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Stellpflug SJ, Stolbach A, Ghorayeb J, Magraken E, Twohey E, Lapoint J, deWeber K. Cannabis in combat sports: position statement of the Association of Ringside Physicians. PHYSICIAN SPORTSMED 2024; 52:432-443. [PMID: 38949963 DOI: 10.1080/00913847.2024.2375788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 06/30/2024] [Indexed: 07/03/2024]
Abstract
and ARP Position Statement: Based on the available body of scientific evidence and with the goals of promoting safety of combat sports athletes and striving for the advancement of clean sport, the Association of Ringside Physicians recommends the following regarding cannabis:• Use of marijuana or synthetic cannabinoids by combat sports athletes is discouraged due to unproven benefits and many known adverse effects. Acute use can impair cognition and complex motor function, which likely leads to reduced performance in combat sports. Chronic use can increase risk for heart and lung disease, several cancers, schizophrenia, and can reduce testosterone in men and impair fertility. Benefits from cannabis in most contexts, including athletic performance, have not been proven.• Use of topical purified CBD is neither encouraged nor discouraged.• Since acute cannabis intoxication can impair complex cognitive and motor function, any athlete suspected of acute intoxication at the time of competition - based on clinical judgment - should be banned from that competition.• Wide-scale regulation of cannabis based on quantitative testing has limited usefulness in combat sports, for the following reasons:∘ Cannabis is not ergogenic and is likely ergolytic.∘ Concentrations in body fluids correlate poorly with clinical effects and timing of use.∘ Access to testing resources varies widely across sporting organizations.
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Affiliation(s)
| | - Andrew Stolbach
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Joe Ghorayeb
- University of Medicine and Health Sciences, New York, NY, USA
| | | | - Eric Twohey
- Mayo Clinic Department of Physical Medicine and Rehabilitation, Rochester, MN, USA
| | - Jeff Lapoint
- Southern California Permanente Medical Group, San Diego Medical Center, Department of Emergency Medicine, San Diego, CA, USA
| | - Kevin deWeber
- SW Washington Sports Medicine Fellowship, Vancouver, WA, USA
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Vitetta L, Henson JD. Comment on "Hall et al., Topical cannabidiol is well tolerated in individuals with a history of elite physical performance and chronic lower extremity pain". J Cannabis Res 2024; 6:13. [PMID: 38494522 PMCID: PMC10946142 DOI: 10.1186/s42238-023-00206-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 08/23/2023] [Indexed: 03/19/2024] Open
Affiliation(s)
- Luis Vitetta
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2006, Australia.
| | - Jeremy D Henson
- Prince of Wales Clinical School, University of NSW, Sydney, NSW, 2052, Australia
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Alaia MJ, Li ZI, Chalem I, Hurley ET, Vasavada K, Gonzalez-Lomas G, Rokito AS, Jazrawi LM, Kaplan K. Cannabidiol for Postoperative Pain Control After Arthroscopic Rotator Cuff Repair Demonstrates No Deficits in Patient-Reported Outcomes Versus Placebo: 1-Year Follow-up of a Randomized Controlled Trial. Orthop J Sports Med 2024; 12:23259671231222265. [PMID: 38322981 PMCID: PMC10846110 DOI: 10.1177/23259671231222265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 08/10/2023] [Indexed: 02/08/2024] Open
Abstract
Background Cannabidiol (CBD) has been shown recently to positively affect patient pain and satisfaction immediately after arthroscopic rotator cuff repair (ARCR). However, it is unclear whether the addition of CBD to a perioperative regimen could affect postoperative outcomes. Purpose To evaluate patient-reported outcomes among patients who underwent ARCR and received buccally absorbed CBD or an identical placebo for early postoperative pain management at 1-year follow-up. Study Design Randomized controlled trial; Level of evidence, 2. Methods Eligible patients had previously participated in a multicenter, placebo-controlled, randomized, double-blinded trial that evaluated the analgesic effects of CBD in the immediate postoperative period after ARCR. The experimental group received 25 mg of CBD 3 times/day if <80 kg and 50 mg of CBD 3 times/day if >80 kg for 14 days, with the control group receiving an identical placebo. The following outcomes were assessed at minimum 1-year follow-up: visual analog scale (VAS) for pain, American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numeric Evaluation (SANE), and patient satisfaction. The rates of achievement of the Patient Acceptable Symptom State (PASS) were compared based on ASES at latest follow-up. Continuous and categorical variables were compared with the Mann-Whitney U test and Fisher exact test, respectively. Results Follow-up was obtained from 83 of 99 patients (83.8%) who completed the original trial. There were no significant differences between the CBD and control groups with respect to age, sex, body mass index, rate of concomitant procedures, or number of anchors used intraoperatively. At 1-year follow-up, there were no significant differences between the CBD and control groups in VAS pain (0.8 vs 1.2, P = .38), ASES (93.0 vs 91.1, P = .71), SANE (87.6 vs 90.1, P = .24), or satisfaction (97.4 vs 95.4, P = .41). A majority of patients achieved the PASS (81.0% [CBD] vs 77.5% [control]; P = .79). Conclusion Perioperative use of CBD for pain control among patients undergoing ARCR did not result in any significant deficits in pain, satisfaction, or patient-reported outcomes at 1-year postoperatively compared with a placebo control group. These findings suggest that CBD can be considered in a postoperative multimodal pain management regimen without detrimental effects on outcome. Registration NCT04672252 (ClinicalTrials.gov identifier).
