Hyaluronic acid. A review of its pharmacology and use as a surgical aid in ophthalmology, and its therapeutic potential in joint disease and wound healing

Topische Ulkustherapie

Therapy of ulcers includes both treating the ulcer itself and the underlying disease. Local or surgical wound therapy depends on the phase of the wound healing. Physiological wound healing can be divided into three phases: the cleansing phase, the granulation phase and the epithelialization phase. The choice of the optimal therapy also depends on degree of secretion, bacterial contamination and anatomical location, as well as size and depth of the wound. While dry wound therapy was performed years ago, moist wound therapy is well-established today. There are a large number of modern wound dressings for local, phase-dependent or phase-independent ulcer therapy, making the optimal treatment of each kind of chronic wound possible.

Hyaluronic acid production in Bacillus subtilis

The hasA gene from Streptococcus equisimilis, which encodes the enzyme hyaluronan synthase, has been expressed in Bacillus subtilis, resulting in the production of hyaluronic acid (HA) in the 1-MDa range. Artificial operons were assembled and tested, all of which contain the hasA gene along with one or more genes encoding enzymes involved in the synthesis of the UDP-precursor sugars that are required for HA synthesis. It was determined that the production of UDP-glucuronic acid is limiting in B. subtilis and that overexpressing the hasA gene along with the endogenous tuaD gene is sufficient for high-level production of HA. In addition, the B. subtilis-derived material was shown to be secreted and of high quality, comparable to commercially available sources of HA.

Delayed Inflammatory Reaction to Hyaluronic Acid (Restylane®)

A 45-year-old man received an injection of Restylane (cross-linked hyaluronic acid) to a mid-forehead furrow line in an attempt to reduce its prominence. The injection was uncomplicated and successful in reducing the line. Five months after the injection, he returned with an inflammatory reaction in the area of injection that resolved without treatment over a period of 3 weeks.

Delivery of a vector encoding mouse hyaluronan synthase 2 via a crosslinked hyaluronan film

We have developed a crosslinked hyaluronic acid (HA) film with DNA incorporated within its structure and have characterized this system for its efficacy in sustained transferring of a vector encoding mouse hyaluronan synthase 2 (Has2). Analysis of the DNA release kinetics indicated that the HA films degraded when treated with hyaluronidase and that they released DNA over a prolonged period of time. Gel electrophoresis revealed that this DNA was intact and immunohistochemical analysis verified the transfection capabilities of DNA release samples. The ability of released DNA encoding Has2 to promote HA synthesis was confirmed by quantifying the amount of HA produced by COS-1 cells that were transfected with release samples. The intended future application of the HA films is in prevention of post-operative peritoneal adhesions. In addition to serving as a physical barrier, the film would function as a vehicle for sustained delivery of DNA encoding Has2, which would promote the synthesis of HA in transfected tissues.

Hyaluronic acid and its use as a "rejuvenation" agent in cosmetic dermatology

Since 1996, hyaluronic acid (HA) has been launched onto the market in Europe. Since then, different companies proposed their HAs. Biomatrix (NJ, USA) proposes an animal-derived HA (from rooster comb). Q-Med AB (Uppsala, Sweden) and LEA-DERM (Paris, France) are the main companies to have a nonanimal HA. HA is produced by bacterial fermentation from a specific strain of streptococci. HA has no species specificity and theoretically has no risk of allergy. No skin testing is necessary before injecting because HA is a biodegradable agent. To be utilized as a filler agent for improving wrinkles, scars, or increasing volumes, HA must be stabilized to obtain a sufficient half-life. Process of stabilization varies, according to each manufacturer. This explains the differences in longevity and in viscosity of the different products. Several HAs are suitable to fine lines, to deep wrinkles/folds, or to increase volume. A new indication for "rejuvenation" is injection into the superficial dermis and epidermis. The HA (stabilized or not) is not used to fill in but rather to hydrate and finally to rejuvenate the skin. This procedure must be repeated at intervals of a few weeks or months. If HA is the safest filler agent in cosmetic indications today, some rare side effects may appear and must be known to inform patients. Most of these complications are not severe and will disappear when the product is degraded.

Native hyaluronan produces less hypersensitivity than cross-linked hyaluronan

Hyaluronan has been used in patients with osteoarthritis to relieve the painful symptoms associated with this condition. The native form of hyaluronan and artificially cross-linked forms of hyaluronan (such as Hylan G-F 20) are widely used brands that are approved by the Food and Drug Administration for use in patients with osteoarthritis. Clinical evidence suggests that some of these hyaluronan products may induce an antigenic reaction in some patients. Therefore, it was critical to do controlled studies on the potential antigenic reaction induced by these substances. The purpose of this study was to assess the immunologic reactions resulting from the native or cross-linked forms of hyaluronan products in guinea pigs after subcutaneous injection. Guinea pigs were sensitized to hyaluronan via three subcutaneous injections. Active cutaneous or delayed-type hypersensitivity to hyaluronan was studied. The elicitation of antihyaluronan antibodies also was studied by indirect competitive ELISAs. Our results showed that Synvisc induced delayed-type hypersensitivity in guinea pigs, however, no hypersensitivity to the native hyaluronan was observed. This delayed-type hypersensitivity reaction to the cross-linked form of hyaluronan was confirmed by our finding that sera from guinea pigs sensitized to the cross-linked form showed increased antihyaluronan-specific antibodies in competitive ELISAs. In a direct comparison, the native form of hyaluronan produced significantly less hypersensitivity than an artificially cross-linked form of high molecular weight hyaluronan. The hypersensitivity to the cross-linked form of hyaluronan can be explained in part by its elicitation of ant-hyaluronan immunoglobulins in sensitized animals.

Development of a novel sustained release formulation of recombinant human growth hormone using sodium hyaluronate microparticles

A novel sustained release formulation of recombinant human growth hormone (SR-rhGH) was developed as a once-a-week injection formulation using sodium hyaluronate. SR-rhGH was produced in the form of solid microparticles by spray drying technology. A single administration of a prototype formulation of SR-rhGH with a ratio of hGH:HA=1:1 to cynomolgus monkeys through a fine 26-gauge needle induced continuous elevation of serum IGF-I level for 6 days demonstrating the bioactivity of hGH released from the prototype formulation. For expanded pre-clinical and clinical developments, a pilot-scale process under aseptic condition was established and used for the preparation of the optimized formulation of SR-rhGH with a ratio of hGH:HA=1:3. When the ratio of hGH to HA changed from 1:1 to 1:3, hGH released more slowly in vitro from SR-rhGH with almost complete release of hGH loaded. According to pharmacokinetic and pharmacodynamic studies in beagle dogs, sustained release of hGH from the optimized formulation of SR-rhGH continued for a more extended period longer than 72 h with a lower C(max) than those of prototype formulations. The single administration resulted in an elevation of serum insulin-like growth factor-I (IGF-I) level for 6 days with a maximum value higher than the baseline level by ca. 350 ng/mL, which supported the possibility of SR-rhGH as a once-a-week injection formulation of hGH. The bioavailability of both formulations was comparable to that of hGH daily injection formulation. Finally, toxicity studies revealed no evidence of adverse effect in both cynomolgus monkeys and beagle dogs.

