Lipid nanoparticle GM-CSF replacement for autoimmune pulmonary alveolar proteinosis

L Liming Lian (Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University School of Medicine) B Bora Jang (Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University School of Medicine) S Sebastian G. Huayamares (Wallace H. Coulter Department of Biomedical Engineering, Emory University School of Medicine and Georgia Institute of Technology) A Avraham Shakked (Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University School of Medicine) K Kara Gentry (Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University School of Medicine) R Ryan Zenhausern (Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University School of Medicine) A Afsane Radmand (Petit Institute for Bioengineering and Biosciences, Georgia Institute of Technology) E Elisa Schrader Echeverri (Wallace H. Coulter Department of Biomedical Engineering, Emory University School of Medicine and Georgia Institute of Technology) V Vaunita C. Parihar (Cancer Tissue Pathology Shared Resource, Winship Cancer Institute, Emory University School of Medicine) R Ricardo C. Guerrero-Ferreira (Robert P. Apkarian Integrated Electron Microscopy Core, Emory University School of Medicine) R Randi Calkins (Wallace H. Coulter Department of Biomedical Engineering, Emory University School of Medicine and Georgia Institute of Technology) D Daryll Vanover (Wallace H. Coulter Department of Biomedical Engineering, Emory University School of Medicine and Georgia Institute of Technology) P Philip J. Santangelo (Wallace H. Coulter Department of Biomedical Engineering, Emory University School of Medicine and Georgia Institute of Technology) H Hyejin Kim (Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University School of Medicine) J James E. Dahlman (Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University School of Medicine)

Abstract

Granulocyte–macrophage colony-stimulating factor (GM-CSF) deficiency drives autoimmune pulmonary alveolar proteinosis (aPAP), a disease characterized by impaired macrophage-mediated clearance of pulmonary surfactants. Clinical data suggest that inhaled recombinant GM-CSF reduces symptoms in aPAP patients, providing a rationale for mRNA-based GM-CSF replacement therapies. However, these require effective mRNA delivery after nebulization. Here, we report the iterative in vivo design of a lipid nanoparticle, named nebulized lung delivery 2 (NLD2), that efficiently delivers mRNA after nebulization. NLD2 carrying GM-CSF mRNA transfected alveolar macrophages in vivo, leading to interleukin-10 pathway activation and subsequent surfactant lipoprotein clearance. In a preclinical disease model of aPAP, GM-CSF mRNA delivery reduced surfactant protein thickness more than recombinant GM-CSF. These data support continued exploration of nebulized lipid nanoparticle therapies for aPAP.

Article Details

Volume / Issue Vol. 123, Issue 7
Published February 17, 2026
ISSN 0027-8424
Publisher National Academy of Sciences

Authors (15)

L

Liming Lian

Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University School of Medicine

B

Bora Jang

Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University School of Medicine

S

Sebastian G. Huayamares

Wallace H. Coulter Department of Biomedical Engineering, Emory University School of Medicine and Georgia Institute of Technology

A

Avraham Shakked

Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University School of Medicine

K

Kara Gentry

Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University School of Medicine

R

Ryan Zenhausern

Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University School of Medicine

A

Afsane Radmand

Petit Institute for Bioengineering and Biosciences, Georgia Institute of Technology

E

Elisa Schrader Echeverri

Wallace H. Coulter Department of Biomedical Engineering, Emory University School of Medicine and Georgia Institute of Technology

V

Vaunita C. Parihar

Cancer Tissue Pathology Shared Resource, Winship Cancer Institute, Emory University School of Medicine

R

Ricardo C. Guerrero-Ferreira

Robert P. Apkarian Integrated Electron Microscopy Core, Emory University School of Medicine

R

Randi Calkins

Wallace H. Coulter Department of Biomedical Engineering, Emory University School of Medicine and Georgia Institute of Technology

D

Daryll Vanover

Wallace H. Coulter Department of Biomedical Engineering, Emory University School of Medicine and Georgia Institute of Technology

P

Philip J. Santangelo

Wallace H. Coulter Department of Biomedical Engineering, Emory University School of Medicine and Georgia Institute of Technology

H

Hyejin Kim

Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University School of Medicine

J

James E. Dahlman

Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University School of Medicine