U.S. patent application number 15/900533 was filed with the patent office on 2018-07-12 for compounds and compositions for the treatment of muscular disorders and bone disorders.
This patent application is currently assigned to Cardero Therapeutics, Inc.. The applicant listed for this patent is Cardero Therapeutics, Inc.. Invention is credited to Guillermo CEBALLOS, Sundeep DUGAR, George F. SCHREINER.
Application Number | 20180193306 15/900533 |
Document ID | / |
Family ID | 62782053 |
Filed Date | 2018-07-12 |
United States Patent
Application |
20180193306 |
Kind Code |
A1 |
SCHREINER; George F. ; et
al. |
July 12, 2018 |
COMPOUNDS AND COMPOSITIONS FOR THE TREATMENT OF MUSCULAR DISORDERS
AND BONE DISORDERS
Abstract
The present invention relates to compounds and compositions and
their applications as pharmaceuticals for treating, preventing, or
reversing injury to skeletal or cardiac muscles, for treating or
preventing diseases relating to the structure and function of
skeletal or cardiac muscle, and for inducing regeneration or
restructuring of skeletal or cardiac muscle as a means of treating
diseases relating to abnormalities in skeletal or cardiac muscle
structure and function in a human or animal subject. Further
aspects relate to the same or similar applications for bone and
bone diseases.
Inventors: |
SCHREINER; George F.;
(Sunnyvale, CA) ; CEBALLOS; Guillermo; (Sunnyvale,
CA) ; DUGAR; Sundeep; (San Jose, CA) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
Cardero Therapeutics, Inc. |
Sunnyvale |
CA |
US |
|
|
Assignee: |
Cardero Therapeutics, Inc.
Sunnyvale
CA
|
Family ID: |
62782053 |
Appl. No.: |
15/900533 |
Filed: |
February 20, 2018 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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14387117 |
Sep 22, 2014 |
9901564 |
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PCT/US2013/033555 |
Mar 22, 2013 |
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15900533 |
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61614721 |
Mar 23, 2012 |
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Current U.S.
Class: |
1/1 |
Current CPC
Class: |
A61K 31/353 20130101;
A61P 21/00 20180101; A61P 19/08 20180101 |
International
Class: |
A61K 31/353 20060101
A61K031/353; A61P 21/00 20060101 A61P021/00; A61P 19/08 20060101
A61P019/08 |
Claims
1. A method to induce increased cellular or muscular or bodily
production of follistatin and follistatin-like proteins in order to
reverse or ameliorate injury to, or weakness of, or loss of, bone,
or to prevent fractures, in a subject in need thereof, comprising
administering to a subject a therapeutically effective dose of
(+)-epicatechin and/or (-)-epicatechin or an epicatechin derivative
of either (+)-epicatechin or (-)-epicatechin
2. The method of claim 1 wherein the (+)-epicatechin and/or
(-)-epicatechin or an epicatechin derivative is administered orally
or intravenously or intramuscularly, at 5 mg to 2 grams per day, in
a single dose or in divided doses.
3. The method of claim 1 wherein the (+)-epicatechin and/or the
(-)-epicatechin or an epicatechin derivative is administered at a
dose between 0.1 mg/kg of bodyweight per day to 10 mg/kg of
bodyweight per day, orally or intravenously or intramuscularly, in
a single dose or in divided doses.
4. The method of claim 1 wherein the method induces new bone
formation or additional bone formation or stronger bone formation
or regeneration of bone in order to prevent bone fractures.
5. A method to induce the increased cellular or muscular or bodily
production of follistatin and follistatin-like proteins in order to
reverse or ameliorate weakness of bone, thus preventing bone
fractures, caused by administration of compounds known to induce
weakness of or damage to bone, impairment of bone generation, or
impairment of bone growth, including but not limited to
corticosteroids such as prednisone, or deflazacort, anticonvulsants
such as phenytoin and phenobarbital, chemotherapeutics such as
aromatase inhibitors, and progestins.
6. A method to induce the increased cellular or muscular or bodily
production of follistatin or follistatin-like proteins in order to
reverse or ameliorate weakness of bone strength, thus preventing
bone fractures, associated with genetic predisposition, aging,
inactive lifestyle, or low estrogen states such as menopause or
post oophorectomy.
7. A method to induce the increased cellular or muscular or bodily
production of follistatin or follistatin-like proteins in order to
reverse or ameliorate weakness of bone caused by medical conditions
known to be associated with weakness of, or damage to, bone,
impairment of bone generation, or impairment of bone growth, such
as celiac disease, kidney or liver disease, and inflammatory
diseases such as systemic lupus erythematosus and rheumatoid
arthritis.
8. A method to induce the increased cellular or muscular or bodily
production of follistatin or follistatin-like proteins in order to
reverse or ameliorate weakness of bone in conjunction with the
administration of other agents used to treat osteoporosis including
calcium, Vitamin D, and calcitonin, in order to prevent bone
fractures.
9. A method to induce increased cellular or muscular or bodily
production of follistatin or follistatin-like proteins as a
therapeutic to accelerate the healing of bone fractures or to
increase the degree of recovery from a bone fracture, such as those
experienced in accidents, athletics, or combat.
10. A method to induce increased cellular or muscular or bodily
production of follistatin or follistatin-like proteins in order to
prevent systemic loss of bone density, and thus prevent subsequent
bone fractures, during the recovery period after orthopedic surgery
or after the onset of a disease or condition necessitating long
periods of bed rest or physical inactivity, which are known to
result in decreased bone density and muscle weakness.
11. The method of claim 4 wherein the (+)-epicatechin and/or
(-)-epicatechin or an epicatechin derivative is administered orally
or intravenously or intramuscularly, at 5 mg to 2 grams per day, in
a single dose or in divided doses.
12. The method of claim 5 wherein the (+)-epicatechin and/or
(-)-epicatechin or an epicatechin derivative is administered orally
or intravenously or intramuscularly, at 5 mg to 2 grams per day, in
a single dose or in divided doses.
13. The method of claim 6 wherein the (+)-epicatechin and/or
(-)-epicatechin or an epicatechin derivative is administered orally
or intravenously or intramuscularly, at 5 mg to 2 grams per day, in
a single dose or in divided doses.
14. The method of claim 7 wherein the (+)-epicatechin and/or
(-)-epicatechin or an epicatechin derivative is administered orally
or intravenously or intramuscularly, at 5 mg to 2 grams per day, in
a single dose or in divided doses.
15. The method of claim 8 wherein the (+)-epicatechin and/or
(-)-epicatechin or an epicatechin derivative is administered orally
or intravenously or intramuscularly, at 5 mg to 2 grams per day, in
a single dose or in divided doses.
16. The method of claim 9 wherein the (+)-epicatechin and/or
(-)-epicatechin or an epicatechin derivative is administered orally
or intravenously or intramuscularly, at 5 mg to 2 grams per day, in
a single dose or in divided doses.
17. The method of claim 10 wherein the (+)-epicatechin and/or
(-)-epicatechin or an epicatechin derivative is administered orally
or intravenously or intramuscularly, at 5 mg to 2 grams per day, in
a single dose or in divided doses.
Description
[0001] This application is a continuation-in-part application of
U.S. application Ser. No. 14/387,117, filed Sep. 22, 2014, which is
the national stage filing of PCT/US2013/033555, filed Mar. 22,
2013, and claims the benefit of U.S. Provisional Application No.
61/614,721, filed Mar. 23, 2012, the disclosures of which are
hereby incorporated by reference as if written herein in their
entireties.
[0002] Disclosed herein are compounds and compositions and their
application as pharmaceuticals for treating, preventing, or
reversing injury to skeletal or cardiac muscles, for treating or
preventing diseases relating to the structure and function of
skeletal or cardiac muscle, and for inducing regeneration or
restructuring of skeletal or cardiac muscle as a means of treating
diseases relating to abnormalities in skeletal or cardiac muscle
structure and function in a human or animal subject. Also disclosed
herein are methods for diagnosing injury to skeletal or cardiac
muscle and for diagnosing the success or failure of therapeutics
designed to treat, prevent, or reverse injury to skeletal muscle or
cardiac muscle.
[0003] Strength and endurance of skeletal muscle is essential for
gripping, carrying, walking, running, carrying or enabling numerous
functions of everyday life. Strength and endurance of cardiac
muscle is essential for the optimum delivery of oxygen and
nutrients to all tissues containing blood vessels and for the
carrying away of waste products of cell metabolism. Injury to
skeletal or cardiac muscle or diseases relating to abnormal
structure or function of skeletal or cardiac muscle can make normal
activities of everyday life difficult or impossible.
[0004] Further, injury to, or weakness of, skeletal muscle
generally results in a loss of bone density in the bones to which
that muscle is attached. In the case of generalized muscle
weakness, reduction in bone density can be generalized, one of the
causes of the bone disease known as osteoporosis.
[0005] Injury to skeletal or cardiac muscle can occur as a result
of genetic mutations in proteins critical to the structure and
function of skeletal muscle or cardiac muscle, inadequate or
interrupted blood flow, inactivity due to joint injury or
inflammation, as is seen with arthritis, excessive exposure to
oxidation injury as a result of defective cell metabolism or
inadequate blood flow, exposure to toxic organic or inorganic
substances such as elevated glucose, heavy metals, or inflammatory
products, trauma due to injury or excessive activity, or exposure
to certain medications such as statins, corticosteroids, or
chemotherapy, among other causes. Examples of inflammatory diseases
associated with muscle disorders include polymyositis, polymyalgia
rheumatic a, and systemic lupus erythematosus.
[0006] Injury to skeletal muscle and consequent weakness or atrophy
can occur as a result of injury or disorders of the neurons
subserving muscle function. Appropriate innervation is essential to
skeletal muscle health and function. Neurodegenerative diseases
amenable to treatment with agents stimulating muscle strength and
neuromuscular health include amyotrophic lateral sclerosis (ALS),
Parkinson's disease, Huntington's disease, spinal cord injury or
abnormality, and peripheral and central neuropathies.
[0007] Currently therapies emphasize prevention, such as use of
stents to improve blood flow through areas of vascular narrowing.
There are general supportive interventions to help the muscle
repair itself, such as the nutritional provision of muscle protein
precursors such as amino acids or creatine. Current therapies may
address the underlying disorder associated with cardiac or skeletal
muscle dysfunction without directly treating the muscle cells
themselves. The only accepted therapy directed at the muscles
themselves is exercise. It has been demonstrated that regular,
moderate activation of muscle cells can improve the structure and
function of cardiac and skeletal muscle cells. However, this is
often inadequate in restoring muscle cell health or function.
[0008] Complicating the potential therapies is the fact that
neither skeletal muscle nor cardiac muscle cells are capable of
sufficient proliferation in order to replace muscle cells
previously damaged or destroyed. There may be some limited capacity
of stem cells to proliferate but this is not generally sufficient
to regenerate functionally significant replacement muscle. Skeletal
muscle is known to contain primitive satellite cells, which can
activate, enlarge, and differentiate into skeletal muscle tissue.
The role of satellite cells in replacing cardiac cells is currently
not well understood. Repair of muscles is enhanced by muscle
cellular expression of folistatin, which allows for activation and
differentiation of muscle precursor cells into mature,
differentiated skeletal muscle cells. Repair of muscle cells or
generation of new, differentiated muscle cells is inhibited by the
expression of a negative regulatory factor known as myostatin.
[0009] Disclosed herein are methods for prophylactic and/or
therapeutic treatment of skeletal or cardiac muscle dysfunction,
injury, or diseases in a patient by administering epicatechin, an
epicatechin derivative, a pharmaceutically acceptable salt or
prodrug thereof, or combinations thereof. The methods and
compositions described herein can assist in prevention of impaired
skeletal and cardiac muscle function, recovery of skeletal or
cardiac muscle health or function, or functionally significant
regeneration of skeletal or cardiac muscle cells or function.
[0010] In certain embodiments, the present invention comprises
administering a compound or composition disclosed herein in an
amount effective to stimulate function, recovery, or regeneration
of skeletal or cardiac muscle cells. Stimulation of muscle cell
function, recovery, or regeneration may comprise increased
expression of one or more of proteins having contractile,
regulatory, transcriptional, or attachment functions. Stimulation
of muscle cell function, recovery, or regeneration may comprise
increased mitochondrial number and function. In certain
embodiments, the compound or composition comprises a
therapeutically effective amount of epicatechin, either (+) or (-)
enantiomers or a combination of both, an epicatechin derivative, or
a pharmaceutically acceptable salt or prodrug thereof.