Evaluation of in vivo biocompatibility and biodegradation of photocrosslinked hyaluronate hydrogels (HADgels)

HADgels are newly developed photocrosslinked hyaluronate hydrogels. They are produced from an aqueous solution of a hyaluronan derivative (HAD) in which cinnamic acid is introduced into the carboxyl moiety of hyaluronan using 3-aminopropanol as a spacer. High-energy ultraviolet irradiation of the HAD solution induces photodimerization of cinnamic acid, resulting in the development of a macromolecular network of each hyaluronan to water-insoluble hydrogels. The biocompatibility and biodegradation of HADgels were evaluated by guinea pig intracutaneous injection testing for up to 28 days. By macroscopic and histological observations, HADgels showed good tissue compatibility and did not induce excess inflammation at the injection sites. Biodegradation of the HADgels clearly depended on the degree of crosslinking at the fixed weight concentrations of HAD (0.5% and 1.0%). In addition, serum analyses showed that the injected guinea pigs did not produce specific antibodies against HADgels. These results indicate that HADgels have preferable biocompatibility and can be used as a new class of injectable, absorbable biomaterial, especially for preventing postsurgical adhesion formations.

[Soft tissue filling with hyaluronic acid]

PHYSIOLOGY AND PHARMACOLOGY: Hyaluronan was discovered by Karl Meyer in 1934 in the vitreous humor of cattle eye. Hyaluronic acid, (AH), is a natural polysaccharide and a ubiquitous component of the extra cellular matrix. It is largely biocompatible and has a short half life. In the early 1990's, preceded by the use of bovine collagen, AH started to be employed in the fields of Dermatology and Plastic Surgery; currently it is a major intervention product in both soft tissue augmentation and facial volume loss treatments. Often well tolerated, AH, has high water retention properties and is an effective tissue volumizer. Industry first attempted to extract AH from rooster comb, then through bacterial fermentation and succeeded in increasing its lifespan by cross linking. However, industrially produced AH can contain residues from the manufacturing process. It thus appears critical to us to be informed of the process used in manufacturing AH including the reticulant utilized. Manufacturers should be legally required to publish this data as well as to conduct physiochemical follow-up studies over the short, mid and long terms.

LEGAL CONSIDERATIONS

In Europe, CE marking is a prerequisite to market injectable products. However, a CE marking does not necessarily imply that the product's efficacy and side effects have been assessed objectively in clinical studies. However, this marking is expected to fall into line with the US legislation, where the marketing of any medicinal product is subject to FDA approval, based on comprehensive animal and clinical studies and on more systematic and better centralised side effect reporting. We have examined most of the products used in Europe and internationally in 2004, whether of animal or bacterial origin, reticulated or non-reticulated, and used to restore, increase volume or as a product vector. Before injecting these products, it is essential to have a thorough understanding of their absolute and relative contraindications and anaesthetic requirements, differences between types of wrinkles to fill in and indicated techniques, differences between concerned regions or tissues, and the impact of associated cosmetic treatments. These resorbable injectable products have mild and, more importantly, short-lived side effects. However, in patients with a relative contraindication, a double test is justified, as allergic reactions are known to occur in 1 to 3% of patients. It is also advisable not to inject HA in a site previously injected with a non-resorbable product. More precise statistics on results and side effects based on double-blind randomised studies are still wanting, due to the lack of legal requirement and effective centralisation of data. Therefore, all side effects must be reported to improve our knowledge as well as the safety of injections.

CONCLUSION

Although their duration of effect is limited, HA products are the most commonly used fillers, before collagens. Many questions have yet to be answered, but they produce very significant results in filling procedures. Both clinicians and patients praise these products for their tolerance, resorbable nature, and limited side effects.

Hyaluronic acid in the treatment and prevention of skin diseases: molecular biological, pharmaceutical and clinical aspects

The glycosaminoglycan hyaluronic acid (HA), or hyaluronan, is a major component of the extracellular matrix of skin, joints, eye and many other tissues and organs. In spite of its simple structure, HA demonstrates remarkable rheological, viscoelastic and hygroscopic properties which are relevant for dermal tissue function. Biological activities in skin, however, are also due to its interaction with various binding proteins (hyaladherins). Due to an influence on signaling pathways, HA is involved in the wound-healing process and scarless fetal healing. Increased HA concentrations have been associated with inflammatory skin diseases. In clinical trials, topical application of HA improved wound healing; in particular, acute radioepithelitis, venous leg ulcers or diabetic foot lesions responded to HA treatment. Moreover, as a topical drug delivery system for diclofenac, an HA gel has recently been approved for the treatment of actinic keratoses. Finally, chemical modifications led to new HA derivates and biomaterials, which may be introduced into therapy in the future. Therefore, ongoing research offers new horizons for the therapeutic use of this glycosaminoglycan which has been regarded as an inert structural component until recently.

Potential Applications of Hyaluronans in Orthopaedics

The use of hyaluronans for the treatment of pain in patients with osteoarthritis of the knee is well established. There are growing data to suggest that they may also alter the rate of disease progression. Reviewed here are preliminary data that also indicate a potential use for hyaluronans in the treatment of inflammatory arthropathies (e.g. acute joint trauma and fractures) that require long periods of immobilisation, and in tissue engineering for chondral defects. Although the trials that have investigated the use of hyaluronan therapy for the management of traumatic and degenerative musculoskeletal disorders seen in sports medicine have limitations in design and patient number, the results have been promising and suggest that larger controlled clinical trials are warranted.

