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Medic N, Boldin I, Berisha B, Matijak-Kronschachner B, Aminfar H, Schwantzer G, Müller-Lierheim WGK, van Setten GB, Horwath-Winter J. Application frequency - key indicator for the efficiency of severe dry eye disease treatment - evidence for the importance of molecular weight of hyaluronan in lubricating agents. Acta Ophthalmol 2024; 102:e663-e671. [PMID: 38131131 DOI: 10.1111/aos.16609] [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] [Received: 05/01/2023] [Revised: 11/09/2023] [Accepted: 12/08/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE Lubricant eye drops are the main therapeutic resource for dry eye disease (DED), with each drop representing the equivalent of ocular surface disease treatment. Thus, any reduction in the frequency of eye drop application reflects a degree of therapeutic success. Considering also the socioeconomic burden of DED, we investigated eye drop application frequency (DF) as a parameter to potentially track the success of therapy in severe DED. Hyaluronan (HA)-containing eye drops have become the first choice for tear substitution in many countries, and recent data indicate that the average molecular weight (Mw) of HA determines the therapeutic efficacy of such eye drops. This post-hoc subgroup analysis of a previously published multicentre prospective randomized open-label study, HYLAN M, is set out to compare the effects of very high Mw HA (hylan A) eye drops to comparator eye drops, containing lower Mw HA (control). METHODS Patients with severe DED (n = 47), recruited as part of the larger HYLAN M prospective, multicentre, open-label study, were randomized into two groups: hylan A and control group. In the hylan A group, 24 patients replaced their HA-containing eye drops with eye drops containing 0.15% hylan A, whereas the 23 control patients continued to use comparator HA eye drops. The DF was recorded daily by all participants over 8 weeks, and other subjective and objective parameters of DED were assessed at the time of inclusion (baseline), as well as at week 4 and 8. RESULTS There was a significant decrease in DF in the hylan A users between the baseline and week 4 (p = 0.004), remaining stable until week 8. Indeed, in contrast to the baseline, the hylan A group had a significantly lower DF than the control group at weeks 4 (p = 0.018) and 8 (p = 0.008). Likewise, the ocular surface disease index (OSDI) improved significantly between the time of inclusion and week 4 (p < 0.001) in hylan A users, remaining stable until week 8. The OSDI was similar in both groups at the baseline but it was significantly lower in the hylan A group than in the control group at week 4 (p = 0.002), remaining lower at week 8. Such a decrease in the DF and OSDI was not witnessed in the control group at any time point. The objective parameters assessed did not differ significantly within or between the two groups. CONCLUSION When treating severe DED, the DF can be significantly reduced by using very high Mw HA (3 MDa) lubricant eye drops, which better alleviate DED symptoms and decrease the OSDI scores. These drops not only provide an attractive and comfortable alternative for patients with severe DED but also offer the possibility of reducing the disease's socioeconomic burden, both for affected individuals and society as a whole.
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Affiliation(s)
- Nika Medic
- Department of Ophthalmology, Medical University of Graz, Graz, Austria
| | - Ingrid Boldin
- Department of Ophthalmology, Medical University of Graz, Graz, Austria
| | - Bujar Berisha
- Department of Ophthalmology, Medical University of Graz, Graz, Austria
| | | | - Haleh Aminfar
- Department of Ophthalmology, Medical University of Graz, Graz, Austria
| | - Gerold Schwantzer
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | | | - Gysbert-Botho van Setten
- Department of Clinical Neuroscience, St. Eriks Eye Hospital, Karolinska Institutet, Stockholm, Sweden
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Wang TJ, Rethi L, Ku MY, Nguyen HT, Chuang AEY. A review on revolutionizing ophthalmic therapy: Unveiling the potential of chitosan, hyaluronic acid, cellulose, cyclodextrin, and poloxamer in eye disease treatments. Int J Biol Macromol 2024; 273:132700. [PMID: 38879998 DOI: 10.1016/j.ijbiomac.2024.132700] [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] [Received: 08/21/2023] [Revised: 05/24/2024] [Accepted: 05/26/2024] [Indexed: 06/18/2024]
Abstract
Ocular disorders, encompassing both common ailments like dry eye syndrome and more severe situations for instance age-related macular degeneration, present significant challenges to effective treatment due to the intricate architecture and physiological barriers of the eye. Polysaccharides are emerging as potential solutions for drug delivery to the eyes due to their compatibility with living organisms, natural biodegradability, and adhesive properties. In this review, we explore not only the recent advancements in polysaccharide-based technologies and their transformative potential in treating ocular illnesses, offering renewed optimism for both patients and professionals but also anatomy of the eye and the significant obstacles hindering drug transportation, followed by an investigation into various drug administration methods and their ability to overcome ocular-specific challenges. Our focus lies on biological adhesive polymers, including chitosan, hyaluronic acid, cellulose, cyclodextrin, and poloxamer, known for their adhesive characteristics enhancing drug retention on ocular surfaces and increasing bioavailability. A detailed analysis of material designs used in ophthalmic formulations, such as gels, lenses, eye drops, nanofibers, microneedles, microspheres, and nanoparticles, their advantages and limitations, the potential of formulations in improving therapeutic outcomes for various eye conditions. Moreover, we underscore the discovery of novel polysaccharides and their potential uses in ocular drug delivery.
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Affiliation(s)
- Tsung-Jen Wang
- Department of Ophthalmology, Taipei Medical University Hospital, Taipei 11031, Taiwan; Department of Ophthalmology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Lekshmi Rethi
- Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, New Taipei City, Taiwan; International Ph.D. Program in Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, New Taipei City, Taiwan
| | - Min-Yi Ku
- School of Biomedical Engineering, Taipei Medical University, New Taipei City, Taiwan
| | - Hieu Trung Nguyen
- Department of Orthopedics and Trauma, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 700000, Viet Nam
| | - Andrew E-Y Chuang
- Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, New Taipei City, Taiwan; International Ph.D. Program in Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, New Taipei City, Taiwan; Cell Physiology and Molecular Image Research Center, Taipei Medical University-Wan Fang Hospital, Taipei 11696, Taiwan.
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Ouyang XW, Fang S, Yi YM, Zou SP, Hu QY, Huang ZX, Li QX, Luo JY. Different concentrations of hyaluronic acid eye drops for dry eye syndrome: a systematic review and Meta-analysis. Int J Ophthalmol 2024; 17:1110-1119. [PMID: 38895674 PMCID: PMC11144765 DOI: 10.18240/ijo.2024.06.17] [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: 09/23/2023] [Accepted: 02/02/2024] [Indexed: 06/21/2024] Open
Abstract
AIM To compare high or low concentration of hyaluronic acid eye drops (HY) for dry eye syndromes (DES). METHODS Randomized controlled trials (RCTs) comparing various concentrations of HY were searched in PubMed, Embase, Web of Science, Cochrane, SinoMed, CNKI, Wanfang Database, CQVIP, and Chinese journals databases between inception and July 2023. Pooled standardized mean differences (SMD) or weighted mean difference (WMD) with 95% confidence intervals (CI) from RCTs evaluating Schirmer's I test (SIT), corneal fluorescein staining score (CFS), tear breakup time (TBUT), DES score (DESS), and Ocular Surface Disease Index (OSDI) were calculated. Sensitivity analysis, Egger's test and Meta-regression analysis were performed for all indicators. RESULTS We conducted a Meta-analysis of 10 RCTs that met the inclusion criteria, involving 1796 cases. High-concentrations group significantly improved the outcome of CFS according to random effects modelling (SMD, -3.37; 95%CI, -5.25 to -1.48; P=0.0005). The rest of the results were not statistically significant, including indicators such as SIT, TBUT, DESS and OSDI. CONCLUSION For dry eyes with positive corneal staining, a high concentration of HY is recommended, whereas in other cases, a high concentration of HY does not offer a more pronounced advantage over a low concentration of HY in the treatment of dry eyes.
