Clinical significance of the immunometric measurements of hyaluronic acid

Our plain-English summary of Clinical significance of the immunometric measurements of hyaluronic acid, by E.H. Cooper, B.J. Rathbone (Annals of Clinical Biochemistry, 1990).

The study

• Authors: E.H. Cooper, B.J. Rathbone
• Journal: Annals of Clinical Biochemistry
• Published: 1990;27 ( Pt 5):444-51
• Type of article: Review
• Cited by: 21 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Hyaluronic acid (HA), an unbranched high molecular weight polysaccharide can now be measured by several immunometric assays. The connective tissues are the main source of HA and it is destroyed mainly in the liver. Very high levels of HA occur in mesothelioma. Wilms' tumour and acute liver failure, and moderate increases in rheumatoid diseases, renal failure and cirrhosis. Local increased production of HA is a feature of several forms of lung disease. HA is an indicator of connective tissue turnover, of the function of the receptor mechanisms for its capture and destruction by the liver, and of the removal of low molecular weight fragments by the kidney.

In plain English

This article was a review, not a new study. The authors described laboratory tests for hyaluronic acid (HA), a substance made mainly by connective tissue and broken down mainly in the liver. They summarized published reports of HA levels in liver, kidney, joint and lung diseases and in several cancers. The article described mesothelioma as a tumour of the pleura usually caused by inhaling asbestos. From earlier reports it noted that pleural fluid HA above 100 micrograms per litre was found in 73% of mesothelioma patients (11 of 15) and in 23% of patients with non-malignant inflammatory conditions. Reported average blood levels in mesothelioma ranged from 118 to 750 micrograms per litre. In a cited group of 98 patients with asbestosis without mesothelioma, average serum HA was 43 micrograms per litre, which the article read as no detectable effect on HA production. The authors judged pleural fluid testing more likely than blood testing to aid diagnosis, but noted overlap with non-malignant effusions. They concluded that only time would tell whether HA assays would have a place in routine clinical chemistry.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Narrative review of published research on immunometric assays for hyaluronic acid and HA levels in various diseases; no new data were collected
• Who was studied: No study population of its own. The authors reviewed earlier published reports, including four reports of blood and pleural fluid HA in mesothelioma, along with studies of liver disease, renal failure, rheumatoid arthritis, lung disease and other cancers
• Exposure: No exposure was studied. Asbestos is mentioned only as the usual cause of mesothelioma, which the article describes as a tumour of the pleura. No fiber types are named. Patients with asbestosis are mentioned in one cited group
• Main results:
  • In a cited report on the diagnosis of pleural effusions, with a cut-off of 100 micrograms per litre in pleural fluid, HA was raised in 73% of patients with mesothelioma (11 of 15) and in 23% of patients with non-malignant inflammatory conditions. It was not raised in congestive heart failure
  • In cited reports on serum HA in mesothelioma, mean levels ranged from 118 to 750 micrograms per litre. Individual levels ranged from 2 to 3800 micrograms per litre
  • Pleural fluid HA concentrations were described as about 1000 times higher than blood concentrations
  • In 98 patients with asbestosis without mesothelioma, the mean serum HA was 43 micrograms per litre (standard deviation 30). The article read this as asbestosis having no detectable effect on HA production
  • In nude mice carrying human malignant mesothelioma xenografts, serum HA rose before the tumours could be detected physically
  • For comparison, the article gives normal blood HA as a mean of 30 to 40 micrograms per litre
• The authors' conclusion: The authors concluded that serum HA concentrations are abnormal in a number of diseases. They also concluded that only time will tell whether HA assays will have a place in routine clinical chemistry. For mesothelioma, they judged that HA measurement in pleural fluid seemed more likely to aid diagnosis than serum measurement
• Limitations the authors state:
  • Pleural fluid HA values in mesothelioma overlap with those in non-malignant pleural effusions
  • For liver disease, the advantage of HA over other tests and its clinical role were described as still unclear

Topics

Medical terms in this study, explained in our Lexicon: Hyaluronic Acid, Mesothelioma.

Related studies

• Is serum hyaluronic acid level useful for evaluating the clinical course of malignant mesothelioma of the tunica vaginalis? — K. Haga, N. Shinohara, et al. (1999)
• Histochemical demonstration of hyaluronic acid in pleural mesotheliomas — J.C. Wagner, D.E. Munday, et al. (1962)
• Mesothelioma of the peritoneum; a case report in which the ascitic fluid contained hyaluronic acid — S. Dvoskin (1954)
• Pleural effusion hyaluronic acid as a prognostic marker in pleural malignant mesothelioma — J. Creaney, I.M. Dick, et al. (2013)
• Hyaluronic acid in the pleural fluid of patients with malignant pleural mesothelioma — N. Fujimoto, K. Gemba, et al. (2013)
• Serum mesothelin has a higher diagnostic utility than hyaluronic acid in malignant mesothelioma — B. Grigoriu, B. Chahine, et al. (2009)

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