1
|
Zeroli C, Gorica A, Monti G, Castelnuovo PGM, Bignami M, Macchi A. A systematic review of randomised controlled trials on topical nasal steroids. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2024; 44:71-75. [PMID: 38651550 PMCID: PMC11042551 DOI: 10.14639/0392-100x-n2745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 12/23/2023] [Indexed: 04/25/2024]
Abstract
Introduction Intranasal corticosteroids (INCs) are the first line of therapy for chronic sinonasal conditions such as rhinitis and rhinosinusitis. Among these, one of the most frequently used is beclomethasone dipropionate (BDP). Over the years many studies have evaluated the efficacy of BDP as part of therapy for chronic rhinosinusitis (CRS) and allergic rhinitis (AR) along with nasal washes, which seems to be very well tolerated. Objective To analyse the data in the literature regarding the various therapeutic regimens of BDP in different sinonasal disease and their efficacy and tolerability. Materials and methods Using different search engines, the posology, efficacy, and tolerability of BDP were reviewed and a total of 64 full-length articles were examined for eligibility. After applying inclusion and exclusion criteria, 4 articles were reviewed. Results BDP is among the group of INCs with significant improvement of nasal symptoms and has good efficacy and safety. Conclusions BDP nasal spray is one of the most frequently prescribed INC for rhinitis and rhinosinusitis. Treatment with BDP resulted in significant and clinically meaningful improvements in nasal symptoms associated with AR and CRS. BDP is well tolerated, and the safety profile is similar to that of placebo in most patients. These results, in conjunction with the significant benefit reported in subjects with CRS and AR, provide convincing evidence of the overall effectiveness of BDP for the treatment of the full spectrum of sinonasal disease.
Collapse
Affiliation(s)
- Chiara Zeroli
- ENT Clinic ASST Settelaghi, Head and Neck Research Foresic Center, Insubria University, Varese, Italy
| | - Armela Gorica
- ENT Clinic ASST Settelaghi, Head and Neck Research Foresic Center, Insubria University, Varese, Italy
| | - Giulia Monti
- ENT Clinic ASST Settelaghi, Head and Neck Research Foresic Center, Insubria University, Varese, Italy
| | | | | | - Alberto Macchi
- ENT Clinic ASST Settelaghi, Head and Neck Research Foresic Center, Insubria University, Varese, Italy
| |
Collapse
|
2
|
Roventa DLC, Pieper-Fürst U, Acikel C, Santos D, Sent U, Mösges R. Effectiveness and Tolerability of Ectoin ® Mouth and Throat Spray Althaea Honey (ERS09) for Sore Throat due to Acute Pharyngitis and Dry Cough: A Multicentre, Actively Controlled, Open Label Study in Germany. J Clin Med 2023; 12:5813. [PMID: 37762768 PMCID: PMC10531782 DOI: 10.3390/jcm12185813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/31/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023] Open
Abstract
Acute pharyngitis can cause sore throat. This multicentre, active-controlled, randomised, open-label, and parallel-group study, conducted according to the German Medical Devices Act, compared the effectiveness and tolerability of ERS09 mouth and throat spray with a well-established device for the treatment of sore throat caused by acute pharyngitis and dry cough. Patients were randomised 1:1 into ERS09/comparator groups (EMSER® Sore Throat Spray) for 7 ± 2 days. Patients and investigators reported effectiveness (change in total symptom score [TSS]) and safety endpoints (incidence of adverse events [AEs]; adverse device effects [ADEs]). A total of 186 patients were included (ERS09: n = 92; comparator: n = 94). The baseline-adjusted mean TSS over 7 days was -90.14 and -74.91 in the ERS09 and comparator groups, respectively (p < 0.05). The majority of patients reached a 50% reduction in symptoms by day 6 (ERS09 = 78.85; comparator = 75.8%). Most patients reported a soothing effect within five minutes (ERS09 = 82%; comparator = 71%). Improvements in individual symptoms were similar with no significant differences between groups; more patients in the ERS09 group reported an improvement in pharyngeal redness/swelling. Three AEs unrelated to medication, one ADE following ERS09, and no serious AE/ADE were reported. ERS09 was as well tolerated and effective as the established device, showing greater improvement in the management of some symptoms and greater patient preference.
Collapse
Affiliation(s)
- Don Lorenzo Constantin Roventa
- Institute of Medical Statistics and Bioinformatics (IMSB), Faculty of Medicine, University of Cologne, 50924 Cologne, Germany;
| | - Ursula Pieper-Fürst
- ClinCompetence Cologne GmbH, Theodor-Heuss-Ring 14, 50668 Cologne, Germany; (U.P.-F.); (C.A.)
| | - Cengizhan Acikel
- ClinCompetence Cologne GmbH, Theodor-Heuss-Ring 14, 50668 Cologne, Germany; (U.P.-F.); (C.A.)
| | - Dunia Santos
- Sanofi, 65926 Frankfurt, Germany; (D.S.); (U.S.)
| | - Ulrike Sent
- Sanofi, 65926 Frankfurt, Germany; (D.S.); (U.S.)
| | - Ralph Mösges
- Institute of Medical Statistics and Bioinformatics (IMSB), Faculty of Medicine, University of Cologne, 50924 Cologne, Germany;
- ClinCompetence Cologne GmbH, Theodor-Heuss-Ring 14, 50668 Cologne, Germany; (U.P.-F.); (C.A.)