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Affiliation(s)
- Xiao-Wei Ouyang
- Department of Ophthalmology, Nanchang Hongdu Hospital of Traditional Chinese Medicine, Nanchang 330000, Jiangxi Province, China
| | - Sheng Fang
- Department of Ophthalmology, Jiangxi Hospital of Integrated Traditional Chinese and Western Medicine, Nanchang 330000, Jiangxi Province, China
| | - Yun-Min Yi
- Department of Cataract, Nanchang University Affiliated Eye Hospital, Nanchang 330000, Jiangxi Province, China
| | - Shi-Peng Zou
- Department of Neuro-ophthalmology, Nanchang University Affiliated Eye Hospital, Nanchang 330000, Jiangxi Province, China
| | - Qi-Yu Hu
- Department of Ophthalmology, Nanchang Hongdu Hospital of Traditional Chinese Medicine, Nanchang 330000, Jiangxi Province, China
| | - Zi-Xuan Huang
- Department of Ophthalmology, Nanchang Hongdu Hospital of Traditional Chinese Medicine, Nanchang 330000, Jiangxi Province, China
| | - Qing-Xia Li
- Department of Ophthalmology, Nanchang Hongdu Hospital of Traditional Chinese Medicine, Nanchang 330000, Jiangxi Province, China
| | - Jin-Yan Luo
- Department of Ophthalmology, Nanchang Hongdu Hospital of Traditional Chinese Medicine, Nanchang 330000, Jiangxi Province, China
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Brugnera M, Vicario-de-la-Torre M, González-Cela Casamayor MA, López-Cano JJ, Bravo-Osuna I, Huete-Toral F, González Rubio ML, Carracedo G, Molina-Martínez IT, Andrés-Guerrero V, Herrero-Vanrell R. Enhancing the hypotensive effect of latanoprost by combining synthetic phosphatidylcholine liposomes with hyaluronic acid and osmoprotective agents. Drug Deliv Transl Res 2024:10.1007/s13346-024-01584-z. [PMID: 38602615 DOI: 10.1007/s13346-024-01584-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2024] [Indexed: 04/12/2024]
Abstract
The first line of glaucoma treatment focuses on reducing intraocular pressure (IOP) through the prescription of topical prostaglandin analogues, such as latanoprost (LAT). Topical ophthalmic medicines have low bioavailability due to their rapid elimination from the ocular surface. Nanotechnology offers innovative ways of enhancing the ocular bioavailability of antiglaucoma agents while reducing administration frequency. This study aims to combine LAT-loaded synthetic phosphatidylcholine liposomes with hyaluronic acid (0.2% w/v) and the osmoprotectants betaine (0.40% w/v) and leucine (0.90% w/v) (LAT-HA-LIP) to extend the hypotensive effect of LAT while protecting the ocular surface. LAT-HA-LIP was prepared as a mixture of 1,2-dioleoyl-sn-glycero-3-phosphocholine and 1,2-dimyristoyl-sn-glycero-3-phosphocholine, cholesterol and α-tocopherol acetate. LAT-HA-LIP exhibited high drug-loading capacity (104.52 ± 4.10%), unimodal vesicle sizes (195.14 ± 14.34 nm) and a zeta potential of -13.96 ± 0.78 mV. LAT-HA-LIP was isotonic (284.00 ± 1.41 mOsm L-1), had neutral pH (7.63 ± 0.01) and had suitable surface tension (44.07 ± 2.70 mN m-1) and viscosity (2.69 ± 0.15 mPa s-1) for topical ophthalmic administration. LAT-HA-LIP exhibited optimal in vitro tolerance in human corneal and conjunctival epithelial cells. No signs of ocular alteration or discomfort were observed when LAT-HA-LIP was instilled in albino male New Zealand rabbits. Hypotensive studies revealed that, after a single eye drop, the effect of LAT-HA-LIP lasted 24 h longer than that of a marketed formulation and that relative ocular bioavailability was almost three times higher (p < 0.001). These findings indicate the potential ocular protection and hypotensive effect LAT-HA-LIP offers in glaucoma treatment.
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Affiliation(s)
- Marco Brugnera
- Innovation, Therapy and Pharmaceutical Development in Ophthalmology (InnOftal) Research Group, Complutense University of Madrid (UCM), Madrid, Spain
- Department of Pharmaceutics and Food Technology, Faculty of Pharmacy, UCM; IdISSC, Madrid, Spain
- University Institute of Industrial Pharmacy (IUFI), Faculty of Pharmacy, UCM, Madrid, Spain
| | - Marta Vicario-de-la-Torre
- Innovation, Therapy and Pharmaceutical Development in Ophthalmology (InnOftal) Research Group, Complutense University of Madrid (UCM), Madrid, Spain
- Department of Pharmaceutics and Food Technology, Faculty of Pharmacy, UCM; IdISSC, Madrid, Spain
- University Institute of Industrial Pharmacy (IUFI), Faculty of Pharmacy, UCM, Madrid, Spain
| | - Miriam Ana González-Cela Casamayor
- Innovation, Therapy and Pharmaceutical Development in Ophthalmology (InnOftal) Research Group, Complutense University of Madrid (UCM), Madrid, Spain
- Department of Pharmaceutics and Food Technology, Faculty of Pharmacy, UCM; IdISSC, Madrid, Spain
| | - José Javier López-Cano
- Innovation, Therapy and Pharmaceutical Development in Ophthalmology (InnOftal) Research Group, Complutense University of Madrid (UCM), Madrid, Spain
- Department of Pharmaceutics and Food Technology, Faculty of Pharmacy, UCM; IdISSC, Madrid, Spain
| | - Irene Bravo-Osuna
- Innovation, Therapy and Pharmaceutical Development in Ophthalmology (InnOftal) Research Group, Complutense University of Madrid (UCM), Madrid, Spain
- Department of Pharmaceutics and Food Technology, Faculty of Pharmacy, UCM; IdISSC, Madrid, Spain
- University Institute of Industrial Pharmacy (IUFI), Faculty of Pharmacy, UCM, Madrid, Spain
| | - Fernando Huete-Toral
- Ocupharm Research Group, Department of Optometry and Vision, Faculty of Optics and Optometry, UCM, Madrid, Spain
| | - María Luisa González Rubio
- Ocupharm Research Group, Department of Optometry and Vision, Faculty of Optics and Optometry, UCM, Madrid, Spain
| | - Gonzalo Carracedo
- Ocupharm Research Group, Department of Optometry and Vision, Faculty of Optics and Optometry, UCM, Madrid, Spain
| | - Irene Teresa Molina-Martínez
- Innovation, Therapy and Pharmaceutical Development in Ophthalmology (InnOftal) Research Group, Complutense University of Madrid (UCM), Madrid, Spain
- Department of Pharmaceutics and Food Technology, Faculty of Pharmacy, UCM; IdISSC, Madrid, Spain
- University Institute of Industrial Pharmacy (IUFI), Faculty of Pharmacy, UCM, Madrid, Spain
| | - Vanessa Andrés-Guerrero
- Innovation, Therapy and Pharmaceutical Development in Ophthalmology (InnOftal) Research Group, Complutense University of Madrid (UCM), Madrid, Spain.
