Sodium hyaluronate

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Sodium hyaluronate
Clinical data
Trade namesHealon, Provisc, Viscoat, Hyalgan, Euflexxa, Supartz, Gel-One
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Identifiers
  • Hyaluronan Sodium
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Sodium hyaluronate is the sodium salt of hyaluronic acid, a glycosaminoglycan found in various connective tissue of humans.

Chemistry

Sodium hyaluronate is the

affinity
.

The polyanionic form, commonly referred to as

vitreous humour of the eye and in the fluid of articulating joints
.

Natural occurrence

Sodium hyaluronate, as hyaluronic acid, is distributed widely in the

neural tissues, as well as the corneal endothelium
.

Mechanism of action

Sodium hyaluronate functions as a tissue lubricant and is thought to play an important role in modulating the interactions between adjacent tissues. It forms a viscoelastic solution in water. Mechanical protection for tissues (iris, retina) and cell layers (corneal, endothelium, and epithelium) are provided by the high viscosity of the solution. Elasticity of the solution assists in absorbing mechanical stress and providing a protective buffer for tissues. In facilitating wound healing, it is thought that it acts as a protective transport vehicle, taking peptide growth factors and other structural proteins to a site of action. It is then enzymatically degraded and active proteins are released to promote tissue repair.[1]

Pharmacokinetics

Sodium hyaluronate is cleared within hours of injection but appears to have residual effects on contacted cells. In the eye it is eliminated via the canal of Schlemm.[citation needed]

Adverse effects

Adverse effects are relatively rare when used to treat the joints.[2]

When used in ophthalmological procedures, sodium hyaluronate may cause postoperative inflammation, corneal edema or decompensation, and short-term increases in intraocular pressure.[citation needed]

Medical uses

Intra-articular injection

It is used to treat knee pain in patients with osteoarthritis who have not received relief from other treatments. It is injected into the joint capsule, to act as both a shock absorber and a lubricant for the joint.[3][4][5] Thus sodium hyaluronate is used as a viscosupplement, administered through a series of

symptomatic relief, by recovering the viscoelasticity of the articular fluid, and by stimulating new production of synovial fluid.[2] Use of sodium hyaluronate may reduce the need for joint replacement.[8] Injections appear to increase in effectiveness over the course of four weeks, reaching a peak at eight weeks and retaining some effectiveness at six months, with greater benefit for osteoarthritis than oral analgesics.[9] It may also be effective when used with the ankle joint.[10]

Intraocular viscoelastic injection

It is used as an aid in

photocoagulation.[12]

Skin injections in plastic surgery

Sodium hyaluronate is injected to reduce wrinkles on the face. As of 2017, the FDA had approved 13 hyaluronate preparations as so called dermal fillers.[13] They are also used as a filler of lips or in other parts of the body, though not FDA approved.[14] The filling effect is temporary and lasts for about six months or longer in most people.[15]

Topical application

Topically applied sodium hyaluronate can facilitate the absorption of biomacromolecules, i.e. pharmaceuticals, and function like a nanocarrier.[16] Its effects on skin depend on the hyaluronate formulation and skin health: In barrier-deficient skin it restricted the delivery of biomacromolecules to the stratum corneum and viable epidermis. In normal skin, low-molecular weight hyaluronate (5 kDa) enhanced penetration into the epidermis.[17]

Transepidermal water loss increased by 55.5% with low-molecular weight, and was reduced by 28% with crosslinked resilient, and by 16% with HMW.[18] Its efficacy against wrinkles has not been tested in clinical trials.[19]

Dry, scaly skin, such as that caused by atopic dermatitis, may be treated with lotion or another skin product containing sodium hyaluronate as its active ingredient.[20]

After instillation into the lung, higher molecular weight hyaluronate appears to persist longer in the lung but if > 215 kD there was poor lung penetration and mucociliary clearance. Hyaluronate could allow access to lymph nodes draining the pulmonary bed.[21]

Intravesical instillation

Sodium hyaluronate can be instilled into the bladder for the treatment of various forms of

bladder pain, by replenishing the glycosaminoglycan layer of the bladder urothelium.[22] [23]

Contraindications

Sodium hyaluronate has a very low incidence of side effects, however it is contraindicated in people who are sensitive to

hyaluronate preparations. If being administered as an intra-articular injection, it should not be given when there are infections or skin disease at the injection site.[24][25]

History

In the late 1970s and early 1980s the material was used with the brand names of Hylartin and Hylartin Vetused in human and veterinary clinical trials (race horses) to treat osteoarthritis.[26] The first commercially sold sodium hyaluronate had been developed by Endre Alexander Balazs under the brand name of Healon, manufactured by Pharmacia AB in Sweden in 1980. In 1986, sodium hyaluronate was used as an intra-articular injection to treat osteoarthritis of the knee with the product Hyalart/Hyalgan by Fidia of Italy.[27]

See also

References

  1. PMID 11743360
    .
  2. ^
    S2CID 28214461
    .
  3. ^ "Hyaluronate sodium: Indications, Side Effects, Warnings" (Web). Drugs.com. 5 February 2014. Retrieved 25 February 2014.
  4. S2CID 207538194
    .
  5. PMID 25560716
    .
  6. PMID 9486013
    .
  7. PMID 12421996
    .
  8. PMID 10587245
    .
  9. PMID 21443958
    .
  10. PMID 16452740
    .
  11. PMID 8534643
    .
  12. ^ "Healon (Sodium Hyaluronate)" [package insert]. (2002). Kalamazoo, Michigan: Pharmacia Corporation. (Web). RxList. (Updated 8 December 2004). RxList, Inc. Retrieved 25 February 2014.
  13. ^ "Soft Tissue Fillers Approved by the Center for Devices and Radiological Health". U.S. Food and Drug Administration. 2015-07-27.
  14. S2CID 12498280
    .
  15. ^ "Filling in Wrinkles Safely". U.S. Food and Drug Administration. 2016-12-20.
  16. PMID 28017836
    .
  17. PMID 25871518
    .
  18. PMID 27050698
    .
  19. ^ Stukin S (27 August 2009). "Makeup gets in on the anti-aging craze". The LA Times.
  20. ^ "Hylira gel: Indications, Side Effects, Warnings". Drugs.com. 14 February 2019. Retrieved 16 March 2019.
  21. PMID 27157508
    .
  22. ^ "Hyacyst® (sodium hyaluronate)". Syner-Med. November 2021. Retrieved 29 September 2022.
  23. ^ "Cystistat®". Bladder Health UK. 2022. Retrieved 29 September 2022.
  24. ^ "Bladder Instillation of Cystistat (sodium hyaluronate)" (PDF). East Sussex Healthcare NHS Trust. 5 September 2020. Retrieved 29 September 2022.
  25. ^ "Patient Information Triluron™ (Sodium Hyaluronate)" (PDF). Fidia Pharma USA. 2019. Retrieved 29 September 2022.
  26. ISBN 978-0-9820350-4-7
    .
  27. ^ "Fidia Farmaceutici S.p.A. to Distribute and Promote HYALGAN® (sodium hyaluronate) for Treatment of Osteoarthritis". Fidia Pharma. 26 September 2011. Archived from the original on 27 July 2014.
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