Roxithromycin downmodulates Th2 chemokine production by keratinocytes and chemokine receptor expression on Th2 cells: its dual inhibitory effects on the ligands and the receptors

Seasonal facial erythema in a patient with allergic rhinitis treated using a combination of tranilast and roxithromycin

OBJECTIVE

A competitive effect with suppression of Th2 immune responses of the tranilast and roxithromycin combination is examined in an allergic rhinitis patient.

PATIENT AND METHODS

A 42-year-old female patient with allergic rhinitis caused by cedar pollen, which is one of the most common allergies during the spring, exhibited facial erythema with itching, particularly on both cheeks, and rhinitis symptoms, such as nasal discharge, and 200 mg/day of tranilast (original) and 300 mg/day of roxithromycin were administered.

RESULTS

After 2 weeks, the patient's skin lesions were mostly eliminated, with the skin appearing almost normal; itching was nearly absent; and rhinitis symptoms disappeared.

CONCLUSION

This combination may be a promising new therapeutic strategy for allergic rhinitis.

Azithromycin Differentially Alters TCR-Activated Helper T Cell Subset Phenotype and Effector Function

In addition to their antibiotic activities, azithromycin (AZM) exhibits anti-inflammatory effects in various respiratory diseases. One of the potent anti-inflammatory mechanisms is through inhibition of CD4+ helper T (Th) cell effector function. However, their impact on specific Th subset is obscure. Herein, we demonstrate the cellular basis of phenotypic and functional alterations associated with Th subsets following AZM treatment in vitro. Using well-characterized Th subset specific chemokine receptors, we report significant suppression of T cell receptor (TCR)-stimulated hyperactivated CCR4+CXCR3+ (Th0) expansion compared to CCR4-CXCR3+ (Th1-like) and CCR4+CXCR3- (Th2-like) cells. Interestingly, this effect was associated with diminished cell proliferation. Furthermore, AZM significantly inhibited the inflammatory cytokines IFN-γ and IL-4 production, CCR4 and CXCR3 receptor expression, and viability of Th0, Th1-like, and Th2-like subsets. Our findings suggest that AZM differentially affects TCR-activated Th subsets phenotype and function, and CCR4 and CXCR3 downregulation and suppressed Th0 subset expansion could potentially influence their trafficking and differentiation into cytokine-producing effector cells.

Voriconazole-induced photocarcinogenesis is promoted by aryl hydrocarbon receptor-dependent COX-2 upregulation

Voriconazole (VRCZ) induces the development of UV-associated skin cancers. The mechanism underlying the VRCZ-induced carcinogenesis has been largely unknown. Here, we showed that VRCZ metabolites plus UVA generated reactive oxygen species and resultant DNA damage of the epidermis, but did not induce substantial apoptosis in human keratinocytes (KCs). Furthermore, VRCZ per se stimulates aryl hydrocarbon receptor (AhR) and upregulates COX-2, which is a pivotal enzyme for the promotion of UV-associated tumors, in an AhR-ARNT dependent manner of the classical (genomic) pathway. Our findings suggest that the phototoxic moieties of VRCZ metabolites may participate in the initiation phase of VRCZ skin cancer, while VRCZ per se promotes the tumor development. Therefore, during VRCZ therapy, sun exposure protection is essential to prevent photocarcinogenesis caused by VRCZ metabolites plus UV. Chemoprevention with selective COX-2 inhibitors may be helpful to repress the development of skin cancers derived from DNA-damaged KCs.

The Immunomodulatory Effects of Macrolides-A Systematic Review of the Underlying Mechanisms

Background

The mechanisms underlying the non-antimicrobial immunomodulatory properties of macrolides are not well understood.

Objectives

To systematically review the evidence for the immunomodulatory properties of macrolides in humans and to describe the underlying mechanism and extent of their influence on the innate and adaptive immune system.

Methods

A systematic literature search was done in MEDLINE using the OVID interface from 1946 to December 2016 according to the preferred reporting items for systematic reviews and meta-analysis (PRISMA). Original articles investigating the influence of four macrolides (azithromycin, clarithromycin, erythromycin, and roxithromycin) on immunological markers in humans were included.