[0011] In further embodiments, the present invention provides
methods and compositions for preventing or treating adverse events
or diseases associated with impaired skeletal muscle or cardiac
muscle cell number or function. The methods comprise administering
to a subject in need thereof one or more compounds or compositions
disclosed herein. In further embodiments the method reduces
symptoms of impaired skeletal or cardiac muscle cell number or
function. In certain embodiments, the method comprises
administering, or the composition comprises, a therapeutically
effective amount of epicatechin, either (+) or (-) enantiomers or a
combination of both, an epicatechin derivative, or a
pharmaceutically acceptable salt or prodrug thereof.
[0012] In certain embodiments, disclosed herein are methods and
compositions for the treatment of diseases associated with loss of
number, function, or correct, optimally efficient internal
organization of skeletal muscle cells or cardiac muscle cells. In
certain embodiments, the method comprises administering, or the
composition comprises, a therapeutically effective amount of
epicatechin, either (+) or (-) enantiomers or a combination of
both, an epicatechin derivative, or a pharmaceutically acceptable
salt or prodrug thereof.
[0013] In further embodiments, disclosed herein are methods and
compositions for the treatment of impaired skeletal or cardiac
muscle function due to aging, obesity, disuse or inactivity,
exposure to potentially toxic nutritional agents such as fructose,
or exposure to inadequate nutrition such as starvation or
malnutrition. In certain embodiments, the method comprises
administering, or the composition comprises, a therapeutically
effective amount of epicatechin, either (+) or (-) enantiomers or a
combination of both, an epicatechin derivative, or a
pharmaceutically acceptable salt or prodrug thereof.
[0014] In further embodiments, disclosed herein are methods and
compositions for the treatment of muscle-related side effects of
athletic training or competition including soreness, cramping,
weakness, pain, or injury. In certain embodiments, the method
comprises administering, or the composition comprises, a
therapeutically effective amount of epicatechin, either (+) or (-)
enantiomers or a combination of both, an epicatechin derivative, or
a pharmaceutically acceptable salt or prodrug thereof.
[0015] In further embodiments, disclosed herein are methods and
compositions for the treatment of skeletal or cardiac muscle
diseases associated with ischemia, or impaired or inadequate blood
flow. Examples of such states include, but are not limited to,
atherosclerosis, trauma, diabetes, vascular stenosis, peripheral
arterial disease, vasculopathy, and vasculitis. In certain
embodiments, the method comprises administering, or the composition
comprises, a therapeutically effective amount of epicatechin,
either (+) or (-) enantiomers or a combination of both, an
epicatechin derivative, or a pharmaceutically acceptable salt or
prodrug thereof.
[0016] In further embodiments, disclosed herein are methods and
compositions for the treatment of diseases associated with genetic
disorders that directly or indirectly affect the number, structure,
or function of cardiac muscle cells or skeletal muscle cells.
Examples of such states include, but are not limited to, the set of
diseases broadly classified as muscular dystrophies and
Friedreich's ataxia. In certain embodiments, the method comprises
administering, or the composition comprises, a therapeutically
effective amount of epicatechin, either (+) or (-) enantiomers or a
combination of both, an epicatechin derivative, or a
pharmaceutically acceptable salt or prodrug thereof.
[0017] In further embodiments, disclosed herein are methods and
compositions for the therapeutic treatment of diseases associated
with impaired neurological control of muscular activity resulting
in consequent abnormalities in structure and function of skeletal
muscles due to inactivity, aberrant contractility, or contracted
states. These include, but are not limited to, states associated
with absent, diminished, or abnormal neurological activity
including peripheral denervation syndromes, trauma, amyotrophic
lateral sclerosis, meningitis, and structural abnormalities of the
spine, whether congenital or acquired. In certain embodiments, the
method comprises administering, or the composition comprises, a
therapeutically effective amount of epicatechin, either (+) or (-)
enantiomers or a combination of both, an epicatechin derivative, or
a pharmaceutically acceptable salt or prodrug thereof.
[0018] In certain embodiments, disclosed herein are methods and
compositions for the treatment of diseases associated with loss of
number, loss of function, or loss of correct, optimally efficient
internal organization of skeletal muscle cells or cardiac muscle
cells. Such diseases may eventuate in a state of functionally
significant muscle wasting, which, in its most pronounced form, is
termed sarcopenia. Sarcopenia may be secondary to a variety of
disorders, including aging, diabetes or other abnormal metabolic
conditions, infection, inflammation, autoimmune disease, cardiac
dysfunction, or severe disuse syndromes or inactivity associated
with arthritis. Examples of such diseases include, but are not
limited to, congestive heart failure, aging, myocarditis, myositis,
polymyalgia rheumatic, polymyositis, HIV, cancer and/or the side
effects of chemotherapy targeting the cancer, malnutrition, aging,
inborn errors of metabolism, trauma, and stroke or other types of
neurological impairment. In certain embodiments, the method
comprises administering, or the composition comprises, a
therapeutically effective amount of epicatechin, either (+) or (-)
enantiomers or a combination of both, an epicatechin derivative, or
a pharmaceutically acceptable salt or prodrug thereof.
[0019] In certain embodiments, disclosed herein are methods and
compositions for use in combination with exercise or programmatic
sequences or intensities of exercise to optimize methods for the
prophylactic or therapeutic treatment of diseases or disorders
associated with loss of number, loss of function, or loss of
correct, optimally efficient internal organization of skeletal
muscle or cardiac muscle cells. In certain embodiments, the method
comprises administering, or the composition comprises, a
therapeutically effective amount of epicatechin, either (+) or (-)
enantiomers or a combination of both, an epicatechin derivative, or
a pharmaceutically acceptable salt or prodrug thereof.
[0020] In certain embodiments, disclosed herein are methods and
compositions for use to enhance sports performance and endurance,
to build muscle shape and strength, and to facilitate recovery from
the muscle related side effects of training or competition, such as
soreness, weakness, cramping, pain, or injury. In certain
embodiments, the method comprises administering, or the composition
comprises, a therapeutically effective amount of epicatechin,
either (+) or (-) enantiomers or a combination of both, an
epicatechin derivative, or a pharmaceutically acceptable salt or
prodrug thereof.
[0021] In certain embodiments, disclosed herein are methods and
compositions for use to prevent, ameliorate, or reverse muscle
injury, weakness, or pain associated with the administration of
certain medicines, including, but not limited to, corticosteroids
such as prednisone, methyl prednisone, or halogenated derivatives
thereof, chemotherapeutics such as doxorubicin or methotrexate, and
inhibitors of HMG co-reductase, known as statins, that are
frequently associated with muscle disorders or myopathy, including:
Advicor''' (niacin extended-release/lovastatin), Altoprev'''
(lovastatin extended-release), Caduet''' (amlodipine and
atorvastatin), Crestor''' (rosuvastatin), Juvisync'''
(sitagliptin/simvastatin), Lescol''' (fluvastatin), Lescol XL
(fluvastatin extended-release), Lipitor''' (atorvastatin),
Compactin (mevastatin), Livalo.RTM. (pitavastatin), Mevacor'''
(lovastatin), Pravachol''' (pravastatin), Simcor''' (niacin
extended-release/simvastatin), Vytorin''' (ezetimibe/simvastatin),
and Zocor'' (simvastatin). In certain embodiments, the method
comprises administering, or the composition comprises, a
therapeutically effective amount of epicatechin, either (+) or (-)
enantiomers or a combination of both, an epicatechin derivative, or
a pharmaceutically acceptable salt or prodrug thereof.
[0022] In certain embodiments, disclosed herein are methods and
compositions for use to prevent, ameliorate, or reverse muscle
injury associated with medicines that damage mitochondria and/or
cause myopathy as a secondary consequence.
[0023] In certain embodiments, a subject is selected for treatment
with a compound or composition disclosed herein based on the
occurrence of one or more physiological manifestations of skeletal
or cardiac muscle injury or dysfunction in the subject. Such
manifestations include elevations in biomarkers known to be related
to injury of the heart or skeletal muscle. Examples of such
biomarkers include, but are not limited to, elevated plasma levels
of cardiac or skeletal muscle enzymes or proteins, such as
myoglobin, troponin, or creatine phosphokinase, lactic acidosis,
and elevated serum creatinine.
[0024] In certain embodiment, a compound or composition as
disclosed herein is administered in an amount which stimulates
increased number or function of skeletal muscle cells or
contractile muscle cells. Such stimulation of muscle cells may
comprise stimulation of one or more aspects of muscle cell
function, including cell division, muscle cell regeneration,
activation of muscle satellite cells and their differentiation into
adult muscle cells, recovery from injury, increased number or
function of mitochondria or processes serving mitochondrial
function, increased expression of proteins contributing to
contractility, regulation of biochemical or translational
processes, mitoses, or transduction of mechanical energy via
dystrophin or other attachment processes. The methods and
compositions described herein can assist in prevention of the
consequences of muscle injury or dysfunction which have not yet
occurred, as well as provide for the active therapy of muscle
injury, dysfunction, or diseases which have already occurred.
[0025] In certain embodiments, disclosed herein are methods to
utilize the muscle proteins whose expression is stimulated by
administration of compounds or compositions disclosed herein as
diagnostic biomarkers by which to determine the time and degree of
muscle response to the therapeutic methods and compositions
disclosed herein. Such biomarkers may be determined by measuring in
tissue, plasma, blood, or urine the proteins themselves or the DNA
or RNA nucleotides that encode for the proteins. In one embodiment,
a decrease in the body of useful muscle proteins, such as
dystrophin, or the presence of inhibitory proteins, such as
thromobospondin, may be used to diagnose the severity of the
abnormality of cardiac muscle structure or function or the
probability of response to the therapeutic methods and compositions
described herein. In another embodiment, changes in the levels of
such biomarkers may be used to gauge the success or failure of
certain therapeutic modalities, including those disclosed herein,
in order to optimize the dose and to decide whether to maintain or
change therapeutic methods and compositions.
[0026] In another embodiment, an increase in the plasma
concentration of follistatin, or a decrease in myostatin, or an
increase in the ratio of plasma follistatin to plasma myostatin,
may be used as a diagnostic method to diagnose the degree of
severity of a muscle disorder or the extent of response to
therapy.
[0027] In certain embodiments, the methods disclosed herein
comprise the administration to cells at least 0.1) IM epicatechin
or an epicatechin derivative, at least 0.25)IM epicatechin or an
epicatechin derivative, at least 0.5) IM epicatechin or an
epicatechin derivative, and at least 1) IM epicatechin or an
epicatechin derivative.
[0028] In further embodiments, the methods disclosed herein
comprise the administration of compounds of the disclosure in a
total daily dose of about 0.1 mg/kg/dose to about 100 mg/kg/dose,
alternately from about 0.3 mg/kg/dose to about 30 mg/kg/dose. In
another embodiment the dose range is from about 0.5 to about 10
mg/kg/day. Alternately about 0.5 to about 1 mg/kg/day is
administered. Generally between about 25 mg and about 1 gram per
day can be administered; alternately between about 25 mg and about
200 mg can be administered. The dose may be administered in as many
divided doses as is convenient.
[0029] In further embodiments, the methods disclosed herein
comprise the administration of epicatechin, an epicatechin
derivative, or a mixture thereof in a range of about 1 to about
1000 mg per kg body weight, about 1 to about 50 mg per kg body
weight, or about 10 to about 100 mg per kg body weight of said
subject.
[0030] In further embodiments, the desired concentration is
maintained for at least 30 minutes, 1 hour, 3 hours, 6 hours, 12
hours, 24 hours, 48 hours, 72 hours, or more. In yet further
embodiments, the desired concentration is achieved at least once
during each 12-hour period over at least 24 hours, 48 hours, 72
hours, 1 week, one month, or more; or at least once during each
24-hour period over at least 48 hours, 72 hours, 1 week, one month,
or more. In order to maintain a desired concentration for a desired
time, multiple doses of one or more compounds may be employed. The
dosing interval may be determined based on the clearance half-life
for each compound of interest from the body.
