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Pal P, Sambhakar S, Paliwal S. Revolutionizing Ophthalmic Care: A Review of Ocular Hydrogels from Pathologies to Therapeutic Applications. Curr Eye Res 2024:1-17. [PMID: 39261982 DOI: 10.1080/02713683.2024.2396385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 08/12/2024] [Accepted: 08/20/2024] [Indexed: 09/13/2024]
Abstract
PURPOSE This comprehensive review is designed to elucidate the transformative role and multifaceted applications of ocular hydrogels in contemporary ophthalmic therapeutic strategies, with a particular emphasis on their capability to revolutionize drug delivery mechanisms and optimize patient outcomes. METHODS A systematic and structured methodology is employed, initiating with a succinct exploration of prevalent ocular pathologies and delineating the corresponding therapeutic agents. This serves as a precursor for an extensive examination of the diverse methodologies and fabrication techniques integral to the design, development, and application of hydrogels specifically tailored for ophthalmic pharmaceutical delivery. The review further scrutinizes the pivotal manufacturing processes that significantly influence hydrogel efficacy and delves into an analysis of the current spectrum of hydrogel-centric ocular formulations. RESULTS The review yields illuminating insights into the escalating prominence of ocular hydrogels within the medical community, substantiated by a plethora of ongoing clinical investigations. It reveals the dynamic and perpetually evolving nature of hydrogel research and underscores the extensive applicability and intricate progression of transposing biologics-loaded hydrogels from theoretical frameworks to practical clinical applications. CONCLUSIONS This review accentuates the immense potential and promising future of ocular hydrogels in the realm of ophthalmic care. It not only serves as a comprehensive guide but also as a catalyst for recognizing the transformative potential of hydrogels in augmenting drug delivery mechanisms and enhancing patient outcomes. Furthermore, it draws attention to the inherent challenges and considerations that necessitate careful navigation by researchers and clinicians in this progressive field.
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Affiliation(s)
- Pankaj Pal
- Department of Pharmacy, Banasthali Vidyapith, Vanasthali, India
- IIMT College of Pharmacy, IIMT Group of Colleges, Greater Noida, India
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Jiang X, Jin Y, Zeng Y, Shi P, Li W. Self-Implantable Core-Shell Microneedle Patch for Long-Acting Treatment of Keratitis via Programmed Drug Release. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2024; 20:e2310461. [PMID: 38396201 DOI: 10.1002/smll.202310461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/20/2024] [Indexed: 02/25/2024]
Abstract
Bacteria-induced keratitis is a major cause of corneal blindness in both developed and developing countries. Instillation of antibiotic eyedrops is the most common management of bacterial keratitis but usually suffers from low bioavailability (i.e., <5%) and frequent administration, due to the existence of corneal epithelial barrier that prevents large and hydrophilic drug molecules from entering the cornea, and the tear film on corneal surface that rapidly washes drug away from the cornea. Here, a self-implantable core-shell microneedle (MN) patch with programmed drug release property to facilitate bacterial keratitis treatment is reported. The pH-responsive antimicrobial nanoparticles (NPs), Ag@ZIF-8, which are capable of producing antibacterial metal ions in the infected cornea and generating oxidative stress in bacteria, are loaded in the dissolvable core, while the anti-angiogenic drug, rapamycin (Rapa), is encapsulated in the biodegradable shell, thereby enabling rapid release of Ag@ZIF-8 NPs and sustained release of Rapa after corneal insertion. Owing to the programmed release feature, one single administration of the core-shell MN patch in a rat model of bacterial keratitis, can achieve satisfactory antimicrobial activity and superior anti-angiogenic and anti-inflammation effects as compared to daily topical eyedrops, indicating a great potential for the infectious keratitis therapy in clinics.
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Affiliation(s)
- Xue Jiang
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, School of Pharmaceutical Sciences, Wuhan University, Wuhan, 430071, China
| | - Yinli Jin
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, School of Pharmaceutical Sciences, Wuhan University, Wuhan, 430071, China
| | - Yongnian Zeng
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, School of Pharmaceutical Sciences, Wuhan University, Wuhan, 430071, China
| | - Peng Shi
- Department of Biomedical Engineering, The City University of Hong Kong, Kowloon, Hong Kong SAR, 999077, China
| | - Wei Li
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, School of Pharmaceutical Sciences, Wuhan University, Wuhan, 430071, China
- TaiKang Center for Life and Medical Sciences, Wuhan University, Wuhan, 430071, China
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Farrag Y, Ait Eldjoudi D, Farrag M, González-Rodríguez M, Ruiz-Fernández C, Cordero A, Varela-García M, Torrijos Pulpón C, Bouza R, Lago F, Pino J, Alvarez-Lorenzo C, Gualillo O. Poly(ethylene Glycol) Methyl Ether Methacrylate-Based Injectable Hydrogels: Swelling, Rheological, and In Vitro Biocompatibility Properties with ATDC5 Chondrogenic Lineage. Polymers (Basel) 2023; 15:4635. [PMID: 38139888 PMCID: PMC10747511 DOI: 10.3390/polym15244635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 11/30/2023] [Accepted: 12/02/2023] [Indexed: 12/24/2023] Open
Abstract
Here, we present the synthesis of a series of chemical homopolymeric and copolymeric injectable hydrogels based on polyethylene glycol methyl ether methacrylate (PEGMEM) alone or with 2-dimethylamino ethyl methacrylate (DMAEM). The objective of this study was to investigate how the modification of hydrogel components influences the swelling, rheological attributes, and in vitro biocompatibility of the hydrogels. The hydrogels' networks were formed via free radical polymerization, as assured by 1H nuclear magnetic resonance spectroscopy (1H NMR). The swelling of the hydrogels directly correlated with the monomer and the catalyst amounts, in addition to the molecular weight of the monomer. Rheological analysis revealed that most of the synthesized hydrogels had viscoelastic and shear-thinning properties. The storage modulus and the viscosity increased by increasing the monomer and the crosslinker fraction but decreased by increasing the catalyst. MTT analysis showed no potential toxicity of the homopolymeric hydrogels, whereas the copolymeric hydrogels were toxic only at high DMEAM concentrations. The crosslinker polyethylene glycol dimethacrylate (PEGDMA) induced inflammation in ATDC5 cells, as detected by the significant increase in nitric oxide synthase type II activity. The results suggest a range of highly tunable homopolymeric and copolymeric hydrogels as candidates for cartilage regeneration.
