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The therapeutic effect of oral Channa striatus extract on primary knee osteoarthritis patients

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Channa striatus is a fresh water fish known as natural remedy for traditional medicine in Southeast Asian region. This is a randomized, double-blind, placebo-controlled trial comparing the effects of oral Channa striatus extract 500 mg/day with placebo given for 3-month intervention period among primary knee osteoarthritis patients. Eighty eight patients were randomly assigned to C.striatus and placebo group. The objectives were to compare pain, symptoms, activity of daily living, sports and quality of life between intervention and control group using Knee Injury and Osteoarthritis Outcome Score (KOOS). Analgesic consumption was also compared using analgesic score. There were significant improvement of pain, symptoms and quality of life (QOL) domain score (p<0.05) in C. striatus group compared to patients who received placebo. There were no changes in safety profile parameters among the patients before and after treatment. In conclusion, the oral administration of Channa striatus extract would be a new alternative for knee osteoarthritis treatment.
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KEYWORDS: channa striatus, knee osteoarthritis, pain, symptom, quality of life, analgesic consumption
Abstract
Channa striatus is a fresh water fish known as natural remedy for traditional medicine in Southeast Asian
region. This is a randomized, double-blind, placebo-controlled trial comparing the effects of oral Channa
striatus extract 500 mg/day with placebo given for 3-month intervention period among primary knee osteoarthritis patients. Eighty eight
patients were randomly assigned to C.striatus and placebo group. The objectives were to compare pain, symptoms, activity of daily
living, sports and quality of life between intervention and control group using Knee Injury and Osteoarthritis Outcome Score (KOOS).
Analgesic consumption was also compared using analgesic score.
There were significant improvement of pain, symptoms and quality of life (QOL) domain score (p<0.05) in C. striatus group compared to
patients who received placebo. There were no changes in safety profile parameters among the patients before and after treatment. In
conclusion, the oral administration of Channa striatus extract would be a new alternative for knee osteoarthritis treatment.
The therapeutic effect of oral
Channa striatus extract on primary
knee osteoarthritis patients
44
INTRODUCTION
Channa striatus (CS) is a freshwater snakehead  sh that
belongs to the Channidae family (1). Recognized as a
valuable source of protein throughout the Asia Paci c region,
the  sh is a well known natural remedy in traditional medicine
and has been long been used by people in the region for
healing wounds, particularly post-partum and post-operative
wounds (1). Studies done on the biochemical composition
of the  sh have revealed that it contains both fatty acids
and amino acids that are important for wound healing (2-6)
and anti-nociceptive processes (7, 8). The major amino acids
in its extract are glycine, alanine, lysine, aspartic acid, and
praline (2, 3). In addition, the major fatty acids are oleic acid,
stearic acid, linoleic acid, and arachidonic acid (2, 3). These
essential amino acids and fatty acids have been shown to
facilitate wound healing while simultaneously enhancing anti-
nociceptive activity (2-8).
Osteoarthritis (OA), a degenerative joint disease, involves the
structural and functional failure of synovial joints. The disease
is the leading cause of chronic disability in the elderly, and
is particularly tied to knee and hip issues (9). While the exact
biochemical cause of OA remains unclear, there is evidence
that the disease may be tied to up-regulations of various
pro-in ammatory mediators during in ammatory processes.
The in ammation, which is due to progressive articular
destruction, appears to be localized within the particular
joint affected (10). Simple analgesia, mainly non-steroidal
anti-in ammatories (NSAIDS) and COX-2 speci c NSAIDS,
are currently being used for OA pain relief (10). However,
these pharmacologic therapies are suboptimal and have
side-effects (12). As a result, complementary and alternative
medicines are gaining popularity (11).
In animal models,
CS extract has been reported to be
bene cial in treating OA (11). In a study done by Michelle et
al. in 2004, in ammation of the arthritic joints in animals was
reduced when treated by CS as evidenced by radiographic
overall innervations of the synovial membrane and changes
in pro-in ammatory mediators (prostaglandin) (13). The
bene cial effects of CS are supported by studies in animal
models, but these have yet to be clinically validated. As
a result of this initial evidence, it is here postulated that CS
may have bene cial effects in treating patients suffering
from osteoarthritis.The present study seeks to determine the
effectiveness and safety of CS extract in the treatment of
knee osteoarthritis patients.
MATERIALS AND METHODS
Study design and setting
This randomised, double-blinded, placebo-controlled
study sought to compare the effects of CS extract and
a placebo among primary knee osteoarthritis patients at
the Hospital Universiti Sains Malaysia (HUSM) from June to
December of 2011.
JOINT HEALTH
AZIDAH ABDUL KADIR
1
*, SITI ZUBAIDAH AB WAHAB
2
, MARYAM MOHD ZULKIFLI
1
, NORHAYATI MOHD NOOR
1
,
SARINGAT BIN BAI @ BAIE
3
, JUHARA HARON
4
*Corresponding Author:
1. University Sains Malaysia, School of Medical Sciences, Department of Family Medicine,
Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia
2. University Sains Malaysia, School of Medical Sciences, Women Health Development Unit,
Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia
3. University Sains Malaysia, School of Pharmaceutical Sciences, 11800, Pulau Pinang, Malaysia
4. University Sains Malaysia, School of Medical Sciences, Department of Radiology,
Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia
Agro FOOD Industry Hi Tech - vol 25(3) - May/June 2014
45
Agro FOOD Industry Hi Tech - vol 25(3) - May/June 2014
long-term osteoarthritis and knee injuries (16). This instrument
holds 42 items in the following 5 separately scored subscales:
pain, other symptoms, function in daily living (ADL), function
in sport and recreation (Sport), and knee-related quality of
life (QOL) (15). Standardized answer options were given on
the KOOS questionnaires (5 Likert boxes), with each question
receiving a score from 0 to 4. A normalized score (with 100
indicating no symptoms and 0 indicating extreme symptoms)
was calculated for each subscale. The Malay version of the
KOOS was validated with a Cronbach’s alpha ranging from
0.94 to 0.96 and a factor loading of 0.25 to 0.89.
