Hyaluronic Acid in the Third Millennium

Hyaluronic acid promotes heat-induced gelation of ginkgo seed proteins

This study aimed to investigate how varying concentrations (0.01-0.5 %, w/v) and molecular weights (50, 500, 1500 kDa) of hyaluronic acid (HA) affect the physicochemical properties of heat-induced ginkgo seed protein isolate (GSPI)-HA composite gel. Incorporating HA increased viscosity (up to 14 times) and charge (up to 23 %) of GSPI-HA aggregates, while reducing particle size (up to 31 %) and improving gel texture, particularly with high molecular weight HA. However, high concentrations (0.5 %, w/v) of HA weakened gel texture. Non-covalent bonds primarily drive the formation of a continuous gel network between HA and GSPI, resulting in small pores and enhanced hydration properties. With increasing HA molecular weight, non-covalent interactions between GSPI and HA increased, leading to improved gel thermal stability. Overall, the study suggests that manipulating the molecular weight and concentration of HA can enhance the gelling properties of GSPI, leading to the development of a diverse array of GSPI-HA composite gels with varied properties.

Hydrogel-Forming Microneedles and Applications in Interstitial Fluid Diagnostic Devices

Hydrogel-forming microneedles are constructed from or coated with polymeric, hydrophilic materials that swell upon insertion into the skin. Designed to dissolve or disintegrate postinsertion, these microneedles can deliver drugs, vaccines, or other therapeutics. Recent advancements have broadened their application scope to include the collection, transport, and extraction of dermal interstitial fluid (ISF) for medical diagnostics. This review presents a brief introduction to the characteristics of dermal ISF, methods for extraction and sampling, and critical assessment of the state-of-the-art in hydrogel-forming microneedles for ISF diagnostics. Key factors are evaluated including material composition, swelling behavior, biocompatibility, and mechanical strength necessary for effective microneedle performance and ISF collection. The review also discusses successful examples of dermal ISF assays and microneedle sensor integrations, highlighting notable achievements, identifying research opportunities, and addressing challenges with potential solutions. Despite the predominance of synthetic hydrogels in reported hydrogel-forming microneedle technologies due to their favorable swelling and gelation properties, there is a significant variety of biopolymers and composites reported in the literature. The field lacks consensus on the optimal material, composition, or fabrication methods, though emerging evidence suggests that processing and fabrication techniques are critical to the performance and utility of hydrogel-forming microneedles for ISF diagnostics.

Injectable Salecan/hyaluronic acid-based hydrogels with antibacterial, rapid self-healing, pH-responsive and controllable drug release capability for infected wound repair

Designing materials for wound dressings with superior therapeutic benefits, self-healing and injectable characteristics is important in clinical practice. Herein, a new self-healing injectable hydrogel was prepared via thermal treatment and dynamic Schiff base reaction by mixing oxidized hyaluronic acid (OHA) and hydrazided Salecan (Sal-ADH). The versatility of the wound dressing was confirmed by studying the inherent rheological properties, high swelling rate, sustained-release behavior of the drug, pH/hyaluronidase-dependent biodegradation, in vitro antimicrobial as well as in vivo wound healing performance. The presence of the antimicrobial drug polyhexamethylene biguanide (PHMB) conferred good antimicrobial properties to the Sal-ADH/OHA/PHMB (SOP) hydrogel, which could effectively prevent wound infection (the width of the inhibition circle of SOP-0.20 hydrogel was 4.97 mm, 5.93 mm for Staphylococcus aureus and Escherichia coli, respectively). The findings suggested that SOP hydrogel exhibited remarkable self-healing and injectability properties, as well as excellent hemostasis and biocompatibility. In vivo experiments indicated that the application of SOP hydrogels would obviously accelerate wound healing and attenuate the inflammatory response while increasing collagen deposition and angiogenesis. Altogether, antibacterial SOP hydrogels with moderate mechanical properties, pH-responsive release, excellent injectability, exceptional self-healing ability and anti-inflammatory effects could expand potential applications of injectable hydrogels in the biomedical field.

Electrostatic Force-Enabled Microneedle Patches that Exploit Photoredox Catalysis for Transdermal Phototherapy

Microneedle patches for topical administration of photodynamic therapy (PDT) sensitizers are attractive owing to their safety, selectivity, and noninvasiveness. However, low-efficiency photosensitizer delivery coupled with the limitations of the hypoxic tumor microenvironment remains challenging. To overcome these issues, we developed an effective microneedle patch based on intermolecular electrostatic interactions within a photosensitizer matrix containing a zinc-containing porphyrin analogue, ZnBP (w). This design improved the mechanical strength of the microneedle patch and enhanced the photosensitizer loading efficiency in aqueous environments. A key feature of the system is efficient electron transfer between ZnBP (w) and NADH upon photoirradiation. Electrostatic interactions between ZnBP (w) and NADH were hypothesized to support initial binding and subsequent photoinduced electron transfer, disrupting NADH/NAD+ homeostasis and inducing tumor cell death. The developed microneedle patch demonstrated an antiangiogenesis effect in a vascular malformation model and an antitumor effect in a melanoma mouse model after transdermal administration. This study highlights the benefits of electrostatic interactions in designing microneedle PDT patches and their clinical potential, particularly in reducing systemic phototoxicity.

Case report: Improving quality of life through hyaluronic acid-based fillers after orbital cancer treatment

Background

Myoepithelial carcinoma is a very rare yet aggressive tumor in children. Surgical intervention and local radiotherapy often lead to post-therapy complications, affecting both the aesthetic and functional quality of life in survivors. Hyaluronic acid (HA) dermal fillers offer a minimally invasive option to improve the appearance and quality of life for these patients once they are declared tumor-free.

Case presentation

We present the case of an 18-year-old girl with a history of myoepithelial carcinoma in the right upper orbit, diagnosed at the age of 8. The patient underwent surgery to remove the tumor and lacrimal gland, followed by chemotherapy and radiotherapy. A complete response to treatment was achieved, and the patient was monitored with regular clinical and radiological exams for 5 years, after which she was declared tumor-free and followed for late effects of therapy. Post-surgical radiotherapy resulted in atrophy of the upper orbital frame and functional complications. The patient exhibited upper eyelid retraction, ptosis, continuous lacrimation, and conjunctival redness. Ten years after treatment, the patient underwent dermal filler injections using Aliaxin® Essential Volume (AEV) and Aliaxin® Superior Volume (ASV) to address the aesthetic impairment of the upper right orbit. ASV was administered using a 22G x 50mm cannula on the periosteum of the superior orbital frame, entering from the outer canthus. AEV was injected with a cannula into the muscle, also entering from the outer canthus. Before treatment, the patient exhibited upper eyelid retraction, ptosis, continuous lacrimation, and conjunctival redness. Following the injections, improvements were observed in all pre-treatment symptoms. The closing ability of the upper eyelid was restored, along with superior orbital volume and symmetry. Enhanced eyelid function improved eye hydration, reduced redness in the conjunctiva, and led to better vision and overall quality of life.

Conclusion

To our knowledge, this is the first reported case of using dermal fillers to treat ocular changes resulting from cancer treatment. Injections of AEV and ASV provided both aesthetic and functional improvements.

Injectable Nanocomposite Hydrogel with Synergistic Biofilm Eradication and Enhanced Re-epithelialization for Accelerated Diabetic Wound Healing

Diabetic wounds remain a critical clinical challenge due to their harsh microenvironment, which impairs cellular function, hinders re-epithelialization and tissue remodeling, and slows healing. Injectable nanocomposite hydrogel dressings offer a promising strategy for diabetic wound repair. In this study, we developed an injectable nanocomposite hydrogel dressing (HDL@W379) using LAP@W379 nanoparticles and an injectable hyaluronic acid-based hydrogel (HA-ADH-ODEX). This dressing provided a sustained, pH-responsive release of W379 antimicrobial peptides, effectively regulating the wound microenvironment to enhance healing. The HDL@W379 hydrogel featured multifunctional properties, including mechanical stability, injectability, self-healing, biocompatibility, and tissue adhesion. In vitro, the HDL@W379 hydrogel achieved synergistic biofilm elimination and subsequent activation of basal cell migration and endothelial cell tube formation. Pathway analysis indicated that the HDL@W379 hydrogel enhances basal cell migration through MEK/ERK pathway activation. In methicillin-resistant Staphylococcus aureus (MRSA)-infected diabetic wounds, the HDL@W379 hydrogel accelerated wound healing by inhibiting bacterial proliferation and promoting re-epithelialization, regenerating the granulation tissue, enhancing collagen deposition, and facilitating angiogenesis. Overall, this strategy of biofilm elimination and basal cell activation to continuously regulate the diabetic wound microenvironment offers an innovative approach to treating chronic wounds.

