Giarritiello Fabiana, De La Motte Luigi Regenburgh, Drago Lorenzo
UOC Laboratory of Clinical Medicine with Specialized Areas, IRCCS MultiMedica, 20138 Milan, Italy.
Department of Medicine and Health Sciences "V. Tiberio", University of Molise, 86100 Campobasso, Italy.
Microorganisms. 2025 Mar 21;13(4):700. doi: 10.3390/microorganisms13040700.
Synovial fluid (SF) plays a critical role in joint lubrication, load distribution, and maintaining homeostasis within the synovial cavity. Its rheological properties, primarily influenced by hyaluronic acid (HA) and other macromolecules, are essential for normal joint function. However, alterations in the physicochemical characteristics of SF can occur due to septic conditions, including septic arthritis (SA) and periprosthetic joint infections (PJIs), which significantly impact joint health. Bacterial colonization in infected joints often leads to the formation of biofilms, microbial aggregates encased in an extracellular matrix, which confer resistance to antibiotics and host immune responses. Biofilm formation in SF-altered environments is a major challenge in treating joint infections, particularly in patients with prosthetic implants. , primarily through intra-articular hyaluronic acid (HA) injections, has been widely used to restore SF viscosity and function in degenerative joint diseases. More recently, polyacrylamide (PAA)-based gels have emerged as an alternative viscosupplementation strategy. However, concerns have been raised regarding the potential impact of viscosupplements on biofilm formation and bacterial adhesion in septic joints, as changes in SF viscosity and composition may influence bacterial colonization and persistence. This review aims to assess the interaction between viscosupplementation and biofilm formation in septic joint pathologies, examining the effects of HA and PAA on SF rheology and bacterial adhesion. Understanding these interactions is crucial for optimizing therapeutic strategies and mitigating the risk of biofilm-associated infections in patients undergoing viscosupplementation.
滑液（SF）在关节润滑、负荷分布以及维持滑膜腔内的稳态方面发挥着关键作用。其流变学特性主要受透明质酸（HA）和其他大分子的影响，对于正常关节功能至关重要。然而，由于包括脓毒性关节炎（SA）和人工关节周围感染（PJI）在内的脓毒症情况，滑液的物理化学特性可能会发生改变，这会对关节健康产生重大影响。感染关节中的细菌定植通常会导致生物膜的形成，生物膜是包裹在细胞外基质中的微生物聚集体，具有对抗生素和宿主免疫反应的抗性。在滑液改变的环境中形成生物膜是治疗关节感染的主要挑战，尤其是在有假体植入物的患者中。，主要通过关节内注射透明质酸（HA），已被广泛用于恢复退行性关节疾病中滑液的粘度和功能。最近，基于聚丙烯酰胺（PAA）的凝胶已成为一种替代的粘弹性补充策略。然而，人们对粘弹性补充剂对脓毒性关节中生物膜形成和细菌粘附的潜在影响表示担忧，因为滑液粘度和成分的变化可能会影响细菌定植和持续存在。本综述旨在评估脓毒性关节病变中粘弹性补充与生物膜形成之间的相互作用，研究HA和PAA对滑液流变学和细菌粘附的影响。了解这些相互作用对于优化治疗策略和降低接受粘弹性补充治疗的患者中与生物膜相关感染的风险至关重要。
