En el tratamiento de la lipoproteinosis alveolar puede ser eficaz la administración de GM-CSF. En caso de recaídas posteriores a la respuesta inicial, el re-tratamiento con el mismo fármaco constituye una opción útil.

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Bibliografía del caso clínico
1. Rosen SH, Castleman B, Liebow AA. Pulmonary alveolar proteinosis. N Engl J Med 258:1123-43, 1958.
2. Seymour JF, Presneill JJ. Pulmonary alveolar proteinosis. Progress in the first 44 years. Am J Respir Crit Care Med 166:215-235, 2002.
3. Trapnell BC, Whitsett JA, Nakata K. Pulmonary alveolar proteinosis. N Engl J Med 349:2527-39, 2003.
4. Presneill JJ, Nakata K, Inoue Y, Seymour JF. Pulmonary alveolar proteinosis. Clin Chest Med 25:593-613, 2004.
5. Seymour JF, Begley CG, Dirksen U, y col. Attenuated hematopoietic response to granulocyte-macrophage colony-stimulating factor in patients with acquired pulmonary alveolar proteinosis. Blood 92:2657-67, 1998.
6. Bonfield TL, Russell D, Burgess S, Malur A, Kavuru MS, Thomassen MJ. Autoantibodies against granulocyte macrophage colony-stimulating factor are diagnostic for pulmonary alveolar proteinosis. Am J Respir Cell Mol Biol 27:481-6, 2002.
7. Kavuru MS, Sullivan EJ, Piccin R, Thomassen MJ, Stoller JK. Exogenous granulocyte-macrophage colony-stimulating factor administration for pulmonary alveolar proteinosis. Am J Respir Crit Care Med 161:1143-8, 2000.
8. González Barcala FJ, Blanco González S, Valdés Cuadrado L, García Prim JM, Golpe Gómez AL, Ledo Andión R. Proteinosis alveolar, un hallazgo incidental en un estudio preoperatorio con respuesta insuficiente al lavado broncopulmonar completo. An Med Interna 8:410-2, 2003.
9. Valdés L, Pose A, Alvarez D, Ventura M. GM-CSF: una alternativa al lavado broncoalveolar en el tratamiento de la proteinosis alveolar. Med Clin 120:117-9, 2003.
10. Delaval P, Brinchault G, Corre R, Jouneau S, Meunier C, Briens E. Lipoprotéinose alvéolaire pulmonaire. Rev Pneumol Clin 61:186-92, 2005.
11. Stanley E, Lieschke GJ, Grail D, y col. Granulocyte/macrophage colony-stimulating factor-deficient mice show no major perturbation of hematopoiesis but develop a characteristic pulmonary pathology. Proc Natl Acad Sci USA 91:5592-6, 1994.
12. Dranoff G, Crawford AD, Sadelain M, y col. Involvement of granulocyte-macrophage colony-stimulating factor in pulmonary homeostasis. Science 264:713-6, 1994.
13. Huffman JA, Hull WM, Dranoff G, Mulligan RC, Whitsett JA. Pulmonary epithelial cell expression of GM-CSF corrects the alveolar proteinosis in GM-CSF-deficient mice. J Clin Invest 97:649-55, 1996.
14. Reed JA, Ikegami M, Cianciolo ER, y col. Aerosolized GM-CSF ameliorates pulmonary alveolar proteinosis in GM-CSF-deficient mice. Am J Physiol 276:L556-63, 1999.
15. Zsengeller ZK, Reed JA, Bachurski CJ, y col. Adenovirus-mediated granulocyte-macrophage colony-stimulating factor improves lung pathology of pulmonary alveolar proteinosis in granulocyte-macrophage colony-stimulating factor-deficient mice. Hum Gene Ther 9:2101-9, 1998.
16. Ikegami M, Jobe AH, Huffman Reed JA, Whitsett JA. Surfactant metabolic consequences of overexpression of GM-CSF in the epithelium of GM-CSF-deficient mice. Am J Physiol 273:L709-14, 1997.
17. Thomassen MJ, Raychaudhuri B, Bonfield TL, y col. Elevated IL-10 inhibits GM-CSF synthesis in pulmonary alveolar proteinosis. Autoimmunity 36:285-90, 2003.