Bacterial exopolysaccharides: Characteristics and antioxidant mechanism

Bacterial exopolysaccharides (EPS) are secondary metabolites of microorganisms which play important roles in adhesion, protection, biofilm formation, and as a source of nutrition. Compared with polysaccharides obtained from animal and plant species, bacterial polysaccharides have significant advantages in terms of production cost and large-scale production due to their abundant metabolic pathways and efficient polysaccharide production capacity. Most extracellular polysaccharides are water-soluble, and some are insoluble, such as bacterial cellulose. Some soluble bacterial EPS also have biological activities such as anticancer, antioxidant, antibacterial and immunomodulatory activities. These biological activities are mainly affected by the molecular weight, monosaccharide type, composition and structure of EPS. In recent years, bacterial EPS are considered as novel functional polysaccharides with important application prospects, especially in free radical scavenging and antioxidation. This review focuses on the characteristics of bacterial EPS, their ability to scavenge free radicals and their corresponding antioxidant mechanisms, and summarizes the relationship between different structures (such as monosaccharide composition, functional groups, molecular weight, etc.) and antioxidant activities. It provides a new idea for the development of more bioactive bacterial EPS antioxidants, points out a new direction for the commercial production of natural, safe and economical polysaccharide drugs and health products.

Safety and Efficacy of Hydroxypropyl Guar-Hyaluronic Acid Dual-Polymer Lubricating Eye Drops in Indian Subjects with Dry Eye: A Phase IV Study

INTRODUCTION

This work aimed to evaluate the safety and efficacy of hydroxypropyl guar-hyaluronic acid (HPG-HA) dual-polymer lubricating drops in Indian subjects with dry eye disease (DED).

METHODS

This prospective, open-label, single-arm, phase IV study was conducted in India.

INCLUSION CRITERIA

Adults (18-65 years) with an average total ocular surface staining (TOSS) score ≥ 4, best-corrected visual acuity of ≥ 20/40 in each eye, tear break-up time (TBUT) ≤ 10 s, and dry eye questionnaire (DEQ-5) score ≥ 6. Subjects received the first dose of HPG-HA eye drops on day 1 and self-administered 1-2 drops four times daily for 90 ± 5 days.

PRIMARY ENDPOINTS

Frequency and characteristics of treatment-emergent adverse events (TEAEs) throughout the study and TOSS score at day 90. Secondary/other endpoints: Dry eye symptoms score (through dry eye questionnaire [DEQ-5]) and TBUT.

RESULTS

Of 175 subjects, 36 (20.6%) had ≥ 1 TEAE, and 27 (15.4%) of this reported ≥ 1 mild drug-related TEAE (eye irritation [n = 9], eye pruritus [n = 8], blurred vision [n = 6], increased lacrimation [n = 4], ocular hyperemia [n = 3], and ocular discomfort [n = 1]). One subject discontinued due to TEAEs, and none led to drug interruptions. No serious adverse events were reported. The mean TOSS score reduced from day 1 (6.12 ± 1.69, OU [both eyes]) to day 90 (2.40 ± 1.97, OU). The mean DEQ-5 score reduced from day 1 (11.50 ± 2.27) to day 90 (5.50 ± 2.50). TBUT increased from day 1 (right eye [OD], 5.70 ± 1.94; left eye [OS], 5.70 ± 1.96) to day 90 (OD, 9.51 ± 3.08; OS, 9.63 ± 3.01).

CONCLUSIONS

HPG-HA dual-polymer eye drop was safe and effective in relieving signs and symptoms of DED over 90 days in Indian subjects.

TRIAL REGISTRATION

Clinical Trial Registry India, CTRI/2022/03/041175.

Polysaccharide-based implant drug delivery systems for precise therapy: Recent developments, and future trends

Implantable drug delivery systems offer numerous benefits, including effective drug administration at lower concentrations, fewer side effects, and improved patient compliance. Various polymers are used for fabricating implants, with biopolymers, particularly polysaccharides, being notable for their ability to modulate drug delivery characteristics. The review aims to describe the strategies employed in the development of polysaccharide-based implants and provide a comprehensive understanding of various polysaccharides such as starch, cellulose, alginate, chitosan, pullulan, carrageenan, dextran, hyaluronic acid, agar, pectin, and gellan gum in the fabrication of implant for targeted therapy. The review explores the biomedical applications of polysaccharide-based implantable devices, highlighting recent advancements in the development of these systems. Detailed discussions cover implants used in the oral cavity, nasal cavity, bone, ocular applications, and antiviral therapy. Additionally, regulatory considerations concerning implantable drug delivery are emphasized. The findings of the study show that polysaccharides can be used for the development of implants for drug delivery applications.

Ion-Mediated Cross-Linking of Hyaluronic Acid into Hydrogels without Chemical Modification

Hyaluronic acid (HA) is a biomedically relevant polymer widely explored as a component of hydrogels. The prevailing approaches for cross-linking HA into hydrogels require chemically modifying the polymer, which can increase processing steps and complicate biocompatibility. Herein, we demonstrate an alternative approach to cross-link HA that eliminates the need for chemical modifications by leveraging the interactions between metal cations and the negatively charged, ionizable functional groups on HA. We demonstrate that HA can be cross-linked with the bivalent metal cations Mn(II), Fe(II), Co(II), Ni(II), Cu(II), Zn(II), Pd(II), and notably Mg(II). Using Mg(II) as a model, we show that ion-HA hydrogel rheological properties can be tuned by altering the HA molecular weight and concentrations of ions, NaOH, and HA. Mg(II)-HA hydrogels showed the potential for self-healing and stimulus response. Our findings lay the groundwork for developing a new class of HA-based hydrogels for use in biomedical applications and beyond.

Range of Flexion Improvement in Degenerative Stages of the First Metatarsophalangeal Joint (Hallux rigidus) with Cross-Linked Hyaluronic Acid: A Cadaveric Study

BACKGROUND

Viscosupplementation consists of intraarticular hyaluronic acid injections applied to treat pain and improve joint mobility. The objective of the study was to analyze the improvement of the range of mobility of the first metatarsophalangeal joint with a single dose of cross-linked hyaluronic acid.

METHODS

Ten fresh frozen specimens of feet sectioned below the knee were selected. Before and after the infiltration procedure, the range of flexion was calculated for all specimen's metatarsophalangeal joints. To detect complications due to the procedure, five feet were dissected and five were sectioned with a diamond saw.

RESULTS

The range of the first metatarsophalangeal joint flexion differences between the preoperative and the postoperative period was as follows: (1) 47° (range, 37-51.5) to 58° (range, 49-69.5) degrees of loaded dorsiflexion (p > 0.006); (2) 41° (range, 40-51.5) to 58° (range, 52.5-66.5) degrees of unloaded dorsiflexion (p > 0.009); and (3) 14° (range, 10.5-24.25) to 16° (range, 14.25-28.5) degrees of unloaded plantarflexion (p > 0.083). No injuries of anatomical structures were observed either by anatomical dissection or in the anatomical sections.

CONCLUSIONS

The results obtained in this viscosupplementation study demonstrate the improvement of the range of mobility of the first metatarsophalangeal joint without evidence of extravasation and lesions of the periarticular anatomical structures.

In Vivo and Ex Vivo Evaluation of a Novel Method for Topical Delivery of Macromolecules Through the Stratum Corneum for Cosmetic Applications

BACKGROUND

Effective topical delivery of large/charged molecules into skin has always been challenging. Chemical penetration enhancers, organic substances that increase permeability of skin, have been in use for decades with variable success. One application of enhancers involves multilamellar vesicles composed of submicron emulsion droplets and micelles surrounded by concentric phospholipid bilayers.

OBJECTIVE

This report introduces the next generation of multilamellar vesicles, termed Tiered-Release Vesicles (TRVs), as a new platform for topical delivery of macromolecules such as peptides and hyaluronic acid (HA).

METHODS

Fluorescently labeled peptides and HA, diffusion cells, and confocal microscopy were employed to assess the penetration efficiency of macromolecules in TRV formulations using an ex vivo human skin model. Two in vivo studies utilized punch biopsies followed by histochemical staining and analysis.

RESULTS

Based on fluorescent intensity, TRV formulations delivered a large peptide more completely (2-5 fold) into ex vivo human skin than optimized liposomes. The penetration of 2 HA species in TRV formulations was 3- to 13-fold higher than with a simple gel vehicle. In the case studies, reduction of solar elastosis was observed from a topical TRV formulation.

CONCLUSION

Topical delivery of large peptides and HA into human skin using TRV technology has been demonstrated.

