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Kolarijani NR, Mirzaii M, Zamani S, Maghsoodifar H, Naeiji M, Douki SAHS, Salehi M, Fazli M. Assessment of the ability of Pseudomonas aeruginosa and Staphylococcus aureus to create biofilms during wound healing in a rat model treated with carboxymethyl cellulose/carboxymethyl chitosan hydrogel containing EDTA. Int Wound J 2024; 21:e14878. [PMID: 38682897 PMCID: PMC11057379 DOI: 10.1111/iwj.14878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 03/20/2024] [Accepted: 03/25/2024] [Indexed: 05/01/2024] Open
Abstract
The primary objective of this study was to develop a carboxymethyl cellulose (CMC) and carboxymethyl chitosan (CMCS) hydrogel containing ethylene diamine tetra acetic acid (EDTA) as the materials for wound healing. CMC and CMCS solutions were prepared with a concentration of 4% (w/v). These solutions were made using normal saline serum with a concentration of 0.5% (v/v). Additionally, EDTA with the concentrations of 0.01%, 0.05%, 0.1%, 0.5%, 1%, and 2% (w/v) was included in the prepared polymer solution. The analysis of the hydrogels revealed that they possess porous structures with interconnected pores, with average in size 88.71 ± 5.93 μm. The hydrogels exhibited a swelling capacity of up to 60% of their initial weight within 24 h, as indicated by the weight loss and swelling measurements. The antibacterial experiments showed that the formulated CMC/CMCS/EDTA 0.5% hydrogel inhibited the growth of Staphylococcus aureus and Pseudomonas aeruginosa. Moreover, the produced hydrogels were haemocompatible and biocompatible. At the last stage, the evaluation of wound healing in the animal model demonstrated that the use of the produced hydrogels significantly improved the process of wound healing. Finally, the findings substantiated the effectiveness of the formulated hydrogels as the materials for promoting wound healing and antibacterial agents.
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Affiliation(s)
| | - Mehdi Mirzaii
- Department of Microbiology, School of MedicineShahroud University of Medical SciencesShahroudIran
| | - Sepehr Zamani
- Student Research Committee, School of MedicineShahroud University of Medical SciencesShahroudIran
| | - Hasan Maghsoodifar
- Student Research Committee, School of MedicineShahroud University of Medical SciencesShahroudIran
| | - Mahdi Naeiji
- Student Research Committee, School of MedicineShahroud University of Medical SciencesShahroudIran
| | | | - Majid Salehi
- Department of Tissue Engineering, School of MedicineShahroud University of Medical SciencesShahroudIran
- Tissue Engineering and Stem Cells Research CenterShahroud University of Medical SciencesShahroudIran
- Health Technology Incubator CenterShahroud University of Medical SciencesShahroudIran
| | - Mozhgan Fazli
- School of MedicineShahroud University of Medical SciencesShahroudIran
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Nancy Ward C, LeBlanc PE, Edward Burrell R. Effects of composition and pH on the degradation of hyaluronate and carboxymethyl cellulose gels and release of nanocrystalline silver. J Appl Biomater Funct Mater 2024; 22:22808000241257124. [PMID: 38819121 DOI: 10.1177/22808000241257124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024] Open
Abstract
Adhesions are fibrous tissue connections which are a common complication of surgical procedures and may be prevented by protecting tissue surfaces and reducing inflammation. The combination of biodegradable polymers and nanocrystalline silver can be used to create an anti-inflammatory gel to be applied during surgery. In this study, sodium hyaluronate and sodium carboxymethyl cellulose were added in concentrations from 0.25% to 1% w/v to aqueous nanocrystalline silver solutions to create viscous gels. Gels were loaded into dialysis cassettes and placed in PBS for 3 days. pH was adjusted using potassium phosphate monobasic and sodium hydroxide. Release of silver into the PBS was measured at several time points. Polymer degradation was compared by measuring the viscosity of the gels before and after the experiment. Gels lost up to 84% of initial viscosity over 3 days and released between 24% and 41% of the added silver. Gels with higher initial viscosity did not have a greater degree of degradation, as measured by percent viscosity reduction, but still resulted in a higher final viscosity. Silver release was not significantly impacted by pH or composition, but still varied between experimental groups.
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Affiliation(s)
- Colleen Nancy Ward
- Donadeo Innovation Centre for Engineering, University of Alberta, Edmonton, AB, Canada
| | - Payton E LeBlanc
- Donadeo Innovation Centre for Engineering, University of Alberta, Edmonton, AB, Canada
| | - Robert Edward Burrell
- Donadeo Innovation Centre for Engineering, University of Alberta, Edmonton, AB, Canada
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Budai L, Budai M, Fülöpné Pápay ZE, Szalkai P, Niczinger NA, Kijima S, Sugibayashi K, Antal I, Kállai-Szabó N. Viscoelasticity of Liposomal Dispersions. NANOMATERIALS (BASEL, SWITZERLAND) 2023; 13:2340. [PMID: 37630925 PMCID: PMC10459094 DOI: 10.3390/nano13162340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/08/2023] [Accepted: 08/12/2023] [Indexed: 08/27/2023]
Abstract
Janus-faced viscoelastic gelling agents-possessing both elastic and viscous characteristics-provide materials with unique features including strengthening ability under stress and a liquid-like character with lower viscosities under relaxed conditions. The mentioned multifunctional character is manifested in several body fluids such as human tears, synovial liquids, skin tissues and mucins, endowing the fluids with a special physical resistance property that can be analyzed by dynamic oscillatory rheology. Therefore, during the development of pharmaceutical or cosmetical formulations-with the intention of mimicking the physiological conditions-rheological studies on viscoelasticity are strongly recommended and the selection of viscoelastic preparations is highlighted. In our study, we aimed to determine the viscoelasticity of various liposomal dispersions. We intended to evaluate the impact of lipid concentration, the presence of cholesterol or 1,2-distearoyl-sn-glycero-3-phosphocholine (DSPC) and the gelling agents polyvinyl alcohol (PVA) and hydroxyethylcellulose (HEC) on the viscoelasticity of vesicular systems. Furthermore, the effect of two model drugs (phenyl salicylate and caffeine) on the viscoelastic behavior of liposomal systems was studied. Based on our measurements, the oscillation rheological properties of the liposomal formulations were influenced both by the composition and the lamellarity/size of the lipid vesicles.