| |
Collapse
|
3
|
Werkhäuser N, Bilstein A, Mahlstedt K, Sonnemann U. Observational study investigating Ectoin ® Rhinitis Nasal Spray as natural treatment option of acute rhinosinusitis compared to treatment with Xylometazoline. Eur Arch Otorhinolaryngol 2021; 279:1371-1381. [PMID: 34089097 PMCID: PMC8897346 DOI: 10.1007/s00405-021-06916-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 05/26/2021] [Indexed: 02/07/2023]
Abstract
Introduction Symptomatic relief of acute rhinosinusitis is commonly achieved with nasal decongestants. The current observational study investigated the efficacy and safety of treatment of acute rhinosinusitis with Ectoin® Rhinitis Spray compared to or in combination with Xylometazoline-containing decongesting nasal spray. Methods Patients with acute rhinosinusitis applied either Ectoin® Rhinitis Spray, Xylometazoline nasal spray or a combination of both products. Rhinosinusitis symptoms were assessed, and nasal oedema and endonasal redness were determined by rhinoscopy. Patient diaries based on the validated SNOT (Sino Nasal Outcome Test) questionnaire evaluated rhinosinusitis parameters over time and influences of the disease on quality of life. Following treatment, investigators and patients judged the efficacy and tolerability. Results Ectoin® Rhinitis Spray diminished common rhinosinusitis symptoms such as nasal obstruction, nasal secretion, facial pain/headache, and smell/taste impairment. Upon treatment over 7 days, rhinosinusitis sum scores decreased statistically significantly (p < 0.001) by − 64.25%, which was comparable to that achieved with Xylometazoline-containing decongesting nasal spray (− 67.60%). No side effects were observed during treatment with Ectoin® Rhinitis Spray, whereas treatment with Xylometazoline-containing nasal spray resulted in nasal mucosa dryness. Concomitant treatment with both products diminished the development of nasal dryness and required fewer applications of Xylometazoline-containing nasal spray. Conclusion Ectoin® Rhinitis Spray is an effective, natural treatment option for acute rhinosinusitis, which may be used as monotherapy or as add-on treatment with a Xylometazoline-containing nasal spray. The concomitant use of Ectoin® Rhinitis Spray might reduce the needed dose of decongestant nasal spray and counteract bothersome side effects such as dry nasal mucosa. Trial registration The current study was registered in the ClinicalTrials.gov database under the identifier: NCT03693976 (date of registration: Oct 3, 2018).
Collapse
|
4
|
The Effectiveness of the Bacteria Derived Extremolyte Ectoine for the Treatment of Allergic Rhinitis. BIOMED RESEARCH INTERNATIONAL 2021; 2021:5562623. [PMID: 34159193 PMCID: PMC8187048 DOI: 10.1155/2021/5562623] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 05/20/2021] [Indexed: 11/24/2022]
Abstract
Nonpharmacological therapies with a good tolerability and safety profile are of interest to many patients with allergic rhinitis, as a relevant proportion of them have reservations about guideline-concordant pharmacological therapies due to their local irritations and side effects. Ectoine is a bacterial-derived extremolyte with an ability to protect proteins and biological membranes against damage caused by extreme conditions of salinity, drought, irradiation, pH, and temperature. Evidence from preclinical and clinical studies attests its effectiveness in the treatment of several inflammatory diseases, including allergic rhinitis. In this review, we analyzed 14 recent clinical trials investigating ectoine nasal spray in patients with allergic rhinitis and/or conjunctivitis, including sensitive patient groups like children or pregnant women. Some studies investigated monotherapy with ectoine; others investigated combination therapy of ectoine and an antihistamine or a corticosteroid. Analysis of the study results demonstrated that patients with mild-to-moderate symptoms of allergic rhinitis can be successfully treated with ectoine-containing nasal spray. When applied as monotherapy, ectoine exerted noninferior effects compared to first-line therapies such as antihistamines and cromoglicic acid. Using ectoine as an add-on therapy to antihistamines or intranasal glucocorticosteroids accelerated symptom relief by days and improved the level of symptom relief. Importantly, concomitant treatment with ectoine was proven beneficial in a group of difficult-to-treat patients suffering from moderate-to-severe rhinitis symptoms. Taken together, the natural substance ectoine represents a viable alternative for allergic rhinitis and conjunctivitis patients who wish to avoid local reactions and side effects associated with pharmacological therapies.