Results

We identified 22 randomized, controlled trials, 16 prospective cohort studies, and 8 case–control studies investigating 47 different immunological markers (186 measurements) in 1,834 participants. The most frequently reported outcomes were a decrease in the number of neutrophils, and the concentrations of neutrophil elastase, interleukin (IL)-8, IL-6, IL-1beta, tumor necrosis factor (TNF)-alpha, eosinophilic cationic protein, and matrix metalloproteinase 9. Inhibition of neutrophil function was reported more frequently than eosinophil function. A decrease in T helper (Th) 2 cells cytokines (IL-4, IL-5, IL-6) was reported more frequently than a decrease in Th1 cytokines (IL-2, INF-gamma).

Conclusion

Macrolides influence a broad range of immunological mechanisms resulting in immunomodulatory effects. To optimize the treatment of chronic inflammatory diseases by macrolides, further studies are necessary, particularly comparing different macrolides and dose effect relationships.

HaCaT Cells as a Reliable In Vitro Differentiation Model to Dissect the Inflammatory/Repair Response of Human Keratinocytes

Cultured primary human keratinocytes are frequently employed for studies of immunological and inflammatory responses; however, interpretation of experimental data may be complicated by donor to donor variability, the relatively short culture lifetime, and variations between passages. To standardize the in vitro studies on keratinocytes, we investigated the use of HaCaT cells, a long-lived, spontaneously immortalized human keratinocyte line which is able to differentiate in vitro, as a suitable model to follow the release of inflammatory and repair mediators in response to TNFα or IL-1β. Different treatment conditions (presence or absence of serum) and differentiation stimuli (increase in cell density as a function of time in culture and elevation of extracellular calcium) were considered. ELISA and Multiplex measurement technologies were used to monitor the production of cytokines and chemokines. Taken together, the results highlight that Ca²⁺ concentration in the medium, cell density, and presence of serum influences at different levels the release of proinflammatory mediators by HaCaT cells. Moreover, HaCaT cells maintained in low Ca²⁺ medium and 80% confluent are similar to normal keratinocytes in terms of cytokine production suggesting that HaCaT cells may be a useful model to investigate anti-inflammatory interventions/therapies on skin diseases.

Anti-inflammatory and Immunomodulatory Effects of Antibiotics and Their Use in Dermatology

Antibiotics (antibacterial, antiviral, and antiparasitic) are class of drugs which result in either killing or inhibiting growth and multiplication of infectious organisms. Antibiotics are commonly prescribed by all specialties for treatment of infections. However, antibiotics have hitherto immunomodulatory and anti-inflammatory properties and can be exploited for various noninfectious dermatoses. Dermatologists routinely prescribe antibiotics in treatment of various noninfectious disorders. This study will review anti-inflammatory and immunomodulatory effects of antibiotics and their use in dermatology.

Mechanism of Macrophage-Derived Chemokine/CCL22 Production by HaCaT Keratinocytes

Background

CC chemokine ligand 17 (CCL17) and CCL22 are the functional ligands for CCR4. We previously reported that inhibitors of nuclear factor-kappa B and p38 mitogen-activated protein kinase (p38 MAPK), but not of extracellular signal-related kinase (ERK), inhibited tumor necrosis factor (TNF)-α- and interferon (IFN)-γ-induced production of CCL17 by the human keratinocyte cell line, HaCaT. Further, an inhibitor of epidermal growth factor receptor (EGFR) enhanced the CCL17 production by these keratinocytes.

Objective

To identify the mechanism underlying CCL22 production by HaCaT cells.

Methods

We investigated the signal transduction pathways by which TNF-α and IFN-γ stimulate HaCaT cells to produce CCL22 by adding various inhibitors.

Results

TNF-α- and IFN-γ-induced CCL22 production was inhibited by PD98059, PD153035, Bay 11-7085, SB202190, c-Jun N-terminal kinase (JNK) inhibitor II, and Janus kinase (JAK) inhibitor 1.

Conclusion

Our results indicate that CCL22 production in HaCaT cells is dependent on ERK, EGFR, p38 MAPK, JNK, and JAK and is mediated by different signal pathways from those regulating CCL17 production. Altogether, our previous and present results suggest that EGFR activation represses CCL17 but enhances CCL22 production by these cells.

