Synergistic proteoglycan compositions for inflammatory conditions

The invention is generally related to the treatment of inflammatory conditions. More specifically, the invention is related to compositions containing inhibitors of mast cell activation and secretion designed to be used as dietary supplement in the treatment of inflammatory conditions.

There have been a number of mostly anecdotal reports that the proteoglycan chondroitin sulfate, as well as glucosamine sulfate, a product of the intestinal breakdown of proteoglycans may be helpful in relieving the pain of osteoarthritis:--Shute N. Aching for an arthritis cure. US News and World Report, Feb. 10, 1997.--Cowley G. The arthritis cure? Newsweek, Feb. 17, 1997.--Foreman J. People, and their pets, tout arthritis remedy. The Boston Globe, Apr. 7, 1997; Tye L. Treatment gains scientific attention. The Boston Globe, Sep. 25, 2000.

A recent meta-analysis showed potential therapeutic benefit of chondroitin sulfate in osteoarthritis [McAlindon et al. J Am Med Assn. 283:1469 (2000), and NIH-funded clinical trial OD-98-003 dated Oct. 10, 1997]. However, less than 5% of the chondroitin sulfate in available preparations is absorbed orally. Furthermore, such commercial preparations use chondroitin sulfate obtained from cow trachea, with the possible danger of contracting "mad cow disease" [McAlindon et al. above]. In fact, the European Union has banned even cosmetics that contain bovine-derived products.

Theoharides et al., British Journal of Pharmacology 131:1039, (2000) indicated for the first time how proteoglycans such as chondroitin sulfate may work. The paper reported that chondroitin sulfate and, to a lesser degree, glucosamine sulfate, inhibit activation of mast cells that are known to trigger allergy and asthma. Mast cells are also now recognized as important causative intermediary in many painflul inflammatory conditions[Galli, N Eng J Med. 328:257 (1993); Theoharides, Int J Tissue Reactions 18:1 (1996)], such as insterstitial cystitis and irritable bowel syndrome [Theoharides, Ann NY Acad, Sci. 840:619 (1998)], as well as in migraines and possibly multiple sclerosis [Theoharides, Persp Biol Med. 26:672 (1983); Theoharides, Life Sci 46:607 (1996)]. In fact, glucosamine was recently considered to be prophylactic for migraines [Russell, Med Hypoth 55:195 (2000)].

Mast cells are increasingly implicated in conditions involving inflamed joints, such as in rheumatoid arthritis, through activation of local mast cells by, for example, neuropeptides. Additional indirect evidence also supports the involvement of mast cells in bone resorption: (a) systemic mastocytosis is invariably associated with osteoporosis; (b) inhibition of mast cell mediator release reversed lytic bone changes; (c) depletion of mast cells inhibited bone resorption in organ culture; (d) human synovial mast cells were shown to secrete in response to allergic and non-immunologic stimuli; (e) human mast cells release the cytokine IL-6 and (f) IL-6 has been definitively linked to bone resorption and osteoporosis.

It was recently shown that chondroitin sulfate's ability to inhibit the activation of mast cells is synergistic with the inhibitory effects on mast cell activation of another class of naturally occurring compounds, the flavonoids [Middleton et al. Pharm Rev 52:1 (2000)]. Certain plant flavones (in citrus fruit pulp, seeds, sea weed) are now recognized as anti-allergic, anti-inflammatory, anti-oxidant and cytoprotective with possible anti-cancer properties. Only some flavones, such as quercetin, inhibit mast cell activation and inflammatory cells.

Quercetin inhibits secretion from human activated mast cells [Kimata et al. Allergy30:501(2000)], and has also been used effectively for the treatment of chronic prostatitis [Shoskes et al., Urology54:960 (1999)]. Other flavonoids may have opposite effects. Use of the term "bioflavonoids" listed in certain commercial products, therefore, provides little information, and may include molecules that have detrimental effects.

Copending U.S. patent application Ser. No. 09/056,707, filed Apr. 8, 1998, claims the use of proteoglycans, without and with flavonoids, for the treatment of mast cell activation-induced diseases. The information contained therein is incorporated by reference into the present application.

