Low-molecular-weight hyaluronic acid improves regeneration of cystic fibrosis airway epithelium

Background: Cystic fibrosis is characterised by defective mucociliary clearance, chronic lung infection and exaggerated neutrophilic inflammation. Airway epithelium damage and remodelling affect lung defence functions and are therefore important components of lung pathology progression in cystic fibrosis. Identifying compounds that favour mucociliary clearance by improving airway epithelial structure and regeneration is therefore crucial for patients with cystic fibrosis. Materials and methods: Using air-liquid interface culture of human airway epithelial cells obtained from patients with cystic fibrosis, we examined the influence of low-molecular-weight hyaluronic acid (LMW-HA) (∼40 kDa) on the regeneration and remodelling of cystic fibrosis human airway epithelial cells. Results: Our results show that LMW-HA normalises cystic fibrosis epithelial regeneration, even in an inflamed environment, by preventing remodelling in terms of epithelial height and basal cell hyperplasia, by avoiding inflammation-related goblet cell hyperplasia and by stimulating multiciliated cell differentiation. Because remodelling is mainly due to either intrinsic inflammation of cystic fibrosis human airway epithelial cells or an extrinsic inflammatory environment, we examined the impact of LMW‑HA on epithelial interleukin 8 pro-inflammatory chemokine and found that it exerts an anti-inflammatory effect, evidenced by reduced epithelial interleukin 8 expression and secretion. Conclusion: We report here that LMW-HA prevents cystic fibrosis human airway epithelial cell remodelling and normalises its cell structure, probably through the epithelial cell inflammatory phenotype modulation, and improves multiciliated cell differentiation by a mechanism that is independent of its anti-inflammatory effect. These results demonstrate that LMW-HA should be considered as a therapeutic candidate for the treatment of cystic fibrosis lung disease.