CS extract preparation
Whole CS were cleaned, weighed, and placed into an
autoclave bin. The water mixture for autoclaving was
prepared relative to a sh’s weight with respect to the
volume of water used. Preservatives were then added.
The preservatives used in this study were a combination
of two esters of p-hydroxy benzoic acids: methyl paraben
0.1 percent and propyl paraben 0.02 percent. Sterilization
was carried out with a temperature setting of 110°C for 15
minutes. Upon completion of sterilization, the sh were mixed
thoroughly and then dried using an industrial oven at 60°C
for 48 hours continuously. Upon completion, sheets of crispy
akes were ground into a rened powder.
Statistical analysis
The study’s sample size calculations were based on
power and sample size calculation software (17) for
the comparison of two means (α =0.05, Power= 0.9). A
sample size of 37 in each group was needed to detect the
decrease of 2.4 in the analgesic score at month 3 of the
study with standard deviation of 3.1. Forty-four patients in
each group were enrolled to allow for 10 percent dropout.
Analysis was done using SPSS version 20.0. Randomized
groups were compared in order to recognize possible
differences at baseline using independent-T, Pearson
chi-square, and simple logistic regression. To determine
the differences in the outcome parameters, repeated
co-variance (ANCOVA) was used while controlling for the
baseline values. Changes were reported as estimated
marginal means with the condence interval (CI) adjusted
at 95 percent. All reported p-values were 2-tailed with
values less than 0.05 considered signicant. There was no
co-variate used for the analgesic score, and the Kruskal-
Wallis test was used to detect differences in score between
the two groups.
Approval by the research and ethics committee
The protocol of the study was approved by the Research
Ethics Committee (Human) at the School of Medical
Sciences, Universiti Sains Malaysia [Ref: USMKK/PPP/JEPeM
[236.3.(12)].
RESULTS
Eighty-eight patients completed the study. There were no
statistical differences between the baseline characteristics
of the CS group and the placebo group in terms of
demographics, clinical characteristics, radiographic
features, or the KOOS baseline scores of all domains (i.e.,
pain, other symptoms, activity in daily living, function in
sport and recreation, and quality of life) (Table 1).
Participants and instruments
The study’s participants included those aged 40 years
and older who were diagnosed with primary monolateral
or bilateral knee osteoarthritis according to the clinical
and radiological criteria of the American College of
Rheumatology (ACR) (14). The study’s participants had body
mass indexes (BMI) ranging from 18 to 30 kg/m
2
, and showed
radiologic evidence of knee osteoarthritis (grades I to III)
using the Kellgren-Lawrence method.
The study excluded those with secondary knee OA, as
well as those with severe co-morbid conditions, such as
severe-hematologic disorders, renal disease, liver disease,
neoplasms, and other rheumatic diseases. In addition,
patients with severe knee pain and were waiting for surgical
intervention, patients who had joint lavage, arthroscopy
performed, treatment with hyaluronic acid, or has been
taking glucosamine during the previous six months,
and patients who had been treated with intra-articular
corticosteroids during the past three months were also
excluded from the study.
The study’s participants were acquired from the Outpatient
and Orthopaedic Clinic at the Hospital Universiti Sains
Malaysia. Informed consent was obtained once they agreed
to participate in the study. Having satised the inclusion
and exclusion criteria, the patients were then randomly
placed into two groups using a computer-generated table
of random numbers. One group received 500 mg of freeze-
dried CS extract daily, while the other group received a 500
mg placebo of maltodextrin daily. This was done for each
group for three months. The investigators were not aware
of the randomization scheme. Compliance was measured
using the numbers of capsules taken. Any subject taking less
than 80 percent of the trial medications provided would be
considered non-compliant.
The participants’ past medical and orthopaedic histories
were assessed. Physical examinations of blood pressure,
weight, and height were performed at the beginning of the
study, and each patient was assessed in following at month
1, 2, and 3 after randomization, respectively. Upon each visit,
the patients were given self-administered Knee Injury and
Osteoartritis Outcome Score (KOOS) questionnaires to assess
their knee osteoarthritis pain, symptoms, activity in daily
living (ADL), function in sport and recreation, and quality
of life (QOL) (15). For patients with bilateral OA, the most
compromised knee was used as a reference. The patients
also needed to report to the investigators any possible side
effects that ensued after taking the medication. Blood
samples were taken in order to assess renal function, liver
function, and full blood count in study-safety proles created
at both the beginning and end of the study.
Patients were allowed to consume tablets of
acetaminophen (1 g) or ibuprofen (400 mg) as needed for
rescue analgesia. Patients were not allowed to change to
other forms of analgesia without having previously informed
the investigators. The patients were asked to document
the types, dosage, and number of analgesia tablets they
took in a diary to be brought to every visit. To calculate the
analgesic score, acetaminophen (1000 mg) was scored as
1, and ibuprofen (400 mg) was scored as 2.5. The score was
assessed at month 1, 2, and 3, respectively.