Non-Animal Stabilized Hyaluronic Acid

Hyaluronic acid (HA) is a major component of human synovial fluid, providing the rheologic properties (elasticity and viscosity) that enable the synovial fluid to perform lubricating and shock-absorbing functions within the healthy joint. Over the last 2 decades, HA preparations have become established in intra-articular therapy of osteoarthritis (OA), particularly OA of the knee. Existing HA preparations, both cross-linked and non-cross-linked, are all administered by courses of multiple injections, and all have been associated with variable success rates. The clinical profile of an HA preparation is inextricably linked to the product's physicochemical properties. For example, the molecular structure of the HA affects the intra-articular residence time, which should in turn influence the duration of action post-injection. Non-animal stabilized hyaluronic acid (NASHA) is a new-generation HA preparation, produced wholly from non-animal sources. NASHA is stabilized using a carefully controlled cross-linking process, which increases the intra-articular residence time from hours to weeks. This facilitates single-injection treatment for OA without affecting the biocompatibility of HA. This review evaluates the properties of NASHA, including the available clinical data, in the context of previously developed HA preparations.

Effects of glans penis augmentation using hyaluronic acid gel for premature ejaculation

The main limitation of medical treatment for premature ejaculation is recurrence after withdrawal of medication. We evaluated the effect of glans penis augmentation using injectable hyaluronic acid (HA) gel for the treatment of premature ejaculation via blocking accessibility of tactile stimuli to nerve receptors. In 139 patients of premature ejaculation, dorsal neurectomy (Group I, n=25), dorsal neurectomy with glandular augmentation (Group II, n=49) and glandular augmentation (Group III, n=65) were carried out, respectively. Two branches of dorsal nerve preserving that of midline were cut at 2 cm proximal to coronal sulcus. For glandular augmentation, 2 cc of HA was injected into the glans penis, subcutaneously. At 6 months after each procedure, changes of glandular circumference were measured by tapeline in Groups II and III. In each groups, ejaculation time, patient's satisfaction and partner's satisfaction were also assessed. There was no significant difference in preoperative ejaculation time among three groups. Preoperative ejaculation times were 89.2+/-40.29, 101.54+/-59.42 and 96.5+/-52.32 s in Groups I, II and III, respectively. Postoperative ejaculation times were significantly increased to 235.6+/-58.6, 324.24+/-107.58 and 281.9+/-93.2 s in Groups I, II and III, respectively (P<0.01). The percentage of postoperative satisfaction in both patient and his partner was 68% (17/25) and 44% (7/16) in Group I, 80% (39/49) and 66% (25/38) in Group II and 75% (49/65) and 62% (32/52) in Group III, respectively. Maximal glandular girth was significantly increased from 9.16+/-0.59 to 10.95+/-0.4 cm in Group II and 8.95+/-0.54 to 11.67+/-0.71 cm in Group III, respectively. These results suggest that glandular augmentation with injectable HA gel is a safe and effective modality to reduce sensory of glans penis. Long-term follow-up for residual volume and efficacy should be requested to establish its precise therapeutic potentials in premature ejaculation.

Hyaluronan-Induced Stimulation of Corneal Wound Healing is a Pure Pharmacological Effect

The aim of this study was to evaluate whether corneal reparative activity of hyaluronan is a concentration-dependent phenomenon. Corneal blocks from rabbit eyes were cultured for 20 hours with hyaluronan in different concentrations and molecular weight ranges. In another experiment, the corneal epithelium was denuded and hyaluronan was administered as eye drops. Distances of epithelial migration increased over exposed stroma proportionally to concentration, when hyaluronan was added with a molecular weight of 800-1,400 kD. Maximum effect was observed with 0.2% hyaluronan concentration. No difference was seen when corneal blocks were cultured with hyaluronan 0.2% in different molecular weight ranges (800-1,400, 1,400-2,000, and 2,000-2,600 kD). When hyaluronan (molecular weight, 800-1,400 kD) eye drops were administered after corneal epithelial denudation in rabbits, it was found to have faster wound reparation. This effect was concentration-dependent. The 2 highest concentrations (0.2% and 0.4%) were not different for the time needed to complete wound healing. In conclusion, hyaluronan-induced stimulation of corneal wound healing fulfills standards for being considered as a pharmacological effect.

Metal-ion environment in solid Mn(II), Co(II) and Ni(II) hyaluronates

Amorphous powders and films of some metal hyaluronate complexes of general composition (C14H20O11N)2 x xH2O (M = Mn2+, Ni2+ and Co2+) have been prepared at pH 5.5-6.0. The coordination geometry around the metal ions has been analyzed by EXAFS (extended X-ray absorption fine structure) and FTIR spectroscopy. Mn2+, Ni2+, and Co2+ ions are coordinated to carboxylate oxygen atoms and water molecules. The process of local geometry formation round the metal ions is sensitive to sample preparation.

Characterization of the purified hyaluronan synthase from Streptococcus equisimilis

Hyaluronan synthase (HAS) utilizes UDP-GlcUA and UDP-GlcNAc in the presence of Mg(2+) to form the GAG hyaluronan (HA). The purified HAS from Streptococcus equisimilis (seHAS) shows high fidelity in that it only polymerizes the native substrates, UDP-GlcNAc and UDP-GlcUA. However, other uridinyl nucleotides and UDP-sugars inhibited enzyme activity, including UDP-GalNAc, UDP-Glc, UDP-Gal, UDP-GalUA, UMP, UDP, and UTP. Purified seHAS was approximately 40% more active in 25 mM, compared to 50 mM, PO(4) in the presence of either 50 mM NaCl or KCl, and displayed a slight preference for KCl over NaCl. The pH profile was surprisingly broad, with an effective range of pH 6.5-11.5 and the optimum between pH 9 and 10. SeHAS displayed two apparent pK(a) values at pH 6.6 and 11.8. As the pH was increased from approximately 6.5, both K(m) and V(max) increased until pH approximately 10.5, above which the kinetic constants gradually declined. Nonetheless, the overall catalytic constant (120/s) was essentially unchanged from pH 6.5 to 10.5. The enzyme is temperature labile, but more stable in the presence of substrate and cardiolipin. Purified seHAS requires exogenous cardiolipin for activity and is very sensitive to the fatty acyl composition of the phospholipid. The enzyme was inactive or highly activated by synthetic cardiolipins containing, respectively, C14:0 or C18:1(Delta9) fatty acids. The apparent E(act) for HA synthesis is 40 kJ (9.5 kcal/mol) disaccharide. Increasing the viscosity by increasing concentrations of PEG, ethylene glycol, glycerol, or sucrose inhibited seHAS activity. For PEGs, the extent of inhibition was proportional to their molecular mass. PEGs with average masses of 2.7, 11.7, and 20 kg/mol caused 50% inhibition of V(max) at 21, 6.5, and 3.5 mM, respectively. The apparent K(i) values for ethylene glycol, glycerol, and sucrose were, respectively, 4.5, 3.3, and 1.2 mM.