- Department of Pharmaceutics and Food Technology, Faculty of Pharmacy, UCM; IdISSC, Madrid, Spain.
- University Institute of Industrial Pharmacy (IUFI), Faculty of Pharmacy, UCM, Madrid, Spain.
| | - Rocío Herrero-Vanrell
- Innovation, Therapy and Pharmaceutical Development in Ophthalmology (InnOftal) Research Group, Complutense University of Madrid (UCM), Madrid, Spain.
- Department of Pharmaceutics and Food Technology, Faculty of Pharmacy, UCM; IdISSC, Madrid, Spain.
- University Institute of Industrial Pharmacy (IUFI), Faculty of Pharmacy, UCM, Madrid, Spain.
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Higa K, Kimoto R, Kojima T, Dogru M, Müller-Lierheim WGK, Shimazaki J. Therapeutic Aqueous Humor Concentrations of Latanoprost Attained in Rats by Administration in a Very-High-Molecular-Weight Hyaluronic Acid Eye Drop. Pharmaceutics 2024; 16:523. [PMID: 38675184 PMCID: PMC11053993 DOI: 10.3390/pharmaceutics16040523] [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: 01/22/2024] [Revised: 03/25/2024] [Accepted: 04/08/2024] [Indexed: 04/28/2024] Open
Abstract
The temporal change in concentration of a novel medicine, Latanoprost (LP), was evaluated in the aqueous humor of rats (6-8-week-old Jcl:Wister rats) when delivered in a very-high-molecular-weight hyaluronic acid (vHiHA) eye drop. Animals were randomly assigned to three treatment groups (LP + vHiHA (LPvHiHA), commercial LP (cLP), and diluted LP (dLP)) and after instilling the eye drops, the aqueous humor (AH) was collected at 0.5, 1, 2, 4, and 6 h to measure the LP concentration using an enzyme-linked immunosorbent assay (ELISA). Although the LP concentration in the LPvHiHA eye drop formulation was 3.57 times lower than in the commercial eye drops used (cLP), the LP concentration in the AH following LPvHiHA administration reached a value close to that of cLP. The cLP was diluted to the same concentration of LP as in the LPvHiHA eye drops for the dLP group, but the LP concentration in the AH of these animals was lower than that of the LPvHiHA rats at all time points. The higher LP concentration in the AH of the LPvHiHA rats suggests that vHiHA may aid the transport of LP across the ocular surface epithelium.
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Affiliation(s)
- Kazunari Higa
- Cornea Center Eye Bank, Tokyo Dental College Ichikawa General Hospital, 5-11-13 Sugano, Ichikawa 272-8513, Japan; (R.K.); (J.S.)
| | - Reona Kimoto
- Cornea Center Eye Bank, Tokyo Dental College Ichikawa General Hospital, 5-11-13 Sugano, Ichikawa 272-8513, Japan; (R.K.); (J.S.)
| | - Takashi Kojima
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Tokyo 160-8582, Japan; (T.K.); (M.D.)
| | - Murat Dogru
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Tokyo 160-8582, Japan; (T.K.); (M.D.)
| | | | - Jun Shimazaki
- Cornea Center Eye Bank, Tokyo Dental College Ichikawa General Hospital, 5-11-13 Sugano, Ichikawa 272-8513, Japan; (R.K.); (J.S.)
- Department of Ophthalmology, Tokyo Dental College Ichikawa General Hospital, 5-11-13 Sugano, Ichikawa 272-8513, Japan
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Tang X, Liu J, Yan R, Peng Q. Carbohydrate polymer-based bioadhesive formulations and their potentials for the treatment of ocular diseases: A review. Int J Biol Macromol 2023; 242:124902. [PMID: 37210054 DOI: 10.1016/j.ijbiomac.2023.124902] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 04/27/2023] [Accepted: 05/13/2023] [Indexed: 05/22/2023]
Abstract
Eyes are directly exposed to the outer environment and susceptible to infections, leading to various ocular disorders. Local medication is preferred to treat eye diseases due to its convenience and compliance. However, the rapid clearance of the local formulations highly limits the therapeutic efficacy. In the past decades, several carbohydrate bioadhesive polymers (CBPs), such as chitosan and hyaluronic acid, have been used in ophthalmology for sustained ocular drug delivery. These CBP-based delivery systems have improved the treatment of ocular diseases to a large extent but also caused some undesired effects. Herein, we aim to summarize the applications of some typical CBPs (including chitosan, hyaluronic acid, cellulose, cyclodextrin, alginate and pectin) in treating ocular diseases from the general view of ocular physiology, pathophysiology and drug delivery, and to provide a comprehensive understanding of the design of the CBP-based formulations for ocular use. The patents and clinical trials of CBPs for ocular management are also discussed. In addition, a discussion on the concerns of CBPs in clinical use and the possible solutions is presented.
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Affiliation(s)
- Xuelin Tang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jianhong Liu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Ruijiao Yan
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Qiang Peng
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China.
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7
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Thermoresponsive in-situ gel containing hyaluronic acid and indomethacin for the treatment of corneal chemical burn. Int J Pharm 2023; 631:122468. [PMID: 36503038 DOI: 10.1016/j.ijpharm.2022.122468] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/20/2022] [Accepted: 12/04/2022] [Indexed: 12/13/2022]
Abstract
Ocular chemical burns are prevalent injuries that must have immediate and effective treatment to avoid complications. Aiming to improve bioavailability and efficacy, a poloxamer-based thermoresponsive in-situ gelling system containing hyaluronic acid and indomethacin was developed. Formulations with different polymeric proportions were screened through rheological measurements resulting in an optimized system (F2) with gelling temperature of 34.2 ± 0.11 °C. Its maximum viscosity varied from 77.33 mPa (25 °C) to 82.95 mPa (34 °C) following a non-Newtonian profile and a pH of 6.86 ± 0.01. No incompatibilities were found after infrared analysis. Polarized light microscopy and cryo-transmission electron microscopy have demonstrated micelles of nano-sized dimensions (21.86 nm) with indomethacin entrapped in the core, forming a polymeric network under heating. In vitro tests revealed a cumulative release of 59.75 ± 3.17 % up to 24 h under a sustained release profile. Results from HET-CAM assay indicated that F2 was well tolerated. Corneal wound healing was significantly faster in animals treated with F2 compared to a commercial formulation and an untreated group. These findings suggests that F2 could be an efficient system to delivery drugs into the ocular surface improving wound healing.
