U.S. patent application number 17/728601 was filed with the patent office on 2022-08-11 for compositions of nitrates and methods of use thereof.
The applicant listed for this patent is Heartbeet Ltd.. Invention is credited to Jon Lundberg, Eddie Weitzberg.
Application Number | 20220249544 17/728601 |
Document ID | / |
Family ID | |
Filed Date | 2022-08-11 |
United States Patent
Application |
20220249544 |
Kind Code |
A1 |
Lundberg; Jon ; et
al. |
August 11, 2022 |
COMPOSITIONS OF NITRATES AND METHODS OF USE THEREOF
Abstract
Inorganic anions nitrate and nitrite influence metabolic rate
and glucose homeostasis. Infusion of nitrite iv caused an acute
drop in resting energy expenditure (oxygen consumption) and
nitrate, when given perorally, caused a reduction in oxygen
consumption during exercise and a depression of the increase in
blood glucose observed after an oral glucose tolerance test. The
doses of nitrate and nitrite did not cause any detectable change in
methemoglobin levels of blood. Also, nitrate and nitrite did not
alter lactate levels in blood. This discovery provides useful
treatments to regulate the energy expenditure and glucose
homeostasis of a mammal by administration of inorganic nitrite
and/or nitrate.
Inventors: |
Lundberg; Jon; (Djursholm,
SE) ; Weitzberg; Eddie; (Stockholm, SE) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
Heartbeet Ltd. |
Ashbocking Ipswich |
|
GB |
|
|
Appl. No.: |
17/728601 |
Filed: |
April 25, 2022 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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17308007 |
May 4, 2021 |
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17728601 |
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17061321 |
Oct 1, 2020 |
11083747 |
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17308007 |
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15966508 |
Apr 30, 2018 |
10842813 |
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17061321 |
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12528794 |
Aug 26, 2009 |
10406118 |
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PCT/SE08/50212 |
Feb 26, 2008 |
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15966508 |
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14830937 |
Aug 20, 2015 |
10555968 |
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15966508 |
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12528798 |
Aug 26, 2009 |
9180140 |
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PCT/SE2008/050211 |
Feb 26, 2008 |
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14830937 |
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60919709 |
Mar 22, 2007 |
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International
Class: |
A61K 33/00 20060101
A61K033/00; A61K 31/375 20060101 A61K031/375; A61K 36/21 20060101
A61K036/21; A23L 33/105 20060101 A23L033/105; A61K 45/06 20060101
A61K045/06; A23L 33/135 20060101 A23L033/135; A23L 2/52 20060101
A23L002/52; A61K 9/00 20060101 A61K009/00; A61K 36/185 20060101
A61K036/185; A23L 33/16 20060101 A23L033/16; A23L 2/02 20060101
A23L002/02; A61K 33/30 20060101 A61K033/30; A61K 33/14 20060101
A61K033/14; A61K 31/05 20060101 A61K031/05; A61K 31/198 20060101
A61K031/198; A61P 9/12 20060101 A61P009/12; A61K 9/08 20060101
A61K009/08 |
Foreign Application Data
Date |
Code |
Application Number |
Feb 26, 2007 |
SE |
0700520-0 |
Mar 22, 2007 |
SE |
0700729-0 |
Claims
1. A method of reducing blood pressure in a human comprising orally
administering to the human a composition comprising an inorganic
nitrite (NO.sub.2.sup.-) and an acid.
2. The method of claim 1, wherein the administration of the
composition reduces systolic blood pressure and/or diastolic blood
pressure of the human.
3. The method of claim 1, wherein the acid is administered in the
form of juice or dried concentrate of a lemon, juice or dried
concentrate of a lime, ascorbic acid, acetic acid, or vinegar.
4. The method of claim 1, wherein the composition is a nutritional
supplement and further comprises at least one additive.
5. The method of claim 4, wherein the at least one additive is
selected from the group consisting of: natural flavor, artificial
flavor, sweetener, flavor enhancer, color additive, emulsifier,
stabilizer, fat, and preservative.
6. The method of claim 1, wherein the inorganic nitrite
(NO.sub.2.sup.-) is provided from a natural source.
7. The method of claim 6, wherein the natural source of the
inorganic nitrite (NO.sub.2.sup.-) is juice or dried concentrate
from at least one of spinach, lettuce, fennel, cabbage, Chinese
cabbage, and beetroot.
8. The method of claim 7, wherein the natural source of the
inorganic nitrite (NO.sub.2.sup.-) is juice or dried concentrate
from beetroot.
9. The method of claim 1, wherein the source of the inorganic
nitrite (NO.sub.2.sup.-) is in the form of a nitrite salt.
10. The method of claim 9, wherein the nitrite salt is selected
from the group consisting of: sodium nitrite, potassium nitrite,
calcium nitrite, zinc nitrite, ammonium nitrite, and arginine
nitrite.
11. The method of claim 1, wherein 0.1-100 umol inorganic nitrite
(NO.sub.2.sup.-) is administered per kg body weight of the
human.
12. The method of claim 1, wherein the composition is in the form
of a liquid, a paste, a gel, a bar, a cake, a powder, a granulate,
an effervescent tablet, a chewing gum, a tablet, a capsule, a
lozenge, a fast-melting tablet or wafer, a sublingual tablet, or a
spray.
13. The method of claim 12, wherein the administered composition is
in the form of a liquid with a pH of 5 or below.
14. The method of claim 13, wherein the liquid has a pH of between
4-5.
15. The method of claim 12, wherein the composition is a functional
food.
16. The method of claim 1, wherein the composition further
comprises a polyphenol.
17. The method of claim 16, wherein the polyphenol provided is from
at least one natural source selected from the group consisting of:
apple, pear, grapes, lemon, orange, lime, peach, pomegranate,
grapefruit, kiwi, ginger, pineapple, blackberries, black
raspberries, blueberries, cranberries, red raspberries, cherries,
bog wortleberry, lingonberries, black elderberry, black chokeberry,
black currant, cloudberries, strawberries, carrots, chili, rhubarb,
onions, cacao products, green tea, black tea, nuts, Yerba mate, and
coffee.
18. The method of claim 1, wherein the amount of the inorganic
nitrite (NO.sub.2.sup.-) is at least about 10% by weight or by
volume of the composition.
19. A method of decreasing systolic blood pressure comprising
orally administering to an adult human subject a composition
comprising inorganic nitrite (NO.sub.2.sup.-) and an acid.
20. The method of claim 19, wherein administration of the
composition also reduces diastolic blood pressure of the adult
human subject.
21. The method of claim 19, wherein the composition is in the form
of a liquid, a paste, a gel, a bar, a cake, a powder, a granulate,
an effervescent tablet, a chewing gum, a tablet, a capsule, a
lozenge, a fast-melting tablet or wafer, a sublingual tablet, or a
spray.
22. The method of claim 21, wherein the composition is a functional
food
23. The method of claim 19, wherein 0.1-100 umol inorganic nitrite
(NO.sub.2.sup.-) is administered per kg body weight of the adult
human subject.
24. The method of claim 19, wherein the composition is a
nutritional supplement and further comprises at least one
additive.
25. The method of claim 19, wherein the inorganic nitrite
(NO.sub.2.sup.-) is provided from a natural source.
26. The method of claim 25, wherein the natural source of the
inorganic nitrite (NO.sub.2.sup.-) is juice or dried concentrate
from beetroot.
27. The method of claim 19, wherein the inorganic nitrite
(NO.sub.2.sup.-) is a nitrite salt.
28. The method of claim 19, wherein the composition further
comprises a polyphenol.
29. The method of claim 28, wherein the polyphenol provided is from
at least one natural source selected from the group consisting of:
apple, pear, grapes, lemon, orange, lime, peach, pomegranate,
grapefruit, kiwi, ginger, pineapple, blackberries, black
raspberries, blueberries, cranberries, red raspberries, cherries,
bog wortleberry, lingonberries, black elderberry, black chokeberry,
black currant, cloudberries, strawberries, carrots, chili, rhubarb,
onions, cacao products, green tea, black tea, nuts, Yerba mate, and
coffee.
30. The method of claim 19, wherein the amount of the inorganic
nitrite (NO.sub.2.sup.-) is at least 50% by weight or by volume of
the composition.
Description
RELATED APPLICATIONS
[0001] This application is a continuation application of earlier
filed US. Utility Patent Application to Jon Lundberg and Eddie
Weitzberg, titled "Compositions of Nitrates and Methods of Use
Thereof," application Ser. No. 17/308,007, filed May 4, 2021, now
pending, which is a divisional application of earlier filed U.S.
Utility Patent Application to Jon Lundberg and Eddie Weitzberg,
titled "Compositions of Nitrates and Methods of Use Thereof,"
application Ser. No. 17/061,321, filed Oct. 1, 2020, now issued as
U.S. Pat. No. 11,083,747, which is a continuation application of
earlier U.S. Utility Patent Application to Jon Lundberg and Eddie
Weitzberg, titled "Compositions of Nitrates and Methods of Use
Thereof," application Ser. No. 15/966,508, filed Apr. 30, 2018, now
issued as U.S. Pat. No. 10,842,813, which is a continuation-in-part
application of earlier U.S. Utility Patent Application to Jon
Lundberg and Eddie Weitzberg, titled "Use of Nitrites and Nitrates
and Compositions Containing These," application Ser. No.
12/528,794, filed Jun. 17, 2013, now issued as U.S. Pat. No.
10,406,118, which is a national stage application of PCT
application No. PCT/SE08/50212, filed Feb. 26, 2008, which claims
the benefit of the filing date of U.S. Provisional Patent
Application 60/919,709 to Jon Lundberg and Eddie Weitzberg, filed
on Mar. 22, 2007, the disclosures of all of which being hereby
incorporated entirely herein by reference.
[0002] U.S. patent application Ser. No. 15/966,508 is also a
continuation-in-part application of earlier U.S. Utility Patent
Application to Jon Lundberg and Eddie Weitzberg, titled
"Performance Enhancing Compositions and Use Thereof," U.S. patent
application Ser. No. 14/830,937, filed Aug. 20, 2015, now issued as
U.S. Pat. No. 10,555,968, which is a continuation application of
U.S. patent application Ser. No. 12/528,798, filed Aug. 26, 2009,
now issued as U.S. Pat. No. 9,180,140, which was a national stage
application of PCT application No. PCT/SE 2008/050211, filed Feb.
26, 2008, which claims priority to Swedish Patent Application
0700520-0, which was filed Feb. 26, 2007, and Swedish Patent
Application 0700729-0, which was filed Mar. 22, 2007, the
disclosures of all of which being hereby incorporated entirely
herein by reference.
FIELD OF THE INVENTION
[0003] The present invention relates to the field of performance
enhancing nutritional foods and food supplements, including liquid
and solid edible products such as sport drinks, energy drinks and
energy bars. The present invention also relates to the field of
medicine and pharmaceuticals, in particular pharmaceuticals and
therapeutic methods for lowering metabolic rate, oxygen consumption
and/or glucose homeostasis in a human patient or another mammal,
based on the administration of nitrates and/or nitrites to said
patient or mammal.
BACKGROUND OF THE INVENTION
[0004] NO is involved in control of cellular respiration through
interaction with enzymes of the mitochondrial respiratory chain
(for review see MONCADA, S, et al. Does nitric oxide modulate
mitochondrial energy generation and apoptosis?. Nat Rev Mol Cell
Biol. 2002, vol. 3, no. 3, p. 214-20). The classical means by which
NO production occurs is the L-arginine pathway, where NO is
synthesized by specific enzymes, the NO-synthases. A fundamentally
different alternative way of generating NO has been described more
recently (LUNDBERG, J O, et al. Intragastric nitric oxide
production in humans: measurements in expelled air. Gut. 1994, vol.
35, no. 11, p. 1543-6; BENJAMIN, N, et al. Stomach NO synthesis.
Nature. 7 Apr. 1994, vol. 368, no. 6471, p. 502; ZWEIER, J L, et
al. Enzyme-independent formation of nitric oxide in biological
tissues. Nat Med. 1995, vol. 1, no. 8, p. 804-9; and WEITZBERG, E,
et al. Nonenzymatic nitric oxide production in humans. NO Biol.
Chem. 1998, no. 2, p. 1-7). In this NOS-independent pathway the
inorganic anions nitrate (NO3-) and nitrite (NO.sub.2--) are
reduced in vivo to form NO. Dietary nitrate (found mainly in green
leafy vegetables) (MCKNIGHT, G M. Chemical synthesis of nitric
oxide in the stomach from dietary nitrate in humans. Gut. 1997, no.
40, p. 211-214; and Weitzberg, 1998, supra) is absorbed from the
circulation by the salivary glands, secreted in saliva and partly
converted to nitrite in the oral cavity by nitrate reducing
bacteria. Swallowed nitrite can then enter the systemic
circulation. Indeed, a recent study shows that ingestion of nitrate
results in a sustained increase in circulating nitrite levels
(LUNDBERG, J O, et al. Inorganic nitrate is a possible source for
systemic generation of nitric oxide. Free Rad Bio Med. 2004, vol.
