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Abstract
Hyaluronic acid (also known as hyaluronan or hyaluronate) is naturally found in many tissues and fluids, but more abundantly in articular cartilage and synovial fluid (SF). Hyaluronic acid (HA) content varies widely in different joints and species. HA is a non-sulfated, naturally occurring non-protein glycosaminoglycan (GAG), with distinct physico-chemical properties, produced by synoviocytes, fibroblasts, and chondrocytes. HA has an important role in the biomechanics of normal SF, where it is partially responsible for lubrication and viscoelasticity of the SF. The concentration of HA and its molecular weight (MW) decline as osteoarthritis (OA) progresses with aging. For that reason, HA has been used for more than four decades in the treatment of OA in dogs, horses and humans. HA produces anti-arthritic effects via multiple mechanisms involving receptors, enzymes and other metabolic pathways. HA is also used in the treatment of ophthalmic, dermal, burns, wound repair, and other health conditions. The MW of HA appears to play a critical role in the formulation of the products used in the treatment of diseases. This review provides a mechanism-based rationale for the use of HA in some disease conditions with special reference to OA.
Highlights
In 1934, Karl Meyer and John Palmer isolated for the first time a glycosaminoglycan (GAG) from the vitreous humor of the bovine eye and named it “hyaluronic acid”
Gigis et al [77] reported that IA injections using higher-molecular weight (MW) or lower-MW can improve joint function and reduce stiffness and pain in patients suffering from knee OA, no clear difference in benefits seems to exist between the two preparations and neither can slow disease progression based on radiological findings
The findings suggested that Hyaluronic acid (HA) viscosupplementation appears to promote endogenous HA production, since the concentrations and MW of native HA declines in OA [73, 75]
Summary
In 1934, Karl Meyer and John Palmer isolated for the first time a glycosaminoglycan (GAG) from the vitreous humor of the bovine eye and named it “hyaluronic acid” (derived from hyaloid [vitreous] and uronic acid). Gigis et al [77] reported that IA injections using higher-MW or lower-MW can improve joint function and reduce stiffness and pain in patients suffering from knee OA, no clear difference in benefits seems to exist between the two preparations and neither can slow disease progression based on radiological findings.
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