[0031] In certain embodiments, the epicatechin or epicatechin
derivative administered in a method disclosed herein is at least
90% pure relative to other compounds selected from the group
consisting of epicatechin, an epicatechin derivative, catechin, or
a catechin derivative. For example, if the compound is epicatechin,
it contains no more than 10% contamination with epicatechin
derivatives, catechin, and catechin derivatives. In further
embodiments the selected epicatechin or epicatechin derivative is
at least 95% pure relative to other compounds selected from the
group consisting of epicatechin, an epicatechin derivative,
catechin, or a catechin derivative. It is noted that this does not
exclude combination with an additional therapeutic agent in
substantial concentration.
[0032] In further embodiments, said epicatechin is
(-)-epicatechin.
[0033] In further embodiments, said epicatechin is
(+)-epicatechin.
[0034] In further embodiments, said epicatechin is a racemic
mixture of (-)-epicatechin and (+)-epicatechin.
[0035] Also disclosed herein is a novel class of compounds that are
the only known agents that, when administered, induce the
production of circulating follistatin in the body of animals and
humans. Follistatin and its closely homologous (80% sequence
homology) family of follistatin-like proteins are produced by
numerous cell types in the body, including muscle cells and bone
cells. Follistatin is known to induce muscle regeneration in
various disease states. Follistatin-like protein 3 has recently
been shown to stimulate bone regeneration and increase mechanical
bone strength in exercise. See J Nam et. Al. Follistatin-like 3 is
a mediator of exercise-driven bone formation and strengthening.
Bone 2015 78:62-70 doi:10.1016/j.bone.2015.04.038. Exercise, which
strengthens both muscle and bone, induces increased plasma levels
of follistatin and its related, follistatin-like proteins. See
Hansen J et al. Exercise induces a marked increase in plasma
follistatin: evidence that follistatin is a contraction-induced
hepatokine. 2011 Endocrinology 152:164-171 Pub Med 21068158.
Animals lacking follistatin display weak skeletal bone formation
and profound muscle weakness. See Matzuk, M M et al. Multiple
defects and perinatal death in mice deficient in follistatin.
Nature 1995 374:360-3. PubMed 7885475. Production of extracellular
matrix and its mineralization are the essential components of new
bone formation by osteoblasts. Follistatin stimulates both
activities in cultures of human osteoblasts. See Eijken et al, The
activin A-follistatin system: potent regulator of human
extracellular matrix mineralization Faseb J 2007 21:2949-60. During
the healing of bone fractures, the expression of follistatin and
its receptors are strongly increased in the periosteum near the
ends of the bone fractures, indicating that follistatin is
contributing to the formation and remodeling of bone during
fracture healing. See Nagame T et al Immunochemical detection of
activin A, follistatin, and activin receptors during fracture
healing in the rat J Orthop Res 1998 16:314-21. Thus any agent that
stimulates follistatin production should be therapeutic in the
context of the numerous diseases, conditions, drug side effects,
and genetic defects that contribute to the development of
osteoporosis and its attendant increased risk of bone
fractures.
[0036] Some embodiments relate to a method to induce increased
cellular or muscular or bodily production of follistatin and
follistatin-like proteins in order to reverse or ameliorate injury
to, or weakness of, or loss of, bone, or to prevent fractures, in a
subject in need thereof, comprising administering to a subject a
therapeutically effective dose of (+)-epicatechin and/or
(-)-epicatechin or an epicatechin derivative of either
(+)-epicatechin or (-)-epicatechin. In further embodiments, the
(+)-epicatechin and/or (-)-epicatechin or an epicatechin derivative
is administered orally or intravenously or intramuscularly, at 5 mg
to 2 grams per day, in a single dose or in divided doses. In other
embodiments, the (+)-epicatechin and/or the (-)-epicatechin or an
epicatechin derivative is administered at a dose between 0.1 mg/kg
of bodyweight per day to 10 mg/kg of bodyweight per day, orally or
intravenously or intramuscularly, in a single dose or in divided
doses. In still other embodiments, the method induces new bone
formation or additional bone formation or stronger bone formation
or regeneration of bone in order to prevent bone fractures.
[0037] Additional embodiments disclosed herein relate to a method
to induce the increased cellular or muscular or bodily production
of follistatin and follistatin-like proteins in order to reverse or
ameliorate weakness of bone, thus preventing bone fractures, caused
by administration of compounds known to induce weakness of or
damage to bone, impairment of bone generation, or impairment of
bone growth, including but not limited to corticosteroids such as
prednisone, or deflazacort, anticonvulsants such as phenytoin and
phenobarbital, chemotherapeutics such as aromatase inhibitors, and
progestins. Further method aspects relate to a to induce the
increased cellular or muscular or bodily production of follistatin
or follistatin-like proteins in order to reverse or ameliorate
weakness of bone strength, thus preventing bone fractures,
associated with genetic predisposition, aging, inactive lifestyle,
or low estrogen states such as menopause or post oophorectomy; a
method to induce the increased cellular or muscular or bodily
production of follistatin or follistatin-like proteins in order to
reverse or ameliorate weakness of bone caused by medical conditions
known to be associated with weakness of, or damage to, bone,
impairment of bone generation, or impairment of bone growth, such
as celiac disease, kidney or liver disease, and inflammatory
diseases such as systemic lupus erythematosus and rheumatoid
arthritis; a method to induce the increased cellular or muscular or
bodily production of follistatin or follistatin-like proteins in
order to reverse or ameliorate weakness of bone in conjunction with
the administration of other agents used to treat osteoporosis
including calcium, Vitamin D, and calcitonin, in order to prevent
bone fractures; a method to induce increased cellular or muscular
or bodily production of follistatin or follistatin-like proteins as
a therapeutic to accelerate the healing of bone fractures or to
increase the degree of recovery from a bone fracture, such as those
experienced in accidents, athletics, or combat; and a method to
induce increased cellular or muscular or bodily production of
follistatin or follistatin-like proteins in order to prevent
systemic loss of bone density, and thus prevent subsequent bone
fractures, during the recovery period after orthopedic surgery or
after the onset of a disease or condition necessitating long
periods of bed rest or physical inactivity, which are known to
result in decreased bone density and muscle weakness.
[0038] In any of the aforementioned method embodiments, it is
contemplated that the (+)-epicatechin and/or (-)-epicatechin or an
epicatechin derivative may optionally be administered orally or
intravenously or intramuscularly; at 5 mg to 2 grams per day;
and/or in a single dose or in divided doses.
DESCRIPTION OF DRAWINGS
[0039] FIG. 1 shows pictures of mice in the various treatment
groups.
[0040] FIG. 2 shows additional pictures of mice in the various
treatment groups.
[0041] FIG. 3 depicts a chart of bone length in four different
treatment groups.
DETAILED DESCRIPTION
[0042] Accordingly, provided herein is a method of treating,
preventing, or reversing injury to skeletal or cardiac muscles,
comprising the administration of a therapeutically effective amount
of epicatechin, either (+) or (-) enantiomers or a combination of
both, an epicatechin derivative, a pharmaceutically acceptable salt
or prodrug thereof, or combinations thereof to a patient in need
thereof. Also provided is a composition for treating, preventing,
or reversing injury to skeletal or cardiac muscles, comprising the
administration of a therapeutically effective amount of
epicatechin, either (+) or (-) enantiomers or a combination of
both, an epicatechin derivative, a pharmaceutically acceptable salt
or prodrug thereof, or combinations thereof to a patient in need
thereof.
[0043] Also provided is a method of treating a disease relating to
an impaired skeletal or cardiac muscle structure or function of
skeletal or cardiac muscle, comprising the administration of a
therapeutically effective amount of epicatechin, either (+) or (-)
enantiomers or a combination of both an epicatechin derivative, a
pharmaceutically acceptable salt or prodrug thereof, or
combinations thereof to a patient in need thereof. Also provided is
a composition for treating, preventing, or reversing injury to
skeletal or cardiac muscles, comprising a therapeutically effective
amount of epicatechin, either (+) or (-) enantiomers or a
combination of both, an epicatechin derivative, a pharmaceutically
acceptable salt or prodrug thereof, or combinations thereof to a
patient in need thereof.
[0044] In certain embodiments, said impairment is due to aging,
obesity, disuse or inactivity, exposure to potentially toxic
nutritional agents such as fructose, or exposure to inadequate
nutrition such as starvation or malnutrition.
[0045] Also provided herein is a method of inducing regeneration or
restructuring of skeletal or cardiac muscle, comprising the
administration of a therapeutically effective amount of
epicatechin, either (+) or (-) enantiomers or a combination of both
an epicatechin derivative, a pharmaceutically acceptable salt or
prodrug thereof, or combinations thereof to a patient in need
thereof. Also provided is a composition for inducing regeneration
or restructuring of skeletal or cardiac muscle, comprising a
therapeutically effective amount of epicatechin, either (+) or (-)
enantiomers or a combination of both an epicatechin derivative, a
pharmaceutically acceptable salt or prodrug thereof, or
combinations thereof to a patient in need thereof.
[0046] Also provided herein is a method of diagnosing injury to
skeletal or cardiac muscle and for diagnosing the success or
failure of therapeutics designed to treat, prevent, or reverse
injury to skeletal muscle or cardiac muscle, comprising: [0047] a.
observing one or more physiological manifestations of skeletal or
cardiac muscle injury or dysfunction in the subject; [0048] b.
administering a therapeutically effective amount of epicatechin,
either (+) or (-) enantiomers or a combination of both, an
epicatechin derivative, a pharmaceutically acceptable salt or
prodrug thereof, or combinations thereof to a patient in need
thereof; and [0049] c. observing a change or lack thereof in said
physiological manifestations of skeletal or cardiac muscle injury
or dysfunction.
[0050] Also provided herein is a method of improving muscle cell
function, recovery, or regeneration, comprising the administration
of a therapeutically effective amount of epicatechin, either (+) or
(-) enantiomers or a combination of both, an epicatechin
derivative, a pharmaceutically acceptable salt or prodrug thereof,
or combinations thereof to a patient in need thereof. Also provided
is a composition for improving muscle cell function, recovery, or
regeneration, comprising a therapeutically effective amount of
epicatechin, either (+) or (-) enantiomers or a combination of
both, an epicatechin derivative, a pharmaceutically acceptable salt
or prodrug thereof, or combinations thereof to a patient in need
thereof.
[0051] In certain embodiments, improving of muscle cell function,
recovery, or regeneration comprises increased mitochondrial number
and function.
[0052] Also provided herein is a method of treating muscle-related
side effects of athletic training or competition including
soreness, cramping, weakness, pain, or injury, comprising the
administration of a therapeutically effective amount of
epicatechin, either (+) or (-) enantiomers or a combination of
both, an epicatechin derivative, a pharmaceutically acceptable salt
or prodrug thereof, or combinations thereof to a patient in need
thereof. Also provided is a composition for treating muscle-related
side effects of athletic training or competition including
soreness, cramping, weakness, pain, or injury, comprising a
therapeutically effective amount of epicatechin, either (+) or (-)
enantiomers or a combination of both, an epicatechin derivative, a
pharmaceutically acceptable salt or prodrug thereof, or
combinations thereof to a patient in need thereof.
[0053] Also provided herein is a method of treating skeletal or
cardiac muscle diseases associated with ischemia or impaired or
inadequate blood flow, comprising the administration of a
therapeutically effective amount of epicatechin, either (+) or (-)
enantiomers or a combination of both, an epicatechin derivative, a
pharmaceutically acceptable salt or prodrug thereof, or
combinations thereof to a patient in need thereof. Also provided is
a composition for treating skeletal or cardiac muscle diseases
associated with ischemia or impaired or inadequate blood flow,
comprising a therapeutically effective amount of epicatechin,
either (+) or (-) enantiomers or a combination of both, an
epicatechin derivative, a pharmaceutically acceptable salt or
prodrug thereof, or combinations thereof to a patient in need
thereof.
[0054] In certain embodiments, said diseases are selected from the
group consisting of atherosclerosis, trauma, diabetes, vascular
stenosis, peripheral arterial disease, vasculopathy, and
vasculitis.
[0055] Also provided herein is a method of treating a disease
associated with genetic disorders that directly or indirectly
affect the number, structure, or function of cardiac muscle cells
or skeletal muscle cells, comprising the administration of a
therapeutically effective amount of epicatechin, either (+) or (-)
enantiomers or a combination of both, an epicatechin derivative, a
pharmaceutically acceptable salt or prodrug thereof, or
combinations thereof to a patient in need thereof. Also provided is
a composition for treating diseases associated with genetic
disorders that directly or indirectly affect the number, structure,
or function of cardiac muscle cells or skeletal muscle cells,
comprising therapeutically effective amount of epicatechin, either
(+) or (-) enantiomers or a combination of both, an epicatechin
derivative, a pharmaceutically acceptable salt or prodrug thereof,
or combinations thereof to a patient in need thereof.
