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Antimicrobial Agents and Chemotherapy, December 2005, p. 5018-5023, Vol. 49, No. 12
0066-4804/05/$08.00+0 doi:10.1128/AAC.49.12.5018-5023.2005
Copyright © 2005, American Society for Microbiology. All Rights Reserved.
Interaction of Rifalazil with Oxidant-Generating Systems of Human Polymorphonuclear Neutrophils
M. T. Labro,1*
V. Ollivier,2 and
C. Babin-Chevaye1
INSERM U479,1
INSERM U698, CHU Xavier Bichat, 16 rue Henri Huchard, 75018 Paris, France2
Received 11 July 2005/
Returned for modification 19 September 2005/
Accepted 26 September 2005

ABSTRACT
It is well acknowledged that ansamycins display immunosuppressive
and anti-inflammatory properties in vitro and in vivo. Rifalazil,
a new ansamycin derivative, has not been studied in the context
of inflammation. In particular, there are no data on the possible
interference of rifalazil with oxidant production by phagocytes.
We have compared the antioxidant properties of rifalazil to
those of rifampin, a drug well known in this context, by using
cellular and acellular oxidant-generating systems. Oxidant production
by polymorphonuclear neutrophils was measured in terms of cytochrome
c reduction, lucigenin-amplified chemiluminescence (Lu-ACL),
and the 2',7'-dichlorofluorescin diacetate H
2 (DCFDA-H
2) technique
(intracellular oxidant production). Rifalazil impaired O
2 production in a concentration-dependent manner, with 50% inhibitory
concentrations (IC
50) (concentrations which inhibit 50% of the
response) of 5.4 (30 and 60 min of incubation) and 6.4 (30 min)
mg/liter, respectively, for phorbol myristate acetate (PMA)
and formyl-methionyl-leucyl-phenylalanine (fMLP) stimulation.
In agreement with the published fMLP-like activity of rifampin,
the inhibitory effect of rifampin was significantly greater
for fMLP (IC
50 of 5.6 mg/liter) than for PMA (IC
50 of 58 mg/liter)
stimulation. Alteration of intracellular oxidant production
was also observed with IC
50 values similar to those obtained
by the cytochrome assay. In addition, rifalazil and rifampin
(

25 mg/liter) scavenged O
2, as demonstrated by the acellular
(hypoxanthine-xanthine oxidase) system. Interference with light
detection systems was evidenced for both drugs by Lu-ACL. The
clinical relevance of the antioxidant effect of rifalazil demonstrated
in vitro, in particular its potential anti-inflammatory activity,
requires further investigation.

