Effects of high molecular weight hyaluronic acid on induced arthritis of the temporomandibular joint in rats

The bioengineering application of hyaluronic acid in tissue regeneration and repair

The multifaceted role of hyaluronic acid (HA) across diverse biomedical disciplines underscores its versatility in tissue regeneration and repair. HA hydrogels employ different crosslinking including chemical (chitosan, collagen), photo- initiation (riboflavin, LAP), enzymatic (HRP/H2O2), and physical interactions (hydrogen bonds, metal coordination). In biophysics and biochemistry, HA's signaling pathways, primarily through CD44 and RHAMM receptors, modulate cell behavior (cell migration; internalization of HA), inflammation, and wound healing. Particularly, smaller HA fragments stimulate inflammatory responses through toll-like receptors, impacting macrophages and cytokine expression. HA's implications in oncology highlight its involvement in tumor progression, metastasis, and treatment. Elevated HA in tumor stroma impacts apoptosis resistance and promotes tumor growth, presenting potential therapeutic targets to halt tumor progression. In orthopedics, HA's presence in synovial fluid aids in osteoarthritis management, as its supplementation alleviates pain, enhances synovial fluid's viscoelastic properties, and promotes cartilage integrity. In ophthalmology, HA's application in dry eye syndrome addresses symptoms by moisturizing the eyes, replenishing tear film deficiencies, and facilitating wound healing. Intravitreal injections and hydrogel-based systems offer versatile approaches for drug delivery and vitreous humor replacement. For skin regeneration and wound healing, HA hydrogel dressings exhibit exceptional properties by promoting moist wound healing and facilitating tissue repair. Integration of advanced regenerative tools like stem cells and solubilized amnion membranes into HA-based systems accelerates wound closure and tissue recovery. Overall, HA's unique properties and interactions render it a promising candidate across diverse biomedical domains, showcasing immense potentials in tissue regeneration and therapeutic interventions. Nevertheless, many detailed cellular and molecular mechanisms of HA and its applications remain unexplored and warrant further investigation.

Mechanisms of Action and Efficacy of Hyaluronic Acid, Corticosteroids and Platelet-Rich Plasma in the Treatment of Temporomandibular Joint Osteoarthritis-A Systematic Review

Temporomandibular joint osteoarthritis (TMJ OA) is a low-inflammatory disorder with multifactorial etiology. The aim of this review was to present the current state of knowledge regarding the mechanisms of action and the efficacy of hyaluronic acid (HA), corticosteroids (CS) and platelet-rich plasma (PRP) in the treatment of TMJ OA.: The PubMed database was analyzed with the keywords: "(temporomandibular joint) AND ((osteoarthritis) OR (dysfunction) OR (disorders) OR (pain)) AND ((treatment) OR (arthrocentesis) OR (arthroscopy) OR (injection)) AND ((hyaluronic acid) OR (corticosteroid) OR (platelet rich plasma))". After screening of 363 results, 16 studies were included in this review. Arthrocentesis alone effectively reduces pain and improves jaw function in patients diagnosed with TMJ OA. Additional injections of HA, either low-molecular-weight (LMW) HA or high-molecular-weight (HMW) HA, or CS at the end of the arthrocentesis do not improve the final clinical outcomes. CS present several negative effects on the articular cartilage. Results related to additional PRP injections are not consistent and are rather questionable. Further studies should be multicenter, based on a larger group of patients and should answer the question of whether other methods of TMJ OA treatment are more beneficial for the patients than simple arthrocentesis.

Effects of Intra-Articular Resveratrol Injections on Cartilage Destruction and Synovial Inflammation in Experimental Temporomandibular Joint Osteoarthritis

PURPOSE

The aim of this study was to investigate the effects of intra-articular resveratrol injections on cartilage destruction and synovial inflammation in an experimental temporomandibular joint osteoarthritis (TMJ-OA) model.

MATERIALS AND METHODS

Freund's complete adjuvant injection method was used to construct the TMJ-OA model. Twenty-eight male Wistar rats were randomly placed into 4 groups: control (n = 4), TMJ arthritis (n = 8), low-dose intra-articular resveratrol (RES[L]; n = 8), and high-dose intra-articular resveratrol (RES[H]; n = 8). Intra-articular injections of resveratrol were performed 3 times at 1-week intervals, 1 week after the administration of a single dose of Freund's complete adjuvant to the TMJ. The effects of resveratrol on cartilage destruction and synovial inflammation were examined histopathologically. The histomorphometric examination revealed condylar cartilage and articular disc thickness. An apoptotic chondrocyte count was performed with terminal deoxynucleotidyl transferase dUTP nick end labeling staining, and matrix metalloproteinase 13 expression was evaluated through an immunohistochemical examination.

RESULTS

The thickness of the condylar cartilage in the RES(L) and RES(H) groups was statistically significantly greater than that in the control and TMJ arthritis groups (P < .05). The inflammation-induced articular disc thickening was significantly lower in the RES(L) and RES(H) groups (P < .05). The chondrocyte apoptosis in the RES(L) and RES(H) groups was significantly lower than that in the TMJ arthritis group (P < .05). The matrix metalloproteinase 13 expression in the RES(L) and RES(H) groups was obviously less than that in the TMJ arthritis group (P < .05).