Evaluation of the Effectiveness of Antibiotics against Eosinophilic Pustular Folliculitis

Eosinophilic pustular folliculitis (EPF) is a chronic intractable pruritic dermatosis. Although indomethacin is generally effective against EPF and considered as a first-line therapy, quite a few patients with indomethacin still suffer from the symptoms. Among other therapeutic options, some antibiotics have been reported to be effective; however, there has been no epidemiological description regarding oral antibiotics use in patients with EPF. In this study, we investigated the frequency of antibiotics use and the effectiveness in patients with EPF.

Macrolides: from in vitro anti-inflammatory and immunomodulatory properties to clinical practice in respiratory diseases

BACKGROUND

Macrolides have long been recognised to exert immunomodulary and anti-inflammatory actions. They are able to suppress the "cytokine storm" of inflammation and to confer an additional clinical benefit through their immunomodulatory properties.

METHODS

A search of electronic journal articles was performed using combinations of the following keywords: macrolides, COPD, asthma, bronchitis, bronchiolitis obliterans, cystic fibrosis, immunomodulation, anti-inflammatory effect, diabetes, side effects and systemic diseases.

RESULTS

Macrolide effects are time- and dose-dependent, and the mechanisms underlying these effects remain incompletely understood. Both in vitro and in vivo studies have provided ample evidence of their immunomodulary and anti-inflammatory actions. Importantly, this class of antibiotics is efficacious with respect to controlling exacerbations of underlying respiratory problems, such as cystic fibrosis, asthma, bronchiectasis, panbrochiolitis and cryptogenic organising pneumonia. Macrolides have also been reported to reduce airway hyper-responsiveness and improve pulmonary function.

CONCLUSION

This review provides an overview on the properties of macrolides (erythromycin, clarithromycin, roxithromycin, azithromycin), their efficacy in various respiratory diseases and their adverse effects.

Roxithromycin downregulates production of CTACK/CCL27 and MIP-3α/CCL20 from epidermal keratinocytes

Cutaneous T cell-attracting chemokine (CTACK)/CCL27 and macrophage inflammatory protein (MIP)-3α/CCL20 are the major inflammatory chemokines involved in skin inflammation. The present study showed that roxithromycin (RXM) suppressed the TNFα-induced production of CCL27 and CCL20 in HaCaT keratinocytes and normal human keratinocytes (NHKs) in a dose-dependent manner. The production of CCL20 induced by TNFα was suppressed by the addition of inhibitors of nuclear factor kappa B (NFκB). RXM suppressed NFκB activity induced by TNFα. RXM, by regulating CCL27 and CCL20, may contribute to the modulation of inflammation.

Effect of erythromycin A and its new derivative EM201 on type I collagen production by cultured dermal fibroblasts

Thinning of the dermis is the principal histological change in atrophic skin disorders and aged skin. It is caused due to a decreased amount of collagen in the dermis. Macrolides have been reported to exert various pharmacological activities, including anti-inflammatory activity, tumor angiogenesis inhibition and growth inhibition of fibroblasts, in addition to antimicrobial activity. In this study, we investigated the effects of erythromycin A (EMA) and its new derivative EM201 on type I collagen production by cultured dermal fibroblasts. Dermal fibroblasts were cultured with 10(-9) M-10(-5) M EMA or EM201, and collagen production was measured by incubation with radioactive proline, SDS-polyacrylamide gel electrophoresis and fluorography. mRNA levels were measured by Northern blots analysis, and to investigate transcriptional levels luciferase assays were also performed. The results showed that both EMA and EM201 increased collagen production and type I collagen mRNA level (to a maximum of 200% with EMA and 250% with EM201) in a dose-dependent manner in cultured dermal fibroblasts. Transcription of the type I collagen gene was also increased by both macrolides. These results suggest that EMA and EM201 have the potential to improve the thinning of the dermis in atrophic skin disorders and aged skin.

Roxithromycin inhibits chemokine-induced chemotaxis of Th1 and Th2 cells but regulatory T cells

BACKGROUND

Roxithromycin (RXM), a 14-member macrolide antibiotic, has a variety of bioregulatory functions such as anti-inflammatory effects, anti-oxidant effects, and modulation of immune responses.

