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The molecular weight of therapeutic hyaluronan (sodium hyaluronate): how significant is it?
Abstract: Various molecular weight hyaluronic acid (HA) preparations have been injected into joints for the treatment of human and equine osteoarthritis. A therapeutic advantage has been claimed for commercial products with a molecular weight in the range found in normal synovial fluid (SF), compared to lower molecular weight products. But a correlation between molecular weight and efficacy is not borne out by an analysis of the available literature on clinical results. SF viscosity, HA concentration, HA molecular weight and rate of synthesis in joint disease. It is proposed that the beneficial effect of injected HA in joint disease may be due to pharmacological rather than to physical properties.
Publication Date: 1994-02-01 PubMed ID: 8182640 The Equine Research Bank provides access to a large database of publicly available scientific literature. Inclusion in the Research Bank does not imply endorsement of study methods or findings by Mad Barn.
- Journal Article
- Review
Summary
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The research article explores the effectiveness of various molecular weight hyaluronic acid (HA) preparations for the treatment of osteoarthritis in humans and horses. The study questions the claim that moderately sized molecules in typical joint fluid have a therapeutic advantage; the article proposes that the beneficial effects may instead stem from pharmacological properties rather than physical ones.
An Overview of the Research Question
- The purpose of the research is to analyse the efficacy of hyaluronic acid (HA) preparations of different molecular weights in treating human and equine osteoarthritis.
- The research was driven by the commonly held belief that commercial molecules similar in size to those found in normal joint fluid (synovial fluid, or SF) are more effective in treatment than those that are smaller.
- The hypothesis put forward in this paper is that the effectiveness of HA is more significantly tied to pharmacological rather than physical properties.
Assessment of Previous Literature
- An analysis was conducted on pre-existing clinical reports to determine the correlation between molecular size of HA and its effectiveness. The research found no substantial evidence linking the two.
- This observation is important since it disperses the belief that larger-sized HA molecules are automatically more effective therapeutic agents.
About the Molecular Weight and Synovial Fluid
- Four factors were considered: the viscosity of the synovial fluid (SF), the concentration of HA in the fluid, the molecular weight of the HA, and the speed at which HA is synthesized in joint disease.
- These factors were assessed for their potential relationship with the effectiveness of the HA in the treatment of osteoarthritis.
Proposed Explanation of Hyaluronic Acid Benefits
- The article suggests that positive medical effects seen from using HA for joint disease treatment might not be due to physical properties such as molecular weight.
- Instead, the therapeutic benefits may come as a result of HA’s pharmacological properties. These could potentially include promotion of wound healing or exerting anti-inflammatory actions.
- If proven, this theorized explanation could lead to adjustments in how treatments for osteoarthritis are developed.
Cite This Article
APA
Aviad AD, Houpt JB.
(1994).
The molecular weight of therapeutic hyaluronan (sodium hyaluronate): how significant is it?
J Rheumatol, 21(2), 297-301.
Publication
Researcher Affiliations
- Rheumatic Disease Unit, Mount Sinai Hospital, University of Toronto, ON, Canada.
MeSH Terms
- Animals
- Horse Diseases / drug therapy
- Horses
- Humans
- Hyaluronic Acid / chemistry
- Hyaluronic Acid / therapeutic use
- Joint Diseases / drug therapy
- Joint Diseases / veterinary
- Molecular Weight
- Osteoarthritis / drug therapy
- Osteoarthritis / veterinary
- Synovial Fluid / drug effects
- Synovial Fluid / physiology
- Viscosity
References
This article includes 56 references
Citations
This article has been cited 12 times.- Hirose R, Yoshida T, Naito Y, Watanabe N, Hashimoto H, Sugino S, Bandou R, Daidoji T, Inoue K, Dohi O, Yoshida N, Nakaya T, Itoh Y. Differences between two sodium hyaluronate-based submucosal injection materials currently used in Japan based on viscosity analysis. Sci Rep 2021 Mar 11;11(1):5693.
- Maheu E, Avouac B, Dreiser RL, Bardin T. A single intra-articular injection of 2.0% non-chemically modified sodium hyaluronate vs 0.8% hylan G-F 20 in the treatment of symptomatic knee osteoarthritis: A 6-month, multicenter, randomized, controlled non-inferiority trial. PLoS One 2019;14(12):e0226007.
- Gupta RC, Lall R, Srivastava A, Sinha A. Hyaluronic Acid: Molecular Mechanisms and Therapeutic Trajectory. Front Vet Sci 2019;6:192.
- Sirin DY, Kaplan N, Yilmaz I, Karaarslan N, Ozbek H, Akyuva Y, Kaya YE, Oznam K, Akkaya N, Guler O, Akkaya S, Mahirogullari M. The association between different molecular weights of hyaluronic acid and CHAD, HIF-1α, COL2A1 expression in chondrocyte cultures. Exp Ther Med 2018 May;15(5):4205-4212.
- Boutefnouchet T, Puranik G, Holmes E, Bell KM. Hylan GF-20 Viscosupplementation in the Treatment of Symptomatic Osteoarthritis of the Knee: Clinical Effect Survivorship at 5 Years. Knee Surg Relat Res 2017 Jun 1;29(2):129-136.
- Shen X, Gatti R. The safety and efficacy of intra-articular dual molecular weighted hyaluronic Acid in the treatment of knee osteoarthritis: the I.d.e.h.a. Study. Orthop Rev (Pavia) 2013;5(4):e33.
- McArthur BA, Dy CJ, Fabricant PD, Valle AG. Long term safety, efficacy, and patient acceptability of hyaluronic acid injection in patients with painful osteoarthritis of the knee. Patient Prefer Adherence 2012;6:905-10.
- Harris JD, Griesser MJ, Copelan A, Jones GL. Treatment of adhesive capsulitis with intra-articular hyaluronate: A systematic review. Int J Shoulder Surg 2011 Apr;5(2):31-7.
- Bellamy N, Campbell J, Robinson V, Gee T, Bourne R, Wells G. Viscosupplementation for the treatment of osteoarthritis of the knee. Cochrane Database Syst Rev 2006 Apr 19;2006(2):CD005321.
- Kotevoglu N, Iyibozkurt PC, Hiz O, Toktas H, Kuran B. A prospective randomised controlled clinical trial comparing the efficacy of different molecular weight hyaluronan solutions in the treatment of knee osteoarthritis. Rheumatol Int 2006 Feb;26(4):325-30.
- Adams ME, Lussier AJ, Peyron JG. A risk-benefit assessment of injections of hyaluronan and its derivatives in the treatment of osteoarthritis of the knee. Drug Saf 2000 Aug;23(2):115-30.
- George E. Intra-articular hyaluronan treatment for osteoarthritis. Ann Rheum Dis 1998 Nov;57(11):637-40.
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