Rheological properties of synovial fluid due to viscosupplements: A review for osteoarthritis remedy

The Effect of Intra-Articular Injections of Hyaluronic Acid for the Treatment of Trapezio-Metacarpal Joint Osteoarthritis

BACKGROUND

Osteoarthritis of the basal thumb joint is a debilitating disease with a high prevalence. Among pharmacological treatments, intra-articular injections of hyaluronic acid have been clinically applied. This study aimed to investigate the effectiveness and safety of intra-articular injections of hyaluronic acid for the treatment of trapezio-metacarpal joint osteoarthritis (TMOA), over a one-year period.

METHODS

Patients with TMOA were enrolled and treated with five consecutive intra-articular injections of hyaluronic acid (20 mg/2 mL, 500-750 KDa, HyalganBio) at weekly intervals. Primary outcomes were pain during different activities (changes in numerical rating scale) and function (pinch and grip strength), and secondary outcomes were safety (adverse events) and patient-reported outcomes (quick-DASH and SF-12). The outcomes were evaluated at baseline and 1-, 3-, 6-, and 12- months after the last injection.

RESULTS

A total of 29 patients were included. All participants completed the five injective sessions and the first follow-up. A total of 15 patients completed the study. During the follow-up period, intra-articular injections of hyaluronic acid have significantly reduced spontaneous and provoked pain and improved disability. No severe systemic adverse events were reported.

CONCLUSIONS

At a follow-up of up to 12 months, patients with TMOA treated with intra-articular hyaluronic acid injections reported improvements in pain relief and quality of life.

Multidisciplinary Rehabilitation after Hyaluronic Acid Injections for Elderly with Knee, Hip, Shoulder, and Temporomandibular Joint Osteoarthritis

Osteoarthritis (OA) is a prevalent degenerative joint condition characterized by cartilage deterioration, joint inflammation, and functional limitations, particularly impacting the elderly population. Rehabilitation and hyaluronic acid (HA) injections are common therapeutic approaches routinely used in clinical practice, but their synergistic potential is far from being fully characterized. Thus, the aim of this narrative review was to elucidate the multilevel benefits and synergies of integrating these two approaches in multidisciplinary OA rehabilitation. This narrative review follows the scale for the assessment of narrative review articles (SANRA) criteria and involves a comprehensive literature search from July to August 2023. Two independent reviewers screened studies, including those involving human subjects with OA, rehabilitation strategies, and outcomes following HA injection, published in English. Results: HA injections might improve joint biomechanics, reducing friction, absorbing shocks, and potentially regulating inflammation. Rehabilitation plays a pivotal role in strengthening muscles, increasing the range of motion, and enhancing overall function. Optimizing rehabilitation following HA injection might provide additional benefits in joint health. OA management requires a multidisciplinary approach integrating HA injections, rehabilitation, and personalized care. Challenges in patient adherence and healthcare resources currently exist, but emerging technologies offer opportunities to enhance patient engagement and monitoring optimizing sustainability and outcomes of patients with knee, hip, shoulder, and temporomandibular joint OA.

Boron Nitride's Morphological Role in the Design of Injectable Hyaluronic Acid Based Hybrid Artificial Synovial Fluid

The treatment process of osteoarthritis (OA) is challenging as it affects not only cartilage but also subchondral bone, ligament attachment capsules, synovium, and surrounding muscle tissue. Therefore, the search for preventive treatment or methods to slow the onset of the condition. Hexagonal boron nitride (hBN) has a graphite-like lamellar structure and is thought to facilitate cartilage movement for biomedical applications, just like in bearing systems. Hyaluronic acid (HA) is one of the natural polymers that can be used to transport boron nitride and maintain its presence in joints for a long time. In this study, hybrid hydrogels were formulated by using boron nitride nanoparticles and nanosheets. The rheological properties of the hydrogels were evaluated according to the structural differences of hBN. Characterizations have shown that hybrid hydrogels can be produced in injectable form, and the rheological properties are strongly related to the structural properties of the added particle. It has been determined that hBN added to the hydrogel structure reduces the dynamic viscosity of the zero-shear point and the deformation rate of the hydrogel and also changes the viscoelastic properties of the hydrogel depending on boron nitride's structural differences. The suggested mechanism is the hybrid hydrogel that exhibits lower viscosity as the layers detach from each other or disperses the agglomerates under applied shear stress. hBN, which has been proposed as a new strategy for joint injections, is thought to be a promising candidate for the treatment of OA due to its lamellar structures.

