Tanaka), the Division of Respiratory Medicine and Allergology, Department of Medicine, Aichi Medical University School of Medicine, Aichi (E.Y., A.T.), the Department of Respiratory Medicine, Kyorin University School of Medicine (M.O., H.I.), and the Center Hospital of the National Center for Global Health and Medicine (S.I., H.S., A.M.), Tokyo, Kobe City Medical Center General Hospital, Kobe (A.N., K. Tomii), the Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo (M.S., S. Konno), the Department of Respiratory Medicine and Department of Occupational Health, Tohoku University Graduate School of Medicine, Sendai (S.O., N.T.), the Departments of Advanced Medicine for Respiratory Failure (T. Handa) and Respiratory Medicine (T. Handa, T. Hirai), Graduate School of Medicine, Kyoto University, Kyoto, and the National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka (Y.I., T.A.) - all in Japan
| | - Toshinori Takada
- From Niigata University Medical and Dental Hospital, Niigata (R.T., T.U., K.A., T.S., A.H., Takahiro Tanaka, T. Takada, N.K., K.N.), the Department of Respirology, Graduate School of Medicine, Chiba University, Chiba (M.A., K. Tatsumi), Kurashiki Municipal Hospital, Kurashiki (R.E., S. Kondoh), the Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki (K.M., Takeshi Tanaka), the Division of Respiratory Medicine and Allergology, Department of Medicine, Aichi Medical University School of Medicine, Aichi (E.Y., A.T.), the Department of Respiratory Medicine, Kyorin University School of Medicine (M.O., H.I.), and the Center Hospital of the National Center for Global Health and Medicine (S.I., H.S., A.M.), Tokyo, Kobe City Medical Center General Hospital, Kobe (A.N., K. Tomii), the Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo (M.S., S. Konno), the Department of Respiratory Medicine and Department of Occupational Health, Tohoku University Graduate School of Medicine, Sendai (S.O., N.T.), the Departments of Advanced Medicine for Respiratory Failure (T. Handa) and Respiratory Medicine (T. Handa, T. Hirai), Graduate School of Medicine, Kyoto University, Kyoto, and the National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka (Y.I., T.A.) - all in Japan
| | - Ayako Mikami
- From Niigata University Medical and Dental Hospital, Niigata (R.T., T.U., K.A., T.S., A.H., Takahiro Tanaka, T. Takada, N.K., K.N.), the Department of Respirology, Graduate School of Medicine, Chiba University, Chiba (M.A., K. Tatsumi), Kurashiki Municipal Hospital, Kurashiki (R.E., S. Kondoh), the Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki (K.M., Takeshi Tanaka), the Division of Respiratory Medicine and Allergology, Department of Medicine, Aichi Medical University School of Medicine, Aichi (E.Y., A.T.), the Department of Respiratory Medicine, Kyorin University School of Medicine (M.O., H.I.), and the Center Hospital of the National Center for Global Health and Medicine (S.I., H.S., A.M.), Tokyo, Kobe City Medical Center General Hospital, Kobe (A.N., K. Tomii), the Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo (M.S., S. Konno), the Department of Respiratory Medicine and Department of Occupational Health, Tohoku University Graduate School of Medicine, Sendai (S.O., N.T.), the Departments of Advanced Medicine for Respiratory Failure (T. Handa) and Respiratory Medicine (T. Handa, T. Hirai), Graduate School of Medicine, Kyoto University, Kyoto, and the National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka (Y.I., T.A.) - all in Japan
| | - Nobutaka Kitamura
- From Niigata University Medical and Dental Hospital, Niigata (R.T., T.U., K.A., T.S., A.H., Takahiro Tanaka, T. Takada, N.K., K.N.), the Department of Respirology, Graduate School of Medicine, Chiba University, Chiba (M.A., K. Tatsumi), Kurashiki Municipal Hospital, Kurashiki (R.E., S. Kondoh), the Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki (K.M., Takeshi Tanaka), the Division of Respiratory Medicine and Allergology, Department of Medicine, Aichi Medical University School of Medicine, Aichi (E.Y., A.T.), the Department of Respiratory Medicine, Kyorin University School of Medicine (M.O., H.I.), and the Center Hospital of the National Center for Global Health and Medicine (S.I., H.S., A.M.), Tokyo, Kobe City Medical Center General Hospital, Kobe (A.N., K. Tomii), the Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo (M.S., S. Konno), the Department of Respiratory Medicine and Department of Occupational Health, Tohoku University Graduate School of Medicine, Sendai (S.O., N.T.), the Departments of Advanced Medicine for Respiratory Failure (T. Handa) and Respiratory Medicine (T. Handa, T. Hirai), Graduate School of Medicine, Kyoto University, Kyoto, and the National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka (Y.I., T.A.) - all in Japan
| | - Koh Nakata
- From Niigata University Medical and Dental Hospital, Niigata (R.T., T.U., K.A., T.S., A.H., Takahiro Tanaka, T. Takada, N.K., K.N.), the Department of Respirology, Graduate School of Medicine, Chiba University, Chiba (M.A., K. Tatsumi), Kurashiki Municipal Hospital, Kurashiki (R.E., S. Kondoh), the Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki (K.M., Takeshi Tanaka), the Division of Respiratory Medicine and Allergology, Department of Medicine, Aichi Medical University School of Medicine, Aichi (E.Y., A.T.), the Department of Respiratory Medicine, Kyorin University School of Medicine (M.O., H.I.), and the Center Hospital of the National Center for Global Health and Medicine (S.I., H.S., A.M.), Tokyo, Kobe City Medical Center General Hospital, Kobe (A.N., K. Tomii), the Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo (M.S., S. Konno), the Department of Respiratory Medicine and Department of Occupational Health, Tohoku University Graduate School of Medicine, Sendai (S.O., N.T.), the Departments of Advanced Medicine for Respiratory Failure (T. Handa) and Respiratory Medicine (T. Handa, T. Hirai), Graduate School of Medicine, Kyoto University, Kyoto, and the National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka (Y.I., T.A.) - all in Japan
| |
Collapse
|
14
|
McCarthy C, Kokosi M, Bonella F. Shaping the future of an ultra-rare disease: unmet needs in the diagnosis and treatment of pulmonary alveolar proteinosis. Curr Opin Pulm Med 2019; 25:450-458. [PMID: 31365379 DOI: 10.1097/mcp.0000000000000601] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW Pulmonary alveolar proteinosis (PAP) can be considered the archetype of ultra-rare diseases with a prevalence of under 10 cases per million. We discuss the classification of PAP, the current diagnostic practice and the supplementary role of genetic testing and granulocyte-macrophage colony-stimulating factor (GM-CSF) signalling in the diagnosis of congenital and hereditary PAP. We report on novel therapeutic approaches such as GM-CSF substitution, stem cell transplantation, pioglitazone, statins and immunomodulation. RECENT FINDINGS The discovery of new genetic mutations underlying this syndrome raises the question whether the classification should be radically revised in the future. Serum GM-CSF autoantibody is the best diagnostic marker for autoimmune PAP, the most common form, but does not correlate with disease severity. Several circulating biomarkers have been investigated to assess disease activity and predict outcome. Imaging techniques have also enormously evolved and offer new tools to quantify disease burden and possibly drive therapeutic decisions. Promising clinical trials are ongoing and will generate new treatment strategies besides or in addition to whole lung lavage in the next future. SUMMARY Despite impressive advances in understanding pathogenesis, PAP remains a rare syndrome with several unanswered questions impacting diagnosis, management and treatment, and, as a result, patients' quality of life.