Collapse
|
5
|
Ecevit MC, Özcan M, Haberal Can İ, Çadallı Tatar E, Özer S, Esen E, Atan D, Göde S, Elsürer Ç, Eryılmaz A, Uslu Coşkun B, Yazıcı ZM, Dinç ME, Özdoğan F, Günhan K, Bilal N, Korkut AY, Kasapoğlu F, Türk B, Araz Server E, Önerci Çelebi Ö, Şimşek T, Kum RO, Adalı MK, Eren E, Yüksel Aslıer NG, Bayındır T, Çakır Çetin A, Enise Göker A, Adadan Güvenç I, Köseoğlu S, Soylu Özler G, Şahin E, Şahin Yılmaz A, Güne C, Aksoy Yıldırım G, Öca B, Durmuşoğlu M, Kantekin Y, Özmen S, Orhan Kubat G, Köybaşı Şanal S, Altuntaş EE, Selçuk A, Yazıcı H, Baklacı D, Yaylacı A, Hancı D, Doğan S, Fidan V, Uygur K, Keleş N, Cingi C, Topuz B, Çanakçıoğlu S, Önerci M. Turkish Guideline for Diagnosis and Treatment of Allergic Rhinitis (ART). Turk Arch Otorhinolaryngol 2021; 59:1-157. [PMID: 34212158 PMCID: PMC8221269 DOI: 10.4274/tao.2021.suppl.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECT To prepare a national guideline for Otorhinolaryngologist who treat allergic rhinitis patients. METHODS The study was conducted by three authors, namely the writing support team. The support team made the study plan, determined the writing instructions, chose the subgroups including the advisory committee, the advisors for authors and the authors. A workshop was organized at the very beginning to explain the details of the study to the team. Advisors took the chance to meet their coworkers in their subgroups and determined the main headings and subheadings of the guideline, together with the authors. After key words were determined by the authors, literature search was done in various databases. The authors keep in touch with the advisors and the advisors with the advisory committee and the support group at every stage of the study. National and International published articles as well as the abstracts of unpublished studies, imperatively presented in National Congresses, were included in this guideline. Only Guideline and meta-analyses published in last seven years (2013-2017) and randomized controlled studies published in last two years (2015-2017) were included. After all work was completed by the subgroups, support team brought all work together and edited the article. RESULTS A detailed guideline about all aspects of allergic rhinitis was created. CONCLUSION The authors believe that this guideline will enable a compact and up-to-date information on allergic rhinitis to healthcare professionals. This guideline is the first in the field of Otolaryngology in Turkey. It should be updated at regular intervals.
Collapse
Affiliation(s)
- Mustafa Cenk Ecevit
- Department of Otorhinolaryngology, Dokuz Eylül University Faculty of Medicine, İzmir
| | - Müge Özcan
- Department of Otorhinolaryngology, University of Health Sciences Turkey Faculty of Medicine, Ankara
| | - İlknur Haberal Can
- Department of Otorhinolaryngology, Yozgat Bozok University Faculty of Medicine, Yozgat
| | - Emel Çadallı Tatar
- Department of Otorhinolaryngology, University of Health Sciences Turkey Faculty of Medicine, Ankara
| | - Serdar Özer
- Department of Otorhinolaryngology, Hacettepe University Faculty of Medicine, Ankara
| | - Erkan Esen
- Department of Otorhinolaryngology, Derince Training and Research Hospital, İzmit
| | - Doğan Atan
- Department of Otorhinolaryngology, Lokman Hekim Hospital, Ankara
| | - Sercan Göde
- Department of Otorhinolaryngology, Ege University Faculty of Medicine, İzmir
| | - Çağdaş Elsürer
- Department of Otorhinolaryngology, Selçuk University Faculty of Medicine, Konya
| | - Aylin Eryılmaz
- Department of Otorhinolaryngology, Adnan Menderes University Faculty of Medicine, Aydın
| | - Berna Uslu Coşkun
- Department of Otorhinolaryngology, University of Health Sciences Turkey, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul
| | - Zahide Mine Yazıcı
- Department of Otorhinolaryngology, University of Health Sciences Turkey, Faculty of Medicine, İstanbul
| | - Mehmet Emre Dinç
- Department of Otorhinolaryngology, University of Health Sciences Turkey, Prof. Dr. Cemil Taşçıoğlu City Hospital, İstanbul
| | - Fatih Özdoğan
- Department of Otorhinolaryngology, Derince Training and Research Hospital, İzmit
| | - Kıvanç Günhan
- Department of Otorhinolaryngology, Celal Bayar University, Manisa
| | - Nagihan Bilal
- Department of Otorhinolaryngology, Kahramanmaraş Sütçü İmam University Faculty of Medicine, Kahramanmaraş
| | - Arzu Yasemin Korkut
- Department of Otorhinolaryngology, University of Health Sciences Turkey, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul
| | - Fikret Kasapoğlu
- Department of Otorhinolaryngology, Uludağ University Faculty of Medicine, Bursa
| | - Bilge Türk
- Department of Otorhinolaryngology, University of Health Sciences Turkey, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul
| | - Ela Araz Server
- Department of Otorhinolaryngology, University of Health Sciences Turkey, İstanbul Training and Research Hospital, İstanbul
| | - Özlem Önerci Çelebi
- Department of Otorhinolaryngology, University of Health Sciences Turkey, İstanbul Training and Research Hospital, İstanbul
| | - Tuğçe Şimşek
- Department of Otorhinolaryngology, Amasya University Sabuncuoğlu Şerefeddin Training and Research Hospital, Amasya
| | - Rauf Oğuzhan Kum
- Department of Otorhinolaryngology, University of Health Sciences Turkey Faculty of Medicine, Ankara
| | - Mustafa Kemal Adalı
- Department of Otorhinolaryngology, Trakya University Faculty of Medicine, Edirne
| | - Erdem Eren
- Department of Otorhinolaryngology, Atatürk Training and Research Hospital, İzmir
| | - Nesibe Gül Yüksel Aslıer
- Department of Otorhinolaryngology, University of Health Sciences Turkey, Bursa Yüksek İhtisas Training and Research Hospital, Bursa
| | - Tuba Bayındır
- Department of Otorhinolaryngology, İnönü University Faculty of Medicine, Malatya
| | - Aslı Çakır Çetin