Ex Vivo Functional Benchmarking of Hyaluronan-Based Osteoarthritis Viscosupplement Products: Comprehensive Assessment of Rheological, Lubricative, Adhesive, and Stability Attributes

While many injectable viscosupplementation products are available for osteoarthritis (OA) management, multiple hydrogel functional attributes may be further optimized for efficacy enhancement. The objective of this study was to functionally benchmark four commercially available hyaluronan-based viscosupplements (Ostenil, Ostenil Plus, Synvisc, and Innoryos), focusing on critical (rheological, lubricative, adhesive, and stability) attributes. Therefore, in vitro and ex vivo quantitative characterization panels (oscillatory rheology, rotational tribology, and texture analysis with bovine cartilage) were used for hydrogel product functional benchmarking, using equine synovial fluid as a biological control. Specifically, the retained experimental methodology enabled the authors to robustly assess and discuss various functional enhancement options for hyaluronan-based hydrogels (chemical cross-linking and addition of antioxidant stabilizing agents). The results showed that the Innoryos product, a niacinamide-augmented linear hyaluronan-based hydrogel, presented the best overall functional behavior in the retained experimental settings (high adhesivity and lubricity and substantial resistance to oxidative degradation). The Ostenil product was conversely shown to present less desirable functional properties for viscosupplementation compared to the other investigated products. Generally, this study confirmed the high importance of formulation development and control methodology optimization, aiming for the enhancement of novel OA-targeting product critical functional attributes and the probability of their clinical success. Overall, this work confirmed the tangible need for a comprehensive approach to hyaluronan-based viscosupplementation product functional benchmarking (product development and product selection by orthopedists) to maximize the chances of effective clinical OA management.

3D culture of bovine articular chondrocytes in viscous medium encapsulated in agarose hydrogels for investigation of viscosity influence on cell functions

The mechanical properties of an extracellular microenvironment can affect cell functions. The effects of elasticity and viscoelasticity on cell functions have been extensively studied with hydrogels of tunable mechanical properties. However, investigation of the viscosity effect on cell functions is still very limited and it can be tricky to explore how viscosity affects cells in three-dimensional (3D) culture due to the lack of appropriate tools. In this study, agarose hydrogel containers were prepared and used to encapsulate viscous media for 3D cell culture to investigate the viscosity effect on the functions of bovine articular chondrocytes (BACs). Polyethylene glycol of different molecular weights was used to adjust culture medium viscosity in a large range (72.8-679.2 mPa s). The viscosity affected gene expression and secretion of cartilagenious matrices, while it did not affect BAC proliferation. The BACs cultured in the lower viscosity medium (72.8 mPa s) showed a higher level of cartilaginous gene expression and matrix secretion.

Targeting the Inflammatory Hallmarks of Obesity-Associated Osteoarthritis: Towards Nutraceutical-Oriented Preventive and Complementary Therapeutic Strategies Based on n-3 Polyunsaturated Fatty Acids

Obesity (Ob), which has dramatically increased in the last decade, is one of the main risk factors that contribute to the incidence and progression of osteoarthritis (OA). Targeting the characteristics of obesity-associated osteoarthritis (ObOA) may offer new chances for precision medicine strategies in this patient cohort. First, this review outlines how the medical perspective of ObOA has shifted from a focus on biomechanics to the significant contribution of inflammation, mainly mediated by changes in the adipose tissue metabolism through the release of adipokines and the modification of fatty acid (FA) compositions in joint tissues. Preclinical and clinical studies on n-3 polyunsaturated FAs (PUFAs) are critically reviewed to outline the strengths and weaknesses of n-3 PUFAs' role in alleviating inflammatory, catabolic and painful processes. Emphasis is placed on potential preventive and therapeutic nutritional strategies based on n-3 PUFAs, with a focus on ObOA patients who could specifically benefit from reformulating the dietary composition of FAs towards a protective phenotype. Finally, tissue engineering approaches that involve the delivery of n-3 PUFAs directly into the joint are explored to address the perspectives and current limitations, such as safety and stability issues, for implementing preventive and therapeutic strategies based on dietary compounds in ObOA patients.