INTRODUCTION
The immunosuppressive potential of ansamycins and their interference
with the immune system are widely acknowledged (
14,
15). The
antimicrobial activity of ansamycins has been proposed to play
a role in the treatment of various inflammatory diseases (including
arthritis and Crohn's disease) for which the presence of an
underlying pathogen may trigger a chronic inflammatory response.
However, the therapeutic effectiveness of ansamycins in inflammatory
diseases has also been suggested to rely on their interaction
with one or more components of the inflammatory response, among
which polymorphonuclear neutrophils (PMN) appear to be critical
effectors. NADPH oxidase is the multicomponent enzyme system
which reduces oxygen into superoxide anion and H
2O
2 in a process
known as the respiratory burst (
29). The oxidative burst is
essential for the killing of a number of microorganisms, as
shown by the susceptibility to infection of individuals with
chronic granulomatous disease (
11,
23). However, when oxidants
are produced in excess, a detrimental (acute or chronic) inflammatory
response may occur. Increase in oxidant production has been
associated with and may be causally related to a variety of
acute and chronic inflammatory states, such as adult respiratory
distress syndrome, hyperoxia, asbestosis, silicosis, ischemia/reperfusion
injury, rheumatoid arthritis, cancer, atherosclerosis, cigarette
smoking, ionizing radiation, etc. Modulation of oxidant production
has become a target for new anti-inflammatory drugs (
6,
18).
Various antibacterial agents interfere with the phagocyte oxidative
burst (
16,
17). Many authors have investigated the antioxidant
properties of ansamycins. Rifampin, the most important representative
of this group, impairs various PMN functions, such as chemotaxis
and the oxidative burst (although light-absorbing activity and
superoxide anion scavenging can artifactually interact with
the detection method) (
9,
12,
31). Rifampin inhibits the formyl-methionyl-leucyl-phenylalanine
(fMLP)-induced chemiluminescence response of PMN (
7) and monocyte
oxidative metabolism at therapeutic concentrations (
20). Various
experimental approaches support the hypothesis that rifampin
competes for receptors on neutrophils with small peptide chemoattractants,
e.g., fMLP, but not with serum-derived chemoattractants (
9)
and is a nonchemotactic ligand for fMLP-type receptors (
9,
10).
Rifampin has also been shown to decrease oxidant production
by phagocytes in vivo with animal models (
4). In addition, rifamycin
SV, rifamycin B, rifampin, and five semisynthetic derivatives
impair various human neutrophil functions, including superoxide
anion production induced by PMA, although rifamycin SV, rifamycin
B, and rifampin are effective only at high concentrations (
27,
28). A correlation between improvement of clinical symptoms
after treatment of rheumatoid arthritis by local infiltration
with rifamycin SV and the impairment of phagocytosis and oxidant
production has been suggested (
26). Rifalazil, also known as
ABI-1648 and KRM-1648, is a new semisynthetic rifamycin with
a long half-life of approximately 60 h (
24,
25). Originally,
rifalazil was developed as a therapeutic agent to replace rifampin
as part of a multiple-drug regimen for the treatment of tuberculosis.
However, new targets, such as
Chlamydia trachomatis,
Chlamydia pneumoniae,
Clostridium difficile, and
Helicobacter pylori,
have been proposed (
22,
25). The ability of rifalazil to rapidly
accumulate in human macrophages, including
Mycobacterium avium-infected
cells, has been reported (
3). Rifalazil has not been studied
in the context of inflammation, and there are no data on its
interference with oxidant production by phagocytes. In this
study, we have compared the antioxidant properties of rifalazil
to those of rifampin. PMN were used as the major representative
of oxidant-producing cells. To discriminate true antioxidant
properties from artifactual results, various acellular oxidant-generating
systems were used comparatively.
(These results were presented in part at the 45th Interscience Conference on Antimicrobial Agents and Chemotherapy, Washington, D.C., 16 to 19 December 2005 [M. T. Labro and C. Babin-Chevaye, Abstr. 45th Intersci. Conf. Antimicrob. Agents Chemother., abstr. C1-1411, 2005]).