[0056] In certain embodiments, said diseases are selected from the
group consisting of muscular dystrophies and Friedreich's
ataxia.
[0057] Also provided herein is a method of treating diseases
associated with impaired neurological control of muscular activity
resulting in consequent abnormalities in structure and function of
skeletal muscles due to inactivity, aberrant contractility, or
contracted states, comprising the administration of a
therapeutically effective amount of epicatechin, either (+) or (-)
enantiomers or a combination of both, an epicatechin derivative, a
pharmaceutically acceptable salt or prodrug thereof, or
combinations thereof to a patient in need thereof. Also provided is
a composition for treating diseases associated with impaired
neurological control of muscular activity resulting in consequent
abnormalities in structure and function of skeletal muscles due to
inactivity, aberrant contractility, or contracted states,
comprising a therapeutically effective amount of epicatechin,
either (+) or (-) enantiomers or a combination of both, an
epicatechin derivative, a pharmaceutically acceptable salt or
prodrug thereof, or combinations thereof to a patient in need
thereof.
[0058] In certain embodiments, said diseases are selected from the
group consisting of peripheral denervation syndromes, trauma,
amyotrophic lateral sclerosis, meningitis, and structural
abnormalities of the spine.
[0059] Also provided herein is a method of treating diseases
associated with loss of number, loss of function, or loss of
correct, optimally efficient internal organization of skeletal
muscle cells or cardiac muscle cells, comprising the administration
of a therapeutically effective amount of epicatechin, either (+) or
(-) enantiomers, or a combination of both, an epicatechin
derivative, a pharmaceutically acceptable salt or prodrug thereof,
or combinations thereof to a patient in need thereof. Also provided
is a composition for treating diseases associated with loss of
number, loss of function, or loss of correct, optimally efficient
internal organization of skeletal muscle cells or cardiac muscle
cells, comprising a therapeutically effective amount of
epicatechin, either (+) or (-) enantiomers, or a combination of
both, an epicatechin derivative, a pharmaceutically acceptable salt
or prodrug thereof, or combinations thereof to a patient in need
thereof.
[0060] In certain embodiments, said disease is muscle wasting.
[0061] In certain embodiments, said disease is sarcopenia.
[0062] In certain embodiments, said sarcopenia is associated with
aging, diabetes, abnormal metabolic conditions, infection,
inflammation, autoimmune, disease, cardiac dysfunction, arthritis
congestive heart failure, aging, myocarditis, myositis, polymyalgia
rheumatic, polymyositis, HIV, cancer, side effects of chemotherapy,
malnutrition, aging, inborn errors of metabolism, trauma, stroke,
and neurological impairment.
[0063] In certain embodiments, the method of treating diseases
associated with loss of number, loss of function, or loss of
correct, optimally efficient internal organization of skeletal
muscle cells or cardiac muscle cells further comprises exercise or
programmatic sequences or intensities of exercise.
[0064] Also provided herein is a method of enhancing sports
performance, endurance, building muscle shape or strength, or
facilitating recovery from the effects of training or competition,
comprising the administration of a therapeutically effective amount
of epicatechin, either (+) or (-) enantiomers or a combination of
both, an epicatechin derivative, a pharmaceutically acceptable salt
or prodrug thereof, or combinations thereof to a patient in need
thereof. Also provided is a composition for enhancing sports
performance, endurance, building muscle shape or strength, or
facilitating recovery from the effects of training or competition,
comprising a therapeutically effective amount of epicatechin,
either (+) or (-) enantiomers or a combination of both, an
epicatechin derivative, a pharmaceutically acceptable salt or
prodrug thereof, or combinations thereof to a patient in need
thereof.
[0065] Also provided herein is a method of treating muscle injury,
weakness, or pain associated with the administration of medicines,
comprising the administration of a therapeutically effective amount
of epicatechin, either (+) or (-) enantiomers or a combination of
both, an epicatechin derivative, a pharmaceutically acceptable salt
or prodrug thereof, or combinations thereof to a patient in need
thereof. Also provided is a composition for treating muscle injury,
weakness, or pain associated with the administration of medicines,
comprising a therapeutically effective amount of epicatechin,
either (+) or (-) enantiomers or a combination of both, an
epicatechin derivative, a pharmaceutically acceptable salt or
prodrug thereof, or combinations thereof to a patient in need
thereof.
[0066] In certain embodiments, said medicine is selected from the
group consisting of corticosteroids such as prednisone, methyl
prednisone, or halogenated derivatives thereof, chemotherapeutics
such as doxorubicin or methotrexate, and inhibitors of HMG
co-reductase, known as statins, that are frequently associated with
muscle disorders or myopathy, including: Advicor''' (niacin
extended-release/lovastatin), Altoprev''' (lovastatin
extended-release), Caduet''' (amlodipine and atorvastatin),
Crestor''' (rosuvastatin), Juvisync''' (sitagliptin/simvastatin),
Lescol.RTM. (fluvastatin), Lescol XL (fluvastatin
extended-release), Lipitor''' (atorvastatin), Compactin
(mevastatin), Livalo.RTM. (pitavastatin), Mevacor''' (lovastatin),
Pravachol''' (pravastatin), Simcor''' (niacin
extended-release/simvastatin), Vytorin''' (ezetimibe/simvastatin),
and Zocor.RTM. (simvastatin).
[0067] In certain embodiments of anyone of the embodiments
disclosed above, said epicatechin is substantially
(-)-epicatechin.
[0068] In certain embodiments of anyone of the embodiments
disclosed above, said epicatechin is substantially
(+)-epicatechin.
[0069] In certain embodiments of anyone of the embodiments
disclosed above, said epicatechin is a racemic mixture of
(-)-epicatechin and (+)-epicatechin.
[0070] In certain embodiments of anyone of the embodiments
disclosed above, said patient is selected for treatment based on
the occurrence of one or more physiological manifestations of
skeletal or cardiac muscle injury or dysfunction in the
subject.
[0071] In further embodiments, said manifestation is elevation in a
biomarker selected from the group consisting of elevated plasma
levels of myoglobin, troponin, or creatine phosphokinase, lactic
acidosis, and creatinine.
[0072] In certain embodiments of anyone of the embodiments
disclosed above, a diagnostic biomarker is used to determine the
time and degree of muscle response.
[0073] In further embodiments, said diagnostic biomarker is
dystrophin or thromobospondin.
[0074] In certain embodiments of anyone of the embodiments
disclosed above, epicatechin is administered.
[0075] In certain embodiments of anyone of the embodiments
disclosed above, an epicatechin derivative is administered.
[0076] In further embodiments, said epicatechin, epicatechin
derivative, pharmaceutically acceptable salts and prodrugs thereof,
or combinations thereof, are administered orally.
[0077] In other embodiments, said epicatechin, epicatechin
derivative, pharmaceutically acceptable salts and prodrugs thereof,
or combinations thereof, are administered parenterally.
[0078] In other embodiments, said epicatechin, epicatechin
derivative, pharmaceutically acceptable salts and prodrugs thereof,
or combinations thereof, are administered as a neutraceutical.
[0079] In further embodiments, epicatechin, epicatechin
derivatives, pharmaceutically acceptable salts and prodrugs
thereof, or combinations thereof, are administered in combination
with an additional therapeutics agent. Said additional therapeutic
agent is selected from the group consisting of hormones which
stimulate muscle cell growth, y-amino butyric acid or its
derivatives, dietary protein supplements, anabolic steroids,
biological factors known to enhance the growth, strength,
endurance, or metabolism of skeletal or cardiac muscle, or recovery
of skeletal muscle or cardiac muscle from injury or weakness,
compounds known to be associated with increased nitric oxide
production which promotes blood flow through muscles, extracts of
natural products known to promote muscle strength or endurance,
inhibitors of myostatin, and stimulators of follistatin
expression.
[0080] Also provided herein is a method of diagnosing the degree of
severity of a muscle disorder, comprising the step of measuring the
plasma levels of follistatin, myostatin, or the ratio of
follistatin to myostatin.
[0081] Also provided herein is a method of determining the extent
of response to therapy for a muscle disorder, comprising the steps
of: [0082] a) measuring the pre-treatment plasma levels of
follistatin, myostatin, or the ratio of follistatin to myostatin;
[0083] b) measuring the post-treatment plasma levels of
follistatin, myostatin, or the ratio of follistatin to myostatin;
and [0084] c) comparing the pre- and post-treatment levels of
follistatin, myostatin, or the ratio of follistatin to
myostatin.
[0085] Also provided herein is a method of treatment of a muscle
disorder, comprising the steps of: [0086] a) measuring the plasma
levels of follistatin, myostatin, or the ratio of follistatin to
myostatin a first time; [0087] b) administering a first amount of
epicatechin (either (+) or (-) enantiomers, or a combination of
both), an epicatechin derivative, or a pharmaceutically acceptable
salt or prodrug thereof; [0088] c) measuring the post-treatment
plasma levels of follistatin, myostatin, or the ratio of
follistatin to myostatin; [0089] d) comparing the pre- and
post-treatment levels of follistatin, myostatin, or the ratio of
follistatin to myostatin; and [0090] e) either: [0091] i)
increasing the dose of epicatechin (either (+) or (-) enantiomers,
or a combination of both), an epicatechin derivative, or a
pharmaceutically acceptable salt or prodrug thereof administered in
step b when the measured follistatin concentration in the subject
has increased, when the measured myostatin concentration in the
subject has decreased, or when the ratio of plasma follistatin to
plasma myostatin has increased; or [0092] ii) decreasing or
maintaining the dose of epicatechin (either (+) or (-) enantiomers,
or a combination of both), an epicatechin derivative, or a
pharmaceutically acceptable salt or prodrug thereof administered in
step b when the measured follistatin concentration in the subject
has decreased, when the measured myostatin concentration in the
subject has increased, or when the ratio of plasma follistatin to
plasma myostatin has decreased.
[0093] In certain embodiments of anyone of the embodiments
disclosed above, said epicatechin is a racemic mixture of greater
than 50% (-)-epicatechin and less than 50% (+)-epicatechin.
[0094] In certain embodiments of anyone of the embodiments
disclosed above, said a racemic mixture is greater than 75%
(-)-epicatechin.
[0095] In certain embodiments of anyone of the embodiments
disclosed above, said a racemic mixture is greater than 90%
(-)-epicatechin.
[0096] In certain embodiments of anyone of the embodiments
disclosed above, said a racemic mixture is greater than 75%
(+)-epicatechin.
[0097] In certain embodiments of anyone of the embodiments
disclosed above, said a racemic mixture greater than 90%
(+)-epicatechin.
[0098] Also provided herein is the use of epicatechin,
(+)-epicatechin, (-)-epicatechin, a combination of (+)- and
(-)-epicatechin, an epicatechin derivative, a pharmaceutically
acceptable salt or prodrug of any of the foregoing, or a
combination of any of the foregoing, in the manufacture of a
medicament for the treatment of any of the diseases, or for the
achievement of any therapeutic or functional endpoint, as disclosed
herein.
[0099] As used herein, the terms below have the meanings
indicated.
[0100] When ranges of values are disclosed, and the notation "from
n, . . . to n," or "between n, . . . and n," is used, where n, and
n2 are the numbers, then unless otherwise specified, this notation
is intended to include the numbers themselves and the range between
them. This range may be integral or continuous between and
including the end values. By way of example, the range "from 2 to 6
carbons" is intended to include two, three, four, five, and six
carbons, since carbons come in integer units. Compare, by way of
example, the range "from 1 to 3 uM (micromolar)," which is intended
to include 1 uM, 3 uM, and everything in between to any number of
significant figures (e.g., 1.255 uM, 2.1 uM, 2.9999 uM, etc.).
[0101] The term "about," as used herein, is intended to qualify the
numerical values which it modifies, denoting such a value as
variable within a margin of error. When no particular margin of
error, such as a standard deviation to a mean value given in a
chart or table of data, is recited, the term "about" should be
understood to mean that range which would encompass the recited
value and the range which would be included by rounding up or down
to that figure as well, taking into account significant
figures.
