Cartilage (Bovine and Shark)
- Questions and Answers About Cartilage (Bovine and Shark)
- Changes To This Summary (10/07/2010)
- General CAM Information
- Evaluation of CAM Approaches
- Questions to Ask Your Health Care Provider About CAM
- To Learn More About CAM
- About PDQ
- Cartilage is a type of tough, flexible connective tissue (see Question 1).
- Cartilage from cows (bovine cartilage) and sharks has been studied as a treatment for people with cancer and other medical conditions for more than 30 years (see Question 2).
- Laboratory and animal studies have looked at whether bovine and shark cartilage products can kill cancer cells, make the immune system more active against cancer, and prevent the body from making the new blood vessels that a tumor needs to grow (see Question 5).
- The results have been mixed in the human studies of cartilage as a treatment for cancer reported to date (see Question 6).
- The US Food and Drug Administration (FDA) has not approved cartilage as a treatment for cancer (see Question 8).
What is cartilage?
Cartilage is a type of tough, flexible connective tissue that forms parts of the skeleton in many animals. Cartilage contains cells called chondrocytes, which are surrounded by collagen (a fibrous protein) and proteoglycans, which are made of protein and carbohydrate.
Products containing cartilage are sold in the United States as dietary supplements. Companies that make cartilage products may not have a process in place to check that all batches they make are exactly the same. This means different batches of a cartilage product may contain different amounts or strengths of ingredients. Different binding agents (substances that make loose mixtures stick together) and fillers may be used in different batches. Therefore, the results of a particular clinical trial may be true only for the batch that was used in the study.
What is the history of the discovery and use of cartilage as a complementary or alternative treatment for cancer?
Cartilage from cows (bovine cartilage) and sharks has been studied as a treatment for cancer and other medical conditions for more than 30 years. It was once believed that sharks, whose skeletons are made mostly from cartilage, do not develop cancer. This caused interest in cartilage as a possible treatment for cancer. Although malignant tumors are rare in sharks, cancers have been found in these animals.
Early studies used extracts of bovine cartilage.
- In the 1960s, it was first reported that bovine cartilage decreased inflammation (redness, swelling, pain, and feeling of heat).
- In the 1970s, it was first reported that bovine cartilage contains a substance that blocks angiogenesis (the forming of new blood vessels). If blood vessel growth into a tumor can be blocked, the tumor will stop growing or shrink.
- In the 1980s, researchers first described laboratory and animal studies and clinical trials (research studies in people) testing bovine cartilage as a treatment for cancer.
Interest in using shark cartilage grew because it was believed that shark cartilage may be more active than bovine cartilage in preventing new blood vessels from being formed. Since a shark's skeleton is made mostly of cartilage, shark cartilage is more plentiful than bovine cartilage.
- In the 1980s, it was first published that shark cartilage contains a substance that blocks blood vessel growth.
- In 1998 and 2005, there were published reports of clinical trials of shark cartilage as a treatment for cancer.
What is the theory behind the claim that cartilage is useful in treating cancer?
Three theories have been suggested to explain how cartilage acts against cancer:
- As cartilage is broken down by the body, it releases products that kill cancer cells.
- Cartilage increases the action of the bodyâs immune system to kill cancer cells.
- Cartilage makes substances that block tumor angiogenesis (the growth of new blood vessels that feed a tumor and help it grow).
Based on laboratory and animal studies, the third theory may be most likely. Cartilage does not contain blood vessels, so cancer cannot easily grow in it. It is suggested that a cancer treatment using cartilage may keep blood vessels from forming in a tumor, causing the tumor to stop growing or shrink.
How is cartilage administered?
In animal studies, cartilage products have been given by mouth; injected into a vein or the abdomen; applied to the skin; or placed in slow-release plastic pellets that were surgically implanted (put into the body).
In studies with people, cartilage products have been given by mouth; applied to the skin; injected under the skin; or given by enema (injected as a liquid into the rectum). The dose and length of time the cartilage treatment was given was different for each study, in part because different types of products were used.
Have any preclinical (laboratory or animal) studies been conducted using cartilage?
A number of preclinical studies have been done with cartilage. Preclinical studies in a laboratory or using animals are done to find out if a drug, procedure, or treatment is likely to be safe and useful in humans. These preclinical studies are done before testing in humans is begun. Some research studies are published in scientific journals. Most scientific journals have experts who review research reports before they are published, to make sure that the evidence and conclusions are sound.
Preclinical studies of cartilage looked at whether bovine and shark cartilage products can kill cancer cells in the laboratory, make the immune system more active against cancer, and prevent blood vessels from forming.
