title: Hyaluronan molecular weight distribution is associated with the risk of knee osteoarthritis progression.
abstract: OBJECTIVE
  We investigated the relationship between the molecular weight (MW) distribution of hyaluronan (HA) in synovial fluid (SF) and risk of knee osteoarthritis (OA) progression.
  
  
  METHODS
  HA MW was analyzed for 65 baseline knee SFs. At 3-year follow-up, knees were scored for change in joint space narrowing (JSN), osteophyte (OST) progression, or occurrence of total knee arthroplasty (TKA). HA MW distribution was analyzed using agarose gel electrophoresis (AGE), and its relationship to OA progression was evaluated using logistic regression. The association between HA MW and self-reported baseline knee pain was analyzed using Pearson's correlation coefficients.
  
  
  RESULTS
  Knee OA was categorized as non-progressing (OST-/JSN-, 26 knees, 40%), or progressing based on OST (OST+/JSN-, 24 knees, 37%), OST and JSN (OST+/JSN+, 7 knees, 11%) or total knee arthroplasty (TKA, 8 knees, 12%). The MW distribution of HA in baseline SFs was significantly associated with the odds of OA progression, particularly for index knees. After adjusting for age, gender, BMI, baseline X-ray grade and pain, each increase of one percentage point in %HA below 1 million significantly increased the odds of JSN (odds ratios (OR) = 1.45, 95% CI 1.02-2.07), TKA or JSN (OR = 1.24, 95%CI 1.01-1.53) and the odds of any progression (OR = 1.16, 95% CI 1.01-1.32). HA MW distribution significantly correlated with pain.
  
  
  CONCLUSIONS
  These data suggest that the odds of knee OA progression increases as HA MW distribution shifts lower and highlight the value of reporting MW distribution rather than just average MW values for HA.
authors.affiliation: NYU School of Medicine, New York, NY, USA; NYU Hospital for Joint Diseases, New York, NY, USA. Electronic address: philip.band@nyumc.org.
authors.forename: P A
authors.initials: PA
authors.lastname: Band
authors.affiliation: Matrix Biology Institute, Fort Lee, NJ, USA.
authors.forename: J
authors.initials: J
authors.lastname: Heeter
authors.affiliation: NYU School of Medicine, New York, NY, USA. Electronic address: hans-georg.wisniewski@nyumc.org.
authors.forename: H-G
authors.initials: HG
authors.lastname: Wisniewski
authors.affiliation: Harvard University, Cambridge, MA, USA. Electronic address: vliublin@fas.harvard.edu.
authors.forename: V
authors.initials: V
authors.lastname: Liublinska
authors.affiliation: Wellesley College, Wellesley, MA, USA.
authors.forename: C W
authors.initials: CW
authors.lastname: Pattanayak
authors.affiliation: NYU Hospital for Joint Diseases, New York, NY, USA.
authors.forename: R J
authors.initials: RJ
authors.lastname: Karia
authors.affiliation: Duke University School of Medicine, Durham, NC, USA.
authors.forename: T
authors.initials: T
authors.lastname: Stabler
authors.affiliation: Matrix Biology Institute, Fort Lee, NJ, USA.
authors.forename: E A
authors.initials: EA
authors.lastname: Balazs
authors.affiliation: Duke University School of Medicine, Durham, NC, USA. Electronic address: vbk@duke.edu.
authors.forename: V B
authors.initials: VB
authors.lastname: Kraus
mesh_terms: D000368:Aged; D018450:Disease Progression; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000032:analysis*; D008297:Male; D008875:Middle Aged; D008970:Molecular Weight; D020370:Osteoarthritis, Knee / Q000378:metabolism*; D012306:Risk; D013582:Synovial Fluid / Q000737:chemistry*
chemical_list: D006820:Hyaluronic Acid
keywords: Hyaluronan; Molecular weight; Osteoarthritis progression; Synovial fluid