Aloe vera: an in vitro study of effects on corneal wound closure and collagenase activity

Aloe vera-Based Hydrogels for Wound Healing: Properties and Therapeutic Effects

Aloe vera-based hydrogels have emerged as promising platforms for the delivery of therapeutic agents in wound dressings due to their biocompatibility and unique wound-healing properties. The present study provides a comprehensive overview of recent advances in the application of Aloe vera-based hydrogels for wound healing. The synthesis methods, structural characteristics, and properties of Aloe vera-based hydrogels are discussed. Mechanisms of therapeutic agents released from Aloe vera-based hydrogels, including diffusion, swelling, and degradation, are also analyzed. In addition, the therapeutic effects of Aloe vera-based hydrogels on wound healing, as well as the reduction of inflammation, antimicrobial activity, and tissue regeneration, are highlighted. The incorporation of various therapeutic agents, such as antimicrobial and anti-inflammatory ones, into Aloe vera-based hydrogels is reviewed in detail. Furthermore, challenges and future prospects of Aloe vera-based hydrogels for wound dressing applications are considered. This review provides valuable information on the current status of Aloe vera-based hydrogels for the delivery of therapeutic agents in wound dressings and highlights their potential to improve wound healing outcomes.

TFOS Lifestyle: Impact of elective medications and procedures on the ocular surface

The word "elective" refers to medications and procedures undertaken by choice or with a lower grade of prioritization. Patients usually use elective medications or undergo elective procedures to treat pathologic conditions or for cosmetic enhancement, impacting their lifestyle positively and, thus, improving their quality of life. However, those interventions can affect the homeostasis of the tear film and ocular surface. Consequently, they generate signs and symptoms that could impair the patient's quality of life. This report describes the impact of elective topical and systemic medications and procedures on the ocular surface and the underlying mechanisms. Moreover, elective procedures performed for ocular diseases, cosmetic enhancement, and non-ophthalmic interventions, such as radiotherapy and bariatric surgery, are discussed. The report also evaluates significant anatomical and biological consequences of non-urgent interventions to the ocular surface, such as neuropathic and neurotrophic keratopathies. Besides that, it provides an overview of the prophylaxis and management of pathological conditions resulting from the studied interventions and suggests areas for future research. The report also contains a systematic review investigating the quality of life among people who have undergone small incision lenticule extraction (SMILE). Overall, SMILE refractive surgery seems to cause more vision disturbances than LASIK in the first month post-surgery, but less dry eye symptoms in long-term follow up.

Inhibition potential of Caryocar brasiliense on methicillin-resistant Staphylococcus pseudintermedius isolated from the ocular surface of dogs with ophthalmopathies

ABSTRACT The indiscriminate use of antibiotics has contributed to the emergence of multiresistant bacteria. Faced with this, the search for antibiotics from plants has proven to be a promising alternative. The objective of this work was to isolate and identify Staphylococcus sp. resistant to methicillin of the ocular surface of dogs with ophthalmopathies and to evaluate its susceptibility to alcoholic extract of the bark and hexane extract of the pulp of Caryocar brasiliense. Biological material was collected from the ocular surface of 21 dogs presenting ophthalmopathies. We isolated 64 S. pseudintermedius, among these, 4 isolates were identified as methicillin-resistant S. pseudintermedius (MRSP). The alcoholic extract of C. brasiliense peel was able to inhibit the bacterial growth of MRSP isolates at a concentration of 2.2%. Thus, the extract from the C. brasiliense peel has antimicrobial potential and represents an alternative in the control of MRSP.

