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Yang YZ, Cheng QH, Zhang AR, Qiu Y, Guo HZ. Progress in the treatment of Osteoarthritis with avocado-soybean unsaponifiable. Inflammopharmacology 2024; 32:2177-2184. [PMID: 38814416 DOI: 10.1007/s10787-024-01496-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 03/30/2024] [Indexed: 05/31/2024]
Abstract
Osteoarthritis (OA) is one of the leading causes of joint dysfunction and disability in the elderly, posing serious social problems and a huge socio-economic burden. Existing pharmacological treatments have significant drawbacks, and searching for an effective pharmacological intervention is an urgent priority. Recent studies have demonstrated the chondroprotective, anabolic, and anti-catabolic properties of avocado-soybean unsaponifiable (ASU), a natural plant extract made from avocado and soybean oils, consisting of the remainder of the saponified portion of the product that cannot be made into soap. The main components of ASU are phytosterols, beta-sitosterol, canola stanols, and soya stanols, which are rapidly incorporated into cells. Studies have confirmed the anti-inflammatory, antioxidant, and analgesic properties of phytosterols. ASU slows down the progression of OA primarily by inhibiting pathways involved in the development of OA disease. ASU prevents cartilage degradation by inhibiting the release and activity of matrix metalloproteinases and by increasing the tissue inhibition of these catabolic enzymes; ASU is also involved in the inhibition of the activation of nuclear factor κB (NF-κB) which is a transcriptional inhibitor that regulates the inflammatory response of chondrocytes. NF-κB is a transcription factor that regulates the inflammatory response of chondrocytes, and inhibition of the transfer of the transcription factor NF-κB from the cytoplasm to the nucleus regulates the transcription of many pro-inflammatory factors. By appealing to the mechanism of action and thus achieving anti-inflammatory, anti-catabolic, and pro-synthetic effects on cartilage tissues, AUS is clinically responsive to the reduction of acute pain and OA symptom progression. This paper aims to summarize the studies on the use of avocado-soybean unsaponifiable in the pharmacological treatment of osteoarticular.
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Affiliation(s)
- Yong-Ze Yang
- First Clinical Medical College of Gansu, University of Traditional Chinese Medicine, Lanzhou, China
- People's Hospital of Gansu Province, 204 Donggang West Road, Chengguan District, Lanzhou, 730000, China
| | - Qing-Hao Cheng
- People's Hospital of Gansu Province, 204 Donggang West Road, Chengguan District, Lanzhou, 730000, China
| | - An-Ren Zhang
- First Clinical Medical College of Gansu, University of Traditional Chinese Medicine, Lanzhou, China
- People's Hospital of Gansu Province, 204 Donggang West Road, Chengguan District, Lanzhou, 730000, China
| | - Yi Qiu
- Harbin Medical University, Harbin, 150000, Heilongjiang, China
| | - Hong-Zhang Guo
- People's Hospital of Gansu Province, 204 Donggang West Road, Chengguan District, Lanzhou, 730000, China.
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Chevalier X, Sheehan B. Predictors of Clinical Benefit with Intra-articular Hyaluronic Acid in Patients with Knee Osteoarthritis - A Narrative Review. Curr Rheumatol Rev 2024; 20:379-387. [PMID: 38243964 PMCID: PMC11275314 DOI: 10.2174/0115733971274662240108074038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/21/2023] [Accepted: 12/13/2023] [Indexed: 01/22/2024]
Abstract
BACKGROUND There is conflicting evidence regarding the efficacy of viscosupplementation with intra-articular hyaluronic acid injections in knee osteoarthritis. One possible explanation for the inconsistent findings on its efficacy is that only certain subpopulations of patients benefit from this therapy. OBJECTIVE The purpose of this narrative review is to succinctly summarize the existing data on the predictive factors of clinical response to intra-articular hyaluronic acid to identify the patient profile most likely to benefit from this therapy. METHODS For this narrative review, a PubMed search was conducted in January 2023, with no date limits, to identify publications reporting predictive factors of response to viscosupplementation using the following terms: hyaluronic acid OR viscosupplem* AND osteoarthritis AND knee AND predict*. Searches were limited to randomized controlled trials, systematic reviews and meta- analyses, or observational studies written in English. Other relevant references were identified by searching the references of retrieved articles. RESULTS The disease severity was found to reliably predict response to intra-articular hyaluronic acid injections; patients with less severe disease consistently had a more robust therapeutic response than those with more severe disease. Other clinical variables such as level of baseline pain did not reliably predict response. Body mass index, and possibly age, may also be independent predictors of the response. CONCLUSION A review of the existing literature suggests that patients with less severe clinical symptoms and radiological findings, who are younger, and with a lower or normal body mass index are the best candidates for intra-articular hyaluronic acid therapy.
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Affiliation(s)
- Xavier Chevalier
- Department of Rheumatology, Hôpital Henri-Mondor, Université Paris X11, Créteil, France
| | - Brendan Sheehan
- Department of Orthopaedic Surgery, Dalhousie University (Halifax), Saint John, NB, Canada
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Xue Y, Zhou L, Wang J. Classification of distinct osteoarthritis subtypes with different knee joint tissues by gene expression profiles. Bone Joint Res 2023; 12:702-711. [PMID: 38035595 PMCID: PMC10689063 DOI: 10.1302/2046-3758.1212.bjr-2023-0021.r2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2023] Open
Abstract
Aims Knee osteoarthritis (OA) involves a variety of tissues in the joint. Gene expression profiles in different tissues are of great importance in order to understand OA. Methods First, we obtained gene expression profiles of cartilage, synovium, subchondral bone, and meniscus from the Gene Expression Omnibus (GEO). Several datasets were standardized by merging and removing batch effects. Then, we used unsupervised clustering to divide OA into three subtypes. The gene ontology and pathway enrichment of three subtypes were analyzed. CIBERSORT was used to evaluate the infiltration of immune cells in different subtypes. Finally, OA-related genes were obtained from the Molecular Signatures Database for validation, and diagnostic markers were screened according to clinical characteristics. Quantitative reverse transcription polymerase chain reaction (qRT-PCR) was used to verify the effectiveness of markers. Results C1 subtype is mainly concentrated in the development of skeletal muscle organs, C2 lies in metabolic process and immune response, and C3 in pyroptosis and cell death process. Therefore, we divided OA into three subtypes: bone remodelling subtype (C1), immune metabolism subtype (C2), and cartilage degradation subtype (C3). The number of macrophage M0 and activated mast cells of C2 subtype was significantly higher than those of the other two subtypes. COL2A1 has significant differences in different subtypes. The expression of COL2A1 is related to age, and trafficking protein particle complex subunit 2 is related to the sex of OA patients. Conclusion This study linked different tissues with gene expression profiles, revealing different molecular subtypes of patients with knee OA. The relationship between clinical characteristics and OA-related genes was also studied, which provides a new concept for the diagnosis and treatment of OA.
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Affiliation(s)
- Yuan Xue
- Department of Orthopaedic, Wuxi Ninth People’s Hospital of Soochow University, Wuxi, China
| | - Liang Zhou
- Department of Orthopaedic, Lianshui County People’s Hospital, Huai‘an, China
| | - Jiaqian Wang
- Department of Orthopaedic, Zhongshan Hospital, Fudan University, Shanghai, China
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Jerosch J. [Conservative treatment options for arthritis of the ankle : What is possible, what is effective?]. Unfallchirurg 2022; 125:175-182. [PMID: 35041020 DOI: 10.1007/s00113-021-01122-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2021] [Indexed: 11/26/2022]
Abstract
In this article the causes of arthritis in the region of the ankle are introduced and the conservative treatment options are described and discussed more extensively. The risks of treatment with nonopioid analgesics (NOPA) are presented in detail. The topical use of nonsteroidal anti-inflammatory drugs (NSAID) should always be considered in the clinical routine. If contraindications for oral NSAIDs are present, intra-articular treatment is a meaningful option. The best evidence is currently available for viscosupplementation but the study situation for the use of platelet-rich plasma (PRP) is still not sufficiently comprehensive and there are only a few case reports on the use of mesenchymal stem cells..
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Affiliation(s)
- Jörg Jerosch
- Medizinisches Wissenschafts- und Gutachten-Institut Meerbusch (WGI) Meerbusch, Grabenstr. 11, 40667, Meerbusch, Deutschland.
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Shi L, Xu X, Meng B, He K, Sun Y, Tong J, Xu J, Cheng Y, Gan G, Xiang G. Neuregulin 4 Attenuates Osteoarthritis Progression by Inhibiting Inflammation and Apoptosis of Chondrocytes in Mice. Calcif Tissue Int 2022; 110:131-142. [PMID: 34383111 DOI: 10.1007/s00223-021-00897-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 07/28/2021] [Indexed: 10/20/2022]
Abstract
Osteoarthritis (OA) is characterized by chondrocyte apoptosis and increased degradation of type II collagen. Inflammation is one of the major risk factors involved in the pathophysiology of OA. Neuregulin 4 (Nrg4) plays a protective role in a variety of low-level inflammatory diseases, such as non-alcoholic fatty liver disease, inflammatory bowel disease, or type 2 diabetes mellitus. Here we found that (1) Nrg4 deficiency aggravated the destruction and inflammation of articular cartilage and the apoptosis of chondrocytes in vivo. (2) Nrg4 restoration reversed these changes in vivo. (3) Murine recombinant Nrg4 (rNrg4) suppressed inflammation and apoptosis of chondrocytes and decreased the degradation of extracellular matrix in vitro. (4) Mechanistically, the mitogen-activated protein kinase/c-jun N-terminal kinase (MAPK/JNK) signaling pathway may be involved in the regulation of Nrg4 in the pathophysiology of OA. Therefore, we concluded that Nrg4 alleviated the progression of OA by inhibiting the inflammation, protecting against apoptosis of chondrocyte, and decreasing the degradation of extracellular matrix in a manner involving MAPK/JNK signaling.
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Affiliation(s)
- Lingfeng Shi
- The First School of Clinical Medicine, Southern Medical University, No.1023, South Shatai Road, Baiyun District, Guangzhou, 510515, Guangdong, China
| | - Xiaoli Xu
- The First School of Clinical Medicine, Southern Medical University, No.1023, South Shatai Road, Baiyun District, Guangzhou, 510515, Guangdong, China
- Department of Endocrinology, General Hospital of Central Theater Command, Wuluo Road 627, Wuhan, 430070, Hubei Province, China
| | - Biying Meng
- Department of Endocrinology, General Hospital of Central Theater Command, Wuluo Road 627, Wuhan, 430070, Hubei Province, China
| | - Kaiyue He
- The First School of Clinical Medicine, Southern Medical University, No.1023, South Shatai Road, Baiyun District, Guangzhou, 510515, Guangdong, China
| | - Yin Sun
- Department of Endocrinology, General Hospital of Central Theater Command, Wuluo Road 627, Wuhan, 430070, Hubei Province, China
| | - Jiayue Tong
- The First School of Clinical Medicine, Southern Medical University, No.1023, South Shatai Road, Baiyun District, Guangzhou, 510515, Guangdong, China
| | - Jinling Xu
- The First School of Clinical Medicine, Southern Medical University, No.1023, South Shatai Road, Baiyun District, Guangzhou, 510515, Guangdong, China
| | - Yangyang Cheng
- Department of Endocrinology, General Hospital of Central Theater Command, Wuluo Road 627, Wuhan, 430070, Hubei Province, China
| | - Guosheng Gan
- The First School of Clinical Medicine, Southern Medical University, No.1023, South Shatai Road, Baiyun District, Guangzhou, 510515, Guangdong, China.
- General Hospital of Central Theater Command, Wuluo Road 627, Wuhan, 430070, Hubei Province, China.
| | - Guangda Xiang
- The First School of Clinical Medicine, Southern Medical University, No.1023, South Shatai Road, Baiyun District, Guangzhou, 510515, Guangdong, China.
- Department of Endocrinology, General Hospital of Central Theater Command, Wuluo Road 627, Wuhan, 430070, Hubei Province, China.
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Effect of Intra-Articular Injection of Platelet-Rich Plasma on the Serum Levels of Osteoarthritic Biomarkers in Patients with Unilateral Knee Osteoarthritis. J Clin Med 2021; 10:jcm10245801. [PMID: 34945097 PMCID: PMC8706559 DOI: 10.3390/jcm10245801] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/08/2021] [Accepted: 12/10/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The aim of this study is to determine the effect of three doses of intra-articular injection of platelet-rich plasma (PRP) into the osteoarthritic (OA) knee joint on the functional status and on the changes in the levels of specific OA biomarkers in blood serum. METHODS Forty patients with unilateral primary knee osteoarthritis were enrolled in this single center, prospective clinical trial. For each patient, three intra-articular PRP injections were administered one week apart. Clinical and laboratory assessment was performed before the first PRP injection (baseline), and 3 months after the third PRP application (3-month follow up). Pain in the affected knee joint was assessed with the Visual Analog Scale for Pain (VAS). Change in clinical status was evaluated with the Western Ontario and McMaster Universities Arthritis Index Questionnaire (WOMAC). Concentrations of 19 biomarkers (EGF, Eotaxin, FGF-2, GRO, IL-10, IL-1RA, IL-8, IP-10, MCP-1, PDGF-AB/BB, RANTES, MMP-3, MMP-13, Collagen type 2, BMP-2, TIMP-1, TIMP-2, TGF beta 1, and COMP) in the serum of studied patients were quantified. RESULTS At 3-month follow up, there was a significant decrease in the VAS score and significant improvement in the WOMAC score. There was a significant decrease in the levels of Eotaxin, MCP-1, MMP-1, IL-10, EGF, PDGF-AB/BB, TGF- β1 compared to baseline levels. A significant increase in markers BMP-2, COMP, Collagen type 2 and GRO was found at the same time point. There was no significant change in the concentrations of other biomarkers (FGF-2, IL-1RA, IL-8, IL-10, MMP-3, RANTES, TIMP-1, TIMP-3). CONCLUSIONS We found an increase in specific pro-anabolic and anti-inflammatory biomarkers with a concomitant decrease in pro-inflammatory biomarkers at 3 months after three intra-articular applications of PRP. Significant improvement in VAS and WOMAC scores was observed. Treatment with PRP may be an effective therapeutic option with anti-inflammatory and regenerative potential in patients with primary knee OA.
