.....
Another compound that has been experimentally used to control SLE is
pioglitazone.
Pioglitazone corresponds to a peroxisome proliferator-activated receptor (PPAR)-γ agonist that is widely used to treat diabetes.
In addition to its anti-diabetic effect, this drug also has anti-inflammatory properties (
118).
Such anti-inflammatory effect has been reported to benefit inflammatory diseases, including SLE.
Indeed, an
ex vivo study of newly diagnosed lupus patients showed that activation of PPAR-γ by pioglitazone could induce anti-inflammatory properties by promoting the expression of M2-like macrophages and decreasing the expression of M1-like macrophage (
119).
.....
Clinically,
Virgin olive oil (VOO) has been successfully used to ease symptoms in patients with lupus. A study conducted in humans proved that the phenolic fraction of extra virgin oil provided a beneficial effect on immune-inflammatory diseases such as SLE (
121). Although this particular article does not state that this immunoregulation is achieved by macrophages, a more recent study has revealed that VOO dampens TLR4, which plays a role in both macrophage activation and polarization (
122).
Moreover, a comparison of the use of virgin olive oil and sunflower oil in murine lupus showed that the former could block the expression of M1 subtype macrophage while enhancing the M2 phenotype (
122). ...
Clinically,
azithromycin, a macrolide antibiotic useful for controlling inflammation in various diseases (
134), has been proven to ease lupus flare
via the regulation of M2-like macrophages.
In vivo and
in vitro studies in SLE patients revealed that azithromycin promotes M2 polarization
via the pl3k/Akt pathway, resulting in the suppression of inflammation and SLE remission (
135). Albeit its reported side effects (
136), azithromycin does have a good record of safety, and exploring it could offer a new therapeutic strategy for lupus patients. Another drug that favors the M2 phenotype is steroid.
