The effect of anti-inflammatory drugs on glycosaminoglycan sulphation in pig cartilage

Outcomes of prolotherapy in chondromalacia patella patients: improvements in pain level and function

We retrospectively evaluated the effectiveness of prolotherapy in resolving pain, stiffness, and crepitus, and improving physical activity in consecutive chondromalacia patients from February 2008 to September 2009. Sixty-nine knees that received prolotherapy in 61 patients (33 female and 36 male) who were 18–82 years old (average, 47.2 years) were enrolled. Patients received 24 prolotherapy injections (15% dextrose, 0.1% procaine, and 10% sarapin) with a total of 40 cc in the anterior knee. At least 6 weeks after their last prolotherapy session, patients provided self-evaluation of knee pain upon rest, activities of daily living (ADL) and exercise, range of motion (ROM), stiffness, and crepitus. Symptom severity, sustained improvement of symptoms, number of pain pills needed, and patient satisfaction before treatment and improvement after treatment were recorded. Following prolotherapy, patients experienced statistically significant decreases in pain at rest, during ADL, and exercise. Stiffness and crepitus decreased after prolotherapy, and ROM increased. Patients reported improved walking ability and exercise ability after prolotherapy. For daily pain level, ROM, daily stiffness, crepitus, and walking and exercise ability, sustained improvement of over 75% was reported by 85% of patients. Fewer patients required pain medication. No side effects of prolotherapy were noted. The average length of time from last prolotherapy session was 14.7 months (range, 6 months to 8 years). Only 3 of 16 knees were still recommended for surgery after prolotherapy. Prolotherapy ameliorates chondromalacia patella symptoms and improves physical ability. Patients experience long-term improvement without requiring pain medications. Prolotherapy should be considered a first-line, conservative therapy for chondromalacia patella.

Boswellia serrata, a potential antiinflammatory agent: an overview

The resin of Boswellia species has been used as incense in religious and cultural ceremonies and in medicines since time immemorial. Boswellia serrata (Salai/Salai guggul), is a moderate to large sized branching tree of family Burseraceae (Genus Boswellia), grows in dry mountainous regions of India, Northern Africa and Middle East. Oleo gum-resin is tapped from the incision made on the trunk of the tree and is then stored in specially made bamboo basket for removal of oil content and getting the resin solidified. After processing, the gum-resin is then graded according to its flavour, colour, shape and size. In India, the States of Andhra Pradesh, Gujarat, Madhya Pradesh, Jharkhand and Chhattisgarh are the main source of Boswellia serrata. Regionally, it is also known by different names. The oleo gum-resins contain 30-60% resin, 5-10% essential oils, which are soluble in the organic solvents, and the rest is made up of polysaccharides. Gum-resin extracts of Boswellia serrata have been traditionally used in folk medicine for centuries to treat various chronic inflammatory diseases. The resinous part of Boswellia serrata possesses monoterpenes, diterpenes, triterpenes, tetracyclic triterpenic acids and four major pentacyclic triterpenic acids i.e. β-boswellic acid, acetyl-β-boswellic acid, 11-keto-β-boswellic acid and acetyl-11-keto-β-boswellic acid, responsible for inhibition of pro-inflammatory enzymes. Out of these four boswellic acids, acetyl-11-keto-β-boswellic acid is the most potent inhibitor of 5-lipoxygenase, an enzyme responsible for inflammation.

Maintenance of the synthesis of large proteoglycans in anatomically intact murine articular cartilage by steroids and insulin-like growth factor I

OBJECTIVES

The exact regulation of the synthesis of cartilage specific molecules, such as collagen type II and aggrecan, by articular chondrocytes is unknown, but growth factors and hormones probably play an important part. The effects of glucocorticosteroids (prednisolone and triamcinolone), in combination with insulin-like growth factor I (IGF-I), on the synthesis and hydrodynamic volume of proteoglycans from murine patellar cartilage were investigated.

METHODS

The in vitro effect of IGF-I and steroids on proteoglycan synthesis in murine patellar cartilage was evaluated by [35S]sulphate incorporation in combination with dissociative gel chromatography using a Sephacryl S-1000 column. The impact of in vivo prednisolone (0-5 mg/kg) on proteoglycan synthesis in murine patellar cartilage was analysed by [35S]sulphate incorporation immediately after dissection from the knee joint.

RESULTS

Prednisolone stimulated proteoglycan synthesis in murine patellar cartilage from normal knees and in cartilage from knees injected with papain in vitro in the absence and presence of IGF-I. Moreover, oral administration of prednisolone for seven days to C57Bl10 mice resulted in enhanced proteoglycan synthesis in patellar cartilage. The incubation of patellar cartilage for 48 hours without serum or growth factors led to the synthesis of proteoglycans with a smaller hydrodynamic volume than those synthesised immediately after dissection of the patellae. This could either be circumvented by the addition of IGF-I or by the addition of glucocorticosteroids (prednisolone or triamcinolone) to the culture medium.

CONCLUSIONS

These results show that in a dose range of 0.0003-0.3 mmol/l, glucocorticosteroids, like IGF-I, stimulate proteoglycan synthesis and maintain the synthesis of hydrodynamically large proteoglycans by chondrocytes from murine articular cartilage. This indicates that glucocorticosteroids might play a part in the preservation of matrix integrity in articular cartilage.

Sulfate homeostasis. III. Effect of chronic naproxen or sulindac treatment on inorganic sulfate disposition in arthritic patients with renal impairment

The purpose of the present investigation was to examine the influence of chronic naproxen (500 mg twice daily) or sulindac (200 mg twice daily) therapy on the disposition of inorganic sulfate in arthritic subjects with impaired renal function. Subjects were studied during a control period (after a 7-day NSAID washout) and after 14 days of treatment with either naproxen or sulindac. During the control period subjects in this investigation exhibited higher serum sulfate concentrations and lower sulfate renal clearance values than reported for younger subjects with normal renal function. Treatment with either sulindac or naproxen significantly decreased creatinine clearance. Sulindac therapy also increased the serum sulfate concentration and decreased the clearance of sulfate; a similar trend was observed after naproxen therapy but the average change was smaller and not statistically significant. There were significant correlations between the creatinine and the sulfate clearances or serum concentrations. The glomerular filtration rate of inorganic sulfate was not altered by drug treatment and there was no impairment of reabsorption. The serum concentrations and renal clearance of other electrolytes (sodium, potassium, magnesium, calcium, phosphorus) were largely unaffected. Therefore, chronic treatment with naproxen or sulindac decreases the renal clearance of endogenous sulfate in humans: this appears to be a consequence of the decrement in renal function observed in subjects with preexisting mild renal impairment.

Studies on the metabolism of glycosaminoglycans under the influence of new herbal anti-inflammatory agents

The in vivo effect of an herbal based, non-steroidal anti-inflammatory product, salai guggal, prepared from the gum resin exudate of Boswellia serrata and its active principle "boswellic acids" on glycosaminoglycan metabolism has been studied in male albino rats. The biosynthesis of sulfated glycosaminoglycans, as evaluated by the uptake of [35S]sulfate, and the content of glycosaminoglycans were measured in specimens of skin, liver, kidney and spleen. Statistical analysis of the data obtained with respect to the boswellic acids and salai guggal were compared with those of ketoprofen. A significant reduction in glycosaminoglycan biosynthesis was observed in rats treated with all of the drugs. Glycosaminoglycan content was found to be decreased in the ketoprofen-treated group, whereas that of the boswellic acids or salai guggal treated groups remained unaltered. The catabolism of glycosaminoglycans was followed by estimating the activities of lysosomal glycohydrolases, namely beta-glucuronidase, beta-N-acetylglucosaminidase, cathepsin B1, cathepsin B2 and cathepsin D, in tissues and by estimating the urinary excretion and hexosamine and uronic acid. The degradation of glycosaminoglycans was found to be reduced markedly in all drug-treated animals as compared to controls. The potential significance of boswellic acids and salai guggal was discussed in the light of changes in the metabolism of glycosaminoglycans.

Anti-rheumatic drugs and cartilage

In this chapter an attempt has been made to draw together the known biology of cartilage and some of the mechanisms thought to be responsible for its failure in arthritis. The picture is far from complete but we are now in a good position to use this information to help appraise the pros and cons of the wide range of drugs now available to treat articular disorders. For convenience, these drugs were classified as NSAIDs, corticosteroids and chondroprotective agents. The influence of each of these classes on the metabolism of cartilage was examined in the light of published laboratory and clinical studies. It has been clearly shown that not all NSAIDs are the same. While many of the older drugs provided no benefit to cartilage metabolism, and in some instances suppressed it, the more recently discovered molecules appear to be free of these undesirable effects. Tiaprofenic acid, diclofenac and piroxicam emerged as drugs with little or no harmful effects on cartilage metabolism when used at concentrations within the human therapeutic range. For all NSAIDs, their potential effects on cartilage must be weighed against their respective anti-inflammatory potency, half-life, and effects on the gastric mucosa and other tissues. Other chapters in this book have addressed these important problems. The long-acting corticosteroids, betamethasone and triamcinolone hexacetonide, also appear to offer some benefit in the management of OA; however, as in RA, their use should be restricted to short-term applications. In terms of cartilage metabolism the chondroprotective agents pentosan polysulphate, Arteparon and Rumalon have been the most extensively studied class of drugs. While the laboratory studies have provided convincing evidence of their chondroprotective efficacy, it has been difficult to prove this clinically. This dichotomy of opinion (laboratory versus clinical) stems largely from the inadequacy of the methodologies currently available for the objective clinical assessment of patient response to anti-rheumatic drug therapy. With the advent of nuclear magnetic resonance imaging techniques and monoclonal antibodies to detect specific proteoglycan breakdown fragments in synovial fluid and plasma, the prospects for a unified research approach for the evaluation of these agents may now be possible.

Effects of NSAIDs on the metabolism of sulphated glycosaminoglycans in healthy and (post) arthritic murine articular cartilage

Several non-steroidal anti-inflammatory drugs (NSAIDs) were studied for their effects on normal and damaged murine articular cartilage, both in vitro and in vivo. In vitro, in the absence of serum, sodium salicylate caused significant suppression of 35S-glycosaminoglycan (GAG) synthesis, whereas tiaprofenic acid, piroxicam, prednisolone sodium phosphate and several other NSAIDs were without effect. Trypsin-mediated proteoglycan depletion did not change the susceptibility of the articular chondrocyte to these drugs. Similarly, no enhancement of drug effect was seen when arthritic cartilage was taken from an acutely inflamed joint, and prenisolone sodium phosphate even seemed to diminish inflammation-mediated suppression of 35S-GAG synthesis. The short term in vivo effects of some of the drugs were tested in mice with unilateral zymosan-induced arthritis. At day 1 after arthritis induction, in vivo 35S-GAG synthesis by the cartilage of the arthritic joint was decreased to 63%. Only sodium salicylate suppressed in vivo 35S-GAG synthesis in the healthy and arthritic joint to the same extent in both. At day 28, GAG synthesis in the postarthritic joint was enhanced to 160%. This type of cartilage appeared to be more susceptible to drug effects, since all drugs tested showed clear suppression of the augmented GAG production in vivo. Finally, in vivo drug effects were tested on normal and enhanced 35S-GAG degradation, the latter in the zymosan-induced arthritic joint. Both tiaprofenic acid and prednisolone sodium phosphate appeared to suppress degradation in healthy and, to some extent, in arthritic cartilage.(ABSTRACT TRUNCATED AT 250 WORDS)

Hydrocortisone stimulation of proliferation and glycosaminoglycan synthesis in rabbit craniofacial chondrocytes in vitro

Hydrocortisone stimulated glycosaminoglycan (GAG) synthesis, a cartilage phenotype, in chondrocytes from mandibular condylar cartilage (MCC), nasal septal cartilage (NSC) and sphenooccipital synchondrosis (SOS). These stimulations were dose- and time-dependent, being maximal 27 h after addition of 10(-7) M hydrocortisone. The maximal induced increase of GAG synthesis was about 100%, 50% and 20% that of non-stimulated MCC, SOS and NSC chondrocytes, respectively. When stained with toluidine blue, all three types of cortisone-treated chondrocytes showed stronger metachromasia than non-treated controls. DNA synthesis was also increased by hydrocortisone, reaching a maximum 20 h after the addition; stimulation was also dose-dependent and maximal at a concentration of 10(-6) M. The maximal increase in DNA synthesis was 200% in NSC chondrocytes, 90% in SOS chondrocytes, and slight in MCC chondrocytes. However, there was no stimulation of DNA synthesis in serum-free medium, in contrast to that of GAG synthesis. These observations suggest that hydrocortisone regulates craniofacial growth by controlling the differentiation of these chondrocytes directly and their proliferation indirectly, and that the difference in their responses to hydrocortisone may reflect different responses in vivo.

Chemically induced renal papillary necrosis and upper urothelial carcinoma. Part 1

In the past, renal papillary necrosis (RPN) has been commonly associated with long-term abusive analgesic intake, but over recent years a wide variety of industrially and therapeutically used chemicals have been shown to induce this lesion experimentally or in man. Destruction of the renal papilla may result in: (1) secondary degenerative cortical changes which precede chronic renal failure or (2) a rapidly metastasizing upper urothelial carcinoma, which has a very poor prognosis. This article will briefly review the published data on the morphology, function, and biochemistry of the normal renal medulla and the pathology associated with RPN, together with the secondary changes which give rise to cortical degeneration or epithelial carcinoma. It will then examine in detail those chemicals which have been reported to cause RPN in an attempt to delineate structure-activity relationships. Finally, the many different theories that have been proposed to explain the pathophysiology of RPN will be examined and an hypothesis will be put forward to explain the primary pathogenesis of the lesion and its secondary consequences.

Chemically induced renal papillary necrosis and upper urothelial carcinoma. Part 2

In the past, renal papillary necrosis (RPN) has been commonly associated with long-term abusive analgesic intake, but over recent years a wide variety of industrially and therapeutically used chemicals have been shown to induce this lesion experimentally or in man. Destruction of the renal papilla may result in: (1) secondary degenerative cortical changes which precede chronic renal failure or (2) a rapidly metastasizing upper urothelial carcinoma, which has a very poor prognosis. This article will briefly review the published data on the morphology, function, and biochemistry of the normal renal medulla and the pathology associated with RPN, together with the secondary changes which give rise to cortical degeneration or epithelial carcinoma. It will then examine in detail those chemicals which have been reported to cause RPN in an attempt to delineate structure-activity relationships. Finally, the many different theories that have been proposed to explain the pathophysiology of RPN will be examined and an hypothesis will be put forward to explain the primary pathogenesis of the lesion and its secondary consequences.

Nonsteroidal anti-inflammatory drugs and modulation of cartilaginous changes in osteoarthritis and rheumatoid arthritis. Clinical implications

Nonsteroidal anti-inflammatory drugs have a potential for modifying the complex pathophysiologic events leading to cartilage destruction in various forms of arthritis. Following an evaluation of basic mechanisms in the pathogenesis of cartilaginous destructive lesions, the effects of nonsteroidal anti-inflammatory drugs on normal chondrocyte metabolism are discussed. Their capacity to modulate cartilage and bone lesions in experimental forms of arthritis is addressed, as is the manner in which they may modify the pathophysiology of cartilage destruction in human forms of arthritis. Different classes of nonsteroidal anti-inflammatory drugs produce different effects in certain in vivo or in vitro settings.