- Department of Otorhinolaryngology, Dokuz Eylül University Faculty of Medicine, İzmir
| | - Ayşe Enise Göker
- Department of Otorhinolaryngology, University of Health Sciences Turkey, Prof. Dr. Cemil Taşçıoğlu City Hospital, İstanbul
| | - Işıl Adadan Güvenç
- Department of Otorhinolaryngology, Bakırçay University Faculty of Medicine, Çiğli Training and Research Hospital, İzmir
| | - Sabri Köseoğlu
- Department of Otorhinolaryngology, Sıtkı Koçman University Faculty of Medicine, Muğla
| | - Gül Soylu Özler
- Department of Otorhinolaryngology, Mustafa Kemal University Faculty of Medicine, Hatay
| | - Ethem Şahin
- Bayındır Heathcare Group İçerenköy Hospital, İstanbul
| | - Aslı Şahin Yılmaz
- Department of Otorhinolaryngology, University of Health Sciences Turkey, Ümraniye Training and Research Hospital, İstanbul
| | - Ceren Güne
- Department of Otorhinolaryngology, Atatürk Training and Research Hospital, İzmir
| | - Gökçe Aksoy Yıldırım
- University of Health Sciences Turkey, Bozyaka Training and Research Hospital, Department of Otorhinolaryngology, İzmir
| | - Bülent Öca
- Department of Otorhinolaryngology, University of Health Sciences Turkey, Prof. Dr. Cemil Taşçıoğlu City Hospital, İstanbul
| | - Mehmet Durmuşoğlu
- Department of Otorhinolaryngology, Bakırçay University Faculty of Medicine, Çiğli Training and Research Hospital, İzmir
| | - Yunus Kantekin
- Department of Otorhinolaryngology University of Health Sciences Turkey, Kayseri City Hospital, Kayseri
| | - Süay Özmen
- Department of Otorhinolaryngology, University of Health Sciences Turkey, Bursa Yüksek İhtisas Training and Research Hospital, Bursa
| | - Gözde Orhan Kubat
- Department of Otorhinolaryngology, Alanya Alaaddin Keykubat University Faculty of Medicine, Antalya
| | - Serap Köybaşı Şanal
- Department of Otorhinolaryngology, Abant İzzet Baysal University Faculty of Medicine, Bolu
| | - Emine Elif Altuntaş
- Department of Otorhinolaryngology, Sivas Cumhuriyet University Faculty of Medicine, Sivas
| | - Adin Selçuk
- Department of Otorhinolaryngology, Bahçeşehir University Faculty of Medicine, İstanbul
| | - Haşmet Yazıcı
- Department of Otorhinolaryngology, Balıkesir University Faculty of Medicine, Balıkesir
| | - Deniz Baklacı
- Department of Otorhinolaryngology, Bülent Ecevit University Faculty of Medicine, Zonguldak
| | - Atılay Yaylacı
- Department of Otorhinolaryngology, Kocaeli University Faculty of Medicine, Kocaeli
| | - Deniz Hancı
- Department of Otorhinolaryngology, University of Health Sciences Turkey, Prof. Dr. Cemil Taşçıoğlu City Hospital, İstanbul
| | - Sedat Doğan
- Department of Otorhinolaryngology, Adıyaman University Faculty of Medicine, Adıyaman
| | - Vural Fidan
- Department of Otorhinolaryngology, University of Health Sciences Turkey, Eskişehir City Hospital, Eskişehir
| | - Kemal Uygur
- Department of Otorhinolaryngology, Gazi University Faculty of Medicine, Ankara
| | - Nesil Keleş
- Department of Otorhinolaryngology, İstanbul University İstanbul Faculty of Medicine, İstanbul
| | - Cemal Cingi
- Department of Otorhinolaryngology, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir
| | - Bülent Topuz
- Department of Otorhinolaryngology, Pamukkale University Faculty of Medicine, Denizli
| | - Salih Çanakçıoğlu
- Department of Otorhinolaryngology, İstanbul University İstanbul Faculty of Medicine, İstanbul
| | - Metin Önerci
- Department of Otorhinolaryngology, Hacettepe University Faculty of Medicine, Ankara
| |
Collapse
|
6
|
Tsai T, Mueller-Buehl AM, Satgunarajah Y, Kuehn S, Dick HB, Joachim SC. Protective effect of the extremolytes ectoine and hydroxyectoine in a porcine organ culture. Graefes Arch Clin Exp Ophthalmol 2020; 258:2185-2203. [PMID: 32710140 PMCID: PMC8478759 DOI: 10.1007/s00417-020-04854-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 06/17/2020] [Accepted: 07/15/2020] [Indexed: 02/07/2023] Open
Abstract
Purpose Hypoxic damage to the retina is a relevant component of neurodegenerative pathologies such as glaucoma or retinal ischemia. In porcine retina organ cultures, hypoxic damage can be induced by applying cobalt chloride (CoCl2). The aim of our study was to investigate possible neuroprotective effects of the extremolytes ectoine and hydroxyectoine in this hypoxia-damaged retina model. Methods To simulate hypoxia, porcine retina organ cultures were damaged with 300 μM CoCl2 for 48 h starting on day 1 (n = 8–9/group). In order to investigate the possible neuroprotective effects of ectoine and hydroxyectoine, 0.5 mM of each extremolyte was added to the culture at the same time as the stressor and for the same duration. On day 8, the retina organ cultures were taken for (immuno)-histochemical examinations. Retinal ganglion cells (RGCs), macroglia, and apoptotic and hypoxic cells were detected with appropriate markers followed by cell counts and group comparisons. Results Treatment with ectoine resulted in RGC protection (p < 0.05) and reduced rate of apoptosis (p < 0.001) in hypoxia-treated retina organ cultures. However, the macroglia area and the amount of hypoxic, HIF-1α+ cells were unaffected by the ectoine treatment (p = 0.99). Treatment with hydroxyectoine also protected RGCs (p < 0.01) by inhibiting apoptosis (p < 0.001). In addition, the number of hypoxic, HIF-1α+ cells could be significantly reduced by treatment with hydroxyectoine (p < 0.05). The macroglia area on the other hand was unchanged after CoCl2 and treatment with hydroxyectoine. Conclusion Both extremolytes had a protective effect on CoCl2-induced hypoxia in the porcine retina organ culture. Regarding the reduction of hypoxic stress, hydroxyectoine appears to be more effective. Thus, both extremolytes represent an interesting potential new therapeutic approach for patients with ocular diseases in which hypoxic processes play a significant role.