MATERIALS AND METHODS
Ansamycins and reagents.
Rifalazil was provided by ActivBiotics (Lexington, MA). Solutions
of 1 mg in 5 µl acetic acid (10 N) were made and further
diluted in Hanks' balanced salt solution (HBSS) (Sigma, Saint
Quentin Fallavier, France) to 1 mg/ml. Further dilutions were
made in HBSS to reach the desired final concentrations. Rifampin
was from Sigma. Solutions (1 mg/ml) were made in HBSS and further
diluted in the same buffer. HBSS was used as the control for
the two drugs. All reagents were from Sigma, except where indicated.
Human neutrophils (PMN).
PMN were obtained from venous blood of healthy volunteers by Ficoll-Paque centrifugation followed by 2% dextran sedimentation and osmotic lysis of residual erythrocytes. The viability and purity of the PMN preparation, as assessed by trypan blue exclusion, were greater than 96%.
PMN viability.
PMN viability was assessed by measuring lactic dehydrogenase (LDH) release by PMN incubated in the presence of rifalazil, rifampin, or control buffer for 30 to 120 min at 37°C.
Superoxide anion production assay.
(i) Superoxide anion (O2·) production was first measured in terms of superoxide dismutase inhibitable cytochrome c reduction by using a Uvikon 860 spectrophotometer (5). PMN (106) were incubated in the presence of rifalazil, rifampin, or control buffer for 30 or 60 min at 37°C before addition of cytochrome c (96 µM) and stimulation with phorbol myristate acetate (PMA) (100 ng/ml) or fMLP (5 x 106 M) and cytochalasin B (5 µg/ml). Cytochrome c reduction was monitored at 550 nm (20 readings over 5 min). Paired tests included the same reagents plus superoxide dismutase (SOD) to obtain the true O2· production. Results are expressed as overall production nmol/min/106 PMN, according to the formula
OD =
x l x C, where l is the path length of the cuvette (1 cm), C is the concentration of superoxide,
is a constant (
= 21,100 M1 min1), and
OD is the optical density difference.
(ii) Superoxide anion production was also measured in terms of lucigenin (bis-N-methylacridinium nitrate)-amplified chemiluminescence (Lu-ACL) (2). Briefly, 106 PMN were incubated with control buffer or corresponding rifalazil solutions for 30 or 60 min at 37°C in the apparatus in the dark; then, lucigenin (25 µM) was added and cells were stimulated with PMA (100 ng/ml). Chemiluminescence was measured with a chemiluminometer (Autolumat LB953; Berthold, Bad-Wildbad, Germany) for 15 min at 37°C. Paired tests included the same reagents plus SOD (150 U). Results were expressed in terms of overall production (cpm/106 PMN/15 min) and peak of chemiluminescence (cpm/106 PMN/min).
(iii) Intracellular oxidant production was also measured by the 2',7'-dichlorofluorescin diacetate H2 (DCFDA-H2) technique (21). PMN were incubated with the fluorogenic probe DCFDA-H2 (Molecular Probes, Eugene, OR) for 30 min; rifalazil or rifampin was then added for a further 30-min incubation period. The cells were seeded at 100,000 cells/well in polystyrene 96-well culture plates (Falcon; BD Biosciences, Le Pont de Chaix, France); after stimulation with PMA, cells were incubated in the dark at 37°C until fluorescence reading with a microspectrofluorimeter (FLUOstar; BMG Lab Technologies, Champigny/Marne, France) after 5- and 30-min incubations (excitation wavelength [
ex], 485 nm; emission wavelength [
em], 530 nm). Controls included cells not labeled with the fluorescent probe (blank), cells not stimulated with PMA (basal level of oxidant production), and cells incubated with the buffer, with/without stimulation with PMA. Results are expressed in arbitrary fluorescence units.
Acellular system.
The acellular system (hypoxanthine [HX] plus xanthine oxidase [XO]) was used to measure superoxide anion production by two techniques.
(i) Cytochrome c reduction.
HX (0.8 mM), cytochrome c (96 µM), and the drugs were placed in the apparatus (Uvikon 860 spectrophotometer). The reaction was started by the addition of XO (10.8 or 5.4 mU). Readings were made each 15 s over 5 min. Paired tests included the same reagents plus SOD (330 U). Results are expressed as overall production nmol/min/mU, according to the formula given above.
(ii) Lu-ACL.
HX (0.8 mM), lucigenin (125 µM), and the drugs were placed in the apparatus. The reaction was started by the addition of XO (0.715 or 0.90 U). Readings were made over 10 min. Paired tests included the same reagents plus SOD (165 U). Results were expressed as indicated above (production and peak).
Statistical analysis.
Results are expressed as means ± 1 standard deviation (SD) of the total number of experiments conducted with PMN from different volunteers or the total number of experiments with acellular systems. Experiments with ansamycins are paired with controls (solutions). Analysis of variance was used for multiple comparisons. Paired, normally distributed data were analyzed using the Student t test. Concentration dependence was analyzed by constructing linear or logarithmic regression curves. All statistical tests were run on the Statworks program, version 1.2 (Cricket software, 1985).

RESULTS
(i) Cell viability.
Only the concentrations of 100 and 50 mg/liter of rifalazil
significantly altered the viability of PMN (Table
1). These
concentrations were not used with the cellular assays. At concentrations
of