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Affiliation(s)
- Yousof Farrag
- Servizo Galego de Saude (SERGAS) and Instituto de Investigación Sanitaria de Santiago (IDIS), Neuroendocrine Interactions in Rheumatology and Inflammatory Diseases (NEIRID Group), Santiago University Clinical Hospital, Building C, Travesía da Choupana S/N, 15706 Santiago de Compostela, Spain; (D.A.E.); (M.F.); (M.G.-R.); (C.R.-F.); (A.C.); (M.V.-G.); (C.T.P.); (O.G.)
| | - Djedjiga Ait Eldjoudi
- Servizo Galego de Saude (SERGAS) and Instituto de Investigación Sanitaria de Santiago (IDIS), Neuroendocrine Interactions in Rheumatology and Inflammatory Diseases (NEIRID Group), Santiago University Clinical Hospital, Building C, Travesía da Choupana S/N, 15706 Santiago de Compostela, Spain; (D.A.E.); (M.F.); (M.G.-R.); (C.R.-F.); (A.C.); (M.V.-G.); (C.T.P.); (O.G.)
| | - Mariam Farrag
- Servizo Galego de Saude (SERGAS) and Instituto de Investigación Sanitaria de Santiago (IDIS), Neuroendocrine Interactions in Rheumatology and Inflammatory Diseases (NEIRID Group), Santiago University Clinical Hospital, Building C, Travesía da Choupana S/N, 15706 Santiago de Compostela, Spain; (D.A.E.); (M.F.); (M.G.-R.); (C.R.-F.); (A.C.); (M.V.-G.); (C.T.P.); (O.G.)
| | - María González-Rodríguez
- Servizo Galego de Saude (SERGAS) and Instituto de Investigación Sanitaria de Santiago (IDIS), Neuroendocrine Interactions in Rheumatology and Inflammatory Diseases (NEIRID Group), Santiago University Clinical Hospital, Building C, Travesía da Choupana S/N, 15706 Santiago de Compostela, Spain; (D.A.E.); (M.F.); (M.G.-R.); (C.R.-F.); (A.C.); (M.V.-G.); (C.T.P.); (O.G.)
| | - Clara Ruiz-Fernández
- Servizo Galego de Saude (SERGAS) and Instituto de Investigación Sanitaria de Santiago (IDIS), Neuroendocrine Interactions in Rheumatology and Inflammatory Diseases (NEIRID Group), Santiago University Clinical Hospital, Building C, Travesía da Choupana S/N, 15706 Santiago de Compostela, Spain; (D.A.E.); (M.F.); (M.G.-R.); (C.R.-F.); (A.C.); (M.V.-G.); (C.T.P.); (O.G.)
| | - Alfonso Cordero
- Servizo Galego de Saude (SERGAS) and Instituto de Investigación Sanitaria de Santiago (IDIS), Neuroendocrine Interactions in Rheumatology and Inflammatory Diseases (NEIRID Group), Santiago University Clinical Hospital, Building C, Travesía da Choupana S/N, 15706 Santiago de Compostela, Spain; (D.A.E.); (M.F.); (M.G.-R.); (C.R.-F.); (A.C.); (M.V.-G.); (C.T.P.); (O.G.)
| | - María Varela-García
- Servizo Galego de Saude (SERGAS) and Instituto de Investigación Sanitaria de Santiago (IDIS), Neuroendocrine Interactions in Rheumatology and Inflammatory Diseases (NEIRID Group), Santiago University Clinical Hospital, Building C, Travesía da Choupana S/N, 15706 Santiago de Compostela, Spain; (D.A.E.); (M.F.); (M.G.-R.); (C.R.-F.); (A.C.); (M.V.-G.); (C.T.P.); (O.G.)
| | - Carlos Torrijos Pulpón
- Servizo Galego de Saude (SERGAS) and Instituto de Investigación Sanitaria de Santiago (IDIS), Neuroendocrine Interactions in Rheumatology and Inflammatory Diseases (NEIRID Group), Santiago University Clinical Hospital, Building C, Travesía da Choupana S/N, 15706 Santiago de Compostela, Spain; (D.A.E.); (M.F.); (M.G.-R.); (C.R.-F.); (A.C.); (M.V.-G.); (C.T.P.); (O.G.)
| | - Rebeca Bouza
- Grupo de Polímeros, Departamento de Física y Ciencias de la Tierra, Escuela Universitaria Politécnica, Universidade da Coruña, Serantes, Avda. 19 de Febrero s/n, 15471 Ferrol, Spain;
| | - Francisca Lago
- Servizo Galego de Saude (SERGAS) and Instituto de Investigación Sanitaria de Santiago (IDIS), Molecular and Cellular Cardiology Lab, Research Laboratory 7, Santiago University Clinical Hospital, C, Travesía da Choupana S/N, 15706 Santiago de Compostela, Spain;
| | - Jesus Pino
- Servizo Galego de Saude (SERGAS) and Instituto de Investigación Sanitaria de Santiago (IDIS), Neuroendocrine Interactions in Rheumatology and Inflammatory Diseases (NEIRID Group), Santiago University Clinical Hospital, Building C, Travesía da Choupana S/N, 15706 Santiago de Compostela, Spain; (D.A.E.); (M.F.); (M.G.-R.); (C.R.-F.); (A.C.); (M.V.-G.); (C.T.P.); (O.G.)