The following have been reported from preclinical studies of the effect of powdered cartilage on cancer cells in vitro (outside of the body):
- In a published laboratory study, a powdered form of bovine cartilage called Catrix slowed the growth of human cancer cells by half or more. It is not clear if Catrix had this effect only on cancer cells, because its effect the growth of normal cells was not tested. It is also not known if the dose used in the laboratory study could safely be used in people.
- In a published laboratory study of powdered shark cartilage, there was no effect on the growth of human astrocytoma cells (cancer cells that begin in the brain or spinal cord).
The following have been reported from preclinical studies of the effect of powdered cartilage on the immune system:
- One published study reported that Catrix injected into mice caused their immune systems to be more active. This effect did not happen when Catrix was given by mouth.
- A laboratory study on the effect of shark cartilage on a tumor model reported an increase in tumor-fighting immune cells in the tumor but not in the blood.
- A study on the effect of shark cartilage on immune system response in mice reported a number of different effects, both helpful and harmful. It increased antibody response but decreased the activity of natural killer cells (tumor-fighting white blood cells). The study also reported a decrease in blood vessel growth.
A large number of laboratory and animal studies on the effect of powdered cartilage on angiogenesis have been published. The following have been reported from these studies:
- Powdered shark cartilage given by mouth to rats decreased the growth of abdominal tissue cells.
- Powdered shark cartilage given by mouth to rats decreased the growth of gliosarcomas, a type of brain cancer.
- Two powdered shark cartilage products (Sharkilage and MIA Shark Powder) given by mouth to mice did not stop the growth or spread of squamous cell skin cancer.
- Three substances that prevent blood vessel growth were found in bovine cartilage. These substances have not shown an effect on the growth of normal cells or tumor cells.
- Two substances that prevent blood vessel growth were found in shark cartilage. These substances have not shown an effect on the growth of normal cells or tumor cells.
The following have been reported from preclinical studies of liquid cartilage products:
- In a laboratory study, a liquid form of shark cartilage called AE-941/Neovastat was reported to stop the growth of a number of cancer cell types. The results have not been published in a scientific journal.
- Several studies have shown that AE-941/Neovastat blocks the growth of new blood vessels.
- AE-941/Neovastat given by mouth to mice slowed the growth of breast cancer cells and the spread of lung cancer. In the lung cancer study, AE-941/Neovastat increased the effect of the anticancer drug cisplatin.
- A substance made from human cartilage slowed the spread of pancreatic cancer cells in an animal study and prevented blood vessel growth in both animal and laboratory studies.
Have any clinical trials (research studies with people) been conducted using cartilage?
Clinical trials are a type of research study that tests how well new drugs or other treatments work in people. Since the 1970s, there have been at least a dozen clinical studies of cartilage as a treatment for cancer.
There has been one randomized clinical trial of cartilage as cancer treatment published in a peer-reviewed scientific journal. This trial compared treatment using a form of shark cartilage to treatment using a placebo (an inactive substance that looks the same as, and is given the same way as, the substance being tested). Patients also received standard care. In 83 patients having either advanced breast or advanced colon cancer, there was no difference in the quality of life or survival rate between the group that received the shark cartilage product and the group that received the placebo.
The following have been reported from clinical trials of powdered cartilage products:
Case series (a collection of detailed information about individual patients) of 31 patients who were treated with Catrix by injection and/or by mouth:
The cancer went into remission (signs and symptoms of cancer went away) in 19 patients and then recurred (came back) in about half of them. Some of these patients also received standard cancer treatment and there was no control group (a group of patients who do not receive the treatment being studied, to show if the treatment being studied makes a difference). For these reasons, the effectiveness of cartilage as a cancer treatment is not proven by this case series.
- A clinical trial of Cartilade by mouth in 60 patients with advanced cancer:
All but 1 patient had been treated with standard therapy before the trial. The cancer stopped growing in 10 of the patients for 12 weeks or more and then began to grow again. The cancer did not shrink or go into remission in any of the patients.
The following have been reported from clinical trials of liquid cartilage products:
- A clinical trial of Catrix in 9 patients whose cancers did not respond to radiation therapy and/or chemotherapy:
Catrix was given by injection. One patient's cancer went into remission for more than 39 weeks and the other 8 patients did not respond to treatment with Catrix.
- Clinical studies on the safety of the liquid shark cartilage product AE-941/Neovastat have reported that it has little harmful effect.
- A randomized clinical trial studied the effect of AE-941/Neovastat on blood vessel growth related to wound healing after surgery. This study reported that one of the ingredients that prevents blood vessel growth can be absorbed and used by the body when taken by mouth.
