Hyaluronate effect on bacterial biofilm in ENT district infections: a review

Abstract

Bacterial resistance is a growing phenomenon which led the scientific community to search for new therapeutic targets, such as biofilm. A bacterial biofilm is a surface-associated agglomerate of microorganisms embedded in a self-produced extracellular polymeric matrix made of polysaccharides, nucleic acids, and proteins. Scientific literature offers several reports on a biofilm's role in infections regarding various body districts. The presence of a bacterial biofilm is responsible for poor efficacy of antibiotic therapies along with bacterial infections in ear, nose, and throat (ENT) districts such as the oral cavity, ear, nasal cavities, and nasal sinuses. In particular, bacterial biofilms are associated with recalcitrant and symptomatically more severe forms of chronic rhinosinusitis. As of today, there are no therapeutic options for the eradication of bacterial biofilm in ENT districts. Hyaluronic acid is a glycosaminoglycan composed of glucuronic acid and N-acetylglucosamine disaccharide units. Its efficacy in treating rhinosinusitis, whether or not associated with polyposis, is well documented, as well as results from its effects on mucociliary clearance, free radical production and mucosal repair. This review's aim is to evaluate the role of bacterial biofilms and the action exerted on it by hyaluronic acid in ENT pathology, with particular attention to the rhinosinusal district. In conclusion, this paper underlines how the efficacy of hyaluronate as an anti-bacterial biofilm agent is well demonstrated by in vitro studies; it is, however, only preliminarily demonstrated by clinical studies.

Current Perspective on Nasal Delivery Systems for Chronic Rhinosinusitis

“…Its presence in bacterial biofilm (BBF) is related to the severe clinical situation of CRS. Some studies have reported the anti-BBF effects of HA in vivo, especially in the form of atomized sodium hyaluronate plus normal saline [59]. Cassandro et al [60] divided 80 patients with CRS and nasal polyposis without FESS into 4 groups.…”

Hyaluronic-Based Antibacterial Hydrogel Coating for Implantable Biomaterials in Orthopedics and Trauma: From Basic Research to Clinical Applications

“…In this experimental study, HA was shown to be able to reduce bacterial adhesion to a cellular substrate in a concentration-dependent manner. The antibiofilm action, exerted by HA in ear, nose and throat districts, has been recently reviewed [31]. The authors conclude that "its efficacy in treating rhinosinusitis, whether or not associated with polyposis, is well documented, as well as results from its effects on mucociliary clearance, free radical production and mucosal repair."…”

Mucociliary Clearance: Measures and Therapies

“…Another product is Hyaluronic Acid. Use of protease products such as papain and bromelain are of value in delivering antibiotics into the biofilm [13].…”