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Endocrine, Metabolic & Immune Disorders - Drug Targets


ISSN (Print): 1871-5303
ISSN (Online): 2212-3873

Research Article

Collagen Peptides, in Association with Vitamin C, Sodium Hyaluronate, Manganese and Copper, as Part of the Rehabilitation Project in the Treatment of Chronic Low Back Pain

Author(s): Giacomo Farì*, Dario Santagati, Giovanni Pignatelli, Venera Scacco, Domenico Renna, Giuseppe Cascarano, Francesco Vendola, Francesco Paolo Bianchi, Pietro Fiore, Maurizio Ranieri and Marisa Megna

Volume 22, Issue 1, 2022

Published on: 10 February, 2021

Page: [108 - 115] Pages: 8

DOI: 10.2174/1871530321666210210153619


Background and Objective: Low back pain (LBP) is a frequent symptom. Among the causes that can determine it, lumbar osteoarthritis plays an important role. Therapeutic exercise, according to McKenzie method, has been shown to be effective in the treatment of LBP. Oral supplementation with collagen peptides represents a new therapeutic possibility in osteoarthritis. The aim of this study is to evaluate the combined efficacy of therapeutic exercise and oral administered viscosupplements in the treatment of osteoarthritis-related chronic LBP.

Methods: Sixty patients were recruited and randomly divided into two groups (Group A and B). Group A performed only kinesitherapy, Group B carried out the same kinesitherapy combined with the daily administration of food supplements such as Fortigel®, Vitamin C, sodium hyaluronate, manganese and copper, during the whole treatment period. Patients were evaluated at the time of recruitment (T0), at the end of the treatment (T1 - 3 weeks after T0) and 6 weeks after T1 (T2). The outcome measures used were: Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), and Short Form-12 (SF-12).

Results: All the outcomes improved significantly at T1 in both groups, but more markedly in group B. Furthermore, in group A at T2, there was a statistically significant worsening in the scores of VAS, ODI and physical component of the SF-12, while in group B, this variation has not been detected.

Conclusion: The combination of rehabilitation based on McKenzie back exercises and oral viscosupplementation with Fortigel®, Vitamin C, sodium hyaluronate, manganese and copper represents a valid option in patients with chronic LBP, as it ensures pain relief and improvement in the quality of life and in lumbar spine functionality. These therapeutic benefits are more evident and long-lasting compared to those obtained with rehabilitation alone.

Keywords: Low back pain, osteoarthritis, rehabilitation, therapeutic exercise, McKenzie method, oral supplementation, hyaluronate sodium, collagen peptides, vitamine C.