OBJECTIVES

In this study, we analyzed the effect of RXM on chemokine-induced chemotaxis of Th1, Th2, and regulatory T (Treg) cells established from three normal human peripheral blood lymphocytes by the reported methods.

METHODS AND RESULTS

Incubation with 10 microM RXM for 18 h did not alter the expression profile of CXCR3 on Th1 cells and CCR4 on Th2 and Treg cells. However, upon RXM preincubation, the migration of Th1 cells to IP-10 and Th2 cells to TARC was partially suppressed, although RXM did not influence Treg cell migration. Erythromycin and clarithromycin at the same concentration did not exert such effects. F-actin polymerization and Ca(++) influx induced by IP-10 and TARC in Th1 and Th2 cells, respectively, was down-regulated by RXM pretreatment.

CONCLUSION

These results imply that RXM exhibits bioregulatory function by influencing chemotaxis of Th1 and Th2 cells while leaving Treg cell migration unaffected.

EM703, the new derivative of erythromycin, inhibits transcription of type I collagen in normal and scleroderma fibroblasts

BACKGROUND

Excessive accumulation of collagen in the skin and internal organs in systemic sclerosis (SSc) is considered to result from enhanced transcription of collagen in fibroblasts. Macrolides have been reported to show various pharmacological activities. Recently, it was reported that EM703, a new derivative of erythromycin, improved bleomycin-induced pulmonary fibrosis in mice.

OBJECTIVE

Therefore, we attempted to examine the effects of EM703 on the type I collagen synthetic activity in normal and SSc dermal fibroblasts.

METHODS

Normal and SSc dermal fibroblasts were cultured with various concentrations of Erythromycin A or EM703 for 48h. Amount of type I collagen in the culture medium was measured with ELISA with anti-type I collagen antibody. Type I collagen mRNA levels were measured by northern blots analysis and type I collagen transcription and regulation of the human COL1A1 promoter activity were examined by transient transfection and luciferase assay. Electrophoretic gel mobility shift assay was also performed for measurement of binding activities of DNA binding factors to the COL1A1 promoter.

RESULTS

We found that EM703 reduced collagen production and the mRNA levels of alpha1(I) collagen in a dose-dependent manner in the normal fibroblasts. The transcription of COL1A1 was downregulated as detected by the luciferase assay. The downregulation was also detected using DNA containing various short lengths of the COL1A1 promoter region. EM703 did not inhibit COL1A1 transcription when the luciferase assay was performed using DNA containing the COL1A1 promoter with a short substitution mutation of the CCAAT box. Decreased production of type I collagen at the transcriptional level was also found in SSc fibroblasts treated with EM703.

CONCLUSION

These results suggest that EM703 inhibits the transcription of type I collagen in both normal and SSc fibroblasts, and that the transcription is inhibited through the CCAAT box of the COL1A1 promoter.

Epidermal chemokines and modulation by antihistamines, antibiotics and antifungals

Growing evidence has demonstrated that chemokines released from epidermal cells control inflammatory skin diseases. Keratinocytes elaborate both Th1- and Th2-associated chemokines, although the former is more abundantly produced than the latter. Downmodulation of keratinocyte production of chemokines is one of the therapeutic approaches for cutaneous inflammatory disorders. Recent observations have shown that keratinocyte chemokine production can be modulated by well-used drugs, including antihistamines, antibiotics and antifungals. Utilization of the beneficial side effects of these drugs may by clinically valuable.