18. Svenson M, Hansen MB, Ross C, y col. Antibody to granulocyte-macrophage colony-stimulating factor is a dominant anti-cytokine activity in human IgG preparations. Blood 91:2054-61, 1998.
19. Thomassen MJ, Yi T, Raychaudhuri B, Malur A, Kavuru MS. Pulmonary alveolar proteinosis is a disease of decreased availability of GM-CSF rather than an intrinsic cellular defect. Clin Immunol 95:85-92, 2000.
20. Carraway MS, Ghio AJ, Carter JD, Piantadosi CA. Detection of granulocyte-macrophage colony-stimulating factor in patients with pulmonary alveolar proteinosis. Am J Respir Crit Care Med 161:1294-9, 2000.
21. Bonfield TL, Kavuru MS, Thomassen MJ. Anti-GM-CSF titer predicts response to GM-CSF therapy in pulmonary alveolar proteinosis. Clin Immunol 105:342-50, 2002.
22. Ragnhammar P, Friesen HJ, Frodin JE, y col. Induction of anti-recombinant human granulocyte-macrophage colony-stimulating factor (Escherichia coli-derived) antibodies and clinical effects in nonimmunocompromised patients. Blood 84:4078-87, 1994.
23. Khanjari F, Watier H, Domenech J, Asquier E, Diot P. GM-CSF and proteinosis. Thorax 58:645, 2003.
24. Seldon PM, Giembycz MA. Suppression of granulocyte/macrophage colony-stimulating factor release from human monocytes by cyclic AMP-elevating drugs: role of interleukin-10. Br J Pharmacol 134:58-67, 2001.
25. Nogee LM. Surfactant protein-B deficiency. Chest 111:129S-135S, 1997.
26. Ikegami M, Ueda T, Hull W, y col. Surfactant metabolism in transgenic mice after granulocyte macrophage-colony stimulating factor ablation. Am J Physiol 270:L650-8, 1996.
27. Ramírez RJ, Schultz RB, Dutton RE. Pulmonary alveolar proteinosis: a new technique and rationale for treatment. Arch Intern Med 112:419-31, 1963.
28. Cohen ES, Elpern E, Siver MR. Pulmonary alveolar proteinosis causing severe hypoxemic respiratory failure treated with sequential whole-lung lavage utilizing venovenous extracorporeal membrane oxygenation: a case report and review. Chest 120:1024-6, 2001.
29. Barraclough RM, Gillies AJ. Pulmonary alveolar proteinosis: a complete response to GM-CSF therapy. Thorax 56:664-5, 2001.
30. Hamvas A, Nogee LM, Mallory GB JR, y col. Lung transplantation for treatment of infants with surfactant protein B deficiency. J Pediatr 130:231-9, 1997.
31. Parker LA, Novotny DB. Recurrent alveolar proteinosis following double lung transplantation. Chest 111:1457-8, 1997.
32. Gaine SP, O'Marcaigh AS. Pulmonary alveolar proteinosis: lung transplant or bone marrow transplant? Chest 113:563-4, 1998.
33. Nishinakamura R, Wiler R, Dirksen U, y col. The pulmonary alveolar proteinosis in granulocyte macrophage colony-stimulating factor/interleukins 3/5 beta c receptor-deficient mice is reversed by bone marrow transplantation. J Exp Med 183:2657-62, 1996.
34. Seymour JF, Presneill JJ, Schoch OD, y col. Therapeutic efficacy of granulocyte-macrophage colony-stimulating factor in patients with idiopathic acquired alveolar proteinosis. Am J Respir Crit Care Med 163:524-531, 2001.
35. Seymour JF, Dunn AR, Vincent JM, Presneill JJ, Pain MC. Efficacy of granulocyte-macrophage colony-stimulating factor in acquired alveolar proteinosis. N Engl J Med 335:1924-5, 1996.
36. Lieschke GJ, Cebon J, Morstyn G. Characterization of the clinical effects after first dose of bacterially synthesized recombinant human granulocyte-macrophage colony-stimulating factor. Blood 74:2634-43, 1989.
37. Morgan C. The benefits of whole lung lavage in pulmonary alveolar proteinosis. Eur Respir J 23:503-5, 2004.

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