The KOOS, which was developed as an extension of
the WOMAC Osteoarthritis Index, was used in this study
(15)
because it is a valid, reliable, and responsive self-
administered instrument in the follow-up of short-term and
46
Agro FOOD Industry Hi Tech - vol 25(3) - May/June 2014
There were also improvements seen in the
domain of ADL and function in sport and
recreation, but they were not significant.
There were 10 (11.4 percent) subjects in the
intervention group and 13 (14.8 percent) subjects
in the control group who took analgesics
during the study period. There was a decrease
in analgesia usage in the CS group. However,
this did not represent a statistically signicant
difference (Table 3).
Overall compliance with the study’s medication
was 98.8 percent. There were also no changes
adapted in the safety prole parameters (full
blood count, renal prole, and liver function test)
before or after treatment. A total of six adverse
events were reported: three in the placebo
group (acute pharyngitis, hypertension, and
hypotension) and three in the CS group (vaginal
candidiasis, leg edema, and toothache). These
adverse effects were considered to be unrelated
to the investigational drugs.
DISCUSSION
Studying the impact of treatments on knee OA
in trials has been challenging due to the fact
that no specic biomarkers have been identied
to monitor or prognosticate the illness, or to use
in clinical trials to assess the effectiveness of
treatment (18). Clinical trials dealing with knee OA have
typically included two main features: a composite scoring
system for pain, and function and joint space measurement
(10). A pain radiograph is insufcient for determining the
progression and outcome of intervention or treatment
over a short period of time. Therefore, in this study we used
composite scoring system.
The results of this study suggest
that CS extract is associated
with signicant improvements
in knee OA symptoms, such
as pain and quality of life.
Improvements were observed
in terms of ADL and function
in sport and recreation.
However, these improvements
did not represent statistically
signicant results. This is likely
due to the fact that most
patients in the study had
good ADL function prior to
the trial, as well as minimal
involvement in sports. Thus, it
does not show much change
in the ADL component
compare to the baseline.
OA primarily occurs in weight-
bearing joints accompanied
with subchondral responses
and synovitis, which
contribute to its pathogenesis
through the formation of
Table 2 shows a comparison of mean pain, symptoms, ADL,
function in sport and recreation, and QOL among the CS
and placebo groups over the course of the study (time-
treatment interaction). There were signicant improvements
seen in terms of pain, symptoms, and QOL score between
the CS and placebo groups over time (p< 0.001 ANCOVA).
Table 1. Baseline characteristic of CS and placebo groups
Table 2: Comparison of mean pain, symptoms, ADL, sport and QOL scores among CS and placebo group
based on time (time-treatment interaction)
* p-value is signicant
Repeated measures ANCOVA between group analysis with regard to time was applied
Numerical covariates (baseline scores) was controlled by using repeated measures ANCOVA
Assumptions of normality, homogeneity of variances, compound symmetry and homogeneity of
regression were checked and were fullled
*Determined by Independent t-test,
∞Determined by Pearson chi-square test
**Determined by Simple logistic regression
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Agro FOOD Industry Hi Tech - vol 25(3) - May/June 2014
terms of analgesic score, there was no
significant difference between the CS
group and the placebo group. This was
probably a result of the small number
of patients (only 23) taking analgesic
rescue in this study. Therefore, the effect
of analgesic consumption is not seen in
this study.
The CS extract was well tolerated in
this study. There was no drop-out in this
study for both groups of patients. The
type and frequency of AEs were similar
between the CS and placebo groups.
Routine laboratory parameters remained
within normal limits during CS treatment,
supporting the tolerability of this agent.
This study has a few limitations. The duration of this
study was short and the sample size was small. A larger
study with multiple doses of CS extract and a longer
treatment period is recommended. Comparison of the CS
extract with other modalities of treatment, for example
glucosamine, would be beneficial.
CONCLUSION
In conclusion, the oral administration of CS extract could
be a new alternative for knee osteoarthritis treatment,
as it is safe and associated with a statistically significant
reduction in pain, improvement of symptoms, and quality
of life in patients with primary knee osteoarthritis.
ACKNOWLEDGEMENT
This study was supported by Universiti Sains Malaysia Short
Term grant (304/PPSP/61312003). The authors also would
like to thank the Research Ethics Committee (Human),
School of Medical Sciences, Universiti Sains Malaysia [Ref:
USMKK/PPP/JEPeM [236.3.(12)] for approving this study.
Conflict of interest statement
We declare there is no financial and personal
relationship with other people or organizations that could
inappropriately influence the research.
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Table 3. Comparison of the analgesic score between CS and placebo group.
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48
Agro FOOD Industry Hi Tech - vol 25(3) - May/June 2014
... The majority of the participants were females (Giordano et al. 2009;Pavelka et al. 2002;Reginster et al. 2001) and the majority of the participants were overweight (Reginster et al. 2001) as shown by the mean body mass index (BMI) of 27 kg/m 2 . The clinical characteristics of the study population were also similar to those of an earlier study of Channa striatus, in which the mean age was 49 years old and the majority (81.8%) of the participants were females, although the mean BMI (25.2 kg/m 2 ) was lower in that study than in the present one (Kadir et al. 2014). ...