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Hick AC, Fonck M, Costes B, Cobraiville E, Pirson S, Garcia L, Labasse A, Vander Poelen S, Henrotin Y. Serum Levels of Coll2-1, a Specific Biomarker of Cartilage Degradation, Are Not Affected by Sampling Conditions, Circadian Rhythm, and Seasonality. Cartilage 2021; 13:540S-549S. [PMID: 31631693 PMCID: PMC8808846 DOI: 10.1177/1947603519878489] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To assess intraindividual biological variability of serum cartilage specific biomarker Coll2-1 and define the best standardized conditions for blood sampling. DESIGN Blood samples were taken from 116 subjects with knee osteoarthritis (OA) at a single time point (PRODIGE study) and from 15 healthy subjects under various conditions, including fasting condition, sampling time and season, blood treatment, and type of blood collection tube (COVAR study). Type II collagen-specific biomarker Coll2-1 was directly measured in serum using an immunoassay. RESULTS There was no significant difference on Coll2-1 values between samples collected at any of the 5 sampling times or at any of the sampling days measured. None of the sampling parameters tested had a significant impact on Coll2-1 value (clotting time, clotting temperature and temperature of blood centrifugation, type of tube). On the contrary, differences were found in between subjects and between subjects with knee OA and healthy subjects. CONCLUSION Coll2-1 measurement is not affected by sampling specific conditions, circadian rhythm or seasons but was found elevated in subject with knee OA indicating that Coll2-1 serum variation is not linked to the study environment, but to cartilage degradation in OA. Coll2-1 assay is sufficiently robust for use in OA clinical trials.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Yves Henrotin
- ARTIALIS SA, Liège, Belgium,Bone and Cartilage Research Unit,
Arthropole Liège, University of Liège, Liège, Belgium,Yves Henrotin, ARTIALIS SA, 11 avenue de
l’hôpital, GIGA Tower, level 3, CHU Sart-Tilman, Liège, 4000, Belgium.
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Hick AC, Malaise M, Loeuille D, Conrozier T, Maugars Y, Pelousse F, Tits C, Henrotin Y. Cartilage Biomarkers Coll2-1 and Coll2-1NO2 Are Associated with Knee OA MRI Features and Are Helpful in Identifying Patients at Risk of Disease Worsening. Cartilage 2021; 13:1637S-1647S. [PMID: 34128409 PMCID: PMC8808823 DOI: 10.1177/19476035211021892] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess the cross-sectional association between serum levels of Coll2-1 and Coll2-1NO2, two cartilage degradation biomarkers; the burden of magnetic resonance imaging (MRI) features and clinical outcomes; and to evaluate the predictive value of these biomarkers on progression. DESIGN A total of 121 subjects with knee osteoarthritis (OA) were followed during 1 year with pain, function, and MRI assessment (PRODIGE study). Type II collagen-specific biomarker Coll2-1 and its nitrated form Coll2-1NO2 were directly measured in serum using immunoassays at baseline and after 3-, 6-, and 12-month follow-up. RESULTS Serum Coll2-1 and Coll2-1NO2 were correlated with several baseline knee features quantified with Whole-Organ Magnetic Resonance Imaging Score (WORMS). Coll2-1 was significantly correlated with periarticular cysts/bursitis (ρ = 0.29, P < 0.01), subarticular bone attrition (ρ = 0.25, P = 0.01), subarticular cysts (ρ = 0.24, P = 0.02), and articular cartilage integrity (ρ = 0.23, P = 0.03) WORMS subscores for the whole joint as well as with the medial femorotibial joint sum score (ρ = 0.26, P = 0.01) and medial femorotibial joint cartilage (ρ = 0.23, P = 0.02). Coll2-1NO2 correlated with WORMS total score (ρ = 0.23, P = 0.02), WORMS scores in the patellofemoral (ρ = 0.23, P = 0.02) and medial femorotibial compartments (ρ = 0.21, P = 0.03), with osteophytes scores (ρ = 0.27, P < 0.01), subarticular cysts (ρ = 0.24, P = 0.019), and intraarticular loose bodies (ρ = 0.27, P = 0.007). Baseline Coll2-1NO2 was higher in subjects with a pain worsening (426.4 pg/mL [278.04-566.95]) as compared to non-progressors (306.84 pg/mL [200.37-427.84]) over 1 year (AUC = 0.655, P = 0.015). CONCLUSION Serum cartilage biomarkers Coll2-1 and Coll2-1NO2 are associated with several knee OA features quantified with WORMS. Our study also shows that the baseline value of Coll2-1NO2 is positively associated with pain worsening.
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Affiliation(s)
| | - Michel Malaise
- Department of Rheumatology, CHU Sart
Tilman, University of Liège, Liège, Belgium
| | - Damien Loeuille
- Department of Rheumatology, University
Hospital of Nancy, Vandœuvre-lès-Nancy, France
- UMR 7365 CNRS-Université de Lorraine
IMoPA, Biopôle de l’Université de Lorraine, Campus Brabois-Santé,
Vandoeuvre-Lès-Nancy, France
| | - Thierry Conrozier
- Department of Rheumatology, Hôpital
Nord Franche-Comté, Belfort, France
| | - Yves Maugars
- Service de rhumatologie, Hôtel-Dieu,
CHU de Nantes, France
| | - Franz Pelousse
- SODIRAY, Solution Diagnostique
Radiologique, Liège, Belgium
| | | | - Yves Henrotin
- ARTIALIS SA, CHU Sart-Tilman, Liège,
Belgium
- Bone and Cartilage Research Unit,
Arthropole Liège, Center for Interdisciplinary Research on Medicines (CIRM),
University of Liège, CHU Sart-Tilman, Liège, Belgium
- Physical Therapy and Rehabilitation
Department, Princess Paola Hospital, Vivalia, Marche-en-Famenne, Belgium
- Yves Henrotin, ARTIALIS SA, 11 avenue de
l’hôpital, GIGA Tower, Level 3, CHU Sart-Tilman, 4000 Liège, Belgium.
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Henrotin Y, Patrier S, Pralus A, Roche M, Nivoliez A. Protective Actions of Oral Administration of Bifidobacterium longum CBi0703 in Spontaneous Osteoarthritis in Dunkin Hartley Guinea Pig Model. Cartilage 2021; 13:1204S-1213S. [PMID: 30982336 PMCID: PMC8804838 DOI: 10.1177/1947603519841674] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the effects of a lyophilized inactivated culture (LIC) from Bifidobacterium longum CBi0703 in a spontaneous model of osteoarthritis (OA) in Dunkin Hartley guinea pigs. Histology of cartilage and synovial membrane was the primary outcome. Biomarkers were also considered to evaluate the treatment efficacy. DESIGN LIC (1 µg/kg) with or without vitamin C (1 mg/kg) were tested in Dunkin Hartley guinea pigs spontaneously developing OA and compared with control (sterile water; CTL). Treatment was initiated orally in 16-week-old animals over a period of 12 weeks. Histological lesions of articular cartilage and synovial membrane were scored according to the OARSI (Osteoarthritis Research Society International) recommendations. Four biomarkers (Coll2-1, PIINAP, Fib3-2, and osteocalcin) were measured in animal sera. RESULTS The global OARSI score increased with time in all group but no significant difference between groups was observed. When score items were analyzed individually, a significant lower score of cartilage structure was observed in the LIC + vitamin C group compared with CTL (P < 0.0001). Synovial membrane showed a mild inflammatory reaction that was not affected by the treatment. LIC significantly decreased serum levels of Coll2-1 (P = 0.0004 vs. CTL), a marker of type II collagen degradation and LIC + vitamin C significantly increased PIINAP (P = 0.0003), a marker of type II collagen synthesis. The ratio Coll2-1/PIINAP was significantly decreased in both LIC groups (P < 0.001). CONCLUSION Lyophilized inactivated culture of B. longum CBi0703 administrated orally over a period of 12 weeks decreased cartilage structure lesions and decreased type II collagen degradation suggesting a potential prophylactic effect on OA development.
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Affiliation(s)
- Yves Henrotin
- Bone and Cartilage Research Unit,
Arthropôle Liège, University of Liège, CHU Sart-Tilman, Belgium,D-BOARD Consortium, A European Committee
FP7 project, University of Surrey, UK,Artialis SA, Tour GIGA, CHU Sart-Tilman,
Liège, Belgium,Physical Therapy and Rehabilitation
Department, Princess Paola Hospital, Vivalia, Marche-en-Famenne, Belgium,Yves Henrotin, Bone and Cartilage Research
Unit, Institute of pathology, level 5, CHU Sart-Tilman, Liège, 4000, Belgium.
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Effect of Resveratrol on Serum Levels of Type II Collagen and Aggrecan in Patients with Knee Osteoarthritis: A Pilot Clinical Study. BIOMED RESEARCH INTERNATIONAL 2021; 2021:3668568. [PMID: 34805399 PMCID: PMC8601845 DOI: 10.1155/2021/3668568] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 10/15/2021] [Indexed: 12/04/2022]
Abstract
Treatment of knee osteoarthritis (OA) remains a challenging concern. Preclinical studies provided accumulating evidence on resveratrol efficacy in ameliorating degenerative articular damage. The present study was conducted to evaluate the effects of resveratrol as monotherapy on the serum level of type II collagen (Coll 2-1) and aggrecan in patients with knee osteoarthritis. The study was an open-labeled noncontrolled clinical trial. Resveratrol 500 mg/day in a single oral dose was given to the patients with knee osteoarthritis for 90 days. The serum levels of Coll-2-1, aggrecan, and biomarkers of inflammation were measured pre- and posttreatment. Hematological profiles and both hepatic and renal function markers were investigated at the baseline and at the end of the treatment for evaluating the tolerability and safety of resveratrol. Visual Analog Scale (VAS) for pain and Knee injury and Osteoarthritis Outcome Score (KOOS) for disease activity were clinically assessed monthly. Administration of 500 mg resveratrol for three months led to a nonsignificant decrease in the serum level of Coll 2-1 while a significant increase in aggrecan serum level. Resveratrol significantly improves pain score measured by VAS and KOOS after 30 days. Improvements in patients' activity and functional status were also evident at day 30 and kept on for three months which was reflected by KOOS subscale scores and with a significant improvement in all KOOS areas. In conclusion, oral administration of resveratrol as a monotherapy provides a remarkable improvement in the clinical status of the patients but has no significant effect on serum levels of Coll 2-1.
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Lv Z, Yang YX, Li J, Fei Y, Guo H, Sun Z, Lu J, Xu X, Jiang Q, Ikegawa S, Shi D. Molecular Classification of Knee Osteoarthritis. Front Cell Dev Biol 2021; 9:725568. [PMID: 34513847 PMCID: PMC8429960 DOI: 10.3389/fcell.2021.725568] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 08/09/2021] [Indexed: 01/15/2023] Open
Abstract
Knee osteoarthritis (KOA) is the most common form of joint degeneration with increasing prevalence and incidence in recent decades. KOA is a molecular disorder characterized by the interplay of numerous molecules, a considerable number of which can be detected in body fluids, including synovial fluid, urine, and blood. However, the current diagnosis and treatment of KOA mainly rely on clinical and imaging manifestations, neglecting its molecular pathophysiology. The mismatch between participants' molecular characteristics and drug therapeutic mechanisms might explain the failure of some disease-modifying drugs in clinical trials. Hence, according to the temporal alteration of representative molecules, we propose a novel molecular classification of KOA divided into pre-KOA, early KOA, progressive KOA, and end-stage KOA. Then, progressive KOA is furtherly divided into four subtypes as cartilage degradation-driven, bone remodeling-driven, inflammation-driven, and pain-driven subtype, based on the major pathophysiology in patient clusters. Multiple clinical findings of representatively investigated molecules in recent years will be reviewed and categorized. This molecular classification allows for the prediction of high-risk KOA individuals, the diagnosis of early KOA patients, the assessment of therapeutic efficacy, and in particular, the selection of homogenous patients who may benefit most from the appropriate therapeutic agents.
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Affiliation(s)
- Zhongyang Lv
- State Key Laboratory of Pharmaceutical Biotechnology, Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Yannick Xiaofan Yang
- State Key Laboratory of Pharmaceutical Biotechnology, Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Jiawei Li
- State Key Laboratory of Pharmaceutical Biotechnology, Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Yuxiang Fei
- State Key Laboratory of Pharmaceutical Biotechnology, Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Hu Guo
- State Key Laboratory of Pharmaceutical Biotechnology, Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Ziying Sun
- State Key Laboratory of Pharmaceutical Biotechnology, Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Jun Lu
- State Key Laboratory of Pharmaceutical Biotechnology, Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Xingquan Xu
- State Key Laboratory of Pharmaceutical Biotechnology, Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Qing Jiang
- State Key Laboratory of Pharmaceutical Biotechnology, Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Shiro Ikegawa
- Laboratory for Bone and Joint Diseases, RIKEN Center for Integrative Medical Science (IMS, RIKEN), Tokyo, Japan
| | - Dongquan Shi
- State Key Laboratory of Pharmaceutical Biotechnology, Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
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12
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Kumavat R, Kumar V, Malhotra R, Pandit H, Jones E, Ponchel F, Biswas S. Biomarkers of Joint Damage in Osteoarthritis: Current Status and Future Directions. Mediators Inflamm 2021; 2021:5574582. [PMID: 33776572 PMCID: PMC7969115 DOI: 10.1155/2021/5574582] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/22/2021] [Accepted: 02/25/2021] [Indexed: 12/25/2022] Open
Abstract
Osteoarthritis (OA) is a disease of the whole joint organ, characterized by the loss of cartilage, and structural changes in bone including the formation of osteophytes, causing disability and loss of function. It is also associated with systemic mediators and low-grade inflammation. Currently, there is negligible/no availability of specific biomarkers that can be used to facilitate the diagnosis and treatment of OA. The most unmet clinical need is, however, related to the monitoring of disease progression over a short period that can be used in clinical trials. In this review, the value of biomarkers identified over the past decade has been highlighted. These biomarkers are associated with the synthesis and breakdown of cartilage, including collagenous and noncollagenous biomarkers, inflammatory and anti-inflammatory biomarkers, expressed in the biological fluid such as serum, synovial fluid, and urine. Broad validation of novel and clinically applicable biomarkers and their involvement in the pathways are particularly needed for early-stage diagnosis, monitoring disease progression, and severity and examining new drugs to mitigate the effects of this highly prevalent and debilitating condition.
