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Keywords:

  • mechanism of action;
  • salicylates;
  • salicylic acid;
  • aspirin;
  • 5-aminosalicylates;
  • 5-ASA;
  • mesalamine;
  • bacteria;
  • microbiota;
  • biofilm;
  • herbal remedies;
  • complementary and alternative medicine

Abstract

Preclinical Research

The proposed mechanism(s) of action of salicylates are as varied as their extraordinary range of clinical indications. Extracted from plant leaves since the beginning of recorded history, salicylates have been used for over 4000 years for the treatment of disease. The anti-inflammatory and antiplatelet agent aspirin (acetylsalicylic acid) was synthesized at the turn of the 20th century and paved the way for salicylates becoming the most widely used drug in the world. Its parent compound salicylic acid as well as the derivatives bismuth subsalicylate and 5-aminosalicylate are invaluable topical treatments for many dermatological and gastrological diseases. Their mode of action is poorly understood, but a developing understanding of the role of the microbiota in diseases of the skin and intestine suggest microbial targets as a possible unifying mechanism. There is a relatively substantial and little-known literature demonstrating the antibiofilm and antibiotic-metabolizing effects of salicylates. A better understanding of this antimicrobial mechanism in dermatological and gastrointestinal diseases could lead to new adjunctive treatments aimed at modulating microbes rather than host inflammation.