Safety and efficacy of sargramostim (GM-CSF) in the treatment of Alzheimer's disease.

INTRODUCTION: Inflammatory markers have long been observed in the brain, cerebrospinal fluid (CSF), and plasma of Alzheimer's disease (AD) patients, suggesting that inflammation contributes to AD and might be a therapeutic target. However, non-steroidal anti-inflammatory drug trials in AD and mild cognitive impairment (MCI) failed to show benefit. Our previous work seeking to understand why people with the inflammatory disease rheumatoid arthritis are protected from AD found that short-term treatment of transgenic AD mice with the pro-inflammatory cytokine granulocyte-macrophage colony-stimulating factor (GM-CSF) led to an increase in activated microglia, a 50% reduction in amyloid load, an increase in synaptic area, and improvement in spatial memory to normal. These results called into question the consensus view that inflammation is solely detrimental in AD. Here, we tested our hypothesis that modulation of the innate immune system might similarly be used to treat AD in humans by investigating the ability of GM-CSF/sargramostim to safely ameliorate AD symptoms/pathology. METHODS: A randomized, double-blind, placebo-controlled trial was conducted in mild-to-moderate AD participants (NCT01409915). Treatments (20 participants/group) occurred 5 days/week for 3 weeks plus two follow-up (FU) visits (FU1 at 45 days and FU2 at 90 days) with neurological, neuropsychological, blood biomarker, and imaging assessments. RESULTS: Sargramostim treatment expectedly changed innate immune system markers, with no drug-related serious adverse events or amyloid-related imaging abnormalities. At end of treatment (EOT), the Mini-Mental State Examination score of the sargramostim group increased compared to baseline (P = .0074) and compared to placebo (P = .0370); the treatment effect persisted at FU1 (P = .0272). Plasma markers of amyloid beta (Aß40 [decreased in AD]) increased 10% (P = .0105); plasma markers of neurodegeneration (total tau and UCH-L1) decreased 24% (P = .0174) and 42% (P = .0019), respectively, after sargramostim treatment compared to placebo. DISCUSSION: The innate immune system is a viable target for therapeutic intervention in AD. An extended treatment trial testing the long-term safety and efficacy of GM-CSF/sargramostim in AD is warranted.

rhGM-CSF subcutaneously combined with rhIL-2 intravenous drip for relieving radiation esophagitis in patients with esophageal cancer undergoing radiotherapy / 肿瘤

Objective: To investigate the effect of subcutaneous injection of recombinant human granulocyte-macrophage colony-stimulating factor (rhGM-CSF) combined with intravenous drip of recombinant human interleukin-2 (rhIL-2) on radiation esophagitis in the patients with esophageal cancer undergoing radiotherapy. Methods: Seventy patients with esophageal cancer were randomly divided into the experimental group and the control group. Thirty-five patients in the experimental group were treated with subcutaneous injection of rhGM-CSF combined with intravenous drip of rhIL-2 and radiotherapy, while 35 patients in the control group were just treated with radiotherapy alone. The occurrence of radiation esophagitis, the degree of pain, intervention measures and treatment compliance were compared between the two groups. Results: There were 3 cases with grade 3 or 4 radiation esophagitis in the experimental group, and 12 cases in the control group (P < 0.05). The number of patients with swallowing pain (more than 7 points) caused by radiation esophagitis in the experimental group was significantly less than that in the control group (P < 0.05). The number of patients used the intervention drugs of radiation esophagitis in the experimental group was significantly less than that in the control group (P < 0.05). After the treatment, the nausea and vomiting, loss of appetite, pain, and insomnia in the experimental group were significantly better than those in the control group (all P < 0.05). There was no interruption of radiotherapy in the experimental group, while the radiotherapy of 3 cases in the control group was interrupted (P < 0.05). Conclusion: Subcutaneous injection of rhGM-CSF combined with intravenous drip of rhIL-2 significantly reduce the proportion of radiation esophagitis-related symptoms in the patients with esophageal cancer, improve the quality of life by reliving the swallowing pain, as well as improve the treatment compliance of patients.

GM-CSF as an option for treatment of residual disease after allo-HSCT / 中华器官移植杂志

ObjectiveTo evaluate the primary effect of granulocyte-monocyte colony stimulating factor (GM-CSF) as an immunotherapy option for treatment of residual disease after alloHSCT.Methods Immunotherapy was performed on two patients with blood malignancy to treat residual disease after allo-HSCT. The patient one,who was diagnosed as having MDS-RAEB Ⅱ,showed bone marrow displasis and incomplete chimerism 6 months after unrelated donor HSCT.Immunosuppressive drug was withdrawn without induction of graft-versus-host disease (GVHD).The patient two B-ALL demonstrated a residual disease at molecular level 30 days post-transplantation.Both of them were given GMCSF (300 μg) subcutaneously once every two days for totally three weeks.During the whole period,skin itch and rash,liver function,subgroups of lymphocytes,and MDSCs and DCs in peripheral blood were investigated.Results In case one,grade Ⅰskin acute GVHD (aGVHD) appeared as early as one week after GM-CSF administration,as well as grade Ⅱ (skin and liver) by the end of the third weeks,and GM-CSF injection was withdrawn.One month later since the start of GM-CSF,the patient showed normal bone marrow morphology and full donor type chimerism. Cyclosporine A (CsA), mycophenolate mofetil and methylprednisolone were administered for two weeks to control GVHD.In the other case,grade Ⅰ aGVHD occurred 9 days after GMCSF administration,and whole blood CsA maintained at 0.134-0.472 μmol/L.Prednisone (30mg per day for 5 days) was used to control grade Ⅱ GVHD from the 11th day after GM-CSF,and grade Ⅰ GVHD continued without any intervention.On the 30th day after GM-CSF treatment,bone marrow aspiration showed complete molecular remission.In both of the two cases,no differences in lymphocytic subtypes were revealed before and after GM-CSF administration,while there were trends of increased DC number and decreased MDSCs in peripheral blood.ConclusionThe administration of GM-CSF as an immunotherapy option for blood malignancy may contribute to the clearance of residual disease after Allo-HSCT.