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Affiliation(s)
- Rajkamal Kumavat
- Department of Integrative and Functional Biology, CSIR-Institute of Genomics & Integrative Biology, Mall Road, -110007, Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad 201002, India
| | - Vijay Kumar
- All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Rajesh Malhotra
- All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Hemant Pandit
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, The University of Leeds, Leeds, UK
| | - Elena Jones
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, The University of Leeds, Leeds, UK
| | - Frederique Ponchel
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, The University of Leeds, Leeds, UK
| | - Sagarika Biswas
- Department of Integrative and Functional Biology, CSIR-Institute of Genomics & Integrative Biology, Mall Road, -110007, Delhi, India
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13
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Bernotiene E, Bagdonas E, Kirdaite G, Bernotas P, Kalvaityte U, Uzieliene I, Thudium CS, Hannula H, Lorite GS, Dvir-Ginzberg M, Guermazi A, Mobasheri A. Emerging Technologies and Platforms for the Immunodetection of Multiple Biochemical Markers in Osteoarthritis Research and Therapy. Front Med (Lausanne) 2020; 7:572977. [PMID: 33195320 PMCID: PMC7609858 DOI: 10.3389/fmed.2020.572977] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 08/31/2020] [Indexed: 12/12/2022] Open
Abstract
Biomarkers, especially biochemical markers, are important in osteoarthritis (OA) research, clinical trials, and drug development and have potential for more extensive use in therapeutic monitoring. However, they have not yet had any significant impact on disease diagnosis and follow-up in a clinical context. Nevertheless, the development of immunoassays for the detection and measurement of biochemical markers in OA research and therapy is an active area of research and development. The evaluation of biochemical markers representing low-grade inflammation or extracellular matrix turnover may permit OA prognosis and expedite the development of personalized treatment tailored to fit particular disease severities. However, currently detection methods have failed to overcome specific hurdles such as low biochemical marker concentrations, patient-specific variation, and limited utility of single biochemical markers for definitive characterization of disease status. These challenges require new and innovative approaches for development of detection and quantification systems that incorporate clinically relevant biochemical marker panels. Emerging platforms and technologies that are already on the way to implementation in routine diagnostics and monitoring of other diseases could potentially serve as good technological and strategic examples for better assessment of OA. State-of-the-art technologies such as advanced multiplex assays, enhanced immunoassays, and biosensors ensure simultaneous screening of a range of biochemical marker targets, the expansion of detection limits, low costs, and rapid analysis. This paper explores the implementation of such technologies in OA research and therapy. Application of novel immunoassay-based technologies may shed light on poorly understood mechanisms in disease pathogenesis and lead to the development of clinically relevant biochemical marker panels. More sensitive and specific biochemical marker immunodetection will complement imaging biomarkers and ensure evidence-based comparisons of intervention efficacy. We discuss the challenges hindering the development, testing, and implementation of new OA biochemical marker assays utilizing emerging multiplexing technologies and biosensors.
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Affiliation(s)
- Eiva Bernotiene
- Department of Regenerative Medicine, State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania
| | - Edvardas Bagdonas
- Department of Regenerative Medicine, State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania
| | - Gailute Kirdaite
- Department of Experimental, Preventive and Clinical Medicine, State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania
| | - Paulius Bernotas
- Department of Regenerative Medicine, State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania
| | - Ursule Kalvaityte
- Department of Regenerative Medicine, State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania
| | - Ilona Uzieliene
- Department of Regenerative Medicine, State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania
| | | | - Heidi Hannula
- Microelectronics Research Unit, Faculty of Information Technology and Electrical Engineering, University of Oulu, Oulu, Finland
| | - Gabriela S. Lorite
- Microelectronics Research Unit, Faculty of Information Technology and Electrical Engineering, University of Oulu, Oulu, Finland
| | - Mona Dvir-Ginzberg
- Laboratory of Cartilage Biology, Institute of Dental Sciences, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ali Guermazi
- Department of Radiology, Veterans Affairs Boston Healthcare System, Boston University School of Medicine, Boston, MA, United States
| | - Ali Mobasheri
- Department of Regenerative Medicine, State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
- Departments of Orthopedics, Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, Netherlands
- Centre for Sport, Exercise and Osteoarthritis Versus Arthritis, Queen's Medical Centre, Nottingham, United Kingdom
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14
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Migliore A, Paoletta M, Moretti A, Liguori S, Iolascon G. The perspectives of intra-articular therapy in the management of osteoarthritis. Expert Opin Drug Deliv 2020; 17:1213-1226. [PMID: 32543240 DOI: 10.1080/17425247.2020.1783234] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Management of Osteoarthritis (OA) still is a challenge for clinicians. Taking into account a multidisciplinary approach including pharmacological and non-pharmacological treatments, intra-articular (IA) injection could be considered as an effective local therapy. Areas covered This review provides a new perspective of IA treatment going beyond current available IA agents. We describe novel biological targets for developing new IA agents and innovative modalities of delivery systems. Additional topics include predictors of response for a better choice of IA agents for each patient, diagnostic and prognostic role of biomarkers, accuracy of IA injection, and cost-effectiveness of IA injection. Expert opinion IA treatments seem to be very promising for the management of OA. Identifying clinical and biochemical predictive factors could drive clinician to the appropriate therapeutic approach. To date, there is a gap regarding the benefit of IA treatments in the 'real practice' once they have been adopted. However, considering these promising effects of IA approach, several open questions remain not clarified.
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Affiliation(s)
| | - Marco Paoletta
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli" , Naples, Italy
| | - Antimo Moretti
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli" , Naples, Italy
| | - Sara Liguori
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli" , Naples, Italy
| | - Giovanni Iolascon
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli" , Naples, Italy
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15
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Henrotin Y, Chevalier X, Raman R, Richette P, Montfort J, Jerosch J, Baron D, Bard H, Carrillon Y, Migliore A, Conrozier T. EUROVISCO Guidelines for the Design and Conduct of Clinical Trials Assessing the Disease-Modifying Effect of Knee Viscosupplementation. Cartilage 2020; 11:60-70. [PMID: 29972025 PMCID: PMC6921954 DOI: 10.1177/1947603518783521] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES Hyaluronic acid viscosupplementation is a commonly used intra-articular treatment for osteoarthritis (OA). Some recent preclinical and clinical trials have demonstrated a potential for its disease-modifying effects. The goal of this expert opinion, consensus-driven exercise is to provide guidelines for the design and conduct of clinical trials assessing the disease-modifying effect of viscosupplementation in the knee. METHODS The EUROVISCO group constitutes 10 members who had expertise in clinical research methodology in the field of OA and viscosupplementation. They initially drafted issues through an iterative process and had to vote on their degree of agreement on these recommendations. The scores were pooled to generate a median agreement score for each recommendation. RESULTS The document includes 31 recommendations regarding study population, imaging, clinical and biological assessment of disease-modifying effects of viscosupplementation. Agreements were reached on some recommendations. In particular, the experts reached unanimous agreement on double-blind study design, imaging primary outcomes, time interval between 2 radiographs, x-ray procedure standardization, and the combined use of imaging and biological markers. The group did not recommend the use of ultrasonography, computed tomography (CT) scan and CT arthrography as a tool for OA diagnosis or to assess progression over time. CONCLUSION In summary, the working group identified 31 recommendations that represent the current best practices regarding clinical trials that target the assessment of viscosupplementation disease-modifying effects in patients with knee OA. These recommendations integrate new imaging technologies and soluble biomarkers.
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Affiliation(s)
- Yves Henrotin
- Bone and Cartilage Research Unit,
Université de Liège, Liège, Belgium
| | - Xavier Chevalier
- Paris XII University, UPEC, Department
of Rheumatology, Henri Mondor Hospital, Creteil, France
| | - Raghu Raman
- Academic Department of Orthopaedics,
Hull and East Yorkshire NHS Trust, Castle Hill Hospital, Cottingham, UK
| | - Pascal Richette
- Université Paris Diderot, UFR Médicale,
Hôpital Lariboisière, Paris, France
| | - Jordi Montfort
- Servei de Reumatologia, Hospital del
Mar, Parc de Salut Mar, Barcelona, Catalonia, Spain
| | - Jörg Jerosch
- Orthopedic Department,
Johanna-Etienne-Hospital, Neuss, Nordrhein-Westfalen, Germany
| | - Dominique Baron
- Centre de réadaptation fonctionnelle de
Lannion-Trestel, Trévou-Tréguignec, France
| | - Hervé Bard
- Department of Rheumatology, Hôpital
Européen Georges-Pompidou, Paris, France
| | | | - Alberto Migliore
- U.O.S. of Rheumatology, Ospedale San
Pietro Fatebenefratelli, Rome, Italy
| | - Thierry Conrozier
- Department of Rheumatology, Hôpital
Nord Franche-Comté, Belfort, France
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16
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Mobasheri A, Lambert C, Henrotin Y. Coll2-1 and Coll2-1NO2 as exemplars of collagen extracellular matrix turnover - biomarkers to facilitate the treatment of osteoarthritis? Expert Rev Mol Diagn 2019; 19:803-812. [PMID: 31327279 DOI: 10.1080/14737159.2019.1646641] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Introduction: Osteoarthritis (OA) is the most common form of arthritis. However, there are no structure or disease-modifying OA drugs (DMOADs). Introducing personalized healthcare to patients and health-care practitioners is a high priority for the management of arthritic and musculoskeletal diseases. However, there are no biomarker tools that can be used for patient stratification, disease management, and drug development. Biomarkers are capable of diagnosing and prognosing some arthritic and musculoskeletal diseases. Cartilage-based biomarkers have the potential to be used in this context to guide the precision treatment of OA. Areas covered: The aim of this review is to focus on the pre-clinical and clinical utility of the Coll2-1 and Coll2-1NO2 biomarkers as unique cartilage-based biomarkers that can guide the development of new treatments for OA. This expert report will begin with a background to collagens and their important biomechanical roles in the musculoskeletal system, but particularly cartilage, before exploring the data and scientific evidence to support the utility of Coll2-1 and Coll2-1NO2 as unique biomarkers. Expert opinion: This review summarises the authors' expert view on the pre-clinical and clinical utility of the Coll2-1 and Coll2-1NO2 biomarkers and their potential for use as drug development tools.
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Affiliation(s)
- Ali Mobasheri
- Department of Regenerative Medicine, State Research Institute Centre for Innovative Medicine , Vilnius , Lithuania.,Centre for Sport, Exercise and Osteoarthritis Versus Arthritis, Queen's Medical Centre , Nottingham , UK.,European Commission, The D-BOARD FP7 Consortium.,The APPROACH IMI Consortium.,Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu , Oulu , Finland
| | - Cecile Lambert
- Bone and Cartilage Research Unit, Arthropole Liège, Institute of Pathology, University of Liège , Liège , Belgium
| | - Yves Henrotin
- European Commission, The D-BOARD FP7 Consortium.,The APPROACH IMI Consortium.,Bone and Cartilage Research Unit, Arthropole Liège, Institute of Pathology, University of Liège , Liège , Belgium
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17
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de Campos GC, de Sousa EB, Hamdan PC, de Almeida CS, Tieppo AM, de Rezende MU, Alchaar AADA, Pinheiro CB, Rocha EDMC, Cunha FG, Pacheco I, Vieira MSR, Antonio SF, Menegassi ZJB. BRAZILIAN CONSENSUS STATEMENT ON VISCOSUPPLEMENTATION OF THE KNEE (COBRAVI). ACTA ORTOPEDICA BRASILEIRA 2019; 27:230-236. [PMID: 31452625 PMCID: PMC6699386 DOI: 10.1590/1413-785220192704218616] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 03/13/2019] [Indexed: 01/25/2023]
Abstract
OBJECTIVE The aim of this consensus statement on viscosupplementation is to serve as a reference document based on relevant literature and clinical experience in the treatment of knee osteoarthritis using an intra-articular injection of hyaluronic acid, covering key aspects such as clinical indications, effectiveness, and tolerability. METHODS A multidisciplinary panel including two sports medicine physicians, six orthopedists, four physiatrists, and two rheumatologists were selected based on their clinical and academic experience of viscosupplementation. Sixteen statements were prepared and discussed, after which a vote was held. Each member of the panel gave a score between 0 and 10 on a Likert scale, specifying their level of agreement with the statement. RESULTS The panel reached a consensus on several issues. Specifically, the panel agreed that the best indication is for mild to moderate knee arthrosis; prior or concomitant use of intraarticular triamcinolone hexacetonide may optimize the effect of hyaluronic acid; viscosupplementation should not be performed as an isolated procedure but in conjunction with other rehabilitative and pharmacological measures; viscosupplementation has analgesic, anti-inflammatory, and chondroprotective effects; and viscosupplementation is cost-effective. CONCLUSION This consensus statement provides clear information and guidance for both individuals and payers. Level of evidence V, Consensus statement.
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Affiliation(s)
| | | | - Paulo César Hamdan
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | | | | | - Marcia Uchôa de Rezende
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Department of Orthopedics and Traumatology (DOT/FMUSP), São Paulo, Brazil
| | | | | | | | | | - Ivan Pacheco
- Hospital Moinhos de Vento, Porto Alegre, RS, Brazil
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18
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Henrotin Y, Bannuru R, Malaise M, Ea HK, Confavreux C, Bentin J, Urbin-Choffray D, Conrozier T, Brasseur JP, Thomas P, Hick AC, Marinello A, Giordan N, Richette P. Hyaluronan derivative HYMOVIS® increases cartilage volume and type ii collagen turnover in osteoarhritic knee: data from MOKHA study. BMC Musculoskelet Disord 2019; 20:293. [PMID: 31215422 PMCID: PMC6580647 DOI: 10.1186/s12891-019-2667-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 06/05/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The objective of this pilot study was to identify biological, clinical or structural biomarkers of an intra-articular hyaluronic acid injection efficacy (HYMOVIS®) for the design of a larger placebo-controlled clinical trial studying the disease-modifying activity of this treatment. METHODS Forty six patients with symptomatic knee Osteoarthritis (OA) were enrolled in this open-label, prospective, multicenter, pilot study. Patients received two treatment cycles of intra-articular injections (3 mL) of HYMOVIS® (8 mg/mL of hyaluronic acid hexadecylamide) at 6 months interval. Each treatment cycle involved two intra-articular injections 1 week apart. All patients had Magnetic Resonance Imaging (MRI) of the target knee at baseline and 1 year, and blood samples to assess joint biomarkers. The primary outcome was the change in type II collagen-specific biomarkers (Coll2-1, Coll2-1NO2 and CTX-II) after HYMOVIS® treatment versus baseline. Secondary endpoints included levels changes in aggrecan chondroitin sulfate 846 epitope (CS-846), Cartilage Oligomeric Matrix Protein (COMP), procollagen type II N-terminal propeptide (PIIANP), Matrix Metalloprotease (MMP)-3, Myeloperoxidase (MPO) and Interleukin (IL)-6 serum biomarkers, the ratio Coll2-1/PIIANP, CTX-II/PIIANP, variation of MRI cartilage volume, and Knee injury and Osteoarthritis Outcome Score (KOOS) index. RESULTS Coll2-1 serum levels significantly increased overtime while Coll2-1NO2 levels were only increased at D360. Serum PIIANP levels also progressively and significantly enhanced with time. In contrast, other serum biomarker levels including CTX-II, CS-846, COMP, MMP-3, MPO or IL-6 did not change significantly overtime. Interestingly, the ratios Coll2-1/PIIANP and CTX-II/PIIANP decreased, indicating a decrease of cartilage catabolism. Compared to baseline value, MRI cartilage volume and thickness increased in lateral femoral and lateral trochlea compartments and not in medial compartment. These results, in addition to an improvement of T2 mapping score suggest a positive structural effect of the product. Interestingly, WORMS effusion score, an indicator of synovitis, significantly decreased. Finally, global KOOS score and subscales significantly increased overtime while pain at rest, walking pain and patients or investigators global assessment of disease activity decreased. The safety profile was favorable with a low incidence of injection-site pain. CONCLUSION HYMOVIS®, a well-tolerated intra-articular treatment, significantly enhanced type II collagen turnover as suggested by the increase in Coll2-1 and PIIANP levels and cartilage volume observed by MRI in lateral knee compartment. Importantly, this study provides critical information for the design of a larger phase III clinical trial investigating Disease Modifying effect of HYMOVIS®. TRIAL REGISTRATION http://www.isrctn.com/ISRCTN12227846 11/02/2015.
