関: hyaluronan、hyaluronic acid

WordNet

a silvery soft waxy metallic element of the alkali metal group; occurs abundantly in natural compounds (especially in salt water); burns with a yellow flame and reacts violently in water; occurs in sea water and in the mineral halite (rock salt) (同)Na, atomic number 11

PrepTutorEJDIC

ソジウム,ナトリウム(金属元素;化学記号はNa)

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/04/18 01:09:05」(JST)

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Sodium hyaluronate is the sodium salt of hyaluronic acid, a glycosaminoglycan found in various connective, epithelial, and neural tissues. Sodium hyaluronate, a long-chain polymer containing repeating disaccharide units of Na-glucuronate-N-acetylglucosamine, occurs naturally on the corneal endothelium, bound to specific receptors for which it has a high affinity. The polyanionic form, commonly referred to as hyaluronan, is a visco-elastic polymer normally found in the aqueous and vitreous humour. As a pharmaceutical, the uses of sodium hyaluronate include:

Sodium hyaluronate for intra-articular injection (brand names: Euflexxa, Hyalgan, Supartz, Gel-One) is used to treat knee pain in patients with osteoarthritis who have not received relief from other treatments. It is very similar to the lubricating fluid that occurs naturally in the articular capsule of the knee joint. Once injected into the joint capsule, it acts as both a shock absorber and a lubricant for the joint.^[1]

Sodium hyaluronate for intraocular viscoelastic injection (brand names: Healon, Provisc, Viscoat) is used as a surgical aid in variety of surgical procedures performed on the eyeball including cataract extraction (intra- and extracapsular), intraocular lens implantation, corneal transplant, glaucoma filtration, and retina attachment surgery. In surgical procedures in the anterior segment of eyeball, instillation of sodium hyaluronate serves to maintain a deep anterior chamber during surgery, allowing for efficient manipulation with less trauma to the corneal endothelium and other surrounding tissues. Its viscoelasticity also helps to push back the vitreous face and prevent formation of a postoperative flat chamber. In posterior segment surgery, sodium hyaluronate serves as a surgical aid to gently separate, maneuver, and hold tissues. It creates a clear field of vision, facilitating intra-operative and post-operative inspection of the retina and photocoagulation.^[2]

Medical uses

Sodium hyaluronate is used as a viscosupplement, administered through a series of injections into the knee, increasing the viscosity of the synovial fluid, which helps lubricate, cushion and reduce pain in the joint.^[3] It is generally used as a last resort before surgery^[4] and provides symptomatic relief, by recovering the viscoelasticity of the articular fluid, and by stimulating new production from synovial fluid.^[5] Use of sodium hyaluronate may reduce the need for joint replacement.^[6] Injections appear to increase in effectiveness over the course of four weeks, reaching a peak at eight weeks and retaining some effectiveness at six months, with greater benefit for osteoarthritis than oral analgesics.^[7] It may also be effective when used with other joints.^[8]

Sodium hyaluronate may also be used in plastic surgery to reduce wrinkles on the face or as a filler in other parts of the body.^[9] It may be used in ophthalmology to assist in the extraction of cataracts, the implantation of intraocular lenses, corneal transplants, glaucoma filtration, retinal attachment and in the treatment of dry eyes.^[10]

Sodium hyaluronate is also used to coat the bladder lining in treating interstitial cystitis.

Contraindications

Sodium hyaluronate is contraindicated for people who are sensitive to hyaluronate preparations, or when there are infections or skin disease at the injection site.

Adverse effects

Adverse effects are relatively rare when used to treat the joints.^[5]

When used in ophthalmological procedures, sodium hyaluronate may cause postoperative inflammation, corneal edema or decompensation, and short-term increases in intraocular pressure.

