Why consider topical Sodium Hyaluronate (HA) in the treatment of tendinopathy?

Firstly, the difference between HA and other glycosaminoglycans is that it is non-sulfated, forms in the plasma membrane instead of the Golgi apparatus, and can be very large, with its molecular weight often reaching the millions1. HA is considered to be a key molecule in the tissue regeneration process. It has been shown to modulate via specific HA receptors, inflammation, cellular migration, and angiogenesis, which are the main phases of wound healing7.

In relation to tendinopathies, hyaluronic acid modulates a variety of cellular functions: anti-inflammatory activity, enhanced cellular proliferation and collagen deposition. Studies have shown a link between the inhibition of fibroblast proliferation, with a reduction in the formation of adhesions at the tendon healing site; by limiting the proliferation of fibroblasts, HA may reduce the risk of adhesions.2

It has sometimes been assumed, in relation to tendinopathic change, that because there is an excess of GAGs detectable within the local bio-chemical environment, there is an excess of hyaluronan, which is not necessarily the case. For example, the activity of hyaluronidase (enzymes that catalyse the degradation of hyaluronan) has been shown to increase during the healing of equine superficial digital flexor tendon injuries6.

Multiple studies analysing tendon healing have confirmed that HA reduces the formation of scars and granulation tissue, and also prevents adhesions2. Importantly, HA forms part of the extracellular matrix as a major component of ground substance, giving structure for other GAGs and proteoglycans3. In tendon healing, the GAGs provide a temporary structure in the early stages of the wound4. So without the presence of HA, there is evidence to suggest that other GAGs are of limited use. Also, high levels of HA are thought to be instrumental in scar-less healing by facilitating the movement and proliferation of fibroblasts, and by regulating the production and type of collagen5.

HA also plays an important role as a hydrating agent, being able to absorb 3,000 times its own weight in water4. HA appears to inhibit the expression of key intermediaries for the inflammatory signalling pathways (NF-kB), by reducing the expression of pro inflammatory factors, exogenous HA may reduce the fragmentation of endogenous HA and further stimulate synthesis of endogenous HA.7,8.

References

1.       Fraser JR, Laurent TC, Laurent UB (1997). "Hyaluronan: its nature, distribution, functions and turnover" (PDF). J. Intern. Med. 242 (1): 27–33. doi:10.1046/j.1365-2796.1997.00170.x. PMID 9260563.
2.       Michele Abate, Cosima Schiavone, and Vincenzo Salini, “The Use of Hyaluronic Acid after Tendon Surgery and in Tendinopathies,” BioMed Research International, vol. 2014, Article ID 783632, 6 pages, 2014. doi:10.1155/2014/783632.
3.       Bertolami, C.N. (1984)Glycosaminoglycan interactions in early wound repair. In: Hunt, T.K., Heppenstall, R.B., Pines., Rovee, D. (eds). Soft and Hard Tissue Repair: Biological and clinical aspects. Eastbourne: Praeger Scientific.
4.       Snyder, R.J. (1999)Wound management: a global perspective. Ostomy/Wound Management 45: 9, 26-30.
5.       Desai, H. (1997)Ageing and wounds, part 2: healing in old age. Journal of Wound Care 6: 5, 237-239.
6.       J. W. Foland, G. W. Trotter, B. E. Powers, R. H. Wrighley, and F. W. Smith, “Effect of sodium hyaluronate in collagenase-induced superficial digital flexor tendinitis in horses,” American Journal of Veterinary Research, vol. 53, no. 12, pp. 2371–2376, 1992.
7.       Litwiniuk M., Krejner A., Grzela T. (2016). Hyaluronic acid in inflammation and tissue regeneration. Wounds 28, 78–88.
8.       Litwiniuk, Malgorzata, Alicja Krejner, and Tomasz Grzela. "Hyaluronic Acid In Inflammation And Tissue Regeneration". Wounds 28.3 (2016): n. pag. Print.

Tear supplements


Currently, tear supplements are available as solutions, ointments and gels. They can be used as often as necessary to keep the corneal surface and conjunctiva wet. Preferably, the topical application of a well-formulated tear supplement and lubricating agent should provide relief for both aqueous- and mucin-deficient dry eye. Moreover, functions associated with the lipid layer of the precorneal tear film should not be altered by the tear supplement.

There are several objectives that tear supplements aim to fulfil in the treatment of dry eye.

