The multifaceted erdostein: facts on the desk. A review

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Abstract

Erdostein is a mucoactive agent belonging to the group of thiol drugs with antioxidant, anti-inflammatory and antibacterial activity against a number of major respiratory pathogens. After transformation in the liver, erdostein is metabolized to a compound with an open ring M1 (MET-1) having unique properties. In the RESTORE study (2022), it was confirmed that erdostein significantly reduces the risks of severe exacerbations in patients with chronic obstructive pulmonary disease (COPD), reduces their duration, and reduces the number of hospitalizations with acute respiratory failure (ARF). The unique preventive properties of erdostein do not depend on the administration of inhaled (ICS) or systemic (SCS) corticosteroids to COPD patients, as well as on the level of eosinophilia in the blood. The results obtained contrast with the available therapy strategy, where thiol mucolytics are indicated in patients who do not use ICS-therapy and/or SCS-therapy. Moreover, this confirms the assumption about the use of erdostein in COPD patients as a drug for the phased withdrawal of ICS-therapy.

About the authors

Sergey L. Babak

Russian University of Medicine

Author for correspondence.
Email: sergbabak@mail.ru
ORCID iD: 0000-0002-6571-1220

D. Sci. (Med.), Assoc. Prof.

Russian Federation, Moscow

Marina V. Gorbunova

Russian University of Medicine

Email: mgorb@mail.ru

D. Sci. (Med.)

Russian Federation, Moscow

Mariia A. Karnaushkina

Patrice Lumumba Peoples' Friendship University of Russia (RUDN University)

Email: kar3745@yandex.ru
ORCID iD: 0000-0002-8791-2920

D. Sci. (Med.)

Russian Federation, Moscow

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Supplementary files

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2. Fig. 1. Schematic representation of the chemical formula of erdostein (a) and MET-1 (b). Adapted from [3].

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3. Fig. 2. Schematic representation of the main signaling cellular pathways of ROS production.

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4. Fig. 3. Graphical representation of the results of the action of erdostein, MET-1 and NAC to inhibit the fimbrial adhesive activity of E. coli. Adapted from [17].

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5. Fig. 4. Graphical representation of the action of the inhibitor- high concentrations of clarithromycin (10 mcg/ml) and a combination of MET-1 and clarithromycin (10 mcg/ml) to suppress the adhesive activity of S. aureus at the fimbrial level. Adapted from [18].

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6. Fig. 5. Graphical representation of patients with COPD of medium/severe functional class ("GOLD-2" and "GOLD-3") and the entire group as a whole with moderate/ severe exacerbations, with monotherapy with an antibiotic or a combination of an antibiotic and SGCs.

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