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Pulmonary macrophage transplantation (PMT) is a gene and cell transplantation approach in development as therapy for hereditary pulmonary alveolar proteinosis (hPAP), a surfactant accumulation disorder caused by mutations in CSF2RA/B (and murine homologs). We conducted a toxicology study of PMT of Csf2ra gene-corrected macrophages (mGM-Rα + Mϕs) or saline-control intervention in Csf2ra KO or wild-type (WT) mice including single ascending dose and repeat ascending dose studies evaluating safety, tolerability, pharmacokinetics, and pharmacodynamics. Lentiviral-mediated Csf2ra cDNA transfer restored GM-CSF signaling in mGM-Rα + Mϕs. Following PMT, mGM-Rα + Mϕs engrafted, remained within the lungs, and did not undergo uncontrolled proliferation or result in bronchospasm, pulmonary function abnormalities, pulmonary or systemic inflammation, anti-transgene product antibodies, or pulmonary fibrosis. Aggressive male fighting caused a similarly low rate of serious adverse events in saline- and PMT-treated mice. Transient, minor pulmonary neutrophilia and exacerbation of pre-existing hPAP-related lymphocytosis were observed 14 days after PMT of the safety margin dose but not the target dose (5,000,000 or 500,000 mGM-Rα + Mϕs, respectively) and only in Csf2ra KO mice but not in WT mice. PMT reduced lung disease severity in Csf2ra KO mice. Results indicate PMT of mGM-Rα + Mϕs was safe, well tolerated, and therapeutically efficacious in Csf2ra KO mice, and established a no adverse effect level and 10-fold safety margin., Competing Interests: B.C.T. has equity in Altius Therapeutics, a biopharmaceutical company with a license from Cincinnati Children’s Hospital Medical Center to develop PMT as a therapeutic platform beyond the planned clinical use as therapy of hPAP., (© 2024 The Authors.)