Graphical Abstract
Hartvigsen, J.; Hancock, M.J.; Kongsted, A.; Louw, Q.; Ferreira, M.L.; Genevay, S.; Hoy, D.; Karppinen, J.; Pransky, G.; Sieper, J.; Smeets, R.J.; Underwood, M. Lancet Low Back Pain Series Working Group. What low back pain is and why we need to pay attention. Lancet, 2018, 391(10137), 2356-2367.
[] [PMID: 29573870]
GBD 2015 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet, 2016, 388(10053), 1545-1602.
[] [PMID: 27733282]
Dionne, C.E.; Dunn, K.M.; Croft, P.R.; Nachemson, A.L.; Buchbinder, R.; Walker, B.F.; Wyatt, M.; Cassidy, J.D.; Rossignol, M.; Leboeuf-Yde, C.; Hartvigsen, J.; Leino-Arjas, P.; Latza, U.; Reis, S.; Gil Del Real, M.T.; Kovacs, F.M.; Oberg, B.; Cedraschi, C.; Bouter, L.M.; Koes, B.W.; Picavet, H.S.; van Tulder, M.W.; Burton, K.; Foster, N.E.; Macfarlane, G.J.; Thomas, E.; Underwood, M.; Waddell, G.; Shekelle, P.; Volinn, E.; Von Korff, M. A consensus approach toward the standardization of back pain definitions for use in prevalence studies. Spine, 2008, 33(1), 95-103.
[] [PMID: 18165754]
Deyo, R.A.; Weinstein, J.N. Low back pain. N. Engl. J. Med., 2001, 344(5), 363-370.
[] [PMID: 11172169]
Brinjikji, W.; Diehn, F.E.; Jarvik, J.G.; Carr, C.M.; Kallmes, D.F.; Murad, M.H.; Luetmer, P.H. MRI findings of disc degeneration are more prevalent in adults with low back pain than in asymptomatic controls: a systematic review and meta-analysis. AJNR Am. J. Neuroradiol., 2015, 36(12), 2394-2399.
[] [PMID: 26359154]
Maher, C.; Underwood, M.; Buchbinder, R. Non-specific low back pain. Lancet, 2017, 389(10070), 736-747.
[] [PMID: 27745712]
Kalichman, L.; Hunter, D.J. Lumbar facet joint osteoarthritis: a review. Semin. Arthritis Rheum., 2007, 37(2), 69-80.
[] [PMID: 17379279]
Eyre, D.R.; Muir, H. Quantitative analysis of types I and II collagens in human intervertebral discs at various ages. Biochim. Biophys. Acta, 1977, 492(1), 29-42.
[] [PMID: 577186]
Snodgrass, J.J. Sex differences and aging of the vertebral column. J. Forensic Sci., 2004, 49(3), 458-463.
[] [PMID: 15171159]
Goode, A.P.; Carey, T.S.; Jordan, J.M. Low back pain and lumbar spine osteoarthritis: how are they related? Curr. Rheumatol. Rep., 2013, 15(2), 305.
[] [PMID: 23307577]
de Schepper, E.I.T.; Damen, J.; van Meurs, J.B.J.; Ginai, A.Z.; Popham, M.; Hofman, A.; Koes, B.W.; Bierma-Zeinstra, S.M. The association between lumbar disc degeneration and low back pain: the influence of age, gender, and individual radiographic features. Spine, 2010, 35(5), 531-536.
[] [PMID: 20147869]
Borenstein, D. Does osteoarthritis of the lumbar spine cause chronic low back pain? Curr. Pain Headache Rep., 2004, 8(6), 512-517.
[] [PMID: 15509467]
Oliveira, C.B.; Maher, C.G.; Pinto, R.Z.; Traeger, A.C.; Lin, C.C.; Chenot, J.F.; van Tulder, M.; Koes, B.W. Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview. Eur. Spine J., 2018, 27(11), 2791-2803.
[] [PMID: 29971708]
Foster, N.E.; Anema, J.R.; Cherkin, D.; Chou, R.; Cohen, S.P.; Gross, D.P.; Ferreira, P.H.; Fritz, J.M.; Koes, B.W.; Peul, W.; Turner, J.A.; Maher, C.G. Prevention and treatment of low back pain: evidence, challenges, and promising directions. Lancet, 2018, 391(10137), 2368-2383.
[] [PMID: 29573872]
Clare, H.A.; Adams, R.; Maher, C.G. A systematic review of efficacy of McKenzie therapy for spinal pain. Aust. J. Physiother., 2004, 50(4), 209-216.
[] [PMID: 15574109]
Oesser, S.; Adam, M.; Babel, W.; Seifert, J. Oral administration of (14)C labeled gelatin hydrolysate leads to an accumulation of radioactivity in cartilage of mice (C57/BL). J. Nutr., 1999, 129(10), 1891-1895.
[] [PMID: 10498764]