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Affiliation(s)
- Lívia Budai
- Department of Pharmaceutics, Semmelweis University, Hőgyes Str. 7, 1092 Budapest, Hungary; (L.B.); (M.B.); (Z.E.F.P.); (P.S.); (N.A.N.)
| | - Marianna Budai
- Department of Pharmaceutics, Semmelweis University, Hőgyes Str. 7, 1092 Budapest, Hungary; (L.B.); (M.B.); (Z.E.F.P.); (P.S.); (N.A.N.)
| | - Zsófia Edit Fülöpné Pápay
- Department of Pharmaceutics, Semmelweis University, Hőgyes Str. 7, 1092 Budapest, Hungary; (L.B.); (M.B.); (Z.E.F.P.); (P.S.); (N.A.N.)
| | - Petra Szalkai
- Department of Pharmaceutics, Semmelweis University, Hőgyes Str. 7, 1092 Budapest, Hungary; (L.B.); (M.B.); (Z.E.F.P.); (P.S.); (N.A.N.)
| | - Noémi Anna Niczinger
- Department of Pharmaceutics, Semmelweis University, Hőgyes Str. 7, 1092 Budapest, Hungary; (L.B.); (M.B.); (Z.E.F.P.); (P.S.); (N.A.N.)
| | - Shosho Kijima
- Faculty of Pharmacy and Pharmaceutical Sciences, Josai University, 1-1 Keyakidai, Sakado 350-0295, Saitama, Japan; (S.K.); (K.S.)
| | - Kenji Sugibayashi
- Faculty of Pharmacy and Pharmaceutical Sciences, Josai University, 1-1 Keyakidai, Sakado 350-0295, Saitama, Japan; (S.K.); (K.S.)
| | - István Antal
- Department of Pharmaceutics, Semmelweis University, Hőgyes Str. 7, 1092 Budapest, Hungary; (L.B.); (M.B.); (Z.E.F.P.); (P.S.); (N.A.N.)
| | - Nikolett Kállai-Szabó
- Department of Pharmaceutics, Semmelweis University, Hőgyes Str. 7, 1092 Budapest, Hungary; (L.B.); (M.B.); (Z.E.F.P.); (P.S.); (N.A.N.)
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Weng J, Fink MK, Sharma A. A Critical Appraisal of the Physicochemical Properties and Biological Effects of Artificial Tear Ingredients and Formulations. Int J Mol Sci 2023; 24:ijms24032758. [PMID: 36769079 PMCID: PMC9917348 DOI: 10.3390/ijms24032758] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 01/26/2023] [Accepted: 01/31/2023] [Indexed: 02/04/2023] Open
Abstract
Dry eye disease is among the most prevalent diseases affecting the ocular surface. Artificial tears remain the cornerstone therapy for its management. There are currently a wide variety of marketed artificial tears available to choose from. These artificial tears differ significantly in their composition and formulation. This article reviews the physicochemical and biological properties of artificial tear components and how these characteristics determine their use and efficacy in the management of dry eye. Furthermore, this article also discusses the various formulations of artificial tears such as macro and nanoemulsion and the type of preservatives present in them.
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Affiliation(s)
- Judy Weng
- Chapman University School of Pharmacy, Chapman University, Irvine, CA 92618, USA
| | - Michael K. Fink
- Department of Pathology, University of Colorado Anschutz Medical Campus, Denver, CO 80045, USA
| | - Ajay Sharma
- Chapman University School of Pharmacy, Chapman University, Irvine, CA 92618, USA
- Correspondence: ; Tel.: +1-714-516-5498
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Preclinical study of a new matrix to help the ocular surface in dry eye disease. Exp Eye Res 2022; 222:109168. [PMID: 35777472 DOI: 10.1016/j.exer.2022.109168] [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: 04/22/2022] [Revised: 06/05/2022] [Accepted: 06/25/2022] [Indexed: 11/23/2022]
Abstract
Dry eye disease (DED), a multifactorial disease of the tears and ocular system, causes loss of tear film homeostasis with damage to the ocular surface. This study aimed to assess whether a peculiar matrix based on sodium hyaluronate (HA), xanthan gum (XNT), glycine (GLY) and betaine (BET) as osmoprotectants, could be involved in biological responses. Wound healing assay on human corneal epithelial (HCE) cells in monolayer showed a synergistic effect of the combination of HA + XNT (**p ≤ 0.01) together with an efficient extracellular matrix remodeling of the formulation in SkinEthic™ HCE 3D-model sought by integrin beta-1 (ITGβ1) expression and morphological analysis by hematoxylin and eosin (H&E), compared to a reference marketed product. The synergistic effect of HA + XNT + GLY + BET showed an antioxidant effect on HCE cells (***p ≤ 0.001). Real-time PCR analysis showed that the combination of GLY + BET seemed to ameliorate the effect exhibited by the single osmoprotectants in reducing tumor necrosis factor-alpha (TNFα, #p ≤ 0.05), interleukin-1 beta (IL1β, ####p ≤ 0.0001) and cyclooxygenases-2 (COX2, ####p ≤ 0.0001) genes in SIRC cells under hyperosmotic stress. Furthermore, pretreatment with XNT, alone and in combination (##p ≤ 0.01), reduced COX2 expression in human non-small cell lung cancer cells (A549). Finally, the formulation was well-tolerated following q.i.d. ocular administration in rabbits during a 28-day study. Due to the synergistic effect of its components, the matrix proved able to repair the ocular surface restoring cell homeostasis and to protect the ocular surface from pro-inflammatory pathways activation and oxidative damage, thus behaving as a reactive oxygen species (ROS) scavenger.