Low-dose Indonesian Aloe vera Increases Viability and Migration of the Fibroblast: An In Vitro Study

BACKGROUND: Important stages in wound healing involve homeostasis, inflammation, proliferation, and remodeling phases. Fibroblasts are essential factors in the healing pathway through the process of cell proliferation and migration. Aloe vera contains various active compounds used for anti-inflammatory, antimicrobial, immunomodulatory, anticancer, and wound healing. AIM: This study aimed to evaluate the effect of A. vera on the viability and migration of fibroblast cells. MATERIALS AND METHODS: Fibroblasts were cultured in a monolayer with Dulbecco’s Modified Eagle Medium containing 10% fetal bovine serum, 1% pinstripe, and 0.5% fungizone. We use fresh A. vera leaves extracted with 95% ethanol. Cell viability will be evaluated using the MTT test and microscopic evaluation. Cell migration was tested using an in vitro wound scratch assay and analyzed with ImageJ software. RESULTS: A. vera stimulated cell viability compared to control (p < 0.05). Administration of A. vera does not change shape and is not toxic to fibroblasts. A. vera stimulated cell migration at doses of 250, 125, 50, and 5 μg/mL compared to control after 24 h of intervention. At 48 h incubation, migration doses of 250, 50, and 5 μg/mL were higher than control (p < 0.05). CONCLUSIONS: A. vera extract may effectively wound healing by increasing viability and migration of fibroblast cells.

Use of autologous serum or Vizoovet to improve healing rates of spontaneous chronic corneal epithelial defects after diamond burr debridement in dogs

PURPOSE

To determine whether the use of autologous serum or Vizoovet® improved healing rates of spontaneous chronic corneal epithelial defects (SCCEDs) after diamond burr debridement (DBD) in dogs.

STUDY DESIGN

Two parallel group randomized prospective study with a historical control group.

MATERIALS AND METHODS

Canine patients having undergone DBD for treatment of SCCEDs were included. Data for the control group (ofloxacin only) were gathered from patient records. Patients were randomly assigned to treatment groups for post-procedural medical treatments of ofloxacin and autologous serum (group 1) or ofloxacin and Vizoovet®, an all-natural eyed drop containing propolis, aloe vera, and chamomile (group 2). Each dog was examined between 2 and 3 weeks until the cornea was fluorescein stain negative. Data points collected included age, sex, breed, type of medications used, retention of bandage contact lens (BCL), time to healing, and number of DBD performed.

RESULTS

A total of 120 dogs, each contributing one eye to the study, underwent DBD for SCCEDs. Mean (± standard deviation) days until healed were 20.1 ± 11.1 days, 16.3 ± 4.5 days, and 16.0 ± 3.7 days for the control group, group 1, and group 2, respectively. There was a marginally significant difference in days until healed between groups (p = .0515). SCCEDs healed significantly faster in group 2 (p = .03) and marginally faster in group 1 (p = .06) compared with the control group. Days until healing between group 1 and 2 were not significantly different (p = .76).

CONCLUSIONS

As compared to the control group, use of Vizoovet® as adjunctive medical treatment resulted in shorter corneal healing time after DBD.

In vitro amoebicidal effect of Aloe vera ethanol extract and honey against Acanthamoeba spp. cysts

This study evaluated in vitro effect of different concentrations of Aloe vera (A. vera) ethanol extract and honey against Acanthamoeba spp. cysts in comparison with chlorhexidine (the drug of choice for treatment of Acanthamoeba infection) at different incubation periods. Four different concentrations of the tested agents were used, 100, 200, 400, and 600 μg/ml for A. vera ethanol extract and 25, 50, 100, and 200 μg/ml for honey. Isolated Acanthamoeba spp. cysts from keratitis patients were incubated with different concentrations of the tested agents as well as chlorhexidine 0.02% (drug control) for different incubation periods (24, 48, 72 h). After each incubation period, the effect of A. vera extract and honey against Acanthamoeba cysts was assessed by counting the number of viable cysts, determining the inhibitory percentage and detecting the morphological alternations of treated cysts compared to non-treated and drug controls. Both A. vera ethanol extract and honey showed a concentration and time-dependent effect on the viability of Acanthamoeba cysts. In comparison with chlorhexidine (the drug control), A. vera ethanol extract possessed a potent cysticidal activity at all tested concentrations throughout different incubation periods, except for concentration 100 μg/ml which recorded the lower inhibitory effect. With increasing the dose of A. vera ethanol extract to 200, 400, 600 µg/ml, the recorded inhibitory percentages of Acanthamoeba cysts viability were 82.3%, 92.9% and 97.9% respectively, after 72 h compared to 76.3% of chlorhexidine. Similarly, honey at concentrations of 50-100 µg/ml gave higher inhibitory effect of 59% and 76.7%, respectively compared to chlorhexidine which showed an inhibitory percentage of 55.7% after 24 h. Meanwhile, the lowest tested concentration of honey (25 µg/ml) gave an inhibitory effect by 47.7-67% which was less than that of chlorhexidine throughout different incubation periods. With increasing the dose of honey to 200 µg/ml, the inhibitory effect was 98.9% after 72 h higher than that of chlorhexidine (76.9%). Using a scanning electron microscope, Acanthamoeba cysts treated by A. vera ethanol extract showed alternations in their shapes with flattening, collapsing, and laceration of their walls. Also, treated cysts by honey were highly distorted and difficult to identify because most of them were shrinkage and collapsed to a tiny size. On the other hand, chlorhexidine showed less structural and morphological changes of Acanthamoeba cysts. A. vera ethanol extract and honey had considerable cysticidal effects on Acanthamoeba cysts. They may give promising results for treatment of Acanthamoeba keratitis.