Effect of hylan G-F 20 in achilles’ tendonitis: An experimental study in rats11No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated

OBJECTIVE

To investigate the local effects of hylan G-F 20 on locally administered corticosteroid-induced experimental Achilles' tendonitis.

DESIGN

Before-after trial.

SETTING

Institutional practice.

ANIMALS

Convenience sample of 18 male Wistar white rats (weight range, 322-375 g).

INTERVENTIONS

After performing Achilles' degeneration with local corticosteroid injections, the rats were divided into 4 groups. The right Achilles' tendon of the rats served as the hylan injection group and the left tendon as the control group, which was injected with saline at 5-day intervals. The tendons and paratenons were excised at the end of 60 or 75 days and evaluated histopathologically and statistically.

MAIN OUTCOME MEASURE

Histopathologic changes, including staining affinity, nuclear appearance, fibrillar appearance for tendon and thickness, occurrence of fibrosis and edema, capillary changes, and inflammation for paratenon, were assessed according to a semiquantitative scoring system. The Mann-Whitney U test was used for statistical analysis, with a P value of.05 or less considered statistically significant.

RESULTS

Semiquantitative scoring of histopathologic changes showed that histologic appearances differed between the hylan and saline groups and between 2 hylan groups. Hylan-injected tendons and paratenons demonstrated significantly lower scores, especially after 75 days.

CONCLUSIONS

Hylan G-F 20 has a promising curative effect on the tendon and paratenon and can be used in Achilles' tendonitis. This finding should be supported by biomechanical and biochemical studies.

Human glans penis augmentation using injectable hyaluronic acid gel

Although augmentation phalloplasty is not an established procedure, some patients still need enlargement of their penis. Current penile augmentation is girth enhancement of penile body by dermofat graft. We performed this study to identify the efficacy and the patient's satisfaction of human glans penis augmentation with injectable hyaluronic acid gel. In 100 patients of subjective small penis (Group I) and 87 patients of small glans after dermofat graft (Group II), 2 cm(3) of hyaluronic acid gel was injected into the glans penis, subcutaneously. At 1 y after injection, changes of glandular diameter were measured by tapeline. Patient's visual estimation of glandular size (Gr 0-4) and patient's satisfaction (Grade (Gr) 0-4) were evaluated, respectively. Any adverse reactions were also evaluated. The mean age of patients was 42.2 (30-70) y in Group I and 42.13 (28-61) y in Group II. The maximal glandular circumference was significantly increased compared to basal circumference of 9.13+/-0.64 cm in Group I (P<0.01) and 9.49+/-1.05 cm in Group II (P<0.01) at 1 y after injection. Net increase of maximal glandular circumference after glans augmentation was 14.93+/-0.80 mm in Group I and 14.78+/-0.89 mm in Group II. In patient's visual estimation, more than 50% of injected volume was maintained in 95% of Group 1 and 100% of Group II. The percentage of postoperative satisfaction (Gr 4, 5) was 77% in Group 1 and 69% in Group II. There was no abnormal reaction in area feeling, texture, and color. In most cases, initial discoloration by glandular swelling recovered to normal within 2 weeks. There were no signs of inflammation and no serious adverse reactions in all cases. These results suggest that injectable hyaluronic acid gel is a safe and effective material for augmentation of glans penis.

Efficacy and safety of a single intra-articular injection of non-animal stabilized hyaluronic acid (NASHA) in patients with osteoarthritis of the knee

OBJECTIVE

Non-animal stabilized hyaluronic acid (NASHA) is a novel hyaluronan (HA) preparation with a 4-week intra-articular half-life. This study compared the efficacy of a single injection of NASHA with placebo in patients with osteoarthritis (OA) of the knee.

DESIGN

This was a 26-week randomized, double-blind, multicenter study of a single intra-articular knee injection with either NASHA or placebo (saline). Assessments included the Western Ontario McMasters Universities osteoarthritis index (WOMAC, Likert Scale) and patients' overall global disease status. A positive response was defined as a reduction in WOMAC pain score for the study knee of 40% from baseline with a minimum improvement of > or =5 points.

RESULTS

A total of 346 (NASHA 172; placebo 174) patients were treated. WOMAC scores and quality of life were improved in both the NASHA and placebo groups. For the overall population, there were no statistically significant between-group differences in response rates for any efficacy parameters. In patients with OA confined to the knee (N=216), a greater response to NASHA than placebo was observed at week 6 (P=0.025). There were few treatment-related events.

CONCLUSIONS

NASHA was not superior to placebo for the primary efficacy analysis. However, these data may be confounded by the inclusion of patients with OA at other sites, as significant benefits over placebo were found among patients with OA confined to the knee. Future trials of OA that examine a local therapy might need to consider restricting the study population to those patients having OA of only the signal joint.

Image analysis of remesothelialization following chemical wounding of cultured human peritoneal mesothelial cells: the role of hyaluronan synthesis

BACKGROUND

To understand what happens during the wound healing process of the mesothelium, we have developed an in vitro wounding model of cultured human peritoneal mesothelial cells (HPMCs) utilizing an image acquisition and analysis system. Using this system, cell mobility and hyaluronan synthesis were quantified and their interrelationship discussed.

METHODS

1N NaOH was used to create circular wounds in cultured HPMC monolayers, which were then exposed for 30 minutes to the peritoneal dialysis solutions or fetal calf serum (FCS)-free M199 culture medium, followed by incubation with 0.3% FCS/M199 culture medium for up to 96 hours. Digitalized microscopic date was captured every 30 minutes to quantify the wound healing process. In separate experiments, the HPMC monolayers were stained with biotin-conjugated hyaluronan-binding protein (B-HABP) at a regular time interval.

RESULTS

Centripetal migration of the HPMCs into the wound area was the predominant process involved in wound repair with proliferation playing a secondary role. Two noticeable observations were made from the digital video movies: (1) cell mobility varied and was dependent upon the morphology and location of the cell relative to the wound edge, and (2) cell migration continued even after wound closure. Staining for B-HABP was confined to the remesothelialized area when wound closure was complete at 24 hours. At 48 hours after wound closure, the stained area was even more visible, although somewhat diffuse; thereafter, staining was reduced to almost background levels.

CONCLUSION

The cell culture model of wound healing used in our study has enabled us to demonstrate quantitative image data of the cellular processes that occur during wound healing. We have been able to continuously observe cell migration, proliferation, and transformation. Synthesis and subsequent decomposition of hyaluronan appears to be related to the mobility of the wounded and intact HPMCs in this model system.