Hydrogel Applications in the Diagnosis and Treatment of Glioblastoma

Glioblastoma multiforme (GBM), a common malignant neurological tumor, has boundaries indistinguishable from those of normal tissue, making complete surgical removal ineffective. The blood-brain barrier (BBB) further impedes the efficacy of radiotherapy and chemotherapy, leading to suboptimal treatment outcomes and a heightened probability of recurrence. Hydrogels offer multiple advantages for GBM diagnosis and treatment, including overcoming the BBB for improved drug delivery, controlled drug release for long-term efficacy, and enhanced relaxation properties of magnetic resonance imaging (MRI) contrast agents. Hydrogels, with their excellent biocompatibility and customizability, can mimic the in vivo microenvironment, support tumor cell culture, enable drug screening, and facilitate the study of tumor invasion and metastasis. This paper reviews the classification of hydrogels and recent research for the diagnosis and treatment of GBM, including their applications as cell culture platforms and drugs including imaging contrast agents carriers. The mechanisms of drug release from hydrogels and methods to monitor the activity of hydrogel-loaded drugs are also discussed. This review is intended to facilitate a more comprehensive understanding of the current state of GBM research. It offers insights into the design of integrated hydrogel-based GBM diagnosis and treatment with the objective of achieving the desired therapeutic effect and improving the prognosis of GBM.

Poly(2-hydroxyethyl methacrylate-co-methacrylated hyaluronan-β-cyclodextrin) hydrogel: A potential contact lens material with high hydrophilicity, good mechanical properties and sustained drug delivery

A novel poly(2-hydroxyethyl methacrylate-co-methacrylated hyaluronan-β-cyclodextrin) [p(HEMA-co-mHA-β-CD)] hydrogel was developed as a potential contact lens for ophthalmic disease. The hydrogel was synthesized from the copolymerization of 2-hydroxyethyl methacrylate (HEMA) monomer and mHA-β-CD as a hydrophilic macromolecular crosslinker. By adjusting the methacrylate substitution degree in hyaluronan (20-29 %) and the mHA-β-CD content (5-11 %), transparent p(HEMA-co-mHA-β-CD) hydrogels were achieved. p(HEMA-co-m20HA-β-CD) hydrogels exhibited an enhanced tensile modulus (from 0.35 to 0.88 MPa) with a decreased elongation at break (from 255 % to 108 %), meanwhile they showed increased hydrophilicity with a decreased water contact angle (from 83.4° to 48.6°) and an increased equilibrium water content (from 38.2 % to 46.4 %). Increasing the mHA-β-CD content resulted in a higher encapsulation and cumulative release of hydrophilic levofloxacin hydrochloride or hydrophobic puerarin, due to the improved hydrophilicity and the formation of β-CD/drug inclusion complexes. Compared with pHEMA hydrogel, p(HEMA-co-m20HA-β-CD) hydrogels better inhibited the deposition of lysozyme and bovine serum albumin, and the bacterial adhesion against S. aureus and E. coli. The hydrogels were stable at physiological conditions and non-toxic to immortalized human keratinocytes. With good mechanical properties, tear protein deposition resistance, antibacterial activity, and sustained drug delivery capabilities, p(HEMA-co-m20HA-β-CD) hydrogels were identified as a promising contact lens material for eye diseases.

Methods for determining the structure and physicochemical properties of hyaluronic acid and its derivatives: A review

Hyaluronic acid (HA) is a linear high molecular weight polymer ubiquitously distributed in humans and animals. The D-glucuronic acid and N-acetyl-D-glucosamine repeating disaccharide backbone along with variable secondary and tertiary structures endows HA with unique rheological characteristics as well as diverse biological functions such as maintaining tissue homeostasis and mediating cell functions. Due to its excellent biocompatibility, biodegradability, viscoelasticity and moisturizing properties, natural HA and its chemically modified derivatives are widely used in medical, pharmaceutical, food and cosmetic industries. For broad application purposes, abundant HA-based biochemical products have been developed, including the methodologies for characterization of these products. This review provides an overview focusing on the methods used for determining HA structure as well as the strategies for constructing its derivatives. Apart from the analytical approaches for defining the physicochemical properties of HA (e.g., molecular weight, rheology and swelling capacity), quantitative methods for assessing the purity of HA-based materials are discussed. In addition, the biological functions and potential applications of HA and its derivatives are briefly embarked and perspectives in methodological development are discussed.

Carbohydrate-binding module could integrate with ELISA and serve the simple and specific quantification of hyaluronic acid

Quantification is essential in the research and development of polysaccharides. However, achieving simplicity and specificity in polysaccharide quantification remains a challenging task. Enzyme-linked immunosorbent assay (ELISA) based on antibodies provides a straightforward and specific quantification strategy. Nevertheless, acquiring antibodies for polysaccharides is complicated. Carbohydrate-binding modules (CBMs), which can be efficiently obtained, exhibit the capability to specifically recognize and bind carbohydrates. In this study, we verified the feasibility of a CBM-based ELISA for the quantification of hyaluronic acid (HA) by replacing an antibody with a CBM. The CBM-based ELISA, which employed a HA-specific CBM, exhibited a linear detection range spanning from 10 to 100 μg/mL. Both intra-assay and inter-assay coefficients of variation remained below 15 % and recoveries ranged from 96.26 % to 98.22 %, indicating favorable precision and accuracy. The method exhibited specificity exclusively to HA, suggesting its reliance on CBM binding specificity. The effectiveness of the method in analyzing commercial products was confirmed. Additionally, a comparison with the carbazole assay revealed a highly significant correlation (r = 0.994). By integrating CBMs with ELISA, the study presented a novel and easily implementable solution for simple and specific quantification of HA while also highlighting the potential of this strategy to advance polysaccharide detection.

Design and preparation of hydrogel microspheres for spinal cord injury repair

A severe disorder known as spinal cord damage causes both motor and sensory impairment in the limbs, significantly reducing the patients' quality of life. After a spinal cord injury, functional recovery and therapy have emerged as critical concerns. Hydrogel microspheres have garnered a lot of interest lately because of their enormous promise in the field of spinal cord injury rehabilitation. The material classification of hydrogel microspheres (natural and synthetic macromolecule polymers) and their synthesis methods are examined in this work. This work also covers the introduction of several kinds of hydrogel microspheres and their use as carriers in the realm of treating spinal cord injuries. Lastly, the study reviews the future prospects for hydrogel microspheres and highlights their limitations and problems. This paper can offer feasible ideas for researchers to advance the application of hydrogel microspheres in the field of spinal cord injury.

Network-Based Bioinformatics Highlights Broad Importance of Human Milk Hyaluronan

Human milk (HM) is rich in bioactive factors promoting postnatal small intestinal development and maturation of the microbiome. HM is also protective against necrotizing enterocolitis (NEC), a devastating inflammatory condition predominantly affecting preterm infants. The HM glycosaminoglycan, hyaluronan (HA), is present at high levels in colostrum and early milk. Our group has demonstrated that HA with a molecular weight of 35 kDa (HA35) promotes maturation of the murine neonatal intestine and protects against two distinct models of NEC. However, the molecular mechanisms underpinning HA35-induced changes in the developing ileum are unclear. CD-1 mouse pups were treated with HA35 or vehicle control daily, from P7 to P14, and we used network and functional analyses of bulk RNA-seq ileal transcriptomes to further characterize molecular mechanisms through which HA35 likely influences intestinal maturation. HA35-treated pups separated well by principal component analysis, and cell deconvolution revealed increases in stromal, Paneth, and mature enterocyte and progenitor cells in HA35-treated pups. Gene set enrichment and pathway analyses demonstrated upregulation in key processes related to antioxidant and growth pathways, such as nuclear factor erythroid 2-related factor-mediated oxidative stress response, hypoxia inducible factor-1 alpha, mechanistic target of rapamycin, and downregulation of apoptotic signaling. Collectively, pro-growth and differentiation signals induced by HA35 may present novel mechanisms by which this HM bioactive factor may protect against NEC.

Advances in Adhesive Materials for Oral and Maxillofacial Soft Tissue Diseases

Oral diseases represent a prevalent global health burden, profoundly affecting patients' quality of life. Given the involvement of oral mucosa and muscles in diverse physiological functions, coupled with clinical aesthetics considerations, repairing oral and maxillofacial soft tissue defects poses a formidable challenge. Wet-adhesive materials are regarded as promising oral repair materials due to their unique advantages in easily overcoming physical and biological barriers in the oral cavity. This review first introduces the intricate wet-state environment prevalent in the oral cavity, meticulously explaining the fundamental physical and chemical adhesion mechanisms that underpin adhesive materials. It then comprehensively summarizes the diverse types of adhesives utilized in stomatology, encompassing polysaccharide, protein, and synthetic polymer adhesive materials. The review further evaluates the latest research advancements in utilizing these materials to treat various oral and maxillofacial soft tissue diseases, including oral mucosal diseases, periodontitis, peri-implantitis, oral and maxillofacial skin defects, and maxillofacial tumors. Finally, it also highlights the promising future prospects and pivotal challenges related to stomatology application of multifunctional adhesive materials.

