In addition, a prophylactic CMV-vector-based SIV vaccine was effe

In addition, a prophylactic CMV-vector-based SIV vaccine was effective in preventing SIV infection in rhesus monkeys. This and similar vaccines are being tested in vivo for their effects on the latent SIV reservoirs. In summary, LRAs are able to activate HIV provirus in memory AZD5363 molecular weight CD4+ T cells and thereby may enhance

the recruitment of immune effector cells to destroy provirus-containing cells. However, a “cure” for HIV infection is still a distant prospect. Furthermore, latent HIV reservoirs are heterogeneous and so a combination of approaches will likely be required. Gerardo Garcia-Lerma, Centers for Disease Control and Prevention, Atlanta, GA, USA Proof-of-concept studies for PrEP, are mostly conducted in non-human primates. These can be used either to model a single high-dose infective challenge or repeated low inoculations, about 10–50 tissue culture infective doses (TCID50). Since 2005, rhesus macaque models have been used in a long series of investigations. In a study, in which the monkeys were treated daily with either oral TDF or TDF/FTC and given a weekly SIV inoculum rectally, TDF/FTC gave a longer delay in infection than did TDF alone. When using the vaginal infection route, TDF/FTC gave 100% protection. In contrast, there was far less protection in clinical trials – why? One possible reason may have been that women were having the contraceptive injection, depot medroxyprogesterone acetate (DMPA). A study, find more in macaque monkeys

given DMPA, confirmed that dosing with TDV/FTC gave good drug levels in plasma and in vaginal secretions. Therefore, this did not explain the poor protection in the clinical trial. The macaque model has been used successfully to investigate various situations that are presented in the clinic. When macaques were co-infected with SIV and a bacteria and treated with TDF/FTC for 12 weeks,

there was good, but not complete, protection (80%). With FTC-resistant virus, TDF/FTC remained protective. In this case, FTC-resistant virus has increased susceptibility to TDF. With the K65R mutant HIV, there was protection against a low inoculum but only partial protection (ca 50%) against a high inoculum. Whereas daily dosing seems to be acceptable for patients living with HIV, another option for PrEP is desirable. GSK-1265744 (generally known as GSK-744) is 3-mercaptopyruvate sulfurtransferase an HIV integrase inhibitor. It can be formulated with nano-particles to provide an injectable drug depot. In the macaque model, GSK-744, injected once monthly, gave full protection against repeated rectal and vaginal exposures. Because metabolism of GSK-744 is much slower in humans than macaques, it was expected to remain effective in humans for up to three months. A Phase I study confirmed that drug levels remained above the predicted effective level with a 20-week dosing interval. A Phase II trial is planned. Another approach is to use vaginal rings, which have been in clinical use as contraceptive devices for years.

(2009), see Table 2 However, official reported cases of dengue u

(2009), see Table 2. However, official reported cases of dengue under-estimate the number of clinical cases of the disease (discussed by Suaya et al., 2009), so the global economic burden of dengue reported based on reported cases is conservative. Therefore, we adjusted the global caseload and economic burden upwards

by a factor of 6, to account for unreported cases Selleckchem Epigenetics Compound Library (Armien et al., 2008). The same assumptions regarding dengue case loads and adjustments for unreported cases were also made for the vaccine impact model (next Section). Our estimates for global clinical case load, economic burden, and weighted average cost per case are presented in Table 3 (top three rows). A dengue drug will have clinical utility if the availability and market penetration of dengue vaccines is insufficient to eliminate transmission of dengue. We constructed a Monte Carlo Simulation model (10,000 simulations) using Oracle Crystal Ball®

to project future dengue case loads based on current trends and publicly available information about dengue vaccines. The key assumptions of the model including distributions, most likely, minimum and maximum values are summarized in Table 4. Generally we have assumed a normal distribution, with a standard deviation of 10% around the most likely value, except where there was specific information from the literature that suggested an alternative distribution might be appropriate. More details regarding some of the assumptions are outlined below. Sanofi’s tetravalent dengue vaccine is in Phase III trials. We selected a probability of successful completion of Sorafenib in vivo the Phase