Hyaluronan microspheres for sustained gene delivery and site-specific targeting

Hyaluronan is a naturally occurring polymer that has enjoyed wide successes in biomedical and cosmetic applications as coatings, matrices, and hydrogels. For controlled delivery applications, formulating native hyaluronan into microspheres could be advantageous but has been difficult to process unless organic solvents are used or hyaluronan has been modified by etherification. Therefore, we present a novel method of preparing hyaluronan microspheres using adipic dihydrazide mediated crosslinking chemistry. To evaluate their potential for medical applications, hyaluronan microspheres are incorporated with DNA for gene delivery or conjugated with an antigen for cell-specific targeting. The results show that our method, originally developed for preparing hyaluronan hydrogels, generates robust microspheres with a size distribution of 5-20mum. The release of the encapsulated plasmid DNA can be sustained for months and is capable of transfection in vitro and in vivo. Hyaluronan microspheres, conjugated with monoclonal antibodies to E- and P-selectin, demonstrate selective binding to cells expressing these receptors. In conclusion, we have developed a novel microsphere preparation using native hyaluronan that delivers DNA at a controlled rate and adaptable for site-specific targeting.

Evaluation of the safety of a non-animal stabilized hyaluronic acid (NASHA - Q-Medical, Sweden) in European countries: a retrospective study from 1997 to 2001

BACKGROUND

In Europe, several filler devices are currently on the market for use in aesthetic dermatology and some of them cause severe, permanent, adverse reactions. Since 1996 a non-animal stabilized hyaluronic acid (NASHA) from Q-Medical, Sweden, has been introduced and is becoming a leading product in aesthetic dermatology. Hyaluronic acid has no species specificity and skin testing is not recommended before treatment.

OBJECTIVE

Our purpose was to evaluate the incidence of adverse reactions from 1997 to 2001 and the safety of NASHA after injections into the skin for aesthetic reasons.

METHOD

Surveys were sent to physicians in European countries that agreed to participate. This is a retrospective study. A total of 12 344 syringes were sold by the Q-Medical to these physicians and we evaluated the total number of patients treated to 35% of this number (4320). We separated immediate hypersensitivity reactions from delayed reactions and analysed infectious and other types of reactions.

RESULTS

From 1997 until 2001, 34 cases of hypersensitivity were reported: 16 cases of immediate hypersensitivity and 18 cases of delayed. The global risk of sensitivity is 0.8%. Since 2000, the amount of protein in the raw product has decreased and the incidence of hypersensitivity reactions is around 0.6%. As 50% of these reactions are immediate and resolved within less than 3 weeks, the risk of strong but transient, delayed reaction is around 0.3%. Four cases of abscess were reported. They were all sterile. No bacterial infection was found. Herpetic recurrence is possible after lip augmentation according to the technique of injection. No systemic reactions were reported.

CONCLUSION

NASHA is a very useful and safe filler product. Skin testing does not seem to be necessary.

Effects of Hyaluronan on Free-Radical Formation, Corneal Endothelium Damage, and Inflammation Parameters After Phacoemulsification in Rabbits

Free-radical formation may play a role in postoperative complications of phacoemulsification (e.g., corneal endothelium damage from mechanical injury). The present experiments were aimed at investigating whether different molecular weight ranges (2000-2600, 2600-3200, or 3200-3800 kDa) of hyaluronan may influence free radical formation, corneal endothelium damage, and inflammation parameters after phacoemulsification in the rabbit eye. The viscoelastic substance was injected in the anterior chamber of rabbits' eyes before phacoemulsification, at a 2.5% concentration. The formation of free radicals was determined by adding luminol to the irrigation media and measuring the chemoluminescence in eyes. The corneal endothelial damage was evaluated by measuring the corneal central thickness by pachimetry. The inflammation parameters were measured by calculation in aqueous humor of peak levels of leukocytes and prostaglandin E(2) (PGE(2)) and evaluation in uveal tissue of myeloperoxidase activity. Hyaluronan decreased by about 58-60% free-radical formation during phacoemulsification, reduced by about 76-80% modifications in mean corneal thickness and by about 54-61% the corneal endothelial cell loss in all molecular weight ranges used. No difference was found among various molecular weight ranges. The highest molecular weight range showed to be more potent than the lowest range for reduced number of inflammation cells and level of PGE(2) in aqueous humor. Thus, hyaluronan reduces free-radical formation, exerts protection on the corneal endothelium and exerts anti-inflammation properties after phacoemulsification in rabbits. The latter effect seems to depend on the molecular weight of the substance.

Clinical comparison of Healon5 and Healon in phacoemulsification and intraocular lens implantation

PURPOSE

To compare the overall clinical performance during phacoemulsification and intraocular lens (IOL) implantation, the effect on intraocular pressure (IOP), and the effect on corneal endothelium of Healon5 (sodium hyaluronate 2.3%) and Healon (sodium hyaluronate 1.0%) ophthalmic viscosurgical devices (OVDs).

SETTING

Multicenter study.

METHODS

In this randomized prospective clinical study, the performance of Healon5 (viscoadaptive; dispersive and cohesive) and Healon (cohesive) during cataract surgery was evaluated in 157 patients, 79 with Healon5 and 78 with Healon. Surgeons evaluated the following on a 5-point scale: retention during phacoemulsification (primary endpoint), ease of injection, anterior chamber maintenance during continuous curvilinear capsulorhexis (CCC), facilitation of IOL implantation, and ease of removal from the eye. Masked examiners other than the surgeon performed the following measurements: IOP preoperatively and 5 and 24 hours, 7 days, and 3 months postoperatively; corneal thickness before and 24 hours, 7 days, and 3 months postoperatively; and corneal endothelial cell count preoperatively and 3 months postoperatively.

RESULTS

Intraocular retention during phacoemulsification was assessed as good or very good in 77% in the Healon5 group and 8% in the Healon group; the difference was statistically significant (P<.0001, Wilcoxon rank sum test). The Healon5 group had significantly better scores for anterior chamber maintenance during CCC (P<.0001) and facilitation of IOL implantation (P =.032), and the Healon group had significantly better scores for ease of injection (P<.0001) and ease of removal (P<.0001). There were no statistically significant between-group differences in IOP, corneal endothelial cell count, or corneal thickness.

CONCLUSIONS

Surgeons rated Healon5 better than Healon in retention during phacoemulsification, anterior chamber maintenance during CCC, and facilitation of IOL implantation. They assessed Healon as easier to inject and remove. There was no difference in safety-related parameters between the 2 OVDs. These findings indicate that Healon5 is effective in cataract surgery.