Patent Overview of Innovative Hyaluronic Acid-Based Hydrogel Biosensors

Hyaluronic acid-based hydrogels are emerging as highly versatile materials for cost-effective biosensors, capable of sensitive chemical and biological detection. These hydrogels, functionalized with specific groups, exhibit sensitivity modulated by factors such as temperature, pH, and analyte concentration, allowing for a broad spectrum of applications. This study presents a patent-centered overview of recent advancements in hyaluronic acid hydrogel biosensors from 2003 to 2023. A total of 50 patent documents-including 41 patent applications and 9 granted patents-reveal a growing interest, primarily driven by United States-based institutions, which account for approximately 54% of all filings. This trend reflects the strong collaboration between universities, industry, and foundations in pushing this technology forward. Most patented technologies focus on biosensors for in vivo blood analysis, measuring critical parameters such as gas concentration and pH, with particular emphasis on glucose monitoring via tissue impedance using enzyme-immobilized oxidase electrodes. Additionally, the 9 granted patents collectively showcase key innovations, highlighting applications from continuous glucose monitors to implantable vascular devices and sweat analyte detection systems. These patents underscore the adaptability and biocompatibility of hyaluronic acid hydrogels, reinforcing their role in enhancing biosensor performance for real-time health monitoring. In summary, this overview highlights the importance of patent analysis in tracking and directing research and development, helping to clarify the field's evolution and identify innovation gaps for hyaluronic acid-based hydrogel biosensors.

Crosslinking by Click Chemistry of Hyaluronan Graft Copolymers Involving Resorcinol-Based Cinnamate Derivatives Leading to Gel-like Materials

The well-known "click chemistry" reaction copper(I)-catalyzed azide-alkyne 1,3-dipolar cycloaddition (CuAAC) was used to transform under very mild conditions hyaluronan-based graft copolymers HA(270)-FA-Pg into the crosslinked derivatives HA(270)-FA-TEGERA-CL and HA(270)-FA-HEGERA-CL. In particular, medium molecular weight (i.e., 270 kDa) hyaluronic acid (HA) grafted at various extents (i.e., 10, 20, and 40%) with fluorogenic ferulic acid (FA) residue bonding propargyl groups were used in the CuAAC reaction with novel azido-terminated crosslinking agents Tri(Ethylene Glycol) Ethyl Resorcinol Acrylate (TEGERA) and Hexa(Ethylene Glycol) Ethyl Resorcinol Acrylate (HEGERA). The resulting HA(270)-FA-TEGERA-CL and HA(270)-FA-HEGERA-CL materials were characterized from the point of view of their structure by performing NMR studies. Moreover, the swelling behavior and rheological features were assessed employing TGA and DSC analysis to evaluate the potential gel-like properties of the resulting crosslinked materials. Despite the 3D crosslinked structure, HA(270)-FA-TEGERA-CL and HA(270)-FA-HEGERA-CL frameworks showed adequate swelling performance, the required shear thinning behavior, and coefficient of friction values close to those of the main commercial HA solutions used as viscosupplements (i.e., 0.20 at 10 mm/s). Furthermore, the presence of a crosslinked structure guaranteed a longer residence time. Indeed, HA(270)-FA-TEGERA-CL-40 and HA(270)-FA-HEGERA-CL-40 after 48 h showed a four times greater enzymatic resistance than the commercial viscosupplements. Based on the promising obtained results, the crosslinked materials are proposed for their potential applicability as novel viscosupplements.

A functional dual responsive CMC/OHA/SA/TOB hydrogel as wound dressing to enhance wound healing

Within the clinical realm, the complexities of wound healing have consistently presented formidable challenges. Recent advancements, notably in hydrogel technologies, have broadened the therapeutic spectrum. This study focuses on investigating a novel dual responsive composite hydrogel for wound healing. This hydrogel is ingeniously designed to maintain an optimal moist environment, expedite healing, and combat bacterial infection during wound recovery. This study combining carboxymethyl chitosan (CMC), oxidized hyaluronic acid (OHA), and sodium alginate (SA), in addition, tobramycin (TOB) was incorporated to create a CMC/OHA/SA/TOB hydrogel. Hydrogel cross-linking was verified by infrared spectroscopy, and the microstructure was examined with scanning electron microscopy. We explored its swelling and degradation behaviors in different pH environments. The drug release profile and biocompatibility was evaluated via cytotoxicity and hemolysis assays. The antibacterial efficacy of hydrogel was tested in both solid and liquid media. Additionally, the wound models in Sprague-Dawley (SD) rat was employed to investigate the hydrogel's wound healing capabilities in vivo. Results showed that CMCOHA/SA/TOB hydrogel was effectively cross-linked with a network structure. The hydrogel exhibited pronounced responsiveness in its swelling and degradation characteristics, which was significantly influenced by different levels of pH. In vitro results demonstrated that the CMC/OHA/SA/TOB hydrogel exhibits limited cytotoxicity and hemolysis, coupled with a drug release profile of dual responsive characteristics. Antibacterial activity of the hydrogel against Staphylococcus aureus, Pseudomonas aeruginosa, and Escherichia coli was confirmed. Furthermore, in vivo experiments underscored the hydrogel's proficiency in promoting wound healing, highlighting its potential for clinical applications. The CMC/OHA/SA/TOB hydrogel not only fosters a moist environment essential for wound healing and enhances structural stability, but it also exhibits functional dual responsive capabilities in swelling and degradation. These distinctive abilities enable the precise release of TOB, thereby optimizing wound healing.

Therapeutic potential of hyaluronic acid hydrogel combined with bone marrow stem cells-conditioned medium on arthritic rats' TMJs

Conditioned media (CM) is derived from mesenchymal stem cells (MSC) culture and contains biologically active components. CM is easy to handle and reduces inflammation while repairing injured joints. Combination therapy of the CM with cross-linked hyaluronic acid (HA) could ameliorate the beneficial effect of HA in treating degenerative changes of articulating surfaces associated with arthritic rats' temporomandibular joints (TMJs). This study aimed to evaluate the therapeutic potential of HA hydrogel combined with bone marrow stem cells-conditioned medium (BMSCs-CM) on the articulating surfaces of TMJs associated with complete Freund's adjuvant (CFA)-induced arthritis. Fifty female Sprague-Dawley rats were divided randomly into five equal groups. Rats of group I served as the negative controls and received intra-articular (IA) injections of 50 µl saline solution, whereas rats of group II were subjected to twice IA injections of 50 µg CFA in 50 µl; on day 1 of the experiment to induce persistent inflammation and on day 14 to induce arthritis. Rats of group III and IV were handled as group II and instead, they received an IA injection of 50 µl HA hydrogel and 50 µl of BMSCs-CM, respectively. Rats of group V were given combined IA injections of 50 µl HA hydrogel and BMSCs-CM. All rats were euthanized after the 4th week of inducing arthritis. The joints were processed for sectioning and histological staining using hematoxylin and eosin, Masson's trichrome and toluidine blue special staining, and immunohistochemical staining for nuclear factor-kappa B (NF-κB). SPSS software was used to analyze the data and one-way analysis of variance followed by post-hoc Tukey statistical tests were used to test the statistical significance at 0.05 for alpha and 0.2 for beta. In the pooled BMSC-CM, 197.14 pg/ml of platelet-derived growth factor and 112.22 pg/ml of interleukin-10 were detected. Compared to TMJs of groups III and IV, TMJs of group V showed significant improvements (P = 0.001) in all parameters tested as the disc thickness was decreased (331.79 ± 0.73), the fibrocartilaginous layer was broadened (0.96 ± 0.04), and the amount of the trabecular bone was distinctive (19.35 ± 1.07). The mean values for the collagen amount were increased (12.29 ± 1.38) whereas the mean values for the NF-κB expression were decreased (0.62 ± 0.15). Combination therapy of HA hydrogel and BMSCs-CM is better than using HA hydrogel or BMSCs-CM, separately to repair degenerative changes in rats' TMJs associated with CFA-induced arthritis.

New Findings in Prominent Lower Eyelid Fat Pads Possibly Contributing to Their Etiology: Two Prospective Studies

Background

Little is known about the actual composition of prominent orbital fat pads. It was incidentally noted that hyaluronidase injections in prominent lower eyelid fat pads attenuated them, suggesting prevalence of hyaluronic acid (HA), and raising questions regarding their etiology. This led to 2 institutional review board studies: The first quantified HA concentration in orbital fat pads and assessed possible correlation between HA levels and degree of lower eyelid puffiness. The second determined if regular hyaluronidase injections in prominent lower eyelid fat pads impacted their size to uncover a possible role of intrinsic HA and its hydrophilic properties in their etiology.

Methods

Lower eyelid orbital fat harvested from 20 filler-naive blepharoplasty patients underwent enzyme linked immunosorbent assay for HA quantification. A separate group of 14 filler-naive patients requesting nonsurgical treatment of lower eyelid puffiness were treated with a series of hyaluronidase injections.

Results

HA levels in prominent eyelid orbital fat pads averaged 39.3 µg/mg of the dry weight, higher than reported in other solid human tissues. Orbital fat HA levels correlated with the degree of clinical puffiness. Hyaluronidase attenuated lower eyelid puffiness in 78.6% of patients. The extent and duration of improvement varied between responders but increased with repetitive injections.