| | - Carmen Alvarez-Lorenzo
- I+D Farma Group (GI-1645), Departamento de Farmacología, Farmacia y Tecnología Farmacéutica, Facultad de Farmacia, Instituto de Materiales (iMATUS), Health Research Institute of Santiago de Compostela (IDIS), Universidade de Santiago de Compostela, 15782 Santiago de Compostela, Spain;
| | - Oreste Gualillo
- Servizo Galego de Saude (SERGAS) and Instituto de Investigación Sanitaria de Santiago (IDIS), Neuroendocrine Interactions in Rheumatology and Inflammatory Diseases (NEIRID Group), Santiago University Clinical Hospital, Building C, Travesía da Choupana S/N, 15706 Santiago de Compostela, Spain; (D.A.E.); (M.F.); (M.G.-R.); (C.R.-F.); (A.C.); (M.V.-G.); (C.T.P.); (O.G.)
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Grecu M, Minea B, Foia LG, Bostanaru-Iliescu AC, Miron L, Nastasa V, Mares M. Short Review on the Biological Activity of Cyclodextrin-Drug Inclusion Complexes Applicable in Veterinary Therapy. Molecules 2023; 28:5565. [PMID: 37513437 PMCID: PMC10383344 DOI: 10.3390/molecules28145565] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/15/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
Cyclodextrins (CDs) are a family of carrier molecules used to improve the pharmacokinetic parameters of therapeutic molecules. These cyclic oligosaccharides have medical and pharmaceutical applications by being able to form inclusion complexes with molecules that are poorly soluble in water. The benefits of these complexes are directed towards improving the chemical and biological properties-i.e., solubility, bioavailability, stability, non-toxicity and shelf life of drug molecules. Since the 1960s, the first inclusion complexes used in therapeutics were those with α-, β- and γ-CD, which proved their usefulness, but had certain degrees of particularly renal toxicity. Currently, to correct these deficiencies, β-CD derivatives are most frequently used, such as sulfobutylether-β-CD, hydroxypropyl-β-CD, etc. Therefore, it is of interest to bring to the attention of those interested the diversity of current and potential future clinical applications of inclusion complexes in veterinary medicine and to present the contribution of these inclusion complexes in improving drug efficacy. The most important biological activities of β-CD complexed molecules in the veterinary field are summarized in this short review.
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Affiliation(s)
- Mariana Grecu
- Laboratory of Antimicrobial Chemotherapy, Faculty of Veterinary Medicine, "Ion Ionescu de la Brad" University of Life Sciences of Iasi (IULS), 8 Mihail Sadoveanu Alley, 700489 Iasi, Romania
| | - Bogdan Minea
- Department of Surgery, Faculty of Dental Medicine, "Grigore T. Popa" University of Medicine and Pharmacy of Iasi, 16 Universitatii Street, 700115 Iași, Romania
| | - Liliana-Georgeta Foia
- Department of Surgery, Faculty of Dental Medicine, "Grigore T. Popa" University of Medicine and Pharmacy of Iasi, 16 Universitatii Street, 700115 Iași, Romania
| | - Andra-Cristina Bostanaru-Iliescu
- Laboratory of Antimicrobial Chemotherapy, Faculty of Veterinary Medicine, "Ion Ionescu de la Brad" University of Life Sciences of Iasi (IULS), 8 Mihail Sadoveanu Alley, 700489 Iasi, Romania
| | - Liviu Miron
- Laboratory of Antimicrobial Chemotherapy, Faculty of Veterinary Medicine, "Ion Ionescu de la Brad" University of Life Sciences of Iasi (IULS), 8 Mihail Sadoveanu Alley, 700489 Iasi, Romania
| | - Valentin Nastasa
- Laboratory of Antimicrobial Chemotherapy, Faculty of Veterinary Medicine, "Ion Ionescu de la Brad" University of Life Sciences of Iasi (IULS), 8 Mihail Sadoveanu Alley, 700489 Iasi, Romania
| | - Mihai Mares
- Laboratory of Antimicrobial Chemotherapy, Faculty of Veterinary Medicine, "Ion Ionescu de la Brad" University of Life Sciences of Iasi (IULS), 8 Mihail Sadoveanu Alley, 700489 Iasi, Romania
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5
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Cyclodextrin regulated natural polysaccharide hydrogels for biomedical applications-a review. Carbohydr Polym 2023; 313:120760. [PMID: 37182939 DOI: 10.1016/j.carbpol.2023.120760] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 02/08/2023] [Accepted: 02/24/2023] [Indexed: 03/12/2023]
Abstract
Cyclodextrin and its derivative (CDs) are natural building blocks for linking with other components to afford functional biomaterials. Hydrogels are polymer network systems that can form hydrophilic three-dimensional network structures through different cross-linking methods and are developing as potential materials in biomedical applications. Natural polysaccharide hydrogels (NPHs) are widely adopted in biomedical field with good biocompatibility, biodegradability, low cytotoxicity, and versatility in emulating natural tissue properties. Compared with conventional NPHs, CD regulated natural polysaccharide hydrogels (CD-NPHs) maintain good biocompatibility, while improving poor mechanical qualities and unpredictable gelation times. Recently, there has been increasing and considerable usage of CD-NPHs while there is still no review comprehensively introducing their construction, classification, and application of these hydrogels from the material point of view regarding biomedical fields. To draw a complete picture of the current and future development of CD-NPHs, we systematically overview the classification of CD-NPHs, and provide a holistic view on the role of CD-NPHs in different biomedical fields, especially in drug delivery, wound dressing, cell encapsulation, and tissue engineering. Moreover, the current challenges and prospects of CD-NPHs are discussed rationally, providing an insight into developing vibrant fields of CD-NPHs-based biomedicine, and facilitating their translation from bench to clinical medicine.