Hyaluronic acid grafting mitigates calcification of glutaraldehyde-fixed bovine pericardium

Pathologic calcification is the leading cause of the clinical failure of glutaraldehyde-fixed bovine pericardium used in bioprosthetic valves. A novel surface modification of glutaraldehyde fixed bovine pericardium was carried out with high molecular weight hyaluronic acid (HA). HA was chemically modified with adipic dihydrazide (ADH) to introduce hydrazide functional groups onto the HA backbone. Glutaraldehyde-fixed bovine pericardium (GFBP) was modified by grafting this HA to the free aldehyde groups on the tissue via the hydrazide groups. Following a 2-week subcutaneous implantation in osteopontin (OPN)-null mice, the calcification of HA-modified bovine pericardium was drastically reduced (by 84.5%) compared to positive controls (tissue without HA-modification) (p = 0.005). The calcification-mitigating effect of HA surface modification was also confirmed by microscopic analysis of explanted tissue stained with Alizarin Red S for calcium.

Augmentation of glans penis using injectable hyaluronic acid gel

Recently, injectable hyaluronic acid gel has been widely used in soft-tissue augmentation. We performed this study to identify the feasibility of hyaluronic acid gel for the augmentation of the glans penis. In experiment I, 0.2 cm(3) of hyaluronic acid gel (HA) was injected into the dermis of the glans penis of 25 New Zealand white rabbits via a 30 G needle. At 3, 7, 14, 30, and 90 days after injection, histological changes of glans were studied, respectively. In experiment II, 0.5 cm(3) of HA was injected into the dermis of the glans penis of 14 Beagle dogs via a 27 G needle. At 6 months after injection, histological changes of the glans penis were also evaluated. At the time of autopsy, the lung, liver, and spleen were studied for systemic adverse reaction in each separate experiment. In experiment I, various sized cavities filled with amorphous basophilic materials were noted in the lamina propria and corpus spongiosum of the glans penis. All implants were positively stained on alcian blue. The intensity decreased in a time-dependent manner. Until 14 days, minimal inflammatory reactions were noted, but no signs of inflammation were identified at 90 days. With the gradual decrease of inflammation, fibrosis and deposition of collagen were noted. In experiment II, implants were well maintained at 6 months after injection in the lamina propria. Grade 1 of the inflammatory reaction was noted in one case. In both the experiments, all the specimens were free from any foreign body reaction and systemic adverse reactions. In conclusion, these results suggest that hyaluronic acid gel can be easily injected into the lamina propria of the glans penis and reside until 6 months. Injectable hyaluronic acid gel has a potential as a new bioimplant for the augmentation of the glans penis.

Modulation of human fibroblast gap junction intercellular communication by hyaluronan

The composition of the extracellular matrix changes during dermal repair. Initially, hyaluronan (HA) concentration is high, however, by day 3, HA is eliminated. HA optimizes collagen organization within granulation tissue. One possible mechanism of HA modulation of collagen packing is through the promotion of gap junction intercellular communication (GJIC). Gap junctions are gated channels that allow rapid intercellular communication and synchronization of coupled cell activities. The gap junction channel is composed of connexin (Cx) proteins that form a gated channel between coupled cells. HA is reported to enhance Cx43 expression in transformed fibroblasts. GJIC was quantified by the scrape loading technique and reported as a coupling index. The coupling index for human dermal fibroblasts was 4.6 +/- 0.2, while the coupling index for fibroblasts treated with HA more than doubled to 10.6 +/- 0.7. By Western blot analysis no differences were appreciated in the protein levels of Cx43 or beta-catenin, a protein involved in the translocation of Cx to the cell surface. By immuno-histology Cx43 and beta-catenin were evenly distributed throughout the cell in controls, but in cells treated with HA these proteins were co-localized to the cell surface. Coupled fibroblasts are reported to enhance the organization of collagen fibrils. It is proposed that HA increases the accumulation of Cx43 and beta-catenin on the cell surface, leading to greater GJIC and enhanced collagen organization.

Characterization of DNA-hyaluronan matrix for sustained gene transfer

DNA-Hyaluronan (DNA-HA) matrix formulations intended for use as gene delivery systems have been developed and their potential for delivering DNA encoding a model therapeutic cytokine, platelet-derived growth factor (PDGF), has been evaluated. The results of enzyme-mediated release kinetics studies suggested that the rate of DNA release from the DNA-HA matrices could be modulated by changing the DNA loading or the degree of crosslinking. SEM imaging of the DNA-HA matrix showed that it was gradually eroded by enzymatic action. The results of gel electrophoresis suggested that there was some degree of interaction between DNA and native HA and that portions of the DNA released from the DNA-HA matrices were associated with crosslinked HA fragments. Only fractions of the DNA released from the DNA-HA matrices were free and the rest was entrapped by HA fragments, which could serve as a mechanism for DNA protection. The results from cell transfection studies using DNA samples collected during the course of release studies confirmed this hypothesis. The PDGF produced by transfection of the DNA released from DNA-HA matrices induced human dermal fibroblast cells to proliferate.

Soft-tissue fillers for wrinkles, folds and volume augmentation

Hyaluronic acid gels, with or without dextran beads, and collagen with suspended PMMA microbeads are exciting new soft-tissue fillers that are becoming increasing popular for facial rejuvenation. Each material provides wrinkle reduction, contour improvement and volume augmentation when placed into lines and furrows or when used for lip augmentation. The duration of action varies from 6 months to permanent, depending on the product.

Purification and characterization of hyaluronic acid from the mollusc bivalve Mytilus galloprovincialis

Hyaluronan (hyaluronic acid, HA) was for the first time extracted, purified and characterized from the species of mollusc bivalve Mytilus galloprovincialis. HA was characterized by agarose-gel electrophoresis, 13C-NMR, HPLC and normal polarity capillary electrophoresis by evaluating the unsaturated disaccharide, DeltaDiHA (Delta-hexuronic acid-N-acetyl-glucosamine) after treatment with chondroitin ABC lyase, and by separating Delta-tetrasaccharide and Delta-hexasaccharide generated by the specific action of hyaluronate lyase from Streptomyces hyalurolyticus. The weight average molecular weight (M(w)) was found to be about 200 kDa as determined by HPSEC. HA from M. galloprovincialis was not able to interact with aggrecan from bovine cartilage to form high molecular mass aggregate and also had a very low specific viscosity, but it showed the same capacity to inhibit cell proliferation (50 microg per 10(3) human fibroblasts inhibit cell proliferation by about 50%) than high molecular mass HA. HA of M. galloprovincialis could have a physiological role in the regulation of cell functions.

