title: Glucosamine and chondroitin sulfate supplementation to treat symptomatic disc degeneration: biochemical rationale and case report.
abstract: BACKGROUND
  Glucosamine and chondroitin sulfate preparations are widely used as food supplements against osteoarthritis, but critics are skeptical about their efficacy, because of the lack of convincing clinical trials and a reasonable scientific rationale for the use of these nutraceuticals. Most trials were on osteoarthritis of the knee, while virtually no documentation exists on spinal disc degeneration. The purpose of this article is to highlight the potential of these food additives against cartilage degeneration in general, and against symptomatic spinal disc degeneration in particular, as is illustrated by a case report. The water content of the intervertebral disc is a reliable measure of its degeneration/ regeneration status, and can be objectively determined by Magnetic Resonance Imaging (MRI) signals.
  
  
  METHODS
  Oral intake of glucosamine and chondroitin sulfate for two years associated with disk recovery (brightening of MRI signal) in a case of symptomatic spinal disc degeneration. We provide a biochemical explanation for the possible efficacy of these nutraceuticals. They are bioavailable to cartilage chondrocytes, may stimulate the biosynthesis and inhibit the breakdown of their extracellular matrix proteoglycans.
  
  
  CONCLUSIONS
  The case suggests that long-term glucosamine and chondroitin sulfate intake may counteract symptomatic spinal disc degeneration, particularly at an early stage. However, definite proof requires well-conducted clinical trials with these food supplements, in which disc de-/regeneration can be objectively determined by MRI. A number of biochemical reasons (that mechanistically need to be further resolved) explain why these agents may have cartilage structure- and symptom-modifying effects, suggesting their therapeutic efficacy against osteoarthritis in general.
authors.affiliation: Division of Cellular Biochemistry, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066CX Amsterdam, The Netherlands. w.v.blitterswijk@nki.nl
authors.forename: Wim J
authors.initials: WJ
authors.lastname: van Blitterswijk
authors.forename: Jos C M
authors.initials: JC
authors.lastname: van de Nes
authors.forename: Paul I J M
authors.initials: PI
authors.lastname: Wuisman
mesh_terms: D002809:Chondroitin Sulfates / Q000008:administration & dosage* / Q000493:pharmacokinetics; D019587:Dietary Supplements; D004334:Drug Administration Schedule; D004338:Drug Combinations; D005944:Glucosamine / Q000008:administration & dosage* / Q000493:pharmacokinetics; D006801:Humans; D007403:Intervertebral Disc / Q000187:drug effects* / Q000378:metabolism / Q000473:pathology; D007405:Intervertebral Disc Displacement / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D008159:Lumbar Vertebrae / Q000473:pathology / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016059:Range of Motion, Articular; D012074:Remission Induction; D014867:Water / Q000378:metabolism; D016474:Weight-Bearing
chemical_list: D004338:Drug Combinations; D014867:Water; D002809:Chondroitin Sulfates; D005944:Glucosamine