Conclusions

Prominent orbital fat pads have a higher HA concentration than reported in other solid human tissues. HA hydrophilic properties likely contribute to fat pad edema manifesting as puffiness. Attenuation of prominent lower eyelid fat pads following hyaluronidase injections further implicates intrinsic HA in the etiology of prominent eyelid fat pads.

Strontium ranelate-loaded human hair keratin-hyaluronic acid hydrogel accelerates wound repair with anti-inflammatory and antioxidant properties

Inflammation and reactive oxygen species (ROS) production often accompany the repair of severe skin wounds, and the management of wounds has always been a clinical challenge, so the design of a hydrogel wound dressing with antioxidant and anti-inflammatory properties is of significant importance. This work incorporated strontium ranelate (SrR) into the keratin/hyaluronic acid (K/HA) hydrogel, which could scavenge ROS and reduce inflammation. The optimized hydrogel exhibits large pore size (217.2 μm), high porosity (57 %), high swelling rate (1759.52 %), and an elastic modulus (3.41 kPa). In the in vitro study, incorporating SrR into hydrogel effectively inhibited oxidative damage in mouse fibroblasts (L929) and improved anti-inflammatory effect in RAW264.7 cells stimulated by lipopolysaccharide. The in vivo study showed that, compared with the control group, the expression of ROS, IL-6 and TNF - α in the K/HA/0.5 mM SrR group were significantly reduced to 31.6 %, 39.7 % and 61.1 %, respectively. The in vivo evaluation in a full-thickness wound defect model demonstrated that K/HA/0.5 mM SrR hydrogel promotes wound healing by attenuating ROS levels, reducing inflammation, and promoting microangiogenesis. In summary, the excellent ROS scavenging and anti-inflammatory properties of SrR make the K/HA/SrR hydrogel a promising and effective strategy for wound healing.

Excipient-free nanotransformation of hydrophilic macromolecules using aqueous counter collision for enhanced bioavailability

The demand for sustainable, eco-friendly biopolymer transdermal delivery systems has increased owing to growing environmental awareness. In this study, we used aqueous counter collision (ACC), a nontoxic nanotransformation method, to convert high- and ultrahigh-molecular-weight hydrophilic macromolecules into their corresponding nanoparticles (NPs). Hyaluronic acid (HA) and crosslinked HA (CLHA) were chosen as the model compounds. Their NPs exhibited particle sizes in the range of 10-100 nm and negative zeta potentials (-20 to -30 mV). Transmission electron microscopy revealed that the NPs were nearly spherical with smooth surfaces. Fourier-transform infrared and proton nuclear magnetic resonance spectroscopy and agarose gel electrophoresis confirmed that the structures and molecular weights of HA and CLHA remained unaltered after ACC. However, the storage and loss moduli of HANPs and CLHANPs were significantly lower than those of HA and CLHA, respectively. Furthermore, the permeation of HANPs and CLHANPs in reconstructed human skin and human cadaver skin was visualized and quantified. HANPs and CLHANPs penetrated deeper into the skin, whereas HA and CLHA were mainly found in the stratum corneum. The total skin absorption (permeation and deposition) of HANPs and CLHANPs was approximately 2.952 and 5.572 times those of HA and CLHA, respectively. Furthermore, HANPs and CLHANPs exhibited resistance to enzyme and free radical degradation. Our findings reveal ACC as a promising, sustainable hydrophilic macromolecule delivery system compared with the chemical hydrolysis of HA.

Tunnel technique and subepithelial connective tissue graft, with or without cross-linked hyaluronic acid, in the treatment of multiple gingival recessions: 12-month outcomes of a randomized clinical trial

BACKGROUND

This study evaluated the influence of the adjunctive application of a cross-linked hyaluronic acid (HA) in the treatment of multiple gingival recessions, using a modified coronally advanced tunnel (MCAT) technique and subepithelial connective tissue graft (SCTG) (MCAT+SCTG±HA).

METHODS

A randomized, split-mouth, double-masked comparison of the effects of MCAT+HA+SCTG (test) versus MCAT+SCTG (control) in the treatment of multiple, contralateral gingival recessions with clinical, esthetic, and histological evaluations was carried out. All samples were stained with hematoxylin and eosin, Masson's trichrome, Verhoeff-Van Gieson, and Alcian blue stain for semiquantitative evaluation. The primary outcome variable was 12-month mean root coverage (MRC).

RESULTS

Twenty-four patients with 266 gingival recessions received both control and test treatments (133 recessions per group). 12-month MRC of the MCAT+HA+SCTG group was not significantly different from the MCAT+SCTG group with 84.32%±  34.46% and 85.71%±  36.43%, respectively (p = 0.991). Both treatment modes produced favorable esthetic outcomes (root coverage esthetic score [RES] 9.51±  1.01 tests vs. 9.26±  1.10 controls, p = 0.7292). However, the application of HA improved soft tissue texture (p = 0.0091). The remaining end point measures did not differ significantly between groups. Histological evaluation showed a significantly greater number of elastic fibers and a moderate increase in collagen fiber density in biopsy samples taken from the test sides when compared to the control sides (p = 0.0419 and p = 0.300, respectively).

CONCLUSIONS

MCAT+SCTG is an effective procedure in the treatment of multiple recession Type 1 (RT1) and RT2 recessions. There were no statistically significant differences in evaluated clinical treatment outcomes in the MCAT+HA+SCTG group compared to the MCAT+SCTG group within a period of 12 months. The application of HA increased collagen and elastic fiber density.

Hyaluronan size and concentration: Effect on key biophysical and biochemical features

The effect of hyaluronan (HA) molecular weight (MW) and concentration (c) on key features of HA-formulations was systematically studied, in vitro, exploring the widest range/number of MW/c to date. Nine pharmaceutical grade HA samples (60-2500 kDa) were hydrodynamically characterized using Size Exclusion Chromatography-Triple Detector Array (SEC-TDA) also providing conformational data. HAs aqueous solutions (thirteen concentrations in the range 0.1-32 g/L) were tested for dynamic viscosity (η). η dependence on MW/c was analyzed providing mathematical correlations not only for the specific zero-shear viscosity, but also for the critical shear rate and the shear-thinning-extent. Besides confirming the dilute and semi-dilute c-regimes for the HAs, a third concentrated regime was evidenced for the 220-2500 kDa samples. Data on how MW affects the dependence of viscosity parameters on c and vice-versa were provided. The 60-90 kDa HAs proved stable to thermal sterilization and enzymatically catalyzed hydrolysis, while the 220-2500 kDa samples depolymerized to an extent depending, beyond concentration, on MW. HA size did not significantly affect fibroblasts behavior: under the conditions here tested, the HAs similarly sustained human dermal fibroblasts growth and wound healing also showing comparable effect on collagen-I, elastin and hyaluronan synthase-1 expression. Overall, results valuably contribute to the understanding of the HA MW/c impact on the rheological, stability and biochemical features of the final formulations, also providing mathematical correlations allowing for their optimization towards specific performance.

Topical hADSCs-HA Gel Promotes Skin Regeneration and Angiogenesis in Pressure Ulcers by Paracrine Activating PPARβ/δ Pathway

Background

Pressure ulcer is common in the bedridden elderly with high mortality and lack of effective treatment. In this study, human-adipose-derived-stem-cells-hyaluronic acid gel (hADSCs-HA gel) was developed and applied topically to treat pressure ulcers, of which efficacy and paracrine mechanisms were investigated through in vivo and in vitro experiments.

Methods

Pressure ulcers were established on the backs of C57BL/6 mice and treated topically with hADSCs-HA gel, hADSCs, hyaluronic acid, and normal saline respectively. The rate of wound closure was observed continuously during the following 14 days and the wound samples were obtained for Western blot, histopathology, immunohistochemistry, and proteomic analysis. Human dermal fibroblasts (HDFs) and human venous endothelial cells (HUVECs) under normal or hypoxic conditions were treated with conditioned medium of human ADSCs (ADSC-CM), then CCK-8, scratch test, tube formation, and Western blot were conducted to evaluate the paracrine effects of hADSCs and to explore the underlying mechanism.

Results

The in vivo data demonstrated that hADSCs-HA gel significantly accelerated the healing of pressure ulcers by enhancing collagen expression, angiogenesis, and skin proliferation. The in vitro data revealed that hADSCs strengthened the proliferation and wound healing capabilities of HDFs and HUVECs, meanwhile promoted collagen secretion and tube formation through paracrine mode. ADSC-CM was also proved to exert protective effects on hypoxic HDFs and HUVECs. Besides, the results of proteomic analysis and Western blot elucidated that lipid metabolism and PPARβ/δ pathway mediated the healing effect of hADSCs-HA gel on pressure ulcers.

Conclusion

Our research showed that topical application of hADSCs-HA gel played an important role in dermal regeneration and angiogenesis. Therefore, hADSCs-HA gel exhibited the potential as a novel stem-cell-based therapeutic strategy of treating pressure ulcers in clinical practices.