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Recchioni A, Mocciardini E, Ponzini E, Tavazzi S. Viscoelastic properties of the human tear film. Exp Eye Res 2022; 219:109083. [PMID: 35460666 DOI: 10.1016/j.exer.2022.109083] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 03/25/2022] [Accepted: 04/18/2022] [Indexed: 12/21/2022]
Abstract
When considering eye blinking from a tribological perspective, tear viscosity is expected to play a fundamental role. The application of rheological techniques to describe the tear film dates back to the late 1980s, but there has been a continuous need of reappraisal due to new findings in tear film biochemistry and to the development of new methods of physico-chemical characterization. This review provides an overview on tear rheological behavior by analyzing the peer-reviewed literature on this topic. Specifically, examples of in-vitro and in-vivo viscosity measurements are detailed, highlighting experimental criticalities and the need of a standard convention for rheological techniques to compare data across different studies, of analyses on tears of single individuals even within the limits of the low volume available, and of a further development of in-vivo techniques. Then, the controversial role of specific tear components on viscosity is discussed, together with the alterations associated to dry eye disease and contact lens wear. Finally, an updated focus is reported on the viscosity of artificial tears formulations.
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Affiliation(s)
- Alberto Recchioni
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, UK; Optometry & Vision Sciences Group, School of Life & Health Sciences, Aston University, Birmingham, UK; Birmingham and Midland Eye Centre, Birmingham, UK
| | - Emanuele Mocciardini
- University of Milano Bicocca, Corso di laurea in Ottica e Optometria, via R. Cozzi 55, I-20125, Milan, Italy
| | - Erika Ponzini
- University of Milano Bicocca, Materials Science Department, via R. Cozzi 55, I-20125, Milan, Italy; University of Milano Bicocca, COMiB research center, via R. Cozzi 55, I-20125, Milan, Italy.
| | - Silvia Tavazzi
- University of Milano Bicocca, Materials Science Department, via R. Cozzi 55, I-20125, Milan, Italy; University of Milano Bicocca, COMiB research center, via R. Cozzi 55, I-20125, Milan, Italy
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Sahu DK, Pradhan D, Biswasroy P, Kar B, Ghosh G, Rath G. Recent trends in nanocarrier based approach in the management of dry eye disease. J Drug Deliv Sci Technol 2021. [DOI: 10.1016/j.jddst.2021.102868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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8
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Cellulosic Polymers for Enhancing Drug Bioavailability in Ocular Drug Delivery Systems. Pharmaceuticals (Basel) 2021; 14:ph14111201. [PMID: 34832983 PMCID: PMC8621906 DOI: 10.3390/ph14111201] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 12/24/2022] Open
Abstract
One of the major impediments to drug development is low aqueous solubility and thus poor bioavailability, which leads to insufficient clinical utility. Around 70–80% of drugs in the discovery pipeline are suffering from poor aqueous solubility and poor bioavailability, which is a major challenge when one has to develop an ocular drug delivery system. The outer lipid layer, pre-corneal, dynamic, and static ocular barriers limit drug availability to the targeted ocular tissues. Biopharmaceutical Classification System (BCS) class II drugs with adequate permeability and limited or no aqueous solubility have been extensively studied for various polymer-based solubility enhancement approaches. The hydrophilic nature of cellulosic polymers and their tunable properties make them the polymers of choice in various solubility-enhancement techniques. This review focuses on various cellulose derivatives, specifically, their role, current status and novel modified cellulosic polymers for enhancing the bioavailability of BCS class II drugs in ocular drug delivery systems.
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A Arshinoff S, Hofmann I, Nae H. Role of rheology in tears and artificial tears. J Cataract Refract Surg 2021; 47:655-661. [PMID: 33278231 DOI: 10.1097/j.jcrs.0000000000000508] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 09/24/2020] [Indexed: 11/26/2022]
Abstract
The study of viscoelastic fluids as artificial tears dates back to the late 1970s. Healon, the first ophthalmic viscosurgical device, was approved in 1980, but studied extensively before then, exhibits very interesting shear-thinning properties that were found to be beneficial in both ophthalmic surgery and somewhat later as a tear replacement solution. Unlike the previous tear film replacements, which were mainly viscous in nature, viscoelastic solutions, particularly those based on hyaluronan, exhibited very interesting, potentially beneficial, rheological properties, especially when slightly altered to become elastoviscous. This review examines the rheological properties that are significant in artificial tear solutions. We define herein the necessary parameters that need to be further studied to design and formulate rheologically better artificial tears, which should provide enhanced efficacy compared with their predecessors.