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Affiliation(s)
- Yves Henrotin
- Bone and Cartilage Research Unit, Arthropole Liège, Université de Liège, Institute of Pathology, CHU Sart-Tilman, 4000 Liège, Belgium
- Artialis SA, GIGA Tower, CHU Sart-Tilman, Liège, Belgium
| | - Raveendhara Bannuru
- Center for Treatment Comparison and Integrative Analysis, Division of Rheumatology, Tufts Medical Center, Boston, MA USA
| | - Michel Malaise
- Service de Rhumatologie - CHU Sart-Tilman, Liège, Belgium
| | - Hang-korng Ea
- Service de Rhumatologie - Centre Viggo Petersen, Hôpital Lariboisière, Paris, France
| | | | - Jacques Bentin
- Service de Rhumatologie - CHU Brugmann, Bruxelles, Belgium
| | | | - Thierry Conrozier
- Service de Rhumatologie - Hôpital Nord Franche-Comté, Trévenans, France
| | | | - Philippe Thomas
- Service de Rhumatologie - CHR Metz-Thionville - Hôpital Bel Air, Thionville, France
| | | | | | | | - Pascal Richette
- Service de Rhumatologie - Centre Viggo Petersen, Hôpital Lariboisière, Paris, France
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19
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Ajeeshkumar KK, Vishnu KV, Navaneethan R, Raj K, Remyakumari KR, Swaminathan TR, Suseela M, Asha KK, Sreekanth GP. Proteoglycans isolated from the bramble shark cartilage show potential anti-osteoarthritic properties. Inflammopharmacology 2019; 27:175-187. [PMID: 30600472 DOI: 10.1007/s10787-018-00554-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 12/14/2018] [Indexed: 01/09/2023]
Abstract
Osteoarthritis (OA) causes articular cartilage destruction, initiating pain and inflammation in the joints, resulting in joint disability. Medications are available to manage these symptoms; however, their effects on the disease progression are limited. Loss of proteoglycans (PGs) was reported to contribute articular cartilage destruction in OA. Therapeutics approaches were previously studied in the animal models of OA. In the present study, we investigated the oral efficacy of four dosages of PGs (25 mg/kg, 50 mg/kg, 100 mg/kg and 200 mg/kg), isolated from the bramble shark cartilage, in an animal model of OA. Indomethacin was used as a bioequivalent formulation. Primarily, the mass spectrum analysis of the purified PGs obtained from bramble shark cartilage revealed the presence of two unique peptides including AGWLSDGSVR and LDGNPINLSK, that showed sequence similarity with aggrecan core-protein and epiphycan, respectively. The levels of C-reactive protein and uric acid in the OA rats were reduced when treated with PGs. Histopathology analysis displayed less cartilage erosion and neovascularization in OA rats treated with PGs. The X-ray imaging presented higher bone density with 200 mg/kg dosage of PG treatment in OA rats. The expressions of the inflammatory modulators including TNF-α, IL-1β, MMP13, NOS2, IL-10 and COX-2 were found to be moderated with PG treatment. In addition, PG treatment maintained the activities of antioxidant enzymes, including SOD and catalase in the joint tissues with a higher GSH content, in a dose-dependent manner. Taken together, our preliminary findings report the anti-osteoarthritic properties of PGs and recommend to evaluate its efficacy and safety in randomized trials.
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Affiliation(s)
| | - Kalladath Venugopal Vishnu
- Biochemistry and Nutrition Division, ICAR-Central Institute of Fisheries Technology, Kochi, Kerala, India
| | - Raju Navaneethan
- Biochemistry and Nutrition Division, ICAR-Central Institute of Fisheries Technology, Kochi, Kerala, India
| | - Kumar Raj
- Peninsular and Marine Fish Genetic Resources Centre, ICAR-National Bureau of Fish Genetic Resources, CMFRI Campus, Kochi, Kerala, India
| | | | - Thangaraj Raja Swaminathan
- Peninsular and Marine Fish Genetic Resources Centre, ICAR-National Bureau of Fish Genetic Resources, CMFRI Campus, Kochi, Kerala, India
| | - Mathew Suseela
- Biochemistry and Nutrition Division, ICAR-Central Institute of Fisheries Technology, Kochi, Kerala, India
| | - Kurukkan Kunnath Asha
- Biochemistry and Nutrition Division, ICAR-Central Institute of Fisheries Technology, Kochi, Kerala, India.
| | - Gopinathan Pillai Sreekanth
- Siriraj Center of Research Excellence for Molecular Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
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20
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Zhu Z, Li J, Ruan G, Wang G, Huang C, Ding C. Investigational drugs for the treatment of osteoarthritis, an update on recent developments. Expert Opin Investig Drugs 2018; 27:881-900. [PMID: 30345826 DOI: 10.1080/13543784.2018.1539075] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Osteoarthritis (OA) is the leading cause of pain, loss of function, and disability among elderly, with the knee the most affected joint. It is a heterogeneous condition characterized by complex and multifactorial etiologies which contribute to the broad variation in symptoms presentation and treatment responses that OA patients present. This poses a challenge for the development of effective treatment on OA. AREAS COVERED This review will discuss recent development of agents for the treatment of OA, updating our previous narrative review published in 2015. They include drugs for controlling local and systemic inflammation, regulating articular cartilage, targeting subchondral bone, and relieving pain. EXPERT OPINION Although new OA drugs such as monoclonal antibodies have shown marked effects and favorable tolerance, current treatment options for OA remain limited. The authors believe there is no miracle drug that can be used for all OA patients'; treatment and disease stage is crucial for the effectiveness of drugs. Therefore, early diagnosis, phenotyping OA patients and precise therapy would expedite the development of investigational drugs targeting at symptoms and disease progression of OA.
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Affiliation(s)
- Zhaohua Zhu
- a Clinical Research Centre, Zhujiang Hospital, Southern Medical University , Guangzhou , China
| | - Jia Li
- a Clinical Research Centre, Zhujiang Hospital, Southern Medical University , Guangzhou , China
| | - Guangfeng Ruan
- a Clinical Research Centre, Zhujiang Hospital, Southern Medical University , Guangzhou , China.,b Department of Rheumatology and Immunology , Arthritis Research Institute, The First Affiliated Hospital of Anhui Medical University , Hefei , China
| | - Guoliang Wang
- c Menzies Institute for Medical Research, University of Tasmania , Hobart , Australia
| | - Cibo Huang
- d Department of Rheumatology & Immunology , Beijing Hospital , Beijing , China
| | - Changhai Ding
- a Clinical Research Centre, Zhujiang Hospital, Southern Medical University , Guangzhou , China.,b Department of Rheumatology and Immunology , Arthritis Research Institute, The First Affiliated Hospital of Anhui Medical University , Hefei , China.,c Menzies Institute for Medical Research, University of Tasmania , Hobart , Australia
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21
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Raman R, Henrotin Y, Chevalier X, Migliore A, Jerosch J, Montfort J, Bard H, Baron D, Richette P, Conrozier T. Decision Algorithms for the Retreatment with Viscosupplementation in Patients Suffering from Knee Osteoarthritis: Recommendations from the EUROpean VIScosupplementation COnsensus Group (EUROVISCO). Cartilage 2018; 9:263-275. [PMID: 29110511 PMCID: PMC6042033 DOI: 10.1177/1947603517693043] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background Viscosupplementation (VS) is a symptomatic treatment of knee osteoarthritis. Although systematic reviews of its repeat use showed favorable benefit/risk ratio, no study has focused on the indication of retreatment. Methods A task force was created to look at issues regarding retreatment with VS in knee osteoarthritis. An attempt was made to reach consensus on several issues: (1) to define treatment "success" and "failure," (2) to determine when to retreat patients successfully treated by a previous VS, (3) to determine how to retreat patients in whom VS failed, (4) to define what to do in case of adverse reaction following previous VS, and (5) to examine the interests of soluble biomarkers to manage retreatment. After debate and review of literature the working group voted on 88 issues. Two "decision trees" were built based on the results of the votes. Results In case of failure, the authors draw attention to the need of a rigorous clinical and radiological analysis, and consider evidence-based medicine. When VS was previously successful, retreatment can be considered after recurrence or increase in pain. However, in subjects with high risk of disease progression, in young patients, and in professional sportsmen, retreatment could be considered systematically, because of the probability of hyaluronic acid to slow osteoarthritis progression. Evidence on soluble biomarkers was not considered as enough strong to support their use as decision tools for patient retreatment. Conclusion The decision algorithms are intended to facilitate consideration of the therapeutic options, in patients with knee osteoarthritis previously treated with VS.
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Affiliation(s)
- Raghu Raman
- Academic Department of Orthopaedics, Hull and East Yorkshire NHS Trust Castle Hill Hospital, Cottingham, UK
| | - Yves Henrotin
- Bone and Cartilage Research Unit, Université de Liège, CHU Sart-Tilman, Liège, Belgium
| | - Xavier Chevalier
- Paris XII University, UPEC, Department of Rheumatology, Henri Mondor Hospital, Creteil, France
| | - Alberto Migliore
- U.O.S. of Rheumatology, Ospedale San Pietro Fatebenefratelli, Rome, Italy
| | - Jörg Jerosch
- Orthopedic Department, Johanna-Etienne-Hospital, Neuss, Germany
| | - Jordi Montfort
- Servei de Reumatologia, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | - Hervé Bard
- Department of Rheumatology. Hôpital Européen Georges-Pompidou, Paris, France
| | - Dominique Baron
- Centre de réadaptation fonctionnelle de Lannion-Trestel, Trévou-Tréguignec, France
| | - Pascal Richette
- Université Paris Diderot, UFR médicale, Hôpital Lariboisière, Paris, France
| | - Thierry Conrozier
- Department of Rheumatology, Hôpital Nord Franche-Comté, Belfort, France
- Thierry Conrozier, Department of Rheumatology, Hôpital Nord Franche-Comté, F-90000, Belfort, France.
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Georgiev T, Ivanova M, Kopchev A, Velikova T, Miloshov A, Kurteva E, Yuzeir K, Penkov M, Kabakchieva P, Rashkov R, Stoilov R. Cartilage oligomeric protein, matrix metalloproteinase-3, and Coll2-1 as serum biomarkers in knee osteoarthritis: a cross-sectional study. Rheumatol Int 2017; 38:821-830. [PMID: 29164307 DOI: 10.1007/s00296-017-3887-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Accepted: 11/19/2017] [Indexed: 02/05/2023]
Abstract
Biochemical markers reflecting joint remodeling in osteoarthritis (OA) are a promising diagnostic tool. The aim of this study was to investigate serum levels of candidate biomarkers in subjects with and without knee OA and assess their correlation with clinical parameters and knee structural damage. 56 patients with primary knee OA and 31 healthy controls participated in this study. Patients were separated into two groups: isolated knee OA and generalized OA. Clinical parameters were obtained by validated self-reported questionnaires and a visual analogue scale. Serum levels of cartilage oligomeric protein (COMP), matrix metalloproteinase-3 (MMP-3), and Coll2-1 were quantified by enzyme-linked immunosorbent assay. Knee structural damage was determined by plain X-ray and 1.5 T magnetic resonance imaging (MRI), using Kellgren-Lawrence (KL) grading scale and Whole-Organ Magnetic Resonance Imaging Score (WORMS), respectively. Compared to controls, patients had significantly higher median serum COMP (985 vs. 625 ng/ml; p < 0.001) and MMP-3 (36.85 vs. 22.10 ng/ml; p = 0.003) levels. Patients with radiographic evidence of KLII/III knee OA had greater median COMP levels than KLI patients (1095 vs. 720 ng/ml; p = 0.001). In the generalized OA group, mean MMP-3 levels were higher than in the isolated knee OA group (30.40 vs. 55.13 ng/ml; p < 0.001). COMP correlated positively with WORMS (r s = 0.454, p < 0.001) and MMP-3 (r s = 0.337, p = 0.003). Cut-off values for serum COMP and MMP-3 were determined. We observed higher serum COMP and MMP-3 levels in knee OA patients compared to controls. COMP may reflect knee structural damage, while MMP-3-OA "generalization".
