Hyaluronic Acid: From Biochemical Characteristics to its Clinical Translation in Assessment of Liver Fibrosis

Abstract

Context:Hyaluronic acid (HA) is a high molecular weight polysaccharide that is distributed in all bodily tissues and fluids. The liver is the most important organ involved in the synthesis and degradation of HA. Research has shown that liver cell injury can affect serum HA levels. In this review, authors aimed to describe the biochemical and physiological roles of this glycosaminoglycan and its changes in various liver diseases.Evidence Acquisition:Liver fibrosis and in more severe form, cirrhosis are results of an imbalance between fibrogenesis and fibrinolysis. Liver biopsy is the gold standard to assess liver necro inflammatory injuries. This method is invasive and has some major side effects; therefore it is an unfavorable method for both physicians and patients. Now, a wide variety of noninvasive methods have been introduced based on evaluating serum level of different markers. They are safe, readily available, and more favorable. Serum HA levels are used by some researchers to assess stages of liver fibrosis.Results:There are several scientific studies indicating HA as a biomarker for high score fibrosis and cirrhosis in various liver diseases alone or in algorithm models. It seems from various algorithm models that the use of HA as a major constituent has more diagnostic reliability and accuracy than the use of HA alone.Conclusions:Use of HA in an algorithm model, is an extra and valuable tool for assessing liver necro inflammatory injuries- in parallel with liver biopsy- but more comprehensive studies are needed to approve the use of HA as an appropriate clinical tool.

Serum hyaluronic acid in chronic viral hepatitis B and C: a biomarker for assessing liver fibrosis in chronic hemodialysis patients

“…Some researchers report that HA is an accurate noninvasive marker in predicting significant F in HD patients with hepatitis C [1,37,38], but we found no studies on the utility of HA in predicting F in chronic VHB. Chen et al [39] showed that HA, laminin (LN), procollagen III N-terminal peptide (PIIINP), and type IV collagen (CIV) were correlated with F in chronic VHB.…”

Fibrosis 4 Score Versus Hyaluronic Acid as Non-Invasive Tools for Assessment of HCV-Related Hepatic Fibrosis: Correlation with Quantitative Morphometric Analysis of Liver Biopsy

“…The accumulation of HA can result as a consequence of activated hepatic stellate cell production or reduced hepatic sinusoidal endothelial cell clearance [28]. Several studies supports that HA level and FIB-4 score may be clinically useful as a non-invasive marker for liver fibrosis and/or cirrhosis [29][30][31][32][33][34][35][36][37].…”

Hyaluronic acid as a non-invasive biomarker of liver fibrosis

“…Due to the limitations of liver biopsy, non-invasive serum biomarkers have been proposed to assess liver fibrosis stage. Hyaluronic acid (HA) is recognized as one the oldest such serum biomarkers (14). First characterized by Meyer and Palmer (15), HA is a high molecular weight linear polymer made up of repeating N-acetyl-glucosamine and β-glucuronic acid disaccharide units, with an abundant distribution throughout numerous species (16).…”