Therapeutic use of hyaluronan

Hyaluronan used today as a therapeutic agent in human and animal medicine must be in a highly purified form, free of immunologically active protein molecules, from endotoxin and from inflammatory molecules originating from the tissues or bacterial cultures—the source of hyaluronan. All hyaluronans, whether in liquid or in covalently crosslinked gel form, must have certain elastoviscous properties to be usable for current therapeutic applications. Elastoviscous properties are especially important in the ophthalmic viscosurgical use. The metabolism of hyaluronan is very fast in most tissues, except in the vitreus. The ability of injected hyaluronan with a short half-life time in the joint to accomplish long-lasting analgesia represents a challenge for the design of the various products. The history of the therapeutic use of hyaluronan and its present status is described, with emphasis on its use in ophthalmic surgery and for a long-lasting analgesia in arthritic joints in humans and animals. The use of hyaluronan gels is described in viscoaugmentation as injected into the dermal layer of the skin. Hyaluronan gels were also used as viscosupplements injected into sphincter muscles to improve their function in aging or disease. The use of hyaluronan and its gel for drug delivery was suggested several decades ago, and is also mentioned.