News release
Monday, February 1, 2021
Naturally produced by the body, hyaluronan represents a new class of biologics that significantly improves lung health in patients with severe COPD.
Researchers at the National Institutes of Health and their collaborators found that inhaling unfragmented hyaluronan improves lung function in patients suffering from severe worsening chronic obstructive pulmonary disease (COPD). Hyaluronan, a sugar secreted by living tissue that acts as a scaffold for cells, is also used in cosmetics as a skin moisturizer and a nasal spray to moisturize the airways in the lungs. Used as a treatment, hyaluronan shortened the time that COPD patients needed respiratory support in intensive care, reduced their number of days in hospital, and saved money by reducing their hospital stay.
The study, published online in Respiratory Research, is a great example of how research into the effects of environmental pollution on the lungs can lead to viable treatments. Several years ago, co-senior author Stavros Garantziotis, MD, medical director of the Clinical Research Unit at the National Institute of Environmental Health Sciences (NIEHS), part of NIH, showed that exposure to pollution causes hyaluronic acid to be broken down in the lungs to smaller fragments. These fragments irritate the lung tissue and activate the immune system, leading to narrowing and inflammation of the airways. He found that inhalation of healthy, unfragmented hyaluronan reduces inflammation by surpassing the smaller hyaluronan fragments.
Garantziotis offered an analogy for how the inflammation occurs. He said that hyaluronic acid surrounds cells like mortar surrounds stones. Introducing contamination causes cracks in the mortar, breaking it into smaller chunks.
“These smaller chunks irritate the body and activate the immune system, leading to inflammation,” said Garantziotis. “Reintroducing full-length hyaluronic acid, such as a fresh coat of mortar, means it is less irritating and reduces the amount of inflammation.”
Since hyaluronic acid was approved in Italy for airway humidification, Garantziotis worked with colleagues in Rome to see if inhalation of full-size hyaluronic acid could improve lung function in critically ill COPD patients. He explained that the patients used a breathing apparatus similar to a CPAP (continuous positive airway pressure) machine to treat their acute exacerbation of COPD. This device provided respiratory support by blowing air into the airways through a mask.
“Inhaled hyaluronic acid qualifies as a stimulant aid for patients with aggravated COPD because it is safe and easy to administer,” said senior co-author Raffaele Incalzi, MD, Department of Medicine, Campus Bio-Medico University and Teaching Hospital, Rome. “In addition, it acts locally, only in the bronchial tree, and so cannot interfere with any systemic drugs.”
Garantziotis also wanted to know what caused airway narrowing in the lungs of COPD patients. He theorized that thick mucus could be involved. In collaboration with scientists at the University of Alabama at Birmingham (UAB), they cultured airway cells from emphysema patients and observed how mucus moved in the cells. They saw that mucus drained more easily after the administration of hyaluronic acid.
Co-author Steven Rowe, MD, director of the Gregory Fleming James Cystic Fibrosis Research Center at UAB, said that if patients with severe COPD took hyaluronan, the treatment would improve mucus transport and promote their recovery.
Current treatments for lung disease include inhaled steroids, antibiotics and bronchodilators, so using a molecule already found in the body is a new concept. Garantziotis’ goal now is to study this treatment in more patients in the US so that he can understand the optimal conditions and dosage that will bring the most benefit.
About the National Institute of Environmental Health Sciences (NIEHS): NIEHS supports research to understand the effects of the environment on human health and is part of the National Institutes of Health. For more information on NIEHS or environmental health topics, visit https://www.niehs.nih.gov/ or subscribe to a news list.
About the National Institutes of Health (NIH): NIH, the national medical research agency, includes 27 institutes and centers and is part of the United States Department of Health and Human Services. NIH is the premier federal agency that conducts and supports basic, clinical and translational medical research, investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.
Grant numbers: Z01ES102605, Z01ES102465, R35HL135816, P30DK072482
About the National Institutes of Health (NIH):
NIH, the national medical research agency, includes 27 institutes and centers and is part of the United States Department of Health and Human Services. NIH is the premier federal agency that conducts and supports basic, clinical and translational medical research, investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.
NIH … Turning Discovery into Health®
References
Galdi F, Pedone C, McGee CA, George M, Rice AB, Hussain SS, Vijaykumar K, Boitet ER, Tearney GJ, McGrath JA, Brown AR, Rowe SM, Incalzi RA, Garantziotis S. 2021. Inhaled high molecular weight hyaluronic acid improves respiratory failure in acute COPD exacerbation: a pilot study. Respir Res: doi: 10.1186 / s12931-020-01610-x.