Medical hypothesis, discovery & innovation in optometry

Chitosan-coated contact lens-based ophthalmic drug delivery system to manage Acanthamoeba keratitis: A preliminary hypothesis

Medical hypothesis, discovery & innovation in optometry, Vol. 2 No. 3 (2021), 14 March 2022 , Page 114-118
https://doi.org/10.51329/mehdioptometry134

Abstract

Background: Acanthamoeba species can cause devastating contact lens (CL)-related microbial keratitis. Its culture is less sensitive, and little evidence is available for the safety or efficacy profile of medications. Therefore, early diagnosis and optimal treatment remain difficult. The aim of this study was to present the hypothesis that a novel chitosan-coated CL-based ophthalmic drug delivery system has therapeutic and prophylactic effects on acanthamoeba keratitis.
Hypothesis: CL-based drug delivery is a popular sustained-release drug delivery that extends the drug release time, thus increasing its bioavailability and treatment efficacy. Chitosan, a derivative of chitin, has antioxidant and broad-spectrum antimicrobial properties against fungi, yeasts, and bacteria. It acts against microbial cells; however, whether its mechanism of action is microbiostatic or microbicidal remains unknown. It exhibits wound healing and film-forming properties. Chitosan composite films permit high transmittance of visible light, making it transparent and therefore desirable for the development of CLs. Chitosan/Ag/ZnO blend films exhibit antimicrobial activities. Further, soft CLs coated with chitosan, sodium hyaluronate, polylysine hydrobromide, and sodium alginate show drug delivery properties and reduced bacterial growth. Recently, concentration-dependent anti-amoebic activities of chitosan and nano-chitosan against the trophozoite and cystic forms of Acanthamoeba have been reported. Based on the existing evidence, we hypothesized that a chitosan-coated CL-based ophthalmic drug delivery system could have therapeutic and prophylactic effects on acanthamoeba keratitis or subsequent endophthalmitis.
Conclusions:  CLs or intraocular implants with chitosan-based nanocoatings alone or in combination with routine treatment may be preventive or therapeutic for acanthamoeba keratitis or endophthalmitis. Experimental studies and further clinical trials are required to explore the efficacy and safety profile. Moreover, randomized controlled trials in healthy eyes with soft or hard CLs or orthokeratology lenses for refractive error correction may shed light on the prophylactic effect of this novel drug delivery system. Other forms of ophthalmic drug delivery systems using chitosan-based nanocoatings should be studied additionally.
Keywords:
  • microbial keratitis
  • acanthamoeba
  • chitosan
  • chitin
  • antimicrobial
  • bacteria
  • yeast
  • fungi
  • contact lens

References

Loh K, Agarwal P. Contact lens related corneal ulcer. Malays Fam Physician. 2010;5(1):6-8. pmid: 25606178

Kam KW, Yung W, Li GKH, Chen LJ, Young AL. Infectious keratitis and orthokeratology lens use: a systematic review. Infection. 2017;45(6):727-735. doi: 10.1007/s15010-017-1023-2 pmid: 28534320

Moshirfar M, Hopping GC, Vaidyanathan U, Liu H, Somani AN, Ronquillo YC, et al. Biological Staining and Culturing in Infectious Keratitis: Controversy in Clinical Utility. Med Hypothesis Discov Innov Ophthalmol. 2019;8(3):145-151. pmid: 31598516

Alkharashi M, Lindsley K, Law HA, Sikder S. Medical interventions for acanthamoeba keratitis. Cochrane Database Syst Rev. 2015;2015(2):CD010792. doi: 10.1002/14651858.CD010792.pub2 pmid: 25710134

Patel A, Cholkar K, Agrahari V, Mitra AK. Ocular drug delivery systems: An overview. World J Pharmacol. 2013;2(2):47-64. doi: 10.5497/wjp.v2.i2.47 pmid: 25590022

Short BG. Safety evaluation of ocular drug delivery formulations: techniques and practical considerations. Toxicol Pathol. 2008;36(1):49-62. doi: 10.1177/0192623307310955 pmid: 18337221

Awwad S, Mohamed Ahmed AHA, Sharma G, Heng JS, Khaw PT, Brocchini S, et al. Principles of pharmacology in the eye. Br J Pharmacol. 2017;174(23):4205-4223. doi: 10.1111/bph.14024 pmid: 28865239

Siafaka PI, Ya?cilar AP. New Era of Ocular Drug Delivery Systems Based on Contact Lenses. FABAD Journal of Pharmaceutical Sciences. 2020;45(2):16174. Link

Rykowska I, Nowak I, Nowak R. Soft Contact Lenses as Drug Delivery Systems: A Review. Molecules. 2021;26(18):5577. doi: 10.3390/molecules26185577 pmid: 34577045