Collapse
Affiliation(s)
- Teresa Tsai
- Experimental Eye Research Institute, University Eye Hospital, Ruhr-University Bochum, In der Schornau 23-25, 44892, Bochum, Germany
| | - Ana M Mueller-Buehl
- Experimental Eye Research Institute, University Eye Hospital, Ruhr-University Bochum, In der Schornau 23-25, 44892, Bochum, Germany
| | - Yathavan Satgunarajah
- Experimental Eye Research Institute, University Eye Hospital, Ruhr-University Bochum, In der Schornau 23-25, 44892, Bochum, Germany
| | - Sandra Kuehn
- Experimental Eye Research Institute, University Eye Hospital, Ruhr-University Bochum, In der Schornau 23-25, 44892, Bochum, Germany
| | - H Burkhard Dick
- Experimental Eye Research Institute, University Eye Hospital, Ruhr-University Bochum, In der Schornau 23-25, 44892, Bochum, Germany
| | - Stephanie C Joachim
- Experimental Eye Research Institute, University Eye Hospital, Ruhr-University Bochum, In der Schornau 23-25, 44892, Bochum, Germany.
| |
Collapse
|
7
|
Topical Ectoine: A Promising Molecule in the Upper Airways Inflammation-A Systematic Review. BIOMED RESEARCH INTERNATIONAL 2019; 2019:7150942. [PMID: 31534961 PMCID: PMC6732621 DOI: 10.1155/2019/7150942] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 07/07/2019] [Accepted: 07/31/2019] [Indexed: 01/31/2023]
Abstract
To date, topical therapies guarantee a better delivery of high concentrations of pharmacologic agents to the mucosa of the upper airways (UA). Recently, topical administration of ectoine has just been recognized as adjuvant treatment in the Allergic Rhinitis (AR) and Rhinosinusitis (ARS). The aim of this work is to review the published literature regarding all the potential therapeutic effects of ectoine in the acute and chronic inflammatory diseases of UA. Pertinent studies published without temporal limitation were selected searching on MEDLINE the following terms: “ectoine” and “nasal spray,” “oral spray,” “upper respiratory tract infections,” “rhinosinusitis,” “rhinitis,” “rhinoconjunctivitis,” “pharyngitis,” and “laryngitis.” At the end of our selection process, six relevant publications were included: two studies about the effect of ectoine on AR, one study about ARS, one study about rhinitis sicca anterior, and two studies about acute pharyngitis and/or laryngitis. Due to its moisturizing and anti-inflammatory properties, topical administration of ectoine could play a potential additional role in treatment of acute and chronic inflammatory diseases of UA, in particular in the management of sinonasal conditions improving symptoms and endoscopic findings. However, these results should be viewed cautiously as they are based on a limited number of studies; some of them were probably underpowered because of their small patient samples.