Evaluation of efficacy of Aloe vera (L.) Burm. f. gel solution in methylcellulose-induced ocular hypertension in New Zealand white rabbits

Objectives The present study aimed to evaluate the efficacy of Aloe vera in the methylcellulose-induced ocular hypertension model. Methods Fifty-six rabbits were randomly divided into seven groups. Intraocular pressure (IOP) was raised by anterior chamber injection of 2% methylcellulose in all the groups except the normal control group. Disease control animals were treated with sterile water and active control with topical 0.5% timolol 12 hourly; 6 and 12% A. vera gel topical solutions 8 hourly were given in group IV and V, respectively; 6 and 12% A. vera gel solutions along with timolol were given in group VI and VII animals, respectively. Mean IOP values and percentage of reduction in IOP were compared at 15 min, 30 min, 1 h, 2 h, 4 h, 8 h, 12 h, 24 h, 36 h, and 48 h. Results A. vera gel solutions (6 and 12%) showed a significant reduction in mean IOP from 4 to 2 h time points, respectively, whereas, A. vera gel solutions (6 and 12%) + timolol showed significant less mean IOP from a 30 min time point as compared with disease control. A. vera gel solutions (6 and 12%) showed 8.6 and 10.4% more reduction in IOP, respectively (66.8 ± 4.9% and 68.6 ± 5.4% vs. 58.2 ± 2.3%; p > 0.05), whereas 6 and 12% A. vera gel solutions along with timolol showed 14.5 and 16.2% more reduction in IOP, respectively (72.7 ± 4.7% and 74.4 ± 4.1% vs. 58.2 ± 2.3%; p < 0.05), than disease control group at 48 h. Conclusions Six and twelve percent A. vera gel solutions reduced the IOP effectively. Concurrent treatment with 12% A. vera gel and timolol produced the maximum reduction in IOP.

Enhancement of the Anti-Skin Wrinkling Effects of Aloe arborescens Miller Extracts Associated with Lactic Acid Fermentation

This work clearly shows that Aloe arborescens but not gels from Aloe vera, a common juice-type product of Aloe, exerted anti-skin wrinkling effects, and these effects were greatly enhanced by lactic acid fermentation with Lactobacillus plantarum. Treatment with the extract from the fermentation process (FE) at a dose of 0.5% highly activated human fibroblast cells by up to 175%, whereas 140% activation and 105% activation were observed with the extract obtained using conventional water extraction (WE) and the gel from A. vera (GE), respectively. The treatment of human fibroblasts with FE at a dose of 0.5% increased collagen production by up to 170% and inhibited MMP-1 synthesis to 48%, which is likely due to its high antioxidant activity because the WE and GE showed markedly lower effects compared with those of the FE. Interestingly, the FE exhibited a profile dominated by relatively low-molecular-weight (MW) polysaccharides: 20% of the total polysaccharides in the FE were in the MW weight range of 600 to 900, whereas 95% of the total polysaccharides in the GE were in the MW range of 200,000 to 300,000. This result suggests that the larger polysaccharide molecules in the extract might be broken down during lactic acid fermentation, and the easy penetration of the small molecules in the extract into fibroblast cells thus results in improved anti-skin wrinkling effects. This conclusion is also supported by the finding that the FE and WE, but not the GE, contained similar amounts of barbaloin, a strong antioxidant eluted from A. arborescens through the fermentation process. Therefore, this study strongly indicates that the enhanced anti-skin wrinkling effects of the FE are most likely due to synergistic effects between the barbaloin and the low-MW polysaccharides retained after the fermentation process.