The effects of hyaluronan and its fragments on lipid models exposed to UV irradiation

The effects of hyaluronan and its degradation products on irradiation-induced lipid peroxidation were investigated. Liposomal skin lipid models with increasing complexity were used. Hyaluronan and its fragments were able to reduce the amount of lipid peroxidation secondary products quantified by the thiobarbituric acid (TBA) assay. The qualitative changes were studied by mass spectrometry. To elucidate the nature of free radical involvement electron paramagnetic resonance (EPR) studies were carried out. The influence of hyaluronan and its fragments on the concentration of hydroxyl radicals generated by the Fenton system was examined using the spin trapping technique. Moreover, the mucopolysaccharide's ability to react with stable radicals was checked. The quantification assay of 2,2-diphenyl-1-picrylhydrazyl hydrate (DPPH) showed no concentration changes of the stable radical caused by hyaluronan. Hyaluronan was found to exhibit prooxidative effects in the Fenton assay in a concentration dependent manner. A transition metal chelation was proposed as a mechanism of this behavior. Considering human skin and its constant exposure to UV light and oxygen and an increased pool of iron in irradiated skin the administration of hyaluronan or its fragments in cosmetic formulations or sunscreens could be helpful for the protection of the human skin.

A blocking antibody to the hyaluronan receptor for endocytosis (HARE) inhibits hyaluronan clearance by perfused liver

Hyaluronan (HA) and chondroitin sulfate clearance from lymph and blood is mediated by the hyaluronan receptor for endocytosis (HARE). The purification and molecular cloning (Zhou, B., Weigel, J. A., Saxena, A., and Weigel, P. H. (2002) Mol. Biol. Cell 13, 2853-2868) of this cell surface receptor were finally achieved after we developed monoclonal antibodies (mAbs) against HARE. There are actually two independent isoreceptors for HA, which in rat are designated the 175-kDa HARE and 300-kDa HARE. Only one mAb (number 174) effectively and completely blocked the specific uptake of 125I-HA at 37 degrees C by rat liver sinusoidal endothelial cells. 125I-HA binding to both the 175-kDa and 300-kDa HARE proteins in a ligand blot assay was almost completely inhibited by <1 microg/ml mAb-174, whereas mouse IgG had little or no effect. MAb-174 also performed very well in Western analysis, indirect fluorescence microscopy, and a variety of immuno-procedures. Immunohistochemistry using mAb-174 localized HARE to the sinusoidal cells of rat liver, spleen, and lymph node. Western analysis using mAb-174 revealed that the sizes of both HARE glycoproteins were the same in these three tissues. 125I-HA was taken up and degraded by excised rat livers that were continuously perfused ex vivo with a recirculating medium. This HA clearance and metabolism by liver, which is a physiological function of HARE, was very effectively blocked by mAb-174 but not by mouse IgG. The results indicate that mAb-174 will be a useful tool to study the functions of HARE and the physiological significance of HA clearance.

Fetal wound healing current perspectives

Early in gestation, fetal wounds are capable of healing scarlessly. Scarless healing in the fetus is characterized by regeneration of an organized dermis with normal appendages and by a relative lack of inflammation. Although there is a transition period between scarless and scar-forming repair, scarless healing also depends on wound size and the organ involved. The ability to heal scarlessly, furthermore, appears to be intrinsic to fetal skin. Unique characteristics of fetal fibroblasts, inflammatory cells, extra-cellular matrix, cytokine profile, and developmental gene regulation may be responsible for the scarless phenotype of early gestation fetal wounds. With the current knowledge, only minimal success has been achieved with the topical application of neutralizing antibodies, antisense oligonucleotides, and growth factors to improve wound-healing outcomes. Thus, further investigation into the mechanisms underlying scarless repair is crucial in order to devise more effective therapies for scar reduction and the treatment of cirrhosis, scleroderma, and other diseases of excessive fibrosis.

Molecular cloning and functional expression of the rat 175-kDa hyaluronan receptor for endocytosis

We recently purified the rat liver hyaluronan receptor for endocytosis (HARE) and found abundant expression of 175- and approximately 300-kDa HARE species in sinusoidal endothelial cells of the liver, spleen, and lymph nodes. We report herein the first cloning and functional expression of the rat 175-kDa HARE. Peptide sequences were obtained from the purified 175-kDa HARE, and degenerate oligonucleotide primers were designed for reverse transcription-polymerase chain reaction and cDNA cloning. Results of 5'-rapid amplification of cDNA ends, Northern analysis, N-terminal sequence, and antibody reactivity analyses indicated the absence of mRNA directly encoding the 175-kDa HARE. This protein is most likely derived from a larger precursor. Accordingly, we constructed an artificial 4.7-kb cDNA encoding the 1431 amino acid 175-kDa HARE. The predicted type I membrane protein has a mass of 156,393 Da and a pI of 7.86. The 175-kDa HARE cDNA, fused to the N-terminal leader sequence of the Ig kappa-chain, was transfected transiently into COS-7 cells and stably into SK-Hep-1 cells, respectively, to assess hyaluronan or hyaluronic acid (HA)-binding activity and endocytosis. In both cases, HARE expression and HA-binding activity were detected. Furthermore, stable SK-175HARE cells demonstrated specific endocytosis of (125)I-HA and receptor recycling. Fluorescence-activated cell sorting analysis confirmed that recombinant HARE was expressed on the cell surface and that fluorescent HA uptake was inhibited by a specific blocking monoclonal antibody against HARE. Additionally, HARE was substantially colocalized with clathrin, but not with internalized HA that was delivered to lysosomes. The results confirm that recombinant 175-kDa HARE is an authentic endocytic receptor for HA and that this receptor can function independently of the approximately 300-kDa HARE. HARE is the first functionally identified member of a protein family that shares a similar organization of Fasciclin, epidermal growth factor-like, Xlink, and transmembrane domains.

Articular cartilage repair: basic science and clinical progress. A review of the current status and prospects

OBJECTIVE

To review the basic scientific status of repair in articular cartilage tissue and to assess the efficiency of current clinical therapies instigated for the treatment of structural lesions generated therein as a result of trauma or during the course of various diseases, notably osteoarthritis (OA). Current scientific trends and possible directions for the future will also be discussed.

