New possibilities of using hyaluronic acid in patients with knee osteoarthritis
New possibilities of using hyaluronic acid in patients with knee osteoarthritis
O.V. Teplyakova
Ural State Medical University, Yekaterinburg
Hyaluronic acid (HA) preparations have been used for intra-articular administration for several decades, however, the question concerning the structure of the most effective HA molecule has not yet been resolved.
This article presents data concerning the native HA mechanism of action and the justification for the use of its intra-articular injections. The article also considers the process of creating hydrogels, focusing on the composition of materials mediating chemical cross-linking in modern modified HA molecules. Data from previous studies prove that 1,4-butanediol diglycidyl ether, due to minimal immunogenicity and toxicity, is currently the optimal molecule for HA cross-linking, and CHAP-crosslinking technology provides maximum degradation resistance and a high molecular weight of the HA product. During randomized studies, the benefits of such a technology for creating hydrogels (aimed at the knee osteoarthritis therapy) were confirmed in terms of the effect duration, functional parameters improvement and pain reduction versus linear HA molecules, as well as HA products cross-linked using other technologies. The realization possibility of preferential damping or viscosupplementation properties, depending on the osteoarthritis stage, made it possible to consider it as a bionic prosthesis.
Keywords: hyaluronic acid, cross-linked hyaluronic acid, CHAP technology, polynucleotides, bionic cross-link.
For citation: Teplyakova O.V. New possibilities of using hyaluronic acid in patients with knee osteoarthritis. RMJ. 2023;7:22–26.
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2. Knudson W., Ishizuka S., Terabe K. et al. The pericellular hyaluronan of articular chondrocytes. Matrix Biol. 2019;78–79:32–46. DOI: 10.1016/j.matbio.2018.02.005.
3. Martin-Alarcon L., Schmidt T.A. Rheological effects of macromolecular interactions in synovial fluid. Biorheology. 2016;53(2):49–67. DOI: 10.3233/BIR-15104.
4. Altman R., Bedi A., Manjoo A. et al. Anti-Inflammatory Effects of Intra-Articular Hyaluronic Acid: A Systematic Review. Cartilage. 2019;10(1):43–52. DOI: 10.1177/1947603517749919.
5. Altman R.D., Manjoo A., Fierlinger A. et al. The mechanism of action for hyaluronic acid treatment in the osteoarthritic knee: a systematic review. BMC Musculoskelet Disord. 2015;16:321. DOI: 10.1186/s12891-015-0775-z.
6. Band P.A., Heeter J., Wisniewski H.G. et al. Hyaluronan molecular weight distribution is associated with the risk of knee osteoarthritis progression. Osteoarthritis Cartilage. 2015;23(1):70–76. DOI: 10.1016/j.joca.2014.09.017.
7. Nicholls M., Manjoo A., Shaw P. et al. Rheological Properties of Commercially Available Hyaluronic Acid Products in the United States for the Treatment of Osteoarthritis Knee Pain. Clin Med Insights Arthritis Musculoskelet Disord. 2018;11:1179544117751622. DOI: 10.1177/1179544117751622.
8. Xu X., Jha A.K., Harrington D.A. et al. Hyaluronic Acid-Based Hydrogels: from a Natural Polysaccharide to Complex Networks. Soft Matter. 2012;8(12):3280–3294. DOI: 10.1039/C2SM06463D.
9. Snetkov P., Zakharova K., Morozkina S. et al. Hyaluronic Acid: The Influence of Molecular Weight on Structural, Physical, Physico-Chemical, and Degradable Properties of Biopolymer. Polymers (Basel). 2020;12(8):1800. DOI: 10.3390/polym12081800.
10. Bannuru R.R., Osani M.C., Vaysbrot E.E. et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis Cartilage. 2019;27(11):1578–1589. DOI: 10.1016/j.joca.2019.06.011.
11. Bruyère O., Honvo G., Veronese N. et al. An updated algorithm recommendation for the management of knee osteoarthritis from the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO). Semin Arthritis Rheum. 2019;49(3):337–350. DOI: 10.1016/j.semarthrit.2019.04.008.
12. Nele V., Wojciechowski J.P., Armstrong J.P.K., Stevens M.M. Tailoring gelation mechanisms for advanced hydrogel applications. Adv Funct Mater. 2020;30(42):2002759. DOI: 10.1002/adfm.202002759.
13. Øvrebø Ø., Perale G., Wojciechowski J.P. et al. Design and clinical application of injectable hydrogels for musculoskeletal therapy. Bioeng Transl Med. 2022;7(2):e10295. DOI: 10.1002/btm2.10295.
14. Haugen H.J., Basu P., Sukul M. et al. Injectable Biomaterials for Dental Tissue Regeneration. Int J Mol Sci. 2020;21(10):3442. DOI: 10.3390/ijms21103442.
15. Echalier C., Valot L., Martinez J. et al. Chemical cross-linking methods for cell encapsulation in hydrogels. Mater Today Commun. 2019;20:100536. DOI: 10.1016/j.mtcomm.2019.05.012.
