Topical Ectoine: A Promising Molecule in the Upper Airways Inflammation—A Systematic Review

Casale, Manuele; Moffa, Antonio; Carbone, Samanta; Fraccaroli, Francesca; Costantino, Andrea; Sabatino, Lorenzo; López, Michele Antonio; Baptista, Peter; Cassano, Michele; Rinaldi, Vittorio

doi:10.1155/2019/7150942

Cited by 14 publications

(16 citation statements)

References 20 publications

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“…Although many of the studies showed limitations regarding their study design or reporting and data is not fully available, the following readout can be supported: ectoine is a natural substance with a unique mode of action on the eye surface and with an excellent tolerability and safety profile. This conclusion is supported by the work of other colleagues, who reviewed the efficacy of ectoine in upper respiratory inflammation [ 23 ] or allergic rhinitis (systematic review submitted) and other indications. Especially, the studies on dry eye syndrome, which have not been subject of this review, should be analysed in detail to further strengthen the evidence base for ocular application of ectoine.…”

Section: Discussionsupporting

confidence: 54%

“…This stabilisation results in a reduction of inflammation, as seen in the reduction of particulate matter-induced inflammation of lung epithelia [ 15 ] and in UV-induced inflammation of the skin [ 77 ]. The effective treatment of upper respiratory tract infections has recently been reviewed [ 23 ], and effects on inflammatory diseases of the lung were also published [ 26 , 29 ]. Applied on the ocular surface, ectoine stabilizes not only the tissue but also the meibum layer as presented recently [ 18 – 20 , 22 ].…”

Section: Discussionmentioning

confidence: 99%

“…Promising findings from clinical trials were reviewed by Casale and colleagues [ 23 ] who attributed topical applied ectoine effectiveness in upper airway inflammations such as acute pharyngitis/laryngitis [ 24 , 25 ], rhinosinusitis, rhinitis sicca, and acute bronchitis [ 26 ]. In addition, several trials showed efficacy of ectoine in various diseases with barrier dysfunctions such as rhinitis sicca [ 27 ], chemotherapy-induced mucositis [ 28 ], lung inflammation caused by environmental pollutants [ 29 ], prevention of upper respiratory infections [ 30 ], and atopic dermatitis [ 31 ].…”

Section: Introductionmentioning

confidence: 99%

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Ectoine in the Treatment of Irritations and Inflammations of the Eye Surface

Bilstein¹,

Heinrich

Rybachuk

et al. 2021

BioMed Research International

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The ocular surface is facing various unspecific stress factors resulting in irritation and inflammation of the epithelia, causing discomfort to the patients. Ectoine is a bacteria-derived extremolyte with the ability to protect proteins and biological membranes from damage caused by extreme environmental conditions like heat, UV-light, high osmolarity, or dryness. Evidence from preclinical and clinical studies attest its effectiveness in treating several epithelium-associated inflammatory diseases, including the eye surface. In this review, we analysed 16 recent clinical trials investigating ectoine eye drops in patients with allergic conjunctivitis or with other unspecific ocular inflammations caused by e.g. ophthalmic surgery. Findings from these studies were reviewed in context with other published work on ectoine. In summary, patients with irritations and unspecific inflammations of the ocular surface have been treated successfully with ectoine-containing eye drops. In these patients, significant improvement was observed in ocular symptoms of allergic rhinoconjunctivitis, postoperative secondary dry eye syndrome, or ocular reepithelisation after surgery. Using ectoine as an add-on therapy to antihistamines, in allergy patients accelerated symptom relief by days, and its use as an add-on to antibiotics resulted in faster wound closure. Ectoine is a natural substance with an excellent tolerability and safety profile thus representing a helpful alternative for patients with inflammatory irritation of the ocular surface, who wish to avoid local reactions and side effects associated with pharmacological therapies or wish to increase the efficacy of standard treatment regimen.

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Section: Discussionsupporting

confidence: 54%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Ectoine in the Treatment of Irritations and Inflammations of the Eye Surface

Bilstein¹,

Heinrich

Rybachuk

et al. 2021

BioMed Research International

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“…This mechanism of action grants Ectoin® the ability to stabilize protein and biomembrane structures such as cell membranes and monolayered lipid layer [23]. The evidence of a protecting and inflammatory-reducing effect of ectoine from preclinical studies has heralded its medical application in the treatment of dermatitis, dry eye syndrome, allergic rhinoconjunctivitis, sinusitis, mucositis, pharyngitis, and lung inflammation [24][25][26][27].…”

Section: Introductionmentioning

confidence: 99%

Prospective randomized study to evaluate the efficacy and tolerability of Ectoin® containing Eye Spray (EES09) and comparison to the liposomal Eye Spray Tears Again® (TA) in the treatment of dry eye disease

