Hyaluronan (HA) is a ubiquitous constituent of extracellular matrices and has two main characteristics: [1] physicochemical properties and [2] cell biological functions. The physicochemical properties of HA are viscosity, elasticity, lubrication and a high capacity for holding water. HA is implicated in a number of cell biological phenomena via HA receptors, CD44 and RHAMM (including cell motility, cell proliferation, cell differentiation, cell-cell interaction), and in the production of cell physiological substances, such as cytokines, PGE2 and matrix metalloproteinases (MMPs). Accordingly, medical applications of HA can be classified into three types: application(s) of [1] the physicochemical properties of HA, [2] the cell biological functions of HA and [3] both the physicochemical properties and cell biological functions of HA (Fig. 1). The molecular weight of HA varies from approximately 0.4 kDa (disaccharides) to several thousand kDa. Both the physicochemical properties and cell biological functions of HA depend on the molecular size of HA (Fig. 2) (1-5). HA can be modified to regulate its properties according to its usage: isolation of a certain range of molecular weight of HA, depolymerization of HA to obtain oligosaccharides and linkage of HA molecules to make a sponge, sheet or gel of HA. HA is highly biocompatible and biodegradable, suggesting that it is a suitable and safe biomaterial for many medical applications.

Figure 1 Three types of medical applications of hyaluronan. HA, hyaluronan; OA, osteoarthritis; EMR, endoscopic mucosal resection. The italic indicates future medical applications.

There are many reports regarding the medical applications of HA. However, only a small number of them have been put into practice. This chapter will review the medical applications of HA that have already been used in practice and some of those that will likely be developed in the near future.

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