About pulmonary alveolar proteinosis

What is pulmonary alveolar proteinosis?

Pulmonary alveolar proteinosis is a lung disorder characterized by a build-up of proteins, lipids, and other substances (together known as surfactants) in the lungs' air sacs, or alveoli. The alveoli are the air-holding cells in the lungs. The exchange of gases between the lungs and the blood takes place here.

  • The alveoli become filled with a surfactant, they do not work properly, and breathing becomes difficult.
  • The cause of pulmonary alveolar proteinosis is unknown. But, it is considered to be associated with a problem in the immune system. 
  • In most cases, the body produces too much surfactant. In other cases, the body does not produce enough SP-A protein, which helps break down surfactants. This can cause the surfactant to build up in the lungs.
  • Pulmonary alveolar proteinosis can be diagnosed with a chest X-Ray or a CT scan of the lungs. A biopsy of the lung tissue may also be done.
  • Treatment for pulmonary alveolar proteinosis involves removing the excess surfactant from the lungs.
  • In this procedure, a person is placed under general anesthesia, and a tube is inserted through the side of the chest into the lungs. A sterile solution is then instilled into the lungs and suctioned out, taking the surfactant with it.

What are the symptoms for pulmonary alveolar proteinosis?

Symptoms of pulmonary alveolar proteinosis typically develop slowly and may include the following:

  • Shortness of breath: Shortness of breath is something we all experience as we move forward to our late 60-70s. The symptoms of pulmonary alveolar proteinosis are so high that Shortness of breath is bound to happen at any age. 
  • Cough: A dry Cough or a productive Cough with yellowish phlegm can occur (sputum). Coughing up phlegm with blood streaks (hemoptysis), whether or not there is a temperature, usually suggests illness.
  • Fatigue and weight loss: Without a proper diet schedule, you can experience Fatigue and Weight loss simultaneously. If you’re experiencing the hardships of pulmonary alveolar proteinosis, consult a doctor immediately. 
  • Chest pain: It is one of the deadliest symptoms of pulmonary alveolar proteinosis. It attacks the outsider sides of your sides, making your body look vulnerable to more diseases. 
  • Apart from the symptoms mentioned above, most patients develop Dyspnea gradually over time, initially only detecting discomfort during activity and afterward at rest. 
  • Because of a lack of oxygen in the blood, the fingertips might become bluish in hue (cyanosis) as the condition progresses due to surfactant buildup.
  • The disease may also cause clubbing of the fingers or toes, blue skin discoloration (cyanosis), and chest pain.

What are the causes for pulmonary alveolar proteinosis?

The lack of or a problem with granulocyte-macrophage colony-stimulating factor is thought to be the cause of the majority of pulmonary alveolar proteinosis instances in adults (GM-CSF). 

  • In autoimmune pulmonary alveolar proteinosis, the body's immune cells (B cells) produce a protein called GM-CSF autoantibody, which targets the hormone and prevents it from stimulating alveolar macrophages. 
  • While the pathogenesis of GM-CSF autoantibodies is well understood, the source of the condition is unknown (etiology). Pulmonary alveolar proteinosis, on the other hand, is more common in smokers, implying that cigarette smoke is a 'trigger' for the condition.
  • Individuals with hereditary pulmonary alveolar proteinosis are born with genetic alterations that prevent proteins (receptors) on alveolar macrophages from interacting with GM-CSF from functioning.
  • Secondary pulmonary alveolar proteinosis occurs when an underlying disease or clinical condition reduces the quantity (or function) of alveolar macrophages, resulting in surfactant buildup in the alveoli and dyspnea. Secondary PAP is linked to a variety of illnesses and toxic chemical exposures. Some of them include HIV infection, inhalation of dusts, and myelodysplasia. 
  • Some forms of congenital pulmonary alveolar proteinosis are caused by recessive genetic abnormalities (see above), while others are caused by dominant genetic mutations (see below), in which only one of the inherited genes is faulty while the other is normal.

What are the treatments for pulmonary alveolar proteinosis?

