The effect of triple CFTR modulator therapy and azithromycin on ion channels and inflammation in cystic fibrosis.

Suhad Bani Melhim, Lisa E.J. Douglas, James A. Reihill, Damian G. Downey, S. Lorraine Martin*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

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Abstract

Background
Inflammation in cystic fibrosis (CF) airways is difficult to treat with well-established regimens often including azithromycin (AZ) as an immunomodulatory drug. As AZ has been reported to require CF transmembrane conductance regulator (CFTR) to be able to reduce interleukin (IL)-8 and given the emergence of highly effective CFTR “triple” modulator therapy (elexacaftor/tezacaftor/ivacaftor; ETI), the aim of this study was to investigate the effect of AZ and ETI, singly and in combination, on ion channel activity and to assess the potential anti-inflammatory effects.

Methods
Electrophysiological assessment of ETI and AZ was performed on three-dimensional cultures of primary CF human bronchial epithelial (HBE) cells using a Multi Trans-Epithelial Current Clamp. IL-8 from NuLi-1 (non-CF) and CuFi-1 (CF) cells treated with AZ was measured by ELISA. Inflammatory mediators from primary CF HBE cells exposed to tumour necrosis factor-α in the presence of AZ, ETI and their combination, were screened using the Proteome Profiler™ Human Cytokine Array Kit, with selected targets validated by ELISA.

Results
AZ did not alter CFTR chloride efflux, nor did it have any synergistic/antagonistic effect in combination with ETI. AZ reduced IL-8 in NuLi-1 but not CuFi-1 cells. The Proteome Profiler™ screen identified several disease-relevant cytokines that were modulated by treatment. Subsequent analysis by ELISA showed IL-8, IL-6, CXCL1 and granulocyte–macrophage colony-stimulating factor to be significantly reduced by treatment with ETI, but not by AZ.

Conclusions
Incorporating ETI into the standard of CF care provides an opportunity to re-evaluate therapeutic regimens to reduce treatment burden and safely discontinue chronic treatments such as AZ, without loss of clinical benefit. Identification of redundant treatments in the era of CFTR modulation may improve medication adherence and overcome potential adverse effects associated with the chronic use AZ and other drugs.

Original languageEnglish
Article number00502-2024
Number of pages11
JournalERJ Open Research
Volume10
Issue number6
Early online date31 Oct 2024
DOIs
Publication statusPublished - Nov 2024

Keywords

  • cystic fibrosis
  • CFTR
  • azithromycin
  • inflammation
  • cytokines
  • ion channels

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