A composite device for viscosupplementation treatment resistant to degradation by reactive oxygen species and hyaluronidase

Osteoarthritis (OA) is one of the most common musculoskeletal disorders in the world. OA is often associated with the loss of viscoelastic and tribological properties of synovial fluid (SF) due to degradation of hyaluronic acid (HA) by reactive oxygen species (ROS) and hyaluronidases. Viscosupplementation is one of the ways how to effectively restore SF functions. However, current viscosupplementation products provide only temporal therapeutic effect because of short biological half-life. In this article we describe a novel device for viscosupplementation (NV) based on the cross-linked tyramine derivative of HA, chondroitin sulfate (CS), and high molecular weight HA by online determination of viscoelastic properties loss during degradation by ROS and hyaluronidase. Rheological and tribological properties of developed viscosupplement were compared with HA solutions with different molecular weights in the range 500-2000 kDa, which are currently commonly used as medical devices for viscosupplementation treatment. Moreover, based on clinical practice and scientific literature all samples were also diluted by model OA SF in the ratio 1:1 (vol/vol) to better predict final properties after injection to the joint. The observed results confirmed that NV exhibits appropriate rheological properties (viscosity, elastic, and viscous moduli) comparable with healthy SF and maintain them during degradation for a significantly longer time than HA solutions with molecular weight in the range 500-2000 kDa and cross-linked material without CS.

Synovial Fluid Regulates the Gene Expression of a Pattern of microRNA via the NF-κB Pathway: An In Vitro Study on Human Osteoarthritic Chondrocytes

Synovial fluid (SF) represents the primary source of nutrients of articular cartilage and is implicated in maintaining cartilage metabolism. We investigated the effects of SF, from patients with osteoarthritis (OA), rheumatoid arthritis (RA), and controls, on a pattern of microRNA (miRNA) in human OA chondrocytes. Cells were stimulated with 50% or 100% SF for 24 h and 48 h. Apoptosis and superoxide anion production were detected by cytometry; miRNA (34a, 146a, 155, 181a), cytokines, metalloproteinases (MMPs), type II collagen (Col2a1), antioxidant enzymes, B-cell lymphoma (BCL)2, and nuclear factor (NF)-κB by real-time PCR. The implication of the NF-κB pathway was assessed by the use of NF-κB inhibitor (BAY-11-7082). RA and OA SF up-regulated miR-34a, -146a, -155, -181a, interleukin (IL)-1β, IL-6, tumor necrosis factor (TNF)-α, MMP-1, MMP-13, and ADAMTs-5 gene expression, while it down-regulated Col2a1. Pathological SF also induced apoptosis, reduced viability, and decreased BCL2 mRNA, whereas it increased superoxide anions, the expression of antioxidant enzymes, p65 and p50 NF-κB. Opposite and positive results were obtained with 100% control SF. Pre-incubation with BAY-11-7082 counteracted SF effects on miRNA. We highlight the role of the SF microenvironment in regulating some miRNA involved in inflammation and cartilage degradation during OA and RA, via the NF-κB pathway.

MicroRNA-1592 in the Bone Marrow Mesenchymal Stem Cell-Derived Exosomes Inhibits the Glioma Development In Vivo and In Vitro

This study evaluated the role of miRNA-1592 (miR-1592) carried by exosomes that originated from bone marrow mesenchymal stem cell (BMSC) in glioma. BMSCs were cultured and identified, followed by being co-cultured with glioma cells to measure cell invasion, metastasis, and apoptosis by transwell assay and flow cytometry, cell proliferation by MTT, PI3K/AKT signal protein expression by western blot. BMSC-originated exosomes with different concentrations were used as a treatment strategy for established tumor models. The tumor volume was measured and tumor tissues were harvested for immunohistochemistry and immunoblot analysis. After co-culture with BMSC-originated exosomes, glioma cells showed an up-regulated transcription of miR-1592, along with inhibited phosphorylation and activation of PI3K/AKT signal pathway. Moreover, glioma cells exhibited reduced migration and invasiveness In Vitro, which was accompanied by diminished levels of proteins involved in cellular invasiveness. Simultaneously, co-culture with BMSC-originated exosomes can restrain glioma cell proliferation via facilitating cell apoptosis In Vivo and In Vitro. In conclusion, exosome-encapsulated microRNA-1592 from BMSCs can suppress the In Vivo and In Vitro development of glioma through interfering with PI3K/AKT signaling pathway.