Collapse
Affiliation(s)
- Cormac McCarthy
- Department of Respiratory Medicine, Rare Lung Disease Centre, St. Vincent's University Hospital, University College Dublin, Dublin, Ireland
| | - Maria Kokosi
- Interstitial Lung Disease Unit, Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, London, UK
| | - Francesco Bonella
- Department of Pneumology, Centre for Interstitial and Rare Lung Disease, Ruhrlandklinik, University Hospital Essen, Essen, Germany
| |
Collapse
|
15
|
Misra S, Das PK, Bal SK, Elayat A, Sahoo S, Dahl AB, Kurian D, Raphael IJ, Youness HA. Therapeutic Whole Lung Lavage for Alveolar Proteinosis. J Cardiothorac Vasc Anesth 2019; 34:250-257. [PMID: 31399308 DOI: 10.1053/j.jvca.2019.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 07/02/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Satyajeet Misra
- Department of Anesthesiology, All India Institute of Medical Sciences, Bhubaneswar, India.
| | - Prasanta Kumar Das
- Department of Anesthesiology, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Shakti Kumar Bal
- Pulmonary Medicine, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Anirudh Elayat
- Department of Anesthesiology, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Satyajeet Sahoo
- Pulmonary Medicine, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Aaron B Dahl
- Department of Anesthesia and Critical Care, University of Chicago Medical Center, Chicago, IL
| | - Dinesh Kurian
- Department of Anesthesia and Critical Care, University of Chicago Medical Center, Chicago, IL
| | - Ibrahim J Raphael
- Interventional Pulmonary Program, Section of Pulmonary, Critical Care, and Sleep, Oklahoma City VA Health Care System, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Houssein A Youness
- Interventional Pulmonary Program, Section of Pulmonary, Critical Care, and Sleep, Oklahoma City VA Health Care System, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| |
Collapse
|
16
|
Piloni D, Campo I. Current management strategies and the potential of inhaled GM-CSF for the treatment of autoimmune pulmonary alveolar proteinosis. Expert Opin Orphan Drugs 2019. [DOI: 10.1080/21678707.2019.1589450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Davide Piloni
- Pneumology Unit, IRCCS Policlinico San Matteo Hospital Foundation, Pavia, Italy
| | - Ilaria Campo
- Pneumology Unit, IRCCS Policlinico San Matteo Hospital Foundation, Pavia, Italy
| |
Collapse
|
17
|
Trapnell BC, Nakata K, Bonella F, Campo I, Griese M, Hamilton J, Wang T, Morgan C, Cottin V, McCarthy C. Pulmonary alveolar proteinosis. Nat Rev Dis Primers 2019; 5:16. [PMID: 30846703 DOI: 10.1038/s41572-019-0066-3] [Citation(s) in RCA: 189] [Impact Index Per Article: 37.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Pulmonary alveolar proteinosis (PAP) is a syndrome characterized by the accumulation of alveolar surfactant and dysfunction of alveolar macrophages. PAP results in progressive dyspnoea of insidious onset, hypoxaemic respiratory failure, secondary infections and pulmonary fibrosis. PAP can be classified into different types on the basis of the pathogenetic mechanism: primary PAP is characterized by the disruption of granulocyte-macrophage colony-stimulating factor (GM-CSF) signalling and can be autoimmune (caused by elevated levels of GM-CSF autoantibodies) or hereditary (due to mutations in CSF2RA or CSF2RB, encoding GM-CSF receptor subunits); secondary PAP results from various underlying conditions; and congenital PAP is caused by mutations in genes involved in surfactant production. In most patients, pathogenesis is driven by reduced GM-CSF-dependent cholesterol clearance in alveolar macrophages, which impairs alveolar surfactant clearance. PAP has a prevalence of at least 7 cases per million individuals in large population studies and affects men, women and children of all ages, ethnicities and geographical locations irrespective of socioeconomic status, although it is more-prevalent in smokers. Autoimmune PAP accounts for >90% of all cases. Management aims at improving symptoms and quality of life; whole-lung lavage effectively removes excessive surfactant. Novel pathogenesis-based therapies are in development, targeting GM-CSF signalling, immune modulation and cholesterol homeostasis.