An important need therefore exists for dietary formulations suitable for human patients that are synergistic in that they have stronger effects than the sum of the effects of the individual components, and also synergistic with standard clinical treatments of inflammatory conditions, such as osteoarthritis. "Synergistic" is intended to mean: "coordinated or correlated action by two or more structures or drugs" [Stedman's Medical Dictionary,23rd edition, Williams & Wilkins, Baltimore, 1976]. Such formulations have been discovered, and are described below.

SUMMARY OF THE INVENTION

The invention comprises compositions for human use containing a sulfated proteoglycan and one or more active ingredients selected from the group consisting of a sulfated hexosamine, a flavonoid compound ("flavone"), an organic virgin kernel seed olive oil, S-adenosylmethionine and diphenhydramine, together with appropriate excipients and carriers, said compositions having improved absorptivity from the gastrointestinal tract and anti-inflammatory effects synergistic with each other and synergistic with standard clinical treatment modalities.

In one embodiment, the proteoglycan is non-bovine chondroitin sulfate, the sulfated hexosamine is D-glucosamine sulfate, the flavone is quercetin, and the kernel seed olive oil is extra virgin (first pressing, no heat, no refining)).

In another embodiment, the compositions are enriched with omega fatty acids and alpha tocopherol.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS OF THE INVENTION

It has been discovered that a combination of a sulfated proteoglycan, a sulfated D-hexoseamine and a flavone, along with an organic extra virgin kernel seed olive oil, has synergistic anti-inflammatory effects when used as a dietary supplement, without or with a conventional clinical treatment for inflammatory diseases. Such inflammatory diseases result from the activation, degranulation and consequent secretion of inflammatory biochemicals from mast cells, and the resultant inflammatory diseases include the group consisting of: osteoarthritis, cancer, fibromyalgia, inflammatory bowel disease, interstitial cystitis, irritable bowel syndrome, migraines, angina, chronic prostatitis, eczema, arthritis, multiple sclerosis, psoriasis, sun burn, and periodontal disease of the gums.

In a highly preferred embodiment, the sulfated proteoglycan is non-bovine chondroitin sulfate which blocks mast cell activation, degranulation and consequent secretion of inflammatory biochemicals from the mast cells. Other natural sulfated proteoglycans suitable for practicing this invention include keratan sulfate, dermatan sulfate and hyaluronic acid. The preferred biological source of the chondroitin sulfate is shark cartilage which is more-highly sulfated than the standard commercial chondroitin sulfate isolated from cow trachea.

The highly preferred flavone is quercetin which inhibits secretion of inflammatory molecules from mast cells by affecting moesin, a unique 78 kDa mast cell protein [Theoharides et al. J Pharm Exp Therap 294:810 (2000)]. In addition to quercetin, other flavones suitable in carrying out the invention include myrisetin, genistein and kaempferol.

The olive oil component of the inventive compositions is preferably an organic (no artificial fertilizers, no pesticides, no insectisides) extra virgin (first pressing, no heat, not refined) kernel seed olive oil produced on the island of Crete in Greece. This olive oil increases absorption of the other ingredients of the anti-inflammatory compositions, and also adds its own content of important anti-oxidants [Bosku, World Rev Nutr Diet, 87:56 (2000)], such as omega fatty acids and alpha tocopherol. Although not claimed herein, it has been claimed that kernel seed olive oil has cytoprotective, longevity-producing effects [Trichopoulou et al. Am J Clin Nutr 61:1346S (1995); Trichopoulou et al, Cancer Epid Biomarker Prevention 9:869 (2000)]. A source of the highly preferred extra virgin kernel seed olive oil is: E.B.E.K., Inc., Commercial, Industrial Enterprises of Crete, 118 Ethnikis Antistasecos, Heraklion, Crete, 71306, Greece.

Supplementation of the compositions described above with the methylation reagent S-adenosylmethionine ("SAM") adds antioxidant, anti-inflammatory and cytoprotective properties, particularly in inflammatory joint diseases. Another supplement to the basic compositions of the invention is diphenhydramine.

The preferred concentration range of the proteoglycan, hexosamine sulfate and flavone components of the oral formulations are 10-3,000 mg per tablet or capsule. The preferred concentration range for S-adenosylmethionine is 3-1,000 mg per capsule or tablet. Generally, where present, the amounts of the olive oil are at least three times those of the other active ingredients. The number of capsules or tablets to be taken per day is determined by the nature and severity of the medical condition, and is readily determinable by the patient's physician. Other representative formulations are described in the examples below.

