<em>In vitro</em> anticancer effect of azithromycin targeting hypoxic lung cancer cells via the inhibition of mitophagy

Toriyama,Kazutoshi; Okuma,Takashi; Abe,Shinji; Nakamura,Hiroyuki; Aoshiba,Kazutetsu

doi:10.3892/ol.2023.14146

In vitro anticancer effect of azithromycin targeting hypoxic lung cancer cells via the inhibition of mitophagy

Authors:
- Kazutoshi Toriyama
- Takashi Okuma
- Shinji Abe
- Hiroyuki Nakamura
- Kazutetsu Aoshiba
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Affiliations: Department of Respiratory Medicine, Tokyo Medical University Ibaraki Medical Center, Ami-machi, Ibaraki 300-0395, Japan, Department of Respiratory Medicine, Tokyo Medical University, Tokyo 160-0023, Japan
Published online on: November 10, 2023 https://doi.org/10.3892/ol.2023.14146
Article Number: 12
Copyright: © Toriyama et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

Solid tumors are predisposed to hypoxia, which induces tumor progression, and causes resistance to treatment. Hypoxic tumor cells exploit auto- and mitophagy to facilitate metabolism and mitochondrial renewal. Azithromycin (AZM), a widely used macrolide, inhibits autophagy in cancer cells. The aim of the present study was to determine whether AZM targeted hypoxic cancer cells by inhibiting mitophagy. Lung cancer cell lines (A549, H1299 and NCI-H441) were cultured for up to 72 h under normoxic (20% O₂) or hypoxic (0.3% O₂) conditions in the presence or absence of AZM (≤25 µM), and the cell survival, autophagy flux and mitophagy flux were evaluated. AZM treatment reduced cell survival under hypoxic conditions, caused mitolysosome dysfunction with raised lysosomal pH and impaired the efficient removal of hypoxia-damaged mitochondria, eventually inducing apoptosis in the cancer cells. The cytotoxic effect of AZM under hypoxic conditions was abolished in mitochondria-deficient A549 cells (ρ⁰ cells). The present study demonstrated that AZM reduced lung cancer cell survival under hypoxic conditions by interfering with the efficient removal of damaged mitochondria through mitophagy inhibition. Thus, AZM may be considered as a promising anticancer drug that targets the mitochondrial vulnerability of hypoxic lung cancer cells.

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