Patent Application
20090182041
To be effective, chemotherapeutic agents must eradicate enough tumor cells for the body's immune defenses to eliminate any remaining tumor cells. Difficulties with most of the chemotherapeutic drugs emanate from their concurrent eradication of normal healthy cells, including those responsible for immunity. Additionally, the eventual development of drug resistance by the tumor cells often renders chemotherapy useless and futile after a period of remission.
While adenosine triphosphate (ATP) is a precursor to the nucleotides needed to produce deoxyribonucleic acid (DNA) and ribonucleic acid (RNA), and is also the major source of intracellular biochemical energy, the inhibition of ATP production has been deemed as too general a mechanism for systemic cancer chemotherapy. It has been regarded that all cells require ATP, and thus, ATP inhibitors would be simultaneously cytotoxic to essential tissues as well as cancer cells.
The endogenous molecular biology of cancer cells, however, is now understood to involve autocrine and paracrine secretion of insulin and insulin-like growth factors (IGF-I & II) that subserve enhanced energy production and growth stimulation, respectively, in these cells (Ayre et al., 2000). Breast cancer cells have an average of seven times more insulin receptors (Papa et al., 1990) and ten times more IGF receptors (Cullen et al., 1990) than normal breast and other tissue cells within the host. Thus, these cancer cells can take up glucose seventeen times faster than normal cells, and, it must be presumed that, they can also utilize glucose seventeen times faster than normal cells, therefore producing ATP at a faster rate.
The depletion of ATP and related nucleotides (all of which are precursors of DNA and RNA) has been demonstrated in vitro in human leukemic cells (Fotopoulos) and the result is an upset of cell timing with subsequent apoptosis (programmed cell death) as demonstrated in malignant B cells (Geahlen). The increase in metabolic activity and cell membrane permeability to glucose makes tumor cells more susceptible than normal cells to the effects of ATP depletion.
The paw paw tree, Asimina triloba (L.) Dunal (Annonaceae), is native to the eastern United States. The major active compounds in the Annonaceae family are called annonaceous acetogenins (or acetogenins). These are long chain fatty acid derivatives (C-32 and C-34) that terminate in an α, β-unsaturated γ-lactone ring, and they typically contain from zero to three tetrahydrofuran (or tetrahydropyran) rings in the chain. The paw paw tree contains over 50 active acetogenins. Several related tropical and subtropical species in the Annonaceae family (e.g., species in the annonaceous genera Annona, Asimina, Goniothalamus, Rollinia, Uvaria, and Xylopia) have yielded an additional 350 compounds in this class.
Biologically annonaceous acetogenins are powerful inhibitors of mitochondrial and cytoplasmic production of ATP. These compounds selectively inhibit cancer cells (vs. normal cells) and in vivo tumors, and also thwart multiple drug resistant (MDR) tumor cells that are dependent on ATP-driven efflux pumps. The annonaceous acetogenins slow or stop ATP production at mitochondrial complex I (NADH: ubiquinone oxidoreductase) and at the NADH oxidase of tumor cell membranes. Tumor cells are typically metabolically more active and have increased membrane permeability to glucose, making them more susceptible than normal cells to the effects of the acetogenins.
Vascular endothelial growth factor, which induces angiogenesis, requires ATP (Satake et al., 1998), and angiostatin inhibits ATP synthase (Moser et al., 1999) as it blocks angiogenesis. Thus, ATP depletion helps to block the growth of new vessels to nourish tumors. In addition, drug resistance in tumors is often due to the development of an ATP-dependent efflux pump, which extrudes the chemotherapeutic agent back into the extracellular matrix/bloodstream, allowing it to harm healthy cells as well as non-drug resistant tumor cells. This ATP-dependent efflux pump is thwarted by the acetogenins as it is driven by ATP, and ATP production is slowed by the acetogenins.
