title: Delivery of Alpha-1 Antitrypsin to Airways.
abstract: Treatment with exogenous alpha-1 antitrypsin (AAT), a potent serine protease inhibitor, was developed originally for chronic obstructive pulmonary disease associated with AAT deficiency; however, other lung conditions involving neutrophilic inflammation and proteolytic tissue injury related to neutrophil elastase and other serine proteases may also be considered for AAT therapy. These conditions include bronchiectasis caused by primary ciliary dyskinesia, cystic fibrosis, and other diseases associated with an increased free elastase activity in the airways. Inhaled AAT may be a viable option to counteract proteolytic tissue damage. This form of treatment requires efficient drug delivery to the targeted pulmonary compartment. Aerosol technology meeting this requirement is currently available and offers an alternative therapeutic approach to systemic AAT administration. To date, early studies in humans have shown biochemical efficacy and have established the safety of inhaled AAT. However, to bring aerosol AAT therapy to patients, large phase 3 protocols in carefully selected patient populations (i.e., subgroups of patients with AAT deficiency, cystic fibrosis, or other lung diseases with bronchiectasis) will be needed with clinical end points in addition to the measurement of proteolytic activity in the airway. The outcomes likely will have to include lung function, lung structure assessed by computed tomography imaging, disease exacerbations, health status, and mortality.
authors: 1 Department of Pediatric Pneumology, Hauner Children's Hospital, University of Munich, German Center for Lung Research, Munich, Germany; and.
authors: Matthias
authors: 0000-0003-0113-912X
authors: M
authors: Griese
authors: 2 Bio-Inhalation GmbH, Gemünden, Germany.
authors: Gerhard
authors: G
authors: Scheuch
mesh_terms: D000280:Administration, Inhalation; D000336:Aerosols; D001987:Bronchiectasis / Q000188:drug therapy*; D003550:Cystic Fibrosis / Q000188:drug therapy*; D006801:Humans; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000209:etiology; D015842:Serine Proteinase Inhibitors / Q000008:administration & dosage*; D000515:alpha 1-Antitrypsin / Q000008:administration & dosage*; D019896:alpha 1-Antitrypsin Deficiency / Q000150:complications / Q000188:drug therapy*
chemical_list: D000336:Aerosols; D015842:Serine Proteinase Inhibitors; D000515:alpha 1-Antitrypsin
keywords: bronchiectasis; inhalation; neutrophil elastase; proteolysis; suppurative lung disease