Cartilage is a connective tissue whose main purpose is to support and withstand the sliding and impacts that normally occur at the articular ends of the bones during movement.
Within cartilage we find chondrocytes (the living cells) and various types of proteins with a structural function, in quantities that vary depending on the type of cartilage.
In fact, depending on its composition, cartilage can be classified into three different types:
- Hyaline cartilage: the most widespread type in the body. It is found on all the main joint surfaces and in the ribs, nose, trachea, bronchi and larynx.
- Elastic cartilage: as the name suggests, it is the most elastic. It is found in the outer ear and the epiglottis, for example.
- Fibrocartilage: found in particular joints such as the intervertebral discs, the menisci of the knee and the pubic symphysis.
A fundamental structure, but with one feature that makes it unique among all the structures of the body: it is not vascularised.
This is very important because it means that cartilage has difficulty obtaining nutrients and, at the same time, is prone to the build-up of toxins.
Another characteristic of cartilage is its water content: 65-80% of the weight of cartilage is made up of water.
Most of the time, cartilage problems are due to wear and tear and tend to appear after the age of 40.
Lesions of the articular cartilage are very often associated with other disorders of the joint. A study[1] of 200 cases found that isolated lesions were present in 6.5% of cases, while in 61.5% they were accompanied by other lesions.
Cartilage discomfort starts with dull aches that are barely noticeable and gradually become more intense. This is due to the progressive wearing away of the cartilage, which over time tends to become thinner and thinner, losing its mechanical properties.
Other similar structures in the joints, which are also subject to extreme stress, are tendons and ligaments , fibrous connective elements with a collagen and elastin component.
In tendons and ligaments, too, regenerative processes are very slow because they are poorly vascularised tissues with fairly low oxygen consumption. They can easily suffer lesions and micro-lesions as a result of excessive effort or small stresses repeated too close together (e.g. the Achilles tendon in runners, epicondylitis in tennis players).
Natural remedies can do a great deal for the wellbeing of cartilage, tendons and ligaments, and can give people who want to preserve the full efficiency of these structures a good quality of life.
Let’s now look at the ones we have chosen for Cartilagea and the supporting scientific literature.
Experimental Phytotherapy
FORTIGEL®
Clark KL et Al. 24-Week study on the use of collagen hydrolysate as a dietary supplement in athletes with activity-related joint pain. Curr Med Res Opin. 2008 May;24(5):1485-96. doi: 10.1185/030079908x291967. Epub 2008 Apr 15. PMID: 18416885.
This clinical study, carried out at Penn State University (USA), involved 147 athletes who had experienced activity-related joint pain. The athletes (average age 20.1 years) were divided into a group that took FORTIGEL® as a food supplement and a control group that took a placebo for 24 weeks. The severity of symptoms was assessed both by the attending physician and by the study participants using an analogue rating scale. At the end of the study period, the subjects showed an improvement in their symptoms.
The researchers therefore highlighted that athletes who consume FORTIGEL® collagen hydrolysate can reduce discomfort (such as pain) that has a negative impact on athletic performance.
McAlindon TE, Nuite M, Krishnan N, Ruthazer R, Price LL, Burstein D, Griffith J, Flechsenhar K. Change in knee osteoarthritis cartilage detected by delayed gadolinium enhanced magnetic resonance imaging following treatment with collagen hydrolysate: a pilot randomized controlled trial. Osteoarthritis Cartilage. 2011 Apr;19(4):399-405. doi: 10.1016/j.joca.2011.01.001. Epub 2011 Jan 18. PMID: 21251991.
This clinical study investigated the long-term effect of treatment with FORTIGEL® on the composition of hyaline cartilage in individuals with early-stage knee osteoarthritis. Monitoring was carried out through the analysis of MRI images of the cartilage. At the end of the study, a statistically significant increase in the density of proteoglycans was observed in the medial part and in the lateral tibial regions of the subjects treated with FORTIGEL® compared with the placebo group. This led to an improvement in knee function.