Roxithromycin favorably modifies the initial phase of resistance against infection with macrolide-resistant Streptococcus pneumoniae in a murine pneumonia model

Sub-MIC levels of macrolides down-regulate bacterial virulence factors and suppress inflammatory processes. The ability of macrolides to reduce the production of pneumolysin has been shown to explain the discrepancy between in vitro resistance and outcomes with macrolides against macrolide-resistant Streptococcus pneumoniae. In this study, we determined whether the ability of macrolides to regulate inflammatory processes is beneficial for innate resistance to macrolide-resistant pneumococci in a murine pneumonia model. Among the macrolides tested, only roxithromycin did not affect in vitro pneumococcal virulence factors at sub-MIC levels. Roxithromycin (1.25 to 10 mg/kg of body weight/day) was administered to mice by oral gavage for 3 days before infection with a resistant strain of S. pneumoniae. We evaluated the efficacy of the treatment by determining mouse survival curves and by measuring bacterial burdens and several inflammatory parameters in the airways. Pneumolysin and PspA in infected lungs were examined by Western blot assay. Roxithromycin at doses of > or =5 mg/kg/day increased the median survival time and retarded bacteremia without suppressing the production of pneumolysin and PspA in infected lungs. This treatment reduced matrix metalloproteinase-7 expression and activation and keratinocyte-derived chemokine production in the lungs, while it increased mononuclear cell responses in the lungs, with enhanced bacterial clearance. Concentrations of roxithromycin in plasma and tissues were below the MICs for the inoculated strain during infection. The treatment also reduced inflammatory responses to killed pneumococci in the lungs. These results suggest that the modification by roxithromycin of airway inflammatory responses, including those of matrix metalloproteinase-7 and phagocytes, is beneficial for initial resistance to macrolide-resistant pneumococci.

Inhibition of T helper 2 chemokine production by narrowband ultraviolet B in cultured keratinocytes

BACKGROUND

Narrowband ultraviolet B (NB-UVB) has recently been used for the treatment of various skin disorders. Its effects on the production of cytokines and chemokines by keratinocytes are unknown.

OBJECTIVES

To investigate the effect of NB-UVB on production of chemokines and proinflammatory cytokines by keratinocytes in comparison with broadband (BB)-UVB.

METHODS

Normal human epidermal keratinocytes (or the human keratinocyte cell line HaCaT in some experiments) at semiconfluency were irradiated with NB-UVB at 10, 100, 500 or 1000 mJ cm(-2) or BB-UVB at 10 or 100 mJ cm(-2). The cultures were maintained in the presence or absence of interferon (IFN)-gamma at 200 U mL(-1). The 72-h culture supernatants were analysed by enzyme-linked immunosorbent assay to quantify T helper (Th)1 chemokines (IFN-inducible protein 10 and monokine induced by IFN-gamma), Th2 chemokines [macrophage-derived chemokine (MDC) and thymus and activation-regulated chemokine (TARC)] and proinflammatory cytokines [interleukin (IL)-1alpha and tumour necrosis factor (TNF)-alpha]. The expression of mRNA for these molecules was simultaneously assessed by reverse transcriptase-polymerase chain reaction. The culture supernatants were also tested for their chemotactic activity for Th1 and Th2 cells. The two UVB sources were compared on the basis of their minimal erythemal doses and clinically used doses.

RESULTS

Although both NB-UVB and BB-UVB increased the production of IL-1alpha and TNF-alpha, the augmentative effect of NB-UVB was less than that of BB-UVB. Both wavelength ranges of UVB enhanced or had no effect on Th1 chemokine production, but suppressed the production of Th2 chemokines MDC and TARC. This was confirmed by chemotactic assay, which showed decreased chemotactic activity for Th2 cells by the culture supernatants from NB-UVB-irradiated keratinocytes.

CONCLUSIONS

NB-UVB reduces the production of Th2 chemokines without excess production of proinflammatory cytokines, suggesting its therapeutic effectiveness on Th2-mediated skin disorders as well as its relative safety in clinical usage.

Treatment with IFN-γ increases serum levels of Th1 chemokines and decreases those of Th2 chemokines in patients with mycosis fungoides

BACKGROUND

Interferon-gamma (IFN-gamma) is used for the treatment of mycosis fungoides, which is a Th2 neoplasm with elevation of serum Th2 chemokines. Although therapeutic effectiveness of IFN-gamma is caused at least partly by augmented activity of cytotoxic T cells against the tumor cells, its modulation on chemokine production remains unknown.

OBJECTIVE

Alterations in the serum levels of Th1 chemokines, IP-10 and MIG, and Th2 chemokines, TARC and MDC, were examined in mycosis fungoides patients treated with recombinant IFN-gamma.

