Clinical implications of the immunomodulatory effects of macrolides - PubMed (original) (raw)

Review

Clinical implications of the immunomodulatory effects of macrolides

Jun Tamaoki et al. Am J Med. 2004.

Abstract

Macrolide antibiotics are known for their efficacy in treating acute airway infections, but just as importantly, they are also effective anti-inflammatory agents. Their anti-inflammatory properties have been studied most thoroughly in chronic inflammatory airway diseases, particularly diffuse panbronchiolitis (DPB). Erythromycin, azithromycin, clarithromycin, and roxithromycin inhibit chemotaxis and infiltration of neutrophils into the airway and, subsequently, decrease mucus secretion. Mucus formation, a significant cause of morbidity and mortality in patients with chronic airway inflammation, is directly inhibited by macrolides and suppressed by decreased inflammation in the airway. The mechanisms of action for the anti-inflammatory properties of the macrolides are still being investigated, but they are clearly multifactorial. Macrolides inhibit the production of many proinflammatory cytokines, such as interleukin (IL)-1, IL-6, IL-8, and tumor necrosis factor-alpha, perhaps by suppressing the transcription factor nuclear factor-kappaB or activator protein-1. Inhibition of cytokine production has been seen in vitro and also in bronchoalveolar lavage fluid, which contains less IL-8 and fewer neutrophils after treatment with macrolides. Macrolides also inhibit formation of leukotriene B4, which attracts neutrophils, and inhibit the release of superoxide anion by neutrophils that may be present in the airway. An important aspect of inflammation is extravasation of neutrophils into the tissues. Macrolides block formation of adhesion molecules necessary for neutrophil migration. Together, these anti-inflammatory effects result in improved pulmonary functions and fewer airway infections. In patients with DPB, the anti-inflammatory effects lead to a significant increase in survival. Further work is needed to characterize the clinical benefits of macrolides in patients with other chronic inflammatory airway diseases.

PubMed Disclaimer

Cited by

Application of anti-inflammatory treatment in two different ovine Acute Respiratory Distress Syndrome injury models: a preclinical randomized intervention study.
Wildi K, Livingstone S, Ainola C, Colombo SM, Heinsar S, Sato N, Sato K, Bouquet M, Wilson E, Abbate G, Passmore M, Hyslop K, Liu K, Wang X, Palmieri C, See Hoe LE, Jung JS, Ki K, Mueller C, Laffey J, Pelosi P, Li Bassi G, Suen J, Fraser J. Wildi K, et al. Sci Rep. 2023 Oct 20;13(1):17986. doi: 10.1038/s41598-023-45081-8. Sci Rep. 2023. PMID: 37863994 Free PMC article.
Bacterial Coinfection and Superinfection in Respiratory Syncytial Virus-Associated Acute Respiratory Illness: Prevalence, Pathogens, Initial Antibiotic-Prescribing Patterns and Outcomes.
Wongsurakiat P, Sunhapanit S, Muangman N. Wongsurakiat P, et al. Trop Med Infect Dis. 2023 Feb 27;8(3):148. doi: 10.3390/tropicalmed8030148. Trop Med Infect Dis. 2023. PMID: 36977149 Free PMC article.
Immunomodulatory role of azithromycin: Potential applications to radiation-induced lung injury.
Yan Y, Wu L, Li X, Zhao L, Xu Y. Yan Y, et al. Front Oncol. 2023 Mar 8;13:966060. doi: 10.3389/fonc.2023.966060. eCollection 2023. Front Oncol. 2023. PMID: 36969016 Free PMC article. Review.
Low-dose erythromycin in pediatrics: Formulation and stability of 20 mg hard gelatin capsules.
Thevin P, Curti C, Benech A, Jean C, Lamy E, Castera Ducros C, Primas N, Bertault-Peres P, Vanelle P. Thevin P, et al. PLoS One. 2023 Feb 24;18(2):e0282164. doi: 10.1371/journal.pone.0282164. eCollection 2023. PLoS One. 2023. PMID: 36827282 Free PMC article.
Immunomodulatory Effects of Macrolides Considering Evidence from Human and Veterinary Medicine.
Blondeau JM. Blondeau JM. Microorganisms. 2022 Dec 9;10(12):2438. doi: 10.3390/microorganisms10122438. Microorganisms. 2022. PMID: 36557690 Free PMC article. Review.

Clinical implications of the immunomodulatory effects of macrolides - PubMed (original) (raw)