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Semp DA, Beeson D, Sheppard AL, Dutta D, Wolffsohn JS. Artificial Tears: A Systematic Review. CLINICAL OPTOMETRY 2023; 15:9-27. [PMID: 36647552 PMCID: PMC9840372 DOI: 10.2147/opto.s350185] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 12/17/2022] [Indexed: 06/17/2023]
Abstract
Artificial tears are the mainstay of dry eye disease management, but also have a role in corneal abrasion and wound healing, pain and inflammation management, conjunctivitis, keratitis, contact lens rewetting and removal, and foreign body removal. A systematic review of randomized controlled trials (PROSPERO registration CRD42022369619) comparing the efficacy of artificial tears in patients with dry eye to inform prescribing choices using Web of Science, PubMed and Medline databases identified 64 relevant articles. There is good evidence that artificial tears improve symptoms of dry eye disease within a month of regular use, applied about four times a day, but signs generally take several months to improve. Not all patients with dry eye disease benefit from artificial tears, so if there is no benefit over a month, alternative management should be considered. Combination formulations are more effective than single active ingredient artificial tears. Artificial tears containing polyethylene glycol are more effective than those containing carboxymethylcellulose/carmellose sodium and hydroxypropyl methylcellulose. Those classified as having evaporative dry eye disease, benefit from artificial tears with liposomes, especially of higher concentration. The data available is limited by the definition of dry eye disease applied in published studies being variable, as well as the disease severity examined and compliance with artificial tears being rarely quantified.
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Affiliation(s)
- David A Semp
- School of Optometry, College of Health and Life Sciences, Aston University, Birmingham, UK
| | - Danielle Beeson
- School of Optometry, College of Health and Life Sciences, Aston University, Birmingham, UK
| | - Amy L Sheppard
- School of Optometry, College of Health and Life Sciences, Aston University, Birmingham, UK
| | - Debarun Dutta
- School of Optometry, College of Health and Life Sciences, Aston University, Birmingham, UK
| | - James S Wolffsohn
- School of Optometry, College of Health and Life Sciences, Aston University, Birmingham, UK
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Zheng X, Wang B, Tang X, Mao B, Zhang Q, Zhang T, Zhao J, Cui S, Chen W. Absorption, metabolism, and functions of hyaluronic acid and its therapeutic prospects in combination with microorganisms: A review. Carbohydr Polym 2023; 299:120153. [PMID: 36876779 DOI: 10.1016/j.carbpol.2022.120153] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 09/21/2022] [Accepted: 09/21/2022] [Indexed: 11/25/2022]
Abstract
Hyaluronic acid (HA) is key to the stability of the internal environment of tissues. HA content in tissues gradually decreases with age, causing age-related health problems. Exogenous HA supplements are used to prevent or treat these problems including skin dryness and wrinkles, intestinal imbalance, xerophthalmia, and arthritis after absorption. Moreover, some probiotics are able to promote endogenous HA synthesis and alleviate symptoms caused by HA loss, thus introducing potential preventative or therapeutic applications of HA and probiotics. Here, we review the oral absorption, metabolism, and biological function of HA as well as the potential role of probiotics and HA in increasing the efficacy of HA supplements.
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Affiliation(s)
- Xueli Zheng
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi 214122, China; School of Food Science and Technology, Jiangnan University, Wuxi 214122, China
| | - Botao Wang
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi 214122, China; School of Food Science and Technology, Jiangnan University, Wuxi 214122, China; Bloomage Biotechnology Co., Ltd, Jinan 250000, China
| | - Xin Tang
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi 214122, China; School of Food Science and Technology, Jiangnan University, Wuxi 214122, China
| | - Bingyong Mao
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi 214122, China; School of Food Science and Technology, Jiangnan University, Wuxi 214122, China
| | - Qiuxiang Zhang
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi 214122, China; School of Food Science and Technology, Jiangnan University, Wuxi 214122, China
| | - Tianmeng Zhang
- Bloomage Biotechnology Co., Ltd, Jinan 250000, China; School of Biotechnology, Jiangnan University, Wuxi 214122, China
| | - Jianxin Zhao
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi 214122, China; School of Food Science and Technology, Jiangnan University, Wuxi 214122, China
| | - Shumao Cui
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi 214122, China; School of Food Science and Technology, Jiangnan University, Wuxi 214122, China.
| | - Wei Chen
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi 214122, China; School of Food Science and Technology, Jiangnan University, Wuxi 214122, China; National Engineering Research Center for Functional Food, Jiangnan University, Wuxi 214122, China
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10
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Chen F, Mundy DC, Le P, Seo YA, Logan CM, Fernandes-Cunha GM, Basco CA, Myung D. In Situ-Forming Collagen-Hyaluronate Semi-Interpenetrating Network Hydrogel Enhances Corneal Defect Repair. Transl Vis Sci Technol 2022; 11:22. [PMID: 36239965 PMCID: PMC9586141 DOI: 10.1167/tvst.11.10.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Purpose Millions worldwide suffer vision impairment or blindness from corneal injury, and there remains an urgent need for a more effective and accessible way to treat corneal defects. We have designed and characterized an in situ-forming semi-interpenetrating polymer network (SIPN) hydrogel using biomaterials widely used in ophthalmology and medicine. Methods The SIPN was formed by cross-linking collagen type I with bifunctional polyethylene glycol using N-hydroxysuccinimide ester chemistry in the presence of linear hyaluronic acid (HA). Gelation time and the mechanical, optical, swelling, and degradation properties of the SIPN were assessed. Cytocompatibility with human corneal epithelial cells and corneal stromal stem cells (CSSCs) was determined in vitro, as was the spatial distribution of encapsulated CSSCs within the SIPN. In vivo wound healing was evaluated by multimodal imaging in an anterior lamellar keratectomy injury model in rabbits, followed by immunohistochemical analysis of treated and untreated tissues. Results The collagen-hyaluronate SIPN formed in situ without an external energy source and demonstrated mechanical and optical properties similar to the cornea. It was biocompatible with human corneal cells, enhancing CSSC viability when compared with collagen gel controls and preventing encapsulated CSSC sedimentation. In vivo application of the SIPN significantly reduced stromal defect size compared with controls after 7 days and promoted multilayered epithelial regeneration. Conclusions This in situ-forming SIPN hydrogel may be a promising alternative to keratoplasty and represents a step toward expanding treatment options for patients suffering from corneal injury. Translational Relevance We detail the synthesis and initial characterization of an SIPN hydrogel as a potential alternative to lamellar keratoplasty and a tunable platform for further development in corneal tissue engineering and therapeutic cell delivery.
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Affiliation(s)
- Fang Chen
- Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA.,VA Palo Alto HealthCare System, Palo Alto, CA, USA
| | - David C Mundy
- Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Peter Le
- Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA.,VA Palo Alto HealthCare System, Palo Alto, CA, USA
| | - Youngyoon Amy Seo
- Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Caitlin M Logan
- Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | | | - Chris A Basco
- Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - David Myung
- Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA.,VA Palo Alto HealthCare System, Palo Alto, CA, USA.,Department of Chemical Engineering, Stanford University, Palo Alto, CA, USA
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11
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Casey-Power S, Ryan R, Behl G, McLoughlin P, Byrne ME, Fitzhenry L. Hyaluronic Acid: Its Versatile Use in Ocular Drug Delivery with a Specific Focus on Hyaluronic Acid-Based Polyelectrolyte Complexes. Pharmaceutics 2022; 14:pharmaceutics14071479. [PMID: 35890371 PMCID: PMC9323903 DOI: 10.3390/pharmaceutics14071479] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/30/2022] [Accepted: 07/12/2022] [Indexed: 12/12/2022] Open
Abstract
Extensive research is currently being conducted into novel ocular drug delivery systems (ODDS) that are capable of surpassing the limitations associated with conventional intraocular anterior and posterior segment treatments. Nanoformulations, including those synthesised from the natural, hydrophilic glycosaminoglycan, hyaluronic acid (HA), have gained significant traction due to their enhanced intraocular permeation, longer retention times, high physiological stability, inherent biocompatibility, and biodegradability. However, conventional nanoformulation preparation methods often require large volumes of organic solvent, chemical cross-linkers, and surfactants, which can pose significant toxicity risks. We present a comprehensive, critical review of the use of HA in the field of ophthalmology and ocular drug delivery, with a discussion of the physicochemical and biological properties of HA that render it a suitable excipient for drug delivery to both the anterior and posterior segments of the eye. The pivotal focus of this review is a discussion of the formation of HA-based nanoparticles via polyelectrolyte complexation, a mild method of preparation driven primarily by electrostatic interaction between opposing polyelectrolytes. To the best of our knowledge, despite the growing number of publications centred around the development of HA-based polyelectrolyte complexes (HA-PECs) for ocular drug delivery, no review articles have been published in this area. This review aims to bridge the identified gap in the literature by (1) reviewing recent advances in the area of HA-PECs for anterior and posterior ODD, (2) describing the mechanism and thermodynamics of polyelectrolyte complexation, and (3) critically evaluating the intrinsic and extrinsic formulation parameters that must be considered when designing HA-PECs for ocular application.