III program and licensure at 75% based on our perception of industry norms for a typical biotech product. A launch of date Inositol monophosphatase 1 of 2015 is feasible if there are no delays in Sanofi’s development program. Inviragen, GSK, and Merck all have dengue vaccines in development, and NIH, has licensed its technology to four institutions or companies regionally. These other efforts appear to be in late Phase I or early Phase II, and so could in theory be licensed in a 2017–2021 time window if development plans remain on track. Therefore, we selected the most likely licensure date as 2019, with minimum and maximum ranges of 2017 and 2021. We have assumed that the probability of achieving licensure for each of these vaccines is approximately 21% (35% probability of success in Phase II × 60% probability of success in Phase III) based on industry norms for a typical biotech product in early clinical development (Zemmel and Shiekh, 2010). The probability of discrete numbers (0–7) of additional vaccines being approved was then calculated. We have assumed that the volume of dengue vaccine doses sold will be limited by capacity, and that the price of dengue vaccines that is negotiated will be set in a manner that will allow the available capacity to be sold.


“The authors regret that there is an error in the ‘Abstrac


“The authors regret that there is an error in the ‘Abstract’ of this published article. The corrected abstract is as follows: We know that from mid-childhood onwards

most new words are learned implicitly via reading; however, most word learning studies have taught novel items explicitly. We examined incidental word learning during reading by focusing on the well-documented finding that words which are acquired early in life are processed more quickly than those acquired PLX3397 later. Novel words were embedded in meaningful sentences and were presented to adult readers early (day 1) or later (day 2) during a five-day exposure phase. At test adults read the novel words in semantically neutral sentences. Participants’ eye movements were monitored throughout exposure and test. Adults also completed a surprise memory test in which they had to match each novel word with its definition. Results showed a decrease in reading times for all novel words over exposure, and significantly shorter total reading times at test for early than late novel words. Early-presented novel words were also remembered better in the offline test. Our results show that order of presentation influences processing time early in the course of acquiring a new word, consistent with partial CX-5461 price and incremental growth

in knowledge occurring as a function of an individual’s experience with each word. “
“Eutrophication drives numerous lakes worldwide to a deteriorated state where phytoplankton dominate over macrophytes (Smith et al., 1999). As a result, species composition changes (Jeppesen et al., 2000 and Smith et al., 1999), toxic algal blooms proliferate (Paerl et al., 2011a) and drinking Phosphoprotein phosphatase water supplies dwindle (Falconer and Humpage, 2005 and Smith et al., 1999). The transition to a phytoplankton dominated state is often non-linear and in many cases catastrophic (Scheffer et al., 2000). In case of a catastrophic transition, a change from the macrophyte dominating

state to the alternative phytoplankton state will be rapid and recovery may show hysteresis (alternative stable states) when positive feedbacks between macrophytes and phytoplankton are strong (Scheffer et al., 1993). Small lakes are more likely to exhibit a macrophyte-rich state than large lakes (Van Geest et al., 2003) primarily because small lakes are less prone to destructive wind forces (Janse et al., 2008) and fish are less abundant (Scheffer and Van Nes, 2007). Examples of small lakes that shifted between the macrophyte and phytoplankton dominated state are the gravel pit lakes in England (< 1 km2, < 2 m depth) (Scheffer et al., 1993 and Wright and Phillips, 1992) and Lake Veluwe in the Netherlands (30 km2, 1.5 m depth) (Meijer, 2000). But there are also larger lakes with macrophytes, and where alternative stable states are presumed.

In addition, a permanent artel (hunting

camp) was establi

In addition, a permanent artel (hunting

camp) was established in 1812 on the Farallon Islands for hunting fur seals and sea lions, and harvesting sea gull feathers, meat, and eggs. The southward expansion of the RAC into northern California took a tremendous toll on the area’s marine fauna. For example, Ogden (1933:36) cited the voyage of the American ship, the Albatross, from which Russian and Native Alaskan workers harvested more than 30,000 fur seals from the Farallon Islands in 1810–11, in addition to the Selleckchem ABT-199 sea otter yields listed in Table 1. RAC documents noted that thousands of fur seal pelts were harvested in California waters after the founding of the Ross Colony, including 3276 from Bodega Bay alone in 1823 ( Ogden, 1933:42). Khlebnikov (1976:123) detailed the wholesale slaughter that took place on the Farallon artel where during the first six years an average of 1200–1500 fur seals were killed (for a total of 8427), which gradually decreased in number see more until only 200–300 were obtained per year. About 200 sea lions were taken each year for their hides, meats, and intestines used for manufacturing baidarkas, waterproof garments, and for food. Anywhere from 5000 to 10,000 sea gulls were dispatched in a typical year, although in 1828 more than 50,000 were killed, primarily for their feathers and meat ( Khlebnikov,