MiR-449b-5p Regulates the Proliferation and Migration of Cervical Cancer Cells by Targeting Forkhead Box Protein P1 (FOXP1)

This study intends to assess miR-449b-5p’s effect on cervical cancer (CC) cells and its mechanism. After transfection of miR-449b-5p mimics, inhibitor, si-Foxp1 and negative control, CC cell viability was analyzed by MTT along with analysis of migration and invasion by transwell and scratch test, and Foxp1 protein level by Western blot. CC cells presented a significantly higher miR-449b-5p level and lower Foxp1 level in relative to normal cervical cells. miR-449b-5p mimic transfection significantly promoted CC cell viability, migration and invasion and decreased Foxp1 expression. However, all the above changes were significantly reversed after treatment with si-Foxp1. In conclusion, miR-449b-5p level is elevated in CC cells and its overexpression promotes the biological behaviors of CC cells possibly through targeting Foxp1, indicating that it might be a new target for the treatment of CC.

Host Environment Shapes S. aureus Social Behavior as Revealed by Microscopy Pattern Formation and Dynamic Aggregation Analysis

Understanding how bacteria adapt their social behavior to environmental changes is of crucial importance from both biological and clinical perspectives. Staphylococcus aureus is among the most common infecting agents in orthopedics, but its recalcitrance to the immune system and to antimicrobial treatments in the physiological microenvironment are still poorly understood. By means of optical and confocal microscopy, image pattern analysis, and mathematical modeling, we show that planktonic biofilm-like aggregates and sessile biofilm lifestyles are two co-existing and interacting phases of the same environmentally adaptive developmental process and that they exhibit substantial differences when S. aureus is grown in physiological fluids instead of common lab media. Physicochemical properties of the physiological microenvironment are proposed to be the key determinants of these differences. Besides providing a new tool for biofilm phenotypic analysis, our results suggest new insights into the social behavior of S. aureus in physiological conditions and highlight the inadequacy of commonly used lab media for both biological and clinical studies of bacterial development.

Gellan gum modified hyaluronic acid hydrogel as viscosupplement with lubrication maintenance and enzymatic resistance

Osteoarthritis (OA) is a common disease caused by damage to articular cartilage and underlying bone tissues. Early OA can be treated by intra-articular injection of viscosupplements to restore the lost...

Sodium hyaluronate-g-2-((N-(6-aminohexyl)-4-methoxyphenyl)sulfonamido)-N-hydroxyacetamide with enhanced affinity towards MMP12 catalytic domain to be used as visco-supplement with increased degradation resistance

The present paper describes the functionalization of sodium hyaluronate (NaHA) with a small molecule (2-((N-(6-aminohexyl)-4-methoxyphenyl)sulfonamido)-N-hydroxyacetamide) (MMPI) having proven inhibitory activity against membrane metalloproteins involved in inflammatory processes (i.e. MMP12). The obtained derivative (HA-MMPI) demonstrated an increased resistance to the in-vitro degradation by hyaluronidase, viscoelastic properties close to those of healthy human synovial fluid, cytocompatibility towards human chondrocytes and nanomolar affinity towards MMP 12. Thus, HA-MMPI can be considered a good candidate as viscosupplement in the treatment of knee osteoarticular disease.

