CSA, Chondroitin Sulfate A and Friends

by Mirk Timon

It is time to add some new words to your nutritional vocabulary. "Mucopolysaccharides" you have heard of before in discussions centering on connective tissue or on green lipped mussel. Yet how well informed are you about chondroitin sulfates, specifically chondroitin sulfates A, B and C? You are soon to be introduced to these new actors in the field of health and nutrition.

But let's learn first about mucopolysaccharides in general. We should because chondroitin sulfates are acidic mucopolysaccharides. And mucopolysaccharides are large complex sugars (polysaccharides) containing amino acids compounded with sugars. They are defined in Taber's Cyclopedic Medical Dictionary as:

"polysaccharides containing hexosamine and sometimes protein. [Mucopolysaccharides form] thick gelatinous material which is found in many places in the body. It glues cells together, lubricates joints, and is found in blood group substances."1

Chondroitin sulfates are some of the most common mucopolysnccharides in the human body. They are mostly bound to collagen and serve as constituents of the fundamental substance of connective tissue.2,3

We are all familiar with collagen. We see it sold as liquid protein supplements. We see it included in cosmetics. We understand that it is a major connective tissue of the human body, holding all cells together. Yes, collagen provides tissue integrity. But something else provides connective tissue with flexibility and elasticity. That "something else" is the mucopolysaccharides, specifically the chondroitin sulfates.

As an analogy, picture in your mind's eye an elastic waistband on a common undergarment. That elastic waistband contains a number of thin grey synthetic rubber strands around which is wound a layer of threads. You may think of the chondroitin sulfates as the grey synthetic rubber strand and of the collagen as the threads wrapped around the grey strand. The rubber at the core provides elasticity and flexibility. It acts as the chondroitin sulfate mucopolysaccharides act in the human body. The threads wrapped around the grey rubber strand provide added strength. They may be looked upon as collagen.

The simplified analogy above should give you a basic understanding of the relationship between chondroitin sulfates and collagen. They work synergistically to keep your tendons, ligaments, skin, arteries and all other tissues strong and resilient. Indeed, collagen supplementation will do very little to improve connective tissue unless there are sufficient chondroitin sulfates available to serve as the infrastructure for the connective tissue.

Chondroitin sulfates (CS) are normally produced by specialized cells called chondrocytes found primarily in cartilage and major connective tissues.4 The trace mineral manganese may be essential to their functioning since lack of manganese in the diets of test animals has resulted in defective growth, bone disease and edema. There was a significant depression of bone growth at the cartilaginous ends of the bone, indicating that CS production was depressed.

As human beings age, the amounts of chondroitin sulfates produced by the chondrocytes decreases. Hardening of the arteries, arthritis and flaccid, wrinkled skin are some of the indicators of decreasing supplies of chondroitin sulfates. But the good news is that the chondrocytes themselves do not die off, do not diminish in number and apparently do not lose their ability to manufacture chondroitin sulfates.5 It is theorized that as we age the chondrocytes are simply deprived of the raw materials they need to manufacture adequate amounts of chondroitin sulfates. Decreasing digestive capabilities, diminished food intake and dietary changes which occur as we grow older may all be contributing factors to the lessening output from our chondrocytes.

When supplemental chondroitin sulfates are given, the chondrocytes spring to life. Supplemental chondroitin sulfate - most especially chondroitin sulfate A, or CSA - immediately boosts the levels of these important mucopolysaccharides in the tissues.6 And the supplements may also provide a stimulating matrix for the chondrocytes. What this means is that we can utilize supplemental chondroitin sulfates directly, and that supplemental chondroitin sulfates can also stimulate our own natural production of these mucopolysaccharides. The mechanism by which the stimulation is achieved is not yet fully understood. Perhaps chondrocytes build additional chondroitin sulfates on to the supplemental chondroitin sulfates which are received.7 Or perhaps there are enzyme systems which break down some of the supplemental chondroitin sulfates, sending these component parts to the chondrocyte cells. The chondrocytes would then use these fragments as the chassis upon which to build complete chondroitin sulfates. But no matter what the mechanism, the activity of human chondrocytes can be returned to youthful levels at any age through the use of supplemental chondroitin sulfates.

You will notice that this article refers to chondroitin sulfates in the plural. That is because there are several forms found in human and animal tissue. Chondroitin sulfate B (CSB) is most abundant in skin. Chondroitin sulfate A (CSA) is most abundant in all other tissues. Should you be a fish, chondroitin sulfate C (CSC) would be your major mucopolysaccharide. In human tissue, the ratio of CSA to CSC is 4 to 1.8 Now that we know some basic facts about chondroitin sulfate, let's move on to understand the justification for this material as a dietary supplement.

Research into the therapeutic uses of CS arose from two histological* discoveries. First, early lesions in the cartilage of osteoarthritics are characterized by a loss of CS from the cartilaginous tissue. Second, the atheroma (fatty tumor or plaque) in the interior wall of large arteries and vessels is associated with a change in both the quality and quantity of the CS mucopolysaccharides at that point in the vessel. These two discoveries led researchers to begin investigating the relationship of CS to the onset and development of osteo-arthritic and cardiovascular diseases.

