New Data Reveal Anti-Inflammatory, Cartilage-Sparing Effect of Shea Extract in Osteoarthritis

Triterpenes from the shea nut, an emerging natural treatment for osteoarthritis and other joint problems, can greatly reduce markers of inflammation and cartilage breakdown, according to a new study by Dr. Philip Cheras, director of the Australian Centre for Complementary Medicine Education and Research (ACCMER), Brisbane.

Dr. Cheras is the major proponent of a new model of arthritis pathogenesis, one that posits a propensity toward clotting, blockage of joint microvasculature, and impaired circulation as key drivers of the disease (join and read The Vascular Roots of Osteoarthritis). He has also pioneered research into the clinical application of shea triterpenes, available as a proprietary formula called FlexNow Joint Formula (BSP Pharma) as a non-pharmaceutical option for OA patients.

Shea (Butyrospermum parkii) is a tree found widely throughout West Africa. Its oil-rich nuts contain a number of compounds that can down-regulate inflammatory mediators; it can also reduce total cholesterol as well as LDL.

Dr. Cheras and colleagues have been studying a cohort of 89 individuals with clinical signs and x-ray evidence of osteoarthritis of the knees and/or hips. They were randomized to treatment with the FlexNow Joint Formula, a 100% shea oil extract containing approximately 75% shea triterpene esters, or a placebo of 100% food grade canola oil identically encapsulated. The patients took a daily dose of three 750 mg capsules of the shea extract or the canola oil every morning for a total of 15 weeks.

In addition to assessing symptom severity, the investigators measured a number of biomarkers of inflammation, collagen breakdown, and bone metabolism, including C-telopeptide fragments of type II collagen (CTX-II), TNF-a, IL-6, and osteocalcin. Compared with the placebo-treated group, those treated with FlexNow had consistently lower measures of all of these.

The most striking finding was a mean 31% reduction in CTX-II, an indicator of type II collagen breakdown and a reliable biomarker of impaired joint function. CTX-II levels are significantly elevated in most patients with OA and damaged joints. In essence, CTX-II is a marker of cartilage deterioration, and CTX-II levels correlate with disease progression.

Dr. Cheras said that FlexNow is the first non-pharmaceutical product to show clinically meaningful reductions in CTX-II. At baseline, all 89 patients in the study had markedly elevated CTX-II levels prior to treatment. After 15 weeks, the FlexNow group showed a mean 31% reduction, with many returning to normal range. Placebo-treated patients generally showed no change in CTX-II.

An earlier study of the effect of glucosamine on CTX-II showed no difference between glucosamine supplementation and placebo. Comparatively, FlexNow, in 15 weeks, was 44% more effective than glucosamine was in a year in reducing cartilage breakdown, Dr. Cheras said.

Participants with above-average levels of major inflammatory markers at baseline showed significant reductions after treatment with the shea extract. TNF-a, which is strongly associated with cartilage breakdown and joint impairment, fell by a mean of 17% in the shea-treated patients versus those on placebo.

High sensitivity C-reactive protein (hs-CRP), a marker of low grade systemic inflammation, also showed a mean 12% drop in the FlexNow versus the placebo groups. This marker is typically elevated in OA and other inflammatory joint conditions, and it correlates with pain severity. The FlexNow group also showed a 17.6% drop in IL-6, compared with the placebo group.

These changes in objective measurements correlated well with significant reductions in the pain subscale of the Comprehensive Osteoarthritis Test (COAT), by week 15.

Osteocalcin, the bone-generated hormone that recently grabbed headlines when Columbia University researchers discovered its role in regulating glucose metabolism, is also an important marker of bone turnover. It has relevance in the context of OA and joint impairment because these patients typically show increases in bone formation within the affected joints, and many have abnormally increased osteocalcin levels.

In arthritic joints, new bone forms around islands of dead bone. Over time, this increases bone density within the joint, leading to increased stiffness and increased biomechanical damage to the overlying cartilage, explained Dr. Cheras. The remodeling process

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