HA is a simple linear polysaccharide consisting of repeated saccharides (N–acetylglucosamine, and B–glucuronic acid disaccharide units form the HA polymer), and was historically considered to be an ‘inert’ structural component. At that time, effects on cell behavior and tissue homeostasis were postulated to result from the physicochemical characteristics of HA that provide tissue hydration, expansion, and elasticity
[12][13][14]. Although these physicochemical characteristics of HA are impressive and critical to the homeostasis of organs such as skin
[15][16], the demonstration that HA activates kinase cascades in cultured fibroblasts
[17] and binds to specific cell receptors such as CD44
[18] and RHAMM (HMMR)
[19] provided initial evidence of its signaling properties. HA has since been shown to regulate MAP kinase, PI3 kinase, Hippo, and multiple growth factor signaling networks
[5][20]. The complex functional information provided by this simple linear polymer is due in large part to metabolism-related changes in both its expression level and in its molecular weight. For example, the native newly synthesized HA polymer (defined here as high molecular weight HA, HMW–HA, >500–700 kDa) blunts cell proliferation and migration and is anti-inflammatory as shown by studies demonstrating its functions to suppress an M1 and enhance M2 polarization of macrophages
[21][22]. These properties of HMW–HA are considered important for maintaining tissue architecture and homeostasis, particularly in the skin. In contrast, smaller HA polymers, produced by enzymatic and/or chemical degradation of HMW–HA (e.g., low molecular weight HA, LMW–HA, 10–250 kDa; and oligosaccharides, O–HA, <10 kDa) as a result of cell stress/death, function as ‘danger alerts’ (DAMPs
[23][24]), and are strongly immunogenic. These tissue damage–induced HA oligomers provide pro-inflammatory (e.g., support M1 macrophage polarization), proliferation and migration signals
[5][25][26] (
Figure 1), and are critical for initiating a response-to-injury.