The Pathogenetic Role of RANK/RANKL/OPG Signaling in Osteoarthritis and Related Targeted Therapies

Background: Osteoarthritis (OA) is the most common degenerative joint disease and affects millions of people worldwide, particularly the elderly population. The pathophysiology of OA is complex and involves multiple factors. Methods: Several studies have emphasized the crucial role of inflammation in this process. The receptor activator of NF-κB ligand (RANKL), the receptor activator of NF-κB (RANK), and osteoprotegerin (OPG) trigger a signaling cascade that leads to the excessive production of RANKL in the serum. Conclusions: The aim of this narrative review is (i) to assess the role of the RANK/RANKL/OPG signaling pathway in the context of OA progression, focusing especially on the physiopathology and on all the mechanisms leading to the activation of the inflammatory cascade, and (ii) to evaluate all the potential therapeutic strategies currently available that restore balance to bone formation and resorption, reducing structural abnormalities and relieving pain in patients with OA.

Homologous cell membrane-based hydrogel creates spatiotemporal niches to improve outcomes of dysregulated chronic wound healing

The (M2M + TGF-β)@HAMA hydrogel dressing improves the outcomes of dysregulated chronic wound healing by protecting the open wound from repeated bacterial infections, reprogramming endogenous monocytes and M1 macrophages into an M2-phenotype, as well as enhancing fibroblastic proliferation and migration for matrix remodeling and granulation tissue formation.Image 1.

Antibacterial properties of photo-crosslinked chitosan/methacrylated hyaluronic acid nanoparticles loaded with bacitracin

The current treatments for wounds often fail to induce adequate healing, leaving wounds vulnerable to persistent infections and development of drug-resistant microbial biofilms. New natural-derived nanoparticles were studied to impair bacteria colonization and hinder the formation of biofilms in wounds. The nanoparticles were fabricated through polyelectrolyte complexation of chitosan (CS, polycation) and hyaluronic acid (HA, polyanion). UV-induced photo-crosslinking was used to enhance the stability of the nanoparticles. To achieve this, HA was methacrylated (HAMA, degree of modification of 20 %). Photo-crosslinked nanoparticles obtained from HAMA and CS had a diameter of 478 nm and a more homogeneous size distribution than nanoparticles assembled solely through complexation (742 nm). The nanoparticles were loaded with the antimicrobial agent bacitracin (BC), resulting in nanoparticles with a diameter of 332 nm. The encapsulation of BC was highly efficient (97 %). The BC-loaded nanoparticles showed significant antibacterial activity against gram-positive bacteria Staphylococcus aureus, Methicillin-resistant S. aureus and S. epidermidis. Photo-crosslinked HAMA/CS nanoparticles loaded with BC demonstrated inhibition of biofilm formation and a positive effect on the proliferation of mammalian cells (L929). These crosslinked nanoparticles have potential for the long-term treatment of wounds and controlled antibiotic delivery at the location of a lesion.

Hydrogels with Antioxidant Microparticles Systems Based on Hyaluronic Acid for Regenerative Wound Healing

This research focuses on the synthesis of hydrogels exhibiting enhanced antioxidant properties derived from hyaluronic acid (HA) and poly(ethylene brassylate-co-squaric acid) (PEBSA), a copolymacrolactone that have the ability to be used in drug delivery applications. Quercetin (Q), a bioflavonoid with strong antioxidant properties, is employed as a bioactive compound. The biomolecule is encapsulated in the polymeric network using different entrapment techniques, including the initial formation of a complex between PEBSA and Q, which is demonstrated through the dynamic light scattering technique. Fourier transform infrared spectroscopy (FT-IR) and rheological studies confirm the formation of the hydrogels, revealing the occurrence of physical interactions between the synthetic polymer and the polysaccharide. Moreover, the hydrogels demonstrate biocompatible properties after direct contact with the HDFa cell line and antioxidant properties, as revealed by DPPH tests.

Application of the Thermal Analysis of Frozen Aqueous Solutions to Assess the Miscibility of Hyaluronic Acid and Polymers Used for Dissolving Microneedles

Background: The combination of multiple polymers is anticipated to serve as a means to diversify the physical properties and functionalities of dissolving microneedles. The mixing state of components is considered as a crucial factor in determining their suitability. Objectives: The purpose of this study was to elucidate whether thermal analysis of frozen aqueous solutions can appropriately predict the miscibility of hyaluronic acid (HA) and other polymers used for dissolving microneedles prepared by a micromolding method. Methods: Aliquots of aqueous polymer solutions were applied for thermal analysis by heating the samples from -70 °C at 5 °C/min to obtain the transition temperature of amorphous polymers and/or the crystallization/melting peaks of polymers (e.g., polyethylene glycol (PEG)). Films and dissolving microneedles were prepared by air-drying of the aqueous polymer solutions to assess the polymer miscibility in the solids. Results: The frozen aqueous single-solute HA solutions exhibited a clear Tg' (the glass transition temperature of maximally freeze-concentrated solutes) at approximately -20 °C. The combination of HA with several polymers (e.g., dextran FP40, DEAE-dextran, dextran sulfate, and gelatin) showed a single Tg' transition at temperatures that shifted according to their mass ratio, which strongly suggested the mixing of the freeze-concentrated solutes. By contrast, the observation of two Tg' transitions in a scan strongly suggested the separation of HA and polyvinylpyrrolidone (PVP) or HA and polyacrylic acid (PAA) into different freeze-concentrated phases, each of which was rich in an amorphous polymer. The combination of HA and PEG exhibited the individual physical changes of the polymers. The polymer combinations that showed phase separation in the frozen solution formed opaque films and microneedles upon their preparation by air-drying. Coacervation occurring in certain polymer combinations was also suggested as a factor contributing to the formation of cloudy films. Conclusions: Freezing aqueous polymer solutions creates a highly concentrated polymer environment that mimics the matrix of dissolving microneedles prepared through air drying. This study demonstrated that thermal analysis of the frozen solution offers insights into the mixing state of condensed polymers, which can be useful for predicting the physical properties of microneedles.

Manufacturing Process of Hyaluronic Acid Dermal Fillers

Hyaluronic acid (HA) fillers are extensively utilized in aesthetic medicine due to their biocompatibility, reversibility, and effectiveness in enhancing skin hydration, volume, and overall appearance. These fillers are predominantly produced through microbial fermentation, followed by a critical cross-linking process that enhances their longevity by resisting enzymatic degradation. This review provides a thorough examination of the manufacturing processes that differentiate HA fillers, with particular attention to the distinctions between biphasic and monophasic variants. Unlike previous studies, this review emphasizes the specific cross-linking techniques and their substantial impact on the fillers' rheological properties, such as elasticity and cohesiveness, which are crucial to their clinical performance and patient outcomes. Additionally, the review offers a comprehensive comparison of HA fillers with non-HA alternatives, including calcium hydroxylapatite, poly-l-lactic acid, and polymethyl methacrylate, highlighting the unique advantages and potential complications associated with each type. By presenting novel insights into the latest advancements and challenges in filler technology, this review aims to provide clinicians with a deeper understanding of filler properties, thereby guiding them in making informed decisions to optimize patient safety and aesthetic results.

Targeting inflammation with hyaluronic acid-based micro- and nanotechnology: A disease-oriented review

Inflammation is a pivotal immune response in numerous diseases and presents therapeutic challenges. Traditional anti-inflammatory drugs and emerging cytokine inhibitors encounter obstacles such as limited bioavailability, poor tissue distribution, and adverse effects. Hyaluronic acid (HA), a versatile biopolymer, is widely employed to deliver therapeutic agents, including anti-inflammatory drugs, genes, and cell therapies owing to its unique properties, such as hydrophilicity, biodegradability, and safety. HA interacts with cell receptors to initiate processes such as angiogenesis, cell proliferation, and immune regulation. HA-based drug delivery systems offer dual strategies for effective inflammation management, capitalizing on passive and active mechanisms. This synergy permits the mitigation of inflammation by lowering the doses of anti-inflammatory drugs and their off-target adverse effects. A diverse array of micro- and nanotechnology techniques enable the fabrication of tailored HA-engineered systems, including hydrogels, microgels, nanogels, microneedles, nanofibers, and 3D-printed scaffolds, for diverse formulations and administration routes. This review explores recent insights into HA pharmacology in inflammatory conditions, material design, and fabrication methods, as well as its applications across a spectrum of inflammatory diseases, such as atherosclerosis, psoriasis, dermatitis, wound healing, rheumatoid arthritis, osteoarthritis, inflammatory bowel disease, and colitis, highlighting its potential for clinical translation.

