Astaxanthin as a potential therapeutic agent for knee osteoarthritis: A review of mechanisms and clinical evidence
DOI:
https://doi.org/10.3329/bsmmuj.v18i1.76227Keywords:
astaxanthin, knee osteoarthritis, therapeutic agent, antioxidantAbstract
Bakground: Knee osteoarthritis (KOA) poses an important challenge in musculoskeletal healthcare, prompting the need for innovative therapeutic strategies. Astaxanthin, a potent antioxidant carotenoid, has gained interest due to its multifaceted mechanisms of action and potential role in KOA management. This review aims to examine the therapeutic mechanisms of astaxanthin in KOA, alongside clinical evidence supporting its effectiveness through a narrative synthesis of preclinical and clinical studies.
Methods: A comprehensive review of the literature was conducted across Web of Science, Pubmed, Scopus and Google Scholar, focusing on studies that explored astaxanthin's antioxidative, anti-inflammatory, and cartilage-protective properties in the context of KOA. Articles published in English between 2014 and 2024 were included (n=44).
Results: The review identified several key mechanisms by which astaxanthin exerts its therapeutic effects, including reducing oxidative stress, attenuating inflammation, and preserving cartilage integrity. Clinical studies also provided promising evidence of its efficacy in alleviating symptoms and improving joint function in patients with KOA.
Conclusion: Astaxanthin demonstrates considerable potential as a therapeutic agent for KOA, though further research is needed to fully understand its long-term efficacy and optimal dosing. Future studies should focus on refining methodological approaches to better elucidate astaxanthin's role in KOA management.
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Qin H, Liu X, Ding Q, Liu H, Ma C, Wei Y, Lv Y, Wang S, Ren Y. Astaxanthin reduces inflammation and promotes a chondrogenic phenotype by upregulating SIRT1 in osteoarthritis. Knee. 2024 Jun;48:83-93. doi: https://doi.org/10.1016/j.knee.2024.03.002
Valenti MT, Perduca M, Romanelli MG, Mottes M, Dalle Carbonare L. A potential role for astaxanthin in the treatment of bone diseases (Review). Mol Med Rep. 2020 Sep;22(3):1695-1701. doi: https://www.spandidos-publications.com/10.3892/mmr.2020.11284
Huang LJ, Chen WP. Astaxanthin ameliorates cartilage damage in experimental osteoarthritis. Mod Rheumatol. 2015 Sep;25(5):768-771. doi: https://doi.org/10.3109/14397595.2015.1008724
Park MH, Jung JC, Hill S, Cartwright E, Dohnalek MH, Yu M, Jun HJ, Han SB, Hong JT, Son DJ. FlexPro MD®, a Combination of Krill Oil, Astaxanthin and Hyaluronic Acid, Reduces Pain Behavior and Inhibits Inflammatory Response in Monosodium Iodoacetate-Induced Osteoarthritis in Rats. Nutrients. 2020 Mar 30;12(4):956. doi: https://doi.org/10.3390/nu12040956
Davan I, Fakurazi S, Alias E, Ibrahim N', Hwei NM, Hassan H. Astaxanthin as a Potent Antioxidant for Promoting Bone Health: An Up-to-Date Review. Antioxidants (Basel). 2023 Jul 24;12(7):1480. doi: https://doi.org/10.3390/antiox12071480