Chondroitin
Martel-Pelletier J, Kwan Tat S, Pelletier JP. Effects of chondroitin sulfate in the pathophysiology of the osteoarthritic joint: a narrative review. Osteoarthritis Cartilage. 2010 Jun;18 Suppl 1:S7-11. doi: 10.1016/j.joca.2010.01.015. Epub 2010 Apr 27. PMID: 20399897.
This review summarises some data on the mechanisms of action of chondroitin sulphate in the pathophysiology of osteoarthritic joint tissues. The researchers propose that the positive effects of chondroitin result from the stimulation of proteoglycan synthesis and the reduction of the catabolic activity of chondrocytes, through the inhibition of the synthesis of proteolytic enzymes and other factors that contribute to damage to the cartilage matrix and cause the death of these cells. Chondroitin sulphate has also been shown to exert an anti-inflammatory activity.
Wildi LM, Raynauld JP, Martel-Pelletier J, Beaulieu A, Bessette L, Morin F, Abram F, Dorais M, Pelletier JP. Chondroitin sulphate reduces both cartilage volume loss and bone marrow lesions in knee osteoarthritis patients starting as early as 6 months after initiation of therapy: a randomised, double-blind, placebo-controlled pilot study using MRI. Ann Rheum Dis. 2011 Jun;70(6):982-9. doi: 10.1136/ard.2010.140848. Epub 2011 Mar 1. PMID: 21367761; PMCID: PMC3086081.
This study set out to highlight the effects of chondroitin on cartilage loss in patients with knee osteoarthritis. The double-blind study involved 69 patients and lasted 6 months. Cartilage volume was measured by magnetic resonance imaging. At the end of the study, the group treated with chondroitin showed markedly better preservation of cartilage volume than the placebo group. The researchers suggest the use of chondroitin for knee osteoarthritis and, more generally, to successfully treat this condition
Glucosamine
Shikhman AR, Brinson DC, Valbracht J, Lotz MK. Differential metabolic effects of glucosamine and N-acetylglucosamine in human articular chondrocytes. Osteoarthritis Cartilage. 2009 Aug;17(8):1022-8. doi: 10.1016/j.joca.2009.03.004. Epub 2009 Mar 24. PMID: 19332174; PMCID: PMC2785807.
This study analyses the effects of Glucosamine on the chondrocytes of knee cartilage. The results show that chondrocytes are able to absorb Glucosamine and that it is used for the production of new hyaluronic acid. The increased synthesis of hyaluronic acid, accelerated by Acetyl-Glucosamine, is associated with the upregulation of the enzyme hyaluronan synthase-2, demonstrating the functional action of this element.
Gallagher B, Tjoumakaris FP, Harwood MI, Good RP, Ciccotti MG, Freedman KB. Chondroprotection and the prevention of osteoarthritis progression of the knee: a systematic review of treatment agents. Am J Sports Med. 2015 Mar;43(3):734-44. doi: 10.1177/0363546514533777. Epub 2014 May 27. PMID: 24866892.
This paper highlights how the combined use of glucosamine and chondroitin sulphate may serve as a non-surgical means of protecting articular cartilage and delaying the progression of osteoarthritis.
Rosehip (Vitamin C)
Sharma G, Saxena RK, Mishra P. Regeneration of static-load-degenerated articular cartilage extracellular matrix by vitamin C supplementation. Cell Tissue Res. 2008 Oct;334(1):111-20. doi: 10.1007/s00441-008-0666-9. Epub 2008 Aug 5. Erratum in: Cell Tissue Res. 2009 May;336(2):347. PMID: 18679720.
This in vitro study examined the use of Vit. C on chondrocytes. After administration, an increase in the number of these cells was observed and, as a result, an improvement in the condition of the articular cartilage.
Chang Z, Huo L, Li P, Wu Y, Zhang P. Ascorbic acid provides protection for human chondrocytes against oxidative stress. Mol Med Rep. 2015 Nov;12(5):7086-92. doi: 10.3892/mmr.2015.4231. Epub 2015 Aug 20. PMID: 26300283.
This study aimed to assess the effects of Vitamin C on human chondrocytes. At the end of the research, the scientists highlighted how ascorbic acid positively stimulates the production of collagen and proteins and, at the same time, inhibits the differentiation of chondrocytes under conditions of oxidative stress, thus promoting the protection of cartilage tissue.