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Affiliation(s)
- Tsvetoslav Georgiev
- Clinic of Rheumatology, University Hospital "St. Ivan Rilski", Medical Faculty, Medical University of Sofia, Sofia, Bulgaria.
| | - Mariana Ivanova
- Clinic of Rheumatology, University Hospital "St. Ivan Rilski", Medical Faculty, Medical University of Sofia, Sofia, Bulgaria
| | - Aleksandar Kopchev
- Clinic of Rheumatology, University Hospital "St. Ivan Rilski", Medical Faculty, Medical University of Sofia, Sofia, Bulgaria
| | - Tsvetelina Velikova
- Laboratory of Clinical Immunology, University Hospital "Lozenets", Medical Faculty, Sofia University, Sofia, Bulgaria
| | - Asen Miloshov
- Radiology Department, University Hospital "St. Ivan Rilski", Sofia, Bulgaria
| | - Ekaterina Kurteva
- Laboratory of Clinical Immunology, University Hospital "St. Ivan Rilski", Medical Faculty, Medical University of Sofia, Sofia, Bulgaria
| | - Kalina Yuzeir
- Laboratory of Clinical Immunology, University Hospital "St. Ivan Rilski", Medical Faculty, Medical University of Sofia, Sofia, Bulgaria
| | - Marin Penkov
- Radiology Department, University Hospital "St. Ivan Rilski", Sofia, Bulgaria
| | - Plamena Kabakchieva
- Clinic of Endocrinology, University Hospital "Aleksandrovska", Medical Faculty, Medical University of Sofia, Sofia, Bulgaria
| | - Rasho Rashkov
- Clinic of Rheumatology, University Hospital "St. Ivan Rilski", Medical Faculty, Medical University of Sofia, Sofia, Bulgaria
| | - Rumen Stoilov
- Clinic of Rheumatology, University Hospital "St. Ivan Rilski", Medical Faculty, Medical University of Sofia, Sofia, Bulgaria
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Bhadra AK, Altman R, Dasa V, Myrick K, Rosen J, Vad V, Vitanzo P, Bruno M, Kleiner H, Just C. Appropriate Use Criteria for Hyaluronic Acid in the Treatment of Knee Osteoarthritis in the United States. Cartilage 2017; 8:234-254. [PMID: 28618868 PMCID: PMC5625860 DOI: 10.1177/1947603516662503] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE A workgroup of clinical experts has developed an Appropriate Use Criteria (AUC) for the use of hyaluronic acid (HA) in the treatment of osteoarthritis (OA) of the knee. The increasingly broad and varied use of HA injections, lack of published clinical guidance, and limited coverage for their use has created the imperative to establish appropriateness criteria. METHODS The experts of this workgroup represent rheumatology, orthopedic surgery, physiatry, sports medicine, and nursing clinicians with substantive knowledge of intra-articular HA therapy. This workgroup utilized the results of a systematic review of evidence, expert clinical opinion, and current evidence-based clinical practice guidelines to develop appropriateness criteria for the use of intra-articular HA for knee OA in 17 real-world clinical scenarios. RESULTS The workgroup scored the appropriateness of treatment of each patient scenario using a 9-point scale to designate a treatment as appropriate (7-9), uncertain (4-6), or inappropriate (1-3). Six scenarios were scored as appropriate, 10 scenarios were scored as uncertain, and 1 scenario was scored as inappropriate. CONCLUSION This article can assist clinicians in shared decision-making by providing best practices in considering HA injections for knee OA treatment. Moreover, this AUC article can aid payers and policy makers in determining reimbursement and preauthorization policies and more appropriately managing health care resources. It is clear that further research is still necessary-particularly in patient populations differentiated by OA severity-that may benefit the greatest from the use of HA injections for the treatment of knee OA.
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Affiliation(s)
- Arup K. Bhadra
- Northeast Orthopedics and Sports Medicine, Airmont, NY, USA
| | - Roy Altman
- Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
| | - Vinod Dasa
- LSU Health Sciences Center Department of Orthopaedics, New Orleans, LA, USA
- LSU School of Medicine, New Orleans, LA, USA
| | - Karen Myrick
- Quinnipiac University School of Nursing, Joint Appointment Frank Netter School of Medicine, North Haven, CT, USA
- Orthopedic Associates, Farmington, CT, USA
| | - Jeffrey Rosen
- Department of Orthopaedics and Rehabilitation, New York-Presbyterian/Queens Hospital, New York, NY, USA
- Weill Medical College of Cornell University, New York, NY, USA
| | - Vijay Vad
- Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY, USA
| | - Peter Vitanzo
- Rothman Institute at Jefferson, Philadelphia, PA, USA
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Fawzy RM, Hashaad NI, Mansour AI. Decrease of serum biomarker of type II Collagen degradation (Coll2-1) by intra-articular injection of an autologous plasma-rich-platelet in patients with unilateral primary knee osteoarthritis. Eur J Rheumatol 2017. [PMID: 28638679 DOI: 10.5152/eurjrheum.2017.160076] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE This study aimed to evaluate the effect of one dose of intra-articular injection of (PRP) in the knee joint on a specific osteoarthritis (OA) serum biomarker of cartilage degeneration, Collagen 2-1 (Coll2-1), over a short period of 3 months. The aim extended to clarify the effect of PRP on the functional status of the osteoarthritic knee joint. MATERIAL AND METHODS Sixty patients with primary unilateral knee OA were enrolled in this study. They were subdivided according to Kellgren-Lawrence grading scale (KL) into (Group I): including patients with KL grade < 3 and (Group II): including patients with KL grade ≥3. Patients were asked to complete the Western Ontario and McMaster Universities Arthritis Index (WOMAC) Score. PRP was prepared and injected immediately into the affected knee. Serum Coll2-1 (S.Coll2-1) concentration was measured by enzyme-linked immunosorbent assay (ELISA) kit pre and 3 months after PRP injection. RESULTS Significant reduction in S.Coll2-1 concentration in primary knee OA patients; (p<0.001) and (p<0.05) in group I and group II respectively as well as significant improvements in WOMAC total and WOMAC sub-scores values were noted after single intra-articular PRP injection with maximal functional improvements were achieved after 3 months (p<0.001). Mild cases experienced favorable results with no remarkable adverse reactions were observed. CONCLUSION Reduction in specific OA biomarker S.Coll2-1 following intra-articular PRP injection emphasize that PRP could be a promising safe and tolerable effective therapeutic option which improves function from basal states in primary knee OA patients.
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Affiliation(s)
- Rasha Mohamed Fawzy
- Department of Rheumatology, Rehabilitation & Physical Medicine, Benha University School of Medicine, Benha, Egypt
| | - Nashwa Ismail Hashaad
- Department of Rheumatology, Rehabilitation & Physical Medicine, Benha University School of Medicine, Benha, Egypt
| | - Amira Ibrahim Mansour
- Department of Clinical and Chemical Pathology, Benha University School of Medicine, Benha, Egypt
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25
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Henrotin Y, Berenbaum F, Chevalier X, Marty M, Richette P, Rannou F. Reduction of the Serum Levels of a Specific Biomarker of Cartilage Degradation (Coll2-1) by Hyaluronic Acid (KARTILAGE® CROSS) Compared to Placebo in Painful Knee Osteoarthritis Patients: the EPIKART Study, a Pilot Prospective Comparative Randomized Double Blind Trial. BMC Musculoskelet Disord 2017; 18:222. [PMID: 28549430 PMCID: PMC5446742 DOI: 10.1186/s12891-017-1585-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 05/17/2017] [Indexed: 11/10/2022] Open
Abstract
Background Viscosupplementation is a symptomatic treatment of the knee osteoarthritis based on the intra-articular injection of hyaluronic acid (IAHA). Although many studies have investigated its effect on symptoms, few clinical studies have focused on its effects on biologicals markers of cartilage metabolism. In this study, we assessed the effect of an intra-articular injection of a reticulated hyaluronic acid compound on the level of a specific biomarker of type II collagen degradation. Methods Eighty one patients with symptomatic knee osteoarthritis were included in this randomized placebo controlled trial testing a reticulated hyaluronic acid (HA) with mannitol (KARTILAGE® CROSS, 16 mg/ml, one single injection of 2.2 mL; IAHA) versus saline solution. Primary outcome was the percentage of patients with a reduction of at least 10 nmol/l of serum Coll2-1 between baseline and day 90 (D90, 3 months after injection). Secondary outcomes concerned clinical evaluation and tolerance to the study product. Results A significant effect of IAHA was revealed by the sensitivity analysis of the decrease in cartilage marker. In the intention-to-treat population, the percentage of patients showing a decrease in the levels of serum Coll2-1 between inclusion and D90 showed was higher in HA (56.8%) than in placebo group (28.6%; P = 0.01). The same significant difference was observed between groups in the per protocol population (57.1% vs 29.0%; P = 0.02) corresponding to all patients having received the intra-articular injection (IA), being evaluated for the primary outcome on D-10 and D90, and with no major defined deviation. No significant differences between groups were observed on the changes in function (Lequesne index) or pain and on the number of adverse events. Conclusions This is the first randomized double-blind placebo controlled trial showing that IA injection of reticulated HA with mannitol in knee osteoarthritis patients can reduce the serum levels of Coll2-1, a marker specific of type II collagen degradation. This finding suggests that IAHA may have a beneficial effect on cartilage degradation and that Coll2-1 could be used for the assessment of a single intra-articular treatment in clinical trials. Trial registration NCT02951585; clinicaltrial.gov. Retrospectively registered on October 28, 2016.
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Affiliation(s)
- Yves Henrotin
- Bone and Cartilage Research Unit, Arthropole Liège, CHU Sart-Tilman, Liège, Belgium.
| | - Francis Berenbaum
- Rheumatology Department, Sorbonnes Universités UMPC Univ Paris 06, Inserm UMRS 938, DHU i2B, Saint Antoine Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | | | - Marc Marty
- Service de Rhumatologie, Hôpital Henri Mondor, Créteil, France
| | - Pascal Richette
- Service de Rhumatologie - Centre Viggo Petersen, Hôpital Lariboisière, Paris, France
| | - François Rannou
- University Paris Descartes, PRES Sorbonne Paris Cité, Service de rééducation et réadaptation de l'appareil locomoteur et des pathologies du rachis, Hôpital Cochin, AP - HP, INSERM UMR-S-1124, UFR Biomédicale des Saints Pères, Paris, France
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27
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Bossert M, Boublil D, Parisaux JM, Bozgan AM, Richelme E, Conrozier T. Imaging Guidance Improves the Results of Viscosupplementation with HANOX-M-XL in Patients with Ankle Osteoarthritis: Results of a Clinical Survey in 50 Patients Treated in Daily Practice. CLINICAL MEDICINE INSIGHTS-ARTHRITIS AND MUSCULOSKELETAL DISORDERS 2016; 9:195-199. [PMID: 27891055 PMCID: PMC5120624 DOI: 10.4137/cmamd.s40401] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 09/29/2016] [Accepted: 10/01/2016] [Indexed: 01/27/2023]
Abstract
BACKGROUND The objective of this survey was to assess retrospectively the interest of performing viscosupplementation using imaging guidance in patients suffering from ankle osteoarthritis (OA). PATIENTS AND METHODS This is a multicenter retrospective survey using a standardized questionnaire. Fifty patients suffering from ankle OA and treated, in daily clinical practice, with a single intra-articular injection of a novel viscosupplement made of a combination of a non-animal cross-linked hyaluronan and mannitol, HANOX M-XL, were included in the survey. The injection procedure (imaging or landmark guidance), demographic data, patient’s self-evaluation of pain, satisfaction, treatment efficacy, and tolerability were collected. Predictive factors of both efficacy and patient’s satisfaction were investigated. RESULTS The percentages of patients very satisfied/satisfied and not really satisfied/dissatisfied with the treatment were 68% and 32%, respectively. Efficacy was rated as very good, good, moderate, and poor by 38%, 30%, 12%, and 20% of the cases, respectively. Efficacy was unrelated to gender and age and was highly correlated with pain score (P < 0.0001). In satisfied patients, the decrease in consumption of analgesics/non-steroidal anti-inflammatory drugs was >75% in 64% of the cases. Efficacy was significantly different with regard to imaging guidance. There was a statistically significant difference in efficacy and satisfaction between landmark-guided and imaging-guided injections (P = 0.02). The success rate was 2.3 times higher in the imaging-guided group than in the landmark-guided group. No significant difference was found between patients injected under fluoroscopy or ultrasound guidance, despite a trend favoring ultrasound (P = 0.09). Tolerability was rated as very good/good in 47 patients, moderate in two, and poor in one and was unrelated to the type of guidance. CONCLUSION This preliminary study suggests that the use of imaging guidance significantly optimizes the success rate of ankle viscosupplementation. No safety concern was observed. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Marie Bossert
- Department of Rheumatology, Hôpital Nord Franche-Comté, Belfort, France
| | - Daniel Boublil
- Department of Orthopaedic Surgery, Clinique du Parc, Lyon, France
| | - Jean-Marc Parisaux
- Department of Sports Medicine, Institut Monégasque de Médecine du Sport, Principauté de Monaco, Monaco
| | - Ana-Maria Bozgan
- Department of Rheumatology, Hôpital Nord Franche-Comté, Belfort, France
| | - Emmanuel Richelme
- Department of Orthopaedic Surgery, Institut de Chirurgie Orthopédique et Sportive, Marseille, France
| | - Thierry Conrozier
- Department of Rheumatology, Hôpital Nord Franche-Comté, Belfort, France
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Möller I, Gharbi M, Martinez Serrano H, Herrero Barbero M, Verges Milano J, Henrotin Y. Effect of chondroitin sulfate on soluble biomarkers of osteoarthritis: a method to analyze and interpret the results from an open-label trial in unilateral knee osteoarthritis patients. BMC Musculoskelet Disord 2016; 17:416. [PMID: 27716158 PMCID: PMC5053075 DOI: 10.1186/s12891-016-1268-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 09/24/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to investigate the effects of chondroitin sulfate (CS) on the serum levels of Coll2-1 in patients with knee OA. METHODS Seventy two patients with unilateral symptomatic knee OA were involved in a post-authorization open-label study evaluating CS (800 mg/day). The primary outcome was the % relative change in serum Coll2-1 (sColl2-1). The secondary outcomes were the evaluation of pain (VAS) and function (Lequesne's Index). Responders and non-responders were classified according to OMERACT-OARSI recommendations. Finally, an original cut-off method was applied to categorize patients and interpret individual variations in serum levels of Coll2-1. RESULTS Patients showed no difference in the sColl2-1 levels at baseline. When considering responders and non-responders from the ITT population, a significant difference was found for Coll2-1 at 3 months (p = 0.030) and 6 months (p = 0.038). A decrease in pain (VAS) and an improvement in function (LI) were recorded throughout the visits (p < 0.01). Considering an intra-batch cut-off of 21 %, CS decreased Coll2-1 serum levels between baseline and 1-month visit compared to the value of Coll2-1 before treatment (screening visit) which can be interpreted as a drastic reduction of the proportion of patients with an increase of Coll2-1 over 21 % (reduction from 13 to 3 %). It also consisted in a more important proportion of patients with a decrease in Coll2-1 (from 5 to 10 %). CONCLUSION This study proposes a new approach for the analysis and the interpretation of the individual variation in biomarker levels and introduces the notion of metabolic responders. TRIAL REGISTRATION ID ISRCTN63795830 . The trial was retrospectively registered on 2 October, 2015.
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Affiliation(s)
| | - Myriam Gharbi
- Artialis SA, GIGA Tower, CHU Sart-Tilman, 4000, Liège, Belgium
| | | | | | | | - Yves Henrotin
- Bone and Cartilage Research Unit, Arthropôle Liège, Institute of Pathology, University of Liège, level +5, CHU Sart-Tilman, 4000, Liège, Belgium.