37, no. 3, p. 395-400). Further reduction of nitrite into bioactive
NO can occur spontaneously in acidic or reducing environments
(Benjamin et al. 1994, supra, Lundberg et al. 1994, supra) but is
also greatly enhanced by various proteins and enzymes including
deoxyhemoglobin in blood (COSBY, K, et al. Nitrite reduction to
nitric oxide by deoxyhemoglobin vasodilates the human circulation.
Nat Med. 2003, vol. 9, no. 12, p. 1498-505), deoxymyoglobin (SHIVA,
S. et al. Deoxymyoglobin is a Nitrite Reductase That Generates
Nitric Oxide and Regulates Mitochondrial Respiration. Circ Res. 9
Feb. 2007), xanthine oxidase (MILLAR, T M, et al. Xanthine
oxidoreductase catalyses the reduction of nitrates and nitrite to
nitric oxide under hypoxic conditions. FEBS Lett. 8 May 1998, vol.
427, no. 2, p. 225-8) and possibly by enzymes of the mitochondrial
respiratory chain (for review see LUNDBERG, J O, et al. Nitrate,
bacteria and human health. Nat Rev Microbiol. 2004, vol. 2, no. 7,
p. 593-602; LUNDBERG, J O, et al. NO generation from nitrite and
its role in vascular control. Arterioscler Thromb Vasc Biol. 2005,
vol. 25, no. 5, p. 915-22; and GLADWIN, M T, et al. The emerging
biology of the nitrite anion. Nat Chem. Biol. 2005, vol. 1, no. 6,
p. 308-14). NOS-independent NO production seems to complement the
endogenous NO production especially during ischemia and acidosis
when oxygen availability is low and the NO synthases operate poorly
(Zweier et al. 1995, supra; Weitzberg et al, 1998, supra; DURANSKI,
M R, et al. Cytoprotective effects of nitrite during in vivo
ischemia-reperfusion of the heart and liver. J Clin Invest. 2005,
vol. 115, no. 5, p. 1232-40; Lundberg et al, 2004, supra). Tissue
acidosis and relative hypoxia is present also during physical
exercise and in this metabolic state, bioactivation of nitrite is
likely enhanced.
[0005] Recent studies indicate that nitrate and nitrite can have
significant biological effects in the body and that these effects
may be beneficial (LUNDBERG, Jon O., et al. Nitrate, bacteria and
human health. Nat Rev Microbiol. 2004, no. 2, p. 593-602). For
example, the nitrite anion can cause vasodilatation at near
physiological concentrations when tested in vitro (MODIN, A., et
al. Nitrite-derived nitric oxide: a possible mediator of
`acidic-metabolic` vasodilation. Acta Physiol Scand. 2001, vol.
171, p. 9-16) or when infused intra-arterially to humans (COSBY,
K., et al. Nitrite reduction to nitric oxide by deoxyhemoglobin
vasodilates the human circulation. Nat Med. 2003, no. 9, p.
1498-505). Nitrate can be converted to nitrite in vivo in a process
dependent on commensal bacteria (SPIEGELHALDER, B., et al.
Influence of dietary nitrate on nitrite content of human saliva:
possible relevance to in vivo formation of N-nitroso compounds.
Food Cosmet Toxicol. 1976, no. 14, p. 545-548). When nitrate is
ingested, it is rapidly absorbed into blood and then accumulates in
saliva. In the oral cavity bacteria reduce parts of the dietary
nitrate to nitrite and nitrite can then enter the systemic
circulation. (LUNDBERG, Jon O., et al. Inorganic nitrate is a
possible source for systemic generation of nitric oxide. Free Radic
Biol Med. 2004, vol. 37, p. 395-400).
[0006] In vitro studies published in the 1990s show that NO is a
modulator of mitochondrial respiration via reversible inhibition of
cytochrome c oxidase (CARR, G J. et al. Nitric oxide formed by
nitrite reductase of Paracoccus denitrificans is sufficiently
stable to inhibit cytochrome oxidase activity and is reduced by its
reductase under aerobic conditions. Biochim Biophys Acta. 15 May
1990, vol. 1017, no. 1, p. 57-62.; BOLANOS, J P, et al. Nitric
oxide-mediated inhibition of the mitochondrial respiratory chain in
cultured astrocytes. J. Neurochem. 1994, vol. 63, no. 2, p. 910-6;
BROWN, G C, et al. Nanomolar concentrations of nitric oxide
reversibly inhibit synaptosomal respiration by competing with
oxygen at cytochrome oxidase. FEBS Lett. 19 Dec. 1994, vol. 356,
no. 2-3, p. 295-8; CLEETER, M W, et al. Reversible inhibition of
cytochrome c oxidase, the terminal enzyme of the mitochondrial
respiratory chain, by nitric oxide. Implications for
neurodegenerative diseases. FEBS Lett. 23 May 1994, vol. 345, no.
1, p. 50-4; and SCHWEIZER, M, et al. Nitric oxide potently and
reversibly deenergizes mitochondria at low oxygen tension. Biochem
Biophys Res Comm. 1994, no. 204, p. 169-75). NO may also interact
at other sites of the mitochondrial respiratory chain and in the
Krebs cycle (for review see Moncada, supra). While this important
action of NO has been very well characterized in cell cultures,
less is known about its physiological relevance in vivo. To date
the focus among researchers has been on the cardiovascular effects
of nitrite after its in vivo reduction to the vasodilator nitric
oxide (NO) (COSBY et al. (supra); DURANSKI, M. R., et al.
Cytoprotective effects of nitrite during in vivo
ischemia-reperfusion of the heart and liver. J Clin Invest. 2005,
vol. 115, p. 1232-1240; GLADWIN, M. T., et al. The emerging biology
of the nitrite anion. Nat Chem Biol. 2005, no. 1, p. 308-14;
LARSEN, F. J., et al. Effects of dietary nitrate on blood pressure
in healthy volunteers. N Engl J Med. 2006, vol. 355, p. 2792-3). WO
2005/004884 A (US GOVERNMENT ET AL.) 2005-01-20 and WO 2005/007173
A (US GOVERNMENT ET AL.) 2005-01-27 describe a method to administer
a nitrite salt specifically to obtain vasodilatation in a subject.
No effects of low-dose nitrate/nitrite on energy expenditure or
glucose homeostasis or the effects of NO on cellular respiration
during physical exercise have been described.
[0007] Physiological adaptation to exercise involves major
cardiovascular and metabolic changes. Oxygen consumption increases
dramatically in the active muscles with a parallel increase in
muscle blood flow. In these processes, the endogenous gas nitric
oxide (NO) plays an important regulatory role. NO increases blood
flow to the muscles and modulates muscular contraction and glucose
uptake (for review see STAMLER, J S. et al. Physiology of nitric
oxide in skeletal muscle. Physiol Rev. 2001, vol. 81, no. 1, p.
209-37).
[0008] The available information on the role of NO in healthy
subjects and in particular in athletes during work or exercise is
both insufficient and contradictory. Shen and colleagues showed
that administration of NOS-inhibitors in vivo during submaximal
exercise leads to increased oxygen consumption in dogs (SHEN, W. et
al. Role of NO in the regulation of oxygen consumption in conscious
dogs. Circulation Res. 1999, no. 84, p. 840-5) and Lacerda and
colleagues showed similar results in rats (LACERDA, A C R, et al.
Evidence that brain nitric oxide inhibition increases metabolic
cost of exercise, reducing running performance in rats.
Neuroscience Letters. 2006, no. 393, p. 260-3). The majority of
studies have been done using NOS-inhibitors while the effects of
administering exogenous NO on exercise are largely unknown. In
addition, studies in healthy humans are scarce.
[0009] Interestingly, the marketing of some currently available
food supplements for athletes and bodybuilders refer to the
vasodilatory effect of NO. One example is "NOX2" (Bodyonics, Ltd.,
USA), a product said to contain arginine alpha-ketoglutarate
(A-AKG) and arginine-ketoisocaproate (A-KIC) and allegedly capable
of boosting short term nitric oxide levels. Other products contain
L-arginine, from which NO is synthesized by the NOS enzymes, and
the beneficial effects of NO are often referred to, however without
offering more detailed explanations.
[0010] The relation between peak work rate and resting levels of
nitrate in plasma and urine from subjects with different levels of
physical fitness has been studied (Jungersten et al., Both physical
fitness and acute exercise regulate nitric oxide formation in
healthy humans. J Appl Physiol 82:760-764, 1997). A positive
relationship between physical fitness and formation of NO at rest
was found and it was hypothesized that this positive relationship
helps to explain the beneficial effects of physical exercise on
cardiovascular health. In Jungersten's study nitrate was used
solely as a marker of NO production and the authors state several
times that nitrate is a stable and inert end product of NO and that
it is biologically inactive.
[0011] Nitrate (NO3-) and nitrite (NO2-) are generally viewed as
unwanted residues in the food chain with potentially harmful
effects (Joint FAO/WHO Expert Committee on Food Additives (JECFA).
Safety Evaluation of Certain Food Additives. WHO, 1970. ISBN
9241660503; TANNENBAUM, S. R., et al. Nitrite in human saliva. Its
possible relationship to nitrosamine formation. J cancer Ins. 1974,
vol. 53, p. 79-84; BARTSCH, H., et al. Inhibitors of endogenous
nitrosation: mechanisms and implications in human cancer
prevention. Mutation Res. 1988, vol. 202, p. 307-324). Proposed
harmful effects of these anions include promotion of gastric
cancers and other malignancies and development of methemoglobinemia
in infants. Because of this the levels of nitrate/nitrite are
strictly regulated in food and drinking water.
SUMMARY OF THE INVENTION
[0012] Disclosed is a method of reducing blood pressure in a human
comprising orally administering to the human a composition
comprising an inorganic nitrite (NO2-) and an acid.
[0013] In some implementations, the administration of the
composition may reduce systolic blood pressure and/or diastolic
blood pressure of the human.
[0014] In some implementations, the acid may be administered in the
form of juice or dried concentrate of a lemon, juice or dried
concentrate of a lime, ascorbic acid, acetic acid, or vinegar.
[0015] In some implementations, the composition may be a
nutritional supplement that further comprises at least one
additive. The at least one additive is selected from the group
consisting of: natural flavor, artificial flavor, sweetener, flavor
enhancer, color additive, emulsifier, stabilizer, fat, and
preservative.
[0016] In some implementations, the inorganic nitrite (NO2-) may be
provided from a natural source. The natural source of the inorganic
nitrite (NO2-) is juice or dried concentrate from at least one of
spinach, lettuce, fennel, cabbage, Chinese cabbage, and beetroot.
The natural source of the inorganic nitrite (NO2-) may be juice or
dried concentrate from beetroot.
[0017] In some implementations, the source of the inorganic nitrite
(NO2-) may be in the form of a nitrite salt. The nitrite salt is
selected from the group consisting of: sodium nitrite, potassium
nitrite, calcium nitrite, zinc nitrite, ammonium nitrite, and
arginine nitrite.
[0018] In some implementations, 0.1-100 umol inorganic nitrite
(NO2-) may be administered per kg body weight of the human.
[0019] In some implementations, the composition may be in the form
of a liquid, a paste, a gel, a bar, a cake, a powder, a granulate,
an effervescent tablet, a chewing gum, a tablet, a capsule, a
lozenge, a fast-melting tablet or wafer, a sublingual tablet, or a
spray. The administered composition may be in the form of a liquid
with a pH of 5 or below. The liquid may have a pH of between 4-5.
The composition may be a functional food.
[0020] In some implementations, the composition may further
comprise a polyphenol. The polyphenol is from at least one natural
source selected from the group consisting of: apple, pear, grapes,
lemon, orange, lime, peach, pomegranate, grapefruit, kiwi, ginger,
pineapple, blackberries, black raspberries, blueberries,
cranberries, red raspberries, cherries, bog wortleberry,
lingonberries, black elderberry, black chokeberry, black currant,
cloudberries, strawberries, carrots, chili, rhubarb, onions, cacao
products, green tea, black tea, nuts, Yerba mate, and coffee.
[0021] In some implementations, the amount of the inorganic nitrite
(NO2-) may be at least about 10% by weight or by volume of the
composition.
[0022] Also disclosed is a method of decreasing systolic blood
pressure comprising orally administering to an adult human subject
a composition comprising inorganic nitrite (NO2-) and an acid.
[0023] In some implementations, the administration of the
composition may also reduce diastolic blood pressure of the adult
human subject.
[0024] In some implementations, the composition may be in the form
of a liquid, a paste, a gel, a bar, a cake, a powder, a granulate,
an effervescent tablet, a chewing gum, a tablet, a capsule, a
lozenge, a fast-melting tablet or wafer, a sublingual tablet, or a
spray. The composition may be a functional food
[0025] In some implementations, 0.1-100 umol inorganic nitrite
(NO2-) may be administered per kg body weight of the adult human
subject.
[0026] In some implementations, the composition may be a
nutritional supplement that further comprises at least one
additive.
[0027] In some implementations, the inorganic nitrite (NO2-) may be
provided from a natural source. The natural source of the inorganic
nitrite (NO2-) may be juice or dried concentrate from beetroot.
[0028] In some implementations, the inorganic nitrite (NO2-) may be
a nitrite salt.