Bullatacin, asimicin and trilobacin (annonaceous acetogenins), in substantially purified form, are the most powerful inhibitors known of complex I in the electron transport system in mitochondria (Lewis et al., 1993; Hollingworth et al., 1994; Ahammadsahib et al., 1993; Landolt et al., 1995; Alfonso et al., 1996; He et al., 1997), and they also inhibit the NADH oxidase found in the plasma membranes of tumor cells (Morre et al., 1995). Their net effect is depletion of ATP levels. In vivo studies, against murine leukemia, myeloma, and human ovarian carcinoma in athymic mice, attest to the biological effectiveness of several of the acetogenins in pure form (Ahammadsahib et al., 1993; Gu et al., 1995).
The present inventions demonstrate, unexpectedly, that complex mixtures of annonaceous acetogenins, as crude extracts (as opposed to conventional substantially purified forms), are biologically active against a wide range of tumor types in cancer patients. The crude extracts also thwart development of resistance to chemotherapeutic agents. As such, an improved and simplified method has been developed for extracting crude extracts of annonaceous acetogenins. The crude extracts of annonaceous acetogenins provide medicinal uses, such as improved and inexpensive treatments for cancer.
Substantially purified forms of annonaceous acetogenins have been used to inhibit specific cancer cells and thwart multiple drug resistant tumor cells. These purified forms, however, are difficult and costly to manufacture. In addition, the purified forms may be limited to include one or a very few acetogenins, and therefore provide specificity towards a limited number of cancer cells. It has been discovered that crude extracts provide a more cost effective way of obtaining a large number of annonaceous acetogenins with broad application across a variety of cancers.
One embodiment includes crude extracts of the twigs of the paw paw tree, Asimina triloba. Such crude extracts are an effective supplement to chemotherapy and, even alone, exert useful anti-tumor effects on a variety of cancers. In an alternative embodiment, a crude extract is derived from the unripe fruit, seed, bark and/or other bioactive part of the paw paw tree. In other alternative embodiments, one or more twig, unripe fruit, seed, bark and/or other bioactive part, or any combination thereof, of annonaceous species in the genera Asimina, Annona, Goniothalamus, Uvaria, Disepalum, Xylopia, and Rollinia may be used to prepare a crude extract in accordance with the present inventions.
Preparation of the Crude Extract
The bioactive components of the paw paw have been isolated and identified individually by bioassay-directed fractionation guided by the brine shrimp lethality test (BST). Using this bioassay to guide fractionation, a complex mixture of over 50 annonaceous acetogenins has been found in paw paw tree. The BST, followed by high performance liquid chromatography/tandem mass spectrometry (LC/MS/MS), demonstrates that concentrations of the annonaceous acetogenins are maximal in the months of May to June. The bioactive components represented in the crude extract are particularly concentrated in the twigs of the paw paw tree. In alternative embodiments, other species of the Annonaceae family may be used to produce the crude extract.
In one embodiment, about 3000 pounds of dried twigs of Asimina triloba are obtained in the month of May. Preferably, only those twigs that are ½ inch or less in diameter are collected. The twigs are dried in a forced air drier at about 50° C. (+/−0-200° C.) and pulverized in a chipper/shredder through a ¼ inch sieve before being introduced into a percolator. Extraction using the percolator is initiated with hot (city) water at one gallon per pound of twigs. After the twigs have soaked for eight hours, the water is drained and discarded to remove the benzyltetrahydroisoquinoline alkaloids. This water extraction is repeated three additional times. The damp mass is then extracted four more times with 95% ethanol, in a similar manner. The ethanolic extract is concentrated, in vacuo, at about 50° C. (+/−0-200° C.), to form a syrup. Upon sitting, a water layer develops and is removed and discarded, leaving the crude extract. The crude extract is standardized for 0% moisture and an LC50 value of 0.5 ppm in the BST. Preferably, the extract will contain from ca 10-40% moisture, and the LC50 value will range from 0.2-0.8 ppm.