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Wang Q, Zhang A, Zhu L, Yang X, Fang G, Tang B. Cyclodextrin-based ocular drug delivery systems: A comprehensive review. Coord Chem Rev 2023. [DOI: 10.1016/j.ccr.2022.214919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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7
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de Almeida Campos L, Fin MT, Santos KS, de Lima Gualque MW, Freire Cabral AKL, Khalil NM, Fusco-Almeida AM, Mainardes RM, Mendes-Giannini MJS. Nanotechnology-Based Approaches for Voriconazole Delivery Applied to Invasive Fungal Infections. Pharmaceutics 2023; 15:pharmaceutics15010266. [PMID: 36678893 PMCID: PMC9863752 DOI: 10.3390/pharmaceutics15010266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/09/2022] [Accepted: 12/20/2022] [Indexed: 01/15/2023] Open
Abstract
Invasive fungal infections increase mortality and morbidity rates worldwide. The treatment of these infections is still limited due to the low bioavailability and toxicity, requiring therapeutic monitoring, especially in the most severe cases. Voriconazole is an azole widely used to treat invasive aspergillosis, other hyaline molds, many dematiaceous molds, Candida spp., including those resistant to fluconazole, and for infections caused by endemic mycoses, in addition to those that occur in the central nervous system. However, despite its broad activity, using voriconazole has limitations related to its non-linear pharmacokinetics, leading to supratherapeutic doses and increased toxicity according to individual polymorphisms during its metabolism. In this sense, nanotechnology-based drug delivery systems have successfully improved the physicochemical and biological aspects of different classes of drugs, including antifungals. In this review, we highlighted recent work that has applied nanotechnology to deliver voriconazole. These systems allowed increased permeation and deposition of voriconazole in target tissues from a controlled and sustained release in different routes of administration such as ocular, pulmonary, oral, topical, and parenteral. Thus, nanotechnology application aiming to delivery voriconazole becomes a more effective and safer therapeutic alternative in the treatment of fungal infections.
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Affiliation(s)
- Laís de Almeida Campos
- Pharmaceutical Nanotechnology Laboratory, Department of Pharmacy, Midwest State University (UNICENTRO), Alameda Élio Antonio Dalla Vecchia St, 838, Guarapuava 85040-167, PR, Brazil
| | - Margani Taise Fin
- Pharmaceutical Nanotechnology Laboratory, Department of Pharmacy, Midwest State University (UNICENTRO), Alameda Élio Antonio Dalla Vecchia St, 838, Guarapuava 85040-167, PR, Brazil
| | - Kelvin Sousa Santos
- Department of Clinical Analysis, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Rodovia Araraquara Jaú, Km 01, Araraquara 14801-902, SP, Brazil
| | - Marcos William de Lima Gualque
- Department of Clinical Analysis, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Rodovia Araraquara Jaú, Km 01, Araraquara 14801-902, SP, Brazil
| | - Ana Karla Lima Freire Cabral
- Department of Clinical Analysis, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Rodovia Araraquara Jaú, Km 01, Araraquara 14801-902, SP, Brazil
| | - Najeh Maissar Khalil
- Pharmaceutical Nanotechnology Laboratory, Department of Pharmacy, Midwest State University (UNICENTRO), Alameda Élio Antonio Dalla Vecchia St, 838, Guarapuava 85040-167, PR, Brazil
| | - Ana Marisa Fusco-Almeida
- Department of Clinical Analysis, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Rodovia Araraquara Jaú, Km 01, Araraquara 14801-902, SP, Brazil
| | - Rubiana Mara Mainardes
- Pharmaceutical Nanotechnology Laboratory, Department of Pharmacy, Midwest State University (UNICENTRO), Alameda Élio Antonio Dalla Vecchia St, 838, Guarapuava 85040-167, PR, Brazil
- Correspondence: (R.M.M.); (M.J.S.M.-G.)
| | - Maria José Soares Mendes-Giannini
- Department of Clinical Analysis, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Rodovia Araraquara Jaú, Km 01, Araraquara 14801-902, SP, Brazil
- Correspondence: (R.M.M.); (M.J.S.M.-G.)
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8
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Wu S, Guo W, Li B, Zhou H, Meng H, Sun J, Li R, Guo D, Zhang X, Li R, Qu W. Progress of polymer-based strategies in fungal disease management: Designed for different roles. Front Cell Infect Microbiol 2023; 13:1142029. [PMID: 37033476 PMCID: PMC10073610 DOI: 10.3389/fcimb.2023.1142029] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 02/22/2023] [Indexed: 04/11/2023] Open
Abstract
Fungal diseases have posed a great challenge to global health, but have fewer solutions compared to bacterial and viral infections. Development and application of new treatment modalities for fungi are limited by their inherent essential properties as eukaryotes. The microorganism identification and drug sensitivity analyze are limited by their proliferation rates. Moreover, there are currently no vaccines for prevention. Polymer science and related interdisciplinary technologies have revolutionized the field of fungal disease management. To date, numerous advanced polymer-based systems have been developed for management of fungal diseases, including prevention, diagnosis, treatment and monitoring. In this review, we provide an overview of current needs and advances in polymer-based strategies against fungal diseases. We high light various treatment modalities. Delivery systems of antifungal drugs, systems based on polymers' innate antifungal activities, and photodynamic therapies each follow their own mechanisms and unique design clues. We also discuss various prevention strategies including immunization and antifungal medical devices, and further describe point-of-care testing platforms as futuristic diagnostic and monitoring tools. The broad application of polymer-based strategies for both public and personal health management is prospected and integrated systems have become a promising direction. However, there is a gap between experimental studies and clinical translation. In future, well-designed in vivo trials should be conducted to reveal the underlying mechanisms and explore the efficacy as well as biosafety of polymer-based products.