METHODS

Four patients with mycosis fungoides received intravenous injections of IFN-gamma for 14 or 28 days. On day 0, 7, 14, and 28, sera were obtained from the patients, and the concentrations of TARC, MDC, IP-10, and MIG were measured by ELISA, along with the percentages of peripheral blood Th1 and Th2 cells.

RESULTS

Whereas the levels of TARC and MDC were decreased by IFN-gamma treatment, those of IP-10 and MIG were increased. In particular, the increment of MIG was remarkable. No substantial change of Th1 or Th2 cell number was observed.

CONCLUSION

In IFN-gamma treatment as well as other therapies, TARC may serve as a marker for the disease activity of mycosis fungoides. The dramatic elevation of MIG by IFN-gamma suggests the strong dependency of MIG production on IFN-gamma and the participation of MIG in skin-infiltration of tumoricidal cytotoxic T cells.

Immunomodulatory effects of antimicrobials in the therapy of respiratory tract infections

PURPOSE OF REVIEW

Several classes of antibiotics, particularly macrolides and to some extent quinolones, exert modulatory effects on inflammatory cells. With a growing number of experimental and clinical studies being performed, the relevance of the immunomodulatory actions of antibiotics to the therapy of respiratory infections is discussed in the light of recent reports.

RECENT FINDINGS

Antibiotics, particularly macrolides, exert both stimulatory and inhibitory effects on leukocytes. These effects seem to be related to the activation state of the leukocytes, facilitating bacterial killing as well as the resolution of local inflammation. In community-acquired pneumonia, this may account for the therapeutic benefit of macrolides, even when bacterial eradication is not complete. A variety of effects of macrolides on Pseudomonas aeruginosa, including the inhibition of biofilm matrix, contribute with immunomodulation to the improvement of respiratory function seen with macrolides in cystic fibrosis.

SUMMARY

Macrolides can facilitate the killing of microorganisms in acute respiratory infections through the stimulation of neutrophil activation. On long-term administration, anti-inflammatory, T helper type 1 lymphocyte-enhancing and biofilm-thinning actions, among others, make macrolides valid therapeutic options in chronic infectious/inflammatory disorders, even for infections with microorganisms that are not completely eradicated.

Nadifloxacin, an antiacne quinolone antimicrobial, inhibits the production of proinflammatory cytokines by human peripheral blood mononuclear cells and normal human keratinocytes

BACKGROUND

Acne vulgaris is a chronic inflammatory disease involving colonization of Propionibacterium acnes (P. acnes), activation of neutrophils and lymphocytes. Circumstantial evidence suggests that antigen-independent and -dependent immune responses against P. acnes are involved in the pathogenesis of inflammatory acne. Epidermal keratinocytes are also suggested to be involved in initiation and progression of cutaneous inflammation. Nadifloxacin, a fluorinated quinolone, has potent antimicrobial activities against Gram-negative and -positive microbes and is used to treat multiple inflamed acne lesions. However, its effect on immune conferring cells such as mononuclear cells and keratinocytes has not been examined.

OBJECTIVE

To evaluate the possible involvement of potential anti-inflammatory activity of nadifloxacin in its therapeutic effect on inflammatory acne, we examined the effects of nadifloxacin, in comparison with other antibiotics used to treat acne vulgaris, on cytokine production by human peripheral blood mononuclear cells (PBMC) and keratinocytes.

METHODS

Cytokine production by PBMC was determined after treatment with heat-killed P. acnes in the presence or absence of antimicrobials using a real-time PCR and ELISA. Cultured human epidermal keratinocytes were stimulated by IFN-gamma plus IL-1beta and the effects of antimicrobials were examined by using ELISA.

RESULTS

Nadifloxacin as well as macrolide antibiotics and clindamycin inhibited IL-12 and IFN-gamma production by PBMC stimulated by heat-killed P. acnes. The drug also inhibited the IL-1alpha, Il-6, IL-8 and GM-CMS production by keratinocytes treated with IFN-gamma plus IL-1beta.

CONCLUSIONS

Inhibitory effects of nadifloxacin to activate T cells and keratinocytes may be involved at least in part in the mechanism of its therapeutic effect against inflammatory acne.