1976:123). RAC documents showed that the joint contract hunting system with American merchants yielded more than 24,000 sea otter pelts from 1803 to 1812 (Table 1). Independent Russian expeditions from 1808 to 1823 harvested, at a minimum, another 6300 sea otter pelts, the majority from northern California waters (i.e., Trinidad Bay to Drake’s Bay) (Table 2). These numbers include only those sea otters hunted by the RAC and their partners. They do not include the thousands of otters obtained as part of the Spanish commercial trade that began in 1786, as well as by independent American skippers and companies (Ogden, 1941:15–44,

66–94, Appendix 1). Market hunting had a devastating outcome for local sea otter populations. Dehydratase It did not help matters that both yearlings and pups were harvested in large numbers (see Table 1 and Table 2). As early as 1817–1818, RAC records indicated that sea otters had been purged from the waters immediately north and south of the Ross Colony (Gibson, 1976:16; Tikhmenev, 1978:135). While the RAC continued sea otter hunting in the 1820s and 1830s, it was undertaken in partnership with the newly formed Mexican government (1823), in which the harvests were split equally between the RAC and Mexican agents. Furthermore, these hunts took place some distance from the Ross Colony using Russian ships to transport hunters from San Francisco Bay southward to southern Alta California and Baja California waters (Khlebnikov, 1976:110–113; Ogden, 1933:46–51). By all accounts sea otters had been extirpated from northern Alta California waters (Trinidad Bay to the Marin Headlands) by 1820.

7; profiles a–b and i–j) They are equipped with dams at 20 km fr

7; profiles a–b and i–j). They are equipped with dams at 20 km from the outlet for Nitta

River, and at 16 and 12 km from the outlet for the Ota river. Only the finest – and most contaminated – material is exported from learn more their reservoirs, as suggested by the very high 134+137Cs activities measured in sediment collected just downstream of the dams (Fig. 7; profiles a–b and i–j). Those reservoirs stored very large quantities of contaminated sediment, as illustrated by the contamination profile documented in sediment accumulated behind Yokokawa dam (Fig. 8). Identification of a 10-cm sediment layer strongly enriched in 134+137Cs (308,000 Bq kg−1) and overlaid by a more recent and less contaminated layer (120,000 Bq kg−1) shows that Fukushima accident produced a distinct geological record that will be useful for

sediment dating and estimation of stocks of contaminated material in this region of Japan during the next years and decades. The succession of typhoons and snowmelt events during the 20 months that Dabrafenib cell line followed FDNPP accident led to the rapid and massive dispersion of contaminated sediment along coastal rivers draining the catchments located in the main radioactive pollution plume. In this unique post-accidental context, the absence of continuous river monitoring has necessitated the combination of indirect approaches (mapping and tracing based on radioisotopic ratios, connectivity assessment) to provide this first overall picture of early sediment dispersion in Fukushima coastal catchments. These results obtained on riverbed sediment should be compared to the measurements PAK6 conducted on suspended sediment that are being collected since December 2012. The combination of those measurements with discharge and suspended sediment concentration data will also allow calculating exports of contaminated sediment to the Pacific Ocean. Our

results showing the rapid dispersion of contaminated sediment from inland mountain ranges along the coastal river network should also be compared to the ones obtained with the conventional fingerprinting technique based on the geochemical signatures of contrasted lithologies. Fukushima coastal catchments investigated by this study are indeed constituted of contrasted sources (volcanic, plutonic and metamorphic sources in upper parts vs. sedimentary sources in the coastal plains). This unique combination of surveys and techniques will provide very important insights into the dispersion of particle-borne contamination in mountainous catchments that are particularly crucial in this post-accidental context, but that will also be applicable in other catchments of the world where other particle-borne contaminants are problematic.

