Therapeutics

Sargramostim

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Overview

Name: Sargramostim
Synonyms: Leukine®, GM-CSF
Therapy Type: Other
Target Type: Inflammation, Other, Unknown
Condition(s): Alzheimer's Disease
U.S. FDA Status: Alzheimer's Disease (Phase 2)
Company: Genzyme, Sanofi
Approved for: Bone Marrow Stimulation

Background

Sargramostim is a synthetic form of the hematopoietic growth factor granulocyte-macrophage colony-stimulating factor (GM-CSF). It is a 127 amino acid glycoprotein produced by recombinant DNA technology in yeast. Sargramostim stimulates the innate immune system. It is FDA-approved for regenerating neutrophils, monocytes, and macrophages after bone marrow transplants and in conjunction with treatment for several types of leukemia. Sargramostim is also used for treating neutropenia, a condition of dangerously low white-blood-cell counts. Sargramostim is not to be confused with filgrastim, a recombinant form of the related granulocyte colony-stimulating factor (G-CSF). 

The rationale for evaluating sargramostim in Alzheimer's is that it might increase phagocytosis of pathogenic protein deposits by bone marrow-derived macrophages or brain-resident microglia, and that it might also stimulate other neuroprotective innate immunity processes. GM-CSF was reported to activate microglia in response to amyloid pathology without also augmenting microglial release of pro-inflammatory cytokines, as is seen in response to other, closely related neurotrophic factors (Murphy et al., 1998). 

In transgenic mouse models of Alzheimer's disease, GM-CSF was reported to reduce amyloid pathology, improve cognition, and increase the number of microglia (Boyd et al., 2010). However, contradictory findings exist, as well (Manczak et al, 2009). 

Both GM-CSF and its receptor appear to be expressed in aging human brains, both in controls and in people with Alzheimer's (Ridwan et al., 2012). Analysis of archived neuropsychology data from 19 patients who had received sagramostim as part of their supportive care for bone-marrow transplantation reported a cognitive benefit (Jim et al., 2012).

 

Findings

A Phase 2 study at the University of Colorado, Denver, and the Byrd Alzheimer's Institute of the University of Southern Florida, Tampa, is enrolling 40 patients with mild to moderate Alzheimer's disease to evaluate a three-week course of sargramostim. Drug or placebo are injected under the skin for five days each week. Tolerability is the primary outcome and is to be monitored for six months. Various cognitive tests will be performed for up to six months after treatment as a secondary outcome.

In 2013, the National Institutes on Aging awarded funding for a Phase 2 study to evaluate a six-month course of sargramostim for clearance of amyloid deposits and for cognitive outcomes. This study will recruit patients with mild cognitive impairment. Sanofi Aventis US, Inc., sponsors this trial, which is not listed in clinicaltrials.gov yet (see Feb 2014 new story).

 

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References

News Citations

  1. New Initiative AMPs Up Alzheimer’s Research

Paper Citations

  1. . Macrophage colony-stimulating factor augments beta-amyloid-induced interleukin-1, interleukin-6, and nitric oxide production by microglial cells. J Biol Chem. 1998 Aug 14;273(33):20967-71. PubMed.
  2. . GM-CSF upregulated in rheumatoid arthritis reverses cognitive impairment and amyloidosis in Alzheimer mice. J Alzheimers Dis. 2010;21(2):507-18. PubMed.
  3. . Neutralization of granulocyte macrophage colony-stimulating factor decreases amyloid beta 1-42 and suppresses microglial activity in a transgenic mouse model of Alzheimer's disease. Hum Mol Genet. 2009 Oct 15;18(20):3876-93. PubMed.
  4. . Distribution of granulocyte-monocyte colony-stimulating factor and its receptor α-subunit in the adult human brain with specific reference to Alzheimer's disease. J Neural Transm. 2012 Mar 20; PubMed.
  5. . Granulocyte Macrophage Colony Stimulating Factor Treatment is Associated with Improved Cognition in Cancer Patients. Brain Disord Ther. 2012;1(1) PubMed.

Further Reading

Papers

  1. . GM-CSF upregulated in rheumatoid arthritis reverses cognitive impairment and amyloidosis in Alzheimer mice. J Alzheimers Dis. 2010;21(2):507-18. PubMed.
  2. . Granulocyte-macrophage colony-stimulating factor is neuroprotective in experimental traumatic brain injury. J Neurotrauma. 2014 May 15;31(10):976-83. Epub 2014 Mar 7 PubMed.