High Molecular Weight Hyaluronic Acid Inhibits Fibrosis of Endometrium

BACKGROUND Elevated fibrosis has been found in patients with intrauterine adhesion, which indicates that fibrotic factors may play a critical role in formation of intrauterine adhesion. The aim of this study was to identify the effect of hyaluronic acid (HA) at high and low molecular weight on fibrosis of the endometrium in a mouse model of Asherman's syndrome. MATERIAL AND METHODS Endometrial fibrosis in a mouse model of Asherman's syndrome was confirmed. Then HA at high and low molecular weight was injected into the uterine cavity. Endometrial fibrosis was compared among the control group, LMW-HA, and HMW-HA group. The extent of endometrial fibrosis was calculated using Masson stain. The fibrosis markers (TGFβ1, CTGF, collagen I, and collagen III) in endometrial tissue were detected using immunohistochemistry and Western blotting. RESULTS The ratio of the area with endometrial fibrosis to total endometrial area in the HMW-HA group was significantly decreased compared to the control group (P<0.05). The expression of fibrosis markers (TGFβ1, CTGF, collagen I, and collagen III) in the endometrium was attenuated in the HMW-HA group compared to the control group, but the LMW-HA group had no similar effect. CONCLUSIONS Hyaluronic acid at high molecular weight may attenuate the degree of endometrial fibrosis after endometrial damage, which may contribute to preventing formation of intrauterine adhesions.