AB0054 SEQUENTIAL INTRA-ARTICULAR INJECTIONS OF LINEAR AND CROSS-LINKED HYALURONIC ACIDS IN THE TREATMENT OF GONARTHROSIS. (June 2019) - Barbieri, Elena
Abstract : Background: Sequential intra-articular injections of linear and cross-linked hyaluronic acids in the treatment of gonarthrosis Objectives: This study evaluates clinical and biochemical effects of sequential intra-articular (IA) injections of two different formulations of hyaluronic acid (HA) in gonarthrosic (GA) patients. The first formulation consists in linear HA (LHA, MW 800-1200kDa; Regenflex Starter, Regenyal Labs, Italy) and the second in an intercalated mixture of cross-linked and linear HAs (CL-LHA, MW 1-2 MDa the crosslinked form and 500kDa the linear, intercalated one; Regenflex BioPlus). Methods: 39 knee GA patients, 19 adults (50–65 years) and 20 elderly (>65 years), underwent two IA injections, i.e. LHA only at baseline and CL-LHA after 1 week. The same injections were repeated after 6 months. Clinical assessment - visual analogic scale (VAS) for pain, range of motion (ROM) and WOMAC index for knee functional limitation - was performed at baseline and after 3, 6, 9, 12 months. Blood, collected at baseline, after 1 week and 3 months, was analysed for relevant cytokines and collagen telopeptide II (CTX-II). Synovial fluid (SF) from patients with recurrent knee effusion (GA worse group) was biochemically analysed at baseline and 1 week. SF proteomic analysis was also carried out at specific time points. Results: This HA-regimen improved joint pain and function independently from the age; plasma and synovial biochemical analyses indicate the attenuation of inflammatory cytokines (IL-1β, IL-9 and IL-17) and the stabilization of CTX-II; ultrasonograph data show an improvement of cartilage conditions and thickness at 12 months. Conclusion: Sequential IA injections of LHA and CL-LHA represent a highly effective treatment especially in low degree GA patients and produce a significant and perduring improvement also in the GA worse group. The efficacy is likely dependent on the sequential administration of LHA and CL-LHA: the pharmacokinetic rationale of this combination will be discussed. References: E. Barbieri 1, 2*, P. Sestili 1, F. Mannello 1, G. Annibalini 1, S. Contarelli 1, L. Vallorani 1, A. M. Gioacchini 1, D. Ligi 1, L. Croce 1, Tung Tran Dang Xuan 3, C. Bartolucci 1 V. Stocchi 1 and I. Capparucci 1 1 Department of Biomolecular Sciences, University Urbino Carlo Bo, via A. Saffi 2, 61029 Urbino, Italy 2 Interuniversity Institute of Myology 3 Stem Cells Center, Van Hanh Hospital, Hochiminh City, Viet Nam Disclosure of Interests: None declared