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Affiliation(s)
- Siyu Wu
- Department of Hand Surgery, The Second Hospital of Jilin University, Changchun, China
| | - Wenlai Guo
- Department of Hand Surgery, The Second Hospital of Jilin University, Changchun, China
| | - Bo Li
- Department of Cardiovascular Surgery, The Second Hospital of Jilin University, Changchun, China
| | - Huidong Zhou
- Department of Hand Surgery, The Second Hospital of Jilin University, Changchun, China
| | - Hongqi Meng
- Department of Hand Surgery, The Second Hospital of Jilin University, Changchun, China
| | - Junyi Sun
- Changchun American International School, Changchun, China
| | - Ruiyan Li
- Orthpoeadic Medical Center, The Second Hospital of Jilin University, Changchun, China
- Jilin Provincial Key Laboratory of Orhtopeadics, Changchun, China
| | - Deming Guo
- Orthpoeadic Medical Center, The Second Hospital of Jilin University, Changchun, China
- Jilin Provincial Key Laboratory of Orhtopeadics, Changchun, China
| | - Xi Zhang
- Department of Burn Surgery, The First Hospital of Jilin University, Changchun, China
- *Correspondence: Xi Zhang, ; Rui Li, ; Wenrui Qu,
| | - Rui Li
- Department of Hand Surgery, The Second Hospital of Jilin University, Changchun, China
- *Correspondence: Xi Zhang, ; Rui Li, ; Wenrui Qu,
| | - Wenrui Qu
- Department of Hand Surgery, The Second Hospital of Jilin University, Changchun, China
- *Correspondence: Xi Zhang, ; Rui Li, ; Wenrui Qu,
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9
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Antifungal Combination Eye Drops for Fungal Keratitis Treatment. Pharmaceutics 2022; 15:pharmaceutics15010035. [PMID: 36678663 PMCID: PMC9866460 DOI: 10.3390/pharmaceutics15010035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/12/2022] [Accepted: 12/20/2022] [Indexed: 12/25/2022] Open
Abstract
Fungal keratitis (FK) is a corneal mycotic infection that can lead to vision loss. Furthermore, the severity of FK is aggravated by the emergence of resistant fungal species. There is currently only one FDA-approved formulation for FK treatment forcing hospital pharmacy departments to reformulate intravenous drug preparations with unknown ocular bioavailability and toxicity. In the present study, natamycin/voriconazole formulations were developed and characterized to improve natamycin solubility, permanence, and safety. The solubility of natamycin was studied in the presence of two cyclodextrins: HPβCD and HPγCD. The HPβCD was chosen based on the solubility results. Natamycin/cyclodextrin (HPβCD) inclusion complexes characterization and a competition study between natamycin and voriconazole were conducted by NMR (Nuclear Magnetic Resonance). Based on these results, several eye drops with different polymer compositions were developed and subsequently characterized. Permeability studies suggested that the formulations improved the passage of natamycin through the cornea compared to the commercial formulation Natacyn®. The ocular safety of the formulations was determined by BCOP and HET-CAM. The antifungal activity assay demonstrated the ability of our formulations to inhibit the in vitro growth of different fungal species. All these results concluded that the formulations developed in the present study could significantly improve the treatment of FK.
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10
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Pardeshi SR, More MP, Patil PB, Mujumdar A, Naik JB. Statistical optimization of voriconazole nanoparticles loaded carboxymethyl chitosan-poloxamer based in situ gel for ocular delivery: In vitro, ex vivo, and toxicity assessment. Drug Deliv Transl Res 2022; 12:3063-3082. [PMID: 35525868 DOI: 10.1007/s13346-022-01171-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2022] [Indexed: 12/16/2022]
Abstract
The research study reflects the development of novel voriconazole (VCZ) loaded nanoparticles (NPs) for prolonged delivery for the management of ocular diseases. The in situ ophthalmic gel was prepared by incorporating NPs into carboxymethyl chitosan (CMCh) and poloxamer. The central composite design was used to optimize the process for the preparation of nanoparticles by the o/w solvent evaporation method. The developed nanoparticles were evaluated for the encapsulation efficiency (89.6 ± 1.2%), particle size (219.3 ± 1.8 nm), polydispersity index (PDI, 0.1), zeta potential (- 21.1 ± 1.12 mV), saturation solubility, DSC study, and drug release. The etherification process grafts carboxyl surface functional groups, on chitosan, and was confirmed by FTIR and NMR studies. The developed CMCh-poloxamer based gelling system was found to be clear and transparent with gelation temperature varying from 33 to 40 °C. The nanoparticle-loaded gel containing CMCh demonstrated enhanced antifungal activity against Candida albicans. The optimized batch containing CMCh showed improved mucoadhesion by 2.86-fold compared to VCZ nanosuspension. The drug release was prolonged up to 8 h with an ex vivo study suggesting the enhanced permeation across goat cornea estimated via fluorescent microscope. The hen's egg chorioallantoic membrane study revealed that the formulation was non-irritant and tolerated by the chorioallantoic membrane. The present study concludes that the VCZ loaded nanoparticulate in situ ophthalmic gel using CMCh may act as a potential alternative for traditional eye drops.