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Affiliation(s)
- Saoirse Casey-Power
- Ocular Therapeutics Research Group, Pharmaceutical and Molecular Biotechnology Research Centre, Waterford Campus, South East Technological University, X91 K0EK Waterford, Ireland; (R.R.); (G.B.); (P.M.); (L.F.)
- Correspondence:
| | - Richie Ryan
- Ocular Therapeutics Research Group, Pharmaceutical and Molecular Biotechnology Research Centre, Waterford Campus, South East Technological University, X91 K0EK Waterford, Ireland; (R.R.); (G.B.); (P.M.); (L.F.)
| | - Gautam Behl
- Ocular Therapeutics Research Group, Pharmaceutical and Molecular Biotechnology Research Centre, Waterford Campus, South East Technological University, X91 K0EK Waterford, Ireland; (R.R.); (G.B.); (P.M.); (L.F.)
| | - Peter McLoughlin
- Ocular Therapeutics Research Group, Pharmaceutical and Molecular Biotechnology Research Centre, Waterford Campus, South East Technological University, X91 K0EK Waterford, Ireland; (R.R.); (G.B.); (P.M.); (L.F.)
| | - Mark E. Byrne
- Biomimetic & Biohybrid Materials, Biomedical Devices & Drug Delivery Laboratories, Department of Biomedical Engineering, Henry M. Rowan College of Engineering, Rowan University, 201 Mullica Hill Road, Glassboro, NJ 08028, USA;
- Department of Chemical Engineering, Henry M. Rowan College of Engineering, Rowan University, 201 Mullica Hill Road, Glassboro, NJ 08028, USA
| | - Laurence Fitzhenry
- Ocular Therapeutics Research Group, Pharmaceutical and Molecular Biotechnology Research Centre, Waterford Campus, South East Technological University, X91 K0EK Waterford, Ireland; (R.R.); (G.B.); (P.M.); (L.F.)
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12
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Alsheikh O, Alzaaidi S, Vargas JM, Al-Sharif E, Alrajeh M, AlSemari MA, Alhommadi A, Alsaati A, Aljwaiser N, Alshahwan E, Abdulhafiz M, Elsayed R, Müller-Lierheim WGK. Effectiveness of 0.15% hylan A eye drops in ameliorating symptoms of severe dry eye patients in Saudi Arabia. Saudi J Ophthalmol 2022; 35:293-298. [PMID: 35814996 PMCID: PMC9266482 DOI: 10.4103/sjopt.sjopt_218_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 03/02/2022] [Accepted: 04/04/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The aim of the HYLAN A study was to investigate if symptoms and/or signs of patients suffering from severe dry eye disease (DED) in Saudi Arabia can be improved by substituting individually optimized artificial tear therapy by high molecular weight hyaluronan (HMWHA) eye drops. METHODS The HYLAN M study, a multicenter prospective randomized open-label study, was performed in 11 centers in eight countries. Patients suffering from severe DED were electronically randomized in two parallel arms. patients with symptoms of at least ocular surface disease index (OSDI) 33 and corneal fluorescein staining (CFS) of at least Oxford grade 3 were included . The patients in the control group continued with their individual optimized therapy as by the time of inclusion. The patients in the hylan A group replaced their individual lubricant eye drops by preservative-free eye drops containing 0.15% hylan A. The total OSDI scores as well as the OSDI subscores for pain and for visual disturbances of each patient at baseline, at 4 weeks, and at 8 weeks of treatment was used to analyse the improvement of symptoms. We focus and report the results obtained at the two study centers in Riyadh ,Saudi Arabia (King Khaled Eye Specialist Hospital and Riyadh Military Hospital). RESULTS A total of 13 patients were included in the study. The majority of the study participants were middle aged (40-65 years). Overall, female patients accounted for 76.9% of all study participants. At the initiation of the study, both hylan A and control groups had relatively similar total OSDI scores together with pain and vision subscores. At 4-week follow-up, both groups demonstrated a noticeable decrease in all study variables. Nevertheless, the OSDI scores improved significantly in the group of patients treated with hylan A eye drops at 8 weeks, whereas the scores increased in the control group. CONCLUSION Saudi Arabia has a very high prevalence of patients with severe dry eye disease. Ethnicity, climate, and a high incidence of diabetes mellitus may contribute to this situation. Lubricant eye drops frequently do not provide adequate relief from ocular pain and instable vision in severe chronic ocular surface disease. High molecular weight hyaluronan (HMWHA) eye drops provide superior relief of symptoms of patients suffering from severe DED. This includes ocular pain as well as unstable vision.