Collapse
Affiliation(s)
- Bruce C Trapnell
- Translational Pulmonary Science Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
| | - Koh Nakata
- Bioscience Medical Research Center, Niigata University, Niigata, Japan
| | - Francesco Bonella
- Interstitial and Rare Lung Disease Unit, Pneumology Department, Ruhrlandklinik University Hospital, University of Essen, Essen, Germany
| | - Ilaria Campo
- Pneumology Unit, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Matthias Griese
- Pediatric Pneumology, University of Munich, German Center for Lung Research (DZL), Munich, Germany
| | - John Hamilton
- University of Melbourne, Parkville, Victoria, Australia
| | - Tisha Wang
- Department of Medicine, University of California, Los Angeles, CA, USA
| | - Cliff Morgan
- Department of Critical Care and Anaesthesia, Royal Brompton Hospital, London, UK
| | - Vincent Cottin
- National Reference Center for Rare Pulmonary Diseases, University of Lyon, Lyon, France
| | - Cormac McCarthy
- Department of Medicine, St. Vincent's University Hospital and University College Dublin, Dublin, Ireland
| |
Collapse
|
18
|
D'Silva K, Brown S, Hunninghake GM, Vivero M, Loscalzo J. Gasping for a Diagnosis. N Engl J Med 2019; 380:961-967. [PMID: 30855747 PMCID: PMC7189901 DOI: 10.1056/nejmcps1809942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Kristin D'Silva
- From the Departments of Medicine (K.D., S.B., G.M.H., J.L.) and Pathology (M.V.), Brigham and Women's Hospital, Boston
| | - Sarah Brown
- From the Departments of Medicine (K.D., S.B., G.M.H., J.L.) and Pathology (M.V.), Brigham and Women's Hospital, Boston
| | - Gary M Hunninghake
- From the Departments of Medicine (K.D., S.B., G.M.H., J.L.) and Pathology (M.V.), Brigham and Women's Hospital, Boston
| | - Marina Vivero
- From the Departments of Medicine (K.D., S.B., G.M.H., J.L.) and Pathology (M.V.), Brigham and Women's Hospital, Boston
| | - Joseph Loscalzo
- From the Departments of Medicine (K.D., S.B., G.M.H., J.L.) and Pathology (M.V.), Brigham and Women's Hospital, Boston
| |
Collapse
|
19
|
Sheng G, Chen P, Wei Y, Chu J, Cao X, Zhang HL. Better approach for autoimmune pulmonary alveolar proteinosis treatment: inhaled or subcutaneous granulocyte-macrophage colony-stimulating factor: a meta-analyses. Respir Res 2018; 19:163. [PMID: 30165864 PMCID: PMC6117963 DOI: 10.1186/s12931-018-0862-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 08/14/2018] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Autoimmune pulmonary alveolar proteinosis (aPAP) is a rare pulmonary disease caused by functional deficiency of granulocyte-macrophage colony-stimulating factor (GM-CSF). GM-CSF therapy in aPAP has been reported effective in some studies. This meta-analyses aimed to evaluate whether GM-CSF therapy, including inhaled and subcutaneous GM-CSF have therapeutic effect in aPAP patients. METHODS We analyzed 10 studies searched from PubMed, EmBase, Web of Science, Wiley Online Library and Cochrane Collaboration databases to evaluate the pooled effects of GM-CSF treatment in aPAP patients. RESULTS Ten observational studies involving 115 aPAP patients were included. The pooled analyses of response rate (81%, p < 0.001), relapse rate (22%, p = 0.009), PaO2 (13.76 mmHg, p < 0.001) and P(A-a)O2 (19.44 mmHg, p < 0.001) showed that GM-CSF treatment was effective on aPAP patients. Further analyses showed that inhaled GM-CSF treatment was more effective than subcutaneous GM-CSF therapy, including a higher response rate (89% vs. 71%, p = 0.023), more improvements in PaO2 (21.02 mmHg vs. 8.28 mmHg, p < 0.001) and P(A-a)O2 (19.63 mmHg vs. 9.15 mmHg, p < 0.001). CONCLUSIONS As two routes of exogenous GM-CSF treatment, inhaled and subcutaneous were both proven to have effect on aPAP patients. Furthermore, inhaled GM-CSF therapy showed a higher response rate, more improvements on PaO2 and P(A-a)O2 than subcutaneous GM-CSF treatment in aPAP patients, suggesting inhaled GM-CSF therapy could have more benefits on aPAP patients. Therefore, GM-CSF therapy, especially inhaled GM-CSF, might be a promising therapeutic option in treating aPAP.
Collapse
Affiliation(s)
- Gaohong Sheng
- Department of Respiratory and Critical Care Medicine, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, No.1095, Jie Fang Road, Han Kou District, Wu Han, 430030, Hu Bei Province, China
| | - Peng Chen
- Division of Cardiology, Departments of Internal Medicine and Genetic Diagnosis Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wu Han, China.,Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiological Disorders, Wuhan, 430030, China
| | - Yanqiu Wei
- Department of Respiratory and Critical Care Medicine, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, No.1095, Jie Fang Road, Han Kou District, Wu Han, 430030, Hu Bei Province, China
| | - Jiaojiao Chu
- Department of Respiratory and Critical Care Medicine, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, No.1095, Jie Fang Road, Han Kou District, Wu Han, 430030, Hu Bei Province, China
| | - Xiaolei Cao
- Division of Respiratory and Critical Care Medicine, the Second Hospital of Huangshi, Huangshi, 435000, China
| | - Hui-Lan Zhang
- Department of Respiratory and Critical Care Medicine, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, No.1095, Jie Fang Road, Han Kou District, Wu Han, 430030, Hu Bei Province, China.
| |
Collapse
|
20
|
Kumar A, Abdelmalak B, Inoue Y, Culver DA. Pulmonary alveolar proteinosis in adults: pathophysiology and clinical approach. THE LANCET RESPIRATORY MEDICINE 2018; 6:554-565. [PMID: 29397349 DOI: 10.1016/s2213-2600(18)30043-2] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 11/16/2017] [Accepted: 11/23/2017] [Indexed: 12/24/2022]
Abstract
Pulmonary alveolar proteinosis (PAP) is a diffuse lung disease that results from the accumulation of lipoproteinaceous material in the alveoli and alveolar macrophages due to abnormal surfactant homoeostasis. Identification of the granulocyte-macrophage colony-stimulating factor (GM-CSF) as an indispensable mediator of macrophage maturation and surfactant catabolism was the key discovery leading to the current understanding of the pathogenesis of most forms of PAP. Impaired GM-CSF bioavailability due to anti-GM-CSF autoimmunity is the cause of approximately 90% of adult PAP cases. Abnormal macrophage function due to endogenous or exogenous triggers, GM-CSF receptor defects, and other genetic abnormalities of surfactant production account for the remainder of causes. The usual physiological consequence of PAP is impairment of gas exchange, which can lead to dyspnoea, hypoxaemia, or even respiratory failure and death. Pulmonary fibrosis occurs occasionally in patients with PAP. For patients with moderate to severe disease, whole lung lavage is still the first-line treatment of choice. Supplemental GM-CSF is also useful, but details about indications, choice of agent, and dosing remain unclear. Other therapies, including rituximab, plasmapheresis, and lung transplantation have been described but should be reserved for refractory cases.
Collapse
Affiliation(s)
- Anupam Kumar
- Division of Pulmonary & Critical Care Medicine, Spectrum Health-Michigan State University College of Human Medicine, Grand Rapids, MI, USA.
