Hyaluronic Acid Publications

HA affects protein and collagen synthesis by in vitro human skin fibroblasts

Given the importance of HA for the homeostasis of connective tissues during embryogenesis and aging and its role in tissue repair, the aim of the present study was to examine the effect of exogenous HA on the synthesis of total protein, collagen and HA by in vitro human dermal fibroblasts. A role for HA is in delaying tissue differentiation during embryogenesis and in preventing fibrosis and scar formation in fetus and in the early phases of wound healing.

Croce MA, Dyne K, Boraldi F, Quaglino D Jr, Cetta G, Tiozzo R, Pasquali Ronchetti I Tissue Cell 2001 Aug;33(4):326-31.

Wound repair

Many of the biological processes mediated by HA are central to the wound healing process. Following injury, wound healing relies on a series of tightly regulated sequential events, e.g. inflammation, formation of granulation tissue, re-epithelialization, and remodeling. HA is likely to have a multifaceted role in the mediation of these cellular and matrix events. Fidia has developed a range of products based on proprietary low-molecular-weight fractions of HA, for the treatment of acute and chronic wounds such as abrasions, donor sites and post-operative incisions, first and second-degree burns, vascular and metabolic ulcers, and pressure sores.

John Chen W.Y , Abatangelo G.: Wound repair and Regeneration, March-April 1999, 79-89

Connections between HA and DIABETES

A lot of medical research has gone on regarding the connections between HA and diabetes. Studies on diabetic rats indicate lowered levels of glycosaminoglycan (GAG)-a component of HA-which in turn would delay wound healing. A lack of HA adversely affects the fibroblast cells, which are necessary to healing. HA supplementation could have a significant effect on diabetic symptoms. It should certainly be considered by anyone with a diabetic condition.

Exp Toxicol Path 1999 May; 51:(3) 239-43

Intravesical HA may be effective in the treatment of refractory interstitial cystitis

A study was carried out to investigate the activity of HA in the treatment of IC. A total of 25 patients, with the characteristic picture of IC and refractory to other medical treatments, participated in a trial with HA. Response to therapy was evaluated by symptom score, voiding diaries, and visual analogue scales. The response of refractory IC patients to the intravesical administration of HA was satisfactory. Further studies will establish the effectiveness of this particular preparation of HA in the treatment of IC.

Morales A; Emerson L; Nickel JC Department of Urology, Queen's University, Kingston, Ontario, Canada. Urology, 49(5A Suppl):111-3 1997 May

Soft tissue augmentation for treatment of wrinkles and scars of the face

Facial wrinkles and scars can be corrected by injecting implants into the dermal connective tissue. Today, several substances can be used for this purpose. Injectable bovine collagen (Zyderm and Zyplast) has been used successfully for more than twenty years in some hundred thousand patients. Due to the xenogenity of the product a skin testing is required before augmentation. As the implant is degraded by the body's own mechanisms periodic maintenance injections are necessary. Gelatin matrix (Fibrel) was developed as an alternative to injectable collagen. It is mainly used for the correction of scars. The long term-correction seems to be better compared to collagen but a skin test must be performed as well. The most promising material for soft tissue augmentation today is Hyaluronic acid and its derivatives. The substance is easy to handle and requires no previous skin testing. The efficacy is comparable to collagen. Apart from the biomaterials synthetic implants are still of interest. The augmentation with expanded polytetrafluorothylene (Gore-tex) requires a surgical procedure because a tubular implant is inserted underneath the wrinkles. The correction is permanent, but scars and an asymmetric of the face may be complications.

Streit M, Brand CU, Braathen LR. Dermatologische Universitatsklinik, Inselspital, Bern. Germany PMID: 10330883 [PubMed - indexed for MEDLINE]

Intra -articular Hyaluronic Acid Injections for Knee Osteoarthritis

Knee osteoarthritis is a common but often difficult problem to manage in primary care. Traditional nonsurgical management, consisting of lifestyle modification, physical therapy and pharmacologic therapy (e.g., analgesics, anti-inflammatory medications), is often ineffective or leaves residual symptoms. Viscosupplementation is a newly available option for patients with symptomatic knee osteoarthritis that involves a series of intra-articular injections of hyaluronic acid. The exact mechanism of action is unclear, although increasing the viscoelasticity of the synovial fluid appears to play a role. Clinical experience and studies of the two hyaluronic acid products available, hyaluronan and hylan G-F 20, are inconclusive but seem to indicate beneficial effects with minimal adverse reactions in a significant number of patients. The exact indications for viscosupplementation are still evolving, but it currently can be considered for use in patients who have significant residual symptoms despite traditional nonpharmacologic and pharmacologic treatments. In addition, patients who are intolerant of traditional treatments (e.g., gastrointestinal problems related to anti-inflammatory medications) can be considered for these injections. Family physicians with the ability to perform intra-articular knee injections should consider them an option in patients with symptomatic knee osteoarthritis.

Dennis Wen, M.D. University of Missouri ­- Columbia Medical School, Columbia, Missouri (Am Fam Physician 2000;62:565-70,572.)

Cigarette smoke degrades hyaluronic acid

Cigarette smoke has been implicated in the pathogenesis of a variety of diseases that affect connective tissues. The effect of the gas phase of cigarette smoke on hyaluronic acid was investigated in vitro. The smoke markedly reduced the chain length of purified hyaluronic acid as assessed by both viscometry and gel chromatography. The hyaluronate exposed to smoke, nevertheless, could aggregate proteoglycans, although the viscosity of the aggregates was lower than in those formed with the unexposed material. The degradation of the hyaluronate was a rapid phenomenon and was inhibited by dimethyl sulfoxide, a known scavenger of hydroxyl radicals. We conclude that free radicals in the gas phase of cigarette smoke degrade hyaluronic acid in vitro.

McDevitt CA, Beck GJ, Ciunga MJ, O'Brien J. Department of Musculoskeletal Research, Cleveland Clinic Foundation Research Institute, Ohio 44195. PMID: 2512457 [PubMed - indexed for MEDLINE]