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Affiliation(s)
- Michael J. Alaia
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, USA
| | - Zachary I. Li
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, USA
| | - Isabel Chalem
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, USA
| | - Eoghan T. Hurley
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, USA
| | - Kinjal Vasavada
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, USA
| | - Guillem Gonzalez-Lomas
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, USA
| | - Andrew S. Rokito
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, USA
| | - Laith M. Jazrawi
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, USA
| | - Kevin Kaplan
- Department of Orthopedic Surgery, Jacksonville Orthopaedic Institute, Jacksonville, Florida, USA
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Ross B, Trojian T, Cushman DM. Physician Perceptions of Cannabidiol (CBD) and Cannabis in Sports Medicine and Performance. TRANSLATIONAL SPORTS MEDICINE 2023; 2023:8824466. [PMID: 38654915 PMCID: PMC11022760 DOI: 10.1155/2023/8824466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 11/07/2023] [Accepted: 11/24/2023] [Indexed: 04/26/2024]
Abstract
Objectives There is growing evidence regarding cannabinoid use in sports medicine and performance, especially cannabidiol (CBD). This study aims to determine if sports medicine physicians are recommending cannabinoids for therapeutic purposes, as well as analyze perceptions of cannabinoids within sports medicine and performance. Methods Physician members of the American Medical Society for Sports Medicine (AMSSM) completed an anonymous survey on demographics, CBD and Cannabis recommendations, as well as attitudes toward cannabinoid products within sports medicine. Factors associated with CBD and cannabis recommendations as well as perceptual differences were found using multivariate regression modelling. Results Responses from 333 physicians were recorded. The following groups were less likely to agree with allowing cannabis for recreational purposes: female gender (coeff. = 0.79 (0.33-1.25), p=0.001), increasing age (coeff. = 0.04 (0.02, 0.07), p < 0.001), and rural respondents (compared to baseline urban, coeff. = 1.16 (0.36, 1.95), p=0.004). Similarly, these three factors were associated with a higher likelihood of disagreeing with WADA removing cannabis from the prohibited substance list and with the NCAA allowing CBD use by collegiate athletes (p ≤ 0.045). CBD was less likely to be recommended by pediatricians, rural physicians, and academic physicians (p ≤ 0.030). Male physicians and younger physicians were less likely to identify cannabis as performance-enhancing (p ≤ 0.042). Conclusions Sports medicine physicians have varying views on cannabinoids. While sports medicine physicians generally have favorable attitudes toward CBD and cannabis, these perceptions appear to be significantly affected by age, practice type, and gender.