Benito-Ruiz, P.; Camacho-Zambrano, M.M.; Carrillo-Arcentales, J.N.; Mestanza-Peralta, M.A.; Vallejo-Flores, C.A.; Vargas-López, S.V.; Villacís-Tamayo, R.A.; Zurita-Gavilanes, L.A. A randomized controlled trial on the efficacy and safety of a food ingredient, collagen hydrolysate, for improving joint comfort. Int. J. Food Sci. Nutr., 2009, 60(Suppl. 2), 99-113.
[] [PMID: 19212858]
Bruyère, O.; Zegels, B.; Leonori, L.; Rabenda, V.; Janssen, A.; Bourges, C.; Reginster, J-Y. Effect of collagen hydrolysate in articular pain: a 6-month randomized, double-blind, placebo controlled study. Complement. Ther. Med., 2012, 20(3), 124-130.
[] [PMID: 22500661]
Oesser, S.; Seifert, J. Stimulation of type II collagen biosynthesis and secretion in bovine chondrocytes cultured with degraded collagen. Cell Tissue Res., 2003, 311(3), 393-399.
[] [PMID: 12658447]
Oesser, S. Degraded collagen modulates the internal remodeling of cartilage extracellular matrix. Arthritis Rheum., 2005, 52(Suppl. 9), S62.
Paolucci, T.; Attanasi, C.; Cecchini, W.; Marazzi, A.; Capobianco, S.V.; Santilli, V. Chronic low back pain and postural rehabilitation exercise: a literature review. J. Pain Res., 2018, 12, 95-107.
[] [PMID: 30588084]
Martin-Martin, L.S.; Pierluigi, B.; La Medica, C.; Melis, G.; Nuvoli, G.; Piccinni, V.; Pietrapertosa, M.; Vincenti, B.; Vinicola, V. Randomized observational multicenter study to assess the efficacy and safety of the association of Fortigel (10 Gr) and Fucoidan (100 Mg) in patients with gonarthrosis. J. Rheumatol. Arthr. Dis., 2016, 1(1), 1-5.
Kumar, S.; Sugihara, F.; Suzuki, K.; Inoue, N.; Venkateswarathirukumara, S. A double-blind, placebo-controlled, randomised, clinical study on the effectiveness of collagen peptide on osteoarthritis. J. Sci. Food Agric., 2015, 95(4), 702-707.
[] [PMID: 24852756]
Asari, A.; Kanemitsu, T.; Kurihara, H. Oral administration of high molecular weight hyaluronan (900 kDa) controls immune system via Toll-like receptor 4 in the intestinal epithelium. J. Biol. Chem., 2010, 285(32), 24751-24758.
[] [PMID: 20504769]
Dionne, C.E.; Laurin, D.; Desrosiers, T.; Abdous, B.; Le Sage, N.; Frenette, J.; Mondor, M.; Pelletier, S. Serum vitamin C and spinal pain: a nation wide study. Pain, 2016, 157(11), 2527-2535.
[] [PMID: 27434504]
Uriu-Adams, J.Y.; Keen, C.L. Copper, oxidative stress, and human health. Mol. Aspects Med., 2005, 26(4-5), 268-298.
[] [PMID: 16112185]
Strause, L.; Saltman, P.; Glowacki, J. The effect of deficiencies of manganese and copper on osteoinduction and on resorption of bone particles in rats. Calcif. Tissue Int., 1987, 41(3), 145-150.
[] [PMID: 3117341]
McAlindon, T.E.; Nuite, M.; Krishnan, N.; Ruthazer, R.; Price, L.L.; 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, 19(4), 399-405.
[] [PMID: 21251991]
Oesser, S.; Raabe, A.; Schunck, M. Orally administered collagen hydrolysate halts the progression of osteoarthritis in STR / ort mice. Osteoarthritis Cartilage, 2007, 15, C61-C62.
Clark, K.L.; Sebastianelli, W.; Flechsenhar, K.R.; Aukermann, D.F.; Meza, F.; Millard, R.L.; Deitch, J.R.; Sherbondy, P.S.; Albert, A. 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, 24(5), 1485-1496.
[] [PMID: 18416885]
Balogh, L.; Polyak, A.; Mathe, D.; Kiraly, R.; Thuroczy, J.; Terez, M.; Janoki, G.; Ting, Y.; Bucci, L.R.; Schauss, A.G.; Ting, Y.; Bucci, L.R.; Schauss, A.G. Absorption, uptake and tissue affinity of high-molecular-weight hyaluronan after oral administration in rats and dogs. J. Agric. Food Chem., 2008, 56(22), 10582-10593.
[] [PMID: 18959406]
Kajimoto, O.; Odanaka, Y.; Sakamoto, W.; Yoshida, K.; Takahashi, T. Clinical effects of dietary hyaluronic acid on dry skin. J. New Remed. Clin., 2001, 50(4), 548-560.
