News Release
Monday 1 February 2021
Hyaluronan, produced naturally by the body, represents a new class of biologics that significantly improve lung health in patients with severe COPD.
Researchers from the National Institutes of Health and their colleagues found that inhalation of unfragmented hyaluronan improves lung function in patients suffering from severe exacerbation of 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 moisturizer for the skin and as a nasal spray to moisturize lung pathways. Hyaluronan, used as a treatment, has reduced the amount of time COPD patients need in intensive care, respiratory support, reduced their number of days in the hospital, and saved money by reducing their hospital stay.
The study, published online in Respiratory Research, is a good example of how the impact of environmental pollution on the lungs can lead to viable treatments. A few years ago, co-senior author Stavros Garantziotis, MD, MD of the clinical research unit at the National Institute of Environmental Health Sciences (NIEHS), part of NIH, showed that exposure to pollutants causes hyaluronan to break down in the lungs into smaller fragments. These fragments irritate lung tissue and activate the immune system, leading to narrowing and inflammation of the airways. He found that inhaling healthy, unfragmented hyaluronan reduces inflammation by competing with the smaller hyaluronan fragments.
Garantziotis offered an analogy about how the inflammation occurs. He said hyaluron surrounds cells, like mortar around bricks. Due to contamination, cracks are caused in the mortar, which breaks it into smaller pieces.
“These smaller pieces irritate the body and activate the immune system, leading to inflammation,” Garantziotis said. “Reintroducing the full-length hyaluronan, like a fresh mortar, means it is less irritating and reduces the amount of inflammation.”
Since hyaluronan has been approved in Italy for airway moisturizing, Garantziotis has worked with colleagues in Rome to see if inhaling full-blown hyaluronan can improve lung function in critically ill COPD patients. He explained that the patients were using a breathing apparatus similar to a continuous positive airway pressure (CPAP) machine to treat their acute exacerbation of COPD. This device provided respiratory support by blowing air through a mask into the airways.
“Hyaluronan inhalation qualifies as a stimulant aid for patients with worsening COPD as it can be administered safely and easily,” said co-senior author Raffaele Incalzi, MD, Department of Medicine, Campus Bio-Medico University and Hospital of Education, Rome. . “Furthermore, it works locally, only in the bronchial tree, and therefore cannot interfere with any systemic agent.”
Garantziotis also wanted to know what causes airway narrowing in the lungs of COPD patients. He has the theory that thick mucus may be involved. In collaboration with scientists at the University of Alabama in Birmingham (UAB), they cultured airway cells from emphysema patients in culture and observed how mucus moves in the cells. They found that mucus flows more easily after hyaluronan has been administered.
Co-author Steven Rowe, MD, director of the Gregory Fleming James Cystic Fibrosis Research Center at UAB, said if patients with severe COPD take hyaluronan, the transport of the mucus will improve and help their recovery.
Current treatments for lung diseases include inhaled steroids, antibiotics and bronchodilators, so using a molecule already present in the body is a new concept. The goal of Garantziotis is to study this treatment in more patients in the US so that he can understand the optimal conditions and dosage that can yield the best 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 country’s medical research agency, contains 27 institutes and centers and is part of the U.S. Department of Health and Human Services. NIH is the primary federal agency that conducts and supports basic, clinical, and translational medical research, investigating the causes, treatments, and drugs for common and rare diseases. Visit www.nih.gov for more information on NIH and its programs.
Award numbers: Z01ES102605, Z01ES102465, R35HL135816, P30DK072482
About the National Institutes of Health (NIH):
NIH, the country’s medical research agency, contains 27 institutes and centers and is part of the U.S. Department of Health and Human Services. NIH is the primary federal agency that conducts and supports basic, clinical, and translational medical research, investigating the causes, treatments, and drugs for common and rare diseases. Visit www.nih.gov for more information on NIH and its programs.
NIH… To turn 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. Hyaluronan improves high molecular weight respiratory failure in acute COPD exacerbation: a pilot study. Respir Res: doi: 10.1186 / s12931-020-01610-x.