Different molecular weights of hyaluronan research in knee osteoarthritis: A state-of-the-art review

Osteoarthritis (OA), the most common form of arthritis, is characterized by progressive cartilage destruction, concomitant adaptive osteogenesis, and loss of joint function. The progression of OA with aging is associated with a decrease in native hyaluronan (HA, hyaluronate or hyaluronic acid) with a high molecular weight (HMW) in synovial fluid and a subsequent increase in lower MW HA and fragments. As HMW HA possesses numerous biochemical and biological properties, we review new molecular insights into the potential of HA to modify OA processes. Different MWs in the formulation of products appear to have varying effects on knee OA (KOA) pain relief, improved function, and postponing surgery. In addition to the safety profile, more evi-dence indicates that intraarticular (IA) HA administration may be an effective option to treat KOA, with a partic-ular emphasis on the use of HA with fewer injections of higher MW, including potential applications of HA of very HMW. We also analyzed published systemic reviews and meta-analyses of IA HA in treating KOA in order to discuss their conclusions and consensus statements. According to its MW, HA may offer a simple way to refine therapeutic information in selective KOA.(c) 2023 Elsevier B.V. All rights reserved.

Automated summary

Osteoarthritis (OA) is characterized by cartilage destruction, osteogenesis, and loss of joint function. The decrease of native hyaluronan (HA) with high molecular weight (HMW) and the increase of lower MW HA are associated with the aging progression of OA. Different MWs of HA formulations have varying effects on knee OA (KOA) pain relief and improved function. Intraarticular (IA) HA administration may be an effective option for treating KOA, especially with HA of higher MW. Systemic reviews and meta-analyses of IA HA in treating KOA have been analyzed to discuss their conclusions and consensus statements. HA may provide a simple way to refine therapeutic information for selective KOA.