Shaping the future of an ultra-rare disease: unmet needs in the diagnosis and treatment of pulmonary alveolar proteinosis

Current Opinion in Pulmonary Medicine
Cormac McCarthyFrancesco Bonella

Abstract

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. 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. Despite impressive advances in understandi...Continue Reading

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Citations

May 5, 2020·Respirology : Official Journal of the Asian Pacific Society of Respirology·Stéphane JouneauMathieu Lederlin
Jul 21, 2020·Breathe·Elena Salvaterra, Ilaria Campo
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Jun 13, 2020·Respiratory Medicine Case Reports·David LawiJean-Paul Janssens

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