Lysozyme in the treatment of non-infectious sore throat

  • Una Glamočlija Scientific Research Unit, Bosnalijek d.d., Sarajevo, Bosnia and Herzegovina; Department for Biochemistry and Clinical Analysis, Faculty of Pharmacy, University of Sarajevo, Sarajevo, Bosnia and Herzegovina https://orcid.org/0000-0003-1206-6990
  • Meliha Mehić Medical Support Unit, Bosnalijek d.d., Sarajevo, Bosnia and Herzegovina
  • Aziz Šukalo Strategic Marketing and Market Support Department, Bosnalijek d.d., Sarajevo, Bosnia and Herzegovina
  • Amna Tanović Avdić Medical Support Unit, Bosnalijek d.d., Sarajevo, Bosnia and Herzegovina
  • Jasna Džananović Jaganjac Scientific Research Unit, Bosnalijek d.d., Sarajevo, Bosnia and Herzegovina https://orcid.org/0000-0001-6751-9497
Keywords: Lysozyme, non-infectious sore throat, anti-inflammatory, immunity

Abstract

Sore throat is a common reason for seeking medical help [1]. It can have infectious and non-infectious etiology [2]. The term “sore throat” is usually associated with an infectious agent (bacteria, viruses, and less commonly fungi) [1,3,4]. The terms “throat discomfort“, “throat irritation“, or “functional dysphonia due to the occupational diseases“ (which represents voice disorder) are often used in the same sense as non-infectious sore throat [2,3]. It is identified by the exclusion of infectious etiology symptoms accompanied with persistent sore throat symptoms (tingling and scratching sensation in the throat, hoarseness or muffled voice, foreign body sensation in the throat, coughing, and difficulty in swallowing accompanied by pain) [2,5].

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Lysozyme in the treatment of non-infectious sore throat
Published
2020-05-01
How to Cite
1.
Glamočlija U, Mehić M, Šukalo A, Tanović Avdić A, Džananović Jaganjac J. Lysozyme in the treatment of non-infectious sore throat. Bosn J of Basic Med Sci [Internet]. 2020May1 [cited 2020Sep.27];20(2):281-2. Available from: https://www.bjbms.org/ojs/index.php/bjbms/article/view/4619
Section
Letter to Editor

Sore throat is a common reason for seeking medical help [1]. It can have infectious and non-infectious etiology [2]. The term “sore throat” is usually associated with an infectious agent (bacteria, viruses, and less commonly fungi) [1,3,4]. The terms “throat discomfort”, “throat irritation”, or “functional dysphonia due to the occupational diseases” (which represents voice disorder) are often used in the same sense as non-infectious sore throat [2,3]. It is identified by the exclusion of infectious etiology symptoms accompanied with persistent sore throat symptoms (tingling and scratching sensation in the throat, hoarseness or muffled voice, foreign body sensation in the throat, coughing, and difficulty in swallowing accompanied by pain) [2,5].

Various factors can lead to non-infectious sore throat. The most important are: environmental (exposure to smog and irritants), individual risk factors (smoking, alcohol and excessive caffeine consumption, incorrect technique of using voice, and snoring), existence of other diseases (allergies, hormonal disorders, gastroesophageal refluxes, and anxiety disorders), and the use of some medications [2,6]. Epidemiological studies for non-infectious sore throat are rare. In a study performed on 1326 adults in the USA, it was found that 6.6% of respondents had current voice disorders while lifetime prevalence was 29.9% [6]. Professions more susceptible to non-infectious sore throat have high demands on vocal performance (for example, teachers, singers, sports coaches, receptionists, television and radio presenters, lawyers, touristic tour guides, and politicians) [2,3,7]. In modern societies, about one-third of the working population belongs to occupations in which the voice is the primary tool [8]. Teaching is a high-risk occupation for developing voice disorders. In a study performed on 2531 adults in the USA, teachers had higher prevalence of lifetime voice disorders (57.7%) as compared to other professions (28.8%) [5]. Voice problems may lead to a lower quality of teaching and a serious personal and emotional burden. This can have detrimental effects on the career of teachers, with negative consequences on pupils and employers [9]. Despite the adverse impact of non-infectious sore throat on professional performance and reduced quality of life, only a small number of teachers is seeking professional medical help [10]. This can be due to a low level of awareness on this topic.

Although exact mechanisms of non-infectious sore throat development vary with etiology, inflammation can be found in the majority of cases [2], with elevated pro-inflammatory cytokines such as interleukin (IL)-6, IL-β, and tumor necrosis factor-α (TNF-α) [2,11,12].

There has been little systematic assessment of treatments for non-infectious sore throat. The field lacks objective outcomes, with most studies relying on subjective (self-reported) endpoints [2]. Although there is no unique doctrine in the treatment, anti-inflammatory medicines and antiseptics are usually used. Inflammation is the pathophysiological mechanism of both infectious and non-infectious sore throat, so similar anti-inflammatory therapies have beneficial effects in both etiologies [2]. Few studies showed positive effects of non-steroidal anti-inflammatory medicines, paracetamol, and steroids [13]. Various herbal formulations and antiseptic lozenges, sprays, and mouthwashes (with or without the addition of an anesthetic or analgesic) are most commonly used [2,12].

