In vitro and in vivo study for antibacterial activity of endolysin-HEC gel and mixture gel on acne vulgaris caused by multidrug-resistant Staphylococcus aureus bacteria

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Haneen Emad Hussain
Ahmed Sahib Abdulamir
Iqbal Ghalib Farhood
Ahmed Rahma Ali
Muhannad Abdullah Al-azzawy


Chronic renal failure, Renin , Aspartate Amino Transferase Alanine Amino Transferase , Albumin, Globulin, Calcium , Sodium , Potassium .


Background: Acne is named “acne vulgaris” medically, and it is classified as the eighth most frequent illness in the world. Acne is derived from the Greek word “acme,” which means “prime of life.” It is predominantly a condition of adolescents and may continue into adulthood.
Aim: This study aimed to extract, purify, and prepare endolysin-hydroxyethyl cellulose (HEC) gel from Staphylococcus aureus–specific bacteriophages, evaluate its effectiveness via in vitro antibacterial validation tests, and clinically investigate its ability to target facial multidrug-resistant (MDR) S. aureus when applied topically to participants with moderate-to-severe acne lesions.
Methods: Twenty-three isolates of MDR S. aureus bacteria were obtained from inflammatory acne lesions of human skin by using disposable cotton swabs. Three bacteriophages with specific lytic activity against MDR S. aureus bacteria were isolated by “conventional microbiological methods” and prepared as bacteriophage cocktail, and endolysin was extracted and purified from them. Gel-based formulations, endolysin-HEC and mixture gel from bacteriophage cocktail, were prepared. In vitro validation tests was performed using spot lysis and top layer plaque assays, and antibacterial activities were also assessed. In vivo tests included the topical application of the gel three times daily for 1 week on facial skin of volunteers aged above 25 years with moderate-to-severe acne lesions caused by MDR S. aureus bacteria.

Results: Gel-based formulations exhibited 100% in vitro lytic spectrum analysis against MDR S. aureus isolates. No allergic reaction was displayed against the therapy when applied topically on the skin (in vivo) of the subjects with moderate-to-severe facial acne lesions caused by MDR S. aureus. It showed excellent results of clinical improvement response, with decrease in inflammatory signs, size, number of comedones, and presence of decolonized MDR S. aureus viable bacterial growth as compared to the untreated acne lesions “control” when cultured microbiologically.
Conclusion: Endolysin-HEC gel and mixture gel therapy have highly significant potential as an alternative strategy for MDR S. aureus infections of acne vulgaris. It offers a real chance for those suffering from chronic acne lesions caused by MDR bacterial infections, and protects teenagers from the overuse of antibiotics, anxiety, and depression.

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