Busting Biofilms: A New Treatment for Blepharitis, Meibomian Gland Dysfunction
and Dry Eye Syndrome
Richard A Eiferman1, Gregory S Schultz2, George T Rodeheaver3, Anthony Sawyer4
1University of Louisville, Louisville, Kentucky; 2University of Florida, Gainesville, Florida; 3University of Virginia, Charlottesville, Virginia; 4Nevada Naturals, Inc, Albuquerque, New Mexico
Purpose: Blepharitis is an intractable disease due to formation of biofilms on the lid margins and in sebaceous glands. It contributes to dry eye syndrome by invading and plugging the meibomian glands causing instability of the tear film. Present therapies do not address this mechanism of action. We have developed a biocompatible surfactant formulation that disrupts a mature biofilm and sterilize the tissue.
Methods: We have developed a pigskin model of a mature staphylococcal biofilm. We have patented a nonionic block co-polymer with a hydrophobic core and hydrophilic termini. When solubilized in water, the surfactant molecules organize into a spherical structure called a micelle, with the center of the sphere being the hydrophobic cores of the surfactant molecules with their hydrophilic tails forming the outer surface. This surfactant solution has the ability to hydrate, soften, penetrate, and ultimately disrupt the glycocalyx of the biofilm structure. It is non cytotoxic, commercially available and FDA approved for treatment of burns and chronic skin wounds. There is a marked synergistic effect when natural anti-microbial compounds such as L-arginine ethyl ester (LAE) and sucrose laurate (SL) are added to the poloxamer surfactant, which helps the antimicrobial agents to penetrate the biofilm matrix. These positively charged antimicrobial ester molecules tightly bind to the negatively charged phospholipid molecules that comprise the bacterial plasma membrane, then the hydrophobic segments of LAE and SL “punches holes” (saponify) in the plasma membrane of both the metabolically active and inactive bacteria in the biofilm. LAE and SL are each effective antimicrobial molecules at very low concentrations and have no significant cytotoxicity at microbicidal concentrations. LAE and SL are commercially available and approved by both the FDA and EU.
Results: The combination of these products had a synergistic effect and completely eradicated the biofilm and sterilized the epidermis, hair shafts, and sebaceous glands.
Conclusions: This is a completely novel approach to the treatment of diseases associated with bacterial biofilms because it disperses the biofilm matrix, kills the embedded and metabolically dormant “persister” bacteria that are tolerant to antibiotics, and rapidly kill planktonic bacteria, which prevents reformation of the biofilm. Furthermore, it has a profound cleansing action by removing dead cells and debris including mascara and makeup from the eyelids.