16. Sindelar M., Jilkova J., Kubala L. et al. Hyaluronidases and hyaluronate lyases: From humans to bacteriophages. Colloids Surf B Biointerfaces. 2021;208:112095. DOI: 10.1016/j.colsurfb.2021.112095.
17. Berdiaki A., Neagu M., Spyridaki I. et al. Hyaluronan and Reactive Oxygen Species Signaling-Novel Cues from the Matrix? Antioxidants (Basel). 2023;12(4):824. DOI: 10.3390/antiox12040824.
18. Ishikawa M., Yoshioka K., Urano K. et al. Biocompatibility of cross-linked hyaluronate (Gel-200) for the treatment of knee osteoarthritis. Osteoarthritis Cartilage. 2014;22(11):1902–1909. DOI: 10.1016/j.joca.2014.08.002.
19. Sun S.F., Hsu C.W., Lin H.S. et al. Comparison of Single Intra-Articular Injection of Novel Hyaluronan (HYA-JOINT Plus) with Synvisc-One for Knee Osteoarthritis: A Randomized, Controlled, Double-Blind Trial of Efficacy and Safety. J Bone Joint Surg Am. 2017;99(6):462–471. DOI: 10.2106/JBJS.16.00469.
20. Ko P.Y., Li C.Y., Li C.L. et al. Single Injection of Cross-Linked Hyaluronate in Knee Osteoarthritis: A 52-Week Double-Blind Randomized Controlled Trial. Pharmaceutics. 2022;14(9):1783. DOI: 10.3390/pharmaceutics14091783.
21. De Boulle K., Glogau R., Kono T. et al. A review of the metabolism of 1,4-butanediol diglycidyl ether-crosslinked hyaluronic acid dermal fillers. Dermatol Surg. 2013;39(12):1758–1766. DOI: 10.1111/dsu.12301.
22. Ha C.W., Park Y.B., Choi C.H. et al. Efficacy and safety of single injection of cross-linked sodium hyaluronate vs. three injections of high molecular weight sodium hyaluronate for osteoarthritis of the knee: a double-blind, randomized, multi-center, non-inferiority study. BMC Musculoskelet Disord. 2017;18(1):223. DOI: 10.1186/s12891-017-1591-4.
23. Huang T.L., Tsai C.H. Safety and efficacy of single CHAP Hyaluronan injection versus three injections of linear Hyaluronan in pain relief for knee osteoarthritis: a prospective, 52-week follow-up, randomized, evaluator-blinded study. BMC Musculoskelet Disord. 2021;22(1):572. DOI: 10.1186/s12891-021-04467-3.
24. Kang L.J., Yoon J., Rho J.G. et al. Self-assembled hyaluronic acid nanoparticles for osteoarthritis treatment. Biomaterials. 2021;275:120967. DOI: 10.1016/j.biomaterials.2021.120967.
25. Lin Y.W., Fang C.H., Meng F.Q. et al. Hyaluronic Acid Loaded with Cerium Oxide Nanoparticles as Antioxidant in Hydrogen Peroxide Induced Chondrocytes Injury: An In Vitro Osteoarthritis Model. Molecules. 2020;25(19):4407. DOI: 10.3390/molecules25194407. Полный список литературы Вы можете найти на сайте http://www.rmj.ru
26. Filho M.C.B., Dos Santos Haupenthal D.P., Zaccaron R.P. et al. Intra-articular treatment with hyaluronic acid associated with gold nanoparticles in a mechanical osteoarthritis model in Wistar rats. J Orthop Res. 2021;39(12):2546–2555. DOI: 10.1002/jor.25008.
27. Kuppa S.S., Kim H.K., Kang J.Y. et al. Polynucleotides Suppress Inflammation and Stimulate Matrix Synthesis in an In Vitro Cell-Based Osteoarthritis Model. Int J Mol Sci. 2023;24(15):12282. DOI: 10.3390/ijms241512282.
28. Kim T.W., Chang M.J., Shin C.Y. et al. A randomized controlled trial for comparing efficacy and safety between intraarticular polynucleotide and hyaluronic acid for knee osteoarthritis treatment. Sci Rep. 2023;13(1):9419. DOI: 10.1038/s41598-023-35982-z.
29. Dallari D., Sabbioni G., Del Piccolo N. et al. Efficacy of Intra-Articular Polynucleotides Associated With Hyaluronic Acid Versus Hyaluronic Acid Alone in the Treatment of Knee Osteoarthritis: A Randomized, Double-Blind, Controlled Clinical Trial. Clin J Sport Med. 2020;30(1):1–7. DOI: 10.1097/JSM.0000000000000569.
30. Stagni C., Rocchi M., Mazzotta A. et al. Randomised, double-blind comparison of a fixed co-formulation of intra-articular polynucleotides and hyaluronic acid versus hyaluronic acid alone in the treatment of knee osteoarthritis: two-year follow-up. BMC Musculoskelet Disord. 2021;22(1):773. DOI: 10.1186/s12891-021-04648-0.
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