Influence of Anticoagulants and Heparin Contaminants on the Suitability of MMP-9 as a Blood-Derived Biomarker

In contrast to other common anticoagulants such as citrate and low-molecular-weight heparin (LMWH), high-molecular-weight heparin (HMWH) induces the expression of matrix metalloproteinase (MMP)-9, which is also measured as a biomarker for stroke in blood samples. Mechanistically, HMWH-stimulated T cells produce cytokines that induce monocytic MMP-9 expression. Here, the influence of further anticoagulants (Fondaparinux, Hirudin, and Alteplase) and the heparin-contaminating glycosaminoglycans (GAG) hyaluronic acid (HA), dermatan sulfate (DS), chondroitin sulfate (CS), and over-sulfated CS (OSCS) on MMP-9 was analyzed to assess its suitability as a biomarker under various conditions. Therefore, starved Jurkat T cells were stimulated with anticoagulants/contaminants. Subsequently, starved monocytic THP-1 cells were incubated with the conditioned Jurkat supernatant, and MMP-9 mRNA levels were monitored (quantitative (q)PCR). Jurkat-derived mediators secreted in response to anticoagulants/contaminants were also assessed (proteome profiler array). The supernatants of HMWH-, Hirudin-, CS-, and OSCS-treated Jurkat cells comprised combinations of activating mediators and led to a significant (in the case of OSCS, dramatic) MMP-9 induction in THP-1. HA induced MMP-9 only in high concentrations, while LMWH, Fondaparinux, Alteplase, and DS had no effect. This indicates that depending on molecular weight and charge (but independent of anticoagulant activity), anticoagulants/contaminants provoke the expression of T-cell-derived cytokines/chemokines that induce monocytic MMP-9 expression, thus potentially impairing the diagnostic validity of MMP-9.

Polymers as Efficient Non-Viral Gene Delivery Vectors: The Role of the Chemical and Physical Architecture of Macromolecules

Gene therapy is the technique of inserting foreign genetic elements into host cells to achieve a therapeutic effect. Although gene therapy was initially formulated as a potential remedy for specific genetic problems, it currently offers solutions for many diseases with varying inheritance patterns and acquired diseases. There are two major groups of vectors for gene therapy: viral vector gene therapy and non-viral vector gene therapy. This review examines the role of a macromolecule's chemical and physical architecture in non-viral gene delivery, including their design and synthesis. Polymers can boost circulation, improve delivery, and control cargo release through various methods. The prominent examples discussed include poly-L-lysine, polyethyleneimine, comb polymers, brush polymers, and star polymers, as well as hydrogels and natural polymers and their modifications. While significant progress has been made, challenges still exist in gene stabilization, targeting specificity, and cellular uptake. Overcoming cytotoxicity, improving delivery efficiency, and utilizing natural polymers and hybrid systems are vital factors for prospects. This comprehensive review provides an illuminating overview of the field, guiding the way toward innovative non-viral-based gene delivery solutions.

Advances in Microbial Exopolysaccharides: Present and Future Applications

Microbial exopolysaccharides (EPSs) are receiving growing interest today, owing to their diversity in chemical structure and source, multiple functions, and immense potential applications in many food and non-food industries. Their health-promoting benefits for humans deserve particular attention because of their various biological activities and physiological functions. The aim of this paper is to provide a comprehensive review of microbial EPSs, covering (1) their chemical and biochemical diversity, including composition, biosynthesis, and bacterial sources belonging mainly to lactic acid bacteria (LAB) or probiotics; (2) their technological and analytical aspects, especially their production mode and characterization; (3) their biological and physiological aspects based on their activities and functions; and (4) their current and future uses in medical and pharmaceutical fields, particularly for their prebiotic, anticancer, and immunobiotic properties, as well as their applications in other industrial and agricultural sectors.

Delivery of Nitric Oxide by Chondroitin Sulfate C Increases the Rate of Wound Healing through Immune Modulation

Chronic wounds impact 2.5% of the United States population and will continue to be a major clinical challenge due to increases in population age, chronic disease diagnoses, and antibiotic-resistant infection. Nitric oxide (NO) is an endogenous signaling molecule that represents an attractive, simple therapeutic for chronic wound treatment due to its innate antibacterial and immunomodulatory function. Unfortunately, modulating inflammation for extended periods by low levels of NO is not possible with NO gas. Herein, we report the utility of a NO-releasing glycosaminoglycan biopolymer (GAG) for promoting wound healing. GAGs are naturally occurring biopolymers that are immunomodulatory and known to be involved in the native wound healing process. Thus, the combination of NO and GAG biopolymers represents an attractive wound therapeutic due to these known independent roles. The influence and contribution of chondroitin sulfate C (CSC) modified to facilitate controlled and targeted delivery of NO (CSC-HEDA/NO) was evaluated using in vitro cell proliferation and migration assays and an in vivo wound model.

Predictors of Satisfaction in Patients with Knee Osteoarthritis Treated with a Single Injection of Mannitol-Modified Crosslinked Hyaluronate Derivative

Background/Objectives: There is a gap between the very positive opinion of patients and doctors regarding knee viscosupplementation (VS) and the contrasting results of controlled studies. The objective of this study was to evaluate the overall satisfaction and predictors of satisfaction with VS in patients with knee osteoarthritis treated with VS. Methods: Post-hoc analysis of a cross-sectional study in patients with knee OA treated with one injection of a mannitol-modified cross-linked HA (HANOX-M-XL). The primary outcome was satisfaction, self-assessed semi-quantitatively by the patients. Demographics, radiological features, comorbidities, OA and comorbidities treatments, and lifestyle associated with satisfaction were studied in bivariate and multivariate analysis. Results: 89 patients (124 knees) were analyzed. A total of 88.7% were satisfied with the treatment. Satisfaction was correlated with duration of effectiveness (DoE) and negatively correlated with BMI. Satisfaction was higher in active versus sedentary patients, in tibiofemoral involvement, in Kellgren-Lawrence grade 1-3 versus 4, and in subjects not requiring intraarticular corticosteroid (IACS) concomitantly to VS. Satisfied subjects were older than dissatisfied ones. In multivariate analysis, older age, K-L grade < 4, absence of IACS, and longer DoE were associated with higher rates of satisfaction. Conclusions: We identified several predictive factors of patient satisfaction after VS of the knee. Alongside these objective factors, there are probably subjective factors linked to patient beliefs, fears, and expectations impacting satisfaction.

Fast one-step acrylate functionalization of hyaluronic acid via Williamson ether synthesis

The synthetic route presented for acrylate-modified hyaluronic acid (HA-A-BEA) offers a simple and efficient process, reducing reaction time and purification steps while retaining biocompatibility. This study demonstrates the ability of HA-A-BEA to form tunable hydrogels via versatile techniques suitable for biomedical applications.

Evaluation of enteral and parenteral hyaluronic acid in induced ischemic skin flaps in rats: a double-blinded and randomized study

PURPOSE

To evaluate exogenous hyaluronic acid (HA) derived from bacterial fermentation through enteral and parenteral routes in ischemic skin flaps induced in rats, using clinical and histological exams; and interleukins (IL) as tissue inflammatory biomarkers.

METHODS

Sixty-four male adults Wistar rats with ischemic skin flaps on the dorsum were randomized into four groups, based on the treatment protocol: subcutaneous administration of saline solution (0.9%) (GI); oral administration of distilled water (GII); subcutaneous administration of HA (0.3%) (GIII); and oral administration of HA (1%) (GIV). Flaps of all groups were comparable regarding clinical and macroscopic evaluation, histological examination, pro-inflammatory cytokines (IL-1β, IL-6, and tumor necrosis factor-α) and anti-inflammatory cytokine IL-10.

RESULTS

A lower percentage of necrosis was identified in flaps treated with subcutaneous administration of HA (0.3%). The pro- and anti-inflammatory cytokines, epidermis thickness, blood vessels, and inflammatory cells showed statistically significant inter-group and intra-group differences (p < 0.05).

CONCLUSIONS

High molecular HA (1,400 ~ 2,000 kDa) administrated by subcutaneous or oral route exhibited beneficial effects in ischemic skin flaps of rats. However, subcutaneous administration of HA (0.3%) showed better results in terms of the percentage of necrosis and epithelialization.

Development of dissolving microneedles loaded with fucoidan for enhanced anti-aging activity: An in vivo study in mice animal model

Skin aging occurs naturally as essential skin components gradually decline, leading to issues such as fine lines, wrinkles, and pigmentation. Fucoidan, a natural bioactive compound, holds potential for addressing these age-related concerns. However, its hydrophilic nature and substantial molecular weight hinder its absorption into the skin. In this study, we utilized polyvinyl pyrrolidone K30 (PVP) and polyvinyl alcohol (PVA) as polymers to fabricate dissolving microneedles loaded with fucoidan (DMN-F). The DMN-F formulations were examined for physical characteristics, stability, permeability, toxicity, and efficacy in animal models. These formulations exhibited consistent polymer blends with a conical structure and uniform cone-shaped design. Microneedle structure and penetration capability gradually decreased with increasing fucoidan concentration, with storage recommended at approximately 33 % relative humidity (RH). Ex vivo studies showed that DMN-F efficiently delivered up to 95.03 ± 2.36 % of the total fucoidan concentration into the skin. In vivo investigations revealed that DMN-F effectively reduced wrinkles, improved skin elasticity, maintained moisture levels, and increased epidermal thickness. Histological images provided additional evidence of DMN-F's positive effects on these aging parameters. The results confirm that the DMN-F formulation effectively delivers fucoidan into the skin, allowing it to treat and mitigate signs of aging.

