Suppression of NLRP3/Caspase-1/GSDMD Mediated Corneal Epithelium Pyroptosis Using Melatonin-Loaded Liposomes to Inhibit Benzalkonium Chloride-Induced Dry Eye Disease

Int J Nanomedicine. 2023 May 9:18:2447-2463. doi: 10.2147/IJN.S403337. eCollection 2023.


Introduction: Benzalkonium chloride (BAC) is widely employed as a preservative in eye drops, which will cause the death of corneal epithelial cells due to ROS production, DNA strand breakage, and mitochondrial dysfunction, resulting in dry eye disease (DED)-like changes in ocular surface tissues. In this study, Melatonin (MT) liposomes (TAT-MT-LIPs) designed by loading MT into TAT-modified liposomes have been developed, characterized, and used for inhibiting BAC-induced DED (BAC-DED).

Methods: The TAT was chemically grafted onto the Mal-PEG2000-DSPE by Michael's addition between the sulfhydryl group in TAT and the maleimide group in Mal-PEG2000-DSPE. TAT-MT-LIPs were prepared using film dispersion followed by the extrusion method and topically treated in rats once a day. BAC-DED was induced in rats by topical administration with 0.2% BAC twice daily. Defects, edema, and inflammation of the corneas, as well as IOP, were examined. Histologic analyses of corneas were performed to assess the change of mitochondrial DNA oxidation and NLRP3/Caspase-1/GSDMD signaling transduction.

Results: After topical administration, TAT-MT-LIPs significantly alleviated DED-clinical symptoms of experimental animals by inhibiting tissue inflammation and preventing the loss of the corneal epithelium and conjunctival goblet cells. Our data suggested continuous ocular surface exposure of BAC-induced NLRP3/Caspase-1/GSDMD mediated corneal epithelium pyroptosis, which was not reported before. BAC caused substantial mt-DNA oxidation, which promoted the transduction of NLRP3/Caspase-1/GSDMD and consequent corneal epithelium pyroptosis. TAT-MT-LIPs could efficiently suppress the BAC-induced corneal epithelium pyroptosis and inflammation by inhibiting mt-DNA oxidation and the subsequent signal transmission.

Conclusion: NLRP3/Caspase-1/GSDMD mediated corneal epithelium pyroptosis is involved in the development of BAC-DED. The present study provided new insights into the adverse effects of BAC, which can serve as a new target for protecting corneal epithelium when applying BAC as a preservative in eye drops. The developed TAT-MT-LIPs can efficiently inhibit BAC-DED and give great potential to be developed as a new DED treatment.

Keywords: NLRP3/Caspase-1/GSDMD signaling axis; benzalkonium chloride; dry eye disease; melatonin liposome; pyroptosis.

MeSH terms

  • Animals
  • Benzalkonium Compounds / toxicity
  • Caspase 1
  • Dry Eye Syndromes* / chemically induced
  • Dry Eye Syndromes* / drug therapy
  • Dry Eye Syndromes* / pathology
  • Epithelium, Corneal* / pathology
  • Inflammation / pathology
  • Liposomes / pharmacology
  • Melatonin* / pharmacology
  • NLR Family, Pyrin Domain-Containing 3 Protein
  • Ophthalmic Solutions / pharmacology
  • Pyroptosis
  • Rats


  • Benzalkonium Compounds
  • Caspase 1
  • NLR Family, Pyrin Domain-Containing 3 Protein
  • Liposomes
  • Melatonin
  • Ophthalmic Solutions
  • Nlrp3 protein, rat