title: Effects of azithromycin on intracellular cytokine responses and mucocutaneous manifestations in Behçet's disease.
abstract: OBJECTIVE
  The aim of this study was to investigate the effects of azithromycin on mucocutaneous manifestations and ex vivo intracellular cytokine responses in patients with Behçet's disease (BD).
  
  
  METHODS
  Ten BD patients with active manifestations and nine healthy controls (HCs) were included in the study. Patients were treated with azithromycin (1500 mg/week) for four weeks. 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-γ (IFN-γ) and tumor necrosis factor-α (TNF-α) levels were measured.
  
  
  RESULTS
  Follicular lesions and genital ulcers completely healed, and the number of oral ulcers decreased after treatment (P = 0.000). The stimulated intracellular IFN-γ 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-γ response was significantly higher than the post-treatment response (1.95%). In BD patients, pretreatment stimulated intracellular IFN-γ 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).
  
  
  CONCLUSIONS
  Azithromycin treatment decreased the mucocutaneous manifestations in BD patients and suppressed the intracellular IFN-γ responses of PBMCs to S. sanguinis ex vivo, which suggests this treatment has an immunomodulatory effect.
authors.affiliation: Department of Health Informatics and Technologies, Faculty of Health Sciences, Marmara University, Istanbul, Turkey.
authors.forename: Gonca
authors.initials: G
authors.lastname: Mumcu
authors.forename: Nevsun
authors.initials: N
authors.lastname: Inanç
authors.forename: Filiz T
authors.initials: FT
authors.lastname: Özdemir
authors.forename: Aysın
authors.initials: A
authors.lastname: Tulunay
authors.forename: Emel
authors.initials: E
authors.lastname: Ekşioğlu-Demiralp
authors.forename: Tülin
authors.initials: T
authors.lastname: Ergun
authors.forename: Haner
authors.initials: H
authors.lastname: Direskeneli
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017963:Azithromycin / Q000627:therapeutic use*; D001528:Behcet Syndrome / Q000188:drug therapy* / Q000276:immunology*; D016207:Cytokines / Q000276:immunology*; D004351:Drug Resistance; D004893:Erythema Nodosum / Q000188:drug therapy / Q000276:immunology; D005260:Female; D006801:Humans; D007963:Leukocytes, Mononuclear / Q000187:drug effects / Q000276:immunology; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000187:drug effects / Q000276:immunology; D019226:Oral Ulcer / Q000188:drug therapy / Q000276:immunology; D012867:Skin / Q000187:drug effects / Q000276:immunology; D012883:Skin Ulcer / Q000188:drug therapy / Q000276:immunology; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D016207:Cytokines; D017963:Azithromycin