Strong archeological evidence suggests that the islands within th

Strong archeological evidence suggests that the islands within the northern

Lagoon have been inhabited since Roman times and up to the Medieval Age. Examples of wooden waterside structures were found dating back between the first century BC and the second century AD (Canal, 1998, Canal, 2013 and Fozzati, 2013). As explained in Housley et al. (2004), due to the need for dry land suitable for building, salt marshes were enclosed and infilled to support small islands on which early settlements were built. Sites that go back to Roman imperial times are now well documented in the northern part of the lagoon. In the city of Venice itself, however, the first archeological evidence found NVP-AUY922 ic50 so far dates back to the 5th century AD. Only later, in the 8th to 9th century AD, did Venice start to take the character of a city (Ammerman, 2003). By the end of the 13th century, Venice was a prosperous city with a population of about 100,000 inhabitants (Housley et al., 2004). At the beginning of the 12th century, sediment delivered by the system of rivers threatened to fill the lagoon (Gatto and Carbognin, 1981). In the short term, the infilling of sediment affected the navigation and harbor activity of Venice, while in the long term,

it opened up the city to military attack by land. This situation motivated the Venetians to divert the rivers away from the lagoon, so that the sediment load of the rivers would discharge directly into the medroxyprogesterone Adriatic Sea. This human intervention was carried out over the next few centuries so that all the main rivers Idelalisib chemical structure flowing into the lagoon were diverted by the 19th century (Favero, 1985 and Bondesan and Furlanetto, 2012). If the Venetians had not

intervened, the fate of the Venice Lagoon could have been the same as that of a lagoon in the central part of the Gulf of Lions in the south of France. This lagoon was completely filled between the 12th and 13th century (Sabatier et al., 2010). In the 19th century, significant modifications included a reduction of the number of inlets from eight to three. The depth of the remaining inlets also increased from ∼5 m to ∼15 m, with a consequent increase in tidal flow and erosive processes (Gatto and Carbognin, 1981). In the last century, dredging of major navigation channels took place in the central part of the lagoon to enhance the harbor activity. The exploitation of underground water for the industrial area of Marghera (Fig. 1) contributed to a sinking of the bottom of the basin (Carbognin, 1992 and Brambati et al., 2003). Also, the lagoon surface decreased by more than 30 percent due to activities associated with land reclamation and fish-breeding. The morphological and ecological properties of the lagoon changed dramatically: salt marsh areas decreased by more than 50 percent (from 68 km2 in 1927 to 32 km2 in 2002) and some parts of the lagoon deepened (Carniello et al., 2009, Molinaroli et al., 2009 and Sarretta et al.

7) to reveal differences in the oil and water content of the crea

7) to reveal differences in the oil and water content of the creams. Spectra resulting from olefin (-CH2) groups from oleaginous bases have been observed [12] in the vicinity of 4300 and 5800 cm−1 and spectra resulting from hydroxyl (-OH) groups from water [13] have been observed in the vicinity of 5200 cm−1. Based on second-derivative NIR absorption spectra, MCZ-B, MCZ-C, and MCZ-D had similar spectra in the vicinity of 4300 cm−1 while MCZ-A had a lower spectrum than

the other 3 creams. MCZ-A and MCZ-C had higher spectra in the vicinity of 5200 cm−1 while MCZ-B and MCZ-D DAPT manufacturer had lower spectra. An assay using HPLC was performed to determine the MCZ content in each cream. This assay revealed that MCZ-A had an MCZ content of 100.6±1.5%, MCZ-B had an MCZ content of 100.3±1.4%, MCZ-C had an MCZ content of 99.6±2.9%, and MCZ-D had an MCZ content of 101.1±1.6%. All of the creams were found to have an MCZ content of 95% or higher. Human sensory testing with regard to 4 attributes (texture, extensibility,

cohesiveness, and availability) was conducted (Fig. 8) in order to determine the correlation between the physical properties and feel of each cream. Testing indicated that MCZ-B and MCZ-D had similar attributes. The MCZ-A, significance has been confirmed RO4929097 mouse in the evaluation item of spreadability with MCZ-D. Moreover, the MCZ-A, significant differences has been confirmed in the evaluation item of availability with MCZ-D and MCZ-B (p<0.05). MCZ-C had a significantly better spreadability than MCZ-B and MCZ-D (p<0.05). The skin permeation test was performed to potential dermal transfer of each of the formulations and to examine the skin permeability