[0102] The term "disease" as used herein is intended to be
generally synonymous, and is used interchangeably with, the terms
"disorder," "syndrome," and "condition" (as in medical condition),
in that all reflect an abnormal condition of the human or animal
body or of one of its parts that impairs normal functioning, is
typically manifested by distinguishing signs and symptoms, and
causes the human or animal to have a reduced duration or quality of
life.
[0103] The term "muscular diseases" refers to diseases associated
with impaired skeletal muscle or cardiac muscle cell number or
function.
[0104] The term "combination therapy" means the administration of
two or more therapeutic agents to treat a therapeutic condition or
disorder described in the present disclosure. Such administration
encompasses co-administration of these therapeutic agents in a
substantially simultaneous manner, such as in a single capsule
having a fixed ratio of active ingredients or in multiple, separate
capsules for each active ingredient. In addition, such
administration also encompasses use of each type of therapeutic
agent in a sequential manner. In either case, the treatment regimen
will provide beneficial effects of the drug combination in treating
the conditions or disorders described herein. In certain
embodiments, a combination of compounds is administered such that
the clearance half-life of each compound from the body overlaps at
least partially with one another. For example, a first
pharmaceutical has a clearance half-life of 1 hour and is
administered at time=O, and a second pharmaceutical has a clearance
half-life of 1 hour and is administered at time=45 minutes.
[0105] The phrase "therapeutically effective" is intended to
qualify the amount of active ingredients used in the treatment of a
disease or disorder or on the effecting of a clinical endpoint.
[0106] The term "therapeutically acceptable" refers to those
compounds (or salts, prodrugs, tautomers, zwitterionic forms, etc.)
which are suitable for use in contact with the tissues of patients
without undue toxicity, irritation, and allergic response, are
commensurate with a reasonable benefit/risk ratio, and are
effective for their intended use.
[0107] As used herein, reference to "treatment" of a patient is
intended to include prophylaxis. Treatment may also be preemptive
in nature, i.e., it may include prevention of disease. Prevention
of a disease may involve complete protection from disease, for
example as in the case of prevention of infection with a pathogen,
or may involve prevention of disease progression. For example,
prevention of a disease may not mean complete foreclosure of any
effect related to the diseases at any level, but instead may mean
prevention of the symptoms of a disease to a clinically significant
or detectable level. Prevention of diseases may also mean
prevention of progression of a disease to a later stage of the
disease.
[0108] The term "patient" is generally synonymous with the term
"subject" and includes all mammals including humans. Examples of
patients include humans, livestock such as cows, goats, sheep,
pigs, and rabbits, and companion animals such as dogs, cats,
rabbits, and horses. Preferably, the patient is a human.
[0109] The term "epicatechin" as used herein refers to
(+)-epicatechin (2R-3R), (-)-epicatechin (2S-3S), or mixtures
thereof. In certain embodiments, "epicatechin" refers to
(+)-epicatechin. In further embodiments, "epicatechin" refers to
(-)-epicatechin. In further embodiments, "epicatechin" refers to a
racemic mixture of (+)-epicatechin and (-)-epicatechin.
[0110] The term "epicatechin derivative" as used herein refers to
any compound which retains the ring structure and stereochemistry
of epicatechin itself, but which contains one or more substituent
groups relative to epicatechin. Certain naturally occurring
epicatechin derivatives are known, such as (-)-epigallocatechin
(EGC), (-)-epicatechin-3-gallate (ECG),
(-)-epigallocatechin-3-gallate (EGCG), (+)-epigallocatechin (EGC),
(+)-epicatechin-3-gallate (ECG), and (+)-epigallocatechin-3-gallate
(EGCG). The term also includes combination molecules or prodrugs
that release epicatechin or a derivative thereof when administered
to a subject. Such a combination molecule may include, for example,
epicatechin and an agent joined by a hydrolysable linker group.
[0111] Epicatechin and its derivatives may be made synthetically,
or may be isolated from natural sources that contain these
compounds, such as chocolate, tea, and nuts. The term "chocolate"
as used herein refers to a solid or semi-plastic food and is
intended to refer to all chocolate or chocolate-like compositions
containing a dispersion of solids within a fat phase. The term is
intended to include compositions conforming to the U.S. Standards
of Identity (SOI), CODEX Alimentarius and/or other international
standards and compositions not conforming to the U.S. Standards of
Identity or other international standards. The term "chocolate"
encompasses sweet chocolate, bittersweet or semisweet chocolate,
milk chocolate, buttermilk chocolate, skim milk chocolate, mixed
dairy product chocolate, sweet cocoa and vegetable fat coating,
sweet chocolate and vegetable fat coating, milk chocolate and
vegetable fat coating, vegetable fat based coating, pastels
including white chocolate or coating made with cocoa butter or
vegetable fat or a combination of these, nutritionally modified
chocolate-like compositions (chocolates or coatings made with
reduced calorie ingredients), and low fat chocolates, unless
specifically identified otherwise. See, e.g., U.S. Pat. No.
6,312,753, which is hereby incorporated by reference herein. By way
of example, epicatechin and its derivatives may be delivered by
administration of tea extracts, cocoa components, partially and
fully defatted cocoa solids, cocoa nibs and fractions derived
therefrom, cocoa polyphenol extracts, cocoa butter, chocolate
liquors, and mixtures thereof.
[0112] The term "prodrug" refers to a compound that is made more
active in vivo. Certain compounds disclosed herein may also exist
as prodrugs, as described in Hydrolysis in Drug and Prodrug
Metabolism: Chemistry, Biochemistry, and Enzymology (Testa, Bernard
and Mayer, Joachim M. Wiley-VHCA, Zurich, Switzerland 2003).
Prodrugs of the compounds described herein are structurally
modified forms of the compound that readily undergo chemical
changes under physiological conditions to provide the compound.
Additionally, prodrugs can be converted to the compound by chemical
or biochemical methods in an ex vivo environment. For example,
prodrugs can be slowly converted to a compound when placed in a
transdermal patch reservoir with a suitable enzyme or chemical
reagent. Prodrugs are often useful because, in some situations,
they may be easier to administer than the compound, or parent drug.
They may, for instance, be bioavailable by oral administration
whereas the parent drug is not. The prodrug may also have improved
solubility in pharmaceutical compositions over the parent drug. A
wide variety of prodrug derivatives are known in the art, such as
those that rely on hydrolytic cleavage or oxidative activation of
the prodrug. An example, without limitation, of a prodrug would be
a compound which is administered as an ester (the "prodrug"), but
then is metabolically hydrolyzed to the carboxylic acid, the active
entity. Additional examples include peptidyl derivatives of a
compound.
[0113] The compounds disclosed herein can exist as therapeutically
acceptable salts. The present invention includes compounds listed
above in the form of salts, including acid addition salts. Suitable
salts include those formed with both organic and inorganic acids.
Such acid addition salts will normally be pharmaceutically
acceptable. However, salts of non-pharmaceutically acceptable salts
may be of utility in the preparation and purification of the
compound in question. Basic addition salts may also be formed and
be pharmaceutically acceptable. For a more complete discussion of
the preparation and selection of salts, refer to Pharmaceutical
Salts: Properties, Selection, and Use (Stahl, P. Heinrich.
Wiley-VCHA, Zurich, Switzerland, 2002).
[0114] The term "therapeutically acceptable salt," as used herein,
represents salts or zwitterionic forms of the compounds disclosed
herein which are water or oil-soluble or dispersible and
therapeutically acceptable as defined herein. The salts can be
prepared during the final isolation and purification of the
compounds or separately by reacting the appropriate compound in the
form of the free base with a suitable acid. Representative acid
addition salts include acetate, adipate, alginate, L-ascorbate,
aspartate, benzoate, benzenesulfonate (besylate), bisulfate,
butyrate, camphorate, camphorsulfonate, citrate, digluconate,
formate, fumarate, gentisate, glutarate, glycerophosphate,
glycolate, hemisulfate, heptanoate, hexanoate, hippurate,
hydrochloride, hydrobromide, hydroiodide, 2-hydroxyethansulfonate
(isethionate), lactate, maleate, malonate, DL-mandelate,
mesitylenesulfonate, methane sulfonate, naphthylenesulfonate,
nicotinate, 2-naphthalenesulfonate, oxalate, pamoate, pectinate,
persulfate, 3-phenylproprionate, phosphonate, picrate, pivalate,
propionate, pyroglutamate, succinate, sulfonate, tartrate,
L-tartrate, trichloroacetate, trifluoroacetate, phosphate,
glutamate, bicarbonate, para-toluene sulfonate (p-tosylate), and
undecanoate. Also, basic groups in the compounds disclosed herein
can be quaternized with methyl, ethyl, propyl, and butyl chlorides,
bromides, and iodides; dimethyl, diethyl, dibutyl, and diamyl
sulfates; decyl, lauryl, myristyl, and steryl chlorides, bromides,
and iodides; and benzyl and phenethyl bromides. Examples of acids
which can be employed to form therapeutically acceptable addition
salts include inorganic acids such as hydrochloric, hydrobromic,
sulfuric, and phosphoric, and organic acids such as oxalic, maleic,
succinic, and citric. Salts can also be formed by coordination of
the compounds with an alkali metal or alkaline earth ion. Hence,
the present invention contemplates sodium, potassium, magnesium,
and calcium salts of the compounds disclosed herein, and the
like.
[0115] Basic addition salts can be prepared during the final
isolation and purification of the compounds by reacting a carboxy
group with a suitable base such as the hydroxide, carbonate, or
bicarbonate of a metal cation or with ammonia or an organic
primary, secondary, or tertiary amine. The cations of
therapeutically acceptable salts include lithium, sodium,
potassium, calcium, magnesium, and aluminum, as well as nontoxic
quaternary amine cations such as ammonium, tetramethylammonium,
tetraethylammonium, methylamine, dimethylamine, trimethylamine,
triethylamine, diethylamine, ethylamine, tributylamine, pyridine,
N,N-dimethyl aniline, N-methyl piperidine, N-methylmorpholine,
dicyclohexylamine, procaine, dibenzylamine,
N,N-dibenzylphenethylamine, 1-ephenamine, and
N,N-dibenzylethylenediamine. Other representative organic amines
useful for the formation of base addition salts include
ethylenediamine, ethanolamine, diethanolamine, piperidine, and
piperazine.
[0116] A salt of a compound can be made by reacting the appropriate
compound in the form of the free base with the appropriate
acid.
[0117] While it may be possible for the compounds of the subject
invention to be administered as the raw chemical, it is also
possible to present them as a pharmaceutical formulation.
Accordingly, provided herein are pharmaceutical formulations which
comprise one or more of certain compounds disclosed herein, or one
or more pharmaceutically acceptable salts, esters, prodrugs,
amides, or solvates thereof, together with one or more
pharmaceutically acceptable carriers thereof and optionally one or
more other therapeutic ingredients. The carriers) must be
"acceptable" in the sense of being compatible with the other
ingredients of the formulation and not deleterious to the recipient
thereof. Proper formulation is dependent upon the route of
administration chosen. Any of the well-known techniques, carriers,
and excipients may be used as suitable and as understood in the
art; e.g., in Remington's Pharmaceutical Sciences. The
pharmaceutical compositions disclosed herein may be manufactured in
any manner known in the art, e.g., by means of conventional mixing,
dissolving, granulating, dragee-making, levigating, emulsifying,
encapsulating, entrapping or compression processes.
[0118] The formulations include those suitable for oral, parenteral
(including subcutaneous, intradermal, intramuscular, intravenous,
intraarticular, and intramedullary), intraperitoneal, transmucosal,
transdermal, rectal and topical (including dermal, buccal,
sublingual and intraocular) administration although the most
suitable route may depend upon for example the condition and
disorder of the recipient. The formulations may conveniently be
presented in unit dosage form and may be prepared by any of the
methods well known in the art of pharmacy. Typically, these methods
include the step of bringing into association a compound of the
subject invention or a pharmaceutically acceptable salt, ester,
amide, prodrug or solvate thereof ("active ingredient") with the
carrier which constitutes one or more accessory ingredients. In
general, the formulations are prepared by uniformly and intimately
bringing into association the active ingredient with liquid
carriers or finely divided solid carriers or both and then, if
necessary, shaping the product into the desired formulation.
