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Inhibition of sulfur mustard-induced cytotoxicity and inflammation by the macrolide antibiotic roxithromycin in human respiratory epithelial cells

Xiugong Gao, Radharaman Ray, Yan Xiao, Peter E Barker and Prabhati Ray*

BMC Cell Biology 2007, 8:17  doi:10.1186/1471-2121-8-17

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Bronchiolitis obliterans is the missing link of the response to macrolides therapy in human respiratory epithelial cells injury induced by sulfur mustard

Mostafa Ghanei   (2007-07-12 14:44)  Research Center of Chemical injuries, Baqiyatallah University of Medical Sciences, Tehran, Iran email

The article on "Inhibition of sulfur mustard-induced cytotoxicity and inflammation by the macrolide antibiotic" in the May 24, 2007 was an interesting research by Gao et al. The study demonstrates that roxithromycin has inhibitory effects on the cytotoxicity and inflammation provoked by sulfur mustard in human respiratory epithelial cells. It suggests that macrolide antibiotics may serve as potential vesicant respiratory therapeutics through mechanisms independent of their antibacterial activity [1]. Although, pathophysiological processes of sulfur mustard inhalation injury is not well understood, indeed, all aspects of different disorders are various presentations of a single underlying disease and bronchiolitis is the original nature of the pathology in these patients. Recent pathological studies revealed bronchiolitis obliterans as delayed respiratory disorders in mustard gas exposed patients [2-4]. We introduced the term of "Mustard Lung" for this phenomenon [5,6]. It seems that similar to post lung transplant bronchiolitis obliterans, pathogenesis of bronchiolitis obliterans in mustard gas exposed patients may be due to the same inflammatory process. Recently, because of anti-inflammatory effects of macrolides, the use of these drugs has been noticed to relieve late lung inflammatory disorders and consequent manifestations in this group of patients.

The Gao et al, in vitro study provide new evidence for previous clinical studies in which macrolides were used according to consideration of bronchiolitis obliterans as known underling disease in patients who were exposed to sulfur mustard [7].


Baqiyatallah University of Medical Sciences

Tehran, Iran



Isfahan University of Medical Sciences,

Isfahan, Iran



1. Gao X, Ray R, Xiao Y, Barker PE, Ray P: Inhibition of sulfur mustard-induced cytotoxicity and inflammation by the macrolide antibiotic roxithromycin in human respiratory epithelial cells. BMC Cell Biology 2007, 8:17.

2. Thomason JW, Rice TW, Milstone AP: Bronchiolitis obliterans in a survivor of a chemical weapons attack. J Am Med Assoc 2003, 290: 598–599.

3. Dompeling E, Jobsis Q, Vandevijver NM, Wesseling G, Hendriks H: Chronic bronchiolitis in a 5-yr-old child after exposure to sulphur mustard gas. Eur Respir 2004, J. 23:343–346.

4. Ghanei M, Mokhtari M, Mohammad MM, Aslani J: Bronchiolitis obliterans following exposure to sulfur mustard: Chest high resolution computed tomography. Eur J Radiol 2004, 52:164–169.

5. Ghanei M, Harandi AA: Long Term Consequences from Exposure to Sulfur Mustard: A Review. Inhal Toxicol 2007, 19:451–456.

6. Beheshti J, Mark EJ, Akbari H, Ghanei, M: Mustard lung secrets: Long term clinicopathological study following mustard gas exposure. Pathol Res Pract 2006, 202:739–744.

7. Ghanei M, Abolmaali K, Aslani J. Efficacy of concomitant administration of clarithromycin and acetylcysteine in bronchiolitis Obliterans in seventeen sulfur mustard-exposed patients: An open-label study. Current Therapeutic Research 2004, 65(6):495-504.

Competing interests

None declared


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