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Affiliation(s)
- Sagar R Pardeshi
- University Institute of Chemical Technology, KBC North Maharashtra University, Jalgaon, Maharashtra, 425001, India
| | - Mahesh P More
- Department of Pharmaceutics, Dr. Rajendra Gode College of Pharmacy, Malkapur, 443101, India
| | - Pritam B Patil
- Department of Chemical Engineering, Shri S'ad Vidya Mandal Institute of Technology, Bharuch, Gujarat, 392001, India
| | - Arun Mujumdar
- Department of Bioresource Engineering, Macdonald College, McGill University, Ste. Anne de Bellevue, QC, Canada
| | - Jitendra B Naik
- University Institute of Chemical Technology, KBC North Maharashtra University, Jalgaon, Maharashtra, 425001, India.
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11
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A Current Overview of Cyclodextrin-Based Nanocarriers for Enhanced Antifungal Delivery. Pharmaceuticals (Basel) 2022; 15:ph15121447. [PMID: 36558897 PMCID: PMC9785708 DOI: 10.3390/ph15121447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 11/18/2022] [Accepted: 11/20/2022] [Indexed: 11/23/2022] Open
Abstract
Fungal infections are an extremely serious health problem, particularly in patients with compromised immune systems. Most antifungal agents have low aqueous solubility, which may hamper their bioavailability. Their complexation with cyclodextrins (CDs) could increase the solubility of antifungals, facilitating their antifungal efficacy. Nanoparticulate systems are promising carriers for antifungal delivery due to their ability to overcome the drawbacks of conventional dosage forms. CD-based nanocarriers could form beneficial combinations of CDs and nanoparticulate platforms. These systems have synergistic or additive effects regarding improved drug loading, enhanced chemical stability, and enhanced drug permeation through membranes, thereby increasing the bioavailability of drugs. Here, an application of CD in antifungal drug formulations is reviewed. CD-based nanocarriers, such as nanoparticles, liposomes, nanoemulsions, nanofibers, and in situ gels, enhancing antifungal activity in a controlled-release manner and possessing good toxicological profiles, are described. Additionally, the examples of current, updated CD-based nanocarriers loaded with antifungal drugs for delivery by various routes of administration are discussed and summarized.
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12
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Jeang L, Tuli SS. Therapy for contact lens-related ulcers. Curr Opin Ophthalmol 2022; 33:282-289. [PMID: 35779052 DOI: 10.1097/icu.0000000000000861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The current review covers the current literature and practice patterns of antimicrobial therapy for contact lens-related microbial keratitis (CLMK). Although the majority of corneal ulcers are bacterial, fungus and acanthamoeba are substantial contributors in CLMK and are harder to treat due to the lack of commercially available topical medications and low efficacy of available topical therapy. RECENT FINDINGS Topical antimicrobials remain the mainstay of therapy for corneal ulcers. Fluoroquinolones may be used as monotherapy for small, peripheral bacterial ulcers. Antibiotic resistance is a persistent problem. Fungal ulcers are less responsive to topical medications and adjunct oral or intrastromal antifungal medications may be helpful. Acanthamoeba keratitis continues to remain a therapeutic challenge but newer antifungal and antiparasitic agents may be helpful adjuncts. Other novel and innovative therapies are being studied currently and show promise. SUMMARY Contact lens-associated microbial keratitis is a significant health issue that can cause vision loss. Treatment remains a challenge but many promising diagnostics and procedures are in the pipeline and offer hope.
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Affiliation(s)
- Lauren Jeang
- Department of Ophthalmology, University of Florida, Gainesville, Florida, USA
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13
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Zhu W, Lv Y, Yang Q, Zu Y, Zhao X. Artemisinin hydroxypropyl-β-cyclodextrin inclusion complex loaded with porous starch for enhanced bioavailability. Int J Biol Macromol 2022; 211:207-217. [PMID: 35490765 DOI: 10.1016/j.ijbiomac.2022.04.170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/19/2022] [Accepted: 04/23/2022] [Indexed: 11/28/2022]
Abstract
The current work aimed to enhance the oral bioavailability of water-insoluble drug Artemisinin (ART) by the inclusion of ART with hydroxypropyl-β-cyclodextrin (HP-β-CD) and then loaded with porous starch (PS). The preparation conditions of ART HP-β-CD inclusion complex loaded with PS (AHPS) were optimized according to drug loading (DL) and entrapment efficiency (EE). The properties of AHPS were characterized by optical and thermodynamic methods. ART was linked by hydrogen bond to HP-β-CD to form hydrophilic supramolecules, which are loaded into PS under the action of hydrogen bond. The maximum DL and EE of AHPS were about 16.51% and 67.26%, respectively. Then we investigated the physicochemical properties and antimalarial activity of AHPS. The solubility and bioavailability of AHPS at 48 h were higher than ART and market ART piperaquine tablets (APT), and showed better antimalarial activity in vitro and vivo. It provides a new idea for the development and application of fat-soluble drug.
