Effects of azithromycin on intracellular cytokine responses and mucocutaneous manifestations in Behcet's disease

Abstract

ObjectiveThe aim of this study was to investigate the effects of azithromycin on mucocutaneous manifestations and ex vivo intracellular cytokine responses in patients with Behcet's disease (BD). MethodsTen BD patients with active manifestations and nine healthy controls (HCs) were included in the study. Patients were treated with azithromycin (1500mg/week) for fourweeks. Clinical and immunological responses were evaluated in the pre- and post-azithromycin treatment periods. Peripheral blood mononuclear cells (PBMCs) of patients and controls were stimulated by Streptococcus sanguinis, lipopolysaccharide (LPS), lipoteichoic acid (LTA), and heat shock protein-60 (HSP-60) for three hours. Ex vivo intracellular interferon- (IFN-) and tumor necrosis factor- (TNF-) levels were measured. ResultsFollicular lesions and genital ulcers completely healed, and the number of oral ulcers decreased after treatment (P=0.000). The stimulated intracellular IFN- response to S.sanguinis was higher in BD patients (5.75%) than in HCs (3.9%) before treatment (P=0.05). Likewise, the pretreatment IFN- response was significantly higher than the post-treatment response (1.95%). In BD patients, pretreatment stimulated intracellular IFN- responses to LTA (5.8%) were also higher than post-treatment responses (3.15%), but the difference did not reach statistical significance (P=0.07). ConclusionsAzithromycin treatment decreased the mucocutaneous manifestations in BD patients and suppressed the intracellular IFN- responses of PBMCs to S.sanguinis ex vivo, which suggests this treatment has an immunomodulatory effect.