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Affiliation(s)
- Steve A Arshinoff
- From the York Finch Eye Associates, Toronto, Ontario, Canada (Arshinoff), University of Toronto, Toronto, Ontario, Canada (Arshinoff), I-MED Pharma Inc., Dollard-des-Ormeaux, Québec, Canada (Hofmann), Hydan Technologies, Inc., Princeton Junction, New Jersey (Nae)
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10
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Rahman MS, Hasan MS, Nitai AS, Nam S, Karmakar AK, Ahsan MS, Shiddiky MJA, Ahmed MB. Recent Developments of Carboxymethyl Cellulose. Polymers (Basel) 2021; 13:1345. [PMID: 33924089 PMCID: PMC8074295 DOI: 10.3390/polym13081345] [Citation(s) in RCA: 148] [Impact Index Per Article: 49.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/15/2021] [Accepted: 04/16/2021] [Indexed: 12/22/2022] Open
Abstract
Carboxymethyl cellulose (CMC) is one of the most promising cellulose derivatives. Due to its characteristic surface properties, mechanical strength, tunable hydrophilicity, viscous properties, availability and abundance of raw materials, low-cost synthesis process, and likewise many contrasting aspects, it is now widely used in various advanced application fields, for example, food, paper, textile, and pharmaceutical industries, biomedical engineering, wastewater treatment, energy production, and storage energy production, and storage and so on. Many research articles have been reported on CMC, depending on their sources and application fields. Thus, a comprehensive and well-organized review is in great demand that can provide an up-to-date and in-depth review on CMC. Herein, this review aims to provide compact information of the synthesis to the advanced applications of this material in various fields. Finally, this article covers the insights of future CMC research that could guide researchers working in this prominent field.
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Affiliation(s)
- Md. Saifur Rahman
- Department of Chemistry and Biochemistry, The University of Texas at El Paso, El Paso, TX 79968, USA
| | - Md. Saif Hasan
- Department of Applied Chemistry and Chemical Engineering, University of Rajshahi, Rajshahi 6205, Bangladesh; (M.S.H.); (A.S.N.); (A.K.K.); (M.S.A.)
| | - Ashis Sutradhar Nitai
- Department of Applied Chemistry and Chemical Engineering, University of Rajshahi, Rajshahi 6205, Bangladesh; (M.S.H.); (A.S.N.); (A.K.K.); (M.S.A.)
| | - Sunghyun Nam
- United States Department of Agriculture, Agricultural Research Service, Southern Regional Research Center, 1100 Robert E. Lee Boulevard, New Orleans, LA 70124, USA;
| | - Aneek Krishna Karmakar
- Department of Applied Chemistry and Chemical Engineering, University of Rajshahi, Rajshahi 6205, Bangladesh; (M.S.H.); (A.S.N.); (A.K.K.); (M.S.A.)
| | - Md. Shameem Ahsan
- Department of Applied Chemistry and Chemical Engineering, University of Rajshahi, Rajshahi 6205, Bangladesh; (M.S.H.); (A.S.N.); (A.K.K.); (M.S.A.)
| | - Muhammad J. A. Shiddiky
- School of Environment and Science (ESC) and Queensland Micro- and Nanotechnology Centre (QMNC), Griffith University, Nathan 4111, Australia;
| | - Mohammad Boshir Ahmed
- School of Materials Science and Engineering, Gwangju Institute of Science and Technology, Gwangju 61005, Korea
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Sharma B, Soni D, Saxena H, Stevenson LJ, Karkhur S, Takkar B, Vajpayee RB. Impact of corneal refractive surgery on the precorneal tear film. Indian J Ophthalmol 2020; 68:2804-2812. [PMID: 33229655 PMCID: PMC7856956 DOI: 10.4103/ijo.ijo_2296_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 03/28/2020] [Accepted: 06/24/2020] [Indexed: 11/13/2022] Open
Abstract
Corneal refractive surgeries are one of the commonly performed procedures for correction of refractive errors. Tear film abnormality is the most common postoperative complication of corneal refractive surgeries. Consequently, these procedures represent a clinically significant cause of dry eye disease. The mechanisms which lead to dry eye disease include corneal sensory nerve dysfunction, ocular surface desiccation, glandular apoptosis and ocular surface inflammation. Although transient tear film abnormalities occur in almost all patients following surgery, patients with pre-existing dry eye symptoms or dry eye disease are at significant risk of developing more severe or long-term ocular surface disease. As such, careful patient selection and preoperative evaluation is essential to ensuring successful surgical outcomes. This is particularly important with LASIK which has the strongest association with dry eye disease. Appropriate surface lubrication and anti-inflammatory therapy remains the cornerstone treatment. Timely and effective management is important to facilitate visual rehabilitation and reduce the risk of secondary complications. In this review we describe the causes, pathophysiology, risk factors, manifestations, and management of tear film dysfunction and dry eye disease following corneal refractive surgery.