... A few studies reported the therapeutic effect of Channa striatus in knee OA (Abdul Kadir et al. 2019;Azidah et al. 2017;Kadir et al. 2014;Michelle, Shanti and Mohamad 2004). In the present study, there were significant improvements in pain, stiffness and physical function within the Channa striatus group. ...
... These significant improvements were evident after 3 months of treatment and were similar to the glucosamine sulphate group (Table 3). The findings of the present study are consistent with those of a 3-month study of Channa Malay J Pharm Sci, Vol. 20, No. 2 (2022): [65][66][67][68][69][70][71][72][73][74][75][76][77] Azlina Ishak et al. 74 striatus extract used to treat primary knee OA that reported a significant improvement in knee pain, other knee OA related symptoms and quality of life in the Channa striatus group (Kadir et al. 2014). In that study, the clinical effects were evident after 2 months of treatment. ...
Article
Channa striatus, an indigenous freshwater fish, has been shown to treat knee osteoarthritis, but no study has been done to compare its effectiveness with other oral therapy. This study aimed to compare the effectiveness of oral Channa striatus extract and glucosamine sulphate in knee osteoarthritis symptoms and physical function. This is a double-blind randomised controlled trial, conducted among 78 patients with primary knee osteoarthritis. Patients were assigned to receive either 500 mg/d of Channa striatus or 1,500 mg/d of glucosamine sulphate for 6 months. The main outcome measures were pain, stiffness and physical function, as assessed by the Western Ontario and Mc Master Osteoarthritis Index (WOMAC) at baseline, 3- and 6-months post-randomisation. Seventy-three patients completed the study (Channa striatus, n = 37; glucosamine sulphate, n = 37). There was no significant between-group difference in the WOMAC index. However, the within-group comparison pointed to a significant improvement in all the WOMAC domains in both groups from baseline to 6 months. The effectiveness of Channa striatus shows no difference from that of glucosamine sulphate in reducing the symptoms of knee osteoarthritis. Channa striatus could be a new alternative treatment for the management of knee osteoarthritis.
... Scientific research has also indicated that CS has anti-nociceptive, anti-inflammatory, and anti-microbial properties (Baie and Sheikh 2000a;Mat Jais et al. 1997, 2008Mohamad Isa et al. 2016;Zakaria et al. 2007). Given the antiinflammatory, wound healing and anti-nociceptive properties of CS extract, its use in treating the amelioration of osteoarthritis has been explored (Al-Saffar et al. 2011a;b;Kadir et al. 2014;Michelle et al. 2004). ...
... A randomized, double-blinded, placebo-controlled trial using oral CS extract 500 mg/day for a 3-month period among primary knee osteoarthritis patients demonstrated significant improvements in pain, symptom scores, and quality of life (QOL) domain score (p < 0.05) in CS compared to placebo (Kadir et al. 2014). We postulate that a CS extract dose of 1000 mg/day would be more effective than 500 mg/day and its usage for a longer duration would have more beneficial effect in treating primary knee OA patients. ...
... The patients were required to document the types, dosages, and number of analgesia tablets taken in the Analgesia Diary and to bring it to every visit. The analgesic score was made based on a previous study (Kadir et al. 2014), whereby acetaminophen 1000 mg was scored as 1 and Ibuprofen 400 mg was scored as 2.5. Patients were not allowed to change to another form of analgesia without first informing the investigators. ...
Article
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Knee osteoarthritis (OA) is the leading cause of chronic disability at older age. Channa striatus (CS) is a freshwater fish that is traditionally valued for its medicinal properties in promoting wound healing and reducing post-operative pain. This study evaluate the efficacy of different doses of oral Channa striatus extract on primary knee osteoarthritis patients. A randomized, double-blind, placebo-controlled 3-arm trial was conducted comparing oral CS extract 1000 mg/day or 500 mg/day and placebo among knee OA patients for a 6-month intervention period. The main outcome measures were Western Ontario and McMaster University Osteoarthritis Index (WOMAC), analgesic scores and serum cartilage oligomeric matric protein (COMP). Laboratory-based blood tests were used as safety measures. A total of 120 patients were randomized, and 112 patients were included in the intention-to-treat analysis. Significant reductions in WOMAC stiffness and function scores were achieved at month 6 in CS 1000 mg/day and CS 500 mg/day compared to placebo groups (p < 0.05). No significant differences were found between the groups in terms of analgesic scores, serum COMP and biochemical parameters. No serious adverse events were reported in the study. In conclusion, both doses of CS showed similar efficacy and were more effective than the placebo in treating the symptoms of knee OA.
... Channa striatus extract has also been shown to increase the tensile strength of the surgically stitched wound (Baie and Sheikh, 2000a) but mostly involved animals such as rabbits and rats. In human studies, Channa striatus extract was used to treat symptoms of knee osteoarthritis in older patients (Kadir et al., 2014;Azidah et al., 2017), reducing pain (Bakar et al., 2015;Wahab et al., 2015), and chronic inflammation (Zuraini et al., 2006) after post-caesarean in women, and also inducing cytokine conversion in pulmonary tuberculosis patients (Paliliewu et al., 2013). A previous study by Michelle et al. (2004) also found that Channa striatus could reduce soft tissue swelling and synovial inflammation, and significantly improved the density of PGP 9.5-immunoreactive nerve fibres in the synovial membrane. ...