Objectives of tear supplements

Ideally, tear supplements should fulfil the physico-chemical role of a normal tear film. In addition, they should not disturb corneal metabolism nor be toxic to the eye, even with frequent use. It should also have a refractive index similar to that of the cornea to see correctly. This involves consideration of certain characteristics in the formulation if tear supplements are to resemble physiological tears. These include electrolyte concentration, viscosity, mucomimetic properties, pH, osmolarity and the absence of preservatives. 

Your can read more about this subject here: http://vismed.trbchemedica.co.uk/business-professionals/vismed-eye-drops/the-ideal-tear-supplement 

Would you like to work for TRB Chemedica?

TRB Chemedica (UK) Ltd is currently recruiting four Graduate Sales Representatives in the South of England. You must have a life sciences degree, particularly in Biology, Medical, Pharmacology, Pharmacy, Chemistry, Nursing, Sports Science, or relevant experience in the field, with excellent language and presentation skills. You will be selling our rheumatology and ophthalmic products to customers in the NHS and private practice. 

If you think you’re the right person for us then please send your CV to recruit@trbchemedica.co.uk.

For more information please also visit our website http://www.trbchemedica.co.uk/careers. 

Most Common Cause of Dry Eye: Meibomian Gland​ Dysfunction

Meibomian glands help to form the superficial layer of fat on the tear film. This reduces the evaporation of the tear fluid, improves stability, protects the surface of the eye and is essential for good visual function. Meibomian Gland Dysfunction (MGD) can lead to dry eye due to increased evaporation. MGD is thus responsible for approximately 60 % of all cases of dry eye alone and for a further 20 % of cases associated with a deficiency in the aqueous tear film phase.

Meibomian Gland Dysfunction (MGD) can therefore be considered as the most common cause of dry eye.

Baudouin et al. presented a new pathological diagram of MGD in an attempt to give a clearer picture of the basic mechanisms involved in the development and interaction of dry eye. It should facilitate a more effective treatment of MGD and dry eye in clinical practice 1:

To continue to read this informative article please click on the link here: http://vismed.trbchemedica.co.uk/clinicians/newsletters/pathophysiology-of-meibomian-gland-dysfunction

1. Baudouin C, Messmer EM, Aragona P, Geerling G, Akova YA, Benítez-Del-Castillo J, Boboridis KG, Merayo-Lloves J, Rolando M, Labetoulle M. Revisiting the vicious circle of dry eye disease: a focus on the pathophysiology of meibomian gland dysfunction. Br J Ophthalmol. 2016 May;100(3):300-6

OSTENIL is #injectionofoil 

In a Twitter conversation this weekend, former Premiership footballer, Don Hutchison, recommended OSTENIL as a "god send" [sic] and as "#injectionofoil":


Thank you for the commendation, and best wishes to you!

New Guidelines Offer Hope for Older UK Osteoarthritis Sufferers

A report on how people suffering with symptomatic Osteoarthritis (OA) of the knee may still be able to remain active in sport has just been published in the Clinical Journal of Sport Medicine. Clinical Journal of Sport Medicine: January 2016 - Volume 26 - Issue 1 - p 1–11 doi: 10.1097/JSM.0000000000000274

The authors – who are all members of The American Medical Society for Sport Medicine (AMSSM), an organisation which represents over 2100 nonsurgical sports medicine physicians - carried out a detailed meta-analysis (a process where the results of many different studies are pooled and then subjected to sensitive statistical testing) of all relevant clinical investigations relating to the use of Viscosupplementation published between 1960 and 2014.  Viscosupplementation is an internationally recognised treatment modality for Osteoarthritis of the knee. The process involves injecting Hyaluronic Acid (HA) or Sodium Hyaluronate as it is often referred to, directly into the affected joint. HA is a viscous fluid which closely resembles the natural synovial fluid found in all healthy articular joints...

Continue here: http://www.trbchemedica.co.uk/news/new-guidelines-offer-hope-to-older-oa-sufferers

Improved VISMED MULTI OSD Bottle

The award-winning OSD bottle we use for VISMED MULTI and VISMED GEL MULTI has recently been updated. This comes as a result of our policy of ongoing improvement to products and procedures. We listened to our customers and patients who were ...asking for some amendments to the OSD bottle and this is what has been achieved:

- Release strength reduced by 25% - 30%.
- The new type bottle now feels the same at half empty as the old style when completely full.
- The bottle can be emptied more easily due to a better drop control.

You can read more about it here:
http://www.trbchemedica.co.uk/news/vismed-multi-osd-improved