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Conrozier T, Eymard F, Afif N, Balblanc JC, Legré-Boyer V, Chevalier X. Safety and efficacy of intra-articular injections of a combination of hyaluronic acid and mannitol (HAnOX-M) in patients with symptomatic knee osteoarthritis: Results of a double-blind, controlled, multicenter, randomized trial. Knee 2016; 23:842-8. [PMID: 27353769 DOI: 10.1016/j.knee.2016.05.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 05/20/2016] [Accepted: 05/31/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND To compare both safety and efficacy of a novel intra-articular viscosupplement made of intermediate molecular weight (MW) hyaluronic acid (HA) mixed with high concentration of mannitol with a marketed high MW HA, in patients with knee osteoarthritis (OA). METHODS Patients with symptomatic knee OA, with radiological OARSI grades 1 to 3, were enrolled in a controlled, double-blind, parallel-group, non-inferiority trial. They were randomized to receive three intra-articular injections, at weekly intervals, of either HAnOX-M made of a combination of HA (MW one to 1.5MDa, 31mg/2ml) and mannitol (70mg/2ml) or Bio-HA (MW 2.3 to 3.6MDa, 20mg/2ml). The primary outcome was six-month change in the WOMAC pain subscale (0 to 20). Sample size was calculated according to a non-inferiority margin of 1.35. Secondary endpoints included six-month change in function and walking pain, analgesic consumption and safety. RESULTS The intention-to-treat (ITT) and per-protocol (PP) populations consisted of 205 and 171 patients. HAnOX-M and Bio-Ha groups did not differ statistically at baseline. The primary analysis was conducted in the PP population, then in the ITT population. The average WOMAC pain score at baseline was 9.5 in both groups. Mean (SD) variations in WOMAC pain score were -4.4 (3.8) and -4.5 (4.3) mm, for HAnOX and Bio-HA respectively, satisfying the claim for non-inferiority. Similar results were obtained for all other secondary endpoints. CONCLUSION Treatment with of HAnOX-M is effective to alleviate knee OA symptoms and to improve joint function over six months, with similar safety than conventional HA viscosupplement.
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Affiliation(s)
- Thierry Conrozier
- Department of Rheumatology, Hôpital Nord Franche-Comté, Belfort, France.
| | - Florent Eymard
- Department of Rheumatology, Hôpital Henri Mondor, Creteil, France
| | - Naji Afif
- Department of Rheumatology, Hôpital Emile Muller, Mulhouse, France
| | | | - Virginie Legré-Boyer
- Institut de l'Appareil Locomoteur Nollet, Paris, France; Hôpital Universitaire Pitié-Salpêtrière, Paris, France
| | - Xavier Chevalier
- Department of Rheumatology, Hôpital Henri Mondor, Creteil, France; Paris XII University, UPEC, France
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Conrozier T, Bozgan AM, Bossert M, Sondag M, Lohse-Walliser A, Balblanc JC. Standardized Follow-up of Patients with Symptomatic Knee Osteoarthritis Treated with a Single Intra-articular Injection of a Combination of Cross-Linked Hyaluronic Acid and Mannitol. CLINICAL MEDICINE INSIGHTS-ARTHRITIS AND MUSCULOSKELETAL DISORDERS 2016; 9:175-9. [PMID: 27688712 PMCID: PMC5036533 DOI: 10.4137/cmamd.s39432] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 05/29/2016] [Accepted: 05/31/2016] [Indexed: 12/23/2022]
Abstract
OBJECTIVES The objective of this study is to obtain pilot data from daily practice conditions of a viscosupplement made of a cross-linked high-molecular-weight hyaluronic acid (HA) combined with mannitol in patients with knee osteoarthritis (KOA). METHODS The data of 40 consecutive patients, 29 women and 11 men, who were prospectively followed up for 6 months, using a standardized procedure, were retrospectively analyzed. All patients have received a single intra-articular injection of HAnox-M-XL (4.4 mL), viscosupplement made of a cross-linked HA (16 mg/mL) + mannitol (35 mg/mL), in the target knee. The primary outcome was safety. The secondary end points included 3- and 6-month change in the WOMAC pain (0–50) and WOMAC total (0–240) and patient’s global assessment (PGA). Patient’s self-assessment of treatment efficacy (0–3) and analgesic consumption were obtained at months 3 and 6. An intent-to-treat analysis was performed. RESULTS Mean (SD) age was 60.7 (13.9) years, and mean BMI was 28.6 (5.0). Kellgren–Lawrence radiological grade was I/II and III/IV in 13 and 27 of the subjects, respectively. The average WOMAC pain and WOMAC total scores at baseline were 21.5 (9.8) and 89.9 (42.8), respectively. Thirty-nine patients completed the follow-up. HAnox-M-XL was well tolerated; two patients experienced knee pain after injection, which resolved within three days. No treatment-related severe adverse event was reported. Mean (SD) variations in WOMAC pain and WOMAC total scores were −8.2 (8.9) and −38.4 (35.6), respectively, at month 6 (P = 0.001). PGA decreased from 5.5 (2.0) to 3.0 (2.2) (P = 0.006). Efficacy was rated as good or very good in 76.9% of the cases. Most of the regular analgesics users decreased their consumption. CONCLUSION Treatment with one injection of 4.4 mL HAnox-M-XL is effective to alleviate KOA symptoms over six months, without safety concern. Controlled trials are needed to confirm these pilot data.
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Affiliation(s)
- Thierry Conrozier
- Department of Rheumatology, Hôpital Nord Franche-Comté, Belfort, France
| | - Ana-Maria Bozgan
- Department of Rheumatology, Hôpital Nord Franche-Comté, Belfort, France
| | - Marie Bossert
- Department of Rheumatology, Hôpital Nord Franche-Comté, Belfort, France
| | - Maxime Sondag
- Department of Rheumatology, Hôpital Nord Franche-Comté, Belfort, France
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Abstract
INTRODUCTION Conventional medical therapies for osteoarthritis are mainly palliative in nature, aiming to control pain and symptoms. Traditional intra-articular therapies are not recommended in guidelines as first line therapy, but are potential alternatives, when conventional therapies have failed. AREAS COVERED Current and future intra-articular drug therapies for osteoarthritis are highlighted, including corticosteroids, hyaluronate, and more controversial treatments marketed commercially, namely platelet rich plasma and mesenchymal cell therapy. Intraarticular disease modifying osteoarthritis drugs are the future of osteoarthritis treatments, aiming at structural modification and altering the disease progression. Interleukin-1β inhibitor, bone morphogenic protein-7, fibroblast growth factor 18, bradykinin B2 receptor antagonist, human serum albumin, and gene therapy are discussed in this review. The evolution of drug development in osteoarthritis is limited by the ability to demonstrate effect. High quality trials are required to justify the use of existing intra-articular therapies and to advocate for newer, promising therapies. EXPERT OPINION Challenges in osteoarthritis therapy research are fundamentally related to the complexity of the pathological mechanisms of osteoarthritis. Novel drugs offer hope in a disease with limited medical therapy options. Whether these future intra-articular therapies will provide clinically meaningful benefits, remains unknown.
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Affiliation(s)
- Shirley P Yu
- a Department of Rheumatology , Royal North Shore Hospital , Sydney , Australia
| | - David J Hunter
- b Institute of Bone and Joint Research , Kolling Institute, University of Sydney , Sydney , Australia
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Habib G, Khatib M, Sakas F, Artul S, Jabaly-Habib H. Pre-injection of hyaluronic acid does not affect the systemic effects of intra-articular depot betamethasone injection at the knee joint. Clin Rheumatol 2016; 36:217-221. [PMID: 27423207 DOI: 10.1007/s10067-016-3352-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 07/02/2016] [Accepted: 07/07/2016] [Indexed: 11/25/2022]
Abstract
Intra-articular injection (IAI) of both hyaluronic acid (HA) and depot-steroid preparations had the advantage of quick and prolonged favorable effects on pain relief among patients with symptomatic osteoarthritis of the knee (OAK). The effect of IAI of HA on the systemic effects of the intra-articular steroids had not been investigated. Non-selected patients attending the rheumatology clinic with symptomatic OAK who failed NSAIDS and physical therapy were offered an IAI of HA at the knee joint followed 20 min later by an IAI of 1 ml of Celestone Chronodose at the same joint (group 1). Morning serum levels of cortisol were obtained just prior to the IAI and 1, 2 and 8 days later. Demographic, clinical, and laboratory parameters were obtained also from all the patients. Age- and sex-matched group of patients from the same clinic were recruited as a control group (group 2). Mean baseline serum cortisol levels in group 1 was 381 ± 154 mmol/l vs. 376 ± 119 in group 2 (p = 0.954). Morning serum cortisol levels at day 1 and day 2 were 24 ± 6 and 22 ± 6 mmol/l, respectively, in group 1 patients vs. 27 ± 5.8 (p = 0.214) and 25 ± 5.6 mmol/l (p = 0.200), respectively, in group 2. These levels were significantly lower than baseline levels in each group. Morning serum cortisol levels at day 8 in group 1 and group 2 were 349 ± 128 and 314 ± 99 mmol/l, respectively (p = 0.419). Pre-injection of HA at the knee joint did not affect the systemic effect on the hypothalamic-pituitary-adrenal axis of IAI of Celestone Chronodose.
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Affiliation(s)
- George Habib
- Rheumatology Unit, Laniado Medical Center, Netanya, 42150, Israel. .,Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel. .,Rheumatology Clinic, Nazareth Hospital, Nazareth, Israel.
| | - Muhamad Khatib
- Department of Medicine, Poriya Medical Center, Poriya, Israel
| | - Fahed Sakas
- Department of Medicine, Rambam Medical Center, Haifa, Israel
| | - Suheil Artul
- Gallile Faculty of Medicine, Bar-Ilan University, Ramat Gan, Israel.,Department of Radiology, Nazareth Hospital, Nazareth, Israel
| | - Haneen Jabaly-Habib
- Gallile Faculty of Medicine, Bar-Ilan University, Ramat Gan, Israel.,Ophthalmology Division, Poriya Medical Center, Poriya, Israel
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Staines KA, Madi K, Mirczuk SM, Parker S, Burleigh A, Poulet B, Hopkinson M, Bodey AJ, Fowkes RC, Farquharson C, Lee PD, Pitsillides AA. Endochondral Growth Defect and Deployment of Transient Chondrocyte Behaviors Underlie Osteoarthritis Onset in a Natural Murine Model. Arthritis Rheumatol 2016; 68:880-91. [PMID: 26605758 PMCID: PMC4832379 DOI: 10.1002/art.39508] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 11/05/2015] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To explore whether aberrant transient chondrocyte behaviors occur in the joints of STR/Ort mice (which spontaneously develop osteoarthritis [OA]) and whether they are attributable to an endochondral growth defect. METHODS Knee joints from STR/Ort mice with advanced OA and age-matched CBA (control) mice were examined by Affymetrix microarray profiling, multiplex polymerase chain reaction (PCR) analysis, and immunohistochemical labeling of endochondral markers, including sclerostin and MEPE. The endochondral phenotype of STR/Ort mice was analyzed by histologic examination, micro-computed tomography, and ex vivo organ culture. A novel protocol for quantifying bony bridges across the murine epiphysis (growth plate fusion) using synchrotron x-ray computed microtomography was developed and applied. RESULTS Meta-analysis of transcription profiles showed significant elevation in functions linked with endochondral ossification in STR/Ort mice (compared to CBA mice; P < 0.05). Consistent with this, immunolabeling revealed increased matrix metalloproteinase 13 (MMP-13) and type X collagen expression in STR/Ort mouse joints, and multiplex quantitative reverse transcriptase-PCR showed differential expression of known mineralization regulators, suggesting an inherent chondrocyte defect. Support for the notion of an endochondral defect included accelerated growth, increased zone of growth plate proliferative chondrocytes (P < 0.05), and widespread type X collagen/MMP-13 labeling beyond the expected hypertrophic zone distribution. OA development involved concomitant focal suppression of sclerostin/MEPE in STR/Ort mice. Our novel synchrotron radiation microtomography method showed increased numbers (P < 0.001) and mean areal growth plate bridge densities (P < 0.01) in young and aged STR/Ort mice compared to age-matched CBA mice. CONCLUSION Taken together, our data support the notion of an inherent endochondral defect that is linked to growth dynamics and subject to regulation by the MEPE/sclerostin axis and may represent an underlying mechanism of pathologic ossification in OA.
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Affiliation(s)
- K. A. Staines
- Royal Veterinary College, University of London, London, UK, and Roslin Institute and Royal (Dick) School of Veterinary StudiesUniversity of Edinburgh, Easter Bush, UK
| | - K. Madi
- Manchester X‐Ray Imaging Facility, University of Manchester, Manchester, UK
| | - S. M. Mirczuk
- Royal Veterinary College, University of London, London, UK;
| | - S. Parker
- Royal Veterinary College, University of London, London, UK;
| | - A. Burleigh
- Royal Veterinary College, University of London, London, UK;
| | - B. Poulet
- University College London Medical School, London, UK
| | - M. Hopkinson
- Royal Veterinary College, University of London, London, UK;
| | - A. J. Bodey
- Diamond Light Source, Harwell Science and Innovation Campus, Didcot, UK
| | - R. C. Fowkes
- Royal Veterinary College, University of London, London, UK;
| | - C. Farquharson
- Roslin Institute and Royal (Dick) School of Veterinary Studies, University of Edinburgh, Easter Bush, UK
| | - P. D. Lee
- Manchester X‐Ray Imaging Facility, University of Manchester, Manchester, UK
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Conrozier T, Patarin J, Mathieu P, Rinaudo M. Steroids, lidocain and ioxaglic acid modify the viscosity of hyaluronic acid: in vitro study and clinical implications. SPRINGERPLUS 2016; 5:170. [PMID: 27026867 PMCID: PMC4766165 DOI: 10.1186/s40064-016-1762-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 02/12/2016] [Indexed: 01/18/2023]
Abstract
Background Viscosupplementaion by intra-articular injection of hyaluronic acid (HA) is a therapeutic modality for treating osteoarthritis of the knee, of the hip and less frequently of other joints. During viscosupplementation, it is usual to inject other drugs, without knowing whether this association may have a deleterious effect thereon. The rheological properties of a viscosupplement are highly dependent on the product [molecular weight × concentration] of HA. Therefore, any reduction of its viscoelastic properties is related either to a decrease of its concentration or/and of its molecular weight. The presence of other molecules can create favorable or unfavorable molecular interactions with HA. The objective of the study was to investigate the effect of products, that are commonly associated with HA (corticosteroids, lidocain, iodinated contrast media), on the rheological behavior of HA, then to try drawing practical conclusions. Methods The rheological behavior of both a linear and a cross-linked HA, was studied before and after mixing with different volumes (ratio 1:0.5–1:4) of the following compounds: phosphate buffered saline (PBS, as a control), cortivazol, triamcinolone hexacetonide, lidocain chlorhydrate and meglumine ioxaglate. The flow curve of the different samples was obtained using a measuring method based on a constant shear rate. Results Whatever the dilution and the added molecule were, viscosity of the cross-linked viscosupplement remained much higher than that of the linear one. Addition of PBS at a ratio 1:1 caused a dramatic decrease (up to 97.5 %) of HA viscosity. Cortivazol and lidocain had a similar effect than PBS on linear HA. Both were much deleterious on cross-linked HA viscosity. Among corticosteroids, triamcinolone decreased much less HA viscosity than cortivazol. The effect of meglumine ioxaglate was dose-dependent. Up to a ratio 1:1 viscosity of the linear HA remained above the dilution effect. On the cross-linked HA, the deleterious effect of the contrast agent was evident as soon as a ratio 1:1 and became very marked at 1:2. Conclusion HA viscosity varies widely in presence of other molecules. These changes are due to both dilution and molecular interactions. This study suggests that addition of other molecules with HA can lead to a major decrease of its viscosity. However, provided to respect a maximum ratio of 1:1, the contrast medium and triamcinolone seem to have no major deleterious effect on the viscosity level, especially on crosslinked HA. The study also suggests a deleterious effect of lidocain on the cross-linked HA. These in vitro data suggest that drugs associations must be avoided when they are not essential. However, clinical trials are needed to determine whether these rheological changes may have a significant impact on the clinical outcome.