Redox-sensitive hydrogel based on hyaluronic acid with selenocystamine cross-linking for the delivery of Limosilactobacillus reuteri in a DSS-induced colitis mouse model

Disrupted gut microbiota homeostasis is an important cause of inflammatory colitis. Studies have shown that effective supplementation with probiotics can maintain microbial homeostasis and alleviate colitis. Here, to increase the viability of probiotics in the harsh gastrointestinal environments and enable targeted delivery, a redox-sensitive selenium hyaluronic acid (HA-Se) hydrogel encapsulating probiotics was developed. HA was modified with selenocystamine dihydrochloride and crosslinked by an amide reaction to generate a redox-sensitive hydrogel with stable mechanical properties, a low hemolysis rate and satisfactory biocompatibility. The HA-Se hydrogel exhibited suitable sensitivity to 10 mM GSH or 100 μM H2O2. The encapsulation of Limosilactobacillus reuteri (LR) in the HA-Se hydrogel (HA-Se-LR) significantly increased the survival rate of the probiotics in simulated gastric and intestinal fluid. HA-Se-LR administration increased the survival rate of mice with dextran sulfate sodium (DSS)-induced colitis, significantly alleviated oxidative stress and inflammation, and increased the effect of LR on microbiota α diversity. These results indicate that the HA-Se hydrogel constructed in this study can be used as a delivery platform to treat colitis, expanding the targeted applications of the natural polymer HA in disease treatment and the administration of probiotics as drugs to alleviate disease symptoms.

Significantly Enhanced Improvement in Dryness, Roughness, Fine Lines and Radiance Following Daily Use of a Novel Multi-Weight Hyaluronic Acid Plus Antioxidant Complex-Based Lotion Compared to a Single-Weight HA Plus Ceramide-Based Lotion

Objective

Hyaluronic acid (HA) has become a commonly used ingredient in topical moisturizing products; however, limitations of delivery of HA to only the surface of skin have hindered leveraging the full capacity of HA for skin rejuvenation. Here, we aimed to evaluate the clinical benefits of a multi-weight HA plus antioxidant complex-based lotion with SPF 30 compared to a single-weight HA plus ceramide-based lotion with SPF 30.

Methods

A double-blind comparative study was conducted on 70 female subjects, aged 25 to 65 years with mild-to-moderate facial dryness and visible fine lines and wrinkles, divided evenly into two groups (n=35 per group). Clinical grading of the face, including dryness, roughness, and fine lines, was assessed after once-daily application for up to eight weeks.

Results

Daily use of the multi-weight HA plus antioxidant lotion demonstrated significant improvements in all clinical grading assessments (dryness, roughness, and fine lines) as early as Week 2 compared to baseline. Statistically significant improvements in visible dryness, roughness, and fine lines were greater for the multi-weight HA plus antioxidant lotion compared to the single-weight HA plus ceramide-based lotion.

Limitations

The overall small sample size.

Conclusion

This study showed the enhanced improvement in dryness, roughness, and fine lines following daily utilization of a novel multi-weight HA plus antioxidant complex-based lotion compared to a single-weight HA plus ceramide-based lotion. These improvements may be attributed to the ability of multi-weight HAs to moisturize the skin surface and penetrate the upper surface layers of the skin, combined with the added benefits of key antioxidants.

ViSCNOVAS: A Novel Classification System for Hyaluronic Acid-Based Gels in Orthobiologic Products and Regenerative Medicine

Hyaluronic acid (HA), a naturally occurring polysaccharide, holds immense potential in regenerative medicine due to its diverse biological functions and clinical applications, particularly in gel formulations. This paper presents a comprehensive exploration of HA, encompassing its origins, molecular characteristics, and therapeutic roles in gel-based interventions. Initially identified in bovine vitreous humor, HA has since been found in various tissues and fluids across vertebrate organisms and bacterial sources, exhibiting consistent physicochemical properties. The synthesis of HA by diverse cell types underscores its integral role in the extracellular matrix and its relevance to tissue homeostasis and repair. Clinical applications of HA, particularly in addressing musculoskeletal ailments such as osteoarthritis, are examined, highlighting its efficacy and safety in promoting tissue regeneration and pain relief. Building upon this foundation, a novel classification system for HA-based interventions is proposed, aiming to standardize treatment protocols and optimize patient outcomes. The ViSCNOVAS classification system refers to viscosity, storage, chain, number, origin, volume, amount, and size. This classification is specifically designed for HA-based orthobiologic products used in regenerative medicine, including orthopedics, sports medicine, aesthetics, cosmetic dermatology, and wound healing. It aims to provide clinicians with a structured framework for personalized treatment strategies. Future directions in HA research are also discussed, emphasizing the need for further validation and refinement of the proposed classification system to advance the field of regenerative medicine. Overall, this manuscript elucidates the biological functions of hyaluronic acid and its potential in clinical practice while advocating for standardization to enhance patient care in various regenerative applications.

Evaluation of mango residues to produce hyaluronic acid by Streptococcus zooepidemicus

Mango processing generates significant amounts of residues (35-65%) that may represent environmental problems owed to improper disposal. The use of mango byproducts as substrates to produce hyaluronic acid (HA) is an attractive alternative to reduce the cost of substrate. In this study, we evaluated the potential of hydrolyzates from mango peels and seeds to produce HA by Streptococcus equi. subsp. zooepidemicus. The physicochemical characterization of mango residues showed that the seeds contain a higher amount of holocellulose (cellulose and hemicellulose), which amounts 54.2% (w/w) whereas it only represents 15.5% (w/w) in the peels. Mango peels, however, are composed mainly of hot water-extractives (62% w/w, that include sucrose, fructose, glucose and organic acids). A higher concentration of monosaccharides (39.8 g/L) was obtained from the enzymatic hydrolysis (with Macerex) of peels as compared to seeds (24.8 g/L with Celuzyme). From mango peels, hydrolyzates were obtained 0.6 g/L HA, while 0.9 g/L HA were obtained with hydrolyzates from mango seeds. These results demonstrate that mango byproducts have the potential to be used for production of HA.

Application frequency - key indicator for the efficiency of severe dry eye disease treatment - evidence for the importance of molecular weight of hyaluronan in lubricating agents

PURPOSE

Lubricant eye drops are the main therapeutic resource for dry eye disease (DED), with each drop representing the equivalent of ocular surface disease treatment. Thus, any reduction in the frequency of eye drop application reflects a degree of therapeutic success. Considering also the socioeconomic burden of DED, we investigated eye drop application frequency (DF) as a parameter to potentially track the success of therapy in severe DED. Hyaluronan (HA)-containing eye drops have become the first choice for tear substitution in many countries, and recent data indicate that the average molecular weight (Mw) of HA determines the therapeutic efficacy of such eye drops. This post-hoc subgroup analysis of a previously published multicentre prospective randomized open-label study, HYLAN M, is set out to compare the effects of very high Mw HA (hylan A) eye drops to comparator eye drops, containing lower Mw HA (control).

METHODS

Patients with severe DED (n = 47), recruited as part of the larger HYLAN M prospective, multicentre, open-label study, were randomized into two groups: hylan A and control group. In the hylan A group, 24 patients replaced their HA-containing eye drops with eye drops containing 0.15% hylan A, whereas the 23 control patients continued to use comparator HA eye drops. The DF was recorded daily by all participants over 8 weeks, and other subjective and objective parameters of DED were assessed at the time of inclusion (baseline), as well as at week 4 and 8.

RESULTS

There was a significant decrease in DF in the hylan A users between the baseline and week 4 (p = 0.004), remaining stable until week 8. Indeed, in contrast to the baseline, the hylan A group had a significantly lower DF than the control group at weeks 4 (p = 0.018) and 8 (p = 0.008). Likewise, the ocular surface disease index (OSDI) improved significantly between the time of inclusion and week 4 (p < 0.001) in hylan A users, remaining stable until week 8. The OSDI was similar in both groups at the baseline but it was significantly lower in the hylan A group than in the control group at week 4 (p = 0.002), remaining lower at week 8. Such a decrease in the DF and OSDI was not witnessed in the control group at any time point. The objective parameters assessed did not differ significantly within or between the two groups.

CONCLUSION

When treating severe DED, the DF can be significantly reduced by using very high Mw HA (3 MDa) lubricant eye drops, which better alleviate DED symptoms and decrease the OSDI scores. These drops not only provide an attractive and comfortable alternative for patients with severe DED but also offer the possibility of reducing the disease's socioeconomic burden, both for affected individuals and society as a whole.