Abstract
Hyaluronic acid (HA) is a key component of the extracellular matrix of the lungs. A unique attribute of HA is its water-retaining properties, so HA has a major role in the regulation of fluid balance in the lung interstitium. Hyaluronic acid has been widely used in the treatment of eyes, ears, joints and skin disorders, but in the last years, it has been also proposed in the treatment of certain lung diseases, including airway diseases, due to its anti-inflammatory and water-binding capacities. Hyaluronic acid aerosol decreases the severity of elastase-induced emphysema in murine models, prevents bronchoconstriction in asthmatics and improves some functional parameters in chronic obstructive pulmonary disease (COPD) patients. Due to the protection of HA against bronchoconstriction and its hydration properties, inhaled HA would increase the volume of airway surface liquid, resulting in mucus hydration, increased mucous transport and less mucous plugging of the airways. In addition, it has been seen in human studies that the treatment with nebulised HA improves the tolerability of nebulised hypertonic saline (even at 6% or 7% of concentration), which has been demonstrated to be an effective treatment in bronchial secretion management in patients with cystic fibrosis and bronchiectasis. Our objective is to review the role of HA treatment in the management of chronic airway diseases.
Highlights
The extracellular matrix of lung tissue is formed by a combination of molecules as collagen, elastin and glycosaminoglycans, key to maintaining its stability [1,2]
The methodology used in this narrative review consisted of a careful analysis of the literature regarding the role of Hyaluronic acid (HA) on the management of chronic airway diseases such as upper respiratory tract infections, chronic obstructive pulmonary disease (COPD), asthma, mucociliary clearance alterations, cystic fibrosis (CF) and bronchiectasis
In the clinical stability phase, showed a reverse correlation with FEV1 (% of predicted) and mortality [31]. Coinciding with these data, previous research has found short fragments of HA in the lung parenchyma [32] and bronchoalveolar lavage (BAL) [32,33] of different respiratory pathologies. These results indicate that HA, as collagens, is a part of the increased extracellular matrix turnover in COPD, a process that determines the disease severity
Summary
The extracellular matrix of lung tissue is formed by a combination of molecules as collagen, elastin and glycosaminoglycans, key to maintaining its stability [1,2]. HA molecules with high molecular weights (>1 million Daltons) and the small fragments with low molecular weights (150,000–300,000 Daltons) produced during inflammation. High-molecular weight HA fragments have antiangiogenic and anti-inflammatory properties, while those of low molecular weights produced during inflammation are proinflammatory and proangiogenic molecules and promote cellular migration [5,6]. HA has the property to retain a significant quantity of water in the extracellular matrix, producing viscous gels that might play an important role both in the homeostasis of the tissues and their biomechanical integrity [7,8,9].
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