Qiu H, Si Z, Luo Y, Feng P, Wu X, Hou W, et al. The Mechanisms and the Applications of Antibacterial Polymers in Surface Modification on Medical Devices. Front Bioeng Biotechnol. 2020;8:910. doi: 10.3389/fbioe.2020.00910 pmid: 33262975

Kumar MN. A review of chitin and chitosan applications. Reactive and functional polymers. 2000;46(1):1-27. doi: 10.1016/S1381-5148(00)00038-9

Dutta PK, Dutta J, Tripathi VS. Chitin and chitosan: Chemistry, properties and applications. Journal of Scientific & Industrial Research. 2004; 63(1): 20-31. Link

Kumirska J, Weinhold MX, Thöming J, Stepnowski P. Biomedical activity of chitin/chitosan based materials—influence of physicochemical properties apart from molecular weight and degree of N-acetylation. Polymers. 2011;3(4):1875-901. doi: 10.3390/polym3041875

Pillai CK, Paul W, Sharma CP. Chitin and chitosan polymers: Chemistry, solubility and fiber formation. Progress in polymer science. 2009;34(7):641-78. doi: 10.1016/j.progpolymsci.2009.04.001

Aranaz I, Mengíbar M, Harris R, Paños I, Miralles B, Acosta N, et al. Functional characterization of chitin and chitosan. Current chemical biology. 2009;3(2):203-30. doi: 10.2174/187231309788166415

Li LH, Deng JC, Deng HR, Liu ZL, Li XL. Preparation, characterization and antimicrobial activities of chitosan/Ag/ZnO blend films. Chemical Engineering Journal. 2010;160(1):378-82. doi: 10.1016/j.cej.2010.03.051

Xin-Yuan S, Tian-Wei T. New contact lens based on chitosan/gelatin composites. Journal of Bioactive and Compatible Polymers. 2004;19(6):467-79. doi: 10.1177/0883911504048410

Tan XW, Tan D, Beuerman RW, Mehta JS. Study of novel Chitosan-coated contact lens as an equivalent substrate for the therapeutic delivery of rabbit limbal epithelium. Investigative Ophthalmology & Visual Science. 2012;53(14):6124. Link

Huang JF, Zhong J, Chen GP, Lin ZT, Deng Y, Liu YL, et al. A Hydrogel-Based Hybrid Theranostic Contact Lens for Fungal Keratitis. ACS Nano. 2016;10(7):6464-73. doi: 10.1021/acsnano.6b00601 pmid: 27244244

Silva D, Sousa HC, Gil MH, Santos LF, Moutinho GM, Serro AP, et al. Antibacterial layer-by-layer coatings to control drug release from soft contact lenses material. Int J Pharm. 2018;553(1-2):186-200. doi: 10.1016/j.ijpharm.2018.10.041 pmid: 30342082

Hoyo J, Ivanova K, Guaus E, Tzanov T. Multifunctional ZnO NPs-chitosan-gallic acid hybrid nanocoating to overcome contact lenses associated conditions and discomfort. J Colloid Interface Sci. 2019;543:114-121. doi: 10.1016/j.jcis.2019.02.043 pmid: 3078251

Elkadery AAS, Elsherif EA, Ezz Eldin HM, Fahmy IAF, Mohammad OS. Efficient therapeutic effect of Nigella sativa aqueous extract and chitosan nanoparticles against experimentally induced Acanthamoeba keratitis. Parasitol Res. 2019;118(8):2443-2454. doi: 10.1007/s00436-019-06359-x pmid: 31144032

Ziaei Hezarjaribi H, Toluee E, Saberi R, Dadi Moghadam Y, Fakhar M, Akhtari J. In vitro anti-Acanthamoeba activity of the commercial chitosan and nano-chitosan against pathogenic Acanthamoeba genotype T4. J Parasit Dis. 2021;45(4):921-929. doi: 10.1007/s12639-021-01380-3 pmid: 34789973

Neelam S, Niederkorn JY. Pathobiology and Immunobiology of Acanthamoeba Keratitis: Insights from Animal Models. Yale J Biol Med. 2017;90(2):261-268 pmid: 28656012

Mehta P, Al-Kinani AA, Arshad MS, Singh N, van der Merwe SM, Chang MW, et al. Engineering and Development of Chitosan-Based Nanocoatings for Ocular Contact Lenses. J Pharm Sci. 2019;108(4):1540-1551. doi: 10.1016/j.xphs.2018.11.036 pmid: 30513319

Ruiz-Lozano RE, Gomez-Elizondo DE, Colorado-Zavala MF, Loya-Garcia D, Rodriguez-Garcia A. Update on indications, complications, and outcomes of scleral contact lenses. Med Hypothesis Discov Innov Ophthalmol. 2021; 10(4):165-178. doi: 10.51329/mehdiophthal1435

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