Статья посвящена инновационному медицинскому изделию с доказанным эзофагопротективным потенциалом – Альфазоксу, в состав которого входят гиалуроновая кислота и хондроитина сульфат, нанесенные на биоадгезивный носитель полоксамер 407. Проведенные доклинические и клинические исследования с применением Альфазокса продемонстрировали высокую эффективность и безопасность данного медицинского изделия у пациентов с гастроэзофагеальной рефлюксной болезнью.
The article presents the innovative nonprescription medication with proven esophagoprotective potential. Alfasoxx is consist of a mixture of hyaluronic acid and chondroitin sulfate with poloxamer 407, which facilitates the product adhesion on the esophageal mucosa. Conducted preclinical and clinical studies of Alfasoxх demonstrated the high efficacy and safety of this nonprescription medication in patients with gastroesophageal reflux disease.
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2. Talley NJ, Armstrong D, Junghard O et al. Predictors of treatment response in patients with non-erosive reflux disease. Aliment Pharmacol Ther 2006; 24 (2): 371–6.
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[Ivashkin V.T., Maev I.V., Trukhmanov A.S. i dr. Klinicheskie rekomendatsii Rossiiskoi gastroenterologicheskoi assotsiatsii po diagnostike i lecheniiu gastroezofageal'noi refliuksnoi bolezni. Ros. zhurn. gastroenterologii, gepatologii, koloproktologii. 2017; 27 (4): 75–95 (in Russian).]
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29. Dumortier G, Grossiord JL, Agnely F, Chaumeil JC. A review of poloxamer 407 pharmaceutical and pharmacological characteristics. Pharm Res 2006; 23 (12): 2709–28.
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31. Meyer K, Palmer J. The polysaccharide of the vitreous humor. J Biol Chem 1934; 107: 629–34.
32. Meyer K. Highly viscous sodium hyaluronate. J Biol Chem 1948; 176 (2): 993–7.
33. Stern R, Asary A. Hyaluronan fragments: an information-rich system. Eur J Cell Biol 2006; 85: 699–715.
34. Vigetti D, Karousou E, Viola M et al. Hyaluronan: Biosynthesis and Signaling. Biochem Biophys Acta 2014; 1840: 2452–9.
35. Volpi N. Antiinflammatory activity of chondroitin sulphate: new functions from an old natural macromolecule. Inflammopharmacology 2011; 19: 299–306.
36. Guelfi G, Stefanetti V, Zampini D et al. Gold nanoparticles approach to detect chondroitin sulphate and hyaluronic acid urothelial coating. Scientific Rep 2017; 7: 10355–62.
37. Savarino V, Pace F, Scarpignato C et al. Randomised clinical trial: mucosal protection combined with acid suppression in the treatment of non-erosive reflux disease – efficacy of Esoxx, a hyaluronic acid–chondroitin sulphate based bioadhesive formulation. Aliment Pharmacol Ther 2017; 45 (5): 631–42.
38. Palmieri B, Corbascio D, Capone S, Lodi D. Preliminary clinical experience with a new natural compound in the treatment of oesophagitis and gastritis: symptomatic effect. Trends Med 2009; 9: 219–25.
39. Palmieri B, Merighi A, Corbascio D et al. Fixed combination of hyaluronic acid and chondroitin sulphate oral formulation in a randomized double blind, placebo controlled study for the treatment of symptoms in patients with non-erosive gastroesophageal reflux. Eur Rev Med Pharmacol Sci 2013; 17: 3272–8.
40. Ghazi K, Deng-Pichon U, Warnet J-M, Rat P. Hyaluronan fragments improve wound healing on in vitro cutaneous model through P2X7 purinoreceptor basal activation: role of molecular weight. PLoS ONE 2012; 7 (11): 48–51.
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1. Fass R, Sifrim D. Management of heartburn not responding to proton pump inhibitors. Gut 2009; 58 (2): 295–309. DOI: 10.1136/gut.2007.145581
2. Talley NJ, Armstrong D, Junghard O et al. Predictors of treatment response in patients with non-erosive reflux disease. Aliment Pharmacol Ther 2006; 24 (2): 371–6.
3. Palmieri B, Merighi A, Corbascio D et al. Fixed combination of hyaluronic acid and chondroitin-sulphate oral formulation in a randomized double blind, placebo controlled study for the treatment of symptoms in patients with non-erosive gastroesophageal reflux. Eur Rev Med Pharmacol Sci 2013; 17: 3272–8.