Zarneshan SN, Fakhri S, Farzaei MH, Khan H, Saso L. Astaxanthin targets PI3K/Akt signaling pathway toward potential therapeutic applications. Food Chem Toxicol. 2020 Nov;145:111714. doi: https://doi.org/10.1016/j.fct.2020.111714
Dohnalek MH, Cartwright EJ, Hill WS. Efficacy and safety of a joint health nutritional supplement for subjects with non-arthritic knee joint pain: A double-blind, placebo-and active-controlled, randomized clinical trial. J Orthop Res Ther. 2023;8:1272. doi: https://doi.org/10.29011/2575-8241.001272
Lee YT, Yunus MHM, Ugusman A, Yazid MD. Natural Compounds Affecting Inflammatory Pathways of Osteoarthritis. Antioxidants (Basel). 2022 Aug 30;11(9):1722. doi: https://doi.org/10.3390/antiox11091722
Li H, Yuan Y, Zhang L, Xu C, Xu H, Chen Z. Reprogramming Macrophage Polarization, Depleting ROS by Astaxanthin and Thioketal-Containing Polymers Delivering Rapamycin for Osteoarthritis Treatment. Adv Sci (Weinh). 2024 Mar;11(9):e2305363. doi: https://doi.org/10.1002/advs.202305363
Wang S, Qi X. The Putative Role of Astaxanthin in Neuroinflammation Modulation: Mechanisms and Therapeutic Potential. Front Pharmacol. 2022 Jun 24;13:916653. doi: https://doi.org/10.3389/fphar.2022.916653
Alugoju P, Krishna Swamy VKD, Anthikapalli NVA, Tencomnao T. Health benefits of astaxanthin against age-related diseases of multiple organs: A comprehensive review. Crit Rev Food Sci Nutr. 2023;63(31):10709-10774. doi: https://doi.org/10.1080/10408398.2022.2084600
Yang G, Liu X, Jing X, Wang J, Wang H, Chen F, Wang W, Shao Y, Cui X. Astaxanthin suppresses oxidative stress and calcification in vertebral cartilage endplate via activating Nrf-2/HO-1 signaling pathway. Int Immunopharmacol. 2023 Jun;119:110159. doi: https://doi.org/10.1016/j.intimp.2023.110159
Cutolo EA, Caferri R, Campitiello R, Cutolo M. The Clinical Promise of Microalgae in Rheumatoid Arthritis: From Natural Compounds to Recombinant Therapeutics. Mar Drugs. 2023 Dec 7;21(12):630. doi: https://doi.org/10.3390/md21120630
Schulze-Tanzil G. Experimental Therapeutics for the Treatment of Osteoarthritis. J Exp Pharmacol. 2021 Feb 11;13:101-125. doi: http://doi.org/10.2147/JEP.S237479
Çağlar C, Kara H, Ateş O, Uğurlu M. Evaluation of Different Intraarticular Injection Therapies with Gait Analysis in a Rat Osteoarthritis Model. Cartilage. 2021 Dec;13(2_suppl):1134S-1143S. doi: https://doi.org/10.1177/19476035211046042
Morilla MJ, Ghosal K, Romero EL. More Than Pigments: The Potential of Astaxanthin and Bacterioruberin-Based Nanomedicines. Pharmaceutics. 2023 Jun 26;15(7):1828. doi: https://doi.org/10.3390/pharmaceutics15071828
Mamun-Or-Rashid ANM, Lucy TT, Yagi M, Yonei Y. Inhibitory Effects of Astaxanthin on CML-HSA-Induced Inflammatory and RANKL-Induced Osteoclastogenic Gene Expression in RAW 264.7 Cells. Biomedicines. 2021 Dec 27;10(1):54. doi: https://doi.org/10.3390/biomedicines10010054
Oppedisano F, Bulotta RM, Maiuolo J, Gliozzi M, Musolino V, Carresi C, Ilari S, Serra M, Muscoli C, Gratteri S, Palma E, Mollace V. The Role of Nutraceuticals in Osteoarthritis Prevention and Treatment: Focus on n-3 PUFAs. Oxid Med Cell Longev. 2021 Dec 10;2021:4878562. doi: https://doi.org/10.1155/2021/4878562
