Granulocyte-macrophage colony-stimulating factor (GM-CSF), also known as colony-stimulating factor 2 (CSF2), is a monomeric glycoprotein secreted by macrophages, T cells, mast cells, natural killer cells, endothelial cells and fibroblasts that functions as a cytokine. The pharmaceutical analogs of naturally occurring GM-CSF are called sargramostim and molgramostim.

Quick Facts CSF2, Available structures ...

CSF2
Available structures PDB Ortholog search: PDBe RCSB List of PDB id codes 1CSG, 2GMF, 4NKQ, 5C7X, 5D70, 5D71, 5D72, 4RS1
Identifiers
Aliases	CSF2, GMCSF, colony stimulating factor 2, CSF
External IDs	OMIM: 138960 MGI: 1339752 HomoloGene: 600 GeneCards: CSF2
Gene location (Human) Chr. Chromosome 5 (human)[1] Band 5q31.1 Start 132,073,789 bp[1] End 132,076,170 bp[1]
Gene location (Mouse) Chr. Chromosome 11 (mouse)[2] Band 11 B1.3|11 32.13 cM Start 54,138,097 bp[2] End 54,140,493 bp[2]
RNA expression pattern Bgee Human Mouse (ortholog) Top expressed in upper lobe of left lung gallbladder stromal cell of endometrium appendix islet of Langerhans muscle tissue smooth muscle tissue rectum bone marrow lymph node Top expressed in left lung lobe right lung lobe jejunum duodenum piriform cortex artery haematopoietic system thymus colon carotid body More reference expression data BioGPS More reference expression data
Gene ontology Molecular function growth factor activity granulocyte macrophage colony-stimulating factor receptor binding protein binding protein tyrosine kinase activity cytokine activity Cellular component extracellular region intracellular membrane-bounded organelle extracellular space Biological process negative regulation of cytolysis positive regulation of macrophage derived foam cell differentiation regulation of cell population proliferation MAPK cascade positive regulation of podosome assembly negative regulation of extrinsic apoptotic signaling pathway in absence of ligand positive regulation of interleukin-23 production positive regulation of gene expression embryonic placenta development epithelial fluid transport regulation of gene expression dendritic cell differentiation myeloid dendritic cell differentiation macrophage activation cellular response to lipopolysaccharide immune response monocyte differentiation response to fluid shear stress response to silicon dioxide neutrophil differentiation peptidyl-tyrosine phosphorylation regulation of circadian sleep/wake cycle, sleep histamine secretion positive regulation of tyrosine phosphorylation of STAT protein cellular response to granulocyte macrophage colony-stimulating factor stimulus regulation of myeloid cell differentiation regulation of signaling receptor activity negative regulation of transcription, DNA-templated cytokine-mediated signaling pathway positive regulation of cell population proliferation macrophage differentiation Sources:Amigo / QuickGO
Orthologs Species Human Mouse Entrez 1437 12981 Ensembl ENSG00000164400 ENSMUSG00000018916 UniProt P04141 P01587 RefSeq (mRNA) NM_000758 NM_009969 RefSeq (protein) NP_000749 NP_034099 Location (UCSC) Chr 5: 132.07 – 132.08 Mb Chr 11: 54.14 – 54.14 Mb PubMed search [3] [4]
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Quick Facts Identifiers, Symbol ...

Granulocyte-macrophage colony-stimulating factor
three-dimensional structure of recombinant human granulocyte-macrophage colony-stimulating factor (rhGM_CSF)
Identifiers
Symbol	GM_CSF
Pfam	PF01109
Pfam clan	CL0053
InterPro	IPR000773
PROSITE	PDOC00584
SCOP2	2gmf / SCOPe / SUPFAM
Available protein structures: Pfam   structures / ECOD   PDB RCSB PDB; PDBe; PDBj PDBsum structure summary

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Quick Facts Clinical data, ATC code ...