[0029] In some implementations, the composition may further
comprise a polyphenol. The polyphenol is from at least one natural
source selected from the group consisting of: apple, pear, grapes,
lemon, orange, lime, peach, pomegranate, grapefruit, kiwi, ginger,
pineapple, blackberries, black raspberries, blueberries,
cranberries, red raspberries, cherries, bog wortleberry,
lingonberries, black elderberry, black chokeberry, black currant,
cloudberries, strawberries, carrots, chili, rhubarb, onions, cacao
products, green tea, black tea, nuts, Yerba mate, and coffee.
[0030] In some implementations, the amount of the inorganic nitrite
(NO2-) may be at least 50% by weight or by volume of the
composition.
[0031] Further implementations will become evident to the skilled
person upon study of the figures, description, and examples, as
well as the appended claims, incorporated herein by reference.
DESCRIPTION OF THE FIGURES
[0032] The invention will be described in closer detail in the
following description, examples, and non-limiting claims, with
reference to the attached drawings in which:
[0033] FIG. 1 shows a graph illustrating numerous ways in which the
combination of nitrate and polyphenols synergistically act to
increase the bioavailability of nitric oxide and at the same time
to reduce the formation of harmful compounds such as oxygen
radicals and nitrosamines. For detailed explanation see text.
[0034] FIG. 2 is a graph showing changes in oxygen consumption
(VO2) following iv infusion of sodium nitrite in increasing doses.
Nitrite was infused over a 10 min period in non-smoking healthy
male volunteers (30-70 years).
[0035] FIG. 3 is a graph showing the effects of a dietary
supplementation with sodium nitrate or sodium chloride (placebo) on
plasma concentrations of nitrite measured at rest and immediately
after exercise in 9 healthy male volunteers.
[0036] FIG. 4 is a bar diagram showing the oxygen consumption (VO2)
and heart rate (HR) measured at 6 different work rates after a
3-day dietary supplementation with sodium nitrate (0.1 mmol/kg body
weight/min, NIT) or an equal amount of sodium chloride (CON). The
study had a randomized double-blind cross-over design with a
washout period of at least 10 days between the tests. *
p.ltoreq.0.05, ** p.ltoreq.0.01.
[0037] FIG. 5 is a graph showing oxygen consumption during bicycle
exercise at 80% of VO2peak in 9 healthy male volunteers.
Measurements were made after a 3-day dietary supplementation with
sodium nitrate (0.1 mmol/kg body weight/day) or an equal amount of
sodium chloride (placebo). The difference between nitrate and
placebo periods was significant (p<0.01).
[0038] FIG. 6 is a bar diagram showing plasma lactate concentration
measured at 6 different work rates after dietary supplementation
with sodium nitrate (0.1 mmol/kg body weight/day for 3 days, filled
bars) or an equal amount of sodium chloride (placebo, empty
bars).
[0039] FIGS. 7a-7c consist of three graphs, showing changes in
blood glucose levels after an oral challenge with glucose for three
test subjects in a double-blind, placebo-controlled cross-over
study (FIGS. 7a, 7b and 7c). A standard oral glucose tolerance test
was performed. The subjects (healthy non-smoking volunteers) had
their diet supplemented for 3 days with either sodium chloride
(placebo) or sodium nitrate (Nitrate) at a dose of 0.1 mmol/kg body
weight/day.
[0040] FIG. 8 is a graph showing changes in blood glucose levels
after an oral challenge with glucose in 8 additional subjects in a
double-blind, placebo-controlled cross-over study. A standard oral
glucose tolerance test was performed. The subjects (healthy
non-smoking volunteers) had their diet supplemented for 3 days with
either sodium chloride (PLACEBO) or sodium nitrate (NITRATE) at a
dose of 0.1 mmol/kg/day. Data are presented as mean.+-.SEM.
[0041] FIG. 9 is a graph showing the effect of a two-week
intervention with beetroot juice (fresh juice 3-4 dl/day) on
systolic, diastolic and mean arterial (MAP) blood pressure in a
43-year-old male with hypertension.
[0042] FIG. 10 shows the plasma nitrate and nitrite concentrations
after intravenous infusion of nitrate. Panel a) shows plasma
nitrate concentration; panel b) shows plasma nitrite
concentrations; and panel c) shows plasma nitrite concentrations in
wild type (C57BL/6), germ free and knockout (eNOS) mice.
[0043] FIG. 11 is a graph showing enhanced post-ischemic blood flow
after nitrate infusion.
DETAILED DESCRIPTION
[0044] Before the present method and compositions are described in
the form of embodiments thereof, it is to be understood that this
invention is not limited to the particular configurations, method
steps, and materials disclosed herein as such configurations, steps
and materials may vary somewhat. It is also to be understood that
the terminology employed herein is used for the purpose of
describing particular embodiments only and is not intended to be
limiting since the scope of the present invention will be limited
only by the appended claims and equivalents thereof.
[0045] It must also be noted that, as used in this specification
and the appended claims, the singular forms "a," "an," and "the"
include plural referents unless the context clearly dictates
otherwise.
[0046] The term "about" when used in the context of numeric values
denotes an interval of accuracy, familiar and acceptable to a
person skilled in the art. Said interval can be +/-2% of the given
value, preferably +/-5%, and most preferably +/-10% of the numeric
values, where applicable.
[0047] The term "indirect calorimetry" is here defined as a method
for calculating heat that living organisms produce from their
production of carbon dioxide and nitrogen waste and from their
consumption of oxygen, well known to persons skilled in the
relevant art.
[0048] The term "catabolism" is defined as the metabolic process
that breaks down molecules into smaller units. It is made up of
degradative chemical reactions in the living cell.
[0049] The term "edible" in this context means non-toxic and
possible to ingest, however not limited to particular modes of
ingesting, such as drinking, chewing, applying to the oral cavity
in various forms, such as, for example a spray or aerosol.
[0050] The term "energy expenditure" is here defined as the amount
of energy expended for a certain metabolic rate.
[0051] The term "functional food" relates to any fresh or processed
food claimed to have a health-promoting and/or disease-preventing
property beyond the basic nutritional function of supplying
nutrients. Functional foods are sometimes called nutraceuticals.
The general category includes processed food made from functional
food ingredients, or fortified with health-promoting additives,
like "vitamin-enriched" products, and also, fresh foods (e.g.
vegetables) that have specific claims attached. Fermented foods
with live cultures are often also considered to be functional foods
with probiotic benefits.
[0052] The term "insulin resistance" is here defined as a condition
in which normal amounts of insulin are inadequate to produce a
normal insulin response from fat, muscle and liver cells.
[0053] The term "mammal" is intended to encompass all mammals, and
in particular humans, pets and agriculturally significant animals,
as well as animals used in competitions, such as horses and
dogs.
[0054] The term "metabolic syndrome" is here defined as a
combination of medical disorders that increase the risk for
cardiovascular disease and diabetes in a human. Symptoms and
feature include fasting hyperglycemia, diabetes mellitus type 2 or
impaired fasting glucose, impaired glucose tolerance or insulin
resistance, high blood pressure, central obesity, decreased HDL
cholesterol, elevated triglycerides and elevated uric acid
levels.
[0055] The term "metabolism" is used to define the complete set of
chemical reactions that occur in living cells and "metabolic rate"
is defined as the speed of metabolism of a mammal.
[0056] Methemoglobin is a form of hemoglobin in which the iron in
the heme group is in the Fe3+ state, not the Fe2+ of normal
hemoglobin. Methemoglobin is unable to carry oxygen.
Methemoglobinemia is defined as a blood disorder characterized by
the presence of a higher-than-normal level of methemoglobin in the
blood.
[0057] The term "oxygen consumption" is defined as the amount of
oxygen (02) consumed by a mammal and is usually expressed as ml of
pure oxygen consumed/min. "Oxygen consumption" relates to the
amount of oxygen consumed by a mammal as whole but also to oxygen
consumption in an isolated tissue or organ, such as, but not
limited to, heart, liver brain or other tissue exposed to
ischemia.
[0058] The term "performance enhancing food or food supplement"
includes sport drinks and energy drinks, as well as other liquid,
semi-solid or solid forms, such as energy bars and tablets. No
distinction is intended between sports drinks and energy drinks.
Sports drinks tend to be more isotonic while energy drinks tend to
contain more sugar and frequently also contain caffeine. Usually,
sports drinks are non-carbonated and frequently contain fructose or
other sugars, and complex carbohydrates, which are easily absorbed
by the body, and are designed to promote the availability of energy
and/or prevent or treat mild dehydration. Sport drinks also contain
electrolytes (mainly sodium and potassium salts) and nutrients
(proteins and amino acids). Sport drinks, energy drinks and other
liquid, semi-solid and solid products, while marketed for athletes,
are also consumed by non-athletes, as a snack, in situations where
extra energy and endurance is desired. It is currently believed
that improved sports performance can be attained by the intake of
so-called sport drinks.
[0059] The term "significant hypotension" means in this context an
acute reduction of systolic and/or diastolic blood pressure,
accompanied by clinical symptoms of hypotension such as dizziness,
nausea, pallor, loss of consciousness, etc. Said symptoms may occur
in various degrees, and it is preferred that they are entirely
avoided, minimized or eliminated as far as possible, or at least to
an extent that they are clinically insignificant.
[0060] The inventors have surprisingly shown that the metabolic
rate and/or the oxygen consumption can be influenced in a mammal
(locally or systemically), by administering inorganic nitrite
(NO2-) and/or nitrate (NO3-) to said mammal in an amount of nitrite
and/or nitrate sufficient to decrease oxygen consumption. The
decreased oxygen consumption is achieved without causing
significant hypotension and without causing any significant
increase of the methemoglobin level in said mammal. In case of
local reduction of the metabolic rate, the oxygen consumption is
decreased in an isolated tissue or organ such as the heart, liver,
brain or other tissue that is exposed to ischemia (a condition in
which blood flow, and thus oxygen, is restricted to a part of the
body). In such cases the interaction of reaction products
(including NO) of nitrite and/or nitrate with enzymes of the
mitochondrial respiratory chain and subsequent inhibition of
respiration leads to lowering of oxygen demand, which is beneficial
for an ischemic tissue. This effect resembles hibernation. Because
the generation of active nitrite and/or nitrate reaction products
is maximized in ischemic tissues the effect of oxygen consumption
will be most pronounced at these sites. In one particular
implementation, the oxygen consumption is lowered in the heart.
[0061] The inventors also showed that dietary supplementation with
inorganic nitrate results in a reduced VO2 during physical exercise
and a significant increase in muscular efficiency. These effects
occurred without any increase in plasma lactate.
[0062] In principle, also other additional approaches can lead to
increased systemic or local nitrite levels. The most obvious is to
administer nitrite or its precursor nitrate as such, but this may
be supplemented by or enhanced by increasing the gastric pH (e.g.
with an acid suppressive drug such as a proton pump inhibitor or H2
receptor antagonist or antacids) to maximize nitrite survival in
the stomach and thereby the systemic delivery of nitrite.
Alternatively, the administration of nitrite or nitrate can be
supplemented by or enhanced by interfering with the oral microflora
in order to maximize the number of nitrate reducing species. This
can be achieved through the delivery of "probiotic" nitrate
reducing bacteria or selective treatment with an antibiotic to
favor the nitrate reducing species.
[0063] The surprising finding that nitrite and its precursor
nitrate affects such vital physiological processes as metabolic
rate and/or oxygen consumption can be used therapeutically, e.g.,
in prophylaxis, alleviation or treatment of several conditions. In
an attempt to increase systemic nitrite levels, nitrite and/or
nitrate can be given by enteral administration (orally, in the form
of a liquid, semi-solid or solid preparation, such as a chewing
gum, tablet, lozenge, wafer, cake, bar or the like) or by
parenteral administration (intravenous, transdermal,
transcutaneous, by inhalation, rectally, vaginally, topical,
intraperitoneally, intra muscular, subcutaneous, sublingual or any
other way of parenteral administration). The nitrite and/or nitrate
comprising composition and possible further combinations described
herein can be administered continuously or as single bolus doses.
In some aspects, the inventors make available a composition,
preferably an edible composition, capable of enhancing performance
manifested as a reduced oxygen uptake (VO2) during physical
exercise when ingested by a mammal, wherein said composition
comprises inorganic nitrate and/or nitrite, and in particular a
composition wherein the effect of enhanced performance is
manifested as both a reduced oxygen uptake (VO2) during physical
work and a significant increase in muscular efficiency.
[0064] Composition
[0065] It is likely that an optimal dose-interval exists, meaning
that below a certain plasma level of nitrite the effects are
insufficient and, correspondingly, that over a certain level the
effect is lower and possibly accompanied by side effects. In one
embodiment, the composition comprising inorganic nitrite and/or
nitrate is a pharmaceutical composition comprising inorganic
nitrite and/or nitrate in an amount which is sufficient to decrease
oxygen consumption, but which does not increase the methemoglobin
level in a subject when administered to said subject in a
prescribed dose. Optionally the composition comprises another
pharmaceutically active compound.
[0066] According to a particular embodiment, said composition
comprises nitrite alone, without the presence of nitrate. According
to another embodiment, said composition in addition to nitrate
and/or nitrite, also comprises arginine.