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Affiliation(s)
- Thierry Conrozier
- Service de rhumatologie, Hôpital Nord Franche-Comté, 14 rue de Mulhouse, 90000 Belfort, France
| | - Jeremy Patarin
- Rhéonova, Domaine Universitaire, 363, rue de la chimie, 38400 Saint Martin d'Hères, France
| | - Pierre Mathieu
- Laboratoire de Rhumatologie Appliquée, 19 place Tolozan, 69001 Lyon, France
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Lugo JP, Saiyed ZM, Lane NE. Efficacy and tolerability of an undenatured type II collagen supplement in modulating knee osteoarthritis symptoms: a multicenter randomized, double-blind, placebo-controlled study. Nutr J 2016; 15:14. [PMID: 26822714 PMCID: PMC4731911 DOI: 10.1186/s12937-016-0130-8] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Accepted: 01/20/2016] [Indexed: 12/26/2022] Open
Abstract
Background Undenatured type II collagen (UC-II) is a nutritional supplement derived from chicken sternum cartilage. The purpose of this study was to evaluate the efficacy and tolerability of UC-II for knee osteoarthritis (OA) pain and associated symptoms compared to placebo and to glucosamine hydrochloride plus chondroitin sulfate (GC). Methods One hundred ninety one volunteers were randomized into three groups receiving a daily dose of UC-II (40 mg), GC (1500 mg G & 1200 mg C), or placebo for a 180-day period. The primary endpoint was the change in total Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) from baseline through day 180 for the UC-II group versus placebo and GC. Secondary endpoints included the Lequesne Functional Index (LFI), the Visual Analog Scale (VAS) for pain and the WOMAC subscales. Modified intent-to-treat analysis were performed for all endpoints using analysis of covariance and mixed model repeated measures, while incremental area under the curve was calculated by the intent-to-treat method. Results At day 180, the UC-II group demonstrated a significant reduction in overall WOMAC score compared to placebo (p = 0.002) and GC (p = 0.04). Supplementation with UC-II also resulted in significant changes for all three WOMAC subscales: pain (p = 0.0003 vs. placebo; p = 0.016 vs. GC); stiffness (p = 0.004 vs. placebo; p = 0.044 vs. GC); physical function (p = 0.007 vs. placebo). Safety outcomes did not differ among the groups. Conclusion UC-II improved knee joint symptoms in knee OA subjects and was well-tolerated. Additional studies that elucidate the mechanism for this supplement’s actions are warranted. Trial registration CTRI/2013/05/003663; CTRI/2013/02/003348.
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Affiliation(s)
| | | | - Nancy E Lane
- Center for Musculoskeletal Health, University of California Davis Health System, 4625 2nd Avenue, Suite 2006, Sacramento, CA, 95817, USA.
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Bay-Jensen AC, Reker D, Kjelgaard-Petersen CF, Mobasheri A, Karsdal MA, Ladel C, Henrotin Y, Thudium CS. Osteoarthritis year in review 2015: soluble biomarkers and the BIPED criteria. Osteoarthritis Cartilage 2016; 24:9-20. [PMID: 26707988 DOI: 10.1016/j.joca.2015.10.014] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 10/16/2015] [Accepted: 10/21/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To review and summarize biomarker data published from April 2014 to May 2015 to provide insight to the ongoing work in the field of osteoarthritis (OA). Furthermore, to summarize the BIPED criteria and set it in context of the medical needs of 2015. METHODS PubMed was used as searching machine: Time period 2014/04/01-2015/05/01, MeSH term [Biomarker] AND [Osteoarthritis], Language; English, Full text available. Reviews were excluded. Only papers describing protein based biomarkers measured in human body fluids from OA patients were included. RESULTS Biomarkers of joint tissue turnover, cytokines, chemokines and peptide arrays were measured in different cohorts and studies. Amongst those were previously tested biomarkers such as osteocalcin, Carboxy-terminal cross-linked fragment of type II collagen (CTX-II) and cartilage oligomeric matrix protein (COMP). A majority of the biomarker were classified as I, B or B biomarkers according to the BIPED criteria. Work is continuing on testing biomarkers in OA. There is still a huge, unmet medical need to identify, test, validate and qualify novel and well-known biomarkers. A pre-requisite for this is better characterization and classification of biomarkers to their needs, which may not be reached before higher understanding of OA phenotypes has been gained. In addition, we provide some references to some recent guidelines from Food and Drug Administration (FDA) and European Medicines Agency (EMA) on qualification and usage of biomarkers for drug development and personalized medicine, which may provide value to the field.
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Affiliation(s)
- A C Bay-Jensen
- Rheumatology, Biomarkers and Research, Nordic Bioscience, Herlev, Denmark.
| | - D Reker
- Rheumatology, Biomarkers and Research, Nordic Bioscience, Herlev, Denmark
| | | | - A Mobasheri
- Faculty of Health and Medical Sciences, University of Surrey, United Kingdom; Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, Arthritis Research UK Pain Centre, Medical Research Council and Arthritis Research UK Centre for Musculoskeletal Ageing Research, University of Nottingham, United Kingdom; Center of Excellence in Genomic Medicine Research (CEGMR), King Fahd Medical Research Center (KFMRC), King AbdulAziz University, Jeddah, Saudi Arabia
| | - M A Karsdal
- Rheumatology, Biomarkers and Research, Nordic Bioscience, Herlev, Denmark
| | - C Ladel
- OA Research & Early Clinical Development, Merck KGaA, Darmstadt, Germany
| | - Y Henrotin
- Bone and Cartilage Research Unit, Arthropole Liège, University of Liège, Institute of Pathology, Liège, Belgium
| | - C S Thudium
- Rheumatology, Biomarkers and Research, Nordic Bioscience, Herlev, Denmark
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Abstract
This article presents the spectrum of indications for the use of hyaluronic acid (HA) based on the recommendations of the European League Against Rheumatism (EULAR), the American College of Rheumatology (ACR), the Osteoarthritis Research Society International (OARSI), the International Institute for Health and Clinical Excellence (NICE) and the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) taking the reality of patient care in Europe into account.
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Affiliation(s)
- J Jerosch
- Klinik für Orthopädie, Unfallchirugie und Sportmedizin, Johanna Etienne Krankenhaus, Am Hasenberg 46, 40416, Neuss, Deutschland.
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Euppayo T, Siengdee P, Buddhachat K, Pradit W, Viriyakhasem N, Chomdej S, Ongchai S, Harada Y, Nganvongpanit K. Effects of low molecular weight hyaluronan combined with carprofen on canine osteoarthritis articular chondrocytes and cartilage explants in vitro. In Vitro Cell Dev Biol Anim 2015; 51:857-65. [PMID: 25982358 DOI: 10.1007/s11626-015-9908-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 04/01/2015] [Indexed: 10/23/2022]
Abstract
Intra-articular injection with non-steroidal anti-inflammatory drugs (NSAIDs) is used to treat inflammatory joint disease, but the side effects of NSAIDs include chondrotoxicity. Hyaluronan has shown positive effects on chondrocytes by reducing apoptosis and increasing proteoglycan synthesis. The purposes of this study were to evaluate the effects of low molecular weight hyaluronan (low MW HA), carprofen 25 mg/ml, carprofen 12.5 mg/ml, and a combination of HA and carprofen on canine osteoarthritis (OA) articular chondrocytes and a cartilage explant model in terms of cell viability, extracellular matrix remaining, and gene expression after exposure. In chondrocyte culture, MTT assay was used to evaluate the chondrotoxicity of IC50 and IC80 of carprofen with HA. In cartilage explant culture, two kinds of extracellular matrix (uronic acid and collagen) remaining in cartilage were used to evaluate cartilage damage for 14 d after treatment. Expression of COL2A1, AGG, and MMP3 was used to evaluate the synthesis and degradation of the matrix for 7 d after treatment. In chondrocyte culture, low MW HA could preserve OA chondrocyte viability but could not reduce the chondrotoxicity level of carprofen (P < 0.05). In explant culture, low MW HA combined with 12.5 mg/ml carprofen caused less destruction of uronic acid and collagen structure when compared with the control (P < 0.05). Low MW HA caused high expression levels of COL2A1 and AGG in OA cartilage (P < 0.05); HA combined with carprofen resulted in higher COL2A1 and AGG expression levels than carprofen alone.
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Affiliation(s)
- Thippaporn Euppayo
- Animal Bone and Joint Research Laboratory, Department of Veterinary Biosciences and Public Health, Faculty of Veterinary Medicine, Chiang Mai University, Chiang Mai, 50100, Thailand
| | - Puntita Siengdee
- Animal Bone and Joint Research Laboratory, Department of Veterinary Biosciences and Public Health, Faculty of Veterinary Medicine, Chiang Mai University, Chiang Mai, 50100, Thailand
| | - Kittisak Buddhachat
- Department of Biology, Faculty of Science, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Waranee Pradit
- Department of Biology, Faculty of Science, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Nawarat Viriyakhasem
- Department of Biochemistry, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50100, Thailand
| | - Siriwadee Chomdej
- Department of Biology, Faculty of Science, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Siriwan Ongchai
- Department of Biochemistry, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50100, Thailand
| | - Yasuji Harada
- Divisions of Veterinary Surgery, Nippon Veterinary and Life Science University, 1-7-1, Kyonann-cho, Musashinoshi, Tokyo, 180-8602, Japan
| | - Korakot Nganvongpanit
- Animal Bone and Joint Research Laboratory, Department of Veterinary Biosciences and Public Health, Faculty of Veterinary Medicine, Chiang Mai University, Chiang Mai, 50100, Thailand. .,Excellence Center in Osteology Research and Training Center, Chiang Mai University, Chiang Mai, 50200, Thailand.
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Henrotin Y, Raman R, Richette P, Bard H, Jerosch J, Conrozier T, Chevalier X, Migliore A. Consensus statement on viscosupplementation with hyaluronic acid for the management of osteoarthritis. Semin Arthritis Rheum 2015; 45:140-9. [PMID: 26094903 DOI: 10.1016/j.semarthrit.2015.04.011] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 04/27/2015] [Indexed: 01/03/2023]
Abstract
Viscosupplementation (VS) with hyaluronic acid is currently used by physicians to treat osteoarthritis. However, many aspects of this treatment remain questionable and subject of controversy. A group of 8 experts in this field, from European countries, met to debate on 24 statements previously listed by the group members. Based on an extensive research of the literature and expert opinion, a consensus position has been proposed for each statement. Agreement was achieved on some recommendations. In particular, the expert achieved unanimous agreement in favor of the following statements: VS is an effective treatment for mild to moderate knee OA; VS is not an alternative to surgery in advanced hip OA; VS is a well-tolerated treatment of knee and other joints OA; VS should not be used only in patients who have failed to respond adequately to analgesics and NSAIDs; VS is a "positive" indication but not a "lack of anything better" indication; the dosing regimen must be supported by evidence-based medicine; cross-linking is a proven means for prolonging IA residence time of HA; the best approach to inject accurately knee joint is the lateral mid-patellar one; when VS is performed under fluoroscopy, the amount of radiopaque contrast agent must be as low as possible to avoid viscosupplement dilution. These clear recommendations have been established to help practitioners in the use of viscosupplementation.
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Affiliation(s)
- Yves Henrotin
- Bone and Cartilageesearch Unit, Université de Liège, CHU Sart-Tilman, Liège, Belgium; Princess Paola Hospital, Marche-en-Famenne, Belgium
| | - Raghu Raman
- Academic Department of Orthopaedics, Hull and East Yorkshire NHS Trust Castle Hill Hospital, Cottingham, UK
| | - Pascal Richette
- UFR médicale, Université Paris Diderot, Paris, France; Hôpital Lariboisière, Fédération de Rhumatologie, Inserm 1132, Paris, France
| | - Hervé Bard
- Hôpital Européen Georges-Pompidou, Paris, France
| | - Jörg Jerosch
- Orthopedic Department, Johanna-Etienne-Hospital, Neuss, Germany
| | - Thierry Conrozier
- Department of Rheumatology, Hôpital Nord Franche-Comté, 14 rue de mulhouse, 90000 Belfort, France.
| | - Xavier Chevalier
- Paris XII University, UPEC, Department of Rheumatology, Henri Mondor Hospital, Creteil, France
| | - Alberto Migliore
- U.O.S. of Rheumatology, Ospedale San Pietro Fatebenefratelli, Rome, Italy
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Abstract
Osteoarthritis (OA) is a painful and life-altering disease that severely limits the daily activity of millions of Americans, and is one of the most common causes of disability in the world. With obesity on the rise and the world's population living longer, the prevalence of OA is expected to increase dramatically in the coming decades, generating burdensome socioeconomic costs. This review summarizes current pharmaceutical, non-pharmaceutical, and prospective new treatments for OA, with primary focus on the dietary supplement Avocado/Soybean Unsaponifiables (ASU). ASU modulates OA pathogenesis by inhibiting a number of molecules and pathways implicated in OA. Anticatabolic properties prevent cartilage degradation by inhibiting the release and activity of matrix metalloproteinases (MMP-2,3,13) and increasing tissue inhibitors of these catabolic enzymes (TIMP-1). ASU also inhibits fibrinolysis by stimulating the expression of plasminogen activator inhibitor (PAI-1). Anabolic properties promote cartilage repair by stimulating collagen and aggrecan synthesis via inhibition of inflammatory cytokines such as IL1, IL6, IL8, TNF, ERK, and PGE2. Chondroprotective effects are mediated by correcting growth factor abnormalities, increasing TGFβ while decreasing vascular endothelial growth factor (VEGF) in synovial fluid. ASU also inhibits cholesterol absorption and endogenous cholesterol biosynthesis, which mediate reactive oxygen species pathology in chondrocytes. At the clinical level, ASU reduces pain and stiffness while improving joint function, resulting in decreased dependence on analgesics.