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Affiliation(s)
- Bhavana Sharma
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Deepak Soni
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Harsha Saxena
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Louis J Stevenson
- Cornea Unit, Royal Victorian Eye and Ear Hospital, East Melbourne, Melbourne, Victoria, Australia
| | - Samendra Karkhur
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Brijesh Takkar
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Rasik B Vajpayee
- Cornea Unit, Royal Victorian Eye and Ear Hospital, East Melbourne, Melbourne, Victoria, Australia
- Cornea Unit, Vision Eye Institute, Melbourne, Victoria, Australia
- Cornea and Cataract Surgery Unit, University of Melbourne, Melbourne, Victoria, Australia
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Aragona P, Benítez-Del-Castillo JM, Coroneo MT, Mukherji S, Tan J, Vandewalle E, Vingrys A, Liu H, Carlisle-Wilcox C, Vehige J, Simmons PA. Safety and Efficacy of a Preservative-Free Artificial Tear Containing Carboxymethylcellulose and Hyaluronic Acid for Dry Eye Disease: A Randomized, Controlled, Multicenter 3-Month Study. Clin Ophthalmol 2020; 14:2951-2963. [PMID: 33061281 PMCID: PMC7534849 DOI: 10.2147/opth.s256480] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 09/01/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To compare the efficacy and safety of an artificial tear combining the polymers carboxymethylcellulose (CMC) and hyaluronic acid (HA), to a formulation of CMC alone in subjects with dry eye. Methods A preservative-free artificial tear (CMC-HA) was compared with an existing artificial tear (CMC). Subjects with mild-to-severe signs and symptoms of dry eye were enrolled in this double-masked, randomized, multicenter trial, and dosed at least twice daily for 90 days, with follow-up visits at Days 7, 30, 60, and 90. Ocular Surface Disease Index (OSDI) was the primary outcome measure. Secondary outcome measures were tear break-up time (TBUT), ocular surface staining, Schirmer test with anesthesia, and visual analog scale (VAS) scores of dry eye symptom severity and formulation acceptability. Safety measures included adverse events, biomicroscopy, and visual acuity. Results A total of 460 subjects were enrolled across 45 sites (38 in Europe; 7 in Australia), of whom 454 were randomized to receive treatment. The per-protocol (PP) population consisted of 394 subjects, 364 (92.4%) of whom completed the study. In the PP population, the mean ± SD change from baseline in OSDI score at the primary timepoint, Day 90, was −16.9±17.5 for CMC-HA and −16.0±16.1 for CMC. CMC-HA was non-inferior to CMC based upon a confidence interval method. Both treatments significantly improved (P<0.001) OSDI, symptom VAS scores, TBUT, and ocular surface staining from baseline at all follow-up visits, with minimal differences between groups. Greater reduction of overall ocular pain/discomfort was reported in subjects using CMC-HA versus CMC (P=0.048). Approximately 10% of subjects in each group reported treatment-related adverse events of generally mild to moderate severity. Conclusion The new CMC-HA formulation was effective and well tolerated, and demonstrates a greater potential for symptom relief compared with CMC. These data support implementation of this formula for the management of dry eye patients.
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Affiliation(s)
- Pasquale Aragona
- Department of Biomedical Sciences, Università di Messina, Messina, Italy
| | | | | | - Subhanjan Mukherji
- Department of Ophthalmology, James Paget University Hospital, Great Yarmouth, UK
| | - Jacqueline Tan
- Optometry and Vision Science, UNSW Sydney, Sydney, NSW, Australia
| | - Evelien Vandewalle
- Department of Ophthalmology, University Hospitals Leuven, Leuven, Belgium
| | - Algis Vingrys
- University of Melbourne EyeCare Clinic, Carlton, VIC, Australia
| | - Haixia Liu
- Allergan, an AbbVie company, Irvine, CA, USA
| | | | | | - Peter A Simmons
- Optometry and Vision Science, UNSW Sydney, Sydney, NSW, Australia.,Allergan, an AbbVie company, Irvine, CA, USA
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Kanikireddy V, Varaprasad K, Jayaramudu T, Karthikeyan C, Sadiku R. Carboxymethyl cellulose-based materials for infection control and wound healing: A review. Int J Biol Macromol 2020; 164:963-975. [PMID: 32707282 DOI: 10.1016/j.ijbiomac.2020.07.160] [Citation(s) in RCA: 148] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 07/03/2020] [Accepted: 07/14/2020] [Indexed: 02/07/2023]
Abstract
The development of ideal wound dressing materials with excellent characteristics is currently a major demand in wound therapy. In recent years, carboxymethyl cellulose (CMC)-based wound dressing materials have been of immense attraction due to their noble properties, such as: biocompatibility, biodegradability, tissue resembling, low cost and non-toxic. It is used extensively, in a variety of applications in the biomedical and pharmaceutical fields. The hydrophilic nature of CMC, makes it possible to blend and cross-link with other materials, such as: synthetic polymers, natural polymers and inorganic materials and it enables the preparation of innovative wound dressing biomaterials. Hence, this review, focuses on the intrinsic characteristics of CMC-based wound dressing materials, including hydrogels, films, 3D printing, fibres, gauzes and their recent advancements in chronic wound healing.
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Affiliation(s)
- Vimala Kanikireddy
- Department of Chemistry, Osmania University, Hyderabad 500 007, Telangana, India.
| | - Kokkarachedu Varaprasad
- Centro de Investigaciòn dePolìmeros Avanzados (CIPA), Edificio de Laboratorios, Avenida Collao 1202, Concepciòn, Chile.