Mechanism of action

Sodium hyaluronate functions as a tissue lubricant and is thought to play an important role in modulating the interactions between adjacent tissues. Sodium hyaluronate is a polysaccharide which is distributed widely in the extracellular matrix of connective tissue in man. It forms a viscoelastic solution in water which makes it suitable for aqueous and vitreous humor in ophthalmic surgery. Mechanical protection for tissues (iris, retina) and cell layers (corneal, endothelium, and epithelium) are provided by the high viscosity of the solution. Elasticity of the solution assists in absorbing mechanical stress and providing a protective buffer for tissues. This viscoelasticity enables maintenance of a deep chamber during surgical manipulation since the solution does not flow out of the open anterior chamber. In facilitating wound healing, it is thought that it acts as a protective transport vehicle, taking peptide growth factors and other structural proteins to a site of action. It is then enzymatically degraded and active proteins are released to promote tissue repair.^[11] Sodium hyaluronate is being used intra-articularly to treat osteoarthritis.

Physical and chemical properties

Sodium hyaluronate is an ophthalmic agent with viscoelastic properties that is used in joints to supplement synovial fluid.

Pharmacokinetics

Sodium hyaluronate is absorbed and diffuses slowly out of the injection site. It is eliminated via the canal of Schlemm.

History

Sodium hyaluronate hyaluronan started to be in use to treat osteoarthritis of the knee in year 1986 with the product Hyalart/Hyalgan by Fidia of Italy, in intra-articular injections.^{[citation needed]}

Economics

Sodium Hyaluronate

Brand names of Sodium hyaluronate in Market include (alphabetically):

AMO Vitrax (ocular)
AMVISIC Plus (ocular)
CYSTISTAR, Healon (ocular)
EYEFILL (ocular)
HYLO-COMOD (Eye Drop)
OLIXIA Pure (Eye Drop)
EUFLEXXA, Bio Technology General (Israel)-Meditrina SA (Rx articular), Molecular weight: 2,400,000-3,600,000 Daltons
GONILERT/Verisfield (UK) (Rx/articular). Molecular weight:1,800,000-2,000,000 Daltons
HYALGAN/HYALART- Fidia (Italy)(Medical Device/Rx articular)
MONOVISC- Anika (USA)(MedicalDevice/articular)
OSTENIL- TRB Chemedica (Switzerland)(articular injection) [1]
RECOSYN- Merckle Recordati (Germany) Recosyn info leaflet
SYNOCROM- Croma Pharma (Austria) (articular injection) . Molecular weight:1,600,000 Daltons
VISCURE- Cube (UK)(Rx/articular), Molecular weight:1,800,000-2,000,000 Daltons
VISMED- TRB Chemedica (Switzerland)(eye drop)[2]
YARDEL- Libytec (Impfstoffwerk Dessau-Tornau/Germany,(Rx/articular), Molecular weight:1,800,000-2,000,000 Daltons