| | - Basem Abdelmalak
- Departments of General Anesthesiology and Outcomes Research, Anesthesiology Institute, Cleveland, OH, USA
| | - Yoshikazu Inoue
- Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Osaka, Japan
| | - Daniel A Culver
- Department of Pulmonary Medicine, Respiratory Institute, and Department of Pathobiology, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| |
Collapse
|
21
|
|
22
|
Trukalj M, Perica M, Ferenčić Ž, Erceg D, Navratil M, Redžepi G, Nogalo B. Successful Treatment of Autoimmune Pulmonary Alveolar Proteinosis in a Pediatric Patient. AMERICAN JOURNAL OF CASE REPORTS 2016; 17:641-5. [PMID: 27592713 PMCID: PMC5012460 DOI: 10.12659/ajcr.897868] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Patient: Male, 13 Final Diagnosis: Pulmonary alveolar protinosis (autoimmune subtype) Symptoms: Dyspnea • general weakness • subfebrile episodes Medication: Vincristine Clinical Procedure: Bronchoscopy • bronchoalveolar lavage • CT scan • lung biopsy • GM CSF antibody testing • diagnosis confirmation • therapy with inhaled GM-CSF • bilateral lung transplantation • chemotherapy due to PTLD Specialty: Pediatrics and Neonatology
Collapse
Affiliation(s)
- Mirjana Trukalj
- Department of Pediatric Allergology and Pulmonology, Children's Hospital Srebrnjak, Zagreb, Croatia
| | - Marija Perica
- Department of Pediatric Allergology and Pulmonology, Children's Hospital Srebrnjak, Zagreb, Croatia
| | - Željko Ferenčić
- Department of Pediatric Allergology and Pulmonology, Children's Hospital Srebrnjak, Zagreb, Croatia
| | - Damir Erceg
- Department of Pediatric Allergology and Pulmonology, Children's Hospital Srebrnjak, Zagreb, Croatia
| | - Marta Navratil
- Department of Pediatric Allergology and Pulmonology, Children's Hospital Srebrnjak, Zagreb, Croatia
| | - Gzim Redžepi
- Department of Pulomonology, University Hospital Zagreb, Zagreb, Croatia
| | - Boro Nogalo
- Department of Pediatric Allergology and Pulmonology, Children's Hospital Srebrnjak, Zagreb, Croatia
| |
Collapse
|
23
|
Abstract
Pulmonary alveolar proteinosis (PAP) is a rare syndrome characterized by the accumulation of surfactant in alveoli and terminal airways resulting in respiratory failure. PAP comprises part of a spectrum of disorders of surfactant homeostasis (clearance and production). The surfactant production disorders are caused by mutations in genes required for normal surfactant production. The PAP syndrome is identified based on history, radiologic, and bronchoalveolar lavage and/or histopathologic findings. The diagnosis of PAP-causing diseases in secondary PAP requires further studies. Whole-lung lavage is the current standard therapy and promising new pharmacologic therapies are in development.
Collapse
Affiliation(s)
- Takuji Suzuki
- Division of Pulmonary Biology, Cincinnati Children's Hospital Medical Center, MLC7029, 3333 Burnet Avenue, Cincinnati, OH 45229, USA.
| | - Bruce C Trapnell
- Division of Pulmonary Biology, Cincinnati Children's Hospital Medical Center, MLC7029, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
| |
Collapse
|
24
|
Tazawa R, Nakata K. Pulmonary alveolar proteinosis and granulocyte/macrophage-colony stimulating factor (GM-CSF) inhalation. Expert Opin Orphan Drugs 2015. [DOI: 10.1517/21678707.2016.1123150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
25
|
Rodríguez Portal JA. Treatment of Adult Primary Alveolar Proteinosis. Arch Bronconeumol 2015; 51:344-9. [PMID: 25896950 DOI: 10.1016/j.arbres.2015.02.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 01/25/2015] [Accepted: 02/09/2015] [Indexed: 12/15/2022]
Abstract
Pulmonary alveolar proteinosis (PAP) is a rare disease characterized by the accumulation of surfactant-like lipoproteinaceous material in the distal air spaces and terminal bronchi, which may lead to impaired gas exchange. This accumulation of surfactant is due to decreased clearance by the alveolar macrophages. Its primary, most common form, is currently considered an autoimmune disease. Better knowledge of the causes of PAP have led to the emergence of alternatives to whole lung lavage, although this is still considered the treatment of choice. Most studies are case series, often with limited patient numbers, so the level of evidence is low. Since the severity of presentation and clinical course are variable, not all patients will require treatment. Due to the low level of evidence, some objective criteria based on expert opinion have been arbitrarily proposed in an attempt to define in which patients it is best to initiate treatment.
Collapse
Affiliation(s)
- José Antonio Rodríguez Portal
- UMQER Centro de investigación en red de enfermedades respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, España; Hospital Universitario Virgen del Rocío/Virgen Macarena, Instituto de Biomedicina de Sevilla (IBIS)/CSIC/Universidad de Sevilla, Sevilla, España.
| |
Collapse
|
26
|
Papiris SA, Tsirigotis P, Kolilekas L, Papadaki G, Papaioannou AI, Triantafillidou C, Papaporfyriou A, Karakatsani A, Kagouridis K, Griese M, Manali ED. Pulmonary alveolar proteinosis: time to shift? Expert Rev Respir Med 2015; 9:337-49. [DOI: 10.1586/17476348.2015.1035259] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
|
27
|
Nakata K. [The Cutting-edge of Medicine; Frontiers in the pathogenesis and treatments for pulmonary alveolar proteinosis]. ACTA ACUST UNITED AC 2015; 104:314-22. [PMID: 26571713 DOI: 10.2169/naika.104.314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
28
|
Potential association between membranous nephropathy and sargramostim therapy for pulmonary alveolar proteinosis. Clin Nephrol Case Stud 2014; 3:31-36. [PMID: 29043131 PMCID: PMC5437997 DOI: 10.5414/cncs108420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 10/21/2014] [Indexed: 11/18/2022] Open
Abstract
We present the case of a 43-year-old woman with a diagnosis of pulmonary alveolar proteinosis, on chronic treatment with sargramostim, a recombinant granulocyte-macrophage colony-stimulating factor, who presented with the nephrotic syndrome secondary to biopsy-proven membranous nephropathy. We discuss potential underlying mechanisms, including speculated effects of sargramostim on mesangial cells and the kidney resident macrophages, and review the existing literature on the potential association between these two disorders.
Collapse
|
29
|
Zhou X, Lu G, Yu Z, Gao F, Bian T. Long-term follow-up of whole lung lavage in patients with pulmonary alveolar proteinosis. Exp Ther Med 2014; 8:763-768. [PMID: 25120596 PMCID: PMC4113632 DOI: 10.3892/etm.2014.1788] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 05/01/2014] [Indexed: 11/06/2022] Open
Abstract
Pulmonary alveolar proteinosis (PAP) is a rare disorder characterized by intra-alveolar accumulation of lipid and proteinaceous material. While a small subset of patients with PAP spontaneously improve or even undergo disease remission, the majority of patients develop persistent or progressive disease. Numerous therapies have been used to treat PAP over the years; however, at present, whole lung lavage (WLL) remains the gold standard treatment for PAP. In the present study, data were accumulated from a cohort of patients with PAP (n=11) between 2003 and 2011 at the Wuxi People’s Hospital Affiliated to Nanjing Medical University. The disease affected males and females with a ratio of 2.7:1 and all the males were current or previous smokers. The disease severity score (DSS) of the patients was mainly distributed in DSS 4 or DSS 5. All the patients underwent WLL at least once, with one patient undergoing WLLs twice and another patient three times. The clinical features, arterial blood gas and pulmonary function of the patients, were assessed prior to and following the lavage. WLL resulted in a significant improvement in symptoms, radiographic features, PaO2, D(A-a)O2 and DLCO in patients with PAP, while pulmonary ventilation function did not significantly improve. WLL appears to be an effective approach for the treatment of PAP and leads to an improvement in survival rate.