Collapse
|
8
|
Pieper-Fürst U, Dao VA, Shah-Hosseini K, Panin G, Lamprecht J, Mösges R. Alpha-tocopherol acetate nasal spray in the treatment of pollen-induced allergic rhinitis. ACTA ACUST UNITED AC 2018. [DOI: 10.1007/s40629-018-0086-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
|
9
|
Dao VA, Bilstein A, Overhagen S, Géczi L, Baráth Z, Mösges R. Effectiveness, Tolerability, and Safety of Ectoine-Containing Mouthwash Versus Those of a Calcium Phosphate Mouthwash for the Treatment of Chemotherapy-Induced Oral Mucositis: A Prospective, Active-Controlled, Non-interventional Study. Oncol Ther 2018; 6:59-72. [PMID: 32700140 PMCID: PMC7360009 DOI: 10.1007/s40487-018-0060-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Indexed: 11/25/2022] Open
Abstract
Introduction Oral mucositis is a frequent complication of cancer chemotherapy and radiotherapy. Ectoine is a natural extremolyte that can stabilize biological membranes and counteract inflammatory reactions. This study investigated ectoine-containing mouthwash for the prophylaxis and the treatment of oral mucositis. Its effectiveness, tolerability, and safety were compared to those of the local standard-of-care calcium phosphate mouthwash. Methods This prospective, active-controlled, observational study was conducted in two study centers in Hungary from January 2016 to October 2017. Sixty patients undergoing chemotherapy were to be recruited and allocated to one of three treatment arms: prophylactic treatment with ectoine (20 patients), active treatment with ectoine (20 patients), or calcium phosphate (20 patients). The study lasted 21 days, comprising four visits on day 0, day 7, day 14, and day 21. Results In all, 45 patients were included in the study (prophylactic ectoine, 10 patients; active ectoine, 20 patients; calcium phosphate, 15 patients). In the prophylactic ectoine group, few mucositis symptoms of mild or moderate severity occurred throughout the study. In the active ectoine and the calcium phosphate groups, symptoms of mild and moderate severity at inclusion were reduced significantly after 14 days of treatment and were mostly resolved at the end of the study. The difference between the active ectoine and the calcium phosphate groups was not significant. According to patients’ assessments, ectoine mouthwash was more effective and tolerable than calcium phosphate mouthwash. Conclusions Ectoine mouthwash is safe, well tolerated, and effective for the active treatment of oral mucositis following chemotherapy. Its effectiveness is comparable to that of calcium phosphate. Patients prefer ectoine mouthwash to calcium phosphate mouthwash. Trial Registration Number NCT02816515. Funding Bitop AG (Dortmund, Germany). Plain Language Summary Plain language summary available for this article. Electronic supplementary material The online version of this article (10.1007/s40487-018-0060-z) contains supplementary material, which is available to authorized users. Oral mucositis is the inflammation of the mucosa of the oral cavity. It is a frequent complication of cancer chemotherapy and radiotherapy. Approximately 20–40% of patients undergoing chemotherapy suffer from oral mucositis. It is very painful, impairs eating, drinking, and quality of life. One of the most effective yet simple measures to prevent and treat oral mucositis is oral care with mouthwash. Ectoine is a natural substance that was discovered in halophilic (salt-loving) bacteria. Ectoine can protect these bacteria against dehydration because it can attract water molecules and strengthen biological membranes. Ectoine is used to treat many diseases caused by allergens, UV light, air pollution, heat, and dryness. Ectoine (Ectoin®) mouthwash is produced by bitop AG (Dortmund, Germany) to treat dry mouth and other symptoms of inflamed oral mucosa. This study investigated ectoine mouthwash for the treatment of oral mucositis following chemotherapy. It was compared to the local standard-of-care calcium phosphate mouthwash. One group of patients was treated with ectoine mouthwash and the other with calcium phosphate mouthwash. After 14 days, mucositis symptoms were substantially reduced in both groups. After 21 days, all patients were almost cured of oral mucositis. Additionally, after the treatment, patients rated how effective and tolerable the treatment was. Here, more patients treated with ectoine rated their treatment as effective and tolerable than those treated with calcium phosphate. This study shows that ectoine mouthwash is tolerable and effective for the treatment of mucositis. Patients preferred ectoine mouthwash to calcium phosphate mouthwash.
Collapse
Affiliation(s)
- Van Anh Dao
- CRI - Clinical Research International Ltd., Genter Str. 7, 50672, Cologne, Germany
| | | | | | - Lajos Géczi
- Department of Oncological Internal Medicine and Clinical Pharmacology "C", National Institute of Oncology Hungary, Budapest, 1026, Hungary
| | - Zoltán Baráth
- National Korányi Institute of TB and Pulmonology, Budapest, 1121, Hungary
| | - Ralph Mösges
- CRI - Clinical Research International Ltd., Genter Str. 7, 50672, Cologne, Germany
- Faculty of Medicine, Institute of Medical Statistics and Computational Biology, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| |
Collapse
|
10
|
Bownik A, Stępniewska Z. Ectoine as a promising protective agent in humans and animals. Arh Hig Rada Toksikol 2017; 67:260-265. [PMID: 28033102 DOI: 10.1515/aiht-2016-67-2837] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Accepted: 11/01/2016] [Indexed: 12/18/2022] Open
Abstract
Ectoine is a compatible water molecule-binding solute (osmoprotectant) produced by several bacterial species in response to osmotic stress and unfavourable environmental conditions. This amino acid derivative can accumulate inside cells at high concentrations without interfering with natural processes and can protect the cell against radiation or osmotic stress. This brief review presents the current state of knowledge about the effects of ectoine on animals and focuses on its practical use for enzyme stabilisation, human skin protection, anti-inflammatory treatment, inhibitory effects in neurodegenerative diseases, and other therapeutic potential in human or veterinary medicine.
Collapse
|
11
|
Mösges R, Shah-Hosseini K, Hucke HP, Joisten MJ. Dexpanthenol: An Overview of its Contribution to Symptom Relief in Acute Rhinitis Treated with Decongestant Nasal Sprays. Adv Ther 2017; 34:1850-1858. [PMID: 28695477 PMCID: PMC5565656 DOI: 10.1007/s12325-017-0581-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Indexed: 11/26/2022]
Abstract
Nasal blockage is the most bothersome symptom of acute rhinitis. Nasal decongestant sprays containing alpha-sympathomimetics, such as oxymetazoline and xylometazoline, have a rapid onset of action. However, this effect decreases with repeated application and, furthermore, the ciliary function of the nasal mucosa is practically paralyzed. Dexpanthenol promotes cell proliferation and protects the epithelium. Combining these two agents has demonstrated beneficial synergetic effects on the symptoms of acute rhinitis. In a post hoc analysis of a large-scale double-blind, active-controlled study including 152 patients, we could demonstrate that the benefit of added dexpanthenol appears as early as on the third day of the combined application of xylometazoline and dexpanthenol in terms of complete or near-to-complete freedom from symptoms. After 5 days, 47% of the patients were cured under the combined treatment compared with only 1% under xylometazoline monotherapy. These data show that the addition of dexpanthenol to an alpha-sympathomimetic nasal spray not only improves its tolerability but also further increases its effectiveness and leads to expedited cure. FUNDING Klosterfrau Healthcare Group.
