Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2017 Jun 19:4:82.
doi: 10.3389/fmed.2017.00082. eCollection 2017.

Polysaccharides As Viscosupplementation Agents: Structural Molecular Characteristics but Not Rheology Appear Crucial to the Therapeutic Response

Rita C Machado  1   2 , Susana Capela  1   2 , Francisco A C Rocha  3
Affiliations
Review

Polysaccharides As Viscosupplementation Agents: Structural Molecular Characteristics but Not Rheology Appear Crucial to the Therapeutic Response

Rita C Machado et al. Front Med (Lausanne). .

Abstract

Introduction: Most clinical studies and basic research document viscosupplementation (VS) in terms of effectiveness and safety, but only a few highlight its molecular mechanisms of action. Besides, there is generally focus on hyaluronic acid (HA) as being the most relevant polysaccharide to reach the clinical endpoints, attributing its effect mainly to its unique viscoelastic properties, related to a high-molecular weight and gel formulation. Usually, studies do not approach the possible biological pathways where HA may interfere, and there is a lack of reports on other biocompatible polysaccharides that could be of use in VS.

Aim: We briefly review the main proposed mechanisms of action of intra-articular hyaluronic acid (IA-HA) treatment and discuss its effectiveness focusing on the role of rheological and intrinsic structural molecular properties of polysaccharides in providing a therapeutic effect.

Methods: We conducted a literature search using PubMed database to find articles dealing with the mechanisms of action of IA-HA treatment and/or emphasizing how the structural properties of the polysaccharide used influenced the clinical outcomes.

Discussion/conclusion: HA is involved in numerous biochemical interactions that may explain the clinical benefits of VS, most of them resulting from HA-cluster of differentiation 44 receptor interaction. There are other important aspects apart from the molecular size or the colloidal state of the IA-HA involved in VS efficiency that still need to be consolidated. Indeed, it seems that clinical response may be dependent on the intrinsic properties of the polysaccharide, regardless of being HA, rather than to rheology, posing some controversy to previous beliefs.

Keywords: cartilage; guar gum; hyaluronic acid; osteoarthritis; pain; polysaccharide; viscosupplementation.

PubMed Disclaimer

References

    1. Elmorsy S, Funakoshi T, Sasazawa F, Todoh M, Tadano S, Iwasaki N. Chondroprotective effects of high-molecular-weight cross-linked hyaluronic acid in a rabbit knee osteoarthritis model. Osteoarthritis Cartilage (2014) 22(1):121–7.10.1016/j.joca.2013.10.005 - DOI - PubMed
    1. Ravera E, Fragai M, Parigi G, Luchinat C. Differences in dynamics between crosslinked and non-crosslinked hyaluronates measured by using fast field-cycling relaxometry. Chemphyschem (2015) 16(13):2803–9.10.1002/cphc.201500446 - DOI - PubMed
    1. Johal H, Devji T, Schemitsch EH, Bhandari M. Viscosupplementation in knee osteoarthritis: evidence revisited. JBJS Rev (2016) 4(4):e1.10.2106/JBJS.RVW.15.00098 - DOI - PubMed
    1. Fraser JRE, Laurent TC, Laurent UBG. Hyaluronan: its nature, distribution, functions and turnover. J Intern Med (1997) 242(1):27–33.10.1046/j.1365-2796.1997.00170.x - DOI - PubMed
    1. Castro RR, Silva CM, Nunes RM, Cunha PL, de Paula RC, Feitosa JP, et al. Structural characteristics are crucial to the benefits of guar gum in experimental osteoarthritis. Carbohydr Polym (2016) 150:392–9.10.1016/j.carbpol.2016.05.031 - DOI - PubMed