Mahmud MK, Jalil S, Rahman AM, Rashid MM, Sultana S, Taher A, Haque L, Fardous J, Nahar K. Etiologies and posttreatment conditions of thyrotoxic patients in Sylhet division, Bangladesh: A clinical series. Avicenna J Med. 2017 Jul-Sep;7(3):125-129. doi: https://doi.org/10.4103/ajm.AJM_161_16
Su J, Yu M, Wang H, Wei Y. Natural anti-inflammatory products for osteoarthritis: From molecular mechanism to drug delivery systems and clinical trials. Phytother Res. 2023 Oct;37(10):4321-4352. doi: https://doi.org/10.1002/ptr.7935
Ku SK, Kim JK, Chun YS, Song CH. Anti-Osteoarthritic Effects of Antarctic Krill Oil in Primary Chondrocytes and a Surgical Rat Model of Knee Osteoarthritis. Mar Drugs. 2023 Sep 28;21(10):513. doi: https://doi.org/10.3390/md21100513
Pérez-Lozano ML, Cano-Lozano MP, Cano MP. Emerging natural-product-based treatments for the management of osteoarthritis. Antioxidants. 2021;10(2):265. doi: https://doi.org/10.3390/antiox10020265
Webber RE, Gupta RC, Doss RB, Miller J, Canerdy RD, Hoffman LK, Srivastava A, Lall R. Therapeutic efficacy and 1. safety evaluation of Flex Choice™ in moderately osteoarthritic dogs. Int J Vet Health Sci Res. 2020;8(1):242-51. doi: http://dx.doi.org/10.19070/2332-2748-2000047
Gao M, Chen C, Zhang Q, Bian J, Qin L, Bao L. Research Progress on the Antiosteoarthritic Mechanism of Action of Natural Products. Evid Based Complement Alternat Med. 2021 Sep 30;2021:7714533. doi: https://doi.org/10.1155/2021/7714533
Vinothkumar R. Recent advancements of astaxanthin from an animal feed to a therapeutic agent in humans—A meta-analysis overview. 2024. doi: https://doi.org/10.5772/intechopen.114958
Gammone MA, Gemello E, Riccioni G, D'Orazio N. Marine bioactives and potential application in sports. Mar Drugs. 2014 Apr 30;12(5):2357-82. doi: https://doi.org/10.3390/md12052357
Wu Z, Yang Z, Liu L, Xiao Y. Natural compounds protect against the pathogenesis of osteoarthritis by mediating the NRF2/ARE signaling. Front Pharmacol. 2023 May 30;14:1188215. doi: https://doi.org/10.3389/fphar.2023.1188215
Ciapała K, Mika J. Advances in Neuropathic Pain Research: Selected Intracellular Factors as Potential Targets for Multidirectional Analgesics. Pharmaceuticals (Basel). 2023 Nov 17;16(11):1624. doi: https://doi.org/10.3390/ph16111624
Sanada Y, Tan SJO, Adachi N, Miyaki S. Pharmacological Targeting of Heme Oxygenase-1 in Osteoarthritis. Antioxidants (Basel). 2021 Mar 9;10(3):419. doi: https://doi.org/10.3390/antiox10030419
AHM MR, Ibrahim FS, Amom Z, Amran AA. The antioxidant mechanism in the prevention of type 2 diabetes and its complications: a narrative review. J Health Transl Med (JUMMEC). 2023;400-11. doi: https://doi.org/10.22452/jummec.sp2023no2.45
Li D, Tong W, Liu D, Zou Y, Zhang C, Xu W. Astaxanthin mitigates cobalt cytotoxicity in the MG-63 cells by modulating the oxidative stress. BMC Pharmacol Toxicol. 2017 Jul 24;18(1):58. doi: https://doi.org/10.1186/s40360-017-0166-1
Curry EJ, Baima J, Matzkin E. Nutraceuticals: an alternative for osteoarthritis management. Musculoskelet Health Women. 2014:107-26. doi: https://doi.org/10.1007/978-1-4471-4712-1_7