References

^ "Hyaluronate sodium: Indications, Side Effects, Warnings" (Web). Drugs.com. Drugs.com. 5 February 2014. Retrieved 25 February 2014.
^ "Healon (Sodium Hyaluronate)" [package insert]. (2002). Kalamazo, Michigan: Pharmacia Corporation. (Web). RxList. (Updated 8 December 2004). RxList, Inc. Retrieved 25 February 2014.
^ Puhl, W.; Scharf, P. (1997). "Intra-articular hyaluronan treatment for osteoarthritis". Annals of the rheumatic diseases 56 (7): 441. doi:10.1136/ard.56.7.441. PMC 1752402. PMID 9486013. edit
^ Karlsson, J.; Sjögren, L. S.; Lohmander, L. S. (2002). "Comparison of two hyaluronan drugs and placebo in patients with knee osteoarthritis. A controlled, randomized, double-blind, parallel-design multicentre study". Rheumatology (Oxford, England) 41 (11): 1240–1248. PMID 12421996. edit
^ ^a ^b Jubb, R. W.; Piva, S.; Beinat, L.; Dacre, J.; Gishen, P. (2003). "A one-year, randomised, placebo (saline) controlled clinical trial of 500-730 kDa sodium hyaluronate (Hyalgan) on the radiological change in osteoarthritis of the knee". International journal of clinical practice 57 (6): 467–474. PMID 12918884. edit
^ Kotz, R.; Kolarz, G. (1999). "Intra-articular hyaluronic acid: Duration of effect and results of repeated treatment cycles". American journal of orthopedics (Belle Mead, N.J.) 28 (11 Suppl): 5–7. PMID 10587245. edit
^ Bannuru, R. R.; Natov, N. S.; Dasi, U. R.; Schmid, C. H.; McAlindon, T. E. (2011). "Therapeutic trajectory following intra-articular hyaluronic acid injection in knee osteoarthritis – meta-analysis". Osteoarthritis and Cartilage 19 (6): 611–619. doi:10.1016/j.joca.2010.09.014. PMID 21443958. edit
^ Salk, R. S.; Chang, T. J.; d'Costa, W. F.; Soomekh, D. J.; Grogan, K. A. (2006). "Sodium Hyaluronate in the Treatment of Osteoarthritis of the Ankle: A Controlled, Randomized, Double-Blind Pilot Study". The Journal of Bone and Joint Surgery 88 (2): 295–302. doi:10.2106/JBJS.E.00193. PMID 16452740. edit
^ Beasley, K.; Weiss, M.; Weiss, R. (2009). "Hyaluronic Acid Fillers: A Comprehensive Review". Facial Plastic Surgery 25 (2): 086–094. doi:10.1055/s-0029-1220647. PMID 19415575. edit
^ Shimmura, S.; Ono, M.; Shinozaki, K.; Toda, I.; Takamura, E.; Mashima, Y.; Tsubota, K. (1995). "Sodium hyaluronate eyedrops in the treatment of dry eyes". The British journal of ophthalmology 79 (11): 1007–1011. PMC 505317. PMID 8534643. edit
^ Boucher, W. S.; Letourneau, R.; Huang, M.; Kempuraj, D.; Green, M.; Sant, G. R.; Theoharides, T. C. (2002). "Intravesical sodium hyaluronate inhibits the rat urinary mast cell mediator increase triggered by acute immobilization stress". The Journal of Urology 167 (1): 380–384. doi:10.1016/S0022-5347(05)65472-9. PMID 11743360. edit

UpToDate Contents

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1. 初期薬物療法に反応しない変形性関節症の治療 treatment of osteoarthritis resistant to initial pharmacologic therapy
2. 関節内および軟部組織注射：注射剤の種類および投与頻度 intraarticular and soft tissue injections what agents to inject and how frequently
3. 注入可能軟部組織充填剤：非永久性充填剤 injectable soft tissue fillers temporary agents
4. 成人における関節吸引または注射：合併症 joint aspiration or injection in adults complications
5. 成人における術後の腹膜癒着とその予防 postoperative peritoneal adhesions in adults and their prevention

English Journal

Recognition and treatment of non-infectious hyaluronic acid reactions.

Hatcher JL1, Goldman ND.Author information 1Department of Otolaryngology, Wake Forest School of Medicine , Winston-Salem , USA.AbstractOBJECTIVE: To differentiate a non-infectious inflammatory reaction following hyaluronic acid injection for facial rejuvenation from other reported complications, and describe appropriate treatment.
The Journal of dermatological treatment.J Dermatolog Treat.2014 Dec;25(6):513-5. doi: 10.3109/09546634.2012.703307. Epub 2012 Jul 25.
OBJECTIVE: To differentiate a non-infectious inflammatory reaction following hyaluronic acid injection for facial rejuvenation from other reported complications, and describe appropriate treatment.METHODS: Using a review of the literature and information available from the manufacturer, recommendati
PMID 22702401

Efficacy and safety of a new monophasic hyaluronic acid filler in the correction of nasolabial folds: a randomized, evaluator-blinded, split-face study.

Rhee do Y1, Won CH, Chang SE, Noh TK, Kim MS, Kim BJ, Park GH, An JS, Lee MW, Choi JH, Moon KC, Lim SH.Author information 1Department of Dermatology, Asan Medical Center , Seoul , Korea.AbstractBACKGROUND: Hyaluronic acid (HA) fillers are frequently used for the correction of facial soft-tissue defects.
The Journal of dermatological treatment.J Dermatolog Treat.2014 Oct;25(5):448-52. doi: 10.3109/09546634.2013.814756.
BACKGROUND: Hyaluronic acid (HA) fillers are frequently used for the correction of facial soft-tissue defects.OBJECTIVE: To compare the efficacy and safety of a novel monophasic HA filler (mono-HA), and a well-studied biphasic HA filler (bi-HA), in the treatment of moderate to severe nasolabial fold
PMID 23789873

Thermosensitive in situ hydrogel based on the hybrid of hyaluronic acid and modified PCL/PEG triblock copolymer.