It's critical to seek therapy if you have severe pulmonary alveolar proteinosis. 

  • Lung washing: A salt solution can be used to wash out the fluid in the alveoli (saline). Lung lavage is the term for this procedure. If your symptoms are severe, you may need to have your entire lung cleansed. Some patients only require whole-lung lavage once. Others may require it every six months or once a year. ‌
  • Removing toxins: If you have secondary pulmonary alveolar proteinosis, you'll need to address the underlying cause. If it's caused by a toxin, for example, the toxin must be eliminated and avoided. ‌
  • Stimulating the immune system: An injection or inhalation of a chemical that stimulates your body to create white blood cells. Recombinant granulocyte-macrophage colony-stimulating factor is the name of this chemical (GM-CSF).
  • This chemical has been demonstrated to be beneficial in the treatment of autoimmune pulmonary alveolar proteinosis in several investigations. However, it is not recommended for people who have secondary or congenital pulmonary alveolar proteinosis.
  • Lung transplant: A lung transplant may be required in some circumstances. However, the illness may reappear in transplanted lungs. Only if all previous therapies have failed is a lung transplant indicated.

What are the risk factors for pulmonary alveolar proteinosis?

The risk factors for pulmonary alveolar proteinosis include:

  • Exposure to hazardous particles in the environment or workplace, such as silica or aluminum dust.
  • An immune response that prevents the breakdown of surfactant lung infection or pneumonia.
  • Although healthy people can have low levels of GM-CSF autoantibodies, having a level of > 5 g/mL increases the risk of pulmonary alveolar proteinosis.
  • Some malignancies exposure to toxic particles in the environment or workplace, such as silica or aluminum dust
  • Furthermore, neutrophils and lymphocytes are functionally altered during PAP, which explains some of the opportunistic infections that develop. 
  • Anti-GM-CSF antibodies are assumed to be harmful because they proliferate on healthy myeloid cells in vitro, causing abnormalities in pulmonary alveolar proteinosis. 
  • Pulmonary alveolar proteinosis caused by a mutant gene is more common in youngsters, and the radio-clinical presentation is determined by the defective gene.
  • Alveolar macrophages are unable to remove surfactants and are also less effective in anti-infectious defense due to diminished or missing GM-CSF activation.
  • The alveoli and terminal airways fill with floccular material formed from surfactant phospholipids and protein components that dyes positive using the periodic acid-Schiff (PAS) method.
  • Clinicians' awareness of pulmonary alveolar proteinosis. Risk factors may help speed up the diagnostic procedure and treatment.

Is there a cure/medications for pulmonary alveolar proteinosis?

Pulmonary alveolar proteinosis is an uncommon condition in which a natural material called surfactant clogs the air sacs in your lungs.

Pulmonary alveolar proteinosis treatment and medications

1) Cleaning the lungs

A salt solution will be used to wash away the fluid within the alveoli (saline). A special tube is put into one of the lungs through the mouth or windpipe. If the symptoms are severe, you may need to have your entire lung cleansed.

2) Toxin removal

 If you have secondary pulmonary alveolar proteinosis, you must address the underlying cause. If it's caused by a toxin, for example, the toxin should be eliminated and avoided.

3) Boosting the system's performance

An injection or inhalation of a chemical that stimulates your body to produce white blood cells is also an option. Recombinant granulocyte-macrophage colony-stimulating factor is the name given to this chemical (GM-CSF).

4) Bronchodilator

If you have asthma symptoms, your doctor may prescribe medicine to help you breathe easier.

5) Transplantation of the lungs

In some situations, a lung transplant may be required. However, the condition is likely to reappear in transplanted lungs. On the condition that all other treatments have failed, a lung transplant is recommended.

List of Symptoms

Dyspnea or shortness of breath, pain or tightness in the chest, fever, loss of weight, coughing (sometimes, but not always), oxygen deficiency in the blood

List of Condition

Lung infection or immune problem, people between 30 to 50 are mostly affected

List of Drugs

Granulocyte-macrophage colony-stimulating factor (GM-CSF)

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