An update on the effect of intra-articular intervention strategies using nanomaterials in osteoarthritis: Possible clinical application

Abstract

Osteoarthritis (OA) is the most common progressive condition affecting joints. It mainly affects the knees and hips as predominant weight-bearing joints. Knee osteoarthritis (KOA) accounts for a large proportion of osteoarthritis and presents numerous symptoms that impair quality of life, such as stiffness, pain, dysfunction, and even deformity. For more than two decades, intra-articular (IA) treatment options for managing knee osteoarthritis have included analgesics, hyaluronic acid (HA), corticosteroids, and some unproven alternative therapies. Before effective disease-modifying treatments for knee osteoarthritis, treatments are primarily symptomatic, mainly including intra-articular corticosteroids and hyaluronic acid, so these agents represent the most frequently used class of drugs for managing knee osteoarthritis. But research suggests other factors, such as the placebo effect, have an essential role in the effectiveness of these drugs. Several novel intra-articular therapies are currently in the clinical trial processes, such as biological therapies, gene and cell therapies. Besides, it has been shown that the development of novel drug nanocarriers and delivery systems could improve the effectiveness of therapeutic agents in osteoarthritis. This review discusses the various treatment methods and delivery systems for knee osteoarthritis and the new agents that have been introduced or are in development.

Functional Nanomaterials for the Treatment of Osteoarthritis

“… 165 Although significant progress has been made in nanotechnology, its development and translation face a number of challenges and limitations that need to be addressed to achieve successful clinical translation. 166 , 167 Firstly, there are significant differences in cartilage composition and thickness between animals and humans. For example, mouse cartilage, is 30–40 times thinner than human cartilage, and nanomaterials may be rapidly removed before they reach the human joint cavity, resulting in lower-than-expected efficacy.…”

Rapid Recovery after Reparation of Full-Thickness Chondral Defects of the Knee with the Use of Hyaluronan (HA)-Based 3-D Scaffold

“…HA, officially identified as hyaluronan, is a natural polymer composed of unsulfated glycosaminoglycan with a high molecular weight, formed from the repetitive accumulation of molecular chains of N-acetyl-glucosamine and glucuronic acid [17]. Several studies have found that when injected intraarticularly for OA, due to its physical properties, it promotes joint lubrication and improves shock absorbency during movement to enhance synovial fluid viscosity, which has been associated with benefits in comparison to placebos for pain and function and improvements in patient global assessment scores with no negative side effects [18].…”

“…Previous studies have demonstrated that HA promotes the formation of new hyalinelike cartilage tissue due to an upregulation in chondrocyte proliferation and differentiation, as well as contributing to an inhibition of the enzymatic cartilage degradation that normally happens in inflammatory conditions [19]. In the presence of an inflammatory condition of the knee, it is estimated that the concentration of HA is reduced by 33-50% and therefore can have satisfactory clinical results, but at an elevated cost since they will need repeated interventions [17].…”