Shabbir MA, Mehak F, Khan MR, Ahmed W, Nawaz MF, Hassoun A, Bhat ZF, Aadil RM. Unraveling the role of natural functional oils in modulating osteoarthritis related complications. Crit Rev Food Sci Nutr. 2024;64(20):6881-6901. doi: https://doi.org/10.1080/10408398.2023.2176815
Guo Z, Lin J, Sun K, Guo J, Yao X, Wang G, Hou L, Xu J, Guo J, Guo F. Deferoxamine Alleviates Osteoarthritis by Inhibiting Chondrocyte Ferroptosis and Activating the Nrf2 Pathway. Front Pharmacol. 2022 Mar 14;13:791376. doi: https://doi.org/10.3389%2Ffphar.2022.791376
Narayanaswam NK, Roy S, Basu S. A randomized interventional clinical trial assessing the safety and effectiveness of PeaNoc XL tablets in managing joint pain and inflammation in arthritis patients. F1000Res. 2023;12:1. doi: https://doi.org/10.12688%2Ff1000research.138477.1
Zhou Y, Liu SQ, Peng H, Yu L, He B, Zhao Q. In vivo anti-apoptosis activity of novel berberine-loaded chitosan nanoparticles effectively ameliorates osteoarthritis. Int Immunopharmacol. 2015 Sep;28(1):34-43. doi: https://doi.org/10.1016/j.intimp.2015.05.014
Lee M, Kim D, Park SJ, Yun JM, Oh DH, Lee J. Antarctic Krill Oil Ameliorates Monosodium Iodoacetate-Induced Irregularities in Articular Cartilage and Inflammatory Response in the Rat Models of Osteoarthritis. Nutrients. 2020 Nov 20;12(11):3550. doi: https://doi.org/10.3390/nu12113550
Cai W, Zhang Y, Jin W, Wei S, Chen J, Zhong C, Zhong Y, Tu C, Peng H. Procyanidin B2 ameliorates the progression of osteoarthritis: An in vitro and in vivo study. Int Immunopharmacol. 2022 Dec;113(Pt A):109336. doi: https://doi.org/10.1016/j.intimp.2022.109336
Ferreira AO, Polonini HC, Dijkers ECF. Postulated adjuvant therapeutic strategies for COVID-19. J Pers Med. 2020;10(3):80. doi: https://doi.org/10.3390/jpm10030080
Jiang Z, Qi G, Lu W, Wang H, Li D, Chen W, Ding L, Yang X, Yuan H, Zeng Q. Omaveloxolone inhibits IL-1β-induced chondrocyte apoptosis through the Nrf2/ARE and NF-κB signalling pathways in vitro and attenuates osteoarthritis in vivo. Front Pharmacol. 2022 Sep 27;13:952950. doi: https://doi.org/10.3389/fphar.2022.952950
Lee SJ, Bai SK, Lee KS, Namkoong S, Na HJ, Ha KS, Han JA, Yim SV, Chang K, Kwon YG, Lee SK, Kim YM. Astaxanthin inhibits nitric oxide production and inflammatory gene expression by suppressing I(kappa)B kinase-dependent NF-kappaB activation. Mol Cells. 2003 Aug 31;16(1):97-105. PMID: 14503852.
Karami A, Fakhri S, Kooshki L, Khan H. Polydatin: Pharmacological Mechanisms, Therapeutic Targets, Biological Activities, and Health Benefits. Molecules. 2022 Oct 1;27(19):6474. doi: https://doi.org/10.3390/molecules27196474
Toldo S, Mauro AG, Cutter Z, Abbate A. Inflammasome, pyroptosis, and cytokines in myocardial ischemia-reperfusion injury. American Journal of Physiology-Heart and Circulatory Physiology. 2018 Dec 1;315(6):H1553-68. doi: https://doi.org/10.1152/ajpheart.00158.2018
Kim JH, Lim SR, Jung DH, Kim EJ, Sung J, Kim SC, Choi CH, Kang JW, Lee SJ. Grifola frondosa extract containing bioactive components blocks skin fibroblastic inflammation and cytotoxicity caused by endocrine disrupting chemical, bisphenol A. Nutrients. 2022 Sep 15;14(18):3812. doi: https://doi.org/10.3390/nu14183812
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