4. Di Simone MP, Baldi F, Vasina V et al. Barrier effect of esoxx on esophageal mucosal damage: Experimental study on ex-vivo swine model. Clin Exp Gastroenterol 2012; 5: 103–7.
5. Vakil N, van Zanten SV, Kahrilas P et al. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol 2006; 101 (8): 1900–20.
6. Gyawali CP, Kahrilas PJ, Savarino E et al. Modern diagnosis of GERD: the Lyon Consensus. Gut 2018; 67 (7): 1351–62. DOI: 10.1136/gutjnl-2017-314722
7. Lazebnik L.B., Alekseenko S.A., Lialiukova E.A. i dr. Rekomendatsii po vedeniiu pervichnykh patsientov s simptomami dispepsii. Eksperim. i klin. gastroenterologiia. 2018; 5 (153): 4–18 (in Russian).
8. Oganov R.G., Simanenkov V.I., Bakulin I.G. i dr. Komorbidnaia patologiia v klinicheskoi praktike. Algoritmy diagnostiki i lecheniia. Kardiovaskuliarnaia terapiia i profilaktika. 2019; 18 (1): 5–66. doi.org/10.15829/1728-8800-2019-1-5-66 (in Russian).
9. Simanenkov V.I., Tikhonov S.V., Lishchuk N.B. Gastroezofageal'naia refliuksnaia bolezn' i ozhirenie: kto vinovat i chto delat'? Meditsinskii alfavit. Prakticheskaia gastroenterologiia. 2017; 27: 5–12 (in Russian).
10. Tack J. Review article: role of pepsin and bile in gastro-oesophageal reflux disease. Alimentary Pharmacol Therap 2005; 1: 48–54.
11. Boeckxstaens GE, Smout A. Systematic review: Role of acid, weakly acidic and weakly alkaline reflux in gastro-oesophageal reflux disease. Alimentary Pharmacol Ther 2010; 32: 334–43.
12. Simanenkov V.I., Tikhonov S.V., Lishchuk N.B. Geterogennost' GERB. Mif ili real'nost'. RMZh. 2016; 17: 1119–24 (in Russian).
13. Fox MR, Kahrilas PJ, Roman S et al. Clinical measurement of gastrointestinal motility and function: who, when and which test? Nat Rev Gastroenterol Hepatol 2018; 15 (9): 568–79.
14. Race C, Chowdry J, Russell JM. Studies of salivary pepsin in patients with gastro-oesophageal reflux disease. Aliment Pharmacol Ther 2019; 49 (9): 1173–80. DOI: 10.1111/apt.15138
15. Frazzoni M, Savarino E, de Bortoli N et al. Analyses of the Post-reflux Swallow-induced Peristaltic Wave Index and Nocturnal Baseline Impedance Parameters Increase the Diagnostic Yield of Impedance-pH Monitoring of Patients With Reflux Disease. Clin Gastroenterol Hepatol 2016; 14 (1): 40–6. DOI: 10.1016/j.cgh.2015.06.026
16. Ivashkin V.T., Abdulkhakov R.A., Alekseeva O.P. i dr. Dekslansoprazol dlia rasshireniia vozmozhnostei terapii gastroezofageal'noi refliuksnoi bolezni. Ros. zhurn. gastroenterologii, gepatologii, koloproktologii. 2015; 6: 120–3 (in Russian).
17. Hershcovici T, Fass R. Management of gastroesophageal reflux disease that does not respond well to proton pump inhibitors. Curr Opin Gastroenterol 2010; 26 (4): 367–78.
18. Orlando RC. The integrity of the esophageal mucosa. Balance between offensive and defensive mechanisms. Best Pract Res Clin Gastroenterol 2010; 24 (6): 873–82.
19. Ravelli A, Villanacci V, Cadei M et al. Dilated intercellular spaces in eosinophilic esophagitis. J Pediatr Gastroenterol Nutr 2014; 59 (5): 589–93.
20. Orlando RC. The pathogenesis of gastroesophageal reflux disease: the relationship between epithelial defense, dysmotility, and acid exposure. Am J Gastroenterol 1997; 92: 3S–5S.