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Affiliation(s)
- Blaine A. Christiansen
- Department of Orthopaedic Surgery, Lawrence J. Ellison Musculoskeletal Research Center, University of California-Davis Health System, Sacramento, CA, USA
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Blanco FJ. Osteoarthritis year in review 2014: we need more biochemical biomarkers in qualification phase. Osteoarthritis Cartilage 2014; 22:2025-32. [PMID: 25456298 DOI: 10.1016/j.joca.2014.09.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 08/21/2014] [Accepted: 09/01/2014] [Indexed: 02/02/2023]
Abstract
The current diagnosis of osteoarthritis (OA) relies on the description of pain symptoms, affected joint stiffness, and radiography used as the reference technique for determining the grade of joint destruction. Limitations of the presently available diagnostic tests have provided an impetus for the substantial increase in interest in finding new specific biological markers for cartilage degradation to facilitate the early diagnosis of joint destruction, evaluate disease progression and improve disease prognosis. Biomarkers for OA are also useful for drug development, treatment monitoring, and as a basis for personalized evidence-based action plans. This review summarizes 29 manuscripts published during 2013 with a focus on soluble biochemical biomarkers, primarily those utilizing proteomic, metabolomics, lipidomic and imaging mass spectrometry technologies.
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Affiliation(s)
- Francisco J Blanco
- Grupo de Proteomica-PBR2-ProteoRed/ISCIII-Servicio de Reumatologia, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade da Coruña (UDC), As Xubias, 15006 A Coruña, Spain.
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Siebuhr AS, He Y, Gudmann NS, Gram A, Kjelgaard-Petersen CF, Qvist P, Karsdal MA, Bay-Jensen AC. Biomarkers of cartilage and surrounding joint tissue. Biomark Med 2014; 8:713-31. [DOI: 10.2217/bmm.13.144] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The identification and clinical demonstration of efficacy and safety of osteo- and chondro-protective drugs are met with certain difficulties. During the last few decades, the pharmaceutical industry has, in the field of rheumatology, experienced disappointments associated with the development of disease modification. Today, the vast amount of patients suffering from serious, chronic joint diseases can only be offered treatments aimed at improving symptoms, such as pain and acute inflammation, and are not aimed at protecting the joint tissue. This huge, unmet medical need has been the driver behind the development of improved analytical techniques allowing better and more efficient clinical trial design, implementation and analysis. With this review, we aim to provide a brief and general overview of biochemical markers of joint tissue, with special focus on neoepitopes. Furthermore, we highlight recent studies applying biochemical markers in joint degenerative diseases. These disorders, including osteoarthritis, rheumatoid arthritis and spondyloarthropathies, are the most predominant disorders in Europe and the USA, and have enormous socioeconomical impact.
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Affiliation(s)
- Anne S Siebuhr
- Nordic Bioscience, Biomarkers & Research, Herlev Hovedgade 207, Herlev DK-2730, Denmark
| | - Yi He
- Nordic Bioscience, Biomarkers & Research, Herlev Hovedgade 207, Herlev DK-2730, Denmark
| | - Natasja S Gudmann
- Nordic Bioscience, Biomarkers & Research, Herlev Hovedgade 207, Herlev DK-2730, Denmark
| | - Aurelie Gram
- Nordic Bioscience, Biomarkers & Research, Herlev Hovedgade 207, Herlev DK-2730, Denmark
| | | | - Per Qvist
- Nordic Bioscience, Biomarkers & Research, Herlev Hovedgade 207, Herlev DK-2730, Denmark
| | - Morten A Karsdal
- Nordic Bioscience, Biomarkers & Research, Herlev Hovedgade 207, Herlev DK-2730, Denmark
| | - Anne C Bay-Jensen
- Nordic Bioscience, Biomarkers & Research, Herlev Hovedgade 207, Herlev DK-2730, Denmark
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Sorbitol-modified hyaluronic acid reduces oxidative stress, apoptosis and mediators of inflammation and catabolism in human osteoarthritic chondrocytes. Inflamm Res 2014; 63:691-701. [PMID: 24858301 DOI: 10.1007/s00011-014-0742-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Revised: 05/06/2014] [Accepted: 05/08/2014] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE AND DESIGN Our study was designed to elucidate the precise molecular mechanisms by which sorbitol-modified hyaluronic acid (HA/sorbitol) exerts beneficial effects in osteoarthritis (OA). METHODS Human OA chondrocytes were treated with increasing doses of HA/sorbitol ± anti-CD44 antibody or with sorbitol alone and thereafter with or without interleukin-1beta (IL-1β) or hydrogen peroxide (H2O2). Signal transduction pathways and parameters related to oxidative stress, apoptosis, inflammation, and catabolism were investigated. RESULTS HA/sorbitol prevented IL-1β-induced oxidative stress, as measured by reactive oxygen species, p47-NADPH oxidase phosphorylation, 4-hydroxynonenal (HNE) production and HNE-metabolizing glutathione-S-transferase A4-4 expression. Moreover, HA/sorbitol stifled IL-1β-induced metalloproteinase-13, nitric oxide (NO) and prostaglandin E2 release as well as inducible NO synthase expression. Study of the apoptosis process revealed that this gel significantly attenuated cell death, caspase-3 activation and DNA fragmentation elicited by exposure to a cytotoxic H2O2 dose. Examination of signaling pathway components disclosed that HA/sorbitol prevented IL-1β-induced p38 mitogen-activated protein kinase and nuclear factor-kappa B activation, but not that of extracellular signal-regulated kinases 1 and 2. Interestingly, the antioxidant as well as the anti-inflammatory and anti-catabolic effects of HA/sorbitol were attributed to sorbitol and HA, respectively. CONCLUSIONS Altogether, our findings support a beneficial effect of HA/sorbitol in OA through the restoration of redox status and reduction of apoptosis, inflammation and catabolism involved in cartilage damage.
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Henrotin Y, Gharbi M, Dierckxsens Y, Priem F, Marty M, Seidel L, Albert A, Heuse E, Bonnet V, Castermans C. Decrease of a specific biomarker of collagen degradation in osteoarthritis, Coll2-1, by treatment with highly bioavailable curcumin during an exploratory clinical trial. Altern Ther Health Med 2014; 14:159. [PMID: 24886572 PMCID: PMC4032499 DOI: 10.1186/1472-6882-14-159] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Accepted: 04/30/2014] [Indexed: 01/06/2023]
Abstract
Background The management of osteoarthritis (OA) remains a challenge. There is a need not only for safe and efficient treatments but also for accurate and reliable biomarkers that would help diagnosis and monitoring both disease activity and treatment efficacy. Curcumin is basically a spice that is known for its anti-inflammatory properties. In vitro studies suggest that curcumin could be beneficial for cartilage in OA. The aim of this exploratory, non-controlled clinical trial was to evaluate the effects of bio-optimized curcumin in knee OA patients on the serum levels of specific biomarkers of OA and on the evaluation of pain. Methods Twenty two patients with knee OA were asked to take 2x3 caps/day of bio-optimized curcumin (Flexofytol®) for 3 months. They were monitored after 7, 14, 28 and 84 days of treatment. Pain over the last 24 hours and global assessment of disease activity by the patient were evaluated using a visual analog scale (100 mm). The serum levels of Coll-2-1, Coll-2-1NO2, Fib3-1, Fib3-2, CRP, CTX-II and MPO were determined before and after 14 and 84 days of treatment. Results The treatment with curcumin was globally well tolerated. It significantly reduced the serum level of Coll2-1 (p < 0.002) and tended to decrease CRP. No other significant difference was observed with the other biomarkers. In addition, curcumin significantly reduced the global assessment of disease activity by the patient. Conclusion This study highlighted the potential effect of curcumin in knee OA patient. This effect was reflected by the variation of a cartilage specific biomarker, Coll2-1 that was rapidly affected by the treatment. These results are encouraging for the qualification of Coll2-1 as a biomarker for the evaluation of curcumin in OA treatment. Trial registration NCT01909037 at clinicaltrials.gov
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Andia I, Abate M. Knee osteoarthritis: hyaluronic acid, platelet-rich plasma or both in association? Expert Opin Biol Ther 2014; 14:635-49. [PMID: 24533435 DOI: 10.1517/14712598.2014.889677] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Bidirectional interactions between cells and fluidic surroundings regulate cellular functions and maintain tissue or organ architecture. Accordingly, the synovial fluid is the primary source of environmental signals and determines to a great extent the molecular interactions within the joint capsule, both in homeostasis and pathology. AREAS COVERED We provided an update on hyaluronic acid (HA) and platelet-rich plasma (PRP) concepts necessary to build the rationale for creating a combined treatment. The information is based on a PubMed search using the terms 'platelet-rich plasma', 'hyaluronic acid', 'knee pathology', 'knee osteoarthritis' (OA). EXPERT OPINION In OA, a deleterious fluidic microenvironment is established, with presence of HA fragments, catabolic enzymes and inflammatory molecules. The central concept underlying intra-articular injection is to modify deleterious fluidic microenvironments. PRP administration has shown pain remission and function improvement, but less than half of the patients showed clinically significant improvement. PRP exceeds HA, the comparator used in PRP clinical trials, albeit both HA and PRP alleviate symptoms in mild-to-moderate OA patients. Combining PRP and HA may benefit from their dissimilar biological mechanisms and help in controlling delivery and presentation of signaling molecules. Three armed randomized studies, using both HA and PRP as comparators, will provide information about the impact of this approach.
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Affiliation(s)
- Isabel Andia
- Cruces University Hospital, BioCruces Health Research Institute, Regenerative Medicine Laboratory , 48903 Barakaldo , Spain
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Abstract
Aberrant redeployment of the 'transient' events responsible for bone development and postnatal longitudinal growth has been reported in some diseases in what is otherwise inherently 'stable' cartilage. Lessons may be learnt from the molecular mechanisms underpinning transient chondrocyte differentiation and function, and their application may better identify disease aetiology. Here, we review the current evidence supporting this possibility. We firstly outline endochondral ossification and the cellular and physiological mechanisms by which it is controlled in the postnatal growth plate. We then compare the biology of these transient cartilaginous structures to the inherently stable articular cartilage. Finally, we highlight specific scenarios in which the redeployment of these embryonic processes may contribute to disease development, with the foresight that deciphering those mechanisms regulating pathological changes and loss of cartilage stability will aid future research into effective disease-modifying therapies.
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Affiliation(s)
- K A Staines
- (Correspondence should be addressed to K A Staines; )
| | | | | | - C Farquharson
- Comparative Biomedical Sciences, The Royal Veterinary CollegeRoyal College Street, London, NW1 0TUUK
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Lafeber FPJG, van Spil WE. Osteoarthritis year 2013 in review: biomarkers; reflecting before moving forward, one step at a time. Osteoarthritis Cartilage 2013; 21:1452-64. [PMID: 23954702 DOI: 10.1016/j.joca.2013.08.012] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 07/25/2013] [Accepted: 08/03/2013] [Indexed: 02/02/2023]
Abstract
In 2010, in Osteoarthritis and Cartilage, we published a comprehensive systematic review applying the consensus BIPED criteria (Burden of Disease, Investigative, Prognostic, Efficacy of Intervention and Diagnostic) criteria on serum and urinary biochemical markers for knee and hip osteoarthritis (OA) using publications that were available at that time. It appeared that none of the biochemical markers at that time were sufficiently discriminating to allow diagnosis and prognosis of OA in individual or limited numbers of patients, nor performed so consistently that they could function as primary outcome parameters in clinical trials. Also at present, almost 3 years later, this ultimate goal has not been reached (yet). Frankly, it might be questioned whether we are making the most adequate steps ahead and maybe we have to take a step back to reconsider our approaches. Some reflections are made and discussed: A critical review of molecular metabolism in OA and validation of currently investigated marker molecules in this may be vital and may lead to new and better markers. Creating cohorts in which synovial fluid (SF) is obtained in a systematic way, together with serum and urine, may also bring the field a further step ahead. Thirdly, better understanding of different phenotypes (subtypes) of OA may facilitate identification and validation of biochemical markers. Finally, the systems biology approach as discussed in the last years OA in review on biomarkers, although very complex, might provide steps forward. Looking ahead, we are optimistic but realistic in our expectations, we believe that the field can be brought forward by critically and cautiously reconsidering our approaches, and making changes forward, one step at a time.
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Affiliation(s)
- F P J G Lafeber
- Rheumatology & Clin. Immunol., University Medical Centre Utrecht, The Netherlands.
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Interplay between cartilage and subchondral bone contributing to pathogenesis of osteoarthritis. Int J Mol Sci 2013; 14:19805-30. [PMID: 24084727 PMCID: PMC3821588 DOI: 10.3390/ijms141019805] [Citation(s) in RCA: 175] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 09/17/2013] [Accepted: 09/23/2013] [Indexed: 12/23/2022] Open
Abstract
Osteoarthritis (OA) is a common debilitating joint disorder, affecting large sections of the population with significant disability and impaired quality of life. During OA, functional units of joints comprising cartilage and subchondral bone undergo uncontrolled catabolic and anabolic remodeling processes to adapt to local biochemical and biological signals. Changes in cartilage and subchondral bone are not merely secondary manifestations of OA but are active components of the disease, contributing to its severity. Increased vascularization and formation of microcracks in joints during OA have suggested the facilitation of molecules from cartilage to bone and vice versa. Observations from recent studies support the view that both cartilage and subchondral bone can communicate with each other through regulation of signaling pathways for joint homeostasis under pathological conditions. In this review we have tried to summarize the current knowledge on the major signaling pathways that could control the cartilage-bone biochemical unit in joints and participate in intercellular communication between cartilage and subchondral bone during the process of OA. An understanding of molecular communication that regulates the functional behavior of chondrocytes and osteoblasts in both physiological and pathological conditions may lead to development of more effective strategies for treating OA patients.
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