[0067] According to one embodiment, nitrate and nitrite are given
in a dose ratio interval of about 5:1 to about 100:1
(nitrate:nitrite), such as 5:1, 10:1, 30:1, 50:1, 70:1 and 100:1.
Preferably the dose ratio is about 10:1. This will ensure acute
effects of the nitrite as soon as it is absorbed, and then provide
a sustained effect of the nitrate following its bioconversion into
nitrite.
[0068] Preferably the dose of nitrate is about 1-1000 umol sodium
nitrate/kg bodyweight/day. Correspondingly, the dose of nitrite is
preferably about 0.1-100 umol/kg bodyweight/day. More specifically,
for the use of a nitrate salt perorally, a dose of about 0.01-100
mmol/kg/24 h is currently preferred or more preferably a dose of
about 0.01-10 mmol/kg/24 h, even more preferably 0.1-1 mmol/kg/24
h. Correspondingly, the dose of nitrite is about 0.001-10
mmol/kg/24 h, preferably about 0.001-1 mmol/kg/24 h and more
preferably about 0.0001-0.1 mmol/kg/24 h.
[0069] Using intravenous administration, the nitrite is preferably
administered in a dose within the interval of about 0.01 to about
10000 nmoles/kg body weight/min, preferably about 0.01 to about
1000 nmoles/kg body weight/min, more preferably about 0.1 to about
100 nmoles/kg body weight/min, most preferably about 1 to about 20
nmoles/kg body weight/min. It is presently contemplated that the
most preferred dose is less than about 15 nmoles/kg body
weight/min. For comparison, it should be noted that the nitrite
dose used in the treatment of cyanide poisoning is about 100000
nmoles/kg body weight, or about 300-400 mg given as a single dose.
The nitrite can also be administered as one or more bolus doses,
preferably 0.01-100 umol/kg body weight, more preferably 0.1-10
umol/kg body weight, and even more preferably 0.1-2 umol/kg body
weight.
[0070] For the use of a nitrate salt perorally, a dose of about
0.01-100 mmol/kg body weight/24 h is currently preferred or more
preferably a dose of about 0.01-10 mmol/kg body weight/24 h, even
more preferably 0.1-1 mmol/kg body weight/24 h.
[0071] Importantly, the administered dose of nitrate or nitrite
should not induce production of more than about 10% methemoglobin,
preferably not more than about 5% methemoglobin, and more
preferably not more than about 2% methemoglobin. Most preferred is
that the dose of nitrate or nitrite does not induce any measurable
change in methemoglobin in the subject when administered or
ingested according to the prescribed dose.
[0072] Pharmaceutically acceptable salts of nitrate and nitrite
include but are not limited to sodium, potassium, calcium, zinc,
arginine and ammonium. Sodium and potassium salts are presently
most preferred.
[0073] The nitrite and nitrate salts may be of synthetic origin,
but may also be isolated from natural sources, such as naturally
nitrate containing plants, e.g., green leafy vegetables, examples
include, but are not limited to spinach, lettuce, fennel, cabbage,
Chinese cabbage and beetroot. Concentrates, such as juices or dried
concentrates of these and other nitrate-rich vegetables or fruits
are suitably used for the manufacture of food products (including
functional food products) or nutritional supplements according to
the present invention. In one preferred embodiment, the nitrate in
the inventive composition originates from beetroot (such as
beetroot juice). In yet another embodiment of the present invention
a nitrate and/or nitrite salt (for example potassium the natural
nitrate source includes a dried vegetable powder. In some aspects,
the dried vegetable powder is used in combination with licorice,
for example salty licorice (ammonium chloride).
[0074] Alternatively, the composition comprising nitrite and/or
nitrate is a nutritional supplement, an enteral nutritional
solution, an infant formula, a snack product or a parenteral
nutritional solution comprising inorganic nitrite and/or nitrate in
an amount which is sufficient to decrease oxygen consumption, but
which does not cause significant hypotension in a subject when
ingested by said subject in a prescribed dose.
[0075] The inventive composition preferably has the form of a
liquid, a paste, a bar, a cake, a powder, a granulate, an
effervescent tablet, a chewing gum, a tablet, a capsule, a lozenge,
a fast-melting tablet or wafer, a sublingual tablet or a spray.
Another composition is a nicotine-free smokeless tobacco and/or wet
snuff. Such products can be manufactured using conventional methods
practiced in the food and beverage industry, or in pharmaceutical
industry. More preferably said composition is in the form of, or
constitutes a part of, a food product, such as a liquid, a paste, a
bar, a cake, a powder, or a granulate.
[0076] According to a preferred embodiment, the composition
according to the invention is prepared as a fermented food product,
such as a yogurt or similar dairy or non-dairy product, comprising
a source of nitrate and/or nitrite in addition to live bacteria
capable of enhancing nitrate or nitrite reduction.
[0077] According to another embodiment, the composition is
presented to the market as a functional food product.
[0078] The present inventors consider presenting the composition to
the market in the form of a sport drink, an energy drink, a sport
bar, or an energy bar. The energy bar may take on a variety of
forms. For convenience, it is preferred that the energy food
product be shaped like a box, square, cylinder, string, pie,
sphere, triangle, or other format suitable for packaging,
transportation, handling and eating. For example, an energy bar
according to the present invention may include, in addition to
nitrate and optionally nitrite, also a variety of other components
such as, for example, nuts, crisps, fruit pieces, chocolate, seeds,
and the like. Preferred nuts are almonds, peanuts, hazelnuts,
cashews, walnuts, pecans, brazil nuts, and the like. Crisp
components include rice crisps, corn crisps, oats, wheat flakes,
and the like. The chocolate can be any type of chocolate or
chocolate like edible component in various forms, such as, for
example, chocolate chips, chunks, flakes and the like. Non-limiting
examples of seeds include sesame, sunflower, poppy, caraway, fennel
and the like.
[0079] Products comprising the inventive composition can easily be
manufactured by persons skilled in the food, sweets and beverage
industry or the pharmaceutical industry, and existing compositions
supplemented with nitrate, nitrite and other combinations described
herein in amounts according to this invention.
[0080] Additionally, traditional food ingredients such as flavors
and the like may be included. For example, additional ingredients
may include natural and artificial flavors, sweeteners, salt,
flavor enhancers, color additives, emulsifiers, stabilizers, fats,
preservatives, and the like.
[0081] In one embodiment of the present invention inorganic nitrite
and/or nitrate is administered or used in combination with a
polyphenol rich compound or product. Polyphenols are a group of
chemical substances found in plants, characterized by the presence
of more than one phenol group per molecule. Polyphenols are
generally further subdivided into hydrolysable tannins, which are
gallic acid esters of glucose and other sugars; and
phenylpropanoids, such as lignins, flavonoids, and condensed
tannins. In one embodiment of the present invention the inorganic
nitrite and/or nitrate is/are mixed with a compound that contains
high levels of polyphenols. It is contemplated that this
combination will have synergistic health promoting effects via
potentiation of NO bioavailability. In some aspects, the
combination of nitrite/nitrate and polyphenol rich compound or
product will act synergistically to enhance NO formation in the
body at the expense of detrimental compounds such as nitrosamines.
The beneficial effects of this includes a reduction in blood
pressure and platelet aggregation, reduced atherosclerosis, reduced
risk of myocardial infarction, stroke and other cardiovascular
disorders, reduced risk of cancer in any form. Polyphenols will
enhance NO generation by several separate mechanisms highlighted in
FIG. 1. First, such agents can directly stimulate endogenous NO
formation from NO synthase enzymes (1 in FIG. 1). Second, it is
contemplated that these compounds will enhance the reduction of
nitrite to bioactive NO due to the presence of reductive --OH
groups on the phenol ring (2 in FIG. 1). Third, by acting as
scavengers of free radicals such as superoxide, they prevent these
radicals from interacting with (and destroying) NO and thereby, NO
becomes more long-lived (3 in FIG. 1). In addition to this, nitrite
or its reaction products can interact with the polyphenol itself
and modify it chemically via nitration or nitrosation reactions (4a
in FIG. 1). The resulting compound can act as a long-lived NO donor
(4b in FIG. 1). An additional effect is that the presence of
polyphenols will divert the chemical reactions away from formation
of potentially carcinogenic nitrosamines (5 in FIG. 1). Nitrate's
reaction product nitrite can react with amines to form
nitrosamines, but polyphenols will inhibit this reaction by a dual
mechanism. First, they help to rapidly reduce HNO2 directly to NO
thereby minimizing the formation of nitrosating species (N2O3,
HNO2). Second, they can directly compete for nitrosation with the
amines by being nitrosated themselves.
[0082] The use of nitrite and/or nitrate or a combination of
nitrate and/or nitrite with polyphenols may also have beneficial
effects on the blood pressure. Thus, in one embodiment the present
invention relates to a method to reduce blood pressure, preferably
to normal levels (about 140/80 mmHg). Examples of nitrite and/or
nitrate sources are natural sources of nitrate (such as vegetables
as mentioned above or juices thereof) or salts of nitrite and/or
nitrate. In one particular embodiment beetroot or a juice thereof
is administered in order to reduce the blood pressure in a
mammal.
[0083] The ratio of nitrite/nitrate comprising composition to
polyphenol-rich compound should be chosen to obtain enough supply
of nitrate. The nitrite/nitrate comprising composition should
therefore be at least about 10%, preferably at least about 20%,
more preferably at least about 30%, even more preferably at least
about 40% and most preferably at least about 50% or even more.
Examples of polyphenol rich fruit or juices thereof include, but
are not limited to, apple, pear, grapes, lemon, orange, lime,
peach, pomegranate, grapefruit, kiwi, ginger and pineapple. Juice
from berries is also usable including from blackberries, black
raspberries, blueberries, cranberries, red raspberries, cherries,
bog wortleberry, lingonberries, black elderberry, black chokeberry,
black currant, cloudberries, and strawberries. Other natural
sources of polyphenols include vegetables such as carrots, chili,
rhubarb, and onions. In addition, cacao products (rich in
flavanols), green or black tea, nuts, Yerba mate and coffee are
rich in polyphenols.
[0084] In one preferred implementation, the nitrate in the
inventive composition originates from beetroot (such as beetroot
juice), which is blended with one or several polyphenol-rich
products. The ratio of beetroot juice to polyphenol-rich compound
should be chosen to obtain enough supply of nitrate and therefore
the beetroot juice part should be at least about 10%, preferably at
least about 20%, more preferably at least about 30%, even more
preferably at least about 40% and most preferably at least about
50%.
[0085] According to one implementation of the present invention the
dose of nitrite and/or nitrate or nitrite and/or nitrate together
with polyphenols is administered or manufactured as a chewing gum,
lozenge or pastille, wafer, cake, bar or the like which optionally
also comprises live non-pathogenic bacteria or some other
microorganism. These microorganisms may also be included in "dry
form" for example in tablets, capsules, bars, and alike. It can
also be administered or manufactured as a functional food product
or as a part of a functional food product.
[0086] Licorice is well known for its blood pressure elevating
effects and it is contemplated that the addition of nitrate/nitrite
alone or in combination with a polyphenol will counteract this via
the NO-mediated blood pressure lowering effect of these compounds.
In particular a salt such as potassium nitrate, sodium nitrate or
ammonium nitrate may be used to replace in part or in whole the
salt content (such as sodium chloride or ammonium chloride) of the
licorice product.
[0087] The purpose with the combination with non-pathogenic live
bacteria (e.g., the "probiotic" nitrate reducing bacteria) is to
further enhance the generation of bioactive compounds such as NO,
nitroso adducts or chemically related compounds. This enhancement
will occur locally in the gastrointestinal (GI) tract via
bacteria-dependent reduction of nitrate and nitrite to NO and other
bioactive nitrogen oxides. In particular, this combination will be
effective in treating and preventing GI disorders such as ulcers in
the stomach, duodenum, jejunum, caecum and colon/rectum. Also, it
is contemplated that this combined product will be effective in
treating and preventing inflammatory bowel disorders including
ulcerative colitis, Crohn's disease, microscopic colitis and other
forms. Irritable bowel disease (IBS) is another condition that
could be treated with said product. In addition, the compounds
formed can be absorbed systemically and have sustained biological
effects for example in reducing blood pressure and in preventing
atherosclerosis, cancer or any other effect related to enhance NO
release as discussed above. The composition with added bacteria can
be in the form of a drink such as a juice, yoghurt, a milk-based
drink or any other fermented food product. The composition with
added bacteria can also be included in different types of
functional food. Suitable bacteria are the so-called probiotic
bacteria, included but not limited to Lactobacilli (for example, L.
acidophilus, L. delbrueckii, L. helveticus, L. salivarius, L.
casei, L. curvatus, L. plantarum, L. sakei, L. brevis, L. buchneri,
L. fermentum, L. reuteri) and Bifidobacteria species (for example,
but not limited to, B. breve, B. bifidum, and B. lactis). Other
suitable non-pathogenic bacteria that enhance nitrate reduction or
nitrite reduction include e.g., Veillonella species, Staphylococcus
species, Actinomyces species, or Rothia species. The microorganisms
to be added to the composition may also be probiotic yeasts (such a
Saccharomyces boulardii).