Efficacy of adjunctive therapy using Vizoovet in improving clinical signs of keratoconjunctivitis sicca in dogs: A pilot study

OBJECTIVE

To assess the clinical safety and efficacy of adjunctive therapy using Vizoovet to ameliorate clinical signs of keratoconjunctivitis sicca (KCS) in dogs.

ANIMALS STUDIED

Twenty client-owned dogs.

PROCEDURES

Canine patients diagnosed with KCS were enrolled in this prospective study. Patients were randomly selected to receive either Vizoovet or GenTeal drops twice daily in addition to twice daily tacrolimus 0.03% solution. Data were collected from only one eye of each patient and included STT-1, IOP, TFBUT, and results of objective clinical scoring performed by pet owners. Statistical significance was set at P ≤ .05.

RESULTS

In all, 20 dogs (20 eyes) were enrolled in this prospective randomized study. Females (n = 12; 60%) outnumbered males (n = 8; 40%) and all dogs were spayed/neutered. Mean age of all dogs was 10.6 ± 3.79 years. In both treatment groups, the improvement in STT-1 values over the course of the study was significant (P = .002). When comparing the STT-1 improvements between groups, no significance was found (P = .78). In both groups, the improvement in TFBUT was significant (P = .0018). When comparing the TFBUT improvements between groups, no significance was found (P = .14). Squinting, rubbing, ocular discharge, and medication administration scores all significantly improved throughout the course of the study; however, they did not differ significantly between groups. Throughout the study, no adverse side effects were noted clinically or by the pet owner in either group.

CONCLUSIONS AND CLINICAL RELEVANCE

Adjunctive treatment with Vizoovet was as safe and effective as GenTeal drops at improving clinical signs of dry eye in dogs.

Pharmacological Update Properties of Aloe Vera and its Major Active Constituents

Aloe vera has been traditionally used to treat skin injuries (burns, cuts, insect bites, and eczemas) and digestive problems because its anti-inflammatory, antimicrobial, and wound healing properties. Research on this medicinal plant has been aimed at validating traditional uses and deepening the mechanism of action, identifying the compounds responsible for these activities. The most investigated active compounds are aloe-emodin, aloin, aloesin, emodin, and acemannan. Likewise, new actions have been investigated for Aloe vera and its active compounds. This review provides an overview of current pharmacological studies (in vitro, in vivo, and clinical trials), written in English during the last six years (2014–2019). In particular, new pharmacological data research has shown that most studies refer to anti-cancer action, skin and digestive protective activity, and antimicrobial properties. Most recent works are in vitro and in vivo. Clinical trials have been conducted just with Aloe vera, but not with isolated compounds; therefore, it would be interesting to study the clinical effect of relevant metabolites in different human conditions and pathologies. The promising results of these studies in basic research encourage a greater number of clinical trials to test the clinical application of Aloe vera and its main compounds, particularly on bone protection, cancer, and diabetes.