The compositions of the invention may be formulated in any standard means of introducing pharmaceuticals parenterally into a patient, e.g., by means of tablets or capsules. The compositions of the invention include salves and creams for skin conditions, and mouth washes and toothpaste for periodontal diseases. Standard excipients and carriers for the active ingredients of the inventive compositions are described in Remington's Pharmaceutical Sciences, Mack Publishing Co., Easton, Pa.

Although not bound by any particular mechanism of action of the components of the claimed compositions, the inventor contemplates that the proteoglycan inhibits the activation and degranulation of the relevant mast cells, while the flavone inhibits the secretion of inflammatory biomolecules from these mast cells. "Activation" and "degranulation" of mast cells are defined herein as is standard and well known in this art.

EXAMPLES

Example 1

Table 1 compares chondroitin sulfate-containing commercial products to the present compositions.

TABLE-US-00001 TABLE 1 Comparison of Chondroitin Sulfate-Containing Products to Present Invention Most Available Product Compositions Present Invention Main ingredient Mixture of chondroitin Chondroitin sulfate C sulfates Source Cow trachea Shark cartilage Amount per capsule 150 mg 10-3000 mg or tablet Degree of sulfation Low High Absorption from g.i. <5% >15% tract Target Unknown Mast cells, bone cells Other ingredients Vitamins, fish oils Flavones, omega-fatty (some preparations) acids, alpha-tocopherol, kernel olive seed oil, SAM Advantages None known Anti-allergic, anti- inflammatory, anti-oxidant, cytoprotective Adverse effects Risk of mad cow None known disease, stomach upset, allergy to fish products Relevant conditions Osteoarthritis Angina, arthritis, chronic prostatitis, eczema, fibromyalgia, interstitial cystitis, irritable bowel syndrome, inflammatory bowel disease, migraines multiple sclerosis, psoriasis, periodontal disease. Scientific None found Theoharides et al. Br J publications Pharm 131:1039 (2000) Middleton et al. Pharm Rev 52:673 (2000)

Example 2

Composition of Formulation One (ALGONOT-PLUS, Registered Mark)

Dietary Supplement

Two capsules to be taken twice daily, at least one hour before meals

TABLE-US-00002 Active ingredients: Chondroitin sulfate 300 mg D-Glucosamine sulfate 300 mg Quercetin 300 mg extra virgin kernel 900 mg seed olive oil

Hypo-allergenic, free from: artificial colors or flavors, corn, milk products, preservatives, salt, starch, sugar, wheat or yeast.

Example 3

Composition of Formulation Two (ALGONOT-PREVENT, Registered Mark)

Dietary Supplement

Two capsules to be taken twice daily, one hour before meals

TABLE-US-00003 Active Ingredients Chondroitin sulfate 300 mg Glucosamine sulfate 300 mg Quercetin 300 mg S-adenosylmethionine 100 mg extra virgin kernel seed 900 mg olive oil

Hypo-allergenic. Free from: artificial colors or flavors, corn, milk products, preservatives, salt, starch, sugar, wheat or yeast.

Example 4

Composition of Formulation Three (ALGONOT-PROTECT, Reg. Mark)

Skin ointment or cream. Apply three times per day to affected areas.

TABLE-US-00004 Active Ingredient % by weight Condroitin sulfate 5 Quercetin 3 Extra virgin kernel seed olive oil 15

Example 5

Composition of Formulation Four (ALGONOT-ALLERGY, Reg. Mark)

Formulation Three plus diphenhydramine, 5% by weight.

Example 6

Composition of Formulation Five (ALGONOT-PERIO)

Mouth Wash

Chondroitin sulfate, 0.4 M

Optionally: D-glucosamine sulfate, 0.4M; quercetin, 0.3M; SAM 0.15M

In a standard mouth wash vehicle.

Example 7

Composition of Formulation Six (ALGONOT-DENTAL)

TABLE-US-00005 Tooth paste mg % *Chondroitin sulfate 5 *Quercetin 3 *In a standard tooth paste vehicle

Example 8

Composition of Formulation Seven (ALGONOT-SUNSCREEN)

TABLE-US-00006 Active ingredients mg % Chondroitin sulfate 5 Quercetin 3 Sun screen (e.g., TiO2) 5