[0088] In one embodiment, a low concentration of ethanol is added
to the inorganic nitrite and/or nitrate composition. In one
embodiment ethanol is used in combination with or administered
together with the inorganic nitrite and/or nitrate composition. It
has surprisingly been found that ethanol even in very low
concentrations can generate the potent vasodilator ethyl nitrite
following reaction with physiological amounts of nitrite. The
reaction is enhanced at acidic conditions such as in the gastric
lumen. It is contemplated that ingestion of nitrate will lead to
accumulation of nitrite in the saliva and the nitrite will react
with ethanol in the stomach thereby forming ethyl nitrite. For
example, if the inventive composition is in the form of a liquid
the ethanol content should be below about 5% (v/v), more preferably
below about 2% (v/v), and most preferable between about 0.5-1.5%
(v/v).
[0089] In one embodiment of the present invention a cacao product
such as dark chocolate that is rich in flavanols is combined with a
nitrate-rich natural compound in a drink or a chocolate bar. One
preferred nitrate-rich compound in this embodiment is rhubarb.
Again, the nitrate will potentiate the effect of the flavanols via
enhancement of NO formation as described above and in FIG. 1.
[0090] Contamination of a nitrate-containing food or drink with
unwanted bacteria may result in a large accumulation of nitrite,
due to nitrate reducing bacterial enzymes. Ingestion of high levels
of nitrite may cause potentially serious methemoglobinemia. In one
embodiment, a nitrate-rich composition is mixed with a compound
that inhibits unwanted bacterial growth. Such compound should be
chosen so as not to affect the taste of the product negatively.
Ideally, it should enhance the taste and at the same time increase
the bioactivity of the product. One option is to acidify the
inventive composition so that final pH is below about 5, and most
preferably between about pH 2-4. This will inhibit and/or abolish
bacterial growth. Suitable acidifying agents can be any agent that
reduces pH and include artificial compounds as well as natural
juices from e.g., but not limited to, lemon or lime, ascorbic acid,
acetic acid or vinegar (from apple, grapes or other fruits). It is
contemplated that with the use of natural products a dual effect is
achieved. Besides having an antibacterial effect, they are rich in
polyphenols, which enhance the generation of bioactive NO from
nitrate/nitrite in the vegetable drink. In one particular
implementation, a nitrate-rich vegetable juice (e.g., beetroot
juice) is mixed with a compound that inhibits undesirable bacterial
growth.
[0091] According to an embodiment of the invention, the nitrate and
nitrite salts are combined with other pharmaceuticals including but
not limited to: anti-diabetic drugs (insulin and oral
anti-diabetics), cardiovascular drugs (statins, ACE inhibitors,
beta-receptor antagonists, diuretics, angiotensin 2 receptor
antagonists, organic nitrates, calcium channel blockers) acid
secretion-inhibitors (proton pump inhibitors, Histamine-2 receptor
blockers), oral anti-diabetics including biguanides,
sulphonureides, alpha-glucosidase inhibitors, thiazolidinediones,
glinides; drugs for treatment of pulmonary hypertension including
prostacyclin analogues, endothelin receptor antagonists and
sildenafil.
[0092] According to one embodiment the nitrite is delivered
systemically via peroral treatment with an organic nitrate
including nitroglycerine or isosorbide mono/di-nitrate.
Nitroglycerine is used clinically to treat angina pectoris and it
acts by releasing vasodilatory nitric oxide systemically. However,
this drug must be given parenterally because the first passage
metabolism in the liver is considerable. Interestingly, it has been
found that the liver metabolism of nitroglycerine yields
predominantly nitrite. Considering the novel biological effects of
nitrite described here, nitroglycerine may therefore be used as a
"prodrug" of nitrite. Preferably the drug should then be given by
the enteral route (with liver metabolism) to maximize nitrite
generation while at the same time avoiding the acute vasodilatation
and drop in systemic blood pressure associated with iv or
sublingual administration of nitroglycerine. A suitable dose range
when giving nitroglycerine perorally is about 0.001 to 10 mol/kg/24
hours, preferably about 0.001 to 1 mol/kg/24 hours, more preferably
0.01 to about 0.1 mmol/kg/24 hours. The tablets should preferably
be coated to avoid absorption in the oral cavity.
[0093] According to one embodiment nitrite and/or nitrate is added
to parenteral and enteral feeding/nutrition solutions to be used in
adults, children, neonates, and prematures. Today such solutions
are generally extremely low in nitrate and nitrite as noted in
measurements performed by the present inventors (not shown). An
intubated mechanically ventilated patient with parenteral nutrition
is particularly deprived of nitrate/nitrite. First, these patients
do not produce and swallow saliva properly and thus one great
nitrate/nitrite source is disrupted. Secondly as stated above, the
feeding they receive contains almost no nitrate/nitrite. Many
intensive care patients suffer from metabolic disturbances, in
particular catabolism due to stress and trauma and their metabolic
rate is often increased. Moreover, insulin resistance is common and
glucose homeostasis is disturbed. Tight control of plasma glucose
by administering insulin is advocated in these patients. Also,
healthy subjects, such as infants or subjects taking enteral
solutions for other reasons can benefit from the compositions and
methods of the present invention. Enteral nutrition is thus meant
to include also infant formulas and other enteral products.
[0094] When given preoperatively, the amount of carbohydrates in
the drink will provide the patient with preferably about 200 kcal,
more preferably about 100 kcal and most preferably about 50 kcal.
For the use of a nitrate salt perorally, a dose of about 0.01-100
mmol/kg body weight/24 h is currently preferred or more preferably
a dose of about 0.01-10 mmol/kg body weight/24 h, even more
preferably 0.1-1 mmol/kg body weight/24 h.
[0095] Using intravenous administration preoperatively and/or
preoperatively, the nitrite is preferably administered in a dose
within the interval of about 0.01 to about 10 000 nmoles/kg body
weight/min, preferably about 0.01 to about 1000 nmoles/kg body
weight/min, more preferably about 0.1 to about 100 nmoles/kg body
weight/min, most preferably about 1 to about 20 nmoles/kg body
weight/min. It is presently contemplated that the most preferred
dose is less than about 15 nmoles/kg body weight/min.
Therapeutic Methods of Use
[0096] In one embodiment, provided herein are uses of nitrites
and/or nitrates, for the manufacture of pharmaceutical products,
enteral or parenteral nutritional solutions, preoperative
compositions, nutritional supplements, or functional food products
for administration to both healthy persons, such as athletes, or to
patients, suffering from one or more of the conditions exemplified
herein. Included in this embodiment are also possible combinations
of nitrites and/or nitrates with other compounds as mentioned
above.
[0097] In one embodiment, provided herein are methods for the
treatment, alleviation and/or prevention of clinical conditions,
comprising administering an effective amount of a nitrate and/or a
nitrite to a patient in need thereof sufficient to treat, alleviate
and/or prevent such condition.
[0098] There are many possible clinical conditions where such
treatment, alleviation and/or prevention is performed using nitrate
and/or nitrite according to the present invention: [0099] glucose
control in diabetes/prediabetes [0100] metabolic syndrome
[0101] The method and composition according to the invention also
has general therapeutic, alleviating and/or prophylactic effects in
patients under metabolic stress. Examples include but are not
limited to: [0102] intensive care patients [0103] patients
undergoing surgery [0104] patients suffering from malnutrition of
different genesis [0105] cancer with anorexia [0106] burn injury
[0107] trauma [0108] neonates/prematures [0109] anorexia nervosa
[0110] thyroid disorders (e.g. hyperthyreosis/hyperthyroidism)
[0111] myocardial infarction, cardiac arrest [0112] major systemic
disease with a catabolic state [0113] stress ulcers (gastric)
[0114] surgical gut anastomosis insufficiency [0115] fever [0081]
myocardial infarction and cardiac arrest [0116]
ischemia-reperfusion injury (MI, stroke, arterial insufficiency or
any other organ ischemia) [0117] sleep apnea syndrome [0118] septic
chock [0119] insufficient perfusion of the intestines
[0120] Patients treated in the ICU (intensive care unit) are often
subjected to severe metabolic stress due to trauma, infection, pain
and other pathological processes. Such patients are treated for
several reasons including but not limited to post-surgical
observation, trauma, bleeding, burn injury, brain injury, stroke,
diabetes, sepsis, septic shock, myocardial infarction, cardiac
arrest, arterial insufficiency or any other organ ischemia, chronic
obstructive pulmonary disease, asthma and other severe inflammatory
conditions, pulmonary hypertension, congestive heart failure,
pulmonary embolism. This results in varying degrees of catabolism
and resistance to insulin with a disturbed glucose handling. They
also often suffer from vascular endothelial dysfunction leading to
microcirculatory disturbances. As mentioned above these patients
are given only minute amounts of nitrate/nitrite in the enteral and
parenteral feeding and due to several reasons (sedation,
intubation) they have a disturbed enterosalivary circulation of
nitrate/nitrite compared to healthy people.
[0121] It is contemplated that addition of sufficient amounts of
nitrite and/or nitrate in the parenteral and/or enteral feeding to
patients treated in the intensive care unit, may alleviate or
prevent the aforementioned metabolic and circulatory disturbances
by decreasing the rate of metabolism, enhancing blood glucose
homeostasis and microcirculatory improvement.
[0122] Patients undergoing surgery are subjected to a varying
degree of surgical trauma. This triggers catabolic hormones like
cortisol, glucagon and adrenalin and such patients may develop
transient insulin resistance. Common clinical procedure involves
fasting in order to reduce gastric content, which could be
accidentally aspirated in the airways if the patient vomits or
regurgitates during anesthesia. Such fasting eliminates the intake
of nitrate/nitrite and it has been shown that systemic levels of
nitrate and nitrite are reduced after fasting. It is contemplated
that administration of nitrite and/or nitrate pre, per or
postoperatively will improve the metabolic situation (decreasing
the rate of metabolism, enhancing blood glucose homeostasis) in
surgical patients. Moreover, during the entire perioperative period
the patients are at higher risk for ischemic events due to
hypotension, hypoxia and microcirculatory disturbances. Such events
will initiate ischemia-reperfusion processes, which may injure
several organ systems within the body. It is contemplated that
prophylactic administration of nitrite and/or nitrate, either as a
preoperative drink containing nitrate and/or nitrite anions, a
suitable vegetable juice such as but not limited to beetroot juice
or by giving nitrate and/or nitrite via the parenteral route, will
reduce the negative effects of ischemia-reperfusion events during
surgery in several organs including but not limited to brain,
heart, lung, liver, kidney and skeletal muscle.
[0123] Ischemia-reperfusion injury during myocardial infarction is
a major problem in clinical care. State-of-the art treatment of
myocardial infarction includes reopening of occluded coronary
vessels by pharmacological means with thrombolytic agents and/or
percutaneous coronary intervention. It is considered that the
method and composition according to the invention will reduce
ischemia-reperfusion injury by increasing blood flow and by
altering mitochondrial function. From experiments in the present
application, it is also considered that during ischemia-reperfusion
nitrate and nitrite could reduce oxygen consumption possibly by a
"hibernating" effect on mitochondria. Another mechanism by which
nitrate and nitrite could ameliorate ischemia-reperfusion injury is
by reducing oxygen radical formation and cytochrome C release from
the mitochondria. The effect of nitrate and nitrite on
mitochondrial function is most likely mediated by nitric oxide (NO)
interacting with oxidative phosphorylation and/or s-nitrosylation
of protein complexes in the mitochondrial respiratory chain. It is
envisaged that the time point for administration of nitrate and/or
nitrite in relation to the myocardial infarction induced
ischemia-reperfusion injury will be effective both pre, per or post
injury. Both a pre- and post-conditioning effect of nitrate and/or
nitrite is considered which means that a patient can receive
treatment already in the ambulance on his/her way to the hospital,
at the hospital before and after reperfusion of the coronary
circulation, and at the ward. Also, patients at high risk of
developing a myocardial infarction (e.g., angina pectoris,
congestive heart failure) could be considered for prophylactic
treatment with the method and composition according to the
invention. After cardiac arrest and resuscitation systemic
ischemia-reperfusion injury develops involving several major organ
systems, including the brain. It is contemplated that nitrate
and/or nitrite is beneficial both given prophylactic to patients
with high risk for cardiac arrest and during resuscitation
procedures.
[0124] According to a preferred embodiment, the nitrate and/or
nitrite or any combination mentioned herein is/are also given
pre-operatively to patients scheduled to undergo surgery or
substantive, invasive examination procedures. In one particular
implementation, inorganic nitrite and/or nitrate are combined with
carbohydrates. Thus, such combinations include, but are not limited
to nitrate alone; nitrate and nitrite; nitrate, nitrite, and
carbohydrates; nitrate and carbohydrates; nitrite alone and nitrite
and carbohydrates. In addition, polyphenols may be added to any of
the aforementioned combinations. Any such combination can be
administered (in single or repeated doses) as a preoperative drink
or the like prior to surgery or intravenously prior or during
surgery. An appropriate time to administer such a preoperative
drink is between 72 and 2 hours before surgery. A combination of
nitrite and/or nitrate with carbohydrates may ameliorate insulin
resistance and ischemia/reperfusion injury common in the
preoperative and postoperative period. Examples of carbohydrates
include but are not limited to glucose, fructose, maltodextrin,
sucrose, lactose, galactose and mannose.
