Hybrid Cooperating Complexes in Osteoarthritis Treatment
Intra-articular application of corticosteroids and hyaluronic acid is part of the treatment of osteoarthritis (OA) in patients for whom oral or topical treatment does not provide sufficient response. The following text addresses the lubricating and protective properties of synovial fluid and the associated choice of suitable intra-articular viscosupplementation, with an emphasis on innovative molecules with high concentrations of hyaluronic acid and low viscosity.
COMMERCIAL NOTICE
Current Recommendations for OA Treatment
According to the latest ESCEO recommendations (European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases), osteoarthritis (OA) treatment can be initiated with oral monotherapy using glucosamine sulfate or chondroitin sulfate, or their combination with the addition of paracetamol as needed. The treatment can be supported with topical non-steroidal anti-inflammatory drugs (NSAIDs) or capsaicin. If symptoms persist, the next step is the intermittent or continuous use of oral NSAIDs. If symptoms continue to persist, intra-articular injections of corticosteroids (CS) or hyaluronic acid (HA) can be used.
Properties of Synovial Fluid
Synovial fluid (SF) ensures joint nutrition, increases and maintains cartilage elasticity, and reduces friction. HA has a high molecular weight, present in joints in various chain lengths, but with age, the number of HA and chondroitin sulfate molecules decreases. This non-Newtonian fluid exhibits lubricating behavior with a viscous response or protective behavior with an elastic response depending on movement frequency.
In osteoarthritis, the protective function of SF is always lower than the lubricating function, which deepens with age, leading to cartilage damage due to insufficient protection. In joint lesions, a similar situation occurs, significantly altering the properties of synovial fluid and reducing HA concentration.
Patients with osteoarthritis experience up to a 92% loss of the lubricating capabilities of endogenous hyaluronic acid. A significant decrease in lubricating properties can be improved by viscosupplementation aimed at restoring the rheological homeostasis of the joint.
Choosing the Right Supplementation
To closely mimic endogenous HA, exogenous HA should have a high concentration and high molecular weight. However, at high HA concentrations, hydrophobic properties and hydrogen bonds within the chain between HA molecules manifest, resulting in highly viscous complex structures − making the gel solution difficult to apply.
In 2012, an invention was patented that transformed HA and created stable cooperating hybrid molecules between low and high molecular weight hyaluronic acid. The result is a high concentration of HA with low viscosity, allowing for easier injection.
Hybrid Cooperating Complexes
Another patented advancement in this field is the invention of hybrid cooperating complexes using biotechnologically produced chondroitin (without the sulfate group), whose molecular shape allows for further viscosity reduction. The result is the maintenance of high HA concentration, requiring less force for application and exhibiting physiological behavior closer to synovial fluid.
Clinical Evidence
A pilot study with a single application of this complex in hip osteoarthritis patients confirmed a rapid and significant reduction in hip pain. An improvement of > 50% in terms of pain reduction was observed. A statistically significant decrease in visual analog scale (VAS) pain scores was noted as early as 7 days (drop from 67.5 to 29.3; p < 0.0001) and persisted at the end of the 6-month observation period (22.8; p < 0.0001).
After 30 days, a significant improvement in the Lequesne index was also recorded – a reduction of > 50% (from 10.4 to 5.1; p < 0.0001). The treatment was well tolerated, with most adverse events involving pain at the injection site and localized arthralgia at the therapy site.
New Viscosupplementation Product Enters the Czech Market
This product, named Sinogel, is now entering the Czech market. It contains a unique hybrid cooperating complex of highly purified sodium hyaluronate (2.4%) with high molecular weight and sodium chondroitin (1.6%), obtained using NAHYCO technology. The product not only offers exceptional rheological properties and the highest glycosaminoglycan (GAG) content (4%) on the market, but its 3 ml volume makes it suitable for viscosupplementation of large joints suffering from pain or reduced mobility caused by degenerative diseases, post-traumatic conditions, or joint and tendon damage.
Sinogel acts locally at the injected joint, where it restores the viscoelastic properties of the synovial fluid, reduces pain, and restores the mobility of joints and tendons. It is intended for single administration in each treatment cycle.
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Source: Guerrasio S. Hybrid cooperative complexes of hyaluronic acid alone or in combination with chondroitin natrium in the treatment of musculoskeletal disorders. Updates in the Treatment of Musculoskeletal Diseases in Practice. 44th Symposium of the Orthopedic Clinic 1st Faculty of Medicine, Charles University and IPVZ and FN Bulovka in Prague, 30.11. – 1.12.2023.
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