- A clinical trial of oral AE-941/Neovastat in 379 patients with advanced non-small cell lung cancer reported that there was no difference in how long patients lived between the group receiving the shark cartilage product and chemoradiotherapy compared to the group receiving the placebo and chemoradiotherapy. Both kinds of treatment were well tolerated.
For more detailed information about these clinical trials and others that are ongoing or have not fully reported, see the health professional version.
Information is available on research studies that use complementary and alternative medicine.
People who are interested in taking part in clinical trials should talk with their health care provider. Information on clinical trials can also be found by searching the following online databases:
- The NCI PDQÂ® Clinical Trials Database can be searched by cancer type, type of trial, location, trial sponsor, and/or drug name. This information is also available by calling NCIâs Cancer Information Service (1-800-4-CANCER [1-800-422-6237]; TTY: 1-800-332-8615).
- The NCCAM Clinical Trials Web page can be searched by the type of treatment or disease.
- The OCCAM Clinical Trials Web page provides links to the NCI PDQÂ® Clinical Trials Database.
- ClinicalTrials.gov, a service of the National Institutes of Health (NIH) developed by the National Library of Medicine, is a searchable database containing information on clinical trials for many diseases and conditions, including cancer. The trials are being sponsored by the NIH and other federal agencies, and by drug companies in the United States, Canada, and other countries.
Have any side effects or risks been reported from cartilage?
The side effects of cartilage treatment are usually mild or moderate.
The most common side effects of treatment with the bovine cartilage product Catrix include the following:
- Inflammation at the injection location.
- A bad taste in the mouth.
- Feeling very tired.
- Upset stomach.
- Feeling dizzy.
- Swelling of the scrotum (the sac that contains the testicles).
The most common side effects of treatment with the shark cartilage include the following:
- Abdominal cramps and/or bloating.
- Lower than normal blood pressure.
- Higher than normal blood sugar.
- General weakness.
- A higher than normal level of calcium in the blood.
Nausea, vomiting, and upset stomach are the side effects reported most often from treatment with the shark cartilage product AEâ941/Neovastat.
There has been one report of hepatitis occurring in a person who used shark cartilage.
Is cartilage approved by the US Food and Drug Administration (FDA) for use as a cancer treatment in the United States?
The US Food and Drug Administration (FDA) has not approved cartilage as a treatment for cancer. A number of cartilage products are sold in the United States as dietary supplements. In the United States, dietary supplements are regulated as foods, not drugs. A company does not need FDA approval to sell a dietary supplement unless it claims the product can treat or prevent disease.
Changes were made to this summary to match those made to the health professional version.
Complementary and alternative medicine (CAM)âalso referred to as integrative medicineâincludes a broad range of healing philosophies, approaches, and therapies. A therapy is generally called complementary when it is used in addition to conventional treatments; it is often called alternative when it is used instead of conventional treatment. (Conventional treatments are those that are widely accepted and practiced by the mainstream medical community.) Depending on how they are used, some therapies can be considered either complementary or alternative. Complementary and alternative therapies are used in an effort to prevent illness, reduce stress, prevent or reduce side effects and symptoms, or control or cure disease.
Unlike conventional treatments for cancer, complementary and alternative therapies are often not covered by insurance companies. Patients should check with their insurance provider to find out about coverage for complementary and alternative therapies.
Cancer patients considering complementary and alternative therapies should discuss this decision with their doctor, nurse, or pharmacist as they would any therapeutic approach, because some complementary and alternative therapies may interfere with their standard treatment or may be harmful when used with conventional treatment.
It is important that the same rigorous scientific evaluation used to assess conventional approaches be used to evaluate CAM therapies. The National Cancer Institute (NCI) and the National Center for Complementary and Alternative Medicine (NCCAM) are sponsoring a number of clinical trials (research studies) at medical centers to evaluate CAM therapies for cancer.
Conventional approaches to cancer treatment have generally been studied for safety and effectiveness through a rigorous scientific process that includes clinical trials with large numbers of patients. Less is known about the safety and effectiveness of complementary and alternative methods. Few CAM therapies have undergone rigorous evaluation. A small number of CAM therapies originally considered to be purely alternative approaches are finding a place in cancer treatmentânot as cures, but as complementary therapies that may help patients feel better and recover faster. One example is acupuncture. According to a panel of experts at a National Institutes of Health (NIH) Consensus Conference in November 1997, acupuncture has been found to be effective in the management of chemotherapy-associated nausea and vomiting and in controlling pain associated with surgery. In contrast, some approaches, such as the use of laetrile, have been studied and found ineffective or potentially harmful.