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Affiliation(s)
- Brendon Ross
- University of Chicago, Department of Orthopedic Surgery & Rehabilitation Medicine, Chicago, IL, USA
| | | | - Daniel M. Cushman
- University of Utah, Department of Physical Medicine & Rehabilitation and Department of Orthopaedics, Salt Lake City, UT, USA
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Karuppagounder V, Chung J, Abdeen A, Thompson A, Bouboukas A, Pinamont WJ, Yoshioka NK, Sepulveda DE, Raup-Konsavage WM, Graziane NM, Vrana KE, Elbarbary RA, Kamal F. Therapeutic Effects of Non-Euphorigenic Cannabis Extracts in Osteoarthritis. Cannabis Cannabinoid Res 2023; 8:1030-1044. [PMID: 35994012 PMCID: PMC10714119 DOI: 10.1089/can.2021.0244] [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] [Indexed: 11/13/2022] Open
Abstract
Introduction: Osteoarthritis (OA) is disabling and degenerative disease of the joints that is clinically characterized by pain and loss of function. With no disease-modifying treatment available, current therapies aim at pain management but are of limited efficacy. Cannabis products, specifically cannabinoids, are widely used to control pain and inflammation in many diseases with no scientific evidence demonstrating their efficacy in OA. Objective: We investigated the effects of non-euphorigenic cannabis extracts, CBD oil and cannabigerol oil (CBG oil), on pain and disease progression in OA mice. Methods and Results: Twelve-week-old male C57BL/6J mice received either sham or destabilization of the medial meniscus (DMM) surgery. DMM mice were treated with vehicle, CBD oil, or CBG oil. The gait of DMM mice was impaired as early as 2 weeks following surgery and continued deteriorating until week 8, which was restored by CBD oil and CBG oil treatments throughout the disease course. Mechanical allodynia developed in DMM mice, however, was not ameliorated by any of the treatments. On the other hand, both CBD oil and CBG oil ameliorated cold allodynia. In open field test, both oil treatments normalized changes in the locomotor activity of DMM mice. CBD oil and CBG oil treatments significantly reduced synovitis in DMM mice. Only CBG oil reduced cartilage degeneration, chondrocyte loss, and matrix metalloproteinase 13 expression, with a significant increase in the number of anabolic chondrocytes. Subchondral bone remodeling found in vehicle-treated DMM mice was not ameliorated by either CBD or CBG oil. Conclusions: Our results show evidence for the therapeutic efficacy of CBD oil and CBG oil, where both oils ameliorate pain and inflammation, and improve gait and locomotor activity in OA mice, representing clinical pain and function. Importantly, only CBG oil is chondroprotective, which may provide superior efficacy in future studies in OA patients.
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Affiliation(s)
- Vengadeshprabhu Karuppagounder
- Center for Orthopedic Research and Translational Science (CORTS), Penn State College of Medicine, Hershey, Pennsylvania, USA
- Department of Orthopedics and Rehabilitation, Departments of Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Juliet Chung
- Center for Orthopedic Research and Translational Science (CORTS), Penn State College of Medicine, Hershey, Pennsylvania, USA
- Department of Orthopedics and Rehabilitation, Departments of Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Ahmed Abdeen
- Center for Orthopedic Research and Translational Science (CORTS), Penn State College of Medicine, Hershey, Pennsylvania, USA
- Department of Orthopedics and Rehabilitation, Departments of Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Amy Thompson
- Center for Orthopedic Research and Translational Science (CORTS), Penn State College of Medicine, Hershey, Pennsylvania, USA
- Department of Orthopedics and Rehabilitation, Departments of Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Andreas Bouboukas
- Center for Orthopedic Research and Translational Science (CORTS), Penn State College of Medicine, Hershey, Pennsylvania, USA
- Department of Orthopedics and Rehabilitation, Departments of Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - William J. Pinamont
- Center for Orthopedic Research and Translational Science (CORTS), Penn State College of Medicine, Hershey, Pennsylvania, USA
- Department of Orthopedics and Rehabilitation, Departments of Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Natalie K. Yoshioka
- Center for Orthopedic Research and Translational Science (CORTS), Penn State College of Medicine, Hershey, Pennsylvania, USA
- Department of Orthopedics and Rehabilitation, Departments of Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Diana E. Sepulveda
- Pharmacology, Penn State College of Medicine, Hershey, Pennsylvania, USA
- Anesthesiology and Perioperative Medicine, and Penn State College of Medicine, Hershey, Pennsylvania, USA
| | | | - Nicholas M. Graziane
- Pharmacology, Penn State College of Medicine, Hershey, Pennsylvania, USA
- Anesthesiology and Perioperative Medicine, and Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Kent E. Vrana
- Pharmacology, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Reyad A. Elbarbary
- Center for Orthopedic Research and Translational Science (CORTS), Penn State College of Medicine, Hershey, Pennsylvania, USA
- Department of Orthopedics and Rehabilitation, Departments of Penn State College of Medicine, Hershey, Pennsylvania, USA