Granulocyte-macrophage colony-stimulating factor

Clinical data
ATC code	L03AA09 (WHO)
Identifiers
IUPAC name Human granulocyte macrophage colony stimulating factor
CAS Number	83869-56-1 Y
DrugBank	DB00020 N
ChemSpider	none
Chemical and physical data
Formula	C639H1006N168O196S8
Molar mass	14434.54 g·mol−1
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Unlike granulocyte colony-stimulating factor, which specifically promotes neutrophil proliferation and maturation, GM-CSF affects more cell types, especially macrophages and eosinophils.^[5]

GM-CSF is a monomeric glycoprotein that functions as a cytokine—it is a white blood cell growth factor.^[6] GM-CSF stimulates stem cells to produce granulocytes (neutrophils, eosinophils, and basophils) and monocytes. Monocytes exit the circulation and migrate into tissue, whereupon they mature into macrophages and dendritic cells. Thus, it is part of the immune/inflammatory cascade, by which activation of a small number of macrophages can rapidly lead to an increase in their numbers, a process crucial for fighting infection.^{[citation needed]}

GM-CSF also has some effects on mature cells of the immune system. These include, for example, enhancing neutrophil migration and causing an alteration of the receptors expressed on the cells surface.^[7]

GM-CSF signals via signal transducer and activator of transcription, STAT5.^[8] In macrophages, it has also been shown to signal via STAT3. The cytokine activates macrophages to inhibit fungal survival. It induces deprivation in intracellular free zinc and increases production of reactive oxygen species that culminate in fungal zinc starvation and toxicity.^[9] Thus, GM-CSF facilitates development of the immune system and promotes defense against infections.^{[citation needed]}

GM-CSF also plays a role in embryonic development by functioning as an embryokine produced by reproductive tract.^[10]

The human gene has been localized in close proximity to the interleukin 3 gene within a T helper type 2-associated cytokine gene cluster at chromosome region 5q31, which is known to be associated with interstitial deletions in the 5q- syndrome and acute myelogenous leukemia. GM-CSF and IL-3 are separated by an insulator element and thus independently regulated.^[11] Other genes in the cluster include those encoding interleukins 4, 5, and 13.^[12]

Human granulocyte-macrophage colony-stimulating factor is glycosylated in its mature form.^{[citation needed]}

GM-CSF was first cloned in 1985, and soon afterwards three potential drug products were being made using recombinant DNA technology: molgramostim was made in Escherichia coli and is not glycosylated, sargramostim was made in yeast, has a leucine instead of proline at position 23 and is somewhat glycosylated, and regramostim was made in Chinese hamster ovary cells (CHO) and has more glycosylation than sargramostim. The amount of glycosylation affects how the body interacts with the drug and how the drug interacts with the body.^[13]

At that time, Genetics Institute, Inc. was working on molgramostim,^[14] Immunex was working on sargramostim (Leukine),^[15] and Sandoz was working on regramostim.^[16]

Molgramostim was eventually co-developed and co-marketed by Novartis and Schering-Plough under the trade name Leucomax for use in helping white blood cell levels recover following chemotherapy, and in 2002 Novartis sold its rights to Schering-Plough.^[17][18]

Sargramostim was approved by the US FDA in 1991 to accelerate white blood cell recovery following autologous bone marrow transplantation under the trade name Leukine, and passed through several hands, ending up with Genzyme,^[19] which was subsequently acquired by Sanofi. Leukine is now owned by Partner Therapeutics (PTx).

Imlygic was approved by the US FDA in October 2015,^[20] and in December 2015 by the EMA, as an oncolytic virotherapy, commercialized by Amgen Inc. This oncolytic herpes virus, named Talimogene laherparepvec, has been genetically engineered to express human GM-CSF using the tumor cells machinery.^[21]

GM-CSF is found in high levels in joints with rheumatoid arthritis and blocking GM-CSF as a biological target may reduce the inflammation or damage. Some drugs (e.g. otilimab) are being developed to block GM-CSF.^[22] In critically ill patients GM-CSF has been trialled as a therapy for the immunosuppression of critical illness, and has shown promise restoring monocyte^[23] and neutrophil^[24] function, although the impact on patient outcomes is currently unclear and awaits larger studies.

GM-CSF stimulates monocytes and macrophages to produce pro-inflammatory cytokines, including CCL17.^[25] Elevated GM-CSF has been shown to contribute to inflammation in inflammatory arthritis, osteoarthritis, colitis asthma, obesity, and COVID-19.^[25][26][27]

Monoclonal antibodies against GM-CSF are being used as treatment in clinical trials against rheumatoid arthritis, ankylosing spondylitis, and COVID-19.^[25]

• CFU-GM
• Filgrastim (Neupogen, a granulocyte colony-stimulating factor (G-CSF) analog)
• Granulocyte-macrophage colony-stimulating factor receptor
• Lenzilumab
• Pegfilgrastim (Neulasta, a PEGylated form filgrastim)