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Affiliation(s)
- Wen Zhu
- Key Laboratory of Forest Plant Ecology, Ministry of Education, Northeast Forestry University, Harbin 150040, People's Republic of China; College of Chemistry, Chemical Engineering and Resource Utilization, Northeast Forestry University, Harbin 150040, People's Republic of China; Engineering Research Center of Forest Bio-preparation, Ministry of Education, Northeast Forestry University, Harbin 150040, People's Republic of China; Heilongjiang Provincial Key Laboratory of Ecological Utilization of Forestry-based Active Substances, Harbin 150040, People's Republic of China; National Engineering Laboratory of BioResource EcoUtilization, Harbin 150040, People's Republic of China
| | - Yue Lv
- Key Laboratory of Forest Plant Ecology, Ministry of Education, Northeast Forestry University, Harbin 150040, People's Republic of China; College of Chemistry, Chemical Engineering and Resource Utilization, Northeast Forestry University, Harbin 150040, People's Republic of China; Engineering Research Center of Forest Bio-preparation, Ministry of Education, Northeast Forestry University, Harbin 150040, People's Republic of China; Heilongjiang Provincial Key Laboratory of Ecological Utilization of Forestry-based Active Substances, Harbin 150040, People's Republic of China; National Engineering Laboratory of BioResource EcoUtilization, Harbin 150040, People's Republic of China
| | - QiLei Yang
- Key Laboratory of Forest Plant Ecology, Ministry of Education, Northeast Forestry University, Harbin 150040, People's Republic of China; College of Chemistry, Chemical Engineering and Resource Utilization, Northeast Forestry University, Harbin 150040, People's Republic of China; Engineering Research Center of Forest Bio-preparation, Ministry of Education, Northeast Forestry University, Harbin 150040, People's Republic of China; Heilongjiang Provincial Key Laboratory of Ecological Utilization of Forestry-based Active Substances, Harbin 150040, People's Republic of China; National Engineering Laboratory of BioResource EcoUtilization, Harbin 150040, People's Republic of China
| | - Yuangang Zu
- Key Laboratory of Forest Plant Ecology, Ministry of Education, Northeast Forestry University, Harbin 150040, People's Republic of China; College of Chemistry, Chemical Engineering and Resource Utilization, Northeast Forestry University, Harbin 150040, People's Republic of China; Engineering Research Center of Forest Bio-preparation, Ministry of Education, Northeast Forestry University, Harbin 150040, People's Republic of China; Heilongjiang Provincial Key Laboratory of Ecological Utilization of Forestry-based Active Substances, Harbin 150040, People's Republic of China; National Engineering Laboratory of BioResource EcoUtilization, Harbin 150040, People's Republic of China
| | - Xiuhua Zhao
- Key Laboratory of Forest Plant Ecology, Ministry of Education, Northeast Forestry University, Harbin 150040, People's Republic of China; College of Chemistry, Chemical Engineering and Resource Utilization, Northeast Forestry University, Harbin 150040, People's Republic of China; Engineering Research Center of Forest Bio-preparation, Ministry of Education, Northeast Forestry University, Harbin 150040, People's Republic of China; Heilongjiang Provincial Key Laboratory of Ecological Utilization of Forestry-based Active Substances, Harbin 150040, People's Republic of China; National Engineering Laboratory of BioResource EcoUtilization, Harbin 150040, People's Republic of China.
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14
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Suvarna P, Chaudhari P, Birangal S, Mallela LS, Roy S, Koteshwara A, Aranjani JM, Lewis SA. Voriconazole-Cyclodextrin Supramolecular Ternary Complex-Loaded Ocular Films for Management of Fungal Keratitis. Mol Pharm 2022; 19:258-273. [PMID: 34928610 DOI: 10.1021/acs.molpharmaceut.1c00746] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Fungal keratitis is one of the leading causes of ophthalmic mycosis affecting the vision due to corneal scarring. Voriconazole (VRC) is the most preferred azole antifungal agent for treating ocular mycotic infections. Ocular drug delivery is challenging due to the shorter corneal residence time of the formulation requiring frequent administration, leading to poor patient compliance. The present study aimed at improving the solubility, transcorneal permeation, and efficacy of voriconazole via the formation of cyclodextrin-based ternary complexes and incorporation of the complex into mucoadhesive films. A phase solubility study suggested a ∼14-fold improvement in VRC solubility, whereas physicochemical characterization confirmed the inclusion of VRC in the cyclodextrin inner cavity. In silico docking studies were performed to predict the docking conformation and stability of the inclusion complex. Complex-loaded films showed sustained release of voriconazole from the films and improved transcorneal permeation by ∼4-fold with an improved flux of 8.36 μg/(cm2 h) for ternary complex-loaded films compared to 1.86 μg/(cm2 h) for the pure VRC film. The 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide (MTT) and hen's egg-chorioallantoic membrane test (HET-CAM) assays confirmed that the complexes and ocular films were nonirritant and safe for ocular administration. The antifungal study performed using Aspergillus fumigatus and Fusarium oxysporum suggested improved antifungal activity compared to the pure drug film. In conclusion, the supramolecular cyclodextrin ternary complex proved to be a promising strategy for enhancing the solubility and permeability and augmenting the antifungal activity of voriconazole in the management of fungal keratitis.