The NCI Best Case Series Program, which was started in 1991, is one way CAM approaches that are being used in practice are being investigated. The program is overseen by the NCIâs Office of Cancer Complementary and Alternative Medicine (OCCAM). Health care professionals who offer alternative cancer therapies submit their patientsâ medical records and related materials to OCCAM. OCCAM conducts a critical review of the materials and develops follow-up research strategies for approaches deemed to warrant NCI-initiated research.
When considering complementary and alternative therapies, patients should ask their health care provider the following questions:
- What side effects can be expected?
- What are the risks associated with this therapy?
- Do the known benefits outweigh the risks?
- What benefits can be expected from this therapy?
- Will the therapy interfere with conventional treatment?
- Is this therapy part of a clinical trial?
- If so, who is sponsoring the trial?
- Will the therapy be covered by health insurance?
National Center for Complementary and Alternative Medicine (NCCAM)
The National Center for Complementary and Alternative Medicine (NCCAM) at the National Institutes of Health (NIH) facilitates research and evaluation of complementary and alternative practices, and provides information about a variety of approaches to health professionals and the public.
- NCCAM Clearinghouse
- Post Office Box 7923 Gaithersburg, MD 20898â7923
- Telephone: 1â888â644â6226 (toll free) 301â519â3153 (for International callers)
- TTY (for deaf and hard of hearing callers): 1â866â464â3615
- Fax: 1â866â464â3616
- E-mail: email@example.com
- Web site: http://nccam.nih.gov
CAM on PubMed
NCCAM and the NIH National Library of Medicine (NLM) jointly developed CAM on PubMed, a free and easy-to-use search tool for finding CAM-related journal citations. As a subset of the NLM's PubMed bibliographic database, CAM on PubMed features more than 230,000 references and abstracts for CAM-related articles from scientific journals. This database also provides links to the Web sites of over 1,800 journals, allowing users to view full-text articles. (A subscription or other fee may be required to access full-text articles.) CAM on PubMed is available through the NCCAM Web site. It can also be accessed through NLM PubMed bibliographic database by selecting the "Limits" tab and choosing "Complementary Medicine" as a subset.
Office of Cancer Complementary and Alternative Medicine
The NCI Office of Cancer Complementary and Alternative Medicine (OCCAM) coordinates the activities of the NCI in the area of complementary and alternative medicine (CAM). OCCAM supports CAM cancer research and provides information about cancer-related CAM to health providers and the general public via the NCI Web site.
National Cancer Institute (NCI) Cancer Information Service
U.S. residents may call the NCI Cancer Information Service toll free at 1-800-4-CANCER (1-800-422-6237) Monday through Friday from 8:00 am to 8:00 pm. A trained Cancer Information Specialist is available to answer your questions.
Food and Drug Administration
The Food and Drug Administration (FDA) regulates drugs and medical devices to ensure that they are safe and effective.
- Food and Drug Administration
- 5600 Fishers Lane
- Rockville, MD 20857
- Telephone: 1â888â463â6332 (toll free)
- Web site: http://www.fda.gov/
Federal Trade Commission
The Federal Trade Commission (FTC) enforces consumer protection laws. Publications available from the FTC include:
- Who Cares: Sources of Information About Health Care Products and Services
- Fraudulent Health Claims: Donât Be Fooled
- Consumer Response Center
- Federal Trade Commission
- Washington, DC 20580
- Telephone: 1-877-FTC-HELP (1-877-382-4357) (toll free)
- TTY (for deaf and hearing impaired callers): 202-326-2502
- Web site: http://www.ftc.gov/
PDQ is a comprehensive cancer database available on NCI's Web site.
PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information database. Most of the information contained in PDQ is available online at NCI's Web site. PDQ is provided as a service of the NCI. The NCI is part of the National Institutes of Health, the federal government's focal point for biomedical research.
PDQ contains cancer information summaries.
The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries are available in two versions. The health professional versions provide detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions provide current and accurate cancer information.
The PDQ cancer information summaries are developed by cancer experts and reviewed regularly.
Editorial Boards made up of experts in oncology and related specialties are responsible for writing and maintaining the cancer information summaries. The summaries are reviewed regularly and changes are made as new information becomes available. The date on each summary ("Date Last Modified") indicates the time of the most recent change.
PDQ also contains information on clinical trials.
A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
Listings of clinical trials are included in PDQ and are available online at NCI's Web site. Descriptions of the trials are available in health professional and patient versions. Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237).
Date first published: 2005-09-23
Date last modified: 2010-10-07