... Azidah et al. (2017) found that the consumption of 500 and 1,000 mg/day of Channa striatus for six months in knee OA patients showed significant improvement in OA symptoms. This finding was supported by Kadir et al. (2014) which reported that the pain and symptoms of knee OA patients were significantly improved in the Channa striatus group as compared to the placebo group. Channa striatus has been reported to elicit anti-inflammatory effects on OA. ...
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Channa striatus contains biochemical components and albumin, which elicit beneficial effects to the consumers. This review aimed to clarify the effects of Channa striatus consumption on humans and animals in in vivo studies. A systematic search in four electronic databases namely ProQuest, EBSCOhost, PubMed, and SpringerLink was performed to choose the studies on Channa striatus as the interventions, and its effects on animals and humans. The intervention involved: (i) Channa striatus with placebo-controlled, (ii) Channa striatus pre-treated and treated with drugs, (iii) Channa striatus with the combination of Chronic Unpredictable Mild Stress (CUMS), and (iv) Channa striatus pre-treated with amino acids and methylene blue. Thirteen animal studies and seven human studies were included in the final analysis. They investigated the effects of Channa striatus on wound healing, anti-depres-sant-like effects, anti-inflammatory effects, and effects on human diseases. Consumption of Channa striatus supplements was found in seven studies to benefit wound healing processes due to the contents of amino acids and fatty acids found in Channa striatus extract. Two studies were found regarding Channa striatus lipid decreased the corticosterone level and nuclear factor-kappa B, while two studies reported of DHA content in Channa striatus inhibited the production of inflammatory mediators. Channa striatus elicits a positive effect on the wound healing process and enhanced antidepressant-like and anti-inflammatory effects due to its high content of amino acids and fatty acids.
... Channa striatus (Channa), a snakehead freshwater fish belonging to the Channidae family, is one of the well-known traditional medicines used for wound healing in South East Asia countries, especially Malaysia. Its use in treating knee osteoarthritis [4] has been explored due to its antiinflammatory [5][6][7], analgesic [6,8], and wound healing properties [9,10]. In vivo studies using a rabbit OA model showed that there was a reduction of the soft tissue swelling of the joint and it also reduced the density of the protein gene product (PGP) 9.5-immunoreactive nerve fibres in the synovial membrane of the Channa-treated group compared with the control [11]. ...
... The improvement of the matrix component in OA by the Channa extract has also been shown by the improvement of the Safranin O fast green staining in terms of the histological assessment of the articular cartilages in an animal study [12]. The incremental increase in GAG will increase the proteoglycans aggregates and strengthen the articular cartilage [4]. ...
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Objectives: The objective of the study is to evaluate the chondroprotective activity of Channa striatus (Channa) and glucosamine sulphate (glucosamine) on histomorphometric examinations, serum biomarker, and inflammatory mediators in experimental osteoarthritis (OA) rabbit model. Design: Anterior cruciate ligament transection (ACLT) was performed to induce OA in thirty-three male New Zealand white rabbits and were randomly divided into three groups: Channa, glucosamine, and control group. The control group received drinking water and the Channa and glucosamine groups were orally administered with 51.4 mg/kg of Channa extract and 77.5 mg/kg of glucosamine sulphate in drinking water, respectively, for eight weeks and then sacrificed. The articular cartilage was evaluated macroscopically and histologically using semiquantitative and quantitative methods. Serum cartilage oligomeric matric protein (COMP), cyclooxygenase 2 (COX-2) enzyme, and prostaglandin E2 (PGE2) were also determined. Results: Macroscopic analysis revealed that Channa group have a significantly lower severity grade of total macroscopic score compared to the control (p < 0.001) and glucosamine (p < 0.05) groups. Semiquantitative histology scoring showed that both Channa and glucosamine groups had lower severity grading of total histology score compared to the control group (p < 0.001). In comparison with the control, Channa group had lower histopathological changes in three compartments of the joint compared to glucosamine group which had lower histological scoring in two compartments only. The cartilage thickness, area, and roughness of both Channa (p < 0.05) and glucosamine (p < 0.05) groups were superior compared to the control group. However, the Channa group demonstrated significantly less cartilage roughness compared to the glucosamine group (p < 0.05). Serum COMP levels were lower in both Channa (p < 0.05) and glucosamine (p < 0.05) groups compared to the control group. Conclusion: Both oral administration of Channa extract and glucosamine exhibited chondroprotective action on an ACLT OA-induced rabbit model. However, Channa was superior to glucosamine in maintaining the structure of the cartilage.
... This study analyzed intervention-related side effects and found that they were generally mild and non-disruptive, indicating that Ophiocephalus striatus supplementation was well-tolerated by most patients [58,59]. Importantly, the intervention did not significantly affect kidney function, aligning with prior research findings. ...
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Sarcopenia, a condition characterized by muscle loss and decreased function in older adults, is a growing public health concern. This study aimed to investigate the effects of Ophiocephalus striatus extract on insulin-like growth factor-1 serum, interleukin-6 serum levels, and sarcopenia-related parameters in older adults with sarcopenia. This double-blind randomized controlled trial included 80 older adults with sarcopenia. Participants were randomly assigned to receive Ophiocephalus striatus extract or a placebo for two weeks. The IGF-1 serum and IL-6 serum levels were assessed as primary outcomes. The Ophiocephalus striatus extract intervention resulted in a significant reduction in serum IL-6 levels. Although the IGF-1 levels did not show significant changes, there was an increase for the intervention group. This study demonstrated that a 2-week intervention with Ophiocephalus striatus extract positively impacted the serum IL-6 levels in older adults with sarcopenia. While the IGF-1 levels did not change significantly in this short intervention period, the observed improvements in IGF-1, calf circumference, muscle mass, and muscle strength are promising. The findings suggest that Ophiocephalus striatus extract may offer a valuable intervention for managing sarcopenia, particularly in regions with abundant Ophiocephalus striatus production, such as South Sumatera. This study was registered with trial number NCT05869383.