| | - Tippabattini Jayaramudu
- Laboratory of Materials Science, Instituto de Química de Recursos Naturales, Universidad deTalca, 747, Talca, Chile
| | - Chandrasekaran Karthikeyan
- Centro de Investigaciòn dePolìmeros Avanzados (CIPA), Edificio de Laboratorios, Avenida Collao 1202, Concepciòn, Chile
| | - Rotimi Sadiku
- Institute of NanoEngineering Research (INER), Department of Chemical, Metallurgical & Materials Engineering (Polymer Division), Tshwane University of Technology, Pretoria West Campus, Staatsarillerie Rd, Pretoria 1083, South Africa
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14
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Yamasaki K, Drolle E, Nakagawa H, Hisamura R, Ngo W, Jones L. Impact of a low molecular weight hyaluronic acid derivative on contact lens wettability. Cont Lens Anterior Eye 2020; 44:101334. [PMID: 32505651 DOI: 10.1016/j.clae.2020.05.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 05/06/2020] [Accepted: 05/07/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE To investigate the interaction of a novel low molecular weight hyaluronic acid derivative containing hydrophobic groups with soft contact lenses and its effect on lens hydrophilicity compared with a conventional form of hyaluronic acid. METHODS This investigation studied the uptake of fluorescently-labelled hyaluronic acid and a low molecular weight hyaluronic acid derivative to four types of contact lenses using fluorescent microscopy and confocal laser scanning microscopy. Further, the four lens types were used to compare efficacy in improving hydrophilicity, as well as maintenance of contact angle measurements, in commercially available multipurpose solutions that contained either hyaluronic acid, the low molecular weight hyaluronic acid derivative, or an alternative wetting agent. RESULTS The low molecular weight hyaluronic acid derivative was found to sorb more readily to silicone hydrogel lenses and exhibit a greater accumulation over time than conventional hyaluronic acid. Multipurpose solutions containing the low molecular weight hyaluronic acid derivative showed an increase in lens hydrophilicity through decreases in contact angle measurements when compared with those obtained from lenses treated with multipurpose solutions containing conventional hyaluronic acid or alternative wetting agents. This increase in lens hydrophilicity associated with the low molecular weight hyaluronic acid derivative was also maintained over multiple cycles in phosphate buffered saline, while alternative solutions with conventional hyaluronic acid did not. CONCLUSION Overall, lens treatment using a low molecular weight hyaluronic acid derivative-based solution lead to improved in vitro lens hydrophilicity.
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Affiliation(s)
- Katsuhide Yamasaki
- Ophtecs Corporation, 5-2-4 Minatojima-Minami-Machi, Chuo-ku, Kobe, Hyogo, 650-0047, Japan
| | - Elizabeth Drolle
- Centre for Ocular Research and Education (CORE), School of Optometry & Vision Science, University of Waterloo, Waterloo, ON, Canada
| | - Haruki Nakagawa
- Ophtecs Corporation, 5-2-4 Minatojima-Minami-Machi, Chuo-ku, Kobe, Hyogo, 650-0047, Japan
| | - Ryuji Hisamura
- Ophtecs Corporation, 5-2-4 Minatojima-Minami-Machi, Chuo-ku, Kobe, Hyogo, 650-0047, Japan
| | - William Ngo
- Centre for Ocular Research and Education (CORE), School of Optometry & Vision Science, University of Waterloo, Waterloo, ON, Canada
| | - Lyndon Jones
- Centre for Ocular Research and Education (CORE), School of Optometry & Vision Science, University of Waterloo, Waterloo, ON, Canada.
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15
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Aragona P, Simmons PA, Wang H, Wang T. Physicochemical Properties of Hyaluronic Acid-Based Lubricant Eye Drops. Transl Vis Sci Technol 2019; 8:2. [PMID: 31695963 DOI: 10.1167/tvst.8.6.22tvst-19-1425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 08/01/2019] [Indexed: 05/25/2023] Open
Abstract
PURPOSE To assess the physicochemical properties of hyaluronic acid (HA)-based artificial tears. METHODS The average molecular weight (MW) and polydispersion index (PDI) of HA in 18 commercially available artificial tears were determined by light scattering/high-performance liquid chromatography. Osmolality, pH, viscosity, and sodium concentration were determined using an osmometer, pH meter, rheometer, and inductively coupled plasma mass spectrometer, respectively. RESULTS The MW of HA varied considerably between formulations. The PDI was >2.0 in two formulations (2.28 and 4.94), suggesting the presence of a copolymer and/or HA size variability. Three formulations exhibited viscosity exceeding the blur threshold at different shear rates. Viscosity at low shear rates was generally highest in formulations containing high-MW HA. Correlations were found between observed viscosity and a predictive/calculated value, except for four copolymer-containing formulations, and osmolality (range, 154-335 mOsm/kg) and sodium concentration (range, 22-183 mM), with two exceptions. Compared with organic osmolytes, adding sodium decreased viscosity, particularly at lower shear rates. CONCLUSIONS In the context of the literature, our findings suggest that for most patients with dry eye disease, the ideal HA-based artificial tear should include high-MW HA with a low PDI and exhibit enhanced viscosity at low shear rate (without exceeding the blur threshold). The inclusion of synergistic copolymers and a low sodium concentration may increase viscosity, but whether any of these physicochemical properties or correlations can predict clinical efficacy will require further investigation. TRANSLATIONAL RELEVANCE Understanding the properties of HA-based artificial tears will support the development of unique formulations that target specific ocular surface conditions.
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Affiliation(s)
- Pasquale Aragona
- Department of Biomedical Science, Regional Referral Center for Ocular Surface Diseases, University of Messina, Messina, Italy
| | - Peter A Simmons
- Allergan plc, Irvine, CA, USA
- School of Optometry and Vision Science, Faculty of Science, University of New South Wales, Sydney, Australia
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16
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Aragona P, Simmons PA, Wang H, Wang T. Physicochemical Properties of Hyaluronic Acid-Based Lubricant Eye Drops. Transl Vis Sci Technol 2019; 8:2. [PMID: 31695963 PMCID: PMC6827422 DOI: 10.1167/tvst.8.6.2] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 08/01/2019] [Indexed: 12/19/2022] Open
Abstract
Purpose To assess the physicochemical properties of hyaluronic acid (HA)-based artificial tears. Methods The average molecular weight (MW) and polydispersion index (PDI) of HA in 18 commercially available artificial tears were determined by light scattering/high-performance liquid chromatography. Osmolality, pH, viscosity, and sodium concentration were determined using an osmometer, pH meter, rheometer, and inductively coupled plasma mass spectrometer, respectively. Results The MW of HA varied considerably between formulations. The PDI was >2.0 in two formulations (2.28 and 4.94), suggesting the presence of a copolymer and/or HA size variability. Three formulations exhibited viscosity exceeding the blur threshold at different shear rates. Viscosity at low shear rates was generally highest in formulations containing high-MW HA. Correlations were found between observed viscosity and a predictive/calculated value, except for four copolymer-containing formulations, and osmolality (range, 154–335 mOsm/kg) and sodium concentration (range, 22–183 mM), with two exceptions. Compared with organic osmolytes, adding sodium decreased viscosity, particularly at lower shear rates. Conclusions In the context of the literature, our findings suggest that for most patients with dry eye disease, the ideal HA-based artificial tear should include high-MW HA with a low PDI and exhibit enhanced viscosity at low shear rate (without exceeding the blur threshold). The inclusion of synergistic copolymers and a low sodium concentration may increase viscosity, but whether any of these physicochemical properties or correlations can predict clinical efficacy will require further investigation. Translational Relevance Understanding the properties of HA-based artificial tears will support the development of unique formulations that target specific ocular surface conditions.
