5-Aminosalicylic Acid Modulates the Immune Response in Chronic Beryllium Disease Subjects

Lung. 2018 Feb;196(1):103-114. doi: 10.1007/s00408-017-0062-x. Epub 2017 Oct 27.


Introduction: Chronic beryllium disease (CBD) is characterized by accumulation of macrophages and beryllium-specific CD4+ T cells that proliferate and produce Th1 cytokines. 5-Amino salicylic acid (5-ASA) is currently used to treat inflammatory bowel disease and has both antioxidant and anti-inflammatory actions. We hypothesized that 5-ASA may be a beneficial therapeutic in CBD.

Methods: Seventeen CBD patients were randomized 3:1 to receive 5-ASA 500-mg capsules or placebo four times daily for 6 weeks orally. Primary study endpoints included changes in beryllium lymphocyte proliferation (BeLPT). Secondary endpoints included changes in bronchoalveolar lavage (BAL) fluid, cells, serum, and blood cell glutathione (GSH) levels, BAL cell TNF-α levels, lung function, and quality of life measures.

Results: 5-ASA decreased BAL cell BeLPT by 20% within the 5-ASA treatment group. No significant changes were observed in serum, PBMCs, BALF, or BAL cell GSH levels in either the 5-ASA or placebo treatment group. 5-ASA treatment decreased ex vivo Be-stimulated BAL cell TNF-α levels within the 5-ASA group and when compared to placebo. Significant improvements were noted in quality of life measurements with 5-ASA treatment.

Conclusions: 5-ASA's ability to decrease BAL cell BeLPT and Be-stimulated BAL cell TNF-α levels suggests that 5-ASA may impact the beryllium-specific immune response in CBD. 5-ASA use in other non-infectious granulomatous lung diseases, such as sarcoidosis, may prove to be a useful alternative treatment to corticosteroids for those with mild to moderate disease.

Keywords: 5-Aminosalicylic acid; Berylliosis; Granuloma; Lung; Quality of life; TNF-alpha; Therapeutic trial (or therapy).

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use*
  • Berylliosis / drug therapy*
  • Berylliosis / immunology*
  • Berylliosis / metabolism
  • Bronchoalveolar Lavage Fluid / chemistry
  • Bronchoalveolar Lavage Fluid / immunology
  • Cell Proliferation / drug effects
  • Chronic Disease
  • Double-Blind Method
  • Female
  • Glutathione / metabolism
  • Humans
  • Immunity, Cellular / drug effects*
  • Leukocytes, Mononuclear
  • Lymphocytes / physiology
  • Male
  • Mesalamine / therapeutic use*
  • Middle Aged
  • Quality of Life
  • Tumor Necrosis Factor-alpha / metabolism


  • Anti-Inflammatory Agents, Non-Steroidal
  • Tumor Necrosis Factor-alpha
  • Mesalamine
  • Glutathione