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Affiliation(s)
- Osama Alsheikh
- Oculoplastics and Orbit Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia,Address for correspondence: Dr. Osama Alsheikh, Oculoplastics and Orbit Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia. E-mail:
| | - Sultan Alzaaidi
- Department of Ophthalmology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia,Department of Medical Services, Ministry of Defense and Aviation, King Abdullah Bin Abdulaziz University Hospital, Riyadh, Saudi Arabia
| | - Jose M. Vargas
- Oculoplastics and Orbit Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia,Department of Ophthalmology, King Abdullah Bin Abdulaziz University Hospital, Riyadh, Saudi Arabia
| | - Eman Al-Sharif
- Oculoplastics and Orbit Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia,Department of Ophthalmology, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Mohammed Alrajeh
- Department of Surgery, Ophthalmology Division, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Mohammad A. AlSemari
- Oculoplastics and Orbit Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | | | - Anoud Alsaati
- Department of Ophthalmology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia,Department of Medical Services, Ministry of Defense and Aviation, King Abdullah Bin Abdulaziz University Hospital, Riyadh, Saudi Arabia
| | - Nouf Aljwaiser
- Department of Ophthalmology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia,Department of Medical Services, Ministry of Defense and Aviation, King Abdullah Bin Abdulaziz University Hospital, Riyadh, Saudi Arabia
| | - Eman Alshahwan
- Department of Ophthalmology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia,Department of Medical Services, Ministry of Defense and Aviation, King Abdullah Bin Abdulaziz University Hospital, Riyadh, Saudi Arabia
| | - Mona Abdulhafiz
- Department of Ophthalmology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia,Department of Medical Services, Ministry of Defense and Aviation, King Abdullah Bin Abdulaziz University Hospital, Riyadh, Saudi Arabia
| | - Rashad Elsayed
- Department of Ophthalmology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia,Department of Medical Services, Ministry of Defense and Aviation, King Abdullah Bin Abdulaziz University Hospital, Riyadh, Saudi Arabia
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13
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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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14
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Jun JH, Bang SP, Park HS, Yoon D, Ahn JY, Kim SJ, Kim HK. A randomized multicenter clinical evaluation of sequential application of 0.3% and 0.15% hyaluronic acid for treatment of dry eye. Jpn J Ophthalmol 2021; 66:58-67. [PMID: 34843023 DOI: 10.1007/s10384-021-00885-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 09/17/2021] [Indexed: 01/02/2023]
Abstract
PURPOSE We report the clinical efficacy of sequential applications of 0.3% and 0.15% unpreserved hyaluronic acid (HA) for the treatment of dry eye disease (DED). STUDY DESIGN Randomized clinical trial. METHODS Patients over 19 years of age with DED level 2 or higher, corneal fluorescein staining (CFS) score > 1, and tear break-up time (TBUT) < 10 s were included. Seventy-six patients were randomly assigned to the 0.15% HA group, 0.3% HA group, or combination group. Each group applied two drops of 0.15% or 0.3% HA, or a single drop of both 0.3% and 0.15% HA. Patients were evaluated using the ocular surface disease index (OSDI), CFS and conjunctival fluorescein stain score, TBUT, and blurring/discomfort after application at baseline, 4 weeks, and 8 weeks. RESULTS The combination group had the greatest improvement in CFS score from baseline to 8 weeks, compared with the 0.15% and 0.3% HA group (p < 0.001). The combined CFS-OSDI responder rates of the combination group (CFS score = 0 and OSDI ≥ 50% improvement at 8 weeks) were significantly higher than those of the 0.15% and 0.3% groups (p = 0.037). At 4 and 8 weeks, blurring after application in both the 0.3% and combination groups was significantly higher than in the 0.15% group, despite no difference between the 0.3% and combination groups. There were no differences in CFS and conjunctival staining score, TBUT, or OSDI within the three groups at baseline, 4 weeks, and 8 weeks. CONCLUSIONS Sequential application of 0.3% and 0.15% HA improved symptoms/signs in moderate to severe DED patients.
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Affiliation(s)
- Jong Hwa Jun
- Department of Ophthalmology, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Seung Pil Bang
- Department of Ophthalmology, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Han Sang Park
- Department of Ophthalmology, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Donghee Yoon
- Department of Ophthalmology, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Ja Young Ahn
- Department of Ophthalmology, Gyeongsang National University School of Medicine, Jinju, Republic of Korea.,Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Seong Jae Kim
- Department of Ophthalmology, Gyeongsang National University School of Medicine, Jinju, Republic of Korea.,Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Hong Kyun Kim
- Department of Ophthalmology, Kyungpook National University Hospital, Daegu, Republic of Korea. .,Department of Ophthalmology, School of Medicine, Kyungpook National University, #130 Dongdeok-ro, Joong-gu, Daegu, 41944, Republic of Korea.
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15
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Černohlávek M, Brandejsová M, Štěpán P, Vagnerová H, Hermannová M, Kopecká K, Kulhánek J, Nečas D, Vrbka M, Velebný V, Huerta-Angeles G. Insight into the Lubrication and Adhesion Properties of Hyaluronan for Ocular Drug Delivery. Biomolecules 2021; 11:1431. [PMID: 34680064 PMCID: PMC8533502 DOI: 10.3390/biom11101431] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/10/2021] [Accepted: 09/27/2021] [Indexed: 12/14/2022] Open
Abstract
Hyaluronan (HA) is widely used for eye drops as lubricant to counteract dry eye disease. High and low molecular weight HA are currently used in ophthalmology. However, a large portion of the current literature on friction and lubrication addresses articular (joint) cartilage. Therefore, eye drops compositions based on HA and its derivatized forms are extensively characterized providing data on the tribological and mucoadhesive properties. The physiochemical properties are investigated in buffers used commonly in eye drops formulations. The tribological investigation reveals that amphiphilic HA-C12 decreases the friction coefficient. At the same time, the combination of trehalose/HA or HAC12 enhances up to eighty-fold the mucoadhesiveness. Thus, it is predicted a prolonged residence time on the surface of the eye. The incorporation of trehalose enhances the protection of human keratinocytes (HaCaT) cells, as demonstrated in an in-vitro cell-desiccation model. The presence of trehalose increases the friction coefficient. Medium molecular weight HA shows significantly lower friction coefficient than high molecular weight HA. This research represents a first, wide array of features of diverse HA forms for eye drops contributing to increase the knowledge of these preparations. The results here presented also provide valuable information for the design of highly performing HA-formulations addressing specific needs before preclinic.
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Affiliation(s)
- Mikuláš Černohlávek
- Department of Applied Chemistry (R&D), Contipro a.s., Dolní Dobrouč 401, 561 02 Dolní Dobrouč, Czech Republic; (M.Č.); (M.B.); (P.Š.); (H.V.); (M.H.); (K.K.); (J.K.); (V.V.)
- Department of Tribology, Faculty of Mechanical Engineering, Brno University of Technology, Technická 2896/2, 616 69 Brno, Czech Republic; (D.N.); (M.V.)
| | - Martina Brandejsová
- Department of Applied Chemistry (R&D), Contipro a.s., Dolní Dobrouč 401, 561 02 Dolní Dobrouč, Czech Republic; (M.Č.); (M.B.); (P.Š.); (H.V.); (M.H.); (K.K.); (J.K.); (V.V.)
| | - Petr Štěpán
- Department of Applied Chemistry (R&D), Contipro a.s., Dolní Dobrouč 401, 561 02 Dolní Dobrouč, Czech Republic; (M.Č.); (M.B.); (P.Š.); (H.V.); (M.H.); (K.K.); (J.K.); (V.V.)
| | - Hana Vagnerová
- Department of Applied Chemistry (R&D), Contipro a.s., Dolní Dobrouč 401, 561 02 Dolní Dobrouč, Czech Republic; (M.Č.); (M.B.); (P.Š.); (H.V.); (M.H.); (K.K.); (J.K.); (V.V.)
| | - Martina Hermannová
- Department of Applied Chemistry (R&D), Contipro a.s., Dolní Dobrouč 401, 561 02 Dolní Dobrouč, Czech Republic; (M.Č.); (M.B.); (P.Š.); (H.V.); (M.H.); (K.K.); (J.K.); (V.V.)
| | - Kateřina Kopecká
- Department of Applied Chemistry (R&D), Contipro a.s., Dolní Dobrouč 401, 561 02 Dolní Dobrouč, Czech Republic; (M.Č.); (M.B.); (P.Š.); (H.V.); (M.H.); (K.K.); (J.K.); (V.V.)
| | - Jaromír Kulhánek
- Department of Applied Chemistry (R&D), Contipro a.s., Dolní Dobrouč 401, 561 02 Dolní Dobrouč, Czech Republic; (M.Č.); (M.B.); (P.Š.); (H.V.); (M.H.); (K.K.); (J.K.); (V.V.)
| | - David Nečas
- Department of Tribology, Faculty of Mechanical Engineering, Brno University of Technology, Technická 2896/2, 616 69 Brno, Czech Republic; (D.N.); (M.V.)
| | - Martin Vrbka
- Department of Tribology, Faculty of Mechanical Engineering, Brno University of Technology, Technická 2896/2, 616 69 Brno, Czech Republic; (D.N.); (M.V.)
| | - Vladimir Velebný
- Department of Applied Chemistry (R&D), Contipro a.s., Dolní Dobrouč 401, 561 02 Dolní Dobrouč, Czech Republic; (M.Č.); (M.B.); (P.Š.); (H.V.); (M.H.); (K.K.); (J.K.); (V.V.)
| | - Gloria Huerta-Angeles
- Department of Applied Chemistry (R&D), Contipro a.s., Dolní Dobrouč 401, 561 02 Dolní Dobrouč, Czech Republic; (M.Č.); (M.B.); (P.Š.); (H.V.); (M.H.); (K.K.); (J.K.); (V.V.)
