The role of hyaluronic acid and hyaluronidase-1 in obstructive sleep apnoea

Abstract

Biological functions of hyaluronic acid (HA) depend on its molecular size. High-molecular weight HA (HMW-HA) is an important component of the endothelial wall and has anti-inflammatory and antioxidant properties. Under inflammation or hypoxia, HMW-HA is degraded by hyaluronidases, such as HYAL-1 resulting in pro-inflammatory low-molecular weight fragments. Obstructive sleep apnoea (OSA) is characterised by intermittent hypoxia and systemic inflammation. Our aim was to evaluate circulating HMW-HA and HYAL-1 in OSA. We recruited 68 patients with OSA and 40 control volunteers. After full-night sleep study blood samples were taken for HMW-HA and HYAL-1 measurements. HYAL-1 levels were significantly higher in patients with OSA compared to controls (0.59/0.31–0.88/ng/mL vs. 0.31/0.31–0.58/ng/mL; p = 0.005) after adjustment for gender, age, BMI and smoking. There was a trend for reduced HMW-HA concentrations in OSA (31.63/18.11–59.25/ng/mL vs. 46.83/25.41–89.95/ng/mL; p = 0.068). Significant correlation was detected between circulating HMW-HA and apnoea-hypopnoea-index (r = − 0.195, p = 0.043), HYAL-1 and apnoea-hypopnoea-index (r = 0.30, p < 0.01) as well as oxygen desaturation index (r = 0.26, p < 0.01). Our results suggest that chronic hypoxia is associated with increased plasma HYAL-1 concentration and accelerated HMW-HA degradation. Altered hyaluronan metabolism may be involved in the inflammatory cascade potentially leading to endothelial dysfunction in OSA.

Mechanisms of Action and Efficacy of Hyaluronic Acid, Corticosteroids and Platelet-Rich Plasma in the Treatment of Temporomandibular Joint Osteoarthritis—A Systematic Review

“…According to the recent research, there has been confirmed a relationship between chronic hypoxia, increased HYAL-1 plasma concentration and increased HMW HA degradation. These changes may enhance systemic inflammation in the course of obstructive sleep apnea [ 32 ].…”

Patients with Obstructive Sleep Apnea Have Altered Levels of Four Cytokines Associated with Cardiovascular and Kidney Disease, but Near Normal Levels with Airways Therapy

“… 42 Finally, when exogenous MMP2 is added to an in vitro wound assay of human epithelial cells, MMP2 significantly accelerated wound healing, 38 suggesting therapeutic supplementation of MMP2 to OSA patients with cardiovascular or kidney disease might be beneficial to vascular tissue development. Hyaluronic acid levels are altered by hypoxia in OSA patients, 43 effect MMP2 expression, 44 and are involved in inflammatory cascades leading to endothelial dysfunction and kidney disease. 43 , 45 Hence, it might be useful to include assays of the serum levels of hyaluronic acid in future expanded studies of inflammatory cytokine levels in airways treated OSA patients.…”

“…Hyaluronic acid levels are altered by hypoxia in OSA patients, 43 effect MMP2 expression, 44 and are involved in inflammatory cascades leading to endothelial dysfunction and kidney disease. 43 , 45 Hence, it might be useful to include assays of the serum levels of hyaluronic acid in future expanded studies of inflammatory cytokine levels in airways treated OSA patients.…”

Neuropeptide Y: An Update on the Mechanism Underlying Chronic Intermittent Hypoxia-Induced Endothelial Dysfunction

“…In the case of inflammation or hypoxia, HMW hyaluronic acid is degraded by hyaluronidases, such as HYAL-1, to produce proinflammatory low-molecular-weight fragments. In a clinical study of 68 OSA patients and 40 control volunteers, Meszaros et al (2020) found that chronic hypoxia is associated with increased plasma hyaluronic acid-1 concentrations and accelerated degradation of HMW hyaluronic acid. These findings suggest that changes in hyaluronic acid metabolism are involved in the inflammatory cascade and promote ED in OSAS.…”