FOR YEARS, medical devices based on Glycosaminoglycans HAVE BEEN IMPROVING LIVES OF MILLIONS OF PATIENTS WORLDWIDE.
Hyaluronic Acid is widely used in aesthetic medicine (as a dermal filler), ophthalmology (for ophthalmic surgery and eye drops), rheumatology (for visco-supplementation and bone regeneration), urology (treatment of vesicoureteral reflux) and more. Heparosan, biomolecules from the same Glycosaminoglycan family, also have great potential in these therapeutic fields.
Skin is in a state of permanent renewal: skin cells die and are renewed daily. Over time, cells regenerate themselves less quickly, and the production of some molecules loses intensity, resulting in skin aging and wrinkles. There is a growing trend for the adoption of solutions to compensate or reduce the loss of skin firmness, elasticity and volume on the face and hands - with the objective of combatting the signs of aging and improving skin quality.
Among wrinkle filling products, injectable Hyaluronic Acid is the preferred biomaterial to produce dermal fillers and perform various aesthetic medicine procedures, due to its efficacy, reversible effects and low secondary effects. Hyaluronic Acid modification opens a wide field of possibilities for filler optimization and differentiation. For example, crosslinking contributes to modulating effect and duration.
Heparosan, a biopolymer with the same sugar backbone as Hyaluronic Acid, is also a good candidate for developing additional functionality to dermal fillers of the future. In particular, Heparosan has a potentially increased lifetime compared to Hyaluronic Acid, because of its non-sensitiveness to hyaluronidase.
Cataracts are among the WHO priority eye diseases, as being responsible for 51% of global blindness (1). In this very common surgical operation, Hyaluronic Acid solutions are the most frequently used visco-surgical devices (2).
Hyaluronic Acid is a natural component of the human eye and has been used in ophthalmic products for decades. It is widely used in ophthalmic surgery, mostly for cataract surgery, but also for glaucoma and corneal transplantation (3). With their viscoelastic and rheological properties, hyaluronic acid solutions protect and lubricate the eye tissues, allow tissues to stay in place and maintain the eye shape by replacing lost vitreous fluid and provide space for manipulation.
Ocular dryness is caused by a chronic lack of sufficient lubrication and moisture on the surface of the eye. It causes visual discomfort that can lead to irritation of the cornea and eye infections. With the increasing use of screen and contact lenses, the prevalence of ocular dryness is dramatically increasing: almost one-third of the adult population could be affected by this disease. Hyaluronic Acid is used as an active ingredient in many eye drops or artificial tears, which hydrate the ocular surface, improve vision and comfort, and allow contact lenses wearers to wear their lenses comfortably (4). Functionalized Hyaluronic Acid derivatives can also be used to increase ocular residence time.
Heparosan, being not degraded by the hyaluronidase enzyme present in the eye and tears, could also be of potential interest in order to reduce the frequency of self-instillation.
Hyaluronic Acid is one of the major lubricating agents in synovial joint fluid, which absorbs mechanical impacts and avoids friction between the bone-ends. When this fluid is reduced or inflamed, disorders such as rheumatoid arthritis and osteoarthritis occur. Osteoarthritis, a chronic, degenerative disease of joint cartilage, is the most common joint disease in the world, affecting 10% to 15% of the population.
In osteoarthritis, HTL’s hyaluronic acid is the key component of viscosupplements used to treat and slow down the progression of osteoarthritis (5) (6). For cases involving severe and continuous pain, which is resistant to treatment, hyaluronic acid is injected in the articulation to decrease pain. Patients with initial to severe osteoarthritis may also benefit from slow-acting anti-arthritics, in which hyaluronic acid can be associated with several active drugs.
Vesicoureteral reflux (VUR) is a congenital pediatric disease. VUR has a low prevalence, but its implications can be severe, including kidney pain and even chronic kidney failure.
Hyaluronic Acid is used for endoscopic injections for the treatment of VUR, which have a very high success rate (7). Preliminary evidence has shown that intravesical hyaluronic acid, administered alone or alpha-blockers, may be able to reduce the recurrence and symptoms of urinary tract infections.
Likewise, hyaluronic acid and combinations of both are used for intravesical instillation for interstitial cystitis / bladder pain syndrome and overreactive bladder (8).