[0125] In patients suffering from arterial insufficiency, including
but not limited to intermittent claudication, pharmacological
treatment aims at improving blood flow in the affected limb(s) and
to stimulate angiogenesis to promote new vessel formation.
Phosphodiesterase inhibitors and growth factors have been studied
in clinical trials, but results are variable. Likewise, studies
with traditional NO donors such as organic nitrates have been less
successful. It is contemplated that the method and composition
according to the invention will positively stimulate both blood
flow and angiogenesis thereby improving the condition in these
patients. Treatment with nitrate/nitrite is attractive since it
will preferentially increase blood flow in the ischemic areas
without causing troublesome systemic effects such as hypotension,
which is a risk when using organic nitrates that dilate
non-selectively in most vascular beds. In addition, nitrite will
affect mitochondrial function as discussed above resulting in less
oxygen demand in the ischemic tissue.
[0126] In patients suffering from malnutrition, including but not
limited to cancer with anorexia, anorexia nervosa, gastrointestinal
disease, it is contemplated that the method and composition
according to the invention will have an anabolic effect and will
reduce oxygen consumption. It is contemplated that this effect is
achieved by improving mitochondrial efficiency and attenuating
mitochondrial uncoupling.
[0127] The method and composition according to the invention also
has general therapeutic effects in patients with erectile
dysfunction. In this condition, the endogenous NO system is
failing. Administration of nitrite and/or nitrate (and possible
combinations outlined above) will enhance NO formation locally in
the corpus cavernosum, thereby enhancing erection.
[0128] It is contemplated that the method and composition according
to the invention has general therapeutic, alleviating and/or
prophylactic effects in patients with gastritis and gastric ulcers
due to Helicobacter pylori infection, stress or side effects from
pharmacological treatment such as the use of Non-Steroidal
Anti-Inflammatory Drugs (NSAID). By improving gastric mucosal blood
flow, mucus generation and by anti-bacterial and anti-inflammatory
properties the method and composition will have beneficial effects
in these patients. In addition, unwanted side effects of treatment
with acetylsalicylic acid, NSAIDs or any other ulcerogenic drug in
other parts of the gastrointestinal tract (duodenum, small and
large intestines) are prevented by said method and composition.
[0129] A feared problem in surgery is gut anastomosis insufficiency
and insufficient perfusion of the intestines. New methods for
improving microcirculation in the anastomosis are constantly
investigated. It is contemplated that the method and composition
according to the invention will improve microcirculation in the
anastomosis, which will enhance the healing process. It is also
considered that the invention will improve circulation in
situations with insufficient perfusion of the intestines.
[0130] Patients with sleep apnea syndrome are at higher risk for
developing hypertension and other cardiovascular diseases.
Moreover, they are subjected to periods of hypoxia during sleep. It
is contemplated that the method and composition according to the
invention will protect against hypoxia-induced injury by improving
circulation and by reducing oxygen consumption possibly by a
"hibernating" effect on mitochondria. Other mechanism by which said
method and composition could have protective effects is by reducing
oxygen radical formation and cytochrome C release from the
mitochondria. The effect of nitrate and nitrite on mitochondrial
function is most likely mediated by nitric oxide (NO) interacting
with oxidative phosphorylation and/or s-nitrosylation of complexes
in the mitochondrial respiratory chain.
[0131] The method and composition according to the invention has
general therapeutic, alleviating and/or prophylactic effects also
in patients with pathological conditions characterized by low
oxygen availability, including but not limited to chronic
obstructive airway disease (COPD), inflammatory airway disease such
as asthma, pulmonary hypertension, congestive heart disease,
interstitial lung disease, pulmonary embolism, ischemic heart
disease, peripheral artery disease, sleep apnea syndrome,
myocardial infarction and systemic inflammatory disorders. In these
conditions, addition of oxygen promptly improves arterial
oxygenation and total body oxygen delivery. For technical and
safety reasons, it is complicated to administer oxygen outside
hospital facilities. Another way to improve the situation for these
patients is to reduce the need for oxygen. The method and
composition according to the invention lead to reduced oxygen cost
in relation to the physical work performed. This highly surprising
finding is especially relevant in the patients with the
aforementioned conditions since oxygen availability is the limiting
factor for physical activity. It is envisaged that the method and
composition according to the invention will facilitate physical
activity in these patient groups.
[0132] In one preferred embodiment nitrate and/or nitrite is given
to patients with a pathological condition characterized by low
oxygen availability. In such situations, it is desirable to reduce
the tissues need for oxygen to prevent sequele and symptoms
associated with the hypoxia. Examples include patients with COPD
whose pulmonary oxygen uptake may be severely compromised and
patients with peripheral artery disease where oxygen delivery to
the tissues is reduced.
[0133] Non-Therapeutic Effects and Methods of Use
[0134] The inventive method and composition are also useful for
healthy subjects, e.g., athletes. The inventive method and
composition provide for less oxygen demand at a certain workload
and improves anabolism. The method and composition are also useful
for oxygen sparing at high altitude, for example in work and sports
performed in a low oxygen environment, such as but not limited to
rescue activities, firefighting, military operations, diving,
mountain climbing, high-altitude flying, and the exploration of
space.
[0135] The present method and composition are also useful in solid
organ or tissue transplantation, in order to minimize metabolic
demand of the donated organ before transplantation, and to improve
survival of the transplanted organ or tissue after transplantation.
Nitrite and/or nitrate or any combination mentioned herein is/are
given either into the organ or tissue by perfusion, topically on
the organ or tissue and/or systemically to the donor before
transplantation, and into the organ or tissue by perfusion or
topically on the organ or tissue and/or systemically to the
receiver after transplantation.
[0136] In one preferred implementation nitrate and/or nitrite or
any combination mentioned herein is/are given to patients that are
at risk of developing significant metabolic stress. Such situations
include many of the conditions listed above including surgical
stress and trauma. Oxygen demand and consumption increases
dramatically during stress. Thus, an improved situation is achieved
by decreasing the oxygen demand in these patients. According to one
preferred embodiment nitrate and/or nitrite is given to patients to
prevent the sequele associated with physiologic or traumatic
stress. Examples include patients that come into the emergency room
after trauma or patients undergoing major surgery.
[0137] To the best of the knowledge of the inventors, this is the
first study to examine the effects of dietary nitrate on the
cardiopulmonary and metabolic response to exercise. The main
finding was that dietary supplementation with inorganic nitrate, in
an amount which does not cause significant hypotension and without
any significant increase in methemoglobin and plasma lactate,
results in a reduced VO2 during submaximal work and a significant
increase in muscular efficiency. These effects occurred without any
changes in VO2peak values or maximal attainable work rate. Thus,
the present invention also makes available a second non-medical use
of inorganic nitrate and/or nitrite, i.e., for the manufacture of a
composition for enhancing the performance of a mammal wherein the
effect of enhancing performance is manifested as reduced VO2 during
physical exercise. Preferably the effect of enhancing performance
is manifested as both a reduced VO2 during physical exercise and a
significant increase in muscular efficiency.
[0138] Accordingly, in one implementation, the inventors make
available a method for non-therapeutically enhancing the
performance of a mammal, wherein inorganic nitrate and/or nitrite
is administered to said mammal. Said mammal is chosen among a
human, a horse, or a dog, preferably a human.
[0139] According to one particular implementation, only nitrite is
administered.
[0140] Without wishing to be bound by theory, the inventors
consider that there is reason to believe that the observed effects
involve initial reduction of nitrate to nitrite. Nitrate itself is
believed to be biologically inert and cannot be metabolized by
mammalian cells. However, after ingestion nitrate re-enters into
the mouth via the salivary glands and is effectively reduced by
commensal bacteria thereby forming nitrite. In contrast to nitrate
the nitrite ion has recently been shown to possess a wide range of
bioactivities. In the present study, the inventors did indeed note
an increase in plasma nitrite after the nitrate treatment period
thereby confirming in vivo reduction of nitrate as described
previously. Another finding in support of nitrite being bioactive
was its effective consumption during exercise in contrast to the
unchanged levels of plasma nitrate. Ultimately the bioactivity of
nitrite is likely related to its further reduction to NO and
possibly other closely related nitrogen intermediates. In addition,
it has been recently suggested that nitrite itself may directly
affect cellular signaling pathways. Although probably unlikely, at
this stage effects of the nitrate ion itself cannot be excluded.
There are several principal ways by which biological effects of
nitrogen oxides may be propagated including activation of cGMP,
alteration of protein function by a nitrosylation/nitration or
direct binding to protein heme-moieties of several proteins as in
the prototypic activation of guanylyl cyclase by NO. In addition,
nitrite itself may also directly affect cellular signaling
pathways.
[0141] If the effects proceed via nitrate reduction to nitrite and
then NO formation, how could this then explain the present results?
Earlier studies using NOS inhibitors to block endogenous NO
production give some indications. NOS-inhibition has been shown to
increase submaximal VO2 in dogs during exercise, independently of
the reduction in blood flow. This increase in VO2 during
NOS-blockade has been linked to the fact that NO affects tissue
respiration in vitro by reversible inhibition of the respiratory
enzyme cytochrome c oxidase. Others have related the increased VO2
during NOS-blockade to an inhibiting effect of NO on proton leakage
via the mitochondrial permeability transition pore (mPTP) were a
considerable number of protons leak over the inner mitochondrial
membrane. If the effects of nitrate were solely due to inhibition
of cytochrome c oxidase (thereby inhibiting oxidative
phosphorylation) one would expect an increase in anaerobic
metabolism during physical exercise and a larger accumulation of
lactate. However, judging from the results this was not the case,
as the plasma lactate concentration was near identical after
nitrate supplementation compared to placebo.
[0142] The finding that the oxygen pulse at a given work rate
decreases by nitrate supplementation is a direct effect of the
lower oxygen demand at that work rate. However, there is no
difference in oxygen pulse at a given absolute oxygen uptake. The
lack of effect of nitrate on VE/VO2 or oxygen pulse indicates that
the improved efficiency originates from muscular or mitochondrial
adaptations rather than from central adaptations in the heart or
the lungs.
[0143] There is reason to believe that the observed effects of
nitrate on physical performance involve initial reduction of
nitrate to nitrite. Nitrate itself is believed to be biologically
inert and cannot be metabolised by mammalian cells. However, after
ingestion nitrate re-enters into the mouth via the salivary glands
and is effectively reduced by commensal bacteria thereby forming
nitrite. In contrast to nitrate the nitrite ion has recently been
shown to possess a wide range of bioactivities.
[0144] The inventors noted an increase in plasma nitrite after the
nitrate treatment period thereby confirming in vivo reduction of
nitrate as described previously (Lundberg & Govoni 2004,
LARSEN, F J, et al. Effects of dietary nitrate on blood pressure in
healthy volunteers. N Engl J Med. 2006, vol. 255, no. 26, p.
2792-3). Another finding in support of nitrite being bioactive was
its effective consumption during exercise in contrast to the
unchanged levels of plasma nitrate. Ultimately the bioactivity of
nitrite is likely related to its further reduction to NO and
possibly other closely related nitrogen intermediates. In addition,
it has been recently suggested that nitrite itself may directly
affect cellular signalling pathways (BRYAN, N S, et al. Nitrite is
a signaling molecule and regulator of gene expression in mammalian
tissues. Nat Chem Biol. 2006, vol. 1, no. 5, p. 290-7). Although
probably unlikely, at this early stage, effects of the nitrate ion
itself cannot be excluded. There are several principal ways by
which biological effects of nitrogen oxides may be propagated
including alteration of protein function by nitrosylation,
nitration or direct binding to protein heme-moieties as in the
prototypic activation of guanylyl cyclase by NO.
[0145] Earlier studies using NOS inhibitors to block endogenous NO
production give some indications. NOS-inhibition has been shown to
increase submaximal VO2 in dogs during exercise, independently of
the reduction in blood flow (SHEN, W. et al. Nitric oxide. An
important signaling mechanism between vascular endothelium and
parenchymal cells in the regulation of oxygen consumption.
Circulation. 15 Dec. 1995, vol. 92, no. 12, p. 3505-12., ISHIBASHI,
Y, et al. ATP-sensitive K+-channels, adenosine and NO-mediated
mechanisms account for coronary vasodilation during exercise.
Circulation Res. 1998, no. 82, p. 346-359.; Shen et al. 1999,
supra). The increase in VO2 during NOS-blockade has been explained
by the fact that NO affects tissue respiration by reversible
inhibition of the respiratory enzyme cytochrome c oxidase (Carr
& Ferguson 1990, supra; Bolanos et al. 1994, supra; Brown &
Cooper 1994, Cleeter et al. 1994, Schweizer & Richter 1994).
Others have related the increased VO2 during NOS-blockade to an
inhibiting effect of NO on proton leakage over the inner
mitochondrial membrane (BOHUSLAVS'KYI, A, et al. Effect of nitric
oxide on the efficiency of oxygen consumption by the working
skeletal muscle in fatigue. Fiziol Zh. 2005, vol. 51, no. 1, p.