Nosch¹,

Joos²,

Job³

2021

Contact Lens and Anterior Eye

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To subjectively and objectively evaluate the efficacy and tolerability of preservative-free Ectoin ® Eye Spray -Colloidal (EES09) and Tears Again ® Eye Spray (TA) in subjects with mild-moderate dry eye disease (DED), and to compare efficacy of these two eye sprays with each other. Methods: Thirty-six volunteers (average age 32.3 ± 16.1 years; 26 females) were successfully recruited for this prospective double-blind study with between-subject design and randomly divided into two groups (gender and age balanced): Group A received EES09 and Group B received TA during the treatment phase. Inclusioncriteria were a minimum age of 18 years, a score of 18.0 or higher on the OSDI questionnaire, and a non-invasive tear break up time (NIKBUT, Oculus Keratograph M5, Oculus, Germany) of no more than 10s in at least one eye. The objective variables NIKBUT, conjunctival redness, lipid layer and osmolarity (TearLab Cooperation, USA) were assessed at baseline, 10 min. after spray application and after a treatment phase of 10±3 days (3x applications daily). Symptoms, tolerance and handling were evaluated with the OSDI and VAS questionnaires. Results: A statistically significant increase in NIKBUT and improvement in DED symptoms were obtained for the overall group (mean NIKBUT 7.7 ± 1.7s vs. 11.6 ± 4.6s, p<0.001; mean OSDI score: 36.1 ± 12.7 vs. 20. 7± 12.7, p<0.001) during course of treatment. No statistically significant effect was established for the variables lipid layer (p = 0.406), conjunctival redness (p = 0.766) and osmolarity (p = 0.378). No statistically significant differences were observed between the groups, for any variable. The noninferioritycriterion for EES09 towards TA could be shown for the scores of the dry eye symptoms via VAS questionnaire and the variable NIKBUT. Conclusions: A beneficial treatment effect was confirmed for both, symptoms of DED and the objective variable NIKBUT. Both eye sprays were rated favourably in view of perceived tolerability and handling of the spray bottle.

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“…A similar effect was observed in model systems for inflammatory bowel disease [ 17 ]. Promising findings from clinical trials harnessed ectoine as a therapeutic agent for several inflammatory diseases such as atopic dermatitis [ 18 ], upper airway inflammations like pharyngitis/laryngitis [ 19 , 20 ], rhinosinusitis and acute bronchitis [ 21 ] as reviewed by Casale and colleagues [ 22 ], rhinitis sicca [ 23 ], chemotherapy-induced mucositis [ 24 ], and also lung inflammation caused by environmental pollutants [ 25 ], even in long-term applications in children to prevent upper respiratory infections [ 26 ] or treatment of vernal keratoconjunctivitis [ 27 ].…”

Section: Introductionmentioning

confidence: 99%

The Effectiveness of the Bacteria Derived Extremolyte Ectoine for the Treatment of Allergic Rhinitis

Bilstein¹,

Werkhäuser

Rybachuk

et al. 2021

BioMed Research International

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Nonpharmacological therapies with a good tolerability and safety profile are of interest to many patients with allergic rhinitis, as a relevant proportion of them have reservations about guideline-concordant pharmacological therapies due to their local irritations and side effects. Ectoine is a bacterial-derived extremolyte with an ability to protect proteins and biological membranes against damage caused by extreme conditions of salinity, drought, irradiation, pH, and temperature. Evidence from preclinical and clinical studies attests its effectiveness in the treatment of several inflammatory diseases, including allergic rhinitis. In this review, we analyzed 14 recent clinical trials investigating ectoine nasal spray in patients with allergic rhinitis and/or conjunctivitis, including sensitive patient groups like children or pregnant women. Some studies investigated monotherapy with ectoine; others investigated combination therapy of ectoine and an antihistamine or a corticosteroid. Analysis of the study results demonstrated that patients with mild-to-moderate symptoms of allergic rhinitis can be successfully treated with ectoine-containing nasal spray. When applied as monotherapy, ectoine exerted noninferior effects compared to first-line therapies such as antihistamines and cromoglicic acid. Using ectoine as an add-on therapy to antihistamines or intranasal glucocorticosteroids accelerated symptom relief by days and improved the level of symptom relief. Importantly, concomitant treatment with ectoine was proven beneficial in a group of difficult-to-treat patients suffering from moderate-to-severe rhinitis symptoms. Taken together, the natural substance ectoine represents a viable alternative for allergic rhinitis and conjunctivitis patients who wish to avoid local reactions and side effects associated with pharmacological therapies.

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Topical Ectoine: A Promising Molecule in the Upper Airways Inflammation—A Systematic Review

Cited by 14 publications

References 20 publications

Ectoine in the Treatment of Irritations and Inflammations of the Eye Surface

Ectoine in the Treatment of Irritations and Inflammations of the Eye Surface

Prospective randomized study to evaluate the efficacy and tolerability of Ectoin® containing Eye Spray (EES09) and comparison to the liposomal Eye Spray Tears Again® (TA) in the treatment of dry eye disease

The Effectiveness of the Bacteria Derived Extremolyte Ectoine for the Treatment of Allergic Rhinitis

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