CONCLUSIONS

The intra-articular resveratrol treatment exerted a curative effect by preventing the inflammation and cartilage destruction associated with TMJ-OA.

Effect of high molecular weight hyaluronic acid in treatment of osteoarthritic temporomandibular joints of rats

OBJECTIVE

The aim of this study was to determine the histological and biochemical effects of high molecular weight hyaluronic acid on experimentally induced osteoarthritic changes in male rat temporomandibular joint (TMJ).

DESIGN

In this in-vivo study, 36 male albino rats were divided into 3 groups; control non-injected, disease and treatment group. Osteoarthritis was induced using a single intra-articular injection of Complete Freund's adjuvant (CFA) (50 μl). High molecular weight hyaluronic acid (HMWHA) was injected intra-articularly once a week, for a total of 3 injections. TMJ tissue samples were dissected from control, disease and treatment groups for biochemical analysis using ELISA test to detect the levels of matrix metalloproteinase-3 (MMP-3) on day 28. Histological examination was done using Hematoxylin &eosin, Mallory's trichrome and Alcian blue stains. Data was analyzed using Kruskal-Wallis test followed by Dunn-Sidek method, with a 5 % significance level.

RESULTS

Treatment group showed regaining of the normal histological features of the TMJ and decreased levels of MMP-3 when compared to disease group.

CONCLUSIONS

These findings may suggest that HMWHA plays a role in the management of CFA-induced osteoarthritic cartilage lesions.

Temporomandibular joint arthritis in juvenile idiopathic arthritis, now what?

BACKGROUND

Arthritis involving the temporomandibular joint (TMJ) complicates 40 - 96% of cases of juvenile idiopathic arthritis (JIA), potentially leading to devastating changes to form and function. Optimal evaluation and management of this joint remains a matter of ongoing discussion.

METHODS

We performed a PubMed search for all articles with keywords "temporomandibular" and "arthritis", covering the dates 2002 through February 28, 2018. A separate PubMed search was performed for all articles with keywords "temporomandibular joint", "arthritis", and "treatment" covering the same dates.

FINDINGS

The TMJ is a particularly challenging joint to assess, both clinically and with imaging studies. Clinical assessment of the TMJ is hampered by the low sensitivity of joint pain as well as the absence of physical exam findings early in the disease process. As with all joints, plain radiography and computed tomography only detect arthritic sequelae. Additionally, there is mixed data on the sensitivity of ultrasound, leaving magnetic resonance imaging (MRI) as the optimal diagnostic modality. However, several recent studies have shown that non-arthritic children can have subtle findings on MRI consistent with TMJ arthritis, such as joint effusion and contrast enhancement. Consequently, there has been an intense effort to identify features that can be used to differentiate mild TMJ arthritis from normal TMJs, such as the ratio of the enhancement within the TMJ itself compared to the enhancement in surrounding musculature. With respect to treatment of TMJ arthritis, there is minimal prospective data on medical therapy of this complicated joint. Retrospective studies have suggested that the response to medical therapy of the TMJ may lag behind that of other joints, prompting use of intraarticular (IA) therapy. Although most studies have shown short-term effectiveness of corticosteroids, the long-term safety of this therapy on local growth as well as on the development of IA heterotopic bone have prompted recommendations to limit use of IA corticosteroids. Severe TMJ disease from JIA can also be managed non-operatively with splints in a growing child, as well as with surgery.

CONCLUSION

In this review, we summarize literature on the diagnosis and management of TMJ arthritis in JIA and suggest a diagnostic and therapeutic algorithm for children with refractory TMJ arthritis.

Low-level laser therapy stimulates tissue repair and reduces the extracellular matrix degradation in rats with induced arthritis in the temporomandibular joint

The objective of this study was to characterize morphological and biochemistry action of low-level laser therapy (LLLT) on induced arthritis in the temporomandibular joint (TMJ) of rats. Twenty-four male Wistar rats were randomly divided into groups with 12 animals each: (AG) group with arthritis induced in the left TMJ and (LG) group with arthritis induced in the left TMJ and treated with LLLT (830 nm, 30 mW, 3 J/cm(2)). Right TMJs in the AG group were used as noninjected control group (CG). Arthritis was induced by intra-articular injection of 50 μl Complete Freund's Adjuvant (CFA) and LLLT began 1 week after arthritis induction. Histopathological analysis was performed using sections stained with hematoxylin-eosin, Toluidine Blue, and picrosirius. Biochemical analysis was determined by the total concentration of sulfated glycosaminoglycans (GAGs) and evaluation of matrix metalloproteinases (MMP-2 and MMP-9). Statistical analysis was performed using paired and unpaired t tests, with p < 0.05. Compared to AG, LG had minor histopathological changes in the TMJ, smaller thickness of the articular disc in the anterior (p < 0.0001), middle (p < 0.0001) and posterior regions (p < 0.0001), high birefringence of collagen fibers in the anterior (p < 0.0001), middle (p < 0.0001) and posterior regions (p < 0.0001) on the articular disc, and statistically lower activity of MMP-2 latent (p < 0.0001), MMP-2 active (P = 0.02), MMP-9 latent (p < 0.0001), and MMP-9 active (p < 0.0001). These results suggest that LLLT can increase the remodeling and enhancing tissue repair in TMJ with induced arthritis.