Abstract
BackgroundCross-linked hyaluronan—also called Hylan G-F 20—is a medical device developed to treat osteoarthritis of the knee. However, it is still controversial whether Hylan G-F 20 has a cartilage protective effect in trauma-induced osteoarthritis. We investigated whether Hylan G-F 20 delayed osteoarthritis progression in a partial meniscectomized rat model.MethodsLewis rats were used for the experiments. The anterior medial meniscus was resected at the level of the medial collateral ligament in both knees. From 1 week after the surgery, 50 μl of Hylan G-F 20 was injected weekly into the left knee and phosphate buffered saline was injected into the right knee. Cartilage was evaluated for macroscopic findings, histology with safranin-o, and expression of type II collagen at 2, 4, and 8 weeks. Synovitis was also evaluated, and immunohistochemical analysis was performed for ED1.ResultsMacroscopic findings demonstrated that India ink positive area, representing fibrillated cartilage, was significantly smaller in the Hylan G-F 20 group than in the control group at 2, 4, and 8 weeks (n = 5). There were no significant differences in osteophyte score between the Hylan G-F 20 group and the control group at 2, 4, and 8 weeks.Histologically, the cartilage in the medial tibial plateau was destroyed at 8 weeks in the control group, while type II collagen expression was still observed at 8 weeks in the Hylan G-F 20 group. OARSI score for cartilage histology was significantly lower in the Hylan G-F 20 group than in the control group at 4 and 8 weeks (n = 5). There were no significant differences in synovial cell number or modified synovitis score between the Hylan G-F 20 group and the control group at 2, 4, and 8 weeks (n = 5). In the Hylan G-F 20 group, foreign bodies surrounded by ED1 positive macrophages were observed in the synovium.ConclusionWeekly injections of Hylan G-F 20 starting 1 week after surgery delayed cartilage degeneration after meniscectomy in a rat model. Synovitis induced by meniscectomy was not alleviated by Hylan G-F 20. Insoluble gels were observed in the synovium after the Hylan G-F 20 injection.
Highlights
Cross-linked hyaluronan— called Hylan G-F 20—is a medical device developed to treat osteoarthritis of the knee
Hylan G-F 20 delayed cartilage degeneration after meniscectomy Macroscopically, in the control group, India ink positive area was already observed at the medial tibial cartilage
In the Hylan G-F 20 group, cartilage degeneration appeared to be milder than in the control group in each period and type II collagen expression was still observed at 8 weeks
Summary
Cross-linked hyaluronan— called Hylan G-F 20—is a medical device developed to treat osteoarthritis of the knee. It is still controversial whether Hylan G-F 20 has a cartilage protective effect in trauma-induced osteoarthritis. Hyaluronan is a constitution of cartilage and synovial fluid, and contributes to joint homeostasis [4]. In the synovial fluid of the normal joint, the molecular weight of hyaluronan is 2000–7000 kDa [6,7,8]. Cross-linked hyaluronan, Hylan G-F 20, is a medical device developed to treat OA of the knee and an elastoviscous high molecular weight fluid derived from chicken combs. It is reasonable to administrate hyaluronic acid with a molecular weight similar to that of the normal joint into OA knees
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