25 mg/liter, rifampin did not alter cell viability over 120
min (percentages of LDH release at 30, 60, and 120 min, respectively,
were as follows: at 25 mg/liter, 5.5, 7, and 7.5%, versus 3.5,
4.5, and 7.5% for controls, and at 10 mg/liter, 6, 6, and 2%,
versus 2, 4, and 9% for controls; means of two experiments).
(ii) Superoxide anion production assay. (a) Cytochrome c reduction.
After PMA stimulation, rifalazil inhibited superoxide anion
production in a concentration-dependent manner (Fig.
1A). The
effect was not time dependent. Logarithmic regressions were
performed to define 50% inhibitory concentrations (IC
50) (concentrations
which inhibit the response by 50%). IC
50 were 5.37 mg/liter
(
P < 0.001;
r = 0.861) and 5.58 mg/liter (
P < 0.001;
r = 0.892), respectively, at 30 and 60 min. Rifampin displayed
a lower inhibitory activity (Fig.
1B), with IC
50 of 58 mg/liter
at 30 min (
P = 0.001;
r = 0.793) and 49.7 mg/liter at 60 min
(
P = 0.004;
r = 0.851). Rifalazil impaired superoxide anion
production after fMLP stimulation to an extent similar to that
observed with PMA (IC
50 of 6.4 mg/liter at 30 min) (Fig.
1C).
By contrast, the inhibitory effect of rifampin was greater for
fMLP stimulation (IC
50 of 5.6 mg/liter) than that obtained with
PMA.
(b) Control (hypoxanthine-xanthine oxidase system).
XO produced about 0.293 ± 0.066 nmol superoxide anion/mU/min
(16 experiments). Only high concentrations (50 and 25 mg/liter)
of rifalazil scavenged superoxide anion, with about 37% ±
25.2% of control response (four experiments;
P = 0.015) at 50
mg/liter and 73% ± 16.6% (seven experiments;
P = 0.005)
at 25 mg/liter. At 10 mg/liter, 96% ± 19.0% (eight experiments)
of control response was obtained. Similar results were obtained
with rifampin (at 50 mg/liter, 39% ± 36.7% [five experiments;
P = 0.021] and at 25 mg/liter, 89% ± 20.7% [seven experiments;
P > 0.05]).
(c) LuACL (PMN).
The inhibitory effects of rifalazil and rifampin were also evidenced with the Lu-ACL technique, whatever the parameter measured, overall production (Fig. 2), and peak. For rifalazil, the IC50 calculated by logarithmic regression for overall production and peak, respectively, were 1.12 (P = 0.026; r = 0.525) and 1.70 mg/liter (P = 0.03; r = 0.530) at 30 min and 0.25 mg/liter (P = 0.031; r = 0.621) and 1.0 mg/liter (P = 0.044; r = 0.589) at 60 min. There was no statistical difference between 30 and 60 min. For rifampin, the results gave IC50 of 27.4 mg/liter (P = 0.01) and 28.0 mg/liter (P < 0.001) at 30 min. However, when the drugs were added to the control hypoxanthine-xanthine oxidase system, rifalazil displayed a potent inhibitory effect (IC50 of 1.19 mg/liter for overall production [P < 0.001; r = 0.845] and 0.89 mg/liter for peak [P < 0.001; r = 0.785]), suggesting light-absorbing activities of the blue solution of this drug. For rifampin, IC50 of 40.1 mg/liter for overall production (P < 0.001; r = 0.875) and 44.5 mg/liter for peak (P < 0.001; r = 0.777) were obtained, indicating a moderate light absorption by the yellow solution.
(iii) Intracellular oxidant production (DCFDA-H2 technique).
The two ansamycins were able to decrease intracellular production
of oxidants with IC
50 of 14.3 mg/liter (
P < 0.001;
r = 0.797)
and 7.3 mg/liter (
P = 0.016;
r = 0.675) for rifalazil at 5 and
30 min (
P > 0.05 [5 versus 30 min]) and with IC
50 of 16 mg/liter
(
P < 0.001;
r = 0.737) and 5.8 mg/liter (
P = 0.004;
r = 0.760)
for rifampin (
P < 0.05 [5 versus 30 min]).