[0119] Formulations of the compounds disclosed herein suitable for
oral administration may be presented as discrete units such as
capsules, cachets or tablets each containing a predetermined amount
of the active ingredient; as a powder or granules; as a solution or
a suspension in an aqueous liquid or a non-aqueous liquid; or as an
oil-in-water liquid emulsion or a water-in-oil liquid emulsion. The
active ingredient may also be presented as a bolus, electuary or
paste.
[0120] Pharmaceutical preparations which can be used orally include
tablets, push-fit capsules made of gelatin, as well as soft, sealed
capsules made of gelatin and a plasticizer, such as glycerol or
sorbitol. Tablets may be made by compression or molding, optionally
with one or more accessory ingredients. Compressed tablets may be
prepared by compressing in a suitable machine the active ingredient
in a free-flowing form such as a powder or granules, optionally
mixed with binders, inert diluents, or lubricating, surface active
or dispersing agents. Molded tablets may be made by molding in a
suitable machine a mixture of the powdered compound moistened with
an inert liquid diluent. The tablets may optionally be coated or
scored and may be formulated so as to provide slow or controlled
release of the active ingredient therein. All formulations for oral
administration should be in dosages suitable for such
administration. The push-fit capsules can contain the active
ingredients in admixture with filler such as lactose, binders such
as starches, and/or lubricants such as talc or magnesium stearate
and, optionally, stabilizers. In soft capsules, the active
compounds may be dissolved or suspended in suitable liquids, such
as fatty oils, liquid paraffin, or liquid polyethylene glycols. In
addition, stabilizers may be added. Dragee cores are provided with
suitable coatings. For this purpose, concentrated sugar solutions
may be used, which may optionally contain gum arabic, talc,
polyvinyl pyrrolidone, carbopol gel, polyethylene glycol, and/or
titanium dioxide, lacquer solutions, and suitable organic solvents
or solvent mixtures. Dyestuffs or pigments may be added to the
tablets or dragee coatings for identification or to characterize
different combinations of active compound doses.
[0121] Specific sustained release formulations of the compounds
disclosed herein are described in U.S. Pat. No. 6,410,052, which is
hereby incorporated by reference.
[0122] The compounds may be formulated for parenteral
administration by injection, e.g., by bolus injection or continuous
infusion. Formulations for injection may be presented in unit
dosage form, e.g., in ampoules or in multi-dose containers, with an
added preservative. The compositions may take such forms as
suspensions, solutions or emulsions in oily or aqueous vehicles,
and may contain formulatory agents such as suspending, stabilizing
and/or dispersing agents. The formulations may be presented in
unit-dose or multi-dose containers, for example sealed ampoules and
vials, and may be stored in powder form or in a freeze-dried
(lyophilized) condition requiring only the addition of the sterile
liquid carrier, for example, saline or sterile pyrogen-free water,
immediately prior to use. Extemporaneous injection solutions and
suspensions may be prepared from sterile powders, granules and
tablets of the kind previously described.
[0123] Formulations for parenteral administration include aqueous
and non-aqueous (oily) sterile injection solutions of the active
compounds which may contain antioxidants, buffers, bacteriostats
and solutes which render the formulation isotonic with the blood of
the intended recipient; and aqueous and non-aqueous sterile
suspensions which may include suspending agents and thickening
agents. Suitable lipophilic solvents or vehicles include fatty oils
such as sesame oil, or synthetic fatty acid esters, such as ethyl
oleate or triglycerides, or liposomes. Aqueous injection
suspensions may contain substances which increase the viscosity of
the suspension, such as sodium carboxymethyl cellulose, sorbitol,
or dextran. Optionally, the suspension may also contain suitable
stabilizers or agents which increase the solubility of the
compounds to allow for the preparation of highly concentrated
solutions.
[0124] In addition to the formulations described previously, the
compounds may also be formulated as a depot preparation. Such long
acting formulations may be administered by implantation (for
example subcutaneously or intramuscularly) or by intramuscular
injection. Thus, for example, the compounds may be formulated with
suitable polymeric or hydrophobic materials (for example as an
emulsion in an acceptable oil) or ion exchange resins, or as
sparingly soluble derivatives, for example, as a sparingly soluble
salt.
[0125] For buccal or sublingual administration, the compositions
may take the form of tablets, lozenges, pastilles, or gels
formulated in conventional manner. Such compositions may comprise
the active ingredient in a flavored basis such as sucrose and
acacia or tragacanth.
[0126] The compounds may also be formulated in rectal compositions
such as suppositories or retention enemas, e.g., containing
conventional suppository bases such as cocoa butter, polyethylene
glycol, or other glycerides.
[0127] Certain compounds disclosed herein may be administered
topically, that is by non-systemic administration. This includes
the application of a compound disclosed herein externally to the
epidermis or the buccal cavity and the instillation of such a
compound into the ear, eye and nose, such that the compound does
not significantly enter the blood stream. In contrast, systemic
administration refers to oral, intravenous, intraperitoneal and
intramuscular administration.
[0128] Formulations suitable for topical administration include
liquid or semi-liquid preparations suitable for penetration through
the skin to the site of inflammation such as gels, liniments,
lotions, creams, ointments or pastes, and drops suitable for
administration to the eye, ear or nose. The active ingredient for
topical administration may comprise, for example, from 0.001% to
10% w/w (by weight) of the formulation. In certain embodiments, the
active ingredient may comprise as much as 10% w/w. In other
embodiments, it may comprise less than 5% w/w. In certain
embodiments, the active ingredient may comprise from 2% w/w to 5%
w/w. In other embodiments, it may comprise from 0.1% to 1% w/w of
the formulation.
[0129] For administration by inhalation, compounds may be
conveniently delivered from an insufflator, nebulizer pressurized
packs or other convenient means of delivering an aerosol spray.
Pressurized packs may comprise a suitable propellant such as
dichlorodifluoromethane, trichlorofluoromethane,
dichlorotetrafluoroethane, carbon dioxide or other suitable gas. In
the case of a pressurized aerosol, the dosage unit may be
determined by providing a valve to deliver a metered amount.
Alternatively, for administration by inhalation or insufflation,
the compounds according to the invention may take the form of a dry
powder composition, for example a powder mix of the compound and a
suitable powder base such as lactose or starch. The powder
composition may be presented in unit dosage form, in for example,
capsules, cartridges, gelatin or blister packs from which the
powder may be administered with the aid of an inhalator or
insufflator.
[0130] Preferred unit dosage formulations are those containing an
effective dose, as herein below recited, or an appropriate fraction
thereof, of the active ingredient.
[0131] It should be understood that in addition to the ingredients
particularly mentioned above, the formulations described above may
include other agents conventional in the art having regard to the
type of formulation in question, for example those suitable for
oral administration may include flavoring agents.
[0132] Compounds may be administered orally or via injection at a
dose of from 0.1 to 500 mg/kg per day.
[0133] The dose range for adult humans is generally from 5 mg to 2
g/day. Tablets or other forms of presentation provided in discrete
units may conveniently contain an amount of one or more compounds
which is effective at such dosage or as a multiple of the same, for
instance, units containing 5 mg to 500 mg, usually around 10 mg to
200 mg.
[0134] The amount of active ingredient that may be combined with
the carrier materials to produce a single dosage form will vary
depending upon the host treated and the particular mode of
administration.
[0135] The compounds can be administered in various modes, e.g.
orally, topically, or by injection. The precise amount of compound
administered to a patient will be the responsibility of the
attendant physician. The specific dose level for any particular
patient will depend upon a variety of factors including the
activity of the specific compound employed, the age, body weight,
general health, sex, diets, time of administration, route of
administration, rate of excretion, drug combination, the precise
disorder being treated, and the severity of the indication or
condition being treated. Also, the route of administration may vary
depending on the condition and its severity.
[0136] In certain instances, it may be appropriate to administer at
least one of the compounds described herein (or a pharmaceutically
acceptable salt, ester, or prodrug thereof) in combination with
another therapeutic agent. By way of example only, if one of the
side effects experienced by a patient upon receiving one of the
compounds herein; is hypertension, then it may be appropriate to
administer an anti-hypertensive agent in combination with the
initial therapeutic agent. Or, by way of example only, the
therapeutic effectiveness of one of the compounds described herein
may be enhanced by administration of an adjuvant (i.e., by itself
the adjuvant may only have minimal therapeutic benefit, but in
combination with another therapeutic agent, the overall therapeutic
benefit to the patient is enhanced). Or, by way of example only,
the benefit of experienced by a patient may be increased by
administering one of the compounds described herein with another
therapeutic agent (which also includes a therapeutic regimen) that
also has therapeutic benefit. By way of example only, in a
treatment for diabetes involving administration of one of the
compounds described herein, increased therapeutic benefit may
result by also providing the patient with another therapeutic agent
for diabetes. In any case, regardless of the disease, disorder or
condition being treated, the overall benefit experienced by the
patient may simply be additive of the two therapeutic agents or the
patient may experience a synergistic benefit.
[0137] Specific, non-limiting examples of possible combination
therapies include use of certain compounds of the invention with
agents which allow or enhance improvements in the number, structure
or function of skeletal muscle cells or cardiac muscle cells.
[0138] In further embodiments, such agents include hormones which
stimulate muscle cell growth, butyric acid or its derivatives,
dietary protein supplements, anabolic steroids, biological factors
known to enhance the growth, strength, endurance, or metabolism of
skeletal or cardiac muscle, or recovery of skeletal muscle or
cardiac muscle from injury or weakness, compounds known to be
associated with increased nitric oxide production which promotes
blood flow through muscles, extracts of natural products known to
promote muscle strength or endurance, inhibitors of myostatin, and
stimulators of folistatin expression.
[0139] In further embodiments, hormones which stimulate muscle cell
growth include, but are not limited to, growth hormone, growth
hormone analogs, growth hormone releasing peptides or analogs
thereof, growth hormone secretagogues, or other hormones such as
somatatropin or mechano growth factor.
[0140] In further embodiments butyric acid derivatives include
neurotransmitters that benefit muscles by modulating the pituitary
gland.
[0141] In further embodiments, dietary protein supplements include,
but are not limited to, proteins such as casein, amino acids
precursors or derivatives thereof with known attributes of
potentiating muscle growth, such as leucine, valine, isovaline,
beta alanine, glutamine, glutamine dipeptide, or glycocyamine.
[0142] In further embodiments anabolic steroids, include, but are
not limited to, testosterone or related steroid compounds with
muscle growth inducing properties, such as cyclostanazol or
methadrostenol, prohomones or derivatives thereof, modulators of
estrogen, and selective androgen receptor modulators (SARMS).
[0143] In further embodiments, biological factors known to enhance
the growth, strength, endurance, or metabolism of skeletal or
cardiac muscle, or recovery of skeletal muscle or cardiac muscle
from injury or weakness, include, but are not limited to,
alpha-lipoic acid, taurine, caffeine, magnesium, niacin, folic
acid, ornithine, vitamin B6, B12, or D, aspartate, creatine and its
diverse salts such creatine monohydrate, betaine, N-acetyl
cysteine, beta-hydroxyl methyl butyrate, lecithin, choline,
phospholipid mixtures, phosphatidyl serine, carnitine, L-carnitine,
and glycine proprionyl-L-carnitine.
[0144] In further embodiments, compounds known to be associated
with increased nitric oxide production which promotes blood flow
through muscles include, but are not limited to, arginine and
citrulline.
[0145] In further embodiments, extracts of natural products known
to promote muscle strength or endurance, include, but are not
limited to, guarana, geranium Robertianum, Cirsium ologophyllum,
Bauhinia purpureae, Yohimbe, Bacopa monniera, beet powder,
rhodiola, or tea extracts.
[0146] In further embodiments, inhibitors of myostatin are
proteins, antibodies, peptides, or small molecules.
[0147] In further embodiments, stimulators of folistatin expression
or function are proteins, peptides, or small molecules.
[0148] In any case, the multiple therapeutic agents (at least one
of which is a compound disclosed herein) may be administered in any
order or even simultaneously. If simultaneously, the multiple
therapeutic agents may be provided in a single, unified form, or in
multiple forms (by way of example only, either as a single pill or
as two separate pills). One of the therapeutic agents may be given
in multiple doses, or both may be given as multiple doses. If not
simultaneous, the timing between the multiple doses may be any
duration of time ranging from a few minutes to four weeks.
