Hyaluronic acid evolution in gynecological practice: from biomechanical properties to receptor-mediated regeneration control

Aesthetic gynecology is a constantly evolving area that is gradually being recognized as a full-fledged area of regenerative medicine, in which the issue of control over biological processes at the tissue level is central. In this context, hyaluronic acid (HA), that occupied the niche of a biomechanical filler over a long time, has undergone a fundamental perceptual shift: from an inert intracellular matrix component to a highly active signaling molecule. Such a paradigm shift from passive substitution to active control over regeneration dictates the need for critical reconsideration of the therapeutic arsenal. In terms of biochemistry, the classical HA-based cross-linked fillers solving the volume adjustment problems demonstrate severe limitations when there is a need for subtle modulation of the cellular microenvironment. Thus, the development of platforms that can not only prolong the HA tissue residence, but also ensure the receptor-specific delivery and controlled release of bioactive ligands, becomes a challenge of modern biomedicine. The review is focused on the evolutionary transition from standard fillers to the fundamentally new class of drugs, biorepair agents, as well as on the scientific substantiation of the targeted conjugation technology as a tool to overcome the existing therapeutic limitations. © 2025, LLC MMA MediaMedika. All rights reserved.