One of skill in the art will appreciate that adjustments are made in the weight to accommodate the standard values. The mixture of acetogenins is monitored chemically using LC/MS/MS (Gu et al., 1999) to be assured of the presence of certain major acetogenins (e.g.,
In one embodiment, the extract is formulated into servings for oral administration in a capsule or tablet, but one of skill in the art will recognize that alternative forms of administration, including tinctures, may also be utilized. Capsules or tablets preferably contain an excipient for the crude extract as well as conventional fillers and tableting agents.
Treatment Using the Crude Extract
In another embodiment, a method for administering the crude extract includes ingesting capsules containing 12.5 mg of the crude extract four times daily (QID) with food. This method is tolerated well in humans and induces tumor reduction. In general, however, this amount (50 mg per day) is based on a 70-kilogram person. Adjustments can be made for those weighing more or less. Children, for example, may decrease the dose by 25 to 50%. As each patient's tolerance level will be different, it is suggested to start slowly and gradually increase the dose. In addition, dosage adjustments may be required for veterinary applications.
In yet another embodiment, a method for determining a patient's tolerance includes ingesting one 12.5 mg capsule on day one, two capsules on day two, and so forth, building up to four capsules. Some patients may not tolerate 50 mg of the crude extract per day while others may take in excess of 200 mg (up to 500 mg) per day without adverse side effects. Thus, preparation and dosages may differ. It has also been noted that taking the extract with food may lessen the occurrence of nausea or stomach upset.
A clinical study was performed to test the crude extract on tumor antigen levels and tumor regression. Capsules including the crude extract at 12.5 mg with excipients were administered four times daily (QID) with food for a study period of at least 180 days. Blood collections were taken over the course of the study at days zero, 60, 120 and 180 to evaluate specific blood serum antigen levels. Day zero blood collection provided a baseline count.
Volunteer participants were recruited from physicians and other healthcare providers whose patients agreed to participate. Only participants diagnosed with clinical cancer were included, and many participants had stage four cancer that was deemed terminal. Those who were concurrently undergoing chemotherapy or radiation were included, along with those who had not had long-term success with chemotherapy/radiation and those who had refused these options due to their known devastating effects on the immune system and general well-being.
Approximately 100 participants enrolled in the study. Each participant signed an informed consent and medical records release statement. Participants were monitored by their healthcare provider for any adverse effects as well as for positive effects. An in-house Institutional Review Board, comprised of outside professionals, reviewed the protocols and found no concern regarding the safety of the participants. The healthcare providers were requested to discuss any adverse events with their patients. Additionally, the providers contacted Nature's Sunshine Products, Inc. to report any adverse event within 24 hours of administration of the capsules. If the providers were unable to be contacted, the participant was able to call an after hours number printed on the informed consent form. The study coordinator compiled the signed consent forms from the participants and recorded adverse events, compliance, positive results, dates of treatment, marker determinations and other concerns the participant or healthcare provider may have had.
The capsules containing the crude extract unexpectedly exhibited significant benefit to the participants by stabilizing and reversing the progression of clinical cancer, as illustrated in the following examples.
Individuals with bone cancer have elevated levels of alkaline phosphatase in their blood. The level of alkaline phosphatase is used to monitor progress of the disease, wherein the normal range is 0-136. A participant suffering from bone cancer had undergone treatments in 2002 including radiation in the spinal area. A blood test taken in September 2002 yielded a level of alkaline phosphatase of 327. The participant started taking four 12.5 mg crude extract capsules per day in November 2002. By December 2002 the level of alkaline phosphatase slightly decreased to 242 and in February 2003 the level decreased to 144. The level has remained stable (between 144 and 150) since February. According to the participant's physician, the cancer is contained and not doing further damage as indicated by the stable level of alkaline phosphatase. The participant reports to have more energy and stamina while taking the capsules.
A participant suffering from a bone tumor in the neck participated in the study. On July 30, 2002, the bone tumor was measured as a 7 mm cavity with a 5 mm mass, according to x-rays. The participant started taking crude extract capsules in September 2002 without any additional treatment. An x-ray taken on March 13, 2003, showed a significant decrease in tumor size such that the cavity was measured to be 4.5 mm with a 3 mm mass.
