Inhaled hyaluronan improves lung function in patients with severe COPD: pilot study
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Inhaled high-molecular-weight hyaluronan shortened the duration of respiratory failure and need for noninvasive ventilation in patients with acute exacerbation of COPD, according to results of a pilot study published in Respiratory Research.
“Treatment for [acute exacerbation of] COPD remains limited, including bronchodilators, nonspecific anti-inflammatory corticosteroid and antibiotics, and novel, effective anti-inflammatory agents are needed,” Flavia Galdi, MD, from the division of geriatrics in the department of medicine at Campus Bio-Medico University and Teaching Hospital, Rome, and colleagues wrote. “High-molecular-weight hyaluronan is a naturally occurring sugar that is abundant in the extracellular matrix, including in the lung. [It] had several properties that make it an attractive candidate as a therapeutic in [acute exacerbation] COPD.”
The single-center, randomized, placebo-controlled, double-blind study included 41 screened patients with severe acute exacerbation COPD who required noninvasive positive-pressure ventilation. The study was conducted at the University of Rome from March 2016 to July 2019.
Patients were randomly assigned to inhaled high-molecular-weight hyaluronan (n = 20; mean age, 77.4 years) or placebo (n = 21; mean age, 74.2 years). The primary endpoint was time until liberation from noninvasive positive-pressure ventilation or noninvasive positive-pressure ventilation failure.
Patients in the inhaled hyaluronan group had a shorter duration of noninvasive ventilation compared with the placebo group (5 vs. 7 days; P = .037).
Patients assigned inhaled also had lower measured peak airway pressure (P < .001) and markers of systemic inflammation (P = .039) after discharge from ventilation.
Results of in vitro testing showed significant improvement in mucociliary transport in air-liquid interface cultures of primary bronchial cells in patients with COPD and in cells from healthy nonsmokers exposed to cigarette smoke (P < .01 for both) among those assigned inhaled hyaluronan group.
The researchers noted several limitations of the pilot study, including a small number of participants and single-center design. Moreover, the study was conducted over a 2- to 3-year period, which may introduce potential variability in treatment options, according to the researchers.
The researchers’ goal is to study treatment with inhaled hyaluronan in more patients in the U.S. to understand the optimal conditions and dosing to produce the most benefit, according to an NIH press release.
“Our study supports the use of a novel class of treatment, ie, matric biologics, in acute and chronic lung disease,” the researchers wrote. “Additional studies should confirm our findings with higher number of patients in additional clinical sites and explore the use of [high-molecular-weight hyaluronan] in chronic COPD, both to reduce COPD progression and to decrease exacerbations, which are the major driver of morbidity, mortality and cost in this devastating disease.”