(Fig. 9). Results, MCZ was detected in the skin, but could not be detected at all measurement time in the receiver solution. Skin MCZ amount, calculated by the skin per area. MCZ amount is 7.4 µg/cm2 for MCZ-A, 5.11 µg/cm2 for MCZ-B, 12.08 µg/cm2 for MCZ-C, 3.75 µg/cm2 for MCZ-D. MCZ-C had migrated into the skin significantly from MCZ-D Astemizole and MCZ-B (p<0.05). In order to determine the physicochemical properties of each cream, flattening, dynamic viscosity, viscoelasticity, viscosity, and water content were measured and microscopy and NIR absorption spectroscopy were performed. Differences in physical properties were noted. In order to determine the effects of differences in physical properties on feel to humans, a sensory test was conducted. Findings indicated that physicochemical properties are associated with feel to humans. Analytical instruments that measure physical properties could presumably help to assess feel to humans. MCZ-C spread more readily than MCZ-B and MCZ-D and MCZ-A spread more readily than MCZ-D. Calculation of the rate of spread revealed differences in that rate. MCZ-A and MCZ-C spread at a faster rate than MCZ-B and MCZ-D. Dynamic viscosity typically changes over time.

4 Da for a peptide of 31 amino acids from P stylirostris (VTDGDA

4 Da for a peptide of 31 amino acids from P. stylirostris (VTDGDADSAVPNLHHENTEYNHYGSHGVYPDK) and 8362.8 Da for a 32 amino acid peptide, also from P. stylirostris (LVVAVTDGDADSAVPNLHENTEYNHYGSHGVY). The two peptides from P. stylirostris revealed perfect homology with the C-terminus of the haemocyanin of Penaeus. In this case, the authors speculated that the penaeid shrimp can

use haemocyanin, which is abundant and readily available in the plasma, to produce C-terminal fragments that possess broad antifungal activities within the first hours of an infection. Therefore, haemocyanin has a potential function in crustacean immunity by serving as a substrate for the generation of antifungal (poly)peptides that could contribute to microorganism elimination in plasma. It remains to be established A-1210477 supplier whether the mechanism leading to the partial cleavage of haemocyanin is part of the shrimp immune reaction and how involved this process can be in an immediate and systemic antimicrobial response in shrimp. This result suggests that, as observed in crustaceans, the cleavage of haemocyanin and the production of peptide fragments with antimicrobial

activity also occur in spiders as a first line of defence against infection. Several studies suggest that haemocyanins are involved in the arthropod immune system. The activity of the haemocyanin fragment discovered in this study reinforces that idea. The identification and characterisation of new substances can lead to the development check details of new

drugs that kill resistant pathogenic microorganisms. This peptide has activity against clinical isolates that cause candidiasis, one of the opportunistic pathogens responsible for nosocomial infections that colonise human mucosal surfaces [30]. Yeasts of the genus Candida are significant due to the high frequency at which they colonise and infect a human host. Candida species are found in the gastrointestinal tract in 20–80% of the healthy adult population. In addition, approximately 20–30% of women have Candida colonies in their vaginas [7]. The increase in the prevalence of yeast infections is likely due to the AIDS epidemic, cancer chemotherapy, organ and bone-narrow transplants and invasive hospital procedures [43] and [45] oxyclozanide because of the overuse of antifungal agents, such as fluconazole [45]. Due to its small size, rondonin can be synthesised quickly and can kill yeast in ten minutes. Furthermore, no toxicity towards human erythrocytes was observed in this study. Therefore, rondonin may represent a new strategy for developing drugs that neutralise or inhibit pathogens. We are grateful to Dr. Mirian A.F. Hayashi (Dept. Farmacology/UNIFESP) for providing the clinical strains. We also appreciate the financial support of Fapesp (CAT/Cepid Project 98-14307-9), Capes and Cnpq. “
“Insects do not have adaptive immunity, but instead they have sophisticated innate immunity that consists of cellular and humoral immune responses.

5c) In contrast, the condyle did not grow in the superior direct

5c). In contrast, the condyle did not grow in the superior direction, but in an almost posterior direction. When the condylar cartilage is destroyed, as in this case, endochondral ossification, which provides the condyle with growth ability to resist against GPCR Compound Library chemical structure compressive forces exerted on it [11], [17] and [26], is disturbed. As a result, the condyle cannot grow in the superior direction, and compensatory posterior growth due to intramembranous ossification at the posterior condylar margin becomes predominant, which is one characteristic of the high-angle type [2] and [26].