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Affiliation(s)
- Pooja Suvarna
- Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India
| | - Pinal Chaudhari
- Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India
| | - Sumit Birangal
- Department of Pharmaceutical Chemistry, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India
| | - Lakshmi Sruthi Mallela
- Prof. Brien Holden Eye Research Centre, LV Prasad Eye Institute, Hyderabad 500034, India
| | - Sanhita Roy
- Prof. Brien Holden Eye Research Centre, LV Prasad Eye Institute, Hyderabad 500034, India
| | - Ananthamurthy Koteshwara
- Department of Pharmaceutical Biotechnology, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India
| | - Jesil Mathew Aranjani
- Department of Pharmaceutical Biotechnology, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India
| | - Shaila Angela Lewis
- Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India
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15
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Chang YF, Cheng YH, Ko YC, Chiou SH, Jui-Ling Liu C. Development of topical chitosan/ β-glycerophosphate-based hydrogel loaded with levofloxacin in the treatment of keratitis: An ex-vivo study. Heliyon 2022; 8:e08697. [PMID: 35028471 PMCID: PMC8741500 DOI: 10.1016/j.heliyon.2021.e08697] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 10/18/2021] [Accepted: 12/27/2021] [Indexed: 12/03/2022] Open
Abstract
Staphylococcus species are responsible for most cases of post-operative endophthalmitis. Topical ocular drug was applied for post-operative infection prevention, but the way of delivery encounters many challenges in terms of patient's compliance, drug efficacy, and drug penetration. We used the levofloxacin-loaded chitosan/gelatin/β-glycerophosphate hydrogel sustained releasing system with good in vitro anti-bacterial efficacy and biocompatibility, which we had previously designed, for ex vivo keratitis model to test the preclinical drug efficacy and to determine drug level in the anterior chamber of the eye. The result showed that the ex-vivo corneal keratitis model with S. aureus infection revealed mild opacity over the central cornea with stromal infiltrate, but without obvious stromal infiltration post levofloxacin-loaded hydrogel treatment after 24 h of infection. Quantification of viable bacteria showed a significant anti-bacterial activity. The histological evidence also showed no visible S. aureus after levofloxacin-loaded hydrogel treatment, with a significant anti-inflammatory effect. We also examined the drug concentration in the aqueous humor 24 h after instilling one drop of the levofloxacin-loaded hydrogel. The concentration achieved to a desired drug level. These results suggested that by the ex-vivo model, levofloxacin-loaded hydrogel can be applied for treatment in post-operative endophthalmitis or keratitis after the ophthalmic surgery.
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Affiliation(s)
- Yu-Fan Chang
- Institute of Clinical Medicine, National Yang-Ming University, Taipei 112, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
- National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yung-Hsin Cheng
- Department of Materials Science and Engineering, National Taiwan University of Science and Technology, Taipei, Taiwan
| | - Yu-Chieh Ko
- National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shih-Hwa Chiou
- Institute of Clinical Medicine, National Yang-Ming University, Taipei 112, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
- National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Catherine Jui-Ling Liu
- National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan
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16
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Yang J, Ma Y, Luo Q, Liang Z, Lu P, Song F, Zhang Z, Zhou T, Zhang J. Improving the solubility of vorinostat using cyclodextrin inclusion complexes: The physicochemical characteristics, corneal permeability and ocular pharmacokinetics of the drug after topical application. Eur J Pharm Sci 2022; 168:106078. [PMID: 34838620 DOI: 10.1016/j.ejps.2021.106078] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/27/2021] [Accepted: 11/17/2021] [Indexed: 02/08/2023]
Abstract
Vorinostat (suberoylanilide hydroxamic acid, SAHA), an FDA-approved drug for cutaneous T cell lymphoma, has antiangiogenic and anti-inflammatory activity and thus has therapeutic potential for inflammatory corneal neovascularization (CNV). However, its practical administration is limited due to its poor aqueous solubility and permeability. This study aimed to enhance the corneal permeability of SAHA by promoting its inclusion into a complex with hydroxypropyl-β-CD (HPβCD) for topical application. In phase-solubility studies, the solubility of SAHA with HPβCD and sulfobutyl ether-β-CD (SEβCD) was assessed at different temperatures, and complexation efficiencies (K) were calculated. The inclusion complexes (ICs) were prepared and characterized by differential scanning calorimetry (DSC), infrared spectrometry (IR), scanning electron microscopy (SEM), and X-ray diffraction (XRD) after freeze-drying. The phase-solubility study showed that the complexation efficiencies of SAHA were higher in HPβCD solutions (297.35 M-1, 115.28 M-1 and 122.75 M-1) than in SEβCD solutions (169.75 M-1, 91.33 M-1 and 96.49 M-1) at 4 °C, 25 °C and 37 °C. HPβCD was selected for SAHA-IC preparation, and characterization revealed IC formation. SAHA existed in an amorphous state in the ICs. The ex vivo corneal permeability of SAHA was also evaluated and found to be greater when formulated as an HPβCD solution than as a suspension. Irritation assays in rabbit eyes showed that the SAHA-IC solution was not irritating after topical application. The ocular pharmacokinetics of SAHA in New Zealand White rabbits were assessed following topical administration (0.2%), and a 0.2% SAHA suspension was used as the control. Compared to its formulation as a suspension, the formulation of SAHA as an HPβCD solution increased its corneal bioavailability by more than 3-fold and its conjunctival bioavailability by more than 2-fold. Thus, IC formation was effective at improving the ocular bioavailability of SAHA. This study provides an important alternative approach for developing liquid pharmaceutical formulations of SAHA for topical ocular applications.
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Affiliation(s)
- Jingjing Yang
- Henan Eye Institute, Henan Eye Hospital, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, No. 7 Weiwu Road, Zhengzhou 450003, China
| | - Yu Ma
- Henan University of Traditional Chinese Medicine, No. 156 Jinshui East Road, Zhengzhou 450000, China
| | - Qing Luo
- Department of Pharmacy, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, No. 7 Weiwu Road, Zhengzhou 450003, China
| | - Zhen Liang
- Henan Eye Institute, Henan Eye Hospital, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, No. 7 Weiwu Road, Zhengzhou 450003, China
| | - Ping Lu
- Henan Eye Institute, Henan Eye Hospital, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, No. 7 Weiwu Road, Zhengzhou 450003, China
| | - Fei Song
- Henan Eye Institute, Henan Eye Hospital, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, No. 7 Weiwu Road, Zhengzhou 450003, China
| | - Zhen Zhang
- Henan Eye Institute, Henan Eye Hospital, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, No. 7 Weiwu Road, Zhengzhou 450003, China
| | - Tianyang Zhou
- Henan Eye Institute, Henan Eye Hospital, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, No. 7 Weiwu Road, Zhengzhou 450003, China
| | - Junjie Zhang
- Henan Eye Institute, Henan Eye Hospital, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, No. 7 Weiwu Road, Zhengzhou 450003, China.
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