33-42; NAVET, R, et al. Proton leak induced by reactive oxygen
species produced during in vitro anoxia/reoxygenation in rat
skeletal muscle mitochondria. J Bioenerg Biomembr. 2006, vol. 38,
no. 1, p. 23-32; WANG, G, et al. Nitric oxide donors protect murine
myocardium against infarction via modulation of mitochondrial
permeability transition. Am J Physiol Heart Circ Physiol. 2005,
vol. 288, no. 3, p. 1290-5). If the effects of nitrate were solely
due to inhibition of cytochrome c oxidase one would expect an
increase in anaerobic metabolism during physical exercise and a
larger accumulation of lactate. However, judging from the results
this was not the case, as the plasma lactate concentration was near
identical after nitrate supplementation compared to placebo. The
inventors consider this to be very surprising.
[0146] The studies using NOS inhibitors cited above all imply that
endogenous NO is involved in regulation of oxygen consumption but
there have been few attempts to study the effect of exogenous NO
delivery. Studies with NO-donors such as nitroprusside and
nitroglycerine have shown somewhat diverging results, with
decreases in VO2 in some cases (RECCHIA, F A, et al. Nitric oxide
controls cardiac substrate utilization in the conscious dog.
Cardiovasc Res. 1999, no. 44, p. 325-32; LOKE, K E, et al. Nitric
oxide modulates mitochondrial respiration in failing human heart.
Circulation. 21 Sep. 1999, vol. 100, no. 12, p. 1291-7), no effect
in one study (NUNEZ, C, et al. Discrepancies between nitroglycerine
and NO-releasing drugs on mitochondrial oxygen consumption,
vasoactivity, and the release of NO. Circ Res. 11 Nov. 2005, vol.
97, no. 10, p. 1063-9) and increases in other settings (DE BACKER,
D, et al. Effects of dobutamine on the relationship between oxygen
consumption and delivery in healthy volunteers: comparison with
sodium nitroprusside. Clin Sci (Lond). 1996, vol. 90, no. 2, p.
105-11).
[0147] Several of the proposed mechanisms for nitrite reduction to
NO described above could theoretically come into play during
physical exercise. Thus, all these pathways are greatly enhanced
during hypoxia and when pH decreases such as in a working muscle.
Shiva and colleagues very recently demonstrated
deoxymyoglobin-dependent nitrite reduction to NO in rat heart
homogenates with a concomitant inhibition of mitochondrial
respiration (Shiva et al 2007, supra). Another possible pathway
includes NO formation by the mitochondria themselves (KOZLOV, A V,
et al. Nitrite reductase activity is a novel function of mammalian
mitochondria. FEBS Lett. 2 Jul. 1999, vol. 454, no. 1-2, p. 127-30)
or even simple acidic reduction of nitrite in the working muscle
(Zweier et al. 1995, supra, MODIN, A, et al. Nitrite-derived nitric
oxide: a possible mediator of `acidic-metabolic` vasodilation. Acta
Physiol Scand. 2001, vol. 171, no. 1, p. 9-16). Cosby and
colleagues described NO formation and vasodilation from the
reaction of circulating nitrite ions with deoxyhemoglobin in blood
(COSBY, K, et al. Nitrite reduction to nitric oxide by
deoxyhemoglobin vasodilates the human circulation. Nat. Med. 2003,
vol. 9, no. 12, p. 1498-505). While this latter pathway, and
possibly also tissue nitrite reduction, very well might explain the
recently described nitrate-induced reduction in resting blood
pressure (Larsen et al. 2006), it is still not obvious how this NO
also would decrease oxygen consumption in the working muscle. Thus,
an effective inhibition of mitochondrial respiration e.g., by
deoxymyoglobin-derived NO, would again be expected to result in
accumulation of plasma lactate which was not the case.
[0148] The efficiency of the muscles to produce work has been
related to the percentage of type I muscle fibres (COYLE, E F, et
al. Cycling efficiency is related to the percentage of type I
muscle fibers. Med Sci Sports Exerc. 1992, vol. 24, no. 7, p.
782-8) and uncoupling protein-3 (UCP3) content of muscle fibres
(MOGENSEN, M, et al. Cycling efficiency in humans is related to low
UCP3 content and to type I fibers but not to mitochondrial
efficiency. J Physiol. 2006, vol. 571, no. 3, p. 669-681). Other
factors that might contribute to the efficiency of movement are
anatomical, biochemical and biomechanical features (WILLIAMS, K R.
The relationship between mechanical and physiological energy
estimates. Med Sci Sports Exerc. 1985, no. 17, p. 317-25). Thus,
simply measuring differences in VO2 at different work rates is not
an optimal estimate of muscular efficiency because the energy
output for a certain VO2 is dependent upon substrate utilization.
Gross efficiency (GE) calculations include possible changes in
respiratory exchange ratio and thereby take substrate utilization
into account. The improved GE after nitrate supplementation
indicates better efficiency, but even so, it cannot be excluded
that this improved efficiency originates from reduced baseline
energy expenditure (EE). The Delta efficiency (DE) calculations are
not dependent on the baseline EE and are also based on all work
rates taken together instead of a single work rate at a time as in
the GE-calculations. It is therefore plausible to expect DE to be
the most valid estimate of muscular efficiency in this case.
Indeed, even DE was significantly improved after nitrate
supplementation. It is unlikely that the improved efficiency by
nitrate comes from mechanical factors. The subjects of this study
were all cyclists with many years of experience of training and
competing. It is improbable that a few visits to the laboratory
would change their efficiency during cycling to any noteworthy
extent. Especially since the subjects used the same cycling shoes,
clip-on pedals and the same seat position as they were used to
during training makes this even more unlikely. More important, the
randomization procedure used in this study rules out any such
differences. Marcheal and Gailly (MARCHEAL, G, et al. Effects of
nitric oxide on the contraction of skeletal muscle. Cell Mol Life
Sci. 1999, no. 55, p. 1088-1102) demonstrated a faster relaxing
velocity of muscle fibres in in situ experiments during
administration of an NO-donor, thereby implicating a neuromuscular
modulatory effect of NO. It remains to be proven if this can
improve the muscular efficiency during cycling.
[0149] The finding that the oxygen pulse at a given work rate
decreases by nitrate supplementation is a direct effect of the
lower oxygen demand at that work rate. However, there is no
difference in oxygen pulse at a given absolute oxygen uptake. The
lack of effect of nitrate on VE/VO2 or oxygen pulse indicates that
the improved efficiency originates from muscular or mitochondrial
adaptations rather than from central adaptations in the heart or
the lungs.
[0150] In summary, the present findings demonstrate a lower oxygen
cost during submaximal work after dietary supplementation with
nitrate, in amounts achievable through the intake of a non-toxic
amount of nitrite. This occurred without an accompanying increase
in plasma lactate, indicating that the energy production had become
more efficient. The mechanism of action and main targets need to be
clarified but the process likely involves in vivo reduction of
nitrate into bioactive nitrogen oxides including nitrite and
NO.
Examples
[0151] Although the invention has been described with regard to its
preferred embodiments, which constitute the best mode presently
known to the inventors, it should be understood that various
changes and modifications as would be obvious to one having the
ordinary skill in this art may be made without departing from the
scope of the invention as set forth in the claims appended
[0152] The present inventors have been studying the effects of
nitrate and nitrite on various physiological functions including
blood pressure, glucose metabolism and energy expenditure in vivo.
In the examples below, unless otherwise noted, nitrate was
administered perorally and nitrite was administered intravenously
(iv). Oxygen consumption was measured using indirect
calorimetry.
1. Intravenous Sodium Nitrite and Resting Energy Expenditure
[0153] Resting energy expenditure (as measured by indirect
calorimetry) is reduced by 10-25% after 10 min of iv infusion of
sodium nitrite (n=4, FIG. 3). Prior to the test the subjects had
been on a diet low in nitrate for one day and had been fasting for
at least 8 h. The major drop in energy expenditure was seen when
infusing nitrite at a concentration of 10 nmoles/kg body weight/min
for 10 minutes. At 1 nmol/kg body weight/min no obvious effects
were noted during the 10 min observation period and after 100
nmol/kg body weight/min no further decrease in oxygen consumption
was noted as compared to the 10 nmol dose. In separate experiments
(n=2) the present inventors noted an increase in plasma nitrite
from 140-165 nM to 370-480 nM after the 10 nmol/kg body weight/min
infusion (10 min infusion). Basal levels of methemoglobin were
1.1-1.3 mmol/1 and did not change significantly after infusion of
nitrite (1.1-1.4 mmol/1) See FIG. 2.
2. Oral Sodium Nitrate and Oxygen Consumption During Exercise
[0154] A. Methods
[0155] Subjects: Nine healthy, well trained (VO2peak 55.+-.3.7
ml.times.kg-1.times.min-1), males (28.+-.6 years) volunteered for
the study. All subjects were trained cyclists or triathletes and
well accustomed to the testing procedure. It was chosen to use
well-trained subjects to avoid training effects from the tests such
as enhanced VO2peak or better mechanical efficiency during
submaximal exercise. The protocol was approved by the regional
ethics committee in Stockholm and all subjects gave their written
consent prior to participation.
[0156] Dietary supplementation with nitrate: The aim with the
present study was to investigate the effects of two distinct
dietary patterns, one with higher, and one with lower-than-normal
nitrate intake. The study had a double-blind placebo-controlled
crossover design. During two three-day periods, separated by a
washout interval of ten days, the subjects were instructed to avoid
all foods with moderate or high nitrate content (all vegetables,
all cured meats, strawberries, grapes, and tea). In addition, they
were told to restrain from alcohol and tobacco products. Otherwise,
they were free to eat any food they liked during the three days of
restricted diet. The subjects were randomized to start with either
ingestion of 0.1 mmol sodium nitrate/kg body weight/day dissolved
in water or an equal amount of sodium chloride (placebo). The daily
dose was divided and ingested three times daily. The different
solutions could not be distinguished by taste or appearance. The
daily nitrate dose corresponded to the amount normally found in
150-250 gram of a nitrate-rich vegetable such as spinach, lettuce
or beetroot. The last dose of nitrate or placebo was ingested in
the morning on the day of measurement (see the main tests below).
The order between the nitrate supplementation period (NIT) and the
placebo period (CON) was balanced. During the washout period the
subjects did not adhere to any specific dietary regime.
[0157] Experimental protocol: Measurements were carried out on an
electrically braked cycle ergometer (Monark 839E, Varberg, Sweden)
that was modified with a racing saddle and the pedal system the
subjects were familiar with from training. The bicycle ergometer
was computer-controlled, permitting a constant work rate regardless
of the cadence the subject chose to pedal with. The pedaling
cadence was individually chosen in the range of 70-90 rpm but kept
constant during the test to minimize differences in work output due
to changes in muscle recruitment patterns.
[0158] Pulmonary ventilation (VE), oxygen uptake (VO2), CO2 output
(VCO2) and respiratory exchange ratio (RER) were measured at 10
second intervals by a computerized gas analyzer (AMIS 2001, Odense,
Denmark) connected to a flow meter which the subjects breathed
through via a mouthpiece and a plastic tube. Heart rate (HR) was
continuously recorded during the tests with a portable heart rate
monitor (Polar 5610, Polar, Kempele, Finland). Capillary blood
samples (20 .mu.l) were collected from the fingertip and were
analyzed for lactate ([Hla]) using a Biosen C-Line Sport Analyzer
(EKF diagnostics, Magdeburg, Germany). Hemoglobin concentration
([Hb]) at rest was determined with capillary blood taken from the
fingertip and analyzed with an Hb-measuring device (Hemocue,
Angelholm, Sweden). Hematocrit (Hct) was determined by centrifuging
capillary blood at 12000 rpm for three minutes.
[0159] Pre-tests: Each subject attended the laboratory twice within
a two-week period before the first main tests. The first pre-test
was carried out to familiarize the subject with the bicycle
ergometer and the testing procedure. The subjects did a preliminary
test at five submaximal levels with every level lasting for five
minutes. There was no rest between the different submaximal levels.
VO2 was continuously measured with the AMIS 2001. At the end of
each submaximal level capillary blood was taken from the fingertip
and later analyzed for [Hla]. At every work rate the subjects rated
their perceived exertion on the Borg's RPE-scale (BORG, G.
Perceived exertion as an indicator of somatic stress. Scand J
Rehabil Med. 1970, vol. 2, no. 2, p. 92-8), both central and
muscular exertions were rated. After eight minutes of recovery, the
subject was instructed to cycle for as long as possible at a work
rate corresponding to his calculated maximal oxygen uptake
(.ANG.STRAND, P-O, et al. Textbook in work physiology. McGraw-Hill,
1970. ISBN 0070024065. p. 619). During this test the subjects
actual VO2peak was measured and if the subject was able to cycle
for longer than seven minutes extra power of 20-30 watts was added
every minute until exhaustion. One and three minutes after the
maximal test capillary blood were sampled from the fingertip for
analysis of [Hla].
[0160] Before the second pre-test, the submaximal levels were
adjusted so that they corresponded to 45, 60, 70, 80 and 85% of
VO2peak. The maximal work rate was also adjusted, if necessary, so
that the time to exhaustion was kept between four and seven
minutes.