... Recently, the application of C. striata extract has been reported to be successfully accelerating tuberculosis recovery in Indonesia on the patients who consumed it [24]. Patients who were diagnosed with primary lateral or bilateral knee osteoarthritis were also reported applying C. striata extract to reduce their pain, and the patients have not exhibited any abnormalities before and after treatment [25]. In short, C. striata is safe to be consumed by patients to improve their wellness and wound healing promotion. ...
Article
Channa striata (also known as Channa striatus) is an air-breathing freshwater snakehead fish which is well known in the Asian region for its medicinal properties, particularly in wound healing. It is recognised as a traditional medicine (TM) which can be served as alternative treatment methods. With the advancement of technology, researchers have made a lot of progress in characterising the biomolecules of this fish. Various types of bioactive molecules have been identified in the fish, and their therapeutic effects are being studied.The C. striata have exhibited antibacterial, antinociceptive and effective wound recovery property through various pharmacology assays. It has been regarded as a source of traditional medicine which could complement modern medicine in promoting human health. The applications of C. striata extracts by practitioners in treating different illnesses are discussed. Besides, the approaches towards scarless wound in future applications involving the snakehead fish are also highlighted. Challenges and solutions to develop an aquatic-derived drug were also covered.The Channa striata extract as a natural product has shown great prospect for wound healing enhancement. Many biomolecules associated with antibacterial and antinociceptive properties, which are crucial for healthy wound recovery were identified in the species. Significant advances and researches in the region have successfully led to a better understanding of the species, which provide a promising future for drug development.
... However, VEGF levels were increasing till week 6. This findings correlated well with the parallel study done by Ab Wahab et al. (2014) which showed an improvement in term of wound cosmetic appearance using visual analogue scale among C.striatus group at the end of week 6 19,20 .This findings indicate that the effectiveness of C.striatus extract starts at week 4 onwards enhancing the production of VEGF during proliferation and remodelling phase. At this particular week, keratinocytes migration and collagen production via fibroblast are in progress to establish healing response. ...
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Background: Wound healing is a dynamic process which is divided into four phases; haemostasis, inflammatory, proliferation and tissue remodelling phases, that encompasses inflammatory cells, cytokines and growth factors. Interleukin-6 (IL-6), Vascular Endothelial Growth Factor (VEGF) and Matrix Metalloproteinase 9 (MMP-9) involve at the different phases of wound healing. Channa striatus (C.striatus) is a fresh water fish that is believed to have natural properties to promote wound healing. Currently, the effects of C.striatus on the cytokines and growth factors are not available. Objective: This study was conducted to evaluate the wound healing biomarkers; IL-6, VEGF and MMP-9 on post Lower Segment Caesarean Section (LSCS) women consuming oral C.striatus extract. Methods: This was a randomised, double-blinded study amongst LSCS women consuming C.striatus extract versus a placebo at Universiti Sains Malaysia Hospital and Raja Perempuan Zainab II Hospital from May 2011 to January 2013. After randomization, the treatment group received freeze dried C.striatus extract 500 mg daily while the placebo group received maltodextrin 500 mg daily for 6 weeks. Blood samples for IL-6, VEGF and MMP-9 were taken from both groups post-operatively at day 3, week 2, week 4 and week 6. The data were analysed using SPSS version 22. Results: A total of 39 patients from C.striatus and 34 patients from placebo group were included in this study. Within C.striatus group, the results of IL-6, MMP-9 and VEGF showed significant differences (P<0.05) for all the study period. Between group comparison showed significant difference (P<0.05) on week 4 and week 6 for IL-6 and MMP-9 whereas VEGF showed significant difference (P<0.05) on day 1, day 3, week 4 and week 6. The trend of IL-6 and MMP-9 exhibit decreasing trend in both groups however, VEGF in C.striatus group exhibit increasing trend till week 6 compared to placebo group. Conclusion: This study showed C.striatus extract had effects on IL-6, VEGF and MMP-9 in post LSCS women. Bangladesh Journal of Medical Science Vol.19(3) 2020 p.520-526
... The fish is known traditionally for its wound healing properties and relieving pain [28].A randomized, double-blinded, placebo-controlled pilot trial using oral CS extract for 3-month intervention period had been conducted among primary knee osteoarthritis patients. There were significant improvement of pain, symptom scores and quality of life (QOL) domain score (p<0.05) in those who consumed CS compared to placebo [29]. ...
... Although extensive studies have been conducted on the biomedical properties of Channa striatus, most of these studies were performed on animals and limited clinical data in humans is available [10]. To our knowledge, there are no published reports on the effect of Channa striatus extract on uterus involution assessed by conventional or Doppler ultrasound in women post LSCS. ...
