Inhibitory effects of sulfonated shale oils (ammonium bituminosulphonates, Ichthyols) on enzymes of polyenoic fatty acid metabolism

Sodium Bituminosulfonate Used to Treat Rosacea Modulates Generation of Inflammatory Mediators by Primary Human Neutrophils

Background

Sodium bituminosulfonate is derived from naturally occurring sulphur-rich oil shale and is used for the treatment of the inflammatory skin disease rosacea. Major molecular players in the development of rosacea include the release of enzymes that process antimicrobial peptides which, together with reactive oxygen species (ROS) and vascular endothelial growth factor (VEGF), promote pro-inflammatory processes and angiogenesis. The aim of this study was to address the molecular mechanism(s) underlying the therapeutic benefit of the formulation sodium bituminosulfonate dry substance (SBDS), which is indicated for the treatment of skin inflammation, including rosacea.

Methods

We investigated whether SBDS regulates the expression of cytokines, the release of the antimicrobial peptide LL-37, calcium mobilization, proteases (matrix metalloproteinase, elastase, kallikrein (KLK)5), VEGF or ROS in primary human neutrophils. In addition, activity assays with 5-lipoxygenase (5-LO) and recombinant human MMP9 and KLK5 were performed.

Results

We observed that SBDS reduces the release of the antimicrobial peptide LL-37, calcium, elastase, ROS and VEGF from neutrophils. Moreover, KLK5, the enzyme that converts cathelicidin to LL-37, and 5-LO that produces leukotriene (LT)A₄, the precursor of LTB₄, were both inhibited by SBDS with an IC₅₀ of 7.6 µg/mL and 33 µg/mL, respectively.

Conclusion

Since LTB₄ induces LL-37 which, in turn, promotes increased intracellular calcium levels and thereby, ROS/VEGF/elastase release, SBDS possibly regulates the LTB₄/LL-37/calcium – ROS/VEGF/elastase axis by inhibiting 5-LO and KLK5. Additional direct effects on other pro-inflammatory pathways such as ROS generation cannot be ruled out. In summary, SBDS reduces the generation of inflammatory mediators from human neutrophils possibly accounting for its anti-inflammatory effects in rosacea.

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Zusammenfassung. In dieser Arbeit wird auf Kortikoid-Alternativen wie Calcineurin-Inhibitoren, sulfonierte Schieferöle, Ultraviolettlicht und Klimatherapie näher eingegangen. Topische Calcineurin-Inhibitoren lassen sich als Immunsuppressiva verstehen, die eine T-Lymphozytenaktivierung inhibieren und eine Freisetzung proinflammatorischer Zytokine über den Calcineurinweg verhindern. Die Entzündungshemmung sulfonierter Schieferöle soll auf einer Hemmung der 5-Lipoxygenase sowie der 5-Hydroxyeicosatetraensäure und des Leukotriens B4 beruhen. Die Rationale für den Einsatz einer UV-Lichtbehandlung liegt in deren antiinflammatorischer Wirkung u.a. auf Antigen-präsentierende Langerhanszellen, infiltrierende T-Zellen und proinflammatorische Zytokine. Eine Klimatherapie im Hochgebirge oberhalb von 1500 Höhenmeter vermag unter anderem eine Freiheit von Hausstaubmilben-Allergenen zu gewährleisten. Andere potente Allergene (z.B. Birken- und Gräserpollen, Schimmelpilzsporen) sind deutlich in der Konzentration als auch in der Zeitdauer ihres Auftretens reduziert.

Efficacy and tolerability of pale sulfonated shale oil cream 4% in the treatment of mild to moderate atopic eczema in children: a multicentre, randomized vehicle-controlled trial

BACKGROUND

Reports on controlled trials on the efficacy and tolerability of sulfonated shale oils in atopic eczema are not available so far. The aim of this study was to investigate whether topically applied, specially prepared pale sulfonated shale oil (PSSO) cream is capable of improving symptoms/signs of mild to moderate atopic eczema in children more efficaciously than a corresponding vehicle cream.

PATIENTS AND METHODS

A total of 99 children suffering from mild to moderate atopic eczema were enrolled in this multicentre, randomized, vehicle-controlled study. Verum or vehicle cream was applied to the affected skin area three times a day over 4 weeks. As the primary outcome parameter served the reduction of the total score after 4 weeks of treatment, compared with the initial examination. Secondary outcome parameters were addressed as well. Tolerability was judged by investigators and patients/parents, and adverse events were documented.

RESULTS

After 4 weeks of treatment, the total score declined from 13.4 ± 3.7 to 4.5 ± 7.4 score points in the verum group and from 13.0 ± 3.1 to 11.7 ± 8.6 score points in the vehicle group (P < 0.0001). The superiority of verum regarding total score was already apparent after a treatment period of 1 week (reduction by 5.6 ± 4.3 vs. 1.3 ± 5.9 score points; P < 0.0001). Tolerability was found superior at the end of the treatment in the verum when compared with the control group--both by investigators (P < 0.0001) and patients/parents (P = 0.0051).

CONCLUSION

Pale sulfonated shale oil cream 4% is capable to treat mild to moderate atopic eczema in children more efficaciously than vehicle and is well tolerated. PSSO thus represents a valuable addition to our therapeutic armamentarium. PSSO should be considered in particular when valid alternatives for topical glucocorticoids are sought for.

Efficacy of topical pale sulfonated shale oil in the treatment of venous leg ulcers: A randomized, controlled, multicenter study

BACKGROUND

Venous leg ulcers are a growing socioeconomic burden. Pale sulfonated shale oils (PSSO) are used for therapy of inflammatory skin diseases and have been shown to enhance wound healing in vitro and in vivo. The aim of this study was to investigate whether PSSO is capable of enhancing venous ulcer healing beyond compression therapy alone.

METHODS

One hundred nineteen patients were enrolled in this randomized, multicenter, observer-blind study. In the treatment group, PSSO 10% was applied daily for 20 weeks, and the control group received the vehicle only. Wounds were covered by a nonadherent gauze dressing, and compression therapy with short-stretch elastic bandages was performed in an outpatient setting. The primary study end point was defined as cumulative reduction in wound area; the secondary study end point was treatment success as assessed by both physicians and patients. Additionally, adverse events, including changes with respect to physical examination and vital signs, were documented.

RESULTS

At the end of the study period, ulcer size was significantly more reduced in the PSSO group compared with the vehicle group (15 +/- 15.9 to 6.2 +/- 12.9 cm(2) vs 11.4 +/- 14.5 to 10.8 +/- 15.7 cm(2); P = .0005). The cumulative relative reduction in ulcer area was significantly higher in the PSSO group (-4391 +/- 4748.7 vs -231.9 +/- 6283.6 % x days; P < .0001). Relative reduction in wound area was significantly greater in the PSSO group as early as 6 weeks after the beginning of treatment (-47.4 +/- 28.4 vs -23.8 +/- 42.2%; P < .001). PSSO was judged successful both by physicians and patients. There were no significant differences in adverse events (PSSO, 9 [12.2%]; vehicle, 7 [11.1%]. Similarly, tolerability of PSSO was equal to the tolerability of the vehicle.

CONCLUSION

Pale sulfonated shale oils were capable of favoring venous ulcer healing in addition to compression therapy. PSSO should be considered for future wound care protocols for treatment of venous leg ulcers.