[0149] Thus, in another aspect, certain embodiments provide methods
for treating muscular diseases in a human or animal subject in need
of such treatment comprising administering to said subject an
amount of a compound disclosed herein effective to reduce or
prevent said disorder in the subject, in combination with at least
one additional agent for the treatment of said disorder that is
known in the art. In a related aspect, certain embodiments provide
therapeutic compositions comprising at least one compound disclosed
herein in combination with one or more additional agents for the
treatment of muscular diseases.
[0150] The compositions of the present invention may also be
formulated as neutraceutical compositions. The term "neutraceutical
composition" as used herein refers to a food product, foodstuff,
dietary supplement, nutritional supplement or a supplement
composition for a food product or a foodstuff comprising
exogenously added catechin and/or epicatechin. Details on
techniques for formulation and administration of such compositions
may be found in Remington, The Science and Practice of Pharmacy
21st Edition (Mack Publishing Co., Easton, Pa.) and Nielloud and
Marti-Mestres, Pharmaceutical Emulsions and Suspensions: 2nd
Edition (Marcel Dekker, Inc, New York).
[0151] As used herein, the term food product refers to any food or
feed suitable for consumption by humans or animals. The food
product may be a prepared and packaged food (e.g., mayonnaise,
salad dressing, bread, grain bar, beverage, etc.) or an animal feed
(e.g., extruded and pelleted animal feed, coarse mixed feed or pet
food composition). As used herein, the term foodstuff refers to any
substance fit for human or animal consumption.
[0152] Food products or foodstuffs are for example beverages such
as nonalcoholic and alcoholic drinks as well as liquid preparation
to be added to drinking water and liquid food, non-alcoholic drinks
are for instance soft drinks, sport drinks, fruit juices, such as
for example orange juice, apple juice and grapefruit juice;
lemonades, teas, near-water drinks and milk and other dairy drinks
such as for example yoghurt drinks, and diet drinks. In another
embodiment food products or foodstuffs refer to solid or semi-solid
foods comprising the composition according to the invention. These
forms can include, but are not limited to baked goods such as cakes
and cookies, puddings, dairy products, confections, snack foods, or
frozen confections or novelties (e.g., ice cream, milk shakes),
prepared frozen meals, candy, snack products (e.g., chips), liquid
food such as soups, spreads, sauces, salad dressings, prepared meat
products, cheese, yogurt and any other fat or oil containing foods,
and food ingredients (e.g., wheat flour).
[0153] Animal feed including pet food compositions advantageously
include food intended to supply necessary dietary requirements, as
well as treats (e.g., dog biscuits) or other food supplements. The
animal feed comprising the composition according to the invention
may be in the form of a dry composition (for example, kibble),
semi-moist composition, wet composition, or any mixture thereof.
Alternatively or additionally, the animal feed is a supplement,
such as a gravy, drinking water, yogurt, powder, suspension, chew,
treat (e.g., biscuits) or any other delivery form.
[0154] The term "dietary supplement" refers to a small amount of a
compound for supplementation of a human or animal diet packaged in
single or multiple dose units.
[0155] Dietary supplements do not generally provide significant
amounts of calories but may contain other micronutrients (e.g.,
vitamins or minerals). The term food products or foodstuffs also
includes functional foods and prepared food products pre-packaged
for human consumption.
[0156] The term nutritional supplement refers to a composition
comprising a dietary supplement in combination with a source of
calories. In some embodiments, nutritional supplements are meal
replacements or supplements (e.g., nutrient or energy bars or
nutrient beverages or concentrates).
[0157] Dietary supplements of the present invention may be
delivered in any suitable format. In certain embodiments, dietary
supplements are formulated for oral delivery. The ingredients of
the dietary supplement of this invention are contained in
acceptable excipients and/or carriers for oral consumption. The
actual form of the carrier, and thus, the dietary supplement
itself, is not critical. The carrier may be a liquid, gel, gelcap,
capsule, powder, solid tablet (coated or noncoated), tea, or the
like.
[0158] In certain embodiments, the dietary supplement is in the
form of a tablet or capsule and in further embodiments is in the
form of a hard (shell) capsule. Suitable excipient and/or carriers
include maltodextrin, calcium carbonate, dicalcium phosphate,
tricalcium phosphate, microcrystalline cellulose, dextrose, rice
flour, magnesium stearate, stearic acid, croscarmellose sodium,
sodium starch glycolate, crospovidone, sucrose, vegetable gums,
lactose, methylcellulose, povidone, carboxymethylcellulose, corn
starch, and the like (including mixtures thereof). In certain
embodiments, carriers include calcium carbonate, magnesium
stearate, maltodextrin, and mixtures thereof. The various
ingredients and the excipient and/or carrier are mixed and formed
into the desired form using conventional techniques. The tablet or
capsule of the present invention may be coated with an enteric
coating that dissolves at a pH of about 6.0 to 7.0. A suitable
enteric coating that dissolves in the small intestine but not in
the stomach is cellulose acetate phthalate.
[0159] In other embodiments, the dietary supplement is provided as
a powder or liquid suitable for adding by the consumer to a food or
beverage. For example, in some embodiments, the dietary supplement
can be administered to an individual in the form of a powder, for
instance to be used by mixing into a beverage, or by stirring into
a semi-solid food such as a pudding, topping, sauce, puree, cooked
cereal, or salad dressing, for instance, or by otherwise adding to
a food or the dietary supplement e.g. enclosed in caps of food or
beverage container for release immediately before consumption. The
dietary supplement may comprise one or more inert ingredients,
especially if it is desirable to limit the number of calories added
to the diet by the dietary supplement. For example, the dietary
supplement of the present invention may also contain optional
ingredients including, for example, herbs, vitamins, minerals,
enhancers, colorants, sweeteners, flavorants, inert ingredients,
and the like.
[0160] In some embodiments, the dietary supplements further
comprise vitamins and minerals including, but not limited to,
calcium phosphate or acetate, tribasic; potassium phosphate,
dibasic; magnesium sulfate or oxide; salt (sodium chloride);
potassium chloride or acetate; ascorbic acid; ferric
orthophosphate; niacinamide; zinc sulfate or oxide; calcium
pantothenate; copper gluconate; riboflavin; beta-carotene;
pyridoxine hydrochloride; thiamin mononitrate; folic acid; biotin;
chromium chloride or picolonate; potassium iodide; sodium selenate;
sodium molybdate; phylloquinone; vitamin D3; cyanocobalamin; sodium
selenite; copper sulfate; vitamin A; vitamin C; inositol; potassium
iodide. Suitable dosages for vitamins and minerals may be obtained,
for example, by consulting the U.S. RDA guidelines.
[0161] In other embodiments, the present invention provides
nutritional supplements (e.g., energy bars or meal replacement bars
or beverages) comprising the composition according to the
invention. The nutritional supplement may serve as meal or snack
replacement and generally provide nutrient calories. In certain
embodiments, the nutritional supplements provide carbohydrates,
proteins, and fats in balanced amounts. The nutritional supplement
can further comprise carbohydrate, simple, medium chain length, or
polysaccharides, or a combination thereof. A simple sugar can be
chosen for desirable organoleptic properties. Uncooked cornstarch
is one example of a complex carbohydrate. If it is desired that it
should maintain its high molecular weight structure, it should be
included only in food formulations or portions thereof which are
not cooked or heat processed since the heat will break down the
complex carbohydrate into simple carbohydrates, wherein simple
carbohydrates are mono or disaccharides. The nutritional supplement
contains, in one embodiment, combinations of sources of
carbohydrate of three levels of chain length (simple, medium and
complex; e.g., sucrose, maltodextrins, and uncooked
cornstarch).
[0162] Sources of protein to be incorporated into the nutritional
supplement of the invention can be any suitable protein utilized in
nutritional formulations and can include whey protein, whey protein
concentrate, whey powder, egg, soy flour, soy milk soy protein, soy
protein isolate, caseinate (e.g., sodium caseinate, sodium calcium
caseinate, calcium caseinate, potassium caseinate), animal and
vegetable protein and hydrolysates or mixtures thereof. When
choosing a protein source, the biological value of the protein
should be considered first, with the highest biological values
being found in caseinate, whey, lactalbumin, egg albumin and whole
egg proteins. In an embodiment, the protein is a combination of
whey protein concentrate and calcium caseinate. These proteins have
high biological value; that is, they have a high proportion of the
essential amino acids. See Modern Nutrition in Health and Disease,
8th ed., Lea & Febiger, 1986, especially Volume 1, pages
30-32.
[0163] The nutritional supplement can also contain other
ingredients, such as one or a combination of other vitamins,
minerals, antioxidants, fiber and other dietary supplements (e.g.,
protein, amino acids, choline, lecithin). Selection of one or
several of these ingredients is a matter of formulation, design,
consumer preferences and end user. The amounts of these ingredients
added to the dietary supplements of this invention are readily
known to the skilled artisan. Guidance to such amounts can be
provided by the U.S. RDA doses for children and adults. Further
vitamins and minerals that can be added include, but are not
limited to, calcium phosphate or acetate, tribasic; potassium
phosphate, dibasic; magnesium sulfate or oxide; salt (sodium
chloride); potassium chloride or acetate; ascorbic acid; ferric
orthophosphate; niacinamide; zinc sulfate or oxide; calcium
pantothenate; copper gluconate; riboflavin; beta-carotene;
pyridoxine hydrochloride; thiamin mononitrate; folic acid; biotin;
chromium chloride or picolonate; potassium iodide; sodium selenate;
sodium molybdate; phylloquinone; vitamin D3; cyanocobalamin; sodium
selenite; copper sulfate; vitamin A; vitamin C; inositol; potassium
iodide.
[0164] The nutritional supplement can be provided in a variety of
forms, and by a variety of production methods. In an embodiment, to
manufacture a food bar, the liquid ingredients are cooked; the dry
ingredients are added with the liquid ingredients in a mixer and
mixed until the dough phase is reached; the dough is put into an
extruder, and extruded; the extruded dough is cut into appropriate
lengths; and the product is cooled. The bars may contain other
nutrients and fillers to enhance taste, in addition to the
ingredients specifically listed herein.
[0165] It is understood by those of skill in the art that other
ingredients can be added to those described herein, for example,
fillers, emulsifiers, preservatives, etc. for the processing or
manufacture of a nutritional supplement.
[0166] Additionally, flavors, coloring agents, spices, nuts and the
like may be incorporated into the neutraceutical composition.
Flavorings can be in the form of flavored extracts, volatile oils,
chocolate flavorings, peanut butter flavoring, cookie crumbs, crisp
rice, vanilla or any commercially available flavoring. Examples of
useful flavoring include, but are not limited to, pure anise
extract, imitation banana extract, imitation cherry extract,
chocolate extract, pure lemon extract, pure orange extract, pure
peppermint extract, imitation pineapple extract, imitation rum
extract, imitation strawberry extract, or pure vanilla extract; or
volatile oils, such as balm oil, bay oil, bergamot oil, cedarwood
oil, walnut oil, cherry oil, cinnamon oil, clove oil, or peppermint
oil; peanut butter, chocolate flavoring, vanilla cookie crumb,
butterscotch or toffee. In one embodiment, the dietary supplement
contains cocoa or chocolate.
[0167] Emulsifiers may be added for stability of the neutraceutical
compositions. Examples of suitable emulsifiers include, but are not
limited to, lecithin (e.g., from egg or soy), and/or mono and
diglycerides. Other emulsifiers are readily apparent to the skilled
artisan and selection of suitable emulsifier(s) will depend, in
part, upon the formulation and final product. Preservatives may
also be added to the nutritional supplement to extend product shelf
life. In certain embodiments, preservatives such as potassium
sorbate, sodium sorbate, potassium benzoate, sodium benzoate or
calcium disodium EDTA are used.
[0168] In addition to the carbohydrates described above, the
neutraceutical composition can contain natural or artificial
(preferably low calorie) sweeteners, e.g., saccharides, cyclamates,
aspartamine, aspartame, acesulfame K, and/or sorbitol. Such
artificial sweeteners can be desirable if the nutritional
supplement is intended to be consumed by an overweight or obese
individual, or an individual with type II diabetes who is prone to
hyperglycemia.
[0169] Moreover, a multi-vitamin and mineral supplement may be
added to the neutraceutical compositions of the present invention
to obtain an adequate amount of an essential nutrient, which is
missing in some diets. The multi-vitamin and mineral supplement may
also be useful for disease prevention and protection against
nutritional losses and deficiencies due to lifestyle patterns.
