Journal
BRITISH JOURNAL OF PHARMACOLOGY
Volume 179, Issue 6, Pages 1201-1219Publisher
WILEY
DOI: 10.1111/bph.15714
Keywords
azithromycin; fibroblasts; GRP78; rheumatoid arthritis; unfolded protein response
Categories
Funding
- Academic promotion programme of Shandong First Medical University [LJ001]
- Youth Innovation Technology Plan of Shandong University [2019KJK003]
- Innovation Project of Shandong Academy of Medical Sciences [2021]
- Natural Science Foundation of Shandong Province [ZR2020YQ55]
- Shandong Taishan Scholarship [tsqn20161076]
- National Natural Science Foundation of China [81772760, 81901666, 82072850]
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Azithromycin, a macrolide antibiotic with anti-inflammatory properties, has shown promising treatment potential in reducing inflammation in rheumatoid arthritis patients. It affects signaling cascades associated with cholesterol and lipid biosynthesis, and targets GRP78, playing a key role in anti-arthritic activity.
Background and Purpose: Azithromycin is a macrolide antibiotic with anti-inflammatory properties. We aim to substantiate the treatment potential of azithromycin in rheumatoid arthritis. Experimental Approach: Gene expression profiles were collected by RNA sequencing and the effects of azithromycin were assessed by in vitro and in vivo assays on the effects of azithromycin-mediated blockade of glucose-regulated protein 78 (GRP78). Anti-inflammatory activity of azithromycin was measured in fibroblast-like synoviocytes from rheumatoid arthritis patients and in collagen-induced arthritis in DBA/1 mice. Characterization of the binding of azithromycin to GRP78 was performed using drug affinity responsive target stability, proteomics and cellular thermal shift assays. Azithromycin-mediated inhibition of GRP78 and its relationship to its anti-arthritic activity was assessed. Key Results: Azithromycin reduced proinflammatory factor production, cell migration, invasion and chemoattraction and enhanced apoptosis, reducing the deleterious inflammatory response of rheumatoid arthritis fibroblast-like synoviocytes in vitro. Azithromycin ameliorated the severity of collagen-induced arthritis lesions as efficiently as the TNF alpha inhibitor etanercept. Transcriptional analyses suggested that azithromycin treatment impairs signalling cascades associated with cholesterol and lipid biosynthesis. GRP78 was identified as a novel target of azithromycin. Azithromycin-mediated activation of the unfolded protein response via the inhibition of GRP78 activity is required not only for inducing the expression of C/EBP-homologous protein (ChOP) but also for the activating sterol-regulatory element binding protein (SREBP) and its targeted genes involved in cholesterol and lipid biosynthetic processes. Furthermore, deletion of GRP78 abolished the anti-arthritic activity of azithromycin. Conclusion and Implications: These findings indicate that azithromycin can used to treat rheumatoid arthritis.
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