21. Mönkemüller K, Wex T et al. Role of tight junction proteins in gastroesophageal reflux disease. BMC Gastroenterol 2012; 12: 128–49.
22. Kim Y, Kessler SP, Obery DR et al. Hyaluronan 35 kDa treatment protects mice from Citrobacter rodentium infection and induces epithelial tight junction protein ZO-1 in vivo. Matrix Biol 2017; 62: 28–39.
23. Bernstein C, Bernstein H, Payne CM et al. Field defects in progression to adenocarcinoma of the colon and esophagus. Electronic J Biotechnol 2008; 260: 1–10.
24. Orlando RС. Gastroesophageal Reflux Disease. New York: Marcel Dekker, 2000.
25. Ivashkin V.T., Maev I.V., Trukhmanov A.S. i dr. Klinicheskie rekomendatsii Rossiiskoi gastroenterologicheskoi assotsiatsii po diagnostike i lecheniiu gastroezofageal'noi refliuksnoi bolezni. Ros. zhurn. gastroenterologii, gepatologii, koloproktologii. 2017; 27 (4): 75–95 (in Russian).
26. Di Simone MP, Baldi F, Vasina V et al. Barrier effect of Esoxx on esophageal mucosal damage: experimental study on ex-vivo swine model. Clin Exp Gastroenterol 2012; 5: 103–7.
27. Fakhari A, Berkland C. Applications and emerging trends of hyaluronic acid in tissue engineering, as a dermal filler and in osteoarthritis treatment. Acta Biomater 2013; 9 (7): 7081–92.
28. Batchelor HK. Novel bioadhesive formulations in drug delivery. Drug Delivery Companies Report 2004; 3: 16–9.
29. Dumortier G, Grossiord JL, Agnely F, Chaumeil JC. A review of poloxamer 407 pharmaceutical and pharmacological characteristics. Pharm Res 2006; 23 (12): 2709–28.
30. Fakhari A, Corcoran M, Schwarz A. Thermogelling properties of purified poloxamer 407. Heliyon 2017; 30 (3): 90–9.
31. Meyer K, Palmer J. The polysaccharide of the vitreous humor. J Biol Chem 1934; 107: 629–34.
32. Meyer K. Highly viscous sodium hyaluronate. J Biol Chem 1948; 176 (2): 993–7.
33. Stern R, Asary A. Hyaluronan fragments: an information-rich system. Eur J Cell Biol 2006; 85: 699–715.
34. Vigetti D, Karousou E, Viola M et al. Hyaluronan: Biosynthesis and Signaling. Biochem Biophys Acta 2014; 1840: 2452–9.
35. Volpi N. Antiinflammatory activity of chondroitin sulphate: new functions from an old natural macromolecule. Inflammopharmacology 2011; 19: 299–306.
36. Guelfi G, Stefanetti V, Zampini D et al. Gold nanoparticles approach to detect chondroitin sulphate and hyaluronic acid urothelial coating. Scientific Rep 2017; 7: 10355–62.
37. Savarino V, Pace F, Scarpignato C et al. Randomised clinical trial: mucosal protection combined with acid suppression in the treatment of non-erosive reflux disease – efficacy of Esoxx, a hyaluronic acid–chondroitin sulphate based bioadhesive formulation. Aliment Pharmacol Ther 2017; 45 (5): 631–42.
38. Palmieri B, Corbascio D, Capone S, Lodi D. Preliminary clinical experience with a new natural compound in the treatment of oesophagitis and gastritis: symptomatic effect. Trends Med 2009; 9: 219–25.
39. Palmieri B, Merighi A, Corbascio D et al. Fixed combination of hyaluronic acid and chondroitin sulphate oral formulation in a randomized double blind, placebo controlled study for the treatment of symptoms in patients with non-erosive gastroesophageal reflux. Eur Rev Med Pharmacol Sci 2013; 17: 3272–8.
40. Ghazi K, Deng-Pichon U, Warnet J-M, Rat P. Hyaluronan fragments improve wound healing on in vitro cutaneous model through P2X7 purinoreceptor basal activation: role of molecular weight. PLoS ONE 2012; 7 (11): 48–51.
Авторы
Н.В. Бакулина, С.В. Тихонов, Н.Б. Лищук
ФГБОУ ВО «Северо-Западный государственный медицинский университет им. И.И. Мечникова» Минздрава России, Санкт-Петербург, Россия