Macrolide antibiotics activate the integrated stress response and promote tumor proliferation

Authors:

Xin Yu1,#, Ai-Ling Tian2,3,4,5,#, Ping Wang6,#, Juanjuan Li1, Juan Wu7, Bei Li7, Zhou Liu1, Siqing Liu1, Zhijie Gao1, Si Sun8, Shengrong Sun1, Yi Tu1 and Qi Wu9

Affiliations:

1 Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei, P. R. China.

2 Gustave Roussy Cancer Campus, Villejuif Cedex, France.

3 Université Paris-Saclay, Faculté de Médecine, Le Kremlin-Bicêtre, France.

4 Centre de Recherche des Cordeliers, INSERM U1138, Équipe Labellisée – Ligue Nationale contre le Cancer, Université Paris Cité, Sorbonne Université, Paris, France.

5 Metabolomics and Cell Biology Platforms, Gustave Roussy Cancer Campus, Villejuif, France.

6 Medical College, Anhui University of Science and Technology, Huainan, AnHui, P. R. China.

7 Department of Pathology, Renmin Hospital of Wuhan University, Wuhan, Hubei, P. R. China.

8 Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan, Hubei, P. R. China.

9 Tongji University Cancer Center, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, P. R. China.

# These authors have contributed equally to this work and share first authorship.

Keywords: 

macrolide antibiotic, azithromycin, autophagy, ROS, ER stress, cancer.

Abbreviations:

AZD – azithromycin;

Baf A1 – Bafilomycin A1;

CHOP – C/EBP homologous protein;

eIF2α – eukaryotic initiation Factor 2α;

EMT - epithelial-mesenchymal transition;

ER – endoplasmic reticulum;

GFP – green fluorescent protein;

ISR – integrated stress response;

NAC – N-acetylcysteine;

PERK – PKR-like ER kinase;

PKR – protein kinase double-stranded RNA-dependent;

RA – roxithromycin;

ROS – reactive oxygen species;

SP – spiramycin;

TFE3 – transcription factor E3;

TFEB – transcription factor EB;

TG – thapsigargin;

TM – tunicamycin;

UPR – unfolded protein response.

Corresponding Author(s):

Dr. Qi Wu, Tongji University Cancer Center, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, P. R. China; waiwai@whu.edu.cn Dr. Yi Tu, Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, 238 Ziyang Road, Wuhan 430060, Hubei Province, P. R. China; rm000750@whu.edu.cn

Conflict of interest statement:

All the authors agree to the submission and consent for publication this paper. The authors have declared that no competing interest exists.

Please cite this article as:

Xin Yu, Ai-Ling Tian, Ping Wang, Juanjuan Li, Juan Wu, Bei Li, Zhou Liu, Siqing Liu, Zhijie Gao, Si Sun, Shengrong Sun, Yi Tu and Qi Wu (2023). Macrolide antibiotics activate the inte-grated stress response and promote tumor proliferation. Cell Stress 7(4): 20-33. doi: 10.15698/cst2023.04.278

© 2023 Yu et al. This is an open-access article released under the terms of the Creative Commons Attribution (CC BY) license, which allows the unrestricted use, distribution, and reproduc-tion in any medium, provided the original author and source are acknowledged.

Abstract:

Macrolide antibiotics are widely used antibacterial agents that are associated with autophagy inhibition. This study aimed to investigate the association between macrolide antibiotics and malignant tumors, as well as the effect on autophagy, reactive oxygen species (ROS) accumulation and integrated stress response (ISR). The meta-analysis indicated a modestly higher risk of cancer in macrolide antibiotic ever-users compared to non-users. Further experiments showed that macrolides block autophagic flux by inhibiting lysosomal acidification. Additionally, azithromycin, a representative macrolide antibiotic, induced the accumulation of ROS, and stimulated the ISR and the activation of transcription factor EB (TFEB) and TFE3 in a ROS-dependent manner. Finally, animal experiments confirmed that azithromycin promoted tumor progression in vivo, which could be receded by N-acetylcysteine, an inhibitor of ROS and ISR. Overall, this study reveals the potential role of macrolide antibiotics in malignant progression and highlights the need for further investigation into their effects.