In most of the clinical research, oral chondroitin sulfate extracts were given. Dr. Lester M. Morrison at Loma Linda University, Drs. Syama, Kurita, Ohdoi, Nakazawa and Murata in Japan and other researchers around the world discovered some startling benefits from CS therapies.

Probably due to its molecular structure reminiscent of heparin, chondroitin sulfate showed an anti-clotting and anti-thrombotic activity.9 In short, it decreases blood platelet adhesion and clears blood of fats, low density and very low density lipoproteins.10 CSA in particular stimulated bio-synthesis of CS by chondrocytes. Supplemental CS speeded wound healing and increased the tensile strength of the new tissue formed.11

In tests on aged atherosclerotic subjects, mortality, serum cholesterol, blood clot formation time and the weight of clots were all reduced when chondroitin sulfates were given.12 Briefly then, chondroitin sulfates may very well provide protection against cardiovascular disease in the same manner as eicosapentaenoic acid (EPA) without providing that fatty acid which can oxidize quickly, forming dangerous free radicals in the absence of sufficient amounts of antioxidants. In addition, CSA goes a step further in helping return elasticity to damaged cardiovascular tissue in which it is found as an important component of the intimal walls of vessels.

Mucopolysaccharides, and the chondroitin sulfates in particular, are also important structural components of cell membranes. As such, they play an important role in the ion transfer mechanism which carries nutrients into and waste materials out of cells. CSA and others are, therefore, vital to the maintenance of efficient cellular metabolism, RNA and DNA synthesis, and cell reproduction.14 The youth of each cell is largely dependent upon the presence of CSA and other mucopolysaccharides in the cell's membranes.

Dr. Morrison has conducted numerous studies into chondroitin sulfate. He maintains that chondroitin sulfate has an inhibitory effect on the development of atherosclerosis. He further claims that atherosclerosis can be reversed with CSA therapy. The plaques themselves can be reduced in size, and elasticity can be returned to arterial tissue. There are reductions in total serum lipid levels, and the tendency of the blood to clot is reduced.15 Morrison's work and the research of others has shown ten biological properties of these acid mucopolysaccharides. They are:
  1. A lipid-clearing effect in the blood.
  2. Stimulation of cellular metabolism.
  3. Increased fatty acid cellular turnover (more rapid and efficient metabolism of fatty acids.)
  4. Increase in RNA and DNA synthesis of cells.
  5. Increase in growth, size and quantity of normal cells.
  6. Anti-atherosclerosis, anti-atherogenic activities.
  7. Anti-inflammatory effect.
  8. Anti-thrombogenic and anti-coagulant activity.
  9. Increases the number of coronary artery branches and collateral circulation in experimental atherosclerosis.
  10. Accelerates healing, regeneration and repair of myocardial necrosis (tissue death) and progressive degeneration (of cardiovascular tissue in heart disease).16
Though this report focuses primarily on the relationship of chondroitin sulfates and CSA in particular to cardiovascular disease, other researchers are investigating the effects of CS therapies on arthritis and aging. The ability of CS to speed healing of bone and soft tissue wounds, its relative absence from the cartilage and bone ends of arthritic tissue, and its known functions in maintaining youthful cell metabolism suggest that supplemental CS and CSA should serve as a restorative to arthritic tissue. A supplement that provides all the primary chondroitin sulfates, A, B and C, will also go farthest in protecting the integrity of all bodily tissues from bone (on the inside) to skin (on the outside).

*Histology is the branch of anatomy that deals with the minute structure of tissues as they can be revealed by the microscope.


1,14- "Nutritional Aspects of Mucopolysaccharides" an information paper by Orville M, Miller, Ph.D. University of Southern California School of Pharmacy.

9,10,12- Nakazowa, K., and Murata, K. "Comparitive study of the effects of chondroitin sulfate isomers on artherosclerotic subjects." Zeitschrift fur Alternsforschung, 34:2, 153-159, 1979.

9,10- Morrison, Lester M., and Enrick, NL., "Coronary Heart Disease: Reduction of Death Rate by Chondroitin Sulfate A." Angiology, 1973.

15- Morrison, LM, Balwa, GS., and Ershoff, BH., "Prolongation of the Plasma Thrombus Formation Time of Dogs Administered Chondroitin Sulfates A and C," Experimental Medical Surgery, 28, 188, 193, 1970.

3- Toole, Brian P. et al., "Develpmental Roles of Hyaluronate and Chondroitin Sulfate Proteoglycans," Cell and Tissue Interactions, Raven Press, New York, 1977.

9,10,11,13,15- Morrison, Lester M., M.D, and Schleide, Arne O., Ph.D., Coronary Heart Disease and the Mucopolysaccharides (Glycosaminoglycans), Charles C. Thomas, Publisher, Springfield, Il, 1974.

15- "Chondroitin Reduces Coronary Incidents," JAMA, 213:8, 1970.

2,4,6,7,8,11,13,16- "Chondroitin Sulfates," an information article by Professor Dr. Fernando Fussi, HEPAR- CHEMIE S.A, Fribourg, Switzerland.

5- Collins, DH, and Meachim, O., "Sulfate (S35O4) Fixation by Human Articulaar Cartilage Compared in the Knee and Shoulder Joints," Annals of Rheumatic Disease, 20, 117-122, 1961.