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Affiliation(s)
- Pasquale Aragona
- Department of Biomedical Science, Regional Referral Center for Ocular Surface Diseases, University of Messina, Messina, Italy
| | - Peter A Simmons
- Allergan plc, Irvine, CA, USA.,School of Optometry and Vision Science, Faculty of Science, University of New South Wales, Sydney, Australia
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17
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Alanazi SA, Badawood YS, Aldawood MA, El-Hiti GA, Masmali AM. Effect of Refresh Plus ® preservative-free lubricant eyedrops on tear ferning patterns in dry eye and normal eye subjects. Clin Ophthalmol 2019; 13:1011-1017. [PMID: 31354235 PMCID: PMC6582768 DOI: 10.2147/opth.s213365] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 05/29/2019] [Indexed: 12/14/2022] Open
Abstract
Purpose To evaluate the tear ferning patterns in dry eye and normal eye subjects in the 3 hours following application of Refresh Plus® preservative-free lubricant eyedrops. Methods Thirty men with dry eye (mean age 22.14±2.34 years) and 30 age-matched men with normal eyes (mean age 23.91±3.24 years) were enrolled. Eyes were classified as normal or dry based on their Ocular Surface Disease Index score, tear meniscus height, and noninvasive tear breakup time. The tear ferning test was performed before and 30, 60, 120, and 180 minutes after application of a Refresh Plus eyedrop into the right eye in each subject. Results There was a significant change in tear ferning grade after application of Refresh Plus eyedrops (P=0.02, Wilcoxon test) in the group with dry eye, but not in the normal eye group (P=0.19, Wilcoxon test). The correlation of tear ferning grade was moderate (r=0.484, P=0.049) at 60 minutes after application of the eyedrops and strong at 120 minutes (r=0.560, P=0.019) and 180 minutes (r=0.726, P=0.001). There was also a strong correlation (r=0.865, P=0.001) between tear ferning grades obtained 120 and 180 minutes after application. In the normal eye group, there was a moderate (r=0.407, P=0.029) correlation between tear ferning grades obtained before and 60 minutes after application of the eyedrops. There was also a strong correlation (r=0.532, P=0.003) between tear ferning grades obtained 120 and 180 minutes after application. Conclusion Tear ferning patterns improved significantly after application of Refresh Plus preservative-free lubricant eyedrops in subjects with dry eye. Artificial tears containing sodium carboxymethylcellulose, such as Refresh Plus, can be used to improve tear ferning patterns in dry eye for at least 3 hours.
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Affiliation(s)
- Saud A Alanazi
- Cornea Research Chair, Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh, 11433, Saudi Arabia
| | - Yousef S Badawood
- Cornea Research Chair, Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh, 11433, Saudi Arabia
| | - Mohammed A Aldawood
- Cornea Research Chair, Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh, 11433, Saudi Arabia
| | - Gamal A El-Hiti
- Cornea Research Chair, Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh, 11433, Saudi Arabia
| | - Ali M Masmali
- Cornea Research Chair, Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh, 11433, Saudi Arabia
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18
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Lievens C, Berdy G, Douglass D, Montaquila S, Lin H, Simmons P, Carlisle-Wilcox C, Vehige J, Haque S. Evaluation of an enhanced viscosity artificial tear for moderate to severe dry eye disease: A multicenter, double-masked, randomized 30-day study. Cont Lens Anterior Eye 2018; 42:443-449. [PMID: 30573298 DOI: 10.1016/j.clae.2018.12.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 12/03/2018] [Accepted: 12/04/2018] [Indexed: 12/20/2022]
Abstract
PURPOSE In a randomized, controlled clinical trial, two lubricant artificial tear formulations with enhanced viscosity were compared: an investigational product at the time, containing carboxymethylcellulose 1.0% and glycerin 0.9% (CMC-GLY) with osmoprotectants, and a standard formula containing carboxymethylcellulose 1.0% alone (CMC). METHODS This double-masked study recruited patients with moderate to severe dry eye at 10 US centers. After a 7-day run-in with CMC 0.5% (Refresh Tears) patients were randomized to use either CMC-GLY or CMC as needed, but at least 2 times daily for 30 days. Patients were stratified by Ocular Surface Disease Index© (OSDI) score into moderate (23-32) and severe (> 32-65) subgroups. Assessments included OSDI (primary efficacy variable), corneal and conjunctival staining, tear break-up time (TBUT), symptom surveys, and safety variables. Study visits were days 1 (baseline/randomization), 7, and 30. RESULTS A total of 188 patients (94 CMC-GLY, 94 CMC) were enrolled. The severe subgroup had 67 CMC-GLY and 65 CMC patients. OSDI scores progressively improved and were similar at day 30 between treatment groups. At day 7, only the CMC-GLY group demonstrated significant improvements from baseline in OSDI score (all patients p < 0.001, severe p < 0.001), corneal staining (p = 0.004), and TBUT (p < 0.001). Between-group dose frequency for CMC-GLY was lower at day 7 (p = 0.031). Other efficacy results were similar between groups. The most commonly reported adverse event in both groups was blurred vision. CONCLUSIONS Overall, the CMC-GLY artificial tear formulation was as effective as the CMC formulation. CMC-GLY demonstrated improvements at an earlier stage (day 7). Both artificial tear formulations were safe and well tolerated, with no treatment-related serious adverse events. These results support the use of the CMC-GLY artificial tear formulation as an effective treatment to reduce the symptoms and signs of dry eye disease.
