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The inflammatory bowel disease drug azathioprine induces autophagy via mTORC1 and the unfolded protein response sensor PERK

Hooper, Kirsty M.; Casanova, Victor; Kemp, Sadie; Staines, Katherine A.; Satsangi, Jack; Barlow, Peter G.; Henderson, Paul; Stevens, Craig


Kirsty M. Hooper

Victor Casanova

Sadie Kemp

Katherine A. Staines

Jack Satsangi

Paul Henderson


Background Genetic studies have strongly linked autophagy to Crohn's disease (CD) and stimulating autophagy in CD patients may be therapeutically beneficial. The aim of this study was to evaluate the effect of current inflammatory bowel disease (IBD) drugs on autophagy and investigate molecular mechanisms of action and functional outcomes in relation to this cellular process. Methods Autophagy marker LC3 was evaluated by confocal fluorescence microscopy and flow cytometry. Drug mechanism of action was investigated by PCR Array with changes in signaling pathways examined by immunoblot and RT-qPCR. Clearance of adherent-invasive Escherichia coli (AIEC) and levels of pro-inflammatory cytokine tumour necrosis factor alpha (TNFα) were evaluated by gentamicin protection assays and RT-qPCR respectively. LC3 was analysed in peripheral blood mononuclear cells (PBMC) from paediatric patients by flow cytometry. Results Azathioprine induces autophagy via mechanisms involving modulation of mechanistic target of rapamycin (mTORC1) signaling and stimulation of the unfolded protein response (UPR) sensor PERK. Induction of autophagy with azathioprine correlated with the enhanced clearance of AIEC and dampened AIEC-induced increases in TNFα. Azathioprine induced significant increase in autophagosome bound LC3-II in PBMC populations ex vivo, supporting in vitro findings. In patients, the CD-associated ATG16L1 T300A single-nucleotide polymorphism did not attenuate azathioprine induction of autophagy. Conclusions Modulation of autophagy via mTORC1 and the UPR may contribute to the therapeutic Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation

Journal Article Type Article
Acceptance Date Feb 7, 2019
Online Publication Date Mar 19, 2019
Publication Date 2019-09
Deposit Date Feb 7, 2019
Publicly Available Date Mar 20, 2020
Journal Inflammatory Bowel Diseases
Print ISSN 1078-0998
Electronic ISSN 1536-4844
Publisher Lippincott, Williams & Wilkins
Peer Reviewed Peer Reviewed
Volume 25
Issue 9
Pages 1481-1496
Keywords Azathioprine; autophagy; mTORC1; unfolded protein response; Adherent-invasive Ecoli
Public URL
Contract Date Feb 7, 2019


The Inflammatory Bowel Disease Drug Azathioprine Induces Autophagy Via MTORC1 And The Unfolded Protein Response Sensor PERK (4.3 Mb)

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