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To compare the mean of anteroposterior (AP) measurements of the uterus in longitudinal and oblique transverse planes, and the pulsatility index (PI) and resistive index (RI) of the uterine artery and superficial skin wound artery between patients taking Channa striatus and placebo. Channa striatus, also known as haruan, is a fresh water snakehead fish consumed in many parts of Southeast Asia. Channa striatus is also normally consumed by women postpartum to promote wound healing as well as to reduce post-operative pain. This study is a randomised, double blind, placebo-controlled study conducted in women after Lower Segment Caesarean Section (LSCS). Subjects were randomised to either a Channa striatus or a placebo group and were given a daily dosage of 500 mg of Channa striatus extract or 500 mg maltodextrin, respectively, for six weeks post LSCS. The anteroposterior measurements of the uterus in the longitudinal and oblique transverse planes, and the pulsatility index (PI) and resistive index (RI) of the uterine and superficial skin wound arteries were assessed using pelvic Gray-scale ultrasound and Doppler ultrasound at baseline (Day 3) and at two weeks, four weeks and six weeks post-operatively. Sixty-six subjects were randomised into the study with 33 in the Channa striatus group and 33 in the placebo group. No significant differences were detected in terms of the pulsatility index (PI) and the resistive index (RI) of the uterine and superficial skin wound arteries between the Channa striatus and placebo groups. However, in the Channa striatus group, the AP measurements of the uterus on the longitudinal and oblique transverse planes were significantly lower compared to the placebo group (p<0.05 and p<0.001, respectively). Daily intake of Channa striatus extract results in marked differences compared to placebo in terms of uterine involution and recovery in women post LSCS. www.isrctn.com 11960786.
... 12 It is a valid, reliable, and responsive self-administered instrument in the follow-up of short-term and long-term osteoarthritis and knee injuries. 13 The Malay version of KOOS was validated with Cronbach alpha ranged from 0.94 to 0.96 and factor loading of 0.25 to 0.89 (Maryam, unpublished thesis, 2013) ...
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Introduction: There is limited data regarding the use of relaxation technique in managing knee osteoarthritis in Asian population.
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The main aim of this study was to compare the immunoreactivity of some osteoarthritis related neuropeptides following oral administration of two natural remedies that is Channa striatus extract and zerumbone against monosodium iodoacetate induced knee osteoarthritis changes in the rat's synovial membrane. Assay of PGE 2 and PGF2α in the serum were performed to evaluate their role during osteoarthritis events and post oral application of the treatment. Forty rats were divided equally into four groups. Rats in the first and second groups were received channa extract and zerumbone, respectively. Rats in the third group were treated with celecoxib, whereas the fourth group was treated with normal saline. Evaluation of immunoreactivity of the following neuropeptides: Protein gene product 9.5, calcitonin gene related peptide and neuropeptide Y in the synovial membranes was implemented with the aid of both histopathology and immunohistochemistry approaches. Results revealed lower pathology score in both first and second groups accompanied with markedly improved immunoreactivity in zerumbone treated groups compared to channa extract group. Significant different concentrations of PGE 2 but not PGF2α were detected within studied groups. Both remedies significantly improved the immunoreactivity which appeared more apparent in the group treated with zerumbone. Prostaglandin E 2 has a role in osteoarthritis development and regulation.
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The objective of this current study was to analyze the biochemical compositions of three Malaysian Channa spp. fish. The proximate analysis revealed that the protein content of Channa lucius, Channa micropeltes and Channa striatus was 19.9%, 22.1%, 23.0% (% of dry weight), respectively. The total lipid content was generally high, ranging from 5.7% to 11.9% and crude ash ranged from 1.0% to 1.8%. The major amino acids were glutamic acid, aspartic acid and lysine, ranging from 9.7% to 21.7%, and the most abundant fatty acid in Channa spp. was C16:0, ranging from 25.6% to 30.4%. The other major fatty acids detected were C22:6, C18:1 and C18:0. The level of arachidonic acid (C20:4) was unusually high in C. striatus (19.02%). The levels of DHA in these fish would also explain the use of Channa spp., especially C. striatus, which has been used for centuries for reducing pain, inflammation and promote wound healing in Malaysia.
Article
Haruan, Channa striatus, is a snakehead fish consumed in many parts of the southeast Asian region. It is believed to promote wound healing, as well as reduce post-operative pain. In an attempt to establish the scientific basis for the alleged pain-relieving benefits of this fish, we studied the antinociceptive effects of whole fillet and mucus extracts from haruan in the mouse using the abdominal constriction and tail flick tests. In the abdominal constriction test, the 30 min fillet extract exhibited concentration-dependent inhibition of the writhing response in the 10-50% concentration range, with 20% as the IC50 value. This activity was not dependent on the duration of extraction, with no significant differences among the extracts obtained at durations of 10, 20, 30, 60, 90 and 120 min (range between 45-54% inhibition at 20% concentration). The mucus extract also showed concentration-dependent inhibition of the abdominal constriction response-at the highest concentration used the average inhibition was 68.9%, while IC50 value was 25%. Neither the fillet extract (30 min, 20%) nor the mucus extract (25%) had any demonstrable effect on the tail flick latency on their own, but significantly enhanced the antinociceptive activity of morphine in this assay. Similarly, low concentrations of the mucus and fillet extract enhanced the effects of morphine in the abdominal constriction test. Collectively, these results suggest a scientific basis for the folklore practice of eating haruan fish in the post-operative period for pain relief: Haruan extracts have antinociceptive activity and enhance the activity of other antinociceptive agents. (C) 1997 Elsevier Science Ireland Ltd.