Collapse
Affiliation(s)
- Xiaoyan Zhou
- Department of Respiratory Medicine, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu 214023, P.R. China
| | - Guochu Lu
- Department of Respiratory Medicine, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu 214023, P.R. China
| | - Zhen Yu
- Department of Respiratory Medicine, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu 214023, P.R. China
| | - Fei Gao
- Department of Respiratory Medicine, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu 214023, P.R. China
| | - Tao Bian
- Department of Respiratory Medicine, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu 214023, P.R. China
| |
Collapse
|
30
|
Long-Term Inhaled Granulocyte Macrophage–Colony-Stimulating Factor in Autoimmune Pulmonary Alveolar Proteinosis: Effectiveness, Safety, and Lowest Effective Dose. Clin Drug Investig 2014; 34:553-64. [DOI: 10.1007/s40261-014-0208-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
|
31
|
Tazawa R, Inoue Y, Arai T, Takada T, Kasahara Y, Hojo M, Ohkouchi S, Tsuchihashi Y, Yokoba M, Eda R, Nakayama H, Ishii H, Nei T, Morimoto K, Nasuhara Y, Ebina M, Akira M, Ichiwata T, Tatsumi K, Yamaguchi E, Nakata K. Duration of Benefit in Patients With Autoimmune Pulmonary Alveolar Proteinosis After Inhaled Granulocyte-Macrophage Colony-Stimulating Factor Therapy. Chest 2014; 145:729-737. [DOI: 10.1378/chest.13-0603] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
|
32
|
Stafford M, Cappa A, Weyant M, Lara A, Ellis J, Weitzel NS, Puskas F. Treatment of Acute Silicoproteinosis by Whole-Lung Lavage. Semin Cardiothorac Vasc Anesth 2013; 17:152-9. [DOI: 10.1177/1089253213486524] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Acute silicoproteinosis is a rare disease that occurs following a heavy inhalational exposure to silica dusts. Clinically, it resembles pulmonary alveolar proteinosis (PAP); silica exposure is thought to be a cause of secondary PAP. We describe a patient with biopsy-confirmed acute silicoproteinosis whose course was complicated by acute hypoxemic respiratory failure requiring mechanical ventilation. Without clinical improvement despite antibiotic and steroid treatment, the patient was scheduled for whole-lung lavage under general anesthesia. Anesthetic challenges included double-lumen tube placement and single-lung ventilation in a hypoxic patient, facilitating lung lavage, and protecting the contralateral lung from catastrophic spillage.
Collapse
Affiliation(s)
| | | | | | | | - James Ellis
- University of Colorado Denver, Aurora, CO, USA
| | | | | |
Collapse
|
33
|
LETH STEFFEN, BENDSTRUP ELISABETH, VESTERGAARD HANNE, HILBERG OLE. Autoimmune pulmonary alveolar proteinosis: Treatment options in year 2013. Respirology 2012; 18:82-91. [DOI: 10.1111/j.1440-1843.2012.02274.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
|
34
|
A simplified method for the efficient refolding and purification of recombinant human GM-CSF. PLoS One 2012; 7:e49891. [PMID: 23166789 PMCID: PMC3498172 DOI: 10.1371/journal.pone.0049891] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Accepted: 10/17/2012] [Indexed: 01/09/2023] Open
Abstract
Human granulocyte macrophage colony-stimulating factor (hGM-CSF) is a haematopoietic growth factor and proinflammatory cytokine. Recombinant hGM-CSF is important not only as a research tool but also as a biotherapeutic. However, rhGM-CSF expressed in E. coli is known to form inclusion bodies of misfolded, aggregated protein. Refolding and subsequent purification of rhGM-CSF from inclusion bodies is difficult with low yields of bioactive protein being produced. Here we describe a method for the isolation, refolding and purification of bioactive rhGM-CSF from inclusion bodies. The method is straightforward, not requiring extensive experience in protein refolding nor purification and using standard laboratory equipment.
Collapse
|
35
|
Campo I, Kadija Z, Mariani F, Paracchini E, Rodi G, Mojoli F, Braschi A, Luisetti M. Pulmonary alveolar proteinosis: diagnostic and therapeutic challenges. Multidiscip Respir Med 2012; 7:4. [PMID: 22958344 PMCID: PMC3415123 DOI: 10.1186/2049-6958-7-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Accepted: 06/11/2012] [Indexed: 01/31/2023] Open
Abstract
Pulmonary Alveolar Proteinosis (PAP) is a rare syndrome characterized by pulmonary surfactant accumulation within the alveolar spaces. It occurs with a reported prevalence of 0.1 per 100,000 individuals and in distinct clinical forms: autoimmune (previously referred to as the idiopathic form, represents the vast majority of PAP cases, and is associated with Granulocyte-Macrophage Colony Stimulating Factor (GM-CSF) auto-antibodies; GMAbs), secondary (is a consequence of underlying disorders), congenital (caused by mutations in the genes encoding for the GM-CSF receptor), and PAP-like syndromes (disorders associated with surfactant gene mutations). The clinical course of PAP is variable, ranging from spontaneous remission to respiratory failure. Whole lung lavage (WLL) is the current standard treatment for PAP patients and although it is effective in the majority of cases, disease persistence is not an unusual outcome, even if disease is well controlled by WLL.In this paper we review the therapeutic strategies which have been proposed for the treatment of PAP patients and the progress which has been made in the understanding of the disease pathogenesis.