Lysozyme is natural enzybiotic with properties that could be beneficial in the treatment of non-infectious sore throat. Different types of lysozymes can be found in nature. They have similar structures and share the ability to hydrolyze bacterial cell wall peptidoglycan [14]. Lysozyme is a significant part of the immune system. In humans, it can be found in body secretions, mucosal surfaces, liver, blood, and immune cells [14]. Human milk is rich in lysozyme, which plays an important role in our immunity from the first days of life [15]. The pharmaceutical industry is mainly using hen egg white lysozyme in products for treatment of certain infectious and inflammatory diseases [16].

Besides its direct antibacterial activity, lysozyme has immunomodulatory and anti-inflammatory effects. Immunomodulatory effects have been demonstrated in cancer patients after chemotherapy, where it improved the recovery of CD4+/CD8+ lymphocyte ratio [17]. One of the proposed mechanisms is through the release of immunomodulatory compounds after degradation of bacteria by lysozyme [18]. Anti-inflammatory effects have been shown in several studies. Lysozyme is effective in the treatment of diabetic nephropathy through the inhibition of IL-6 production and reduction of macrophage recruitment during inflammation [19]. In human monocytes, it transcriptionally inhibits the TNF-α and IL-1β pathways [20], and in mouse macrophages stimulated with lipopolysaccharide, it suppresses the production of TNF-α and IL-6 [21]. Lysozyme directly inhibits inflammatory mediators, which are key factors for development of non-infectious sore throat.

CONCLUSION

Lysozyme, a part of our own immunity, has a great potential in treatment of diseases with inflammatory etiology, including non-infectious sore throat. Clinical studies in this area are warranted. They could offer evidence for safe and effective treatment of this very common but still poorly recognized and treated disorder.

REFERENCES

  1. , , (). Antibiotics for sore throat. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD000023.pub4
  2. , , (). Environmental and non-infectious factors in the aetiology of pharyngitis (sore throat). Inflamm Res. https://doi.org/10.1007/s00011-012-0540-9
  3. , (). Incidence, causes, severity and treatment of throat discomfort:A four-region online questionnaire survey. BMC Ear Nose Throat Disord. https://doi.org/10.1186/1472-6815-12-9
  4. (). Sore throat. BMJ Clin Evid.
  5. , , , , , (). Prevalence of voice disorders in teachers and the general population. J Speech Lang Hear Res. https://doi.org/10.1044/1092-4388(2004/023)
  6. , , , (). Voice disorders in the general population:Prevalence, risk factors, and occupational impact. The Laryngoscope. https://doi.org/10.1097/01.mlg.0000179174.32345.41
  7. , , (). Prevalence and risk factors of voice disorders in French tour guides. J Voice 2019. https://doi.org/10.1016/j.jvoice.2019.05.002
  8. , , (). The importance of the occupational vocal load for the occurence and treatment of organic voice disorders. Zdr Varst. https://doi.org/10.2478/sjph-2018-0003
  9. , , , (). A comparative study of voice complaints and risk factors for voice complaints in female student teachers and practicing teachers early in their career. Eur Arch Otorhinolaryngol. https://doi.org/10.1007/s00405-005-y1010-6
  10. , , , (). Voice disorders in teachers:Occupational risk factors and psycho-emotional factors. Logoped Phoniatr Vocol. https://doi.org/10.3109/14015439.2012.660499
  11. , , , , , (). Cytokines involved in the systemic inflammatory response induced by exposure to particulate matter air pollutants (PM10). Am J Respir Crit Care Med. https://doi.org/10.1164/ajrccm.164.5.2010160
  12. , , , , , (). Ameliorative effect of Koflet formulations against pyridine-induced pharyngitis in rats. Toxicol Rep. https://doi.org/10.1016/j.toxrep.2014.05.003
  13. , , , , , (). Effect of VBC-1814/7J, a poly-phytocompound, on a non-infectious model of pharyngitis. Exp Ther Med. https://doi.org/10.3892/etm.2017.4332
  14. , (). Lysozymes in the animal kingdom. J Biosci. https://doi.org/10.1007/s12038-010-0015-5
  15. (). Nutritional and physiologic significance of human milk proteins. Am J Clin Nutr. https://doi.org/10.1093/ajcn/77.6.1537S
  16. , (). Potential possibilities of production, modification and practical application of lysozyme. Acta Sci Pol Technol Aliment.
  17. , , , , (). Recovery of lymphocyte CD4+:CD8+ratio in patients treated with lysozyme. Drug Investig. https://doi.org/10.1007/BF03258379
  18. , (). From bacterial killing to immune modulation:Recent insights into the functions of lysozyme. PLoS Pathog. https://doi.org/10.1371/journal.ppat.1006512
  19. , , , , , (). Human recombinant lysozyme downregulates advanced glycation endproduct-induced interleukin-6 production and release in an in-vitro model of human proximal tubular epithelial cells. Exp Biol Med (Maywood). https://doi.org/10.1177/1535370213518281
  20. , , , , , (). Lysozyme-induced transcriptional regulation of TNF-αpathway genes in cells of the monocyte lineage. Int J Mol Sci. https://doi.org/10.3390/ijms20215502
  21. , , , (). Anti-inflammatory effect of lysozyme from hen egg white on amouse peritoneal macrophages. Cytotechnology. https://doi.org/10.1007/s10616-017-0184-2

Conflict of interest statement: Una Glamočlija, Meliha Mehić, Aziz Šukalo, Amna Tanović Avdić, and Jasna Džananović Jaganjac disclose the following relationship – employees of Bosnalijek d.d., a pharmaceutical company producing lysozyme based products.