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

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

doi:10.1155/2019/7150942

Abstract

To date, topical therapies guarantee a better delivery of high concentrations of pharmacologic agents to the mucosa of the upper airways (UA). Recently, topical administration of ectoine has just been recognized as adjuvant treatment in the Allergic Rhinitis (AR) and Rhinosinusitis (ARS). The aim of this work is to review the published literature regarding all the potential therapeutic effects of ectoine in the acute and chronic inflammatory diseases of UA. Pertinent studies published without temporal limitation were selected searching on MEDLINE the following terms: “ectoine” and “nasal spray,” “oral spray,” “upper respiratory tract infections,” “rhinosinusitis,” “rhinitis,” “rhinoconjunctivitis,” “pharyngitis,” and “laryngitis.” At the end of our selection process, six relevant publications were included: two studies about the effect of ectoine on AR, one study about ARS, one study about rhinitis sicca anterior, and two studies about acute pharyngitis and/or laryngitis. Due to its moisturizing and anti-inflammatory properties, topical administration of ectoine could play a potential additional role in treatment of acute and chronic inflammatory diseases of UA, in particular in the management of sinonasal conditions improving symptoms and endoscopic findings. However, these results should be viewed cautiously as they are based on a limited number of studies; some of them were probably underpowered because of their small patient samples.

Highlights

Ectoine is a low-molecular, cyclic tetrahydropyrimidine organic osmolyte, which was first identified by Galinski et al [1] in the halophilic bacterium, Ectothiorhodospira halochloris, but since it has been found in other extremophiles microorganisms
A search was made of the PubMed, Google Scholar, and Ovid databases according to the PRISMA guidelines [9] using the following key words or in the case of PubMed medical subject headings: “ectoine” and “nasal spray,” “ectoine” and “oral spray,” “ectoine” and “upper respiratory tract infections,” “ectoine” and “allergic rhinitis,” “ectoine” and “rhinosinusitis,” “ectoine” and “rhinoconjunctivitis,” “ectoine” and “rhinitis,” “ectoine” and “pharyngitis,” ectoine” and “laryngitis.” Only studies in English, published in peer-reviewed journals, reporting data on the role of the topical administration of ectoine in the upper airways (UA) are included; no studies related to dentistry have been considered
The stabilizations effects on the barrier function of the epithelial tissue have led to the hypothesis that ectoine increases the resistance of the UA mucosa and improves its recovery (Figure 1)

Summary

Introduction

Ectoine is a low-molecular, cyclic tetrahydropyrimidine organic osmolyte, which was first identified by Galinski et al [1] in the halophilic bacterium, Ectothiorhodospira halochloris, but since it has been found in other extremophiles microorganisms. To protect themselves from external stress factors such as extreme temperatures, high salt concentrations, and ultraviolet radiations, these microorganisms produce stress-protection molecules, called extremolytes. Among these molecules, there is ectoine [2]. Many stress-protection molecules such as ectoine do not bind to proteins; they are excluded from a protein’s hydration layer (the water molecules adjacent to a protein’s surface) Because of this repulsion, proteins will tend to fold up more compactly, since this will reduce exposure of the peptide-bond backbone to thermodynamically unfavorable interactions with the stabilizing solute

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