Collapse
Affiliation(s)
- Ilaria Campo
- Section of Pneumology, Department of Molecular Medicine, IRCCS Policlinico San Matteo Foundation, University of Pavia, Via Taramelli 5, 27100, Pavia, Italy.
| | | | | | | | | | | | | | | |
Collapse
|
36
|
Khan A, Agarwal R, Aggarwal AN. Effectiveness of granulocyte-macrophage colony-stimulating factor therapy in autoimmune pulmonary alveolar proteinosis: a meta-analysis of observational studies. Chest 2011; 141:1273-1283. [PMID: 22016491 DOI: 10.1378/chest.11-0951] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Autoimmune pulmonary alveolar proteinosis (aPAP) is a rare pulmonary disease caused by functional deficiency of granulocyte-macrophage colony-stimulating factor (GM-CSF). Administration of GM-CSF represents a potential therapeutic strategy in management of aPAP. Herein, we systematically review the efficacy of GM-CSF therapy in aPAP. METHODS We searched the PubMed and EmBase databases for studies reporting the use of GM-CSF in aPAP. We calculated the proportion with 95% CI to assess the response and relapse rates of GM-CSF therapy in individual studies and pooled them using a random-effects model. Statistical heterogeneity was assessed using the I(2) and Cochran Q tests. Publication bias was analyzed using funnel plot and Egger and Begg-Mazumdar tests. RESULTS Our initial searches yielded 1,585 studies. Of these, five observational studies (involving 94 patients) were included for analysis. Three studies used the subcutaneous route, and two studies used the inhalational route for GM-CSF administration. The response rate of GM-CSF varied from 43% to 92%, with the pooled response rate being 58.6% (95% CI, 42.7-72.9). The relapse rate in GM-CSF responders was 29.7% (95% CI, 10.5-60.4). There was no evidence of statistical heterogeneity or publication bias for the outcome of response. GM-CSF therapy was associated with minor complications, such as fever and local complications at the site of administration. CONCLUSIONS GM-CSF represents a useful approach in the treatment of aPAP. The optimal indication, dose and duration of therapy, and the factors predicting response and relapse need to be defined by future studies.
Collapse
Affiliation(s)
- Ajmal Khan
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ritesh Agarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Ashutosh N Aggarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
37
|
Tazawa R, Nakata K. [autoimmune pulmonary alveolar proteinosis and GM-CSF inhalation therapy]. Nihon Yakurigaku Zasshi 2011; 138:64-67. [PMID: 21828940 DOI: 10.1254/fpj.138.64] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
|
38
|
Jayaraman S, Gayathri AR, Senthil Kumar P, Santosham R, Santosham R, Narasimhan R. Whole lung lavage for pulmonary alveolar proteinosis. Lung India 2011; 27:33-6. [PMID: 20539770 PMCID: PMC2878711 DOI: 10.4103/0970-2113.59267] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 26-year-old male presented with complaints of dry cough of six months and progressive breathlessness of three months duration. He was coughing out milky white sputum for two months and had lost 12 kg weight in two months. He had an evening rise in temperature of one month duration. Clinically, the patient was in respiratory distress and the respiratory system examination revealed bilateral velcro crackles. High resolution computed tomography chest showed bilateral diffuse reticulonodular opacities and "Crazy Paving" pattern suggestive of alveolar proteinosis. Broncho alveolar lavage showed eosinophilic granular material, which was periodic acid-Schiff positive. Open lung biopsy was done to confirm the diagnosis and the histopathologic examination revealed eosinophilic secretions with granular appearance suggestive of pulmonary alveolar proteinosis. Subsequently, patient underwent bilateral sequential whole lung lavage under general anesthesia. Patient showed marked clinical and radiological improvement after sequential whole lung lavage.
Collapse
Affiliation(s)
- S Jayaraman
- Department of Respiratory Medicine, Apollo Hospitals, Chennai - 600 006, India
| | | | | | | | | | | |
Collapse
|
39
|
Firat ND, Cıledağ A, Kabalak PA, Karnak D, Meco BC, Alanoğlu Z, Alkiş N. Pulmonary alveolar proteinosis and successful therapy with combined lavage procedures: Case reports. Exp Ther Med 2011; 2:569-573. [PMID: 22977542 DOI: 10.3892/etm.2011.230] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2011] [Accepted: 03/16/2011] [Indexed: 11/05/2022] Open
Abstract
Pulmonary alveolar proteinosis (PAP) is a rare disease characterized by the accumulation of lipoproteinaceous material within alveolar spaces. Whole-lung lavage (WLL) has been the most common therapeutic intervention for this disorder. However, patients presenting with PAP are usually hypoxemic or in poor clinical condition, and WLL may be impossible to perform. In such cases, multiple segmental lavage (MSL) may be advocated as a first-choice therapy prior to WLL. Herein, we present two cases with idiopathic PAP treated successfully with both lavage techniques consecutively. After the MSL procedure, WLL was performed, and both patients showed a marked clinical and physiologic improvement. Therefore, for patients who are not good candidates for general anesthesia, we recommend MSL (or 'prewash') before WLL to produce an increase in the blood oxygen level for long-duration general anesthesia. In the surgical room, close monitoring and repositioning of the patient as well as maintenance and inspection of the correct tube position, and manual chest wall percussion are extremely important for the safety and success of the procedure.
Collapse
|
40
|
Morgan C, Bingham D, Holt DCB, Jones DM, Lewis NJ. Therapeutic whole lung lavage for inhaled plutonium oxide revisited. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2010; 30:735-746. [PMID: 21149935 DOI: 10.1088/0952-4746/30/4/007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Two reviews in the last 12 years have differed widely in their indications for the use of whole lung lavage (WLL) to remove plutonium from the lung, one recommending its use at relatively low radiation doses to prevent stochastic effects and the other recommending restricting its use to high doses to prevent deterministic effects only. Since the publication of these reviews significant data have accumulated demonstrating the increased safety of WLL, and there are additional data on stochastic and deterministic effects. We discuss deterministic and stochastic risks and the practical aspects of undertaking WLL. We recommend that each case be assessed individually.
Collapse
Affiliation(s)
- C Morgan
- Anaesthesia and Critical Care Medicine, Royal Brompton Hospital, Sydney Street, London, UK
| | | | | | | | | |
Collapse
|
41
|
Abstract
IMPORTANCE OF THE FIELD Pulmonary alveolar proteinosis (PAP) is a rare disease in which the abnormalities in surfactant metabolism are caused most often by impairments of GM-CSF pathway at different levels in different disease subsets (congenital, secondary, acquired/idiopathic) and for which there are only few, costly invasive therapeutic methods. AREAS COVERED IN THIS REVIEW This review discusses these impairments, and their pathogenic and clinical consequences along with potential corrective therapies such as exogenous inhaled GM-CSF. WHAT THE READER WILL GAIN Among the PAP disease subsets, in autoimmune PAP the GM-CSF autoantibodies play a major role in disease pathogenesis and their deleterious pulmonary effects can be blocked efficaciously with inhaled GM-CSF. TAKE HOME MESSAGE In PAP correction of the abnormalities of the GM-CSF pathway represent a plausible approach demonstrated to be efficacious also in the case of inhaled GM-CSF used for autoimmune PAP.