DISCUSSION
In this study, we have confirmed that rifampin impairs oxidant
production by phagocytes and also interferes with detection
systems by scavenging oxidants or by light-absorbing activities,
leading to exaggeration of the actual effect. We have also shown
that rifalazil displays interesting inhibitory properties by
decreasing oxidant production inside and outside the cells.
Lu-ACL remains the most sensitive and highly specific test for
extracellular superoxide formation in biological systems (
1).
However, artifactual interferences can be obtained with colored
solutions. For this assay, apparent inhibition of superoxide
anion production by rifalazil was observed, with IC
50 of about
1 mg/liter at 30 min and 60 min of incubation. However, with
the control acellular hypoxanthine-xanthine oxidase system,
similar IC
50 values were obtained, suggesting that light-absorbing
activity was responsible for these results (Fig.
2). Rifampin
solution also exerted moderate light-absorbing activity (IC
50 of about 40 mg/liter). The strong light-absorbing activity of
the blue solution of rifalazil renders Lu-ACL inapplicable to
analyze its antioxidant activity. The cytochrome
c reduction
assay has, however, permitted us to characterize the inhibition
of rifalazil, which was rapid and did not increase with time,
suggesting a rapid cellular uptake. The inhibition was concentration
dependent and occurred at concentrations much higher than those
obtained in serum. In patients, the peak serum levels after
one dose of rifalazil, as measured by the maximum concentration
of drug in serum, are about 13.5 and 26.4 ng/ml for the 10-
and 25-mg doses, respectively (
8), and are higher in normal
volunteers (39.3 ng/ml) (
24). There are no data on tissue concentrations
of rifalazil in humans, but various studies with animals confirm
its wide tissue distribution and cell and tissue accumulation
(
13). The clinical relevance of the inhibitory effects demonstrated
in our study still awaits further investigations with cellular
and human pharmacokinetics. In particular, it is important to
determine whether the inhibitory concentrations that we observed
here in vitro may be attained at the sites of the enzymatic
reactions, in tissues, or inside cells of subjects who have
been administered rifalazil. The inhibitory effect demonstrated
with the cytochrome reduction test was not due to scavenging
of superoxide anion, which was demonstrated to occur in the
acellular system at higher concentrations (50 and 25 mg/liter).
The inhibitory effect was not due to cell toxicity either, since
only when PMN were exposed to 100 and 50 mg/liter of rifalazil,
above the inhibitory concentrations for enzymatic reactions,
was viability of PMN an issue. Rifalazil had similar inhibitory
actions whatever the stimulus, either PMA, a protein kinase
C activator, or fMLP, which triggers a receptor-dependent cascade
of intracellular mediators and enzymes. By contrast, rifampin,
in agreement with previous data (
9,
10), displayed a greater
inhibitory activity in the case of fMLP stimulation, likely
because of occupancy and blockade of the fMLP receptor. Rifalazil
impaired intracellular oxidant production as soon as the first
5 min of incubation, and inhibition did not increase with time.
The IC
50 was similar to that obtained with the cytochrome assay
(extracellular oxidant production). By contrast, rifampin exerted
a time-dependent effect, and interestingly, its inhibitory effect
was more pronounced in the intracellular assay, with an IC
50 10 times lower than that obtained with the cytochrome
c test
(PMA stimulation, 30-min incubation). DCFH-DA has been widely
used to measure the formation of oxidative species in cells.
However, the nature of the oxidant responsible for oxidation
of DCFH to the fluorescent probe dichlorofluorescein is not
clear. Peroxynitrite, hydrogen peroxide, and hydroxyl radical
have been designated potential candidates (
19). The stronger
inhibitory effect of rifampin with this assay system could be
related to intracellular scavenging of peroxynitrite, as previously
shown for acellular systems (
30). Otherwise, intracellular accumulation
of the two ansamycins tested here might result in cellular concentrations
sufficient to scavenge superoxide anion inside the cells, as
observed with the acellular HX-XO system. These hypotheses are
difficult to assess. Whatever its origin, decreased intracellular
oxidant production may result in diminished bactericidal function
of phagocytes. However, this possible defect can be compensated
by the potent bactericidal effect of ansamycins themselves and/or
the oxygen-independent bactericidal system of phagocytes. Various
reports have observed that, despite an impairment of oxidant
production by rifampin, the bactericidal function of PMN was
not altered (
12).
In conclusion, rifalazil impairs superoxide anion production by PMN and this effect is also obtained intracellularly. Whereas this property is unlikely to result in serious bactericidal defects, the possibility that impairment of oxidant production sustains an anti-inflammatory activity should be assessed. The mechanism of inhibition was not studied here and requires further investigation.

ACKNOWLEDGMENTS
This work was supported in part by a grant from ActivBiotics.

FOOTNOTES
* Corresponding author. Mailing address: INSERM U479, CHU Xavier Bichat, 16 rue Henri Huchard, 75018 Paris, France. Phone: 33 1 44 85 62 11. Fax: 33 1 44 85 62 07. E-mail:
mtlabro{at}wanadoo.fr.


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Antimicrobial Agents and Chemotherapy, December 2005, p. 5018-5023, Vol. 49, No. 12
0066-4804/05/$08.00+0 doi:10.1128/AAC.49.12.5018-5023.2005
Copyright © 2005, American Society for Microbiology. All Rights Reserved.