THE UBIQUITY of polysaccharides belies the elegance of their organic chemistry and their importance in biology and biochemistry. Polysaccharides form biomaterials, reshape biochemical pathways, nourish life, and even deliver drugs. They form the very backbone of life—the two side chains of DNA consist of ribose, a five-carbon sugar.
The most exciting roles for polysaccharides are their biochemical activities. Just a few sugars in heparin or enoxaparin polysaccharide can halt the coagulation cascade (Hirsch et al, 2001). One untapped but critical area in clinical medicine is the relationship between acute pain and inflammation.
There are limited options for improving acute pain within minutes or seconds. Steroids and nonsteroidal anti-inflammatory drugs (NSAIDs) take hours to take effect (Troullos et al, 1990). Anesthetics and opioids only address pain symptoms (and not their cause) by blocking the propagation of nerve signals or by altering the perception of pain in the spinal cord or brain, which is invariably inflammation induced when it is not mechanical in origin (Pathan et al, 2012).
Pain is part of the earliest cascade in any inflammatory process, from autoimmune lupus to chemical acid burns. Reduce acute pain and the inflammation subsides at the earliest cascade level to prevent many of the secondary side effects associated with blocking inflammation at a more distal level.
This is akin to placing a lid on top of a frying-pan fire rather than turning on the sprinklers. Polysaccharides avoid water damage from sprinklers like NSAIDs or steroids.
Acmella oleracea is an herb that contains rhamnogalacturonan polysaccharide, which has been shown to reduce pain and inflammation by its effect on the myeloperoxidase, lipid hydroperoxide, and glutathione S-transferases and superoxide dismutase (Maria-Ferreira et al, 2021). Abelmoschus esculentus (okra) has been demonstrated to have both anti-pain and anti-inflammatory activities through its effect on CRP, IL-1, IL-6, NF-κB, and TNF-α (Liu et al, 2021; Malek et al, 2022). Commercially available formulations with active okra polysaccharides have been shown to have immediate and long-term anti-inflammatory effects on the ocular surface with improvements in redness, swelling, and pain within seconds to minutes (Narayanan et al, 2020). This can be especially favorable in treating patients suffering from blepharitis and can be used in conjunction with microblepharoexfoliation to remove biofilm from the lid margins and to manage Demodex.
A single treatment has been found to decrease matrix metalloproteinase-9 (MMP-9), which is a primary hallmark of inflammation, and reduce the need for artificial tears for contact lens patients (Narayanan et al, 2019). In an in-vitro and in-vivo study, okra was shown to be just as effective as tea tree oil against Demodex without the ocular surface side effects (Liu and Gong, 2021) (Figure 1).
Eyelid hygiene is vital to dry eye treatment regimens, and polysaccharides can be used in this arena as both an in-office treatment and an at-home maintenance therapy for patients who suffer from blepharitis and ocular surface disease. The ability of polysaccharides to block pain provides a clinically novel and valuable option to give these patients immediate relief from discomfort and reduce eyelid inflammation without inducing significant secondary side effects compared to other treatment alternatives.
Acknowledgment: The author would like to thank Peter Pham, MD, for his explanation of the science behind polysaccharides for this article.
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