Hyaluronidase: from clinical applications to molecular and cellular mechanisms.

Bettina Alexandra Buhren,Norman-Philipp Hoff,Holger Schrumpf,Edwin Bölke,Said Hilton,Peter Arne Gerber

doi:10.1186/s40001-016-0201-5

Bettina Alexandra Buhren, Norman-Philipp Hoff + Show 4 more

Open Access

https://doi.org/10.1186/s40001-016-0201-5

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Abstract

Over the past 60 years, hyaluronidase has been successfully utilized in ophthalmic surgery and is now being implemented in dermatosurgery as well as in other surgical disciplines. The enzyme is considered a “spreading factor” as it decomplexes hyaluronic acid (also called hyaluronan, HA), an essential component of the extracellular matrix (ECM). When applied as an adjuvant, hyaluronidase enhances the diffusion capacity and bioavailability of injected drugs. Therefore, the enzyme has been used as a local adjuvant to increase the diffusion capacity of local anesthetics, increasing the analgesic efficacy, and the anesthetized area particularly in the first minutes following injection, resulting in diminished intra- and postoperative pain. In aesthetic medicine, the off-label use of hyaluronidase is considered the gold standard for the management of HA-filler-associated complications. Here, we review the clinical use, underlying biological mechanisms, and future directions for the application of hyaluronidase in surgical and aesthetic medicine.

Highlights

Regulation of hyaluronan (HA) metabolism The extracellular matrix (ECM) of the skin consists of a complex and dynamic network of macromolecules
In addition to providing the structural framework, the ECM plays an important role in regulating various cellular mechanisms including proliferation, adhesion, migration, and gene regulation [1]
Hyaluronan (HA) is a linear glycosaminoglycan disaccharide composed of alternating units of n-acteyl-d-glycosamine and d-glucuronic acid via alternating β-1.4 and β-1.3 glycosidic bonds [3]

Summary

Introduction

Regulation of hyaluronan (HA) metabolism The extracellular matrix (ECM) of the skin consists of a complex and dynamic network of macromolecules. Clinical use In Germany, bovine hyaluronidase (Hylase® Dessau, Riemser Pharma GmbH, Greifswald, Germany) is approved as an adjuvant for infiltration anesthesia. By degrading HA in the ECM, hyaluronidase increases membrane permeability, thereby rendering tissues more permeable to injected fluids—the so-called spreading effect.

Results

Conclusion