Aloin Inhibits Müller Cells Swelling in a Rat Model of Thioacetamide-Induced Hepatic Retinopathy

Swelling of retinal Müller cells is implicated in retinal edema and neuronal degeneration. Müller cell swelling is observed in patients with liver failure and is referred to as hepatic retinopathy. In the present study, we evaluated the effects of aloin, an anthraquinone-C-glycoside present in various Aloe species, on Müller cell dysfunction in a rat model of thioacetamide (TAA)-induced hepatic retinopathy. Experimental hepatic retinopathy was induced by three injections of TAA (200 mg/kg/day, intraperitoneal injection) for 3 days in rats. After the last injection of TAA, aloin (50 and 100 mg/kg) was orally gavaged for 5 days. The effects of aloin on the liver injury, serum ammonia levels, Müller cell swelling, glial fibrillary acidic protein (GFAP) expression, and gene expression of Kir4.1 and aquaporin-4 were examined. TAA-injected rats exhibited liver failure and hyperammonemia. In the TAA-injected rats, Müller cell bodies were highly enlarged, and GFAP, an indicator of retinal stress, was highly expressed in the retinas, indicating a predominant Müller cell gliosis. However, administration of aloin suppressed liver injury as well as Müller cell swelling through the normalization of Kir4.1 and aquaporin-4 channels, which play a key role in potassium and water transport in Müller cells. These results indicate that aloin may be helpful to protect retinal injury associated with liver failure.

Use of Copaifera multijuga for acute corneal repair after chemical injury: A clinical, histopathological and toxicogenetic study

Copaiba oil is widely used in medicine, but there are no reports regarding its application in ophthalmology. Therefore, the objective of this study was to evaluate the clinical, histopathological and toxicogenetic effects of eye drops containing 0.1 and 0.5% of Copaifera multijuga Hayne oil on superficial corneal ulcers induced with alkali in the left eye of rats. For histological analysis, the percent reduction in ulcers and thickness of the corneal epithelium and stroma were evaluated 48 and 72 h after ulcer induction. Additionally, neovascularization and polymorphonuclear infiltration were classified in the stroma. The bone marrow micronucleus test was used for toxicogenetic assessment. None of the animals exhibited clinical signs of immediate ocular discomfort after instillation and the eye drops were harmless to the ocular surface. There was a significant difference in percent ulcer reduction and corneal stroma thickness between animals treated with the C. multijuga eye drops and untreated animals with corneal injury and the negative control, respectively, suggesting a healing effect of the oleoresin. Analysis of the thickness of the corneal epithelium at the two time points showed that the eye drops formulated did not significantly reduce the damage caused by alkali. The same was observed for the treatments with the reference drugs. No difference in stromal neovascularization or inflammatory infiltration was observed between the treated groups. The toxicogenetic results revealed the absence of cytotoxicity and genotoxicity of the treatments. In conclusion, the C. multijuga eye drops did not cause damage to the ocular surface under the present experimental conditions and corneal epithelization was similar to the conventional treatments. These results indicate that eye drops containing C. multijuga oleoresin are a promising option for the treatment of superficial keratitis.

Drugs - Do we need them? Applications of non-pharmaceutical therapy in anterior eye disease: A review

Natural products have been in use long before the introduction of modern drug therapies and are still used in various communities worldwide for the treatment of anterior eye disease. The aim of this review is to look at the current non-pharmaceutical modalities that have been tried and assess the body of existing evidence behind them. This includes alternative medicine, existing non-pharmaceutical therapy and more recent low and high tech solutions. A detailed search of all available databases including MEDLINE, Pubmed and Google was made to look for English-language studies for complementary and alternative treatment modalities (CAM), natural therapies and new modalities for anterior eye disease such as blepharitis, dry eye and microbial keratitis. We have included a broad discussion ranging from traditional treatments like honey and aloe vera which have been used for centuries, to the more recent technological advances like Intense Pulsed Light (IPL), LipiFlow and photoactivated chromophore for corneal cross linking in infectious keratitis (PACK-CXL). Alternative management strategies may have a role in anterior eye diseases and have a potential in changing the way we currently approach them. Some of the available CAM could play a role if incorporated in to current management practices of not only chronic diseases like blepharitis and dry eye, but also acute conditions with significant morbidity like microbial keratitis. Further large-scale randomized control trials stratified by disease severity are required to improve our understanding and to evaluate the use of non-pharmaceutical therapy against current practice.