Tashiro, T.; Seino, S.; Sato, T.; Matsuoka, R.; Masuda, Y.; Fukui, N. Oral administration of polymer hyaluronic acid alleviates symptoms of knee osteoarthritis: a double-blind, placebo-controlled study over a 12-month period. ScientificWorldJournal, 2012, 2012, 167928.
[] [PMID: 23226979]
Kalman, D.S.; Heimer, M.; Valdeon, A.; Schwartz, H.; Sheldon, E. Effect of a natural extract of chicken combs with a high content of hyaluronic acid (Hyal-Joint) on pain relief and quality of life in subjects with knee osteoarthritis: a pilot randomized double-blind placebo-controlled trial. Nutr. J., 2008, 7, 3.
[] [PMID: 18208600]
Houpt, J.B.; McMillan, R.; Wein, C.; Paget-Dellio, S.D. Effect of glucosamine hydrochloride in the treatment of pain of osteoarthritis of the knee. J. Rheumatol., 1999, 26(11), 2423-2430.
[PMID: 10555905]
Anderson, J.W.; Nicolosi, R.J.; Borzelleca, J.F. Glucosamine effects in humans: a review of effects on glucose metabolism, side effects, safety considerations and efficacy. Food Chem. Toxicol., 2005, 43(2), 187-201.
[] [PMID: 15621331]
Meikle, P.J.; Whittle, A.M.; Hopwood, J.J. Human acetyl-coenzyme A: alpha-glucosaminide N-acetyltransferase. Kinetic characterization and mechanistic interpretation. Biochem. J., 1995, 308(Pt 1), 327-333.
[] [PMID: 7755582]
Punzi, L.; Schiavon, F.; Cavasin, F.; Ramonda, R.; Gambari, P.F.; Todesco, S. The influence of intra-articular hyaluronic acid on PGE2 and cAMP of synovial fluid. Clin. Exp. Rheumatol., 1989, 7(3), 247-250.
[PMID: 2547540]
Sanghi, D.; Mishra, A.; Sharma, A.C.; Raj, S.; Mishra, R.; Kumari, R.; Natu, S.M.; Agarwal, S.; Srivastava, R.N. Elucidation of dietary risk factors in osteoarthritis knee—a case-control study. J. Am. Coll. Nutr., 2015, 34(1), 15-20.
[] [PMID: 25387081]
Goggs, R.; Vaughan-Thomas, A.; Clegg, P.D.; Carter, S.D.; Innes, J.F.; Mobasheri, A.; Shakibaei, M.; Schwab, W.; Bondy, C.A. Nutraceutical therapies for degenerative joint diseases: a critical review. Crit. Rev. Food Sci. Nutr., 2005, 45(3), 145-164.
[] [PMID: 16048146]
Pacifici, M.; Iozzo, R.V. Remodeling of the rough endoplasmic reticulum during stimulation of procollagen secretion by ascorbic acid in cultured chondrocytes. A biochemical and morphological study. J. Biol. Chem., 1988, 263(5), 2483-2492.
[] [PMID: 3276690]
Clark, A.G.; Rohrbaugh, A.L.; Otterness, I.; Kraus, V.B. The effects of ascorbic acid on cartilage metabolism in guinea pig articular cartilage explants. Matrix Biol., 2002, 21(2), 175-184.
[] [PMID: 11852233]
Aghajanian, P.; Hall, S.; Wongworawat, M.D.; Mohan, S. The roles and mechanisms of actions of vitamin C in bone: new developments. J. Bone Miner. Res., 2015, 30(11), 1945-1955.
[] [PMID: 26358868]
Fife, R.S.; Moody, S.; Houser, D.; Proctor, C. Studies of copper transport in cultured bovine chondrocytes. Biochim. Biophys. Acta, 1994, 1201(1), 19-22.
[] [PMID: 7918577]
Héraud, F.; Savineau, C.; Harmand, M.F. Copper modulation of extracellular matrix synthesis by human articular chondrocytes. Scand. J. Rheumatol., 2002, 31(5), 279-284.
[] [PMID: 12455818]
Ganini, D.; Santos, J.H.; Bonini, M.G.; Mason, R.P. Switch of mitochondrial superoxide dismutase into a prooxidant peroxidase in manganese-deficient cells and mice. Cell Chem. Biol., 2018, 25(4), 413-425.e6.
[] [PMID: 29398562]
Das, A., Jr; Hammad, T.A. Efficacy of a combination of FCHG49 glucosamine hydrochloride, TRH122 low molecular weight sodium chondroitin sulfate and manganese ascorbate in the management of knee osteoarthritis. Osteoarthritis Cartilage, 2000, 8(5), 343-350.
[] [PMID: 10966840]

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