Rheological Properties and Its Effect on the Lubrication Mechanism of PVP K30 and PVP 40-50 G as Artificial Synovial Fluids

The effect of polyvinylpyrrolidone (PVP) on the rheological properties of joint prostheses is still unclear, despite its good lubricity and biocompatibility. In the present work, PVP K30 and PVP 40-50 G solutions at different concentrations were analyzed for rheological and lubrication properties. The rheological properties of the samples were measured at a shear rate range of 0–1800 s−1 (advanced air bearing rheometer Bohlin Gemini 2 and Plate MCR 72/92 rheometer for PVP30 and PVP 40-50 G, respectively). It was found that both the viscosity and shear stress of the samples reduced with a shear rate increase. PVP 40-50 G/sterile water showed higher viscosity as compared to the PVP K30/sterile water sample at a lower shear rate. However, at a higher shear rate, the PVP K30 sample produced better results. Further numerical study results showed the pressure and molecular viscosity distributions. The inclusion of PVP improved the load caring capacity and hence, it is a promising lubrication additive for artificial joints.

Squeeze-film properties of synovial fluid and hyaluronate-based viscosupplements

The rheological properties of synovial fluid and hyaluronate (HA) solutions have been studied using a variety of viscometers and rheometers. These devices measure the viscosity of the fluid's resistance to shearing forces, which is useful when studying the lubrication and frictional properties of movable joints. Less commonly used is a squeeze-film fluid test, mechanistically similar to when two joint surfaces squeeze interposed fluid. In our study, we used squeeze-film tests to determine the rheological response of normal bovine synovial fluid and 10 mg/ml HA-based solutions, Hyalgan/Hyalovet, commercially available 500-700 kDa HA viscosupplements, and a 1000 kDa sodium hyaluronate (NaHy) solution. We found similar rheological responses (fluid thickness, viscosity, viscosity-pressure relationship) for all three fluids, though synovial fluid's minimum squeeze-film thickness was slightly thicker. Squeeze-film loading speed did not affect these results. Different HA concentrations and molecular weights also did not have a significant or consistent effect on the squeeze-film responses. An unexpected result for the HA-solutions was a linear increase in minimum fluid-film thickness with increasing initial fluid-film thickness. This result was attributed to faster gelling of thicker HA-solutions, which formed at a lower squeeze-film strain and higher squeeze-film strain rate compared to thinner layers. Also included is a review of the literature on viscosity measurements of synovial fluid and HA solutions.

Slippery when wet: The free surface of the articular cartilage

The free surface of the articular cartilage must withstand compressive and shearing forces, maintain a low friction coefficient and allow oxygen and metabolites to reach the underlying matrix. In many ways it is critical to the physiology of the whole tissue and its disruption always involves deep pathological alterations and loss of the joint integrity. Being very difficult to image with section-based conventional techniques, it was often described by previous research in conflicting terms or entirely overlooked. High-magnification face-on observations with high resolution scanning electron microscopy and with scanning probe microscopy revealed a very thin, delicate superficial layer rich in glycoconjugates, which may explain the very low friction coefficient of the tissue but which was very easily altered and/or dissolved in the preparation. Beneath this superficial sheet lies a thicker coat of thin, highly uniform, slightly wavy collagen fibrils lying parallel to the surface and mutually interconnected by a huge number of interfibrillar glycosaminoglycan bridges. These bridges and the collagen fibrils form an extended reticular structure able to redistribute tensile and compressive stress across a larger area of the surface and hence a greater volume of tissue.

Rheological behavior of an artificial synovial fluid - influence of temperature, shear rate and pressure

Despite the excellent clinical performance of joint replacements, wear-induced aseptic loosening is a main cause of premature implant failure. Tribological testing is usually carried out using bovine serum as an artificial synovial fluid. In order to gain new insights into the suitability to simulate human synovial fluid and provide recommendations for the conditions of tribological testing, accurate rheological measurements on the influence of temperature, shear rate and pressure on density and viscosity were performed. Thus, a temperature dependence of density and viscosity could be verified, whereas both values decreased with higher temperatures. The temperature dependency of viscosity could be approximated by an Arrhenius model. Moreover, shear-thinning characteristics could be demonstrated and fitted to a Cross model, which agreed well with investigations on human synovial fluid reported in literature. Furthermore, an anomaly of pressure dependence of viscosity was found and correlated with the behavior of water as a main constituent. At room temperature, the viscosity initially decreased to a minimum and then increased again as a function of pressure. This was no longer distinct at human body temperatures. Consequently, the present study confirms the suitability of bovine serum as a substitute synovial fluid and emphasizes the importance of realistic testing conditions in order to ensure transferability and comparability.