One injection of lacosamide every four weeks prevented cartilage loss more effectively than a daily oral dose in preclinical osteoarthritis tests at Yale School of Medicine. Lacosamide is better known as an anti-seizure drug, and the Yale team is testing whether it can be repurposed for a joint disease that has no approved treatment to halt cartilage breakdown.
Chuan-Ju Liu, the Charles W. Ohse Professor of Orthopaedics and Rehabilitation at Yale and principal investigator, described osteoarthritis as a major unmet need. The work was published in Bioactive Materials (2026; volume 61, page 640), and Yale announced it on June 2, 2026, so the October write-ups are recaps of a months-old paper.
An epilepsy drug aimed at the Nav1.7 sodium channel
MedlinePlus lists lacosamide as a treatment for partial-onset seizures, taken by mouth as tablets, capsules or liquid and working by reducing abnormal electrical activity in the brain. Yale’s interest is in a sodium channel called Nav1.7. It was long considered mostly a feature of pain-signaling nerve cells, but Liu’s group reports it is also active in chondrocytes, the cells that maintain cartilage, and that its activity climbs in osteoarthritis.
In the lab, lacosamide at a low, specific concentration pushed cartilage cells toward making cartilage-building proteins and away from tissue-degrading processes, according to Yale’s news article. Doses that were too high or too low lost the benefit. The drug also appeared to trigger release of two proteins, HSP70 and midkine, that the authors say create a more supportive environment for cartilage and, in the Newswise copy of the release, support tissue repair and reduce inflammation. The narrow window matters for design: a delivery method that floods the joint would risk landing on the wrong side of the curve, while a slow-release gel is meant to hold the concentration steady for a month or longer.
A collagen II hydrogel as a local reservoir
Oral dosing circulates through the whole body and can cause side effects, which is the reason the team moved to injecting the drug into the joint. MedlinePlus names dizziness, drowsiness, blurred or double vision, and problems with coordination, balance or walking among the common effects of the tablets, and warns that anticonvulsants as a class can cause mood changes, so a depot placed in the knee changes the exposure calculation. The vehicle is a thermoresponsive hydrogel made from collagen II, a gel that stays liquid in a cool syringe and solidifies at body temperature, releasing lacosamide over several weeks. Liu called the hydrogel a local reservoir and said there is an optimal range where the drug helps restore balance without overcorrecting.
The ScienceDaily summary of the paper reports that lacosamide reduced pain and reversed cartilage damage, with the strongest effects from the hydrogel, and that a single injection every four weeks beat a daily oral dose at preventing cartilage loss.
Species, sample sizes and the human gap
The sources describe the experiments only as preclinical trials. A Newswise copy of the Yale release notes that testing began with cartilage cells and moved to comparing an injected gel with oral dosing, but neither it nor the news article names the animal models, group sizes, drug concentrations or funding. The cartilage-loss result therefore comes with no species attached in any of the summaries read for this article, and the paper’s full methods sit behind the journal.
Nothing in the summaries reports how many animals were treated, how cartilage loss was scored, or how large the gap between gel and pill was, so the four-week-injection-versus-daily-pill comparison stands as a direction rather than a measured margin.
The authors point to one human precedent: lacosamide has been tested in people with nerve-pain conditions linked to Nav1.7 mutations, which they cite as support for moving toward the clinic. That is a different condition from osteoarthritis, and no osteoarthritis trial of lacosamide in patients is described. Because the drug is already approved for seizures, the authors say the path to clinical testing could be shorter than for a new compound.
The National Institute of Arthritis and Musculoskeletal and Skin Diseases describes osteoarthritis as the most common type of arthritis, in which joint tissues break down over time, and lists exercise, weight management, braces, medications for some people and surgery as the current options, with the agency noting that risk rises with age, excess weight, past joint injury or surgery, repetitive joint use and family history, and that women are more likely than men to have it, especially after 50, and with slowing the disease as a goal rather than something a named drug reliably does. An approved drug that preserved cartilage would address that gap, and the Yale data have yet to show it in a single patient.
This article was produced with the assistance of AI and reviewed by Morning Overview editors prior to publication.
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