[0170] The dosage and ratios of catechin and/or epicatechin and
additional components administered via a neutraceutical will vary
depending upon known factors, such as the pharmaceutical
characteristics of the particular composition and its mode and
route of administration; the age, health and weight of the
recipient; the nature and extent of the symptoms; the kind of
concurrent treatment; the frequency of treatment; and the effect
desired which can determined by the expert in the field with normal
trials, or with the usual considerations regarding the formulation
of a neutraceutical composition.
[0171] It will be understood, however, that the specific dose level
for any particular patient will depend on a variety of factors
including the activity of the specific compound employed, the age,
body weight, general health, sex and diet of the individual being
treated; the time and route of administration; the rate of
excretion; other drugs which have previously been administered; and
the severity of the particular disease undergoing therapy, as is
well understood by those skilled in the art.
[0172] Specific diseases to be treated by the compounds,
compositions, and methods disclosed herein include: impaired
skeletal and cardiac muscle function, recovery of skeletal or
cardiac muscle health or function, functionally significant
regeneration of skeletal or cardiac muscle cells or function, and
any other diseases disclosed herein.
[0173] Besides being useful for human treatment, certain compounds
and formulations disclosed herein may also be useful for veterinary
treatment of companion animals, exotic animals and farm animals,
including mammals, rodents, and the like. More preferred animals
include horses, dogs, and cats.
Biological Activity Assays
[0174] Western Blot Assays:
[0175] Cells or skeletal muscle tissue samples were homogenized in
50 ul lysis buffer (1% triton X-100, 20 mmol/L Tris, 140 mmol/L
NaCl, 2 mmol/L EDTA, and 0.1% SDS) with protease and phosphatase
inhibitor cocktails supplemented with 1 mmol/L PMSF, 2 mmol/L
Na.sub.3V0.sub.4 and 1 mmol/L NaP. Homogenates were passed through
an insulin syringe five times, sonicated for 30 min at 4DC and
centrifuged (12,000.times.g) for 10 min. The total protein content
was measured in the supernatant. A total of 40)/g of protein was
loaded onto a 5% or 10% SDS-PAGE, electrotransferred, incubated for
1 h in blocking solution (5% nonfat dry milk in TBS plus 0.1% Tween
20 [TBS-T]), followed by either a 3-h incubation at room
temperature or overnight incubation at 4DC with primary antibodies.
Primary antibodies were typically diluted 1:1000 or 1:2000 in TBS-T
plus 5% bovine serum albumin. Membranes were washed (3.times. for 5
min) in TBS-T and incubated 1 h at room temperature in the presence
of HRP-conjugated secondary antibodies diluted 1:10,000 in blocking
solution. Membranes were again washed 3 times in TBS-T, and the
immunoblots were developed using an enhanced chemiluminescence
detection kit. The band intensities were digitally quantified. All
primary antibodies are commercially available.
[0176] Mouse Myoblast Assay
[0177] Epicatechin induces follistatin expression, suppresses
myostatin expression and accelerates the differentiation of
cultured mouse myoblasts into myotubes. These phenomena are
associated with increased expression of biomarkers of muscle
differentiation, such as myogenin and myoD. The mouse myoblast cell
line, C2C12, was grown to semi-confluence in 6-well tissue culture
plates and then exposed to epicatechin (100 nM) for three days
using literature-standardized differentiation inducing media: DMEM
supplemented with 2% horse serum. Proteins were extracted,
separated by conventional gel electrophoresis and stained as
Western blots by reacting with commercially available antibodies
specific for markers of muscle cell growth and differentiation. In
experiments examining the comparative effects of (-) and (+)
epicatechin enantiomers on muscle cells, the cells were grown to
semi-confluence in 6 well plates, placed into
literature-standardized differentiation medium containing horse
serum, and then stimulated for 24 hours with (-) or (+) epicatechin
enantiomers, at concentrations ranging from 10 nM to 1000 nM. The
cells were then harvested as above, and Western blots were prepared
to determine relative expression of PGCIa and follistatin, using
commercially available, specific, primary antibodies.
[0178] Treatment of Diabetic Patients with Epicatechin-Rich Cocoa
Products
[0179] Five patients with type 2 diabetes and heart failure were
provided epicatechin-rich cocoa products (providing--100 mg
epicatechiniday) every day for three months.
[0180] Epicatechin rich cocoa increased protein levels of the
stimulator of skeletal muscle growth, follistatin, markers of
muscle differentiation, (myogenin, myoD) and suppressed the
expression of the inhibitory protein, myostatin in biopsy samples
of human skeletal muscle after three months of treatment. Patients
underwent biopsies of their quadriceps muscle before and after
completing treatment. The biopsy material was analyzed by Western
blots for the analysis of muscle protein content.
[0181] Electron micrographs of quadriceps muscle biopsy samples
obtained before and after three months of treatment show a severe
disruption and distortion of sarcomere ultrastructure in human
skeletal muscle of diabetic patients with heart failure, consistent
with sarcopenia. Treatment significantly restored sarcomere
organization of skeletal muscle to near normal. This phenomenon was
evidenced in all five patients as average histology score improved
significantly.
[0182] Treatment with epicatechin induced increased expression of
the activated form (de-acetylated) of PGC 1a, a transcriptional
regulator of muscle repair and regeneration, as well as
mitochondrial biogenesis, in the patients' quadriceps muscles.
Treatment also increased the expression of elements of the
sarcoglycan protein family, including dystrophin, dysferlin, and
utrophin, consistent with the observed improvement in sarcomere
morphology. Treatment also increased mitochondrial biogenesis, as
evidenced by increased Electron Transport Complex proteins per mg
of quadriceps tissue.
[0183] Baseline skeletal muscle thiollevels (by using a Cayman Inc.
gluthatione assay kit) in diabetic patients with heart failure
manifested a marked decrease evidencing significant tissue
oxidative stress as compared to normal muscle. Treatment with
epicatechin rich cocoa restored total thiollevels, an indication of
a normalization of tissue oxidative stress levels. Epicatechin
treatment also increased quadriceps expression of superoxide
dismutase and catalase, important enzymes that protect against
oxidative muscle injury.
[0184] In-Vivo Studies in Wild Mice and a Mouse Model of Muscular
Dystrophy
[0185] Wild type (i.e. normal) and delta sarcoglycan (8-SG) null
mice which develop muscular dystrophy were treated by oral gavage
for 30 days with epicatechin at 1 mg/kg twice a day, obtained from
Sigma-Aldrich, or with water only (Control). Quadriceps muscle
protein samples were analyzed by Western blots to assess for
changes in protein levels of the mitochondrial proteins porin,
mitofilin, complex V (CV), superoxide dismutase 2 (SOD2), and
catalase. In wild type mice, epicatechin treatment increases and in
8-SG null mice prevents the loss of mitochondrial proteins. In the
muscular dystrophy mice, epicatechin increased the protein
expression of both catalase and superoxide dismutase 2 in the heart
and quadriceps muscle, important enzymes that counter the damaging
effects of oxidation injury by decreasing the severity of oxidation
injury.
[0186] Delta sarcoglycan (8-SG) muscular dystrophy mice exhibit
reduced glutathione content (GSH, by using a Cayman Inc.
gluthatione assay kit) in quadriceps muscle, evidencing enhanced
tissue oxidative stress. Epicatechin treatment markedly increased
muscle GSH levels in both wild type mice and delta sarcoglycan
knock-out mice.
[0187] Delta sarcoglycan knock-out muscular dystrophy mice
demonstrated a marked increase in PGC 1a, a transcriptional factor
that regulates muscle repair and regeneration, and regulates
mitochondrial biogenesis, in skeletal muscle after treatment with
oral epicatechin, 1 mg/kg twice a day for 4 weeks.
[0188] In one experiment, elderly wild type mice (26 months) with
the muscle impairment of the elderly were treated for 2 weeks with
epicatechin, 1 mg/kg twice a day for two weeks. They also
demonstrated a significant increase in PGC1u in the skeletal
muscle, with a correlative increase in mitochondrial protein
expression.
[0189] In one experiment, mdx mice, characterized by the same
dystrophin mutation as is seen with Duchenne's muscular dystrophy,
were treated orally with epicatechin, 1 mg/kg twice a day for 4
weeks. They demonstrated an increase in muscle strength compared to
controls treated with water, as determined by a standard timed
hanging upside down test.
[0190] In the mouse myocyte cell line, C2C12, both (-) and (+)
epicatechin enantiomers stimulated the expression of PGC1u and
follistatin within 24 hr, consistent with activation of
transcriptional pathways regulating muscle regeneration and
expression of the muscle trophic hormone, follistatin.
[0191] Biomarkers
[0192] The induction of follistatin, a muscle growth hormone and
suppression of myostatin, an inhibitor of muscle growth, by
epicatechin in vitro and in vivo suggest that these proteins might
be useful biomarkers in monitoring the effects of epicatechin in
vivo. In diabetic patients with heart failure, the ratio of
follistatin to myostatin was measured and calculated before and
after treatment with epicatechin rich cocoa. There was a
statistically significant increase in the folistatin/myostatin
ratio associated with treatment, indicating an increase in
follistatin and a decrease in its natural antagonist,
myostatin.
[0193] Effect on Body Growth
[0194] SD rats of the body weight 50-60 g and age 3-4 weeks were
divided into 4 groups. Group A animals were part of vehicle control
group, Group B animals were administered Dexamethasone daily; Group
C animals were dosed Epicatechin 3 mg/kg followed by dosing of
Dexamethasone; Group D animals were dosed 10 mg/kg Epicatechin
followed by Dexamethasone. All dosing were by subcutaneous (SC)
mode of administration. Dosing of animals was continued for 36
days. Body weight was measured every alternate day, overall length
was measured weekly. Animals were photographed periodically to
further support data. Feed intake, general health and movement were
assessed routinely. On 37.sup.th day animals were sacrificed and
femur and tibia length were measured using Vernier Calipers. Blood
was collected and stored.
[0195] It has been confirmed that follistatin can have a beneficial
ameliorating effect on the decrease in body growth associated with
the inhibition of bone formation secondary to the toxicity of
corticosteroids, as shown in Table 1 below.
TABLE-US-00001 TABLES 1-3 Data on growth of 4-week rates on
dexamethasone with or without additional concurrent treatment with
epicatechin. Dex = 1.5 mpk Dex = 1 mpk Dex = 0.5 mpk WEIGHT (g) Day
1 Day 11 Day 23 Day 35 Rat. No Group Ind Avg Ind Avg Ind Avg Ind
Avg 1 CONTROL 58.2 61.2 123.9 132.3 211.2 220.7 302.8 318.4 2 64.2
140.7 230.2 333.9 3 DEX 55.4 59.3 91.1 89.1 88.0 85.7 103.9 96.1 4
57.7 84.3 80.0 93.1 5 64.8 91.9 89.0 91.5 6 DEX + EPI(3) 59.9 59.2
85.6 84.8 104.0 103.5 185.1 183.3 7 55.4 81.2 105.2 181.7 8 62.2
87.6 101.3 183.1 9 DEX + EPI(10) 54.6 60.3 76.9 86.1 93.3 103.8
189.4 199.3 10 65.9 95.3 114.3 209.1 Dex = 1.5 mpk Dex = 1 mpk Dex
= 0.5 mpk LENGTH (cm) Day 1 Day 13 Day 23 Day 35 Rat. No Group Ind
Avg Ind Avg Ind Avg Ind Avg 1 CONTROL #DIV/0! 17.4 17.1 18.0 18.3
21.5 20.8 2 16.7 18.5 20 3 DEX #DIV/0! 15.4 15.3 14.5 14.2 14.5
14.2 4 15.1 14.0 14 5 15.3 14.0 14 6 DEX + EPI(3) #DIV/0! 15.2 15.1
15.0 14.8 17.5 17.7 7 15.1 15.0 17.5 8 15.1 14.5 18 9 DEX + EPI(10)
#DIV/0! 14.5 14.9 15.5 15.5 18.5 18.8 10 15.2 15.5 19 Bone Length
(mm) Groups Femur Length (mm) Tibia Length (mm) Group 1 - Vehicle
Control 32.30 40.89 Group 2 - Dexas/c 22.68 28.67 Group 3 - Epi 1-3
MPK s/c 29.57 34.91 Group 4 - Epi 1-10 MPK s/c 31.30 35.37
* * * * *