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Affiliation(s)
| | - Gregg Berdy
- Washington University School of Medicine, and Ophthalmology Associates, Saint Louis, MO, USA.
| | | | | | - Hugh Lin
- Allergan Clinical Research, Irvine, CA, USA.
| | | | | | | | - Sameena Haque
- Allergan International Medical Affairs, Marlow, Buckinghamshire, UK.
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19
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Fezza JP. Cross-linked hyaluronic acid gel occlusive device for the treatment of dry eye syndrome. Clin Ophthalmol 2018; 12:2277-2283. [PMID: 30510396 PMCID: PMC6231461 DOI: 10.2147/opth.s187963] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose A new cross-linked hyaluronic acid (xlHA) gel occlusive device was assessed for safety and efficacy in the treatment of dry eyes. Methods This was an institutional review board-approved, single-site, open-label, prospective study to assess the efficacy and safety of placing the xlHA gel in the lower canaliculus. Seventy-four participants aged 25-95 years with dry eyes, who failed treatment with artificial tears, were included. Patients were assessed with corneal slit lamp examination with fluorescein staining and with Schirmer's test, breakup time (TBUT), and tear meniscus height (TMH) at baseline, 1 month, and 3 months. Patients were followed at 6 months with a telephone questionnaire. The procedure entailed inserting ~0.2 mL of xlHA gel into each lower lid canaliculus with a syringe and lacrimal irrigator. Patients were followed for adverse events. Results Sixty-three patients completed the study (48 females, 15 males), with an average age of 67 years. Slit lamp demonstrated improved corneal fluorescein staining. Schirmer's tests demonstrated an average increase over baseline of 3.67 mm after 3 months. TBUT improved 87% and TMH increased by 57% at 3 months over baseline. All objective measures were statically significant. There was one case of conjunctivitis that resolved and was felt to be an incidental viral infection. Conclusion The xlHA Occlusive Device offers a new, safe, and effective method to treat dry eyes. It appears to have efficacy for at least 3 months on clinical examination. The xlHA gel demonstrated a good tolerance and safety profile.
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20
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Wallerstein A, Jackson WB, Chambers J, Moezzi AM, Lin H, Simmons PA. Management of post-LASIK dry eye: a multicenter randomized comparison of a new multi-ingredient artificial tear to carboxymethylcellulose. Clin Ophthalmol 2018; 12:839-848. [PMID: 29765198 PMCID: PMC5944453 DOI: 10.2147/opth.s163744] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To compare the efficacy and safety of a preservative-free, multi-ingredient formulation of carboxymethylcellulose 0.5%, hyaluronic acid 0.1%, and organic osmolytes (CMC-HA), to preservative-free carboxymethylcellulose 0.5% (CMC) in the management of postoperative signs and symptoms of dry eye following laser-assisted in situ keratomileusis (LASIK). Methods This was a double-masked, randomized, parallel-group study conducted in 14 clinical centers in Canada and Australia. Subjects with no more than mild dry eye instilled CMC-HA or CMC for 90 days post-LASIK. Ocular Surface Disease Index© (OSDI; primary efficacy measure), corneal staining, tear break-up time (TBUT), Schirmer’s test, acceptability/tolerability surveys, and visual acuity were assessed at screening and days 2, 10, 30, 60, and 90 post-surgery. Safety analyses included all enrolled. Results A total of 148 subjects (CMC-HA, n=75; CMC, n=73) were enrolled and assigned to receive treatment, and 126 subjects completed the study without any protocol violations. Post-LASIK, dry eye signs/symptoms peaked at 10 days. OSDI scores for both groups returned to normal with no differences between treatment groups at day 90 (P=0.775). Corneal staining, Schirmer’s test, TBUT, and survey results were comparable. Higher mean improvements in uncorrected visual acuity were observed in the CMC-HA group at all study visits, reaching statistical significance at day 30 (P=0.013). Both treatments were well tolerated. Conclusion CMC-HA-containing artificial tears relieved post-LASIK ocular dryness as well as CMC alone, and demonstrated incremental benefit in uncorrected vision, with a favorable safety profile. Results support use of CMC-HA eye drops to reduce signs and symptoms of ocular dryness post-LASIK.
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Affiliation(s)
- Avi Wallerstein
- Department of Ophthalmology, McGill University, Montreal, QC, Canada.,LASIK MD, Montreal, QC, Canada
| | - W Bruce Jackson
- University of Ottawa Eye Institute of the Ottawa Hospital, Ottawa, ON, Canada
| | | | - Amir M Moezzi
- Centre for Ocular Research & Education (CORE, formerly Centre for Contact Lens Research), School of Optometry & Vision Science, University of Waterloo, Waterloo, ON, Canada
| | - Hugh Lin
- Allergan Clinical Research, Allergan plc, Irvine, CA, USA
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