DESIGN

A systematic and critical analysis is undertaken, beginning with a description of the spontaneous repair responses in different types of lesion. Surgical interventions aimed at inducing repair without the use of active biologics will then be considered, followed by those involving active biologics and those drawing on autogenic and allogeneic tissue transplantation principles. Cell transplantation approaches, in particular novel tissue engineering concepts, will be critically presented. These will include growth-factor-based biological treatments and gene transfection protocols. A number of technical problems associated with repair interventions, such as tissue integration, tissue retention and the role of mechanical factors, will also be analysed.

RESULTS

A critical analysis of the literature reveals the existence of many novel and very promising biologically-based approaches for the induction of articular cartilage repair, the vast majority of which are still at an experimental phase of development. But prospective, double-blinded clinical trials comparing currently practiced surgical treatments have, unfortunately, not been undertaken.

CONCLUSION

The existence of many new and encouraging biological approaches to cartilage repair justifies the future investment of time and money in this research area, particularly given the extremely high socio-economic importance of such therapeutic strategies in the prevention and treatment of these common joint diseases and traumas. Clinical epidemiological and prospective trials are, moreover, urgently needed for an objective, scientific appraisal of current therapies and future novel approaches.

Injectable gels for tissue engineering

Recently, tissue engineering approaches using injectable, in situ gel forming systems have been reported. In this review, the gelation processes and several injectable systems that exhibit in situ gel formation at physiological conditions are discussed. Applications of selected injectable systems (alginate, chitosan, hyaluronan, polyethylene oxide/polypropylene oxide) in tissue engineering are also described. Injectable polymer formulation can gel in vivo in response to temperature change (thermal gelation), pH change, ionic cross-linking, or solvent exchange. Kinetics of gelation is directly affected by its mechanism. Injectable formulations offer specific advantages over preformed scaffolds such as: possibility of a minimally invasive implantation, an ability to fill a desired shape, and easy incorporation of various therapeutic agents. Several factors need to be considered before an injectable gel can be selected as a candidate for tissue engineering applications. Apart from tissue-specific cell-matrix interactions, the following gel properties need to be considered: gelation kinetics, matrix resorption rate, possible toxicity of degradation products and their elimination routes, and finally possible interference of the gel matrix with histogenesis.

Layilin, a novel integral membrane protein, is a hyaluronan receptor

The actin cytoskeleton plays a significant role in changes of cell shape and motility, and interactions between the actin filaments and the cell membrane are crucial for a variety of cellular processes. Several adaptor proteins, including talin, maintain the cytoskeleton-membrane linkage by binding to integral membrane proteins and to the cytoskeleton. Layilin, a recently characterized transmembrane protein with homology to C-type lectins, is a membrane-binding site for talin in peripheral ruffles of spreading cells. To facilitate studies of layilin's function, we have generated a layilin-Fc fusion protein comprising the extracellular part of layilin joined to human immunoglobulin G heavy chain and used this chimera to identify layilin ligands. Here, we demonstrate that layilin-Fc fusion protein binds to hyaluronan immobilized to Sepharose. Microtiter plate-binding assays, coprecipitation experiments, and staining of sections predigested with different glycosaminoglycan-degrading enzymes and cell adhesion assays all revealed that layilin binds specifically to hyaluronan but not to other tested glycosaminoglycans. Layilin's ability to bind hyaluronan, a ubiquitous extracellular matrix component, reveals an interesting parallel between layilin and CD44, because both can bind to cytoskeleton-membrane linker proteins through their cytoplasmic domains and to hyaluronan through their extracellular domains. This parallelism suggests a role for layilin in cell adhesion and motility.

Ocular biomaterials and implants

The maintenance of vision is a key determinant of healthy ageing. This has been facilitated over recent decades by the development of a wide range of implants and biomedical devices to correct the functional deficiencies of disease, age and ocular trauma. This brief overview provides an insight into the structure of this unique organ, the major physiological functions of the component tissues and the present state of the art with respect to modern ocular implants. The review focuses primarily on the existing limitations of existing ocular biomaterials used in the fabrication of contact lenses, intraocular lenses, glaucoma filtration implants, keratoprostheses, intracorneal implants, scleral buckles and viscoelastic replacement agents. The challenge of improving ocular compatibility and ensuring the longevity of indwelling ocular devices is addressed along with the need to improve the physicochemical and mechanical properties of existing ocular biomaterials.

Reconstructive surgery of the urethra: a pilot study in the rabbit on the use of hyaluronan benzyl ester (Hyaff-11) biodegradable grafts

We investigated the outcome of reconstructive surgery of the urethra through guides composed of a novel biodegradable and highly biocompatible polymer, Hyaff-11. A tract of about 1.5 cm of the rabbit pendulous urethra was totally resected and replaced by a Hyaff-11 tubular graft. Eleven animals were analysed at each of the time points ranging from 7 days to 4 weeks following surgery. Histological and radiological evaluation showed a satisfactory remodelling of the neo-urethra around the implant. The regenerated connective tissue connected both urethral stumps within the first 7 days. On postoperative week 3, the Hyaff-11 guide had disappeared. At the 4-week time point the retrograde urethrogram showed a good distensibility of the neourethra. The regenerated stroma consisted of fibroblastic cells, and collagenous and elastic fibres. The neo-epithelium was pluristratified and exhibited cells of the cuboidal type.

The role of hyaluronic acid in protecting surface-active phospholipids from lysis by exogenous phospholipase A(2)

BACKGROUND

This in vitro study aimed to elucidate the extent and kind of involvement of hyaluronic acid (HA) in the currently accepted view of synovial joint lubrication, in which surface-active phospholipids (SAPL) constitute the main boundary lubricant. The integrity of SAPL is apparently threatened by the lysing activity of phospholipase A(2) (PLA(2)).

METHODS

The effects of increasing concentrations of HA degraded by free radicals and non-degraded HA on the lysing activity of PLA(2) were examined in vitro. Liposomes (lipid model membrane) containing phosphatidylcholine (PC) were used as the substrate, on the assumption that they are appropriate representatives of SAPL.

RESULTS

HA adhered to the phospholipid membrane (liposomes), inhibiting their lysis by PLA(2). However, in its degraded form, HA not only failed to inhibit PLA(2)-lysing activity, but accelerated it.

CONCLUSIONS

It is reasonable to assume that HA plays an important indirect role in the steady state of the boundary lubrication process of joints by protecting SAPL from being lysed by PLA(2). However, as excessive loading generates free radicals within the joint (among other effects), the HA that is degraded in this way is incapable of protecting SAPL from lysis by PLA(2). When the rate of degradation exceeds that of synthesis, there will be insufficient replacement of HA and/or SAPL, resulting in denudation of the articular surfaces. These are then exposed to increasing friction, and hence increased danger of degenerative joint changes.