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Yang, X.* ; Forstner, M.E.* ; Rothenaigner, I. ; Bullo, M.* ; Şismanlar, T.E.* ; Aslan, A.T.* ; Latzin, P.* ; Hadian, K. ; Griese, M.*

Cyclosporine A in children with ABCA3 deficiency.

Pediatr. Pulmonol., DOI: 10.1002/ppul.27178 (2024)
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BACKGROUND: Biallelic ATP-binding cassette subfamily A member 3 (ABCA3) variants can cause interstitial lung disease in children and adults, for which no proven treatments exist. Recent in vitro evidence suggested that cyclosporine A (CsA) could correct some ABCA3 variants, however for other variants this is unknown and no data in patients exist. METHODS: We retrieved the clinical data of two children aged 2 and 4 years carrying homozygous ABCA3 variants (G210C and Q1045R, respectively) and empiric CsA treatment from the Kids Lung Register database. In vitro experiments functionally characterized the two variants and explored the effects of CsA alone or combined with hydroxychloroquine (HCQ) in a human alveolar epithelial cell line (A549) derived from adenocarcinoma cells. RESULTS: Six weeks following the introduction of CsA, both children required a reduced O2 flow supply, which then remained stable on CsA. Later, when CsA was discontinued, the clinical status of the children remained unchanged. Of note, the children simultaneously received prednisolone, azithromycin, and HCQ. In vitro, both ABCA3 variants demonstrated defective lysosomal colocalization and impaired ABCA3+ vesicle size, with proteolytic cleavage impairment only in Q1045R. CsA alone corrected the trafficking impairment and ABCA3+ vesicle size of both variants with a variant-specific effect on phosphatidylcholine recycling in G210C. CsA combined with HCQ were additive for improving trafficking of ABCA3 in G210C, but not in Q1045R. CONCLUSIONS: CsA treatment might be helpful for certain patients with ABCA3 deficiency, however, currently strong clinical supporting evidence is lacking. Appropriate trials are necessary to overcome this unmet need.
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Publication type Article: Journal article
Document type Scientific Article
Corresponding Author
Keywords Abca3 ; Atp‐binding Cassette Subfamily A Member 3 ; Childhood ; Cyclosporine A ; Hydroxychloroquine ; Interstitial Lung Disease
ISSN (print) / ISBN 8755-6863
e-ISSN 1099-0496
Journal Pediatric Pulmonology
Publisher Wiley
Non-patent literature Publications
Reviewing status Peer reviewed
Institute(s) Research Unit Signaling and Translation (SAT)
Grants German center for Lung Research, CPC Munich (82DZL053B2)
UK child lung foundation
Deutsche Forschungsgemeinsachft (DFG Gr 970/9-2)