Collapse
Affiliation(s)
- Ralph Mösges
- Faculty of Medicine, Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Cologne, Germany
| | - Kija Shah-Hosseini
- Faculty of Medicine, Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Cologne, Germany
| | | | - Marie-Josefine Joisten
- Faculty of Medicine, Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Cologne, Germany.
| |
Collapse
|
12
|
Neutrons describe ectoine effects on water H-bonding and hydration around a soluble protein and a cell membrane. Sci Rep 2016; 6:31434. [PMID: 27527336 PMCID: PMC4985633 DOI: 10.1038/srep31434] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 07/21/2016] [Indexed: 01/09/2023] Open
Abstract
Understanding adaptation to extreme environments remains a challenge of high biotechnological potential for fundamental molecular biology. The cytosol of many microorganisms, isolated from saline environments, reversibly accumulates molar concentrations of the osmolyte ectoine to counterbalance fluctuating external salt concentrations. Although they have been studied extensively by thermodynamic and spectroscopic methods, direct experimental structural data have, so far, been lacking on ectoine-water-protein interactions. In this paper, in vivo deuterium labeling, small angle neutron scattering, neutron membrane diffraction and inelastic scattering are combined with neutron liquids diffraction to characterize the extreme ectoine-containing solvent and its effects on purple membrane of H. salinarum and E. coli maltose binding protein. The data reveal that ectoine is excluded from the hydration layer at the membrane surface and does not affect membrane molecular dynamics, and prove a previous hypothesis that ectoine is excluded from a monolayer of dense hydration water around the soluble protein. Neutron liquids diffraction to atomic resolution shows how ectoine enhances the remarkable properties of H-bonds in water—properties that are essential for the proper organization, stabilization and dynamics of biological structures.
Collapse
|
13
|
Sun Y, Zhao H, Ye Y, Nie W, Bai W, Liu J, Li S, Wang F, Han M, He L. Efficacy and safety of using a warming needle for persistent allergic rhinitis: study protocol for a randomized controlled trial. Trials 2016; 17:305. [PMID: 27363578 PMCID: PMC4929718 DOI: 10.1186/s13063-016-1432-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 06/08/2016] [Indexed: 11/26/2022] Open
Abstract
Background Many previous studies have shown the potential therapeutic effect of acupuncture for allergic rhinitis. Most of these studies, however, were limited by the short duration of observations and lack of sham acupuncture as the control group. Our preliminary experiments showed that the use of a warm needling achieved a much more persistent effect in the treatment of allergic rhinitis (AR) compared with simple acupuncture therapy. Hence, we have designed a multicenter, randomized controlled trial (RCT) in which the first-line medication loratadine will be used as the control group, and the effect of warm needling therapy will be evaluated through long-term observation. Methods/design The trial is designed as a multicenter, parallel-group, randomized, single-blinded (outcome assessors), non-inferiority trial. A total of 98 patients with persistent AR will be randomly assigned into two groups. Patients in the treatment group will be treated with warm needling at GV14 and acupuncture at EX-HN3, ST2, LI20, EX-HN8, GV23, LU7, LU5 and LI4 three times a week, for a total of 4 weeks. Patients in the control group will be treated with oral loratadine 10 mg/day for 4 weeks. The primary outcome will be the change in the Total Nasal Symptom Score (TNSS) from baseline to that at 6 months after treatment during the follow-up period. The secondary outcomes will include the Total Non-nasal Symptom Score and the Rhinoconjunctivitis Quality of Life Questionnaire, changes in the TNSS from baseline to that at 2 and 4 weeks during treatment, and 3 months after treatment during the follow-up period. Outcomes will be measured at 2 and 4 weeks, and 3 and 6 months after treatment. Any side effects of treatment will be observed and recorded. Discussion We expect that the study results will provide evidence to determine the effects of warm needling compared with loratadine. Our final goal of the study is to evaluate the difference in the short-term and long-term effects between the two therapeutic methods, especially the long-term effect of warm needling. Trial registration ClinicalTrials.gov NCT02339714. Registered on 14 January 2015. Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1432-z) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Yuxiu Sun
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China.,Hubei University of Chinese Medicine, Wuhan, 430061, China
| | - Hong Zhao
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, 100700, China.