[0161] The main tests: The subjects refrained from heavy exercise
three days prior to the main tests and avoided all exercise the day
before the tests. They were also told to eat their last light meal
at least 3 hours before the start of the tests. When the subjects
came to the laboratory, they received their last dose of either
placebo or nitrate and were allowed to rest in the supine position
for 60 minutes before the test commenced.
[0162] All subjects used a standardized warm up procedure of five
min of cycling at 100 watts followed by five minutes of rest. The
submaximal and maximal tests were performed in the same way as the
second pre-test with five submaximal work rates lasting five
minutes each, without rest between the different levels. Identical
work rates were used during the two main tests. Venous blood (9 ml)
was drawn at rest 45 minutes after the last nitrate/placebo-dose
was ingested and again immediately after the VO2peak-test. The
blood was placed in an ice bath and centrifuged within five minutes
at 1300 rpm and 4.degree. C. The plasma was separated and kept at
-80.degree. C. until it was analyzed for its nitrate and nitrite
concentrations by a chemiluminescence assay as described previously
(LUNDBERG, J O, et al. Inorganic nitrate is a possible source for
systemic generation of nitric oxide. Free Rad Bio Med. 2004, vol.
37, no. 3, p. 395-400).
[0163] Statistics and calculations: Results are expressed as
means.+-.standard deviation (mean.+-.SD). Paired t-tests were used
to evaluate the difference between the nitrate and the placebo
trials. The significance level was set as p.ltoreq.0.05.
[0164] Gross efficiency (GE) was defined as the work rate divided
by the actual energy expenditure (EE). The EE was in turn
calculated with the Brouwer equation (BROUWER, E. On simple
formulae for calculating the heat expenditure and the quantities of
carbohydrate and fat oxidized in metabolism of men and animals,
from gaseous exchange (Oxygen intake and carbonic acid output) and
urine-N. Acta Physiol Pharmacol Neerl. 1957, no. 6, p. 795-802).
Delta efficiency (DE) was defined as the increase in work rate
divided by the increase in EE (GAESSER, G A, et al. Muscular
efficiency during steady-rate exercise: effect of speed and work
rate. J Appl Physiol. 1975, no. 38, p. 1132-1139). The DE was based
on the four lowest work rates and was analyzed with linear
regression. The oxygen pulse is defined as VO2/HR.
[0165] B. Results
[0166] Blood pressure at rest: Average resting systolic blood
pressure was lower after nitrate supplementation (112.+-.8 mmHg)
compared to placebo (120.+-.5.9, p.ltoreq.0.01). The diastolic
blood pressure was also lower after nitrate (68.+-.5.5 mmHg)
compared to placebo (74.+-.6.8 mmHg, p.ltoreq.0.01). Parts of these
findings have been published as a separate communication (Larsen et
al. 2006).
[0167] Blood values: No change was observed in [Hb] at rest (NIT
152.+-.11, CON 153.+-.11 g.times.1-1, p=0.87) or immediately after
the VO2peak-test (MT 163.+-.13, CON 161.+-.13 g.times.1-1, p=0.27).
Nor were there any change in the hematocrit value at rest (NIT
42.+-.4, CON 43.+-.3%, p=0.19) or after the VO2peak-test (NIT
46.+-.4, CON 47.+-.4%, p=0.6).
[0168] Plasma levels of nitrate at rest were 27.+-.6.9 .mu.M in CON
and 182.+-.55 in NIT (p.ltoreq.0.01). Nitrate levels immediately
after the maximal work test were 29.+-.6.1 in CON and 175.+-.61
.mu.M in NIT (p.ltoreq.0.01). Plasma nitrate did not change during
exercise either in NIT or in CON (p=0.8). Nitrite levels at rest
were 124.+-.28 in CON and 226.+-.87 nM in NIT (p.ltoreq.0.01).
Immediately after the maximal work test the nitrite levels were
111.+-.29 in CON and 137.+-.48 in NIT (p=0.17).
[0169] The decrease in nitrite concentrations during exercise was
more pronounced in NIT than in CON (FIG. 6). The increase in c-GMP
concentrations after the maximal work as compared to rest tended to
be higher in NIT than in CON (p=0.08).
[0170] Blood pressure: Average resting systolic blood pressure
decreased from 120+/-5.9 after NIT to 112.+-.8 mmHg after CON
(p=0.003). The diastolic blood pressure decreased from 74.+-.6.8 to
68.+-.5.5 mmHg in the CON and NIT-groups respectively (p=0.005).
Parts of these findings have been published as a separate
communication (LARSEN, F J, et al. Effects of dietary nitrate on
blood pressure in healthy volunteers. N Engl J Med. 2006, vol. 355,
no. 26, p. 2792-3).
[0171] Submaximal work parameters: After nitrate administration VO2
was significantly lower during the four work rates corresponding to
45-80% VO2peak compared to the placebo period (FIG. 5). The most
significant difference was seen at 80% of VO2peak (NIT 3.44.+-.0.31
1.times.min-1 vs CON 3.61.+-.0.31 1.times.min-1, p=0.003, FIG. 5).
On average VO2 was 0.15 1.times.min-1 lower in the NIT-trials over
the 4 submaximal work rates. There was no difference in heart rate
(HR) between the NIT and CON-trials (see FIG. 6). The oxygen pulse
tended to decrease from 21.0.+-.2.0 during CON to 20.3.+-.1.9
ml.times.beat-1 (p=0.08). No significant differences changes were
found between NIT and CON in [Hla] (FIG. 6), VE, VE/V02 or
respiratory exchange ratio (RER) during any of the submaximal work
rates. The average Gross efficiency (GE) is defined as the work
rate divided by the actual energy expenditure (EE). The EE was in
turn calculated with the Brouwer equation (Brouwer, supra). GEgross
efficiency improved from 19.7% during CON to 21.1% during NIT
(p=0.02). Delta efficiency (DE) is the increase in workload divided
by the increase in EE (Gaesser & Brooks, supra). The DE is in
this case based on the four lowest work rates, which were analyzed
with a linear regression analysis. The DE Delta efficiency (DE)
increased significantly from 22.1.+-.1.6% during CON compared to
22.9.+-.1.9% during NIT, (p=0.04).
[0172] Maximal work capacity: There was no significant difference
in the VO2peak between the NIT and CON trials (4.49.+-.0.44 and
4.61.+-.0.281.times.min-1 respectively, p=0.29). These values were
also not significantly different from the VO2peak achieved during
the pre-test (4.54.+-.0.32 1.times.min-1). Likewise, no significant
differences were noted either in VEmax (NIT 182.+-.21.4 vs CON
186.+-.21.7 1.times.min-1, p=0.5), HR.sub.max (NIT 189.8.+-.7.0 vs
CON 190.3.+-.7.5 beats.times.min-1, p=0.94) or maximal work rate
(NIT 360.6.+-.32.8 vs CON 358.9.+-.32.3 watt, p=0.35). There was no
difference between NIT and CON in the rating of perceived exertion
(Borg RPE-scale) at any workload (submax or max).
[0173] Comment to the results: In the present study a significantly
reduced oxygen demand at submaximal workloads was noted after
nitrate administration was noted at the four lowest workloads. The
fifth work rate, at approximately 85% VO2peak, was well above the
lactate threshold in several subjects and thus the anaerobic energy
production became more pronounced. This led to involvement of
accessory muscle groups and a noticeably change in motion pattern.
At this work rate the VO2 did not reach a stable steady-state level
and is therefore unsuitable for the calculation of muscular
efficiency. The reason for including this fifth work rate in the
protocol was to receive a lactate value above the lactate threshold
and thereby get an indication of changes in the upper part of the
lactate curve.
3. Oral Sodium Nitrate and Glucose Homeostasis
[0174] The increase in plasma glucose after a standard Oral Glucose
Tolerance Test (75 g glucose in 250 ml water) is lower when
measured after nitrate pre-treatment (1 mmol/kg body weight NaNO3)
compared to placebo (NaCl). The study was performed with three
healthy test subjects in a double-blind study. Glucose ingestion
started 60 min after the nitrate ingestion. Blood glucose levels
were measured during the 120 min period after the glucose load
(n=3). At 30 min mean plasma glucose was 8.2 mmol/1 with placebo
and in the same subjects 6.5 mmol/1 after nitrate supplementation.
The results are shown in FIGS. 7a, b, and c.
[0175] The lower increase in plasma glucose after nitrate
pre-treatment was verified in a further study wherein a standard
Oral Glucose Tolerance Test (75 g glucose) was performed in 8
healthy non-smoking subjects after a three-day supplementation with
either sodium chloride or sodium nitrate at equal molar amounts
(0.1 mmol/kg body weight/day). The study had a double-blind,
placebo-controlled, cross-over design. Blood glucose levels were
measured at two time points before (-10 and 0 min) and at 15, 30,
45, 60, 75, 90, 105 and 120 min after glucose intake (n=8). At the
occasion when the subjects had taken nitrate, the area under the
curve for blood glucose was smaller compared to when they had
ingested placebo. The results are shown in FIG. 8 as
mean.+-.SEM.
4. Effect of Ingestion of Beetroot on Blood Pressure
[0176] A 43-year-old non-smoking subject with hypertension ingested
fresh beetroot juice (300-400 ml/day) for 14 days. The blood
pressure was measured twice a day for 14 days and then twice on day
20 (counted from day 1 of treatment). The Basal blood pressure was
142/99 on the day when the experiment started.
[0177] The results from the ingestion of beetroot juice are shown
in FIG. 9. The mean of the two daily measurements are shown in the
bars. With ingestion of the beetroot juice (between day 1-14) a
mean reduction in systolic pressure of =15 mmHg and a mean
reduction in diastolic pressure of =16 mmHg was seen. When measured
again 6 days after stopping beetroot juice treatment (day 20), the
blood pressure had increased to basal levels (140/100). Pulse rate
was unchanged throughout the experimental period. MAP =mean
arterial pressure.
5. Concentrations of Plasma Nitrite after Intravenous Infusion of
Nitrate
[0178] A. Methods
[0179] Anesthetized rats (n=11) were given a bolus dose (10 mg/kg
body weight) of NaNO.sub.3 (open boxes) and blood samples were
collected at indicated time points. 7 additional rats were
pre-treated with 30 mg/kg body weight of allopurinol given intra
peritoneally 60 minutes prior to the NaNO.sub.3 infusion (closed
triangles) and blood samples were collected at the time points
indicated. Allopurinol inhibits the xanthine oxidase, an enzyme
suggested being involved in the reduction of nitrate to nitrite in
mammal cells. Plasma was extracted and analyzed for nitrate and
nitrite.
[0180] Three different strains of mice--wild type (n=5 placebo, n=5
nitrate), germ free (n=5 placebo, n=5 nitrate) and eNOS knockout
mice (n=2 placebo, n=3 nitrate), were given an intra peritoneal
injection of 10 mg/kg body weight nitrate or placebo (NaCl) and
plasma level of nitrite measured 1 hour later.
[0181] B. Results
[0182] The results from the intravenous infusion of nitrate are
shown in FIG. 10a-c. FIG. 10 panel a shows the plasma nitrate
concentration and FIG. 10 panel b shows the plasma nitrite
concentration. After infusion of nitrate the concentration of
plasma nitrate increases dramatically both in rats that received
nitrate and rats that received nitrate+allopurinol (a). The plasma
nitrite concentrations increased in rats that received nitrate as
well as in rats that received nitrate+allopurinol, (b). However the
increase in the rats that received only nitrate was significantly
greater, *p<0.05.
[0183] FIG. 10 panel c shows that nitrate-induced increase in
plasma nitrite is equal in wild type (n=5 placebo, n=5 nitrate),
germ free (n=5 placebo, n=5 nitrate) and eNOS knockout mice (n=2
placebo, n=3 nitrate), p=0.05*.
[0184] Previously it has been suggested that only bacterial cells
and not mammalian cells can reduce nitrate to nitrite. These
results surprisingly show that also mammalian cells can metabolize
nitrate to nitrite. Further, they suggest that the xanthine oxidase
enzyme is involved in the reduction of nitrate to nitrite.
6. Enhancement of Post-Ischemic Blood Flow
[0185] Rats received an intravenous bolus dose of 10 mg/kg nitrate
(NaNO3, n=4) or placebo (NaCl, n=4)) diluted in PBS (pH 7.4)
followed by continuous infusion of 3 mg/kg body weight/h. An hour
after the addition of nitrate (open boxes) or placebo (filled
circles), L-NAME (50 mg/kg) was given, and 10 minutes later, a
supra renal clamping of the abdominal aorta was performed. After 30
minutes of ischemia the clamp was removed and the abdominal aortic
blood flow was monitored for 60 minutes.
[0186] The results show that the nitrate-treated rats maintain a
higher blood flow during the early (0-10 minutes) as well as the
late (10-60 minutes) post-ischemic phase compared to the placebo
treated rats (FIG. 11). Remarkably, after 60 min of reperfusion the
blood flow had decreased to only 20% of pre-ischemic values in the
control rats, while in the nitrate-treated rats, the blood flow was
maintained at almost 75% of control values. This demonstrates a
strong augmentation of the nitrate-nitrite-NO pathway during an
ischemic event.
* * * * *