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Kattar A, Concheiro A, Alvarez-Lorenzo C. Diabetic eye: associated diseases, drugs in clinic, and role of self-assembled carriers in topical treatment. Expert Opin Drug Deliv 2021; 18:1589-1607. [PMID: 34253138 DOI: 10.1080/17425247.2021.1953466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Introduction: Diabetes is a pandemic disease that causes relevant ocular pathologies. Diabetic retinopathy, macular edema, cataracts, glaucoma, or keratopathy strongly impact the quality of life of the patients. In addition to glycemic control, intense research is devoted to finding more efficient ocular drugs and improved delivery systems that can overcome eye barriers. Areas covered: The aim of this review is to revisit first the role of diabetes in the development of chronic eye diseases. Then, commercially available drugs and new candidates in clinical trials are tackled together with the pros and cons of their administration routes. Subsequent sections deal with self-assembled drug carriers suitable for eye instillation combining patient-friendly administration with high ocular bioavailability. Performance of topically administered polymeric micelles, liposomes, and niosomes for the management of diabetic eye diseases is analyzed in the light of ex vivo and in vivo results and outcomes of clinical trials. Expert opinion: Self-assembled carriers are being shown useful for efficient delivery of not only a variety of small drugs but also macromolecules (e.g. antibodies) and genes. Successful design of drug carriers may offer alternatives to intraocular injections and improve the treatment of both anterior and posterior segments diabetic eye diseases.
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Affiliation(s)
- Axel Kattar
- Departamento de Farmacología, Farmacia y Tecnología Farmacéutica, I+D Farma Group (GI-1645), Facultad de Farmacia and Health Research Institute of Santiago de Compostela (IDIS), Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Angel Concheiro
- Departamento de Farmacología, Farmacia y Tecnología Farmacéutica, I+D Farma Group (GI-1645), Facultad de Farmacia and Health Research Institute of Santiago de Compostela (IDIS), Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Carmen Alvarez-Lorenzo
- Departamento de Farmacología, Farmacia y Tecnología Farmacéutica, I+D Farma Group (GI-1645), Facultad de Farmacia and Health Research Institute of Santiago de Compostela (IDIS), Universidade de Santiago de Compostela, Santiago de Compostela, Spain
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17
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Leone G, Pepi S, Consumi M, Mahdizadeh FF, Lamponi S, Magnani A. Phosphorylated xanthan gum-Ag(I) complex as antibacterial viscosity enhancer for eye drops formulation. Carbohydr Polym 2021; 267:118196. [PMID: 34119163 DOI: 10.1016/j.carbpol.2021.118196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/12/2021] [Accepted: 04/27/2021] [Indexed: 01/16/2023]
Abstract
Topical instillation of eye drops represents the treatment of choice for many ocular diseases. Ophthalmic formulations must meet general requirements, i.e. pH, osmolality, transparency and viscosity to ensure adequate retention without inducing irritation and the development of eye infections. We developed a phosphorylated xanthan gum-Ag(I) complex (XGP-Ag) showing pH (pH = 7.1 ± 0.3) and osmolality values (311 ± 2 mOsm/kg) close to that of human tears (pH = 6.5-7.6 and 304 ± 23 mOsm/kg) thanks to the presence of phosphate moieties along the chain. The presence of phosphate groups covalently bound to the XG chains avoids their dispersion in fluid, thus reducing the risk of corneal calcification. 0.02% w/v XGP-Ag solution showed high transparency (higher than 95% along the entire visible range), adequate refractive index (1.334 ± 0.001) and viscosity in the range: γ 1 s-1-10,000 s- 1 (26.4 ± 0.8-2.1 ± 0.4 mPa·s). Its cytotoxicity and capability to hinder bacterial proliferation was also verified.
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Affiliation(s)
- Gemma Leone
- Department of Biotechnology, Chemistry and Pharmacy, University of Siena, via A. Moro 2, Siena 53100, Italy; INSTM, via G. Giusti 9, 50121 Firenze, Italy.
| | - Simone Pepi
- Department of Biotechnology, Chemistry and Pharmacy, University of Siena, via A. Moro 2, Siena 53100, Italy
| | - Marco Consumi
- Department of Biotechnology, Chemistry and Pharmacy, University of Siena, via A. Moro 2, Siena 53100, Italy; INSTM, via G. Giusti 9, 50121 Firenze, Italy
| | - Fariba Fahmideh Mahdizadeh
- Department of Biotechnology, Chemistry and Pharmacy, University of Siena, via A. Moro 2, Siena 53100, Italy
| | - Stefania Lamponi
- Department of Biotechnology, Chemistry and Pharmacy, University of Siena, via A. Moro 2, Siena 53100, Italy; INSTM, via G. Giusti 9, 50121 Firenze, Italy
| | - Agnese Magnani
- Department of Biotechnology, Chemistry and Pharmacy, University of Siena, via A. Moro 2, Siena 53100, Italy; INSTM, via G. Giusti 9, 50121 Firenze, Italy.
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18
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Huerta Ángeles G, Nešporová K. Hyaluronan and its derivatives for ophthalmology: Recent advances and future perspectives. Carbohydr Polym 2021; 259:117697. [DOI: 10.1016/j.carbpol.2021.117697] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 01/20/2021] [Accepted: 01/20/2021] [Indexed: 12/26/2022]
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Crosslinked Hyaluronic Acid with Liposomes and Crocin Confers Cytoprotection in an Experimental Model of Dry Eye. Molecules 2021; 26:molecules26040849. [PMID: 33561944 PMCID: PMC7915152 DOI: 10.3390/molecules26040849] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 12/15/2022] Open
Abstract
Dry eye disease (DED) is a multifactorial condition caused by tear deficiency and accompanied by ocular surface damage. Recent data support a key role of oxidative and inflammatory processes in the pathogenesis of DED. Hyaluronic acid (HA) is widely used in artificial tears to treat DED by improving ocular hydration and reducing surface friction. Crocin (Cr), the main constituent of saffron, is a renowned compound that exhibits potent antioxidant and anti-inflammatory effects. The present study was undertaken to assess the viscosity and muco-adhesiveness of a photoactivated formulation with crosslinked HA (cHA), Cr, and liposomes (cHA-Cr-L). Our aim was also to evaluate whether cHA-Cr-L may exert cytoprotective effects against oxidative and inflammatory processes in human corneal epithelial cells (HCECs). Viscosity was measured using a rotational rheometer, and then the muco-adhesiveness was evaluated. Under hyperosmolarity (450 mOsm), the HCECs were treated with cHA-Cr-L. Interleukin-1β (IL-1β) and tumor necrosis factor α (TNFα) were quantified by quantitative real-time polymerase chain reaction (RT-qPCR). The levels of reactive oxygen species (ROS) were measured using the DCF assay. The combined action of cHA-Cr-L produced a higher viscosity and muco-adhesiveness compared to the control. The anti-inflammatory effect of cHA-Cr-L was achieved through a significant reduction of IL-1β and TNFα (p < 0.001). The results also showed that cHA-Cr-L reduces ROS production under conditions of hyperosmolarity (p < 0.001). We conclude that cHA-Cr-L has potential as a therapeutic agent in DED, which should be further investigated.
