Subcutaneous administration of hyaluronan reduces the number of infectious exacerbations in patients with chronic bronchitis.

Abstract

Hyaluronan (HA) is a high molecular weight glycosaminoglycan found in large amounts in the skin, joints, and other organs. Previous studies have shown that HA stimulates neutrophil functions both in vitro and in vivo. The object of this study was to test the hypothesis that HA administration subcutaneously might reduce the number of bacterial infections in humans with an increased susceptibility to such infections. For this purpose we have studied 29 patients with chronic bronchitis and recurrent acute exacerbations of their disease. The patients were randomly separated into two groups. One group had HA for 6 mo followed by 6 mo of placebo, and the other group started with placebo treatment followed by HA. The treatment periods occurred during two consecutive winter periods. HA-treated patients had significantly fewer acute exacerbations (p = 0.01) than did placebo-treated patients. Likewise the consumption of antibiotics and other signs of bacterial infections were reduced. In the crossover study the placebo-treated patients again had much higher numbers of acute exacerbations than did the HA-treated patients (p < 0.0001). It is concluded that HA reduces the number of infectious exacerbations in patients with chronic bronchitis, possibly by enhancing cellular host defense mechanisms. HA is a new endogenous substance that can be used to stimulate host defense reactions and reduce the need of antibiotics. Before being recommended for clinical use, however, our results should be confirmed by further studies.

Hyaluronan Plus Saline Nasal Washes in the Treatment of Rhino-Sinusal Symptoms in Patients Undergoing Functional Endoscopic Sinus Surgery for Rhino-Sinusal Remodeling

“…Therefore, it is likely that therapies targeted at removing biofilms or with an antibacterial action may be of value in the management of post-operative recurrent chronic rhinosinusitis (17). In relation with this important issue, the use ofhyaluronan was shown to be effective in reducing the number of infectious exacerbations in patients with chronic bronchitis (20). In another study carried out on an experimental model (21), hyaluronan reduced bacterial colonisation in the upper airways by counteracting the interaction between CD44 receptors and the microbial capsule.…”

Decreased hyaluronan in airway smooth muscle cells from patients with asthma and COPD

“…In this context, HA blocked acute bronchoconstriction caused by human neutrophil elastase in sheep [33], and a single dose of inhaled HA was suggested to protect against exercise-induced bronchoconstriction in asthma patients [12]. Furthermore, in COPD patients [34] or elastase-induced emphysema [35], treatment with HA had beneficial effects. It is of interest that two other GAG, heparin and HS, have also been reported to be beneficial during asthma therapy by a mechanism of action that is not directly related to their anticoagulant property [36].…”

Role of hyaluronan and hyaluronan-binding proteins in lung pathobiology

“…In patients with chronic bronchitis, subcutaneous administration of HMW-HA for 6 mo protects against acute exacerbations and results in less consumption of antibiotics (148).…”