Collapse
Affiliation(s)
- Sabina A Antoniu
- University of Medicine and Pharmacy Gr T Popa Iasi, Pulmonary Disease University Hospital, Department of Internal Medicine II- Pulmonary Disease, 30 Dr I Cihac Str, 700115 Iasi, Romania.
| |
Collapse
|
42
|
Physical properties, lung deposition modeling, and bioactivity of recombinant GM-CSF aerosolised with a highly efficient nebulizer. Pulm Pharmacol Ther 2010; 24:123-7. [PMID: 20728558 DOI: 10.1016/j.pupt.2010.08.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2010] [Revised: 07/21/2010] [Accepted: 08/12/2010] [Indexed: 11/22/2022]
Abstract
Pulmonary alveolar proteinosis (PAP) is a rare condition characterized by the accumulation of lipoproteinaceous material within air spaces. Although whole lung lavage is the current standard of care, recent advances in our understanding of PAP pathophysiology suggest that the disorder may benefit from inhalation of recombinant granulocyte-macrophage colony-stimulating factor (rGM-CSF). The aim of this study was to determine the physical properties and bioactivity of rGM-CSF aerosolised by the highly efficient AKITA² APIXNEB® nebulizer system. The physical properties of aerosolised rGM-CSF were investigated in terms of droplet size, output and output rate by laser diffraction and gravimetrical analysis. Lung deposition was assessed using deposition modeling (ICRP). Molecular mass before and after aerosolisation was determined by SDS-PAGE, while the bioactivity of rGM-CSF was evaluated by measuring the GM-CSF-stimulated increase in pSTAT5 using mAM-hGM-R cells. Ninety-six % of the rGM-CSF filling dose was aerosolised with the Akita² Apixneb® nebulizer system. Particle size was highly reproducible, and the amount deposited within the lung was 80.35% of the delivered dose. The aerosolisation did not alter the molecular structure of rGM-CSF, nor its ability to stimulate the pSTAT5, which increased by 99.5%, similar to values for rGM-CSF prior to aerosolisation. We conclude that the highly efficient AKITA² APIXNEB® nebulizer system is likely to efficaciously deliver rGM-CSF to the airways of patients with autoimmune PAP.
Collapse
|
43
|
Luisetti M, Kadija Z, Mariani F, Rodi G, Campo I, Trapnell BC. Therapy options in pulmonary alveolar proteinosis. Ther Adv Respir Dis 2010; 4:239-48. [PMID: 20647242 DOI: 10.1177/1753465810378023] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Pulmonary alveolar proteinosis is a rare condition characterized by the accumulation of lipoproteinaceous material within the airspaces, resulting in impaired gas transfer, and clinical manifestations ranging from asymptomatic to severe respiratory failure. To the best of the authors' knowledge, there are only a few conditions whose natural history has been so dramatically changed by the influence of advances in basic science, clinical medicine, and translational research in therapeutic approaches. Whole-lung lavage is the current standard of care and it plays a critical role as a modifier factor of the natural history of proteinosis. That notwithstanding, the identification of autoantibodies neutralizing granulocyte-macrophage colony-stimulating factor in serum and lung of patients affected by the form of proteinosis previously referred to as idiopathic, has opened the way to novel therapeutic options, such as supplementation of exogenous granulocyte-macrophage colony-stimulating factor, or strategies aimed at reducing the levels of the autoantibodies. The aim of this paper is to provide an updated review of the current therapeutic approach to proteinosis.
Collapse
Affiliation(s)
- Maurizio Luisetti
- SC Pneumologia, Fondazione IRCCS, Policlinico San Matteo, Piazza Golgi 1, 27100 Pavia, Italy.
| | | | | | | | | | | |
Collapse
|
44
|
|
45
|
Carey B, Trapnell BC. The molecular basis of pulmonary alveolar proteinosis. Clin Immunol 2010; 135:223-35. [PMID: 20338813 DOI: 10.1016/j.clim.2010.02.017] [Citation(s) in RCA: 142] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2009] [Revised: 02/25/2010] [Accepted: 02/25/2010] [Indexed: 01/12/2023]
Abstract
Pulmonary alveolar proteinosis (PAP) comprises a heterogenous group of diseases characterized by abnormal surfactant accumulation resulting in respiratory insufficiency, and defects in alveolar macrophage- and neutrophil-mediated host defense. Basic, clinical and translational research over the past two decades have raised PAP from obscurity, identifying the molecular pathogenesis in over 90% of cases as a spectrum of diseases involving the disruption of GM-CSF signaling. Autoimmune PAP represents the vast majority of cases and is caused by neutralizing GM-CSF autoantibodies. Genetic mutations that disrupt GM-CSF receptor signaling comprise a rare form of hereditary PAP. In both autoimmune and hereditary PAP, loss of GM-CSF signaling blocks the terminal differentiation of alveolar macrophages in the lungs impairing the ability of alveolar macrophages to catabolize surfactant and to perform many host defense functions. Secondary PAP occurs in a variety of clinical diseases that presumedly cause the syndrome by reducing the numbers or functions of alveolar macrophages, thereby impairing alveolar macrophage-mediated pulmonary surfactant clearance. A similar phenotype occurs in mice deficient in the production of GM-CSF or GM-CSF receptors. PAP and related research has uncovered a critical and emerging role for GM-CSF in the regulation of pulmonary surfactant homeostasis, lung host defense, and systemic immunity.
Collapse
Affiliation(s)
- Brenna Carey
- Division of Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Division of Critical Care, Pulmonary and Sleep Medicine, University of Cincinnati, Cincinnati, OH 45229-3039, USA
| | | |
Collapse
|
46
|
Byun MK, Kim DS, Kim YW, Chung MP, Shim JJ, Cha SI, Uh ST, Park CS, Jeong SH, Park YB, Lee HL, Park MS. Clinical features and outcomes of idiopathic pulmonary alveolar proteinosis in Korean population. J Korean Med Sci 2010; 25:393-8. [PMID: 20191038 PMCID: PMC2826738 DOI: 10.3346/jkms.2010.25.3.393] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2009] [Accepted: 06/01/2009] [Indexed: 11/20/2022] Open
Abstract
Idiopathic pulmonary alveolar proteinosis (PAP) is a rare disorder in which lipoproteinaceous material accumulates within alveoli. There were few reports on Asian populations with idiopathic PAP. We retrospectively reviewed 38 patients with idiopathic PAP in Korea. We assessed clinical features, therapeutic efficacy and outcomes of whole lung lavage in patients with idiopathic PAP. The mean age at diagnosis was 52 yr. Eighty six percent of patients were symptomatic at diagnosis. Dyspnea and cough were the most common symptoms. Crackles were the most common physical examination finding. On pulmonary function test, a mild restrictive ventilatory defect was common, with a predicted mean forced vital capacity (FVC) of 77% and forced expiratory volume in one second (FEV(1)) of 84.6%. Diffusing capacity was disproportionately reduced at 67.7%. Arterial blood gas analysis revealed hypoxemia with a decreased PaO2 of 69.0 mmHg and an increased D(A-a)O2 of 34.2 mmHg. After whole lung lavage, PaO2, D(A-a)O2 and DL(CO) were significantly improved, but FVC and total lung capacity (TLC) were not different. This is the first multicenter study to analyze 38 Korean patients with idiopathic PAP. The clinical features and pulmonary parameters of Korean patients with idiopathic PAP are consistent with reports in other published studies. Whole lung lavage appears to be the most effective form of treatment.
