Therapeutic Applications

Elastoviscous hyaluronan solutions (crowded molecular networks) and elasto-viscous hyaluronan gels (cross-linked molecular networks) have been used in several therapeutic areas. In order to emphasize that in all these therapeutic uses the primary mode of action is based on the viscous and elastic properties of a crowded molecular network, we designated the diverse uses as follows: viscosurgery, used in ophthalmic surgery to protect delicate eye tissues and provide space during surgical manipulation; viscoaugmentation, to fill and augment the intercellular spaces in connective tissues of the skin, sphincter muscles, vocal cords and pharyngeal tissues; viscoseparation, to separate connective tissue surfaces traumatized by surgical procedures in order to prevent adhesion and excessive scar formation; viscosupplementation, to supplement or replace tissue fluids and restore homeostasis in certain pathological conditions such as replacing synovial fluid in painful arthritis to alleviate pain and promote the healing of intra-articular wounds; and viscoprotection, to protect healthy, injured or wounded tissue surfaces from dryness and noxious environmental agents (conjunctiva or cornea) or promote the wound healing of such surfaces as well as of mucous membranes and skin. Finally, we will review briefly the use of elastoviscous hyaluronan solutions and solids used for delivery of drugs and in tissue engineering.

Very dilute solutions made of hyaluronan of any molecular weight or concentrated solutions of hyaluronan of very low molecular weight are not used in the above-described therapeutic applications because they do not have significant elastoviscous properties. We will not review here the emerging therapeutic fields for the possible uses of condensed hyaluronan molecular systems, hyaluronan copolymers with proteins, glycosaminoglycans or lipids, or the potential use of oligosaccharides and small hyaluronan fragments.

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