These results suggest that the balance between intramembranous and endochondral ossification in the condyle may be a factor determining divergent condylar growth direction. Primary cartilage, such as articular cartilage and growth plates in a long bone, synchondroses in the cranial base, and nasal septal cartilage, consists of a chondrocyte NLG919 population (Fig. 6). In contrast, condylar cartilage (i.e., secondary cartilage) is a heterogeneous tissue containing cells at various stages of chondrogenic maturation [31], [32], [33], [34], [35], [36], [37], [38], [39], [40] and [41] (Fig. 7). Classifications and

terminology related to condylar cartilage cell layers differ among investigators (Table 1). Cell layer classification depends on animal species and growth stage, histological method, and molecular markers used in a given study. In this paper, a classification comprising four cell layers is used to explain the characteristics

of each cell layer because four cell layers can be easily distinguished from each other based on type I and II collagen localization. The most superficial layer of the condylar cartilage consists of dense fibrous connective 4-Aminobutyrate aminotransferase tissue with scattered cells, and its periphery is continuous with the outer layer of the periosteum (Fig. 7). The cells are flat and surrounded by dense collagen bundles [38], [39] and [40]. This layer is not related to deeper chondrogenic differentiation, but functions as a protective covering for the underlying cartilaginous tissue [38]. Recently, Ohno et al. [42] revealed that superficial zone protein, also known as proteoglycan-4 and lubricant, is restricted to the superficial part of the condylar cartilage and functions as a joint boundary lubricant. Based on cellular morphology, this layer is further divided into two sublayers: the upper sublayer (i.e., polymorphic cell layer), where irregular polygonal cells with large round nuclei are densely packed; and the lower sublayer (i.e., flattened cell layer), where flattened cells are oriented with their long axes parallel to the articular surface [38] (Fig. 7). The cells in the upper sublayer have poorly developed cytoplasmic organelles, extend thin cell processes to the adjacent cells, and form gap junctions [38].

The onset

The onset selleck chemicals llc is in the third or fourth decade. PAP can be primary or secondary, however most cases are primary [5]. The classification includes two congenital forms and there are suggestions that PAP may be part of a syndrome [5] and [9]. This presentation of a patient with an unresolving pneumonia and diagnosis of PAP is probably the first in the literature. The diagnosis is most likely related to the patient’s chronic lymphocytic leukaemia (CLL) and thus is secondary PAP. The incidence of PAP in a person with a haematological malignancy (usually myeloid) is 5.3% [5] and therefore the case of PAP in this patient is likely to be even less common as the leukaemia is leucocytic. Patients with PAP usually present

with dyspnoea [1] and [5] and a cough [1] and [2]. Approximately 75% of patients are smokers at diagnosis [1], [2] and [8]. Blood tests can highlight a high lactate dehydrogenase (LDH) and raised tumour markers. Spirometry

shows a restrictive pattern [1], [2] and [8], although can be obstructive in smokers. Blood gases can predict the clinical course, for instance a PaO2 of over 9.3 kPa can mean a patient is more likely to recover [5]. Imaging shows non-specific bilateral patchy consolidation [1], [2] and [5] and approximately 20% have unilateral abnormalities. The diagnosis is made from interpreting CT images and lung lavage specimens. A tissue biopsy may not always yield the diagnosis if the consolidation is patchy. The gold standard for treatment of primary PAP is whole lung lavage [1], [4] and [5]. There have been various treatments used in the past, such as steroids, CP-673451 order streptokinase and potassium iodide [5]. There is a report of one patient improving in response to ambroxol, despite this causing an increased production of surfactant [5]. One alternative treatment is aerolsolised trypsin, although this

can lead to allergic reactions and proteolytic damage [5] and [7]. Another is granulocyte-macrophage colony-stimulating factor (GM-CSF), which can clear surfactant and be used in patients resistant to lung lavage [1] and [4]. However, this can be expensive and the patient may go into cardiac failure. Three trials have also shown that patients can acetylcholine relapse after this treatment, although there is a benefit in some patients [10], [11], [12] and [13]. Gene therapy may be a potential future treatment in congenital PAP. PAP is classified as secondary if related to a medical condition such as a malignancy [2] (particularly myeloid leukaemia) [1], [3], [6], [8] and [14], pulmonary infection, immunodeficiency or as a result of the inhalation of chemicals [1], [2], [8] and [14]. Secondary PAP accounts for 5–10% of all cases [1] and [2]. One study shows a patient with secondary PAP receiving GM-CSF had no change in their condition, one improved with stem cell transplantation and the other with antifungal treatment [6]. Another did well with no treatment intervention [6].