Collapse
Affiliation(s)
- Min Kwang Byun
- Division of Pulmonary Medicine, Department of Internal Medicine, Yonsei University, College of Medicine, Yonsei University Health System, Seoul, Korea
| | - Dong Soon Kim
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Whan Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Man Pyo Chung
- Division of Pulmonary and Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Jeong Shim
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Seung Ick Cha
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Soo-Taek Uh
- Division of Allergy and Respiratory Medicine, Department of Internal Medicine, Soonchunhyang University Hospital, Seoul, Korea
| | - Choon Sik Park
- Division of Allergy and Respiratory Medicine, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Sung Hwan Jeong
- Division of Pulmonology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Yong Bum Park
- Division of Pulmonary, Allergy & Critical Care Medicine, Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Hong Lyeol Lee
- Pulmonary Division, Department of Internal Medicine, Inha University Hospital, Incheon, Korea
| | - Moo Suk Park
- Division of Pulmonary Medicine, Department of Internal Medicine, Yonsei University, College of Medicine, Yonsei University Health System, Seoul, Korea
| |
Collapse
|
47
|
Gordon IO, Cipriani N, Arif Q, Mackinnon AC, Husain AN. Update in nonneoplastic lung diseases. Arch Pathol Lab Med 2009; 133:1096-105. [PMID: 19642736 DOI: 10.5858/133.7.1096] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2008] [Indexed: 11/06/2022]
Abstract
CONTEXT Nonneoplastic lung diseases include a wide range of pathologic disorders from asthma to interstitial lung disease to pulmonary hypertension. Recent advances in our understanding of the pathophysiology of many of these disorders may ultimately impact diagnosis, therapy, and prognosis. It is important for the practicing pathologist to be aware of this new information and to understand how it impacts the diagnosis, treatment, and outcome of these diseases. OBJECTIVE To update current progress toward elucidating the pathophysiology of pulmonary alveolar proteinosis, idiopathic pulmonary hemosiderosis, and pulmonary arterial hypertension, as well as to present classification systems for pulmonary hypertension, asthma, and interstitial lung disease and describe how these advances relate to the current practice of pulmonary pathology. DATA SOURCES Published literature from PubMed (National Library of Medicine) and primary material from the authors' institution. CONCLUSIONS Improved understanding of the pathophysiology of pulmonary alveolar proteinosis, pulmonary hypertension, and idiopathic hemosiderosis may impact the role of the surgical pathologist. New markers of disease may need to be assessed by immunohistochemistry or molecular techniques. The classification systems for interstitial lung disease, asthma, and pulmonary hypertension are evolving, and surgical pathologists should consider the clinicopathologic context of their diagnoses of these entities.
Collapse
Affiliation(s)
- Ilyssa O Gordon
- Department of Pathology, University of Chicago, Chicago, Illinois 60637, USA
| | | | | | | | | |
Collapse
|
48
|
Abstract
The present article is the second in a series on rare lung diseases. It focuses on pulmonary alveolar proteinosis (PAP), a disorder in which lipoproteinaceous material accumulates in the alveolar space. PAP was first described in 1958, and for many years the nature of the material accumulating in the lungs was unknown. Major insights into PAP have been made in the past decade, and these have led to the notion that PAP is an autoimmume disorder in which autoantibodies interfere with signalling through the granulocyte-macrophage colony-stimulating factor receptor, leading to macrophage and neutrophil dysfunction. This has spurred new therapeutic approaches to this disorder. The discussion of PAP will begin with a case report, then will highlight the classification of PAP and review recent insights into the pathogenesis of PAP. The approach to therapy and the prognosis of PAP will also be discussed.
Collapse
|
49
|
|
50
|
Inoue Y, Trapnell BC, Tazawa R, Arai T, Takada T, Hizawa N, Kasahara Y, Tatsumi K, Hojo M, Ichiwata T, Tanaka N, Yamaguchi E, Eda R, Oishi K, Tsuchihashi Y, Kaneko C, Nukiwa T, Sakatani M, Krischer JP, Nakata K. Characteristics of a large cohort of patients with autoimmune pulmonary alveolar proteinosis in Japan. Am J Respir Crit Care Med 2008; 177:752-62. [PMID: 18202348 DOI: 10.1164/rccm.200708-1271oc] [Citation(s) in RCA: 291] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
RATIONALE Acquired pulmonary alveolar proteinosis (PAP) is a syndrome characterized by pulmonary surfactant accumulation occurring in association with granulocyte/macrophage colony-stimulating factor autoantibodies (autoimmune PAP) or as a consequence of another disease (secondary PAP). Because PAP is rare, prior reports were based on limited patient numbers or a synthesis of historical data. OBJECTIVES To describe the epidemiologic, clinical, physiologic, and laboratory features of autoimmune PAP in a large, contemporaneous cohort of patients with PAP. METHODS Over 6 years, 248 patients with PAP were enrolled in a Japanese national registry, including 223 with autoimmune PAP. MEASUREMENTS AND MAIN RESULTS Autoimmune PAP represented 89.9% of cases and had a minimum incidence and prevalence of 0.49 and 6.2 per million, respectively. The male to female ratio was 2.1:1, and the median age at diagnosis was 51 years. A history of smoking occurred in 56%, and dust exposure occurred in 23%; instances of familial onset did not occur. Dyspnea was the most common presenting symptom, occurring in 54.3%. Importantly, 31.8% of patients were asymptomatic and were identified by health screening. Intercurrent illnesses, including infections, were infrequent. A disease severity score reflecting the presence of symptoms and degree of hypoxemia correlated well with carbon monoxide diffusing capacity and serum biomarkers, less well with pulmonary function, and not with granulocyte/macrophage colony-stimulating factor autoantibody levels or duration of disease. CONCLUSIONS Autoimmune PAP had an incidence and prevalence higher than previously reported and was not strongly linked to smoking, occupational exposure, or other illnesses. The disease severity score and biomarkers provide novel and potentially useful outcome measures in PAP.
Collapse
Affiliation(s)
- Yoshikazu Inoue
- Bioscience Medical Research Center, Niigata University Medical and Dental Hospital, 754 Ichibannchoh, Asahimachi-Tohri, Niigata 951-8520, Japan
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|