Polysulfated glycosaminoglycan

Polysulfated glycosaminoglycan (PSGAG), sold under the brand name Adequan, is an injectable drug for dogs and horses that is used to alleviate the lameness, pain, and lowered range of motion caused by arthritis. It is made of repeat disaccharide units (comprising hexosamine and hexuronic acid), and is similar to glycosaminoglycans already present in the cartilage; PSAG thus easily integrates itself there. In vitro studies have shown it to inhibit the enzymes that degrade cartilage and bone, as well as suppress inflammation and stimulate the synthesis of replacement cartilage. While it can cause an increased risk of bleeding, its relatively safe and has a high LD50. PSAG and is one of the most widely prescribed joint supplements for horses. Polysulfated glycosaminoglycan (PSGAG), sold under the brand name Adequan, is an injectable drug for dogs and horses that is used to alleviate the lameness, pain, and lowered range of motion caused by arthritis. It is made of repeat disaccharide units (comprising hexosamine and hexuronic acid), and is similar to glycosaminoglycans already present in the cartilage; PSAG thus easily integrates itself there. In vitro studies have shown it to inhibit the enzymes that degrade cartilage and bone, as well as suppress inflammation and stimulate the synthesis of replacement cartilage. While it can cause an increased risk of bleeding, its relatively safe and has a high LD50. PSAG and is one of the most widely prescribed joint supplements for horses. While it is widely used, some studies still show conflicting results in terms of efficacy, causing some to claim that PSGAG is not solely responsible for the significant mitigation of arthritis seen in success cases. PSGAG is mostly used in dogs and horses for treating traumatic arthritis and degenerative joint disease (osteoarthritis). It has shown to be better at treating acute than chronic arthritis, though some studies say that its effectiveness in acute cases is still limited if degenerative enzymes haven't played a role. While it is currently only FDA-approved for dogs and horses, PSGAG is also used off-label to treat lameness in swine, as a chondroprotectant ('joint protector') or treatment of interstitial cystitis in cats, and to treat arthritis in rabbits. PSGAG is first administered as a series of injections over several weeks, and can be continued once or twice a month thereafter. It is normally injected intramuscularly, though can also be injected intra-articularily (directly into the joint) in horses or subcutaneously in off-label uses. Giving PSGAG intra-articularily requires it to be given aseptically, and is sometimes supplemented by the antibiotic amikacin to prevent infection. There are no generic or human-labeled equivalents of PSGAG in the US. Side effects from intra-articular administration can include joint pain, swelling, lameness, and, rarely, infection of the joint. Intramuscular injection can cause dose-dependent inflammation and bleeding, since PSGAG is an analogue of the anticoagulant heparin. In dogs, this may manifest as bleeding from the nose or as bloody stools. The increased risk of bleeding has some advising not to give PSGAG to animals with bleeding disorders, though it's only absolute contraindication is hypersensitivity to PSAGs when it is being given intra-articularily. Overdose on PSGAG is quite rare, as the LD50 is over 1000 mg/kg when given intravenously to dogs. Signs of overdose include exacerbated side effects such as joint pain, swelling, and lameness. When dogs received three times the normal dose intramuscularly twice a week for 13 weeks, they had increased liver and kidney weight, as well as microscopic lesions on the liver, kidneys, and lymph nodes. At 11 times the normal dose, they also had increased alanine transferase, cholesterol, and prothrombin time (i.e. coagulation via the extrinsic pathway took longer), and fewer platelets. Normally, joint cartilages have proteoglycan complexes, which are proteins with side chains made of glycosaminoglycans such as keratan sulfate and chondroitin sulfate attached to strands of hyaluronic acid. The glycosaminoglycan side chains are polyanionic, which causes adjacent side chains to push each other away and create a 'bottle brush', where hyaluronic acid is the stem and the side chains are the bristles. When pressure is exerted on the joint, fluids move between the chondrocytes and synovial fluid, exchanging nutrients. In degenerative joint disease, the proteoglycan complexes start disappearing, and the hyaluronate becomes poorer in quality and scarcer. This lowers the viscosity of the synovial fluid (which increases friction) and causes white blood cells and enzymes to enter and effect cartilage degradation and inflammation. Steroids that are released as a result kill the chondrocytes. The remaining chondrocytes have trouble exchanging nutrients with the synovial fluid, which would allow them to repair some damages.