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van Setten GB, Stachs O, Dupas B, Turhan SA, Seitz B, Reitsamer H, Winter K, Horwath-Winter J, Guthoff RF, Müller-Lierheim WGK. High Molecular Weight Hyaluronan Promotes Corneal Nerve Growth in Severe Dry Eyes. J Clin Med 2020; 9:jcm9123799. [PMID: 33255350 PMCID: PMC7760610 DOI: 10.3390/jcm9123799] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/19/2020] [Accepted: 11/22/2020] [Indexed: 12/31/2022] Open
Abstract
The purpose of this study was to investigate the effect of high molecular weight hyaluronan (HMWHA) eye drops on subbasal corneal nerves in patients suffering from severe dry eye disease (DED) and to evaluate the damage of subbasal corneal nerves associated with severe DED. Designed as an international, multicenter study, 16 patients with symptoms of at least an Ocular Surface Disease Index (OSDI) score of 33, and corneal fluorescein staining (CFS) of at least Oxford grade 3, were included and randomized into two study arms. The control group continued to use their individual optimum artificial tears over the study period of eight weeks; in the verum group, the artificial tears were substituted by eye drops containing 0.15% HMWHA. At the baseline visit, and after eight weeks, the subbasal nerve plexus of 16 patients were assessed by confocal laser scanning microscopy (CSLM). The images were submitted to a masked reading center for evaluation. Results showed a significant increase of total nerve fiber lengths (CNFL) in the HMWHA group (p = 0.030) when compared to the control group, where the total subbasal CNFL did not significantly change from baseline to week 8. We concluded that in severe DED patients, HMWHA from topically applied eye drops could cross the epithelial barrier and reach the subbasal nerve plexus, where it exercised a trophic effect.
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Affiliation(s)
- Gysbert-Botho van Setten
- Department of Clininical Neuroscience, St. Eriks Eye Hospital, Karolinska Institutet, 11282 Stockholm, Sweden;
| | - Oliver Stachs
- Department of Ophthalmology, University Medical Center Rostock, 18057 Rostock, Germany; (O.S.); (R.F.G.)
| | - Bénédicte Dupas
- Quinze-Vingts National Eye Hospital & Vision Institute, 75571 Paris, France;
| | - Semra Akkaya Turhan
- Department of Ophthalmology, Marmara University School of Medicine, 34899 Istanbul, Turkey;
| | - Berthold Seitz
- Department of Ophthalmology, Saarland University Medical Center, 66421 Homburg/Saar, Germany;
| | - Herbert Reitsamer
- Department of Ophthalmology & Department of Experimental Ophthalmology and Glaucoma Research, University Clinic Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria;
| | - Karsten Winter
- Institute of Anatomy, Medical Faculty, University of Leipzig, 04103 Leipzig, Germany;
| | | | - Rudolf F. Guthoff
- Department of Ophthalmology, University Medical Center Rostock, 18057 Rostock, Germany; (O.S.); (R.F.G.)
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van Setten GB, Baudouin C, Horwath-Winter J, Böhringer D, Stachs O, Toker E, Al-Zaaidi S, Benitez-del-Castillo JM, Beck R, Al-Sheikh O, Seitz B, Barabino S, Reitsamer HA, Müller-Lierheim WG. The HYLAN M Study: Efficacy of 0.15% High Molecular Weight Hyaluronan Fluid in the Treatment of Severe Dry Eye Disease in a Multicenter Randomized Trial. J Clin Med 2020; 9:jcm9113536. [PMID: 33147751 PMCID: PMC7693312 DOI: 10.3390/jcm9113536] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 10/23/2020] [Accepted: 10/31/2020] [Indexed: 01/22/2023] Open
Abstract
The aim of the HYLAN M study was to investigate if symptoms and/or signs of patients suffering from severe dry eye disease (DED) can be improved by substituting individually optimized artificial tear therapy by high molecular weight hyaluronan (HMWHA) eye drops. In this international, multicenter study, patients with symptoms of at least ocular surface disease index (OSDI) 33 and corneal fluorescein staining (CFS) of at least Oxford grade 3 were included. A total of 84 per-protocol patients were randomized in two study arms. The control group continued to use their individual optimum artificial tears over the study period of eight weeks; in the verum group, the artificial tears were substituted by eye drops containing 0.15% HMWHA. At the week 8 visit, the average OSDI of the verum group had improved by 13.5 as compared to the control group (p = 0.001). The best corrected visual acuity (BCVA) had improved by 0.04 logMAR (p = 0.033). CFS, tear film break-up time (TBUT), Schirmer I, lid wiper epitheliopathy (LWE), mucocutaneous junction (Yamaguchi score), and tear osmolarity were not significantly different between the verum and control groups (p > 0.050). We conclude that for most patients with severe DED, 0.15% HMWHA eye drops provide excellent improvement of symptoms without impairment of dry eye signs.
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Affiliation(s)
- Gysbert-Botho van Setten
- Karolinska Institutet, Department of Clinical Neuroscience, St. Eriks Eye Hospital, 11282 Stockholm, Sweden;
| | - Christophe Baudouin
- Quinze-Vingts National Eye Hospital & Vision Institute, IHU Foresight, 75571 Paris, France;
| | | | - Daniel Böhringer
- Eye Center, University Eye Hospital Freiburg and Medical Faculty, Albert Ludwigs University, 79106 Freiburg, Germany;
| | - Oliver Stachs
- Department of Ophthalmology, University Medical Center Rostock, 18057 Rostock, Germany; (O.S.); (R.B.)
| | - Ebru Toker
- Department of Ophthalmology, Marmara University School of Medicine, 34899 Istanbul, Turkey;
| | - Sultan Al-Zaaidi
- Department of Ophthalmology, PSMMC Prince Sultan Military Medical City, MSD Medical Services Department, MODA Ministry of Defense and Aviation, Riyadh 12233, Saudi Arabia;
| | | | - Ria Beck
- Department of Ophthalmology, University Medical Center Rostock, 18057 Rostock, Germany; (O.S.); (R.B.)
| | - Osama Al-Sheikh
- KKESH–King Khaled Eye Specialist Hospital, Riyadh 11462, Saudi Arabia;
| | - Berthold Seitz
- Department of Ophthalmology, Saarland University Medical Center, 66421 Homburg/Saar, Germany;
| | - Stefano Barabino
- Ocular Surface & Dry Eye Center, Ospedale L. Sacco, University of Milan, 20157 Milan, Italy;
| | - Herbert A. Reitsamer
- Department of Ophthalmology & Department of Experimental Ophthalmology and Glaucoma Research, University Clinic Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria;
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