Airola Carlo, Severino Andrea, Spinelli Irene, Gasbarrini Antonio, Cammarota Giovanni, Ianiro Gianluca, Ponziani Francesca Romana
Digestive Disease Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy.
Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy.
Antibiotics (Basel). 2024 Dec 4;13(12):1176. doi: 10.3390/antibiotics13121176.
Antibiotics, widely used medications that have significantly increased life expectancy, possess a broad range of effects beyond their primary antibacterial activity. While some are recognized as adverse events, others have demonstrated unexpected benefits. These adjunctive effects, which have been defined as "pleiotropic" in the case of other pharmacological classes, include immunomodulatory properties and the modulation of the microbiota. Specifically, macrolides, tetracyclines, and fluoroquinolones have been shown to modulate the immune system in both acute and chronic conditions, including autoimmune disorders (e.g., rheumatoid arthritis, spondyloarthritis) and chronic inflammatory pulmonary diseases (e.g., asthma, chronic obstructive pulmonary disease). Azithromycin, in particular, is recommended for the long-term treatment of chronic inflammatory pulmonary diseases due to its well-established immunomodulatory effects. Furthermore, antibiotics influence the human microbiota. Rifaximin, for example, exerts a eubiotic effect that enhances the balance between the gut microbiota and the host immune cells and epithelial cells. These pleiotropic effects offer new therapeutic opportunities by interacting with human cells, signaling molecules, and bacteria involved in non-infectious diseases like spondyloarthritis and inflammatory bowel diseases. The aim of this review is to explore the pleiotropic potential of antibiotics, from molecular and cellular evidence to their clinical application, in order to optimize their use. Understanding these effects is essential to ensure careful use, particularly in consideration of the threat of antimicrobial resistance.
抗生素是广泛使用的药物，显著提高了预期寿命，其作用范围远远超出了主要的抗菌活性。虽然有些被认为是不良事件，但其他一些则显示出意想不到的益处。这些附加作用在其他药理学类别中被定义为“多效性”，包括免疫调节特性和微生物群的调节。具体而言，大环内酯类、四环素类和氟喹诺酮类已被证明在急性和慢性疾病中均可调节免疫系统，包括自身免疫性疾病（如类风湿性关节炎、脊柱关节炎）和慢性炎症性肺病（如哮喘、慢性阻塞性肺病）。特别是阿奇霉素，因其已确立的免疫调节作用，被推荐用于慢性炎症性肺病的长期治疗。此外，抗生素会影响人体微生物群。例如，利福昔明具有益生元效应，可增强肠道微生物群与宿主免疫细胞和上皮细胞之间的平衡。这些多效性作用通过与参与脊柱关节炎和炎症性肠病等非感染性疾病的人体细胞、信号分子和细菌相互作用，提供了新的治疗机会。本综述的目的是探讨抗生素的多效性潜力，从分子和细胞证据到临床应用，以优化其使用。了解这些作用对于确保谨慎使用至关重要，尤其是考虑到抗菌药物耐药性的威胁。