| | - Yongming Ye
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
| | - Wenbin Nie
- Mentougou Hospital of TCM, Beijing, 102300, China
| | - Wenjing Bai
- China Academy of Chinese Medical Sciences, Beijing, 100700, China
| | - Jia Liu
- China Academy of Chinese Medical Sciences, Beijing, 100700, China
| | - Sinuo Li
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
| | - Fang Wang
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, 100700, China
| | - Mingjuan Han
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, 100700, China
| | - Liyun He
- China Academy of Chinese Medical Sciences, Beijing, 100700, China
| |
Collapse
|
14
|
Jorge CD, Borges N, Bagyan I, Bilstein A, Santos H. Potential applications of stress solutes from extremophiles in protein folding diseases and healthcare. Extremophiles 2016; 20:251-9. [PMID: 27071404 DOI: 10.1007/s00792-016-0828-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 03/24/2016] [Indexed: 11/26/2022]
Abstract
Protein misfolding, aggregation and deposition in the brain, in the form of amyloid, are implicated in the etiology of several neurodegenerative disorders, such as Alzheimer's, Parkinson's and prion diseases. Drugs available on the market reduce the symptoms, but they are not a cure. Therefore, it is urgent to identify promising targets and develop effective drugs. Preservation of protein native conformation and/or inhibition of protein aggregation seem pertinent targets for drug development. Several studies have shown that organic solutes, produced by extremophilic microorganisms in response to osmotic and/or heat stress, prevent denaturation and aggregation of model proteins. Among these stress solutes, mannosylglycerate, mannosylglyceramide, di-myo-inositol phosphate, diglycerol phosphate and ectoine are effective in preventing amyloid formation by Alzheimer's Aβ peptide and/or α-synuclein in vitro. Moreover, mannosylglycerate is a potent inhibitor of Aβ and α-synuclein aggregation in living cells, and mannosylglyceramide and ectoine inhibit aggregation and reduce prion peptide-induced toxicity in human cells. This review focuses on the efficacy of stress solutes from hyper/thermophiles and ectoines to prevent amyloid formation in vitro and in vivo and their potential application in drug development against protein misfolding diseases. Current and envisaged applications of these extremolytes in neurodegenerative diseases and healthcare will also be addressed.
Collapse
Affiliation(s)
- Carla D Jorge
- Instituto de Tecnologia Química e Biológica António Xavier, Universidade Nova de Lisboa, Av. da República-EAN, 2780-157, Oeiras, Portugal.
| | - Nuno Borges
- Instituto de Tecnologia Química e Biológica António Xavier, Universidade Nova de Lisboa, Av. da República-EAN, 2780-157, Oeiras, Portugal
| | - Irina Bagyan
- Bitop AG, Stockumer Straße 28, 58453, Witten, Germany
| | | | - Helena Santos
- Instituto de Tecnologia Química e Biológica António Xavier, Universidade Nova de Lisboa, Av. da República-EAN, 2780-157, Oeiras, Portugal
| |
Collapse
|
15
|
Kroker M, Sydlik U, Autengruber A, Cavelius C, Weighardt H, Kraegeloh A, Unfried K. Preventing carbon nanoparticle-induced lung inflammation reduces antigen-specific sensitization and subsequent allergic reactions in a mouse model. Part Fibre Toxicol 2015; 12:20. [PMID: 26141115 PMCID: PMC4491258 DOI: 10.1186/s12989-015-0093-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Accepted: 06/15/2015] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Exposure of the airways to carbonaceous nanoparticles can contribute to the development of immune diseases both via the aggravation of the allergic immune response in sensitized individuals and by adjuvant mechanisms during the sensitization against allergens. The cellular and molecular mechanisms involved in these adverse pathways are not completely understood. We recently described that the reduction of carbon nanoparticle-induced lung inflammation by the application of the compatible solute ectoine reduced the aggravation of the allergic response in an animal system. In the current study we investigated the influence of carbon nanoparticles on the sensitization of animals to ovalbumin via the airways. Ectoine was used as a preventive strategy against nanoparticle-induced neutrophilic lung inflammation. METHODS Balb/c mice were repetitively exposed to the antigen ovalbumin after induction of airway inflammation by carbon nanoparticles, either in the presence or in the absence of ectoine. Allergic sensitization was monitored by measurement of immunoglobulin levels and immune responses in lung and lung draining lymph nodes after challenge. Furthermore the role of dendritic cells in the effect of carbon nanoparticles was studied in vivo in the lymph nodes but also in vitro using bone marrow derived dendritic cells. RESULTS Animals exposed to antigen in the presence of carbon nanoparticles showed increased effects with respect to ovalbumin sensitization, to the allergic airway inflammation after challenge, and to the specific TH2 response in the lymph nodes. The presence of ectoine during the sensitization significantly reduced these parameters. The number of antigen-loaded dendritic cells in the draining lymph nodes was identified as a possible cause for the adjuvant effect of the nanoparticles. In vitro assays indicate that the direct interaction of the particles with dendritic cells is not able to trigger CCR7 expression, while this endpoint is achieved by lung lavage fluid from nanoparticle-exposed animals. CONCLUSIONS Using the intervention strategy of applying ectoine into the airways of animals we were able to demonstrate the relevance of neutrophilic lung inflammation for the adjuvant effect of carbon nanoparticles on allergic sensitization.
Collapse
Affiliation(s)
- Matthias Kroker
- IUF - Leibniz Institut für Umweltmedizinische Forschung, Auf'm Hennekamp 50, 40225, Düsseldorf, Germany
| | - Ulrich Sydlik
- IUF - Leibniz Institut für Umweltmedizinische Forschung, Auf'm Hennekamp 50, 40225, Düsseldorf, Germany
| | - Andrea Autengruber
- IUF - Leibniz Institut für Umweltmedizinische Forschung, Auf'm Hennekamp 50, 40225, Düsseldorf, Germany
| | | | | | | | - Klaus Unfried
- IUF - Leibniz Institut für Umweltmedizinische Forschung, Auf'm Hennekamp 50, 40225, Düsseldorf, Germany.
| |
Collapse
|