Article
Objective The purpose of this study was to examine the effects of oral glucosamine supplementation on the functional ability and degree of pain felt by individuals who had regular knee pain, most likely due to previous articular cartilage damage, and possibly osteoarthritis. Methods Subjects were randomly supplemented with either glucosamine (G) (n=24) or placebo (P) (lactose) (n=22) for 12 weeks at a dose of 2000 mg per day. Over this period, four testing sessions were conducted, with changes in knee pain and function assessed by clinical and functional tests, (joint line palpation, a 3 metre “duck walk” and a repeated, walking stair climb), two questionnaires (the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Knee Pain Scale (KPS)) and participant subjective evaluations. Results The clinical and functional test scores improved with time (main effects: p<0.05, p<0.01) but there were no significant differences between the two groups. The questionnaire results also recorded a significant main effect for time (p<0.05), but the glucosamine group was found to have significantly better KOOS quality of life scores at week eight and 12 (p<0.05), and lower KPS scores (p<0.05) at week eight than the placebo group. On self report evaluations of changes across the 12 week supplementation period, 88% (n=21) of the glucosamine group reported some degree of improvement in their knee pain versus only 17% (n=3) in the placebo group. Conclusions These results suggest that glucosamine supplementation can provide some degree of pain relief and improved function in persons who experience regular knee pain, which may be caused by prior cartilage injury and/or osteoarthritis. The trends in the results also suggest that, at a dosage of 2000 mg per day, the majority of improvements are present after eight weeks.
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For the purposes of classification, it should be specified whether osteoarthritis (OA) of the knee is of unknown origin (idiopathic, primary) or is related to a known medical condition or event (secondary). Clinical criteria for the classification of idiopathic OA of the knee were developed through a multicenter study group. Comparison diagnoses included rheumatoid arthritis and other painful conditions of the knee, exclusive of referred or paraarticular pain. Variables from the medical history, physical examination, laboratory tests, and radiographs were used to develop sets of criteria that serve different investigative purposes. In contrast to prior criteria, these proposed criteria utilize classification trees, or algorithms.
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There are a variety of oral and topical pharmaceutical agents for the treatment of osteoarthritis. To date there is no pharmacologic agent proved to prevent disease progression. This article focuses primarily on the medications used for symptomatic relief and palliation of pain. The article reviews the medications' mechanisms of action and the available efficacy literature, as well as indications, contraindications, and common adverse effects. © 2012 American Academy of Physical Medicine and Rehabilitation.
Article
To assess the clinical effectiveness and cost-effectiveness of glucosamine sulphate/hydrochloride and chondroitin sulphate in modifying the progression of osteoarthritis (OA) of the knee. Electronic databases were searched from 1950 to 2008 and included: MEDLINE and PubMed; EMBASE; Cochrane Library (including Cochrane Systematic Reviews Database, CENTRAL, DARE, NHS EED and HTA databases); Allied and Complementary Medicine (AMED); National Research Register (NRR); Web of Science Proceedings; Current Controlled Trials; and Clinical Trials.gov. Other sources included bibliographies of retrieved papers, registered but unpublished trials, internet searches and the Food Standards Agency website. A search was conducted for systematic reviews of randomised controlled trials (RCTs), which were used to identify RCTs of at least 12 months' duration and updated with searches for primary studies. A cost-effectiveness model was constructed using cohort simulation and drawing on available evidence. Sensitivity analysis was undertaken and value of information analysis conducted. A review of studies of mechanism of action was carried out to explore the biological plausibility of the preparations. Five systematic reviews and one clinical guideline met the inclusion criteria. They reported inconsistent conclusions with only modest effects on reported pain and function. A reduction in joint space narrowing was more consistently observed, but the effect size was small and the clinical significance uncertain. A separate review of eight primary trials of > 12 months' duration showed evidence of statistically significant improvements in joint space loss, pain and function for glucosamine sulphate, but the clinical importance of these differences was not clear. In two studies of glucosamine sulphate, the need for knee arthroplasty was reduced from 14.5% to 6.3% at 8 years' follow-up. For other preparations of glucosamine, chondroitin and combination therapy, there was less evidence to support a clinical effect. Cost-effectiveness modelling was restricted to glucosamine sulphate. Over a lifetime horizon the incremental cost per quality-adjusted life-year (QALY) gain for adding glucosamine sulphate to current care was estimated to be 21,335 pounds. Deterministic sensitivity analysis suggested that the cost-effectiveness of glucosamine sulphate therapy was particularly dependent on the magnitude of the quality of life (QoL) gain, the change in knee arthroplasty probability with therapy and the discount rate. At a cost per QALY gained threshold of 20,000 pounds, the likelihood that glucosamine sulphate is more cost-effective than current care is 0.43, while at a threshold of 30,000 pounds, the probability rises to 0.73. Probabilistic sensitivity analysis showed that estimates were imprecise and subject to a degree of decision uncertainty. Value of information analysis demonstrated the need for further research. Several biologically plausible mechanisms of action for glucosamine sulphate and chondroitin were proposed. There was evidence that glucosamine sulphate shows some clinical effectiveness in the treatment of OA of the knee. No trial data came from the UK and caution should be exercised in generalising the findings to the UK health-care setting. Cost-effectiveness was not conclusively demonstrated. There was evidence to support the potential clinical impact of glucosamine sulphate. The value of information analysis identified three research priorities: QoL, structural outcomes and knee arthroplasty. The biological mechanism of glucosamine sulphate and chondroitin remains uncertain and, in particular, the proposal that the active substance may be sulphate should be explored further.