Lv Z1, Chang L1, Long X1, Liu J1, Xiang Y1, Liu J2, Liu J2, Deng H1, Deng L3, Dong A4.Author information 1Department of Polymer Science and Technology, School of Chemical Engineering and Technology, Tianjin University, Tianjin 300072, China.2Institute of Radiation Medicine Chinese Academy of Medical Sciences, Tianjin 300072, China.3Department of Polymer Science and Technology, School of Chemical Engineering and Technology, Tianjin University, Tianjin 300072, China. Electronic address: dengliandong@tju.edu.cn.4Department of Polymer Science and Technology, School of Chemical Engineering and Technology, Tianjin University, Tianjin 300072, China; Key Laboratory of Systems Bioengineering of the Ministry of Education, School of Chemical Engineering and Technology, Tianjin University, Tianjin 300072, China; Collaborative Innovation Center of Chemical Science and Engineering (Tianjin), Tianjin 300072, China.AbstractIn this work, a new hydrogel was constructed using poly(ɛ-caprolactone-co-1,4,8-trioxa[4.6]spiro-9-undecanone)-poly(ethylene glycol)-poly(ɛ-caprolactone-co-1,4,8-trioxa[4.6]spiro-9-undecanone) tri-block copolymers (PECT) with hyaluronic acid (HA) in order to expand application scopes of PECT hydrogel. The rheological and sol-gel phase transition behaviors were investigated by rheometer and test tube inversion method, and the interior morphologies of hydrogel systems were observed by scanning electron microscope (SEM). With the introduction of HA, certain properties of PECT hydrogel, such as viscosity and morphology, have present trends with regularity. Furthermore, with the participation of HA, the degradation and release of acetylsalicylic acid was slightly affected, however, the drug release mechanism of hydrogel has not been changed. PECT/HA hydrogel is confirmed to be non-toxic through a test to NIH3T3 cells. In conclusion, blending with HA is a feasible and safe method to tune properties of PECT hydrogel.
Carbohydrate polymers.Carbohydr Polym.2014 Aug 8;108:26-33. doi: 10.1016/j.carbpol.2014.03.016. Epub 2014 Mar 21.
In this work, a new hydrogel was constructed using poly(ɛ-caprolactone-co-1,4,8-trioxa[4.6]spiro-9-undecanone)-poly(ethylene glycol)-poly(ɛ-caprolactone-co-1,4,8-trioxa[4.6]spiro-9-undecanone) tri-block copolymers (PECT) with hyaluronic acid (HA) in order to expand application scopes of PECT hydro
PMID 24751243

Japanese Journal

Clinical Pathology : Corneal-Protective Effects of an Artificial Tear Containing Sodium Hyaluronate and Castor Oil on a Porcine Short-Term Dry Eye Model

HASEGAWA Takashi,AMAKO Hideki,YAMAMOTO Takeshi [他]
The journal of veterinary medical science 76(9), 1219-1224, 2014-09
NAID 40020214342

関節内注射が奏効しない変形性膝関節症には骨内病変(bone marrow edema)がある (第26回日本臨床整形外科学会学術集会)

吉田竹志
日本臨床整形外科学会雑誌 39(1), 22-28, 2014-05
NAID 40020200092

LABORATORY INVESTIGATION : Rat chronic glaucoma model induced by intracameral injection of microbeads suspended in sodium sulfate-sodium hyaluronate

Matsumoto Yoshiko,Kanamori Akiyasu,Nakamura Makoto [他]
Japanese journal of ophthalmology : the official international journal of the Japanese Ophthalmological Society 58(3), 290-297, 2014-05
NAID 40020062481

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リンク元	「hyaluronan」
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「hyaluronan」

Sodium hyaluronate
Systematic (IUPAC) name
	Hyaluronan Sodium
Clinical data
Trade names	Healon, Provisc, Viscoat, Hyalgan, Euflexxa, Supartz, Gel-One
AHFS/Drugs.com	Multum Consumer Information
Legal status	?
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ATC code	?
Chemical data
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