Hyaluronic acid viscosupplements from avian and non-mammalian sources exhibit biocompatibility profiles with unique, source-specific, antigenic profiles
Wooley PH, Song Z, Harrison A. 2012. Hyaluronic acid viscosupplements from avian and non-mammalian sources exhibit biocompatibility profiles with unique, source-specific, antigenic profiles. J Biomed Mater Res Part B 2012:100B:808–816. doi: 10.1002/jbm.b.32514
The objective of this study was to evaluate and compare the biocompatibility proﬁles of hyaluronic acid (HA) viscosupplements from avian and non-mammalian sources. Inﬂammatory and immune reactions were assessed in models of both clinically relevant and stringent immunological exposure conditions. Experiments were conducted to evaluate tissue reactions and immunological responses and assess antibody formation with the capacity to bind directly to and cross-react with the different viscosupplements. Mice were exposed to viscosupplements using the air pouch inﬂammation model and speciﬁc immunization using Freund’s complete adjuvant (FCA). Murine pouch membrane tissue reactions revealed generally mild to moderate responses, with cellular inﬁltration and cytokine proﬁles of pouch tissue characteristic of predominantly ﬁbroblastic responses rather than marked inﬂammatory reactions. In vitro testing indicated that pouch injections did not elicit detectable T-cell proliferative responses, while antibody assays revealed that mice immunized with viscosupplements in FCA and subsequently boosted were capable of mounting an antibody response with a range of speciﬁcities. High reactivity to avian serum albumin was seen in sera from mice injected with HA from an avian source, while low positive reactivity to the bacterial antigen Staphylococcal Lipotechoic Acid was observed in sera from mice injected with HA from bacterial sources. These speciﬁcities did not indicate any propensity to cross-react, suggesting that patients with adverse immune responses to HA from an avian source should be unresponsive to subsequent injection with HA from a non-avian source. Overall, the ﬁndings demonstrate that viscosupplements exhibit good biocompatibility proﬁles in the murine air pouch, but when provoked to elicit immunological reactions exhibit unique antigenic spectra. These ﬁndings suggest that an immunologically mediated immune reaction directed against avian proteins should not necessarily be a contraindication for the administration of non-avian viscosupplements.