Individuals with breast cancer may have levels of CA2729 (tumor marker) above 15. Blood tests evaluating the level of CA2729 can indicate how a breast cancer tumor is responding to treatment. A participant suffering from breast cancer has not undergone any conventional treatments since being diagnosed. She has taken crude extract capsules since November 2002. Blood tests taken on September 12, 2002, and December 3, 2002, yielded a level of 24.6. By March 2003 the level of CA2729 was within normal range. The tumor size has also reduced.
A participant suffering from breast cancer has not undergone any conventional treatments since being diagnosed. She has taken crude extract capsules since October 2002. She reports that pain in the affected breast has decreased and the non-cancerous fibrocystic lumps have reduced in size. Her doctor reports she has been doing “remarkably well” considering that she has not had surgery, chemotherapy or radiation. She says that she feels good and has gained some weight following a significant loss.
A participant suffering from breast cancer underwent chemotherapy treatments while taking crude extract capsules. The chemotherapy treatments continued for seven months. The tumor almost completely disappeared. The participant had surgery to remove any traces of the cancer, resulting in the removal of 14 axillary lymph nodes that showed no metastatic cancer. The surgery was followed by radiation. The participant continues to be cancer free.
A participant suffering from stage four breast cancer started taking crude extract capsules, without changing any other treatment protocol. After just six weeks of taking the capsules, a 50% percent reduction in the level of CA2729 resulted, dropping from 160 to 80. The size of the tumor also reduced significantly.
The carcinoembryonic antigen or CEA (tumor marker) is not normally found in the blood of adults. Those with lung cancer have elevated levels. The presence and level of CEA is used to determine how widespread a cancer has grown and also to determine the success of a treatment. A participant suffering from stage four lung cancer had undergone two years of chemotherapy without success. During this time, the participant was limited to a wheelchair or bedridden. Within two months of taking crude extract capsules his tumor markers improved, showing a decrease from 275 to 222. The participant had a weight gain of five pounds and did not suffer from side effects of the crude extract capsules. The participant is now able to walk on his own.
A participant suffering from stage four melanoma started taking crude extract capsules in November 2002. The melanoma had previously metastasized to the lungs causing great difficulty while breathing. The participant experienced easier breathing within days of taking crude extract capsules. The participant has since been able to get out of bed and even progressed to riding a bike, walking uphill and working on a farm. In addition, two fatty tumors on the participant's arm have also decreased considerably in size.
The prostate specific antigen or PSA is an indicator of the growth of prostate cancer and is also used to determine the success of a treatment, measured through blood tests. A normal PSA level for a 51-60 year old individual is 0-3.5. A 56 year old participant suffering from prostate cancer, that was confirmed by biopsy, started taking four 12.5 mg crude extract capsules per day in October 2002. His PSA levels dropped from 3.85 on October 2002 to 2.08 on December 2002. This participant continued to take crude extract capsules until April 2003.
A participant suffering from stage four metastasizing prostate cancer started taking crude extract capsules. There was a distinct reduction in the tumor masses within six weeks of taking the capsules, although he was taking only two (instead of four) capsules or 25 mg (instead of 50 mg) per day. A subsequent CT scan showed a 25% reduction in the tumors. The participant's PSA level is remaining constant.
The examples listed above particularly show the efficacy of the crude extract. Table 1 is a complete list of the experiment results.
According to the study, levels of PSA were held constant and even decreased. Likewise, levels of breast tumor antigens were significantly reduced. Tumor sizes, e.g., in breast cancer, lymphomas, and melanomas, decreased and some have even disappeared. Adverse effects were practically nonexistent with this regime of QID supplement servings over 10 or more months. The capsules are safe, effective and helpful at all stages of several types of clinical malignant cancer and are a benefit with or without chemotherapy, surgery and/or radiation.
The present inventions may be embodied in other specific forms without departing from their spirit. The described embodiments are to be considered in all respects only as illustrative and not restrictive. The scope of the inventions is, therefore, indicated by the appended claims rather than