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High molecular weight hyaluronic acid (HMW-HA) is a naturally occurring anionic glycosaminoglycan polymer composed of repeating disaccharide units of D-glucuronic acid and N-acetyl-D-glucosamine. It is found widely in connective tissues and synovial fluid. Medically, HMW-HA is used as a viscoelastic supplement for intra-articular injection to treat pain associated with osteoarthritis of the knee in patients who have not responded adequately to conservative therapy or simple analgesics. It acts primarily by increasing the viscosity and elasticity of synovial fluid within joints, providing lubrication and cushioning that reduces pain and improves joint function[6][7]. High molecular weight forms are also used as ophthalmic surgical aids due to their viscoelastic properties[5]. The mechanism involves physical supplementation rather than direct pharmacological receptor interaction; however, HA can interact with cell surface receptors such as CD44 to modulate inflammation and tissue repair processes[3].
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