Manganese, Copper and Selenium
Valero G, Alley MR, Badcoe LM, Manktelow BW, Merrall M, Lawes GS. Chondrodystrophy in calves associated with manganese deficiency. N Z Vet J. 1990 Dec;38(4):161-7. doi: 10.1080/00480169.1990.35645. PMID: 16031605.
In this other study, it was found that calves with cartilage malformations had been carried by cows given feed that was low in Manganese, which led to a histological deficiency in their cartilage.
Pasqualicchio M, Gasperini R, Velo GP, Davies ME. Effects of copper and zinc on proteoglycan metabolism in articular cartilage. Mediators Inflamm. 1996;5(2):95-9. doi: 10.1155/S0962935196000154. PMID: 18475704; PMCID: PMC2365780.
Copper plays a strategic role in the physiological maintenance of cartilage. In this in vitro study, the ability of Copper and Zinc to stimulate chondroblasts to secrete proteoglycans was compared in a porcine cartilage model. It was observed that zinc did not induce any stimulation of the chondrocytes, whereas Copper was able to do so. This result was supported by histological evidence of a copper-dependent action on proteoglycan depletion in the cartilage.
Kang D, Lee J, Wu C, Guo X, Lee BJ, Chun JS, Kim JH. The role of selenium metabolism and selenoproteins in cartilage homeostasis and arthropathies. Exp Mol Med. 2020 Aug;52(8):1198-1208. doi: 10.1038/s12276-020-0408-y. Epub 2020 Aug 13. PMID: 32788658; PMCID: PMC7423502.
This retrospective study examined the association between selenium deficiency and the dysregulation of joint selenoproteins, which is in turn associated with impaired redox homeostasis in the cartilage, a factor that favours the onset and progression of disease states such as osteoarthritis.
Nutraceuticals containing several specific nutrients may be useful in managing discomfort affecting both cartilage and tendons 2-3, thanks to the anti-inflammatory effects of certain natural ingredients and to the support they provide for the physiological repair processes of connective tissues.
Supplements, for example those made up of collagen peptides, chondroitin, vitamin C, etc., may therefore have valuable potential as an addition to standard treatment methods (exercise/rehabilitation)4-5.
Bibliography
[1] Articular cartilage lesions of the knee. Ronald W. Zamber, M.D. Carol C. Teitz, M.D. David A. McGuire, M.D. John D. Frost, M.D.
[2] Hijlkema A, Roozenboom C, Mensink M, Zwerver J. The impact of nutrition on tendon health and tendinopathy: a systematic review. J Int Soc Sports Nutr. 2022 Aug 3;19(1):474-504.
[3] Burton I, McCormack A. Nutritional Supplements in the Clinical Management of Tendinopathy: A Scoping Review. J Sport Rehabil. 2023 May 5;32(5):493-504.
[4] Choudhary A, Sahu S, Vasudeva A, Sheikh NA, Venkataraman S, Handa G, Wadhwa S, Singh U, Gamanagati S, Yadav SL. Comparing Effectiveness of Combination of Collagen Peptide Type-1, Low Molecular Weight Chondroitin Sulphate, Sodium Hyaluronate, and Vitamin-C Versus Oral Diclofenac Sodium in Achilles Tendinopathy: A Prospective Randomized Control Trial. Cureus. 2021 Nov 19;13(11):e19737.
[5] Dos Santos DR, Xavier DP, de Ataíde LAP, Bentes LGB, Lemos RS, Giubilei DB, de Barros RSM. The Effects of Hydrolyzed Collagen and Collagen Peptide in the Treatment of Superficial Chondral Lesions: An Experimental Study. Rev Bras Ortop (Sao Paulo). 2022 Oct 20;58(1):72-78.
Please note: our texts are for informational purposes only. They should not be taken as guidance on the diagnosis or treatment of medical conditions and are in no way intended to replace the advice of a doctor.
Our texts are for information purposes only; they are not to be understood as an indication for the diagnosis and treatment of medical conditions and are in no way intended to replace the advice of a doctor.