The Effect of High Intensity Focused Ultrasound Keratoplasty on Rabbit Anterior Segment

Purpose. To evaluate the safety of high-intensity focused ultrasound keratoplasty as a treatment for presbyopia by examining its effect on the rabbit anterior segment. Methods. The right corneas of 36 New Zealand rabbits were treated with HIFU keratoplasty. The animals were sacrificed at 1, 7, 15, 30, 60, and 90 days after operation. Collagen type I, MMP-2, and MMP-9 were evaluated using immunohistochemistry. For the detection of apoptosis, the TUNEL method was applied. The SOD and MDA levels were analyzed with assay kits. Results. Collagen type I, MMP-2, and MMP-9 levels were altered after the operation but returned to normal within 90 days. The apoptotic index (AI) of the corneal cells decreased from 1 to 30 days gradually. No apoptosis was observed in the epithelial cells of the lens, and the SOD and MDA levels were normal at any time point. Conclusion. After HIFU keratoplasty, the histomorphology of the cornea changed, the corneal collagen type I levels decreased, the corneal MMP-2 and MMP-9 levels increased, and the corneal cells underwent apoptosis for a period of time. Ninety days after the operation, the levels returned to normal, and the lenses were not affected. Thus, HIFU presents good biological safety for eyes.

Therapeutic effects of Aloe spp. in traditional and modern medicine: A review

Traditional medicine is a useful guide in medical sciences. In the Islamic Iranian traditional medicine, the medicinal properties of many plants have been mentioned that could be exploited in drug discovery. We aimed to explore the nature and properties of Aloe spp. As described in some major Islamic traditional texts including Ferdows al-Hekmah fi'l-Tibbe (The Paradise of Wisdom in Medicine), Al-Hawi fi'l-Tibb (Comprehensive Book of Medicine), Kamel al-Sanaat al-Tibbyyah (Complete Book of the Medical Art), Al-Qanun fi'l-Tibb (Canon of Medicine), Zakhireh Kharazmshahi (Treasure of Kharazmshah), and Makhzan al-Adwiah (Drug Treasure), and assess the conformity of traditional medicine instructions with the findings of modern pharmacological studies. Gastrointestinal activities, hepato-protective properties, beneficial effects against skin problems such as wounds, injuries, and infective diseases are among the most frequently mentioned properties of Aloe spp. Several activities of Aloe spp. described in traditional medicine have been the subject of recent in vitro and in vivo studies as well as clinical trials. Owing to the positive findings, different preparations of Aloe spp. are now present in pharmaceutical markets such as Aloe cosmetic products. On the other hand, there are many traditional therapeutic effects of Aloe spp. which have not been studied and require confirmatory experimental or clinical investigations. It is hoped that the present study could stimulate further research on the unexplored aspects of the medicinal properties of Aloe spp.

Aloe vera gel facilitates re-epithelialization of corneal alkali burn in normal and diabetic rats

Purpose

To investigate the efficacy of topical applied aloe vera (AV) and to facilitate the repair of the standardized alkaline corneal ulcer in normal and diabetic rats.

Materials and methods

The corneal alkali-burn injury model was established unilaterally in Wistar rats by filter paper saturated with 0.01 M NaOH contacting the eyes for 45 seconds. Rats were divided into four groups: normal control (NC), normal AV (NAV), diabetic control (DC), and diabetic AV (DAV). NAV and DAV groups were treated with AV gel eye drops four times daily, and NC and DC groups were treated with normal saline for 3 days. Corneal epithelial wound closure and degree of edema were recorded using slit lamp and optical coherence tomography at 0, 24, 48, and 72 hours postwounding. Histological examination was conducted to evaluate the degree of inflammation and the healing effect.

Results

Corneal epithelial wound healing was better in the NAV group than in the NC group, and it was significantly higher in the DAV group than in the DC group (P<0.05). In comparison to the DC group, DAV treated with AV demonstrated a marked reduction in edema at 48 and 72 hours. Histologically, corneal re-epithelialization was complete and higher in DAV group than that in DC group; moreover, the inflammatory cells were increased in DC group than DAV group (P<0.05).

Conclusion

This study demonstrated the efficacy of AV for enhanced corneal re-epithelialization, as well as reduced inflammatory response after alkali burn in rats; therefore, it could be useful as a therapy for diabetic keratopathy.