- Biochemistry and Molecular Biology, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Fadia Kamal
- Center for Orthopedic Research and Translational Science (CORTS), Penn State College of Medicine, Hershey, Pennsylvania, USA
- Department of Orthopedics and Rehabilitation, Departments of Penn State College of Medicine, Hershey, Pennsylvania, USA
- Pharmacology, Penn State College of Medicine, Hershey, Pennsylvania, USA
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Aguiar AS. Cannabis Is Not Doping. Cannabis Cannabinoid Res 2023; 8:949-954. [PMID: 37279460 DOI: 10.1089/can.2023.0012] [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] [Indexed: 06/08/2023] Open
Abstract
The World Anti-Doping Agency (WADA) classifies cannabis, all phytocannabinoids, and synthetics as doping, except for CBD. For agency, a method for doping substance must meet two criteria: performance enhancement (ergogenicity), health risk, or violation of the spirit of sports. Cannabis is neither ergogenic nor ergolytic (performance worsens), and the health risks for athletes are overestimated after 20 years of research. The significant problem remains in the complex (and difficult interpretation) definition of the spirit of sports, which transcends the objectives of sports excellence (performance and injury prevention) for moral policing. This perspective presents an evidence-based counterargument recommending the removal of cannabis and phytocannabinoids from the WADA Prohibited List.
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Affiliation(s)
- Aderbal Silva Aguiar
- Laboratory of Exercise Biology, Department of Health Sciences, Federal University of Santa Catarina-UFSC, Araranguá, Brazil
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Rojas-Valverde D, Fallas-Campos A. Cannabidiol in sports: insights on how CBD could improve performance and recovery. Front Pharmacol 2023; 14:1210202. [PMID: 37808192 PMCID: PMC10556669 DOI: 10.3389/fphar.2023.1210202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 09/13/2023] [Indexed: 10/10/2023] Open
Affiliation(s)
- Daniel Rojas-Valverde
- Sport Injury Clinic (Rehab Readapt), Escuela Ciencias del Movimiento Humano y Calidad de Vida (CIEMHCAVI), Universidad Nacional, Heredia, Costa Rica
- Núcleo de Estudios para el Alto Rendimiento y la Salud (CIDISAD-NARS), Escuela Ciencias del Movimiento Humano y Calidad de Vida (CIEMHCAVI), Universidad Nacional, Heredia, Costa Rica
| | - Andrea Fallas-Campos
- Núcleo de Estudios para el Alto Rendimiento y la Salud (ACUAUNA-NARS), Escuela Ciencias del Movimiento Humano y Calidad de Vida (CIEMHCAVI), Universidad Nacional, Heredia, Costa Rica
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Li ZI, Chalem I, Berzolla E, Vasavada KD, DeClouette B, Kaplan KM, Alaia MJ. Perceptions and Opinions on Cannabidiol in the Orthopaedic Sports Medicine Community. Orthop J Sports Med 2023; 11:23259671231191766. [PMID: 37745814 PMCID: PMC10517622 DOI: 10.1177/23259671231191766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 05/03/2023] [Indexed: 09/26/2023] Open
Abstract
Background Cannabidiol (CBD) is a known pain modulator that is garnering increased attention in the orthopaedic world. There may be a considerable knowledge gap among orthopaedic sports medicine providers and their perception of its therapeutic value. Purpose To (1) examine the knowledge and beliefs of sports medicine orthopaedic providers with respect to CBD, (2) deliver an educational component, and (3) elucidate potential barriers to its widespread application. Study Design Cross-sectional study. Methods A 3-component, 25-question online survey was distributed to members of the American Orthopaedic Society for Sports Medicine and the Arthroscopy Association of North America between July and October 2022. The first 20 questions assessed baseline knowledge and opinions regarding CBD, followed by an educational component, and then 5 questions assessing whether the respondents' opinions had changed after learning more about CBD. Responses were compared according to age, practice setting, and state's cannabinoid legalization status using the chi-square test, and changes in opinions from before to after the educational component were compared using the paired t test. Results There were 101 survey responses, for a response rate of approximately 1%. Most respondents believed that there is a role for CBD in postoperative pain management (76%), acute pain and inflammation after an injury (62%), and chronic pain (94%). Most respondents admitted that they were not knowledgeable about the mechanism of action (89%) or their state's laws (66%) concerning CBD. A minority (25%) believed that CBD has psychoactive properties. While most respondents (76%) did not believe that they would be stigmatized if they were to suggest CBD to a patient, only 48% had ever suggested CBD. Notably, 94% of respondents had encountered patients who reported trying CBD to treat pain. After reading the fact sheet, 51% of respondents stated that their opinion on CBD had changed, and 63% felt inclined to investigate the topic further. Conclusion Most survey respondents believed that CBD has a role in postoperative and chronic pain management. Although there was a relative familiarity with CBD, there was a knowledge gap, suggesting that increased attention, education, and research are necessary.
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Affiliation(s)
- Zachary I. Li
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, USA
| | - Isabel Chalem
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, USA
| | - Emily Berzolla
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, USA
| | - Kinjal D. Vasavada
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, USA
| | - Brittany DeClouette
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, USA
| | - Kevin M. Kaplan
- Jacksonville Orthopaedic Institute, Jacksonville, Florida, USA
| | - Michael J. Alaia
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, USA
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Alharbi KS, Afzal O, Altamimi ASA, Almalki WH, Kazmi I, Al-Abbasi FA, Alzarea SI, Makeen HA, Albratty M. Potential role of nutraceuticals via targeting a Wnt/β-catenin and NF-κB pathway in treatment of osteoarthritis. J Food Biochem 2022; 46:e14427. [PMID: 36165556 DOI: 10.1111/jfbc.14427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/26/2022] [Accepted: 09/08/2022] [Indexed: 01/13/2023]
Abstract
Osteoarthritis (OA) is a disease due to the aging of the articular cartilage, a post-mitotic tissue that stays functioning until primary homeostatic processes fail. Because of pain and disability, OA significantly influences national healthcare expenses and patient quality of life. It is a whole-joint illness characterized by inflammatory and oxidative signaling pathways and significant epigenetic alterations that cause cartilage extracellular matrix degradation. The canonical Wnt pathway (Wnt/β-catenin pathway) and nuclear factor kappa B (NF-κB) signaling pathways may function in joint tissues by modulating the activity of synovial cells, osteoblasts, and chondrocytes. However, finding innovative ways to treat osteoarthritis and get the joint back to average balance is still a struggle. Nutraceuticals are dietary supplements that promote joint health by balancing anabolic and catabolic signals. New therapeutic methods for OA treatment have been developed based on many research findings that show nutraceuticals have strong anti-inflammation, antioxidant, anti-bone resorption, and anabolic properties. For the treatment of osteoarthritis, we explore the possible involvement of nutraceuticals that target the Wnt/β-catenin and NF-κB pathways. PRACTICAL APPLICATIONS: In keeping with the aging population, osteoarthritis is becoming more widespread. In this extensive research, we studied the role of the Wnt/β-catenin and NF-κB pathway in OA formation and progression. Nutraceuticals that target these OA-related signaling pathways are a viable therapy option. Wnt/β-catenin and NF-κB signaling pathway are inhibited by polyphenols, flavonoids, alkaloids, and vitamins from the nutraceutical category, making them possible therapeutic drugs for OA therapy.
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Affiliation(s)
- Khalid Saad Alharbi
- Department of Pharmacology, College of Pharmacy, Jouf University, Sakaka, Saudi Arabia
| | - Obaid Afzal
- Department of Pharmaceutical Chemistry, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al Kharj, Saudi Arabia
| | | | - Waleed Hassan Almalki
- Department of Pharmacology, College of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Imran Kazmi
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Fahad A Al-Abbasi
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Sami I Alzarea
- Department of Pharmacology, College of Pharmacy, Jouf University, Sakaka, Saudi Arabia
| | - Hafiz A Makeen
- Pharmacy Practice Research Unit, Clinical Pharmacy Department, College of Pharmacy, Jazan University, Jazan, Saudi Arabia
| | - Mohammed Albratty
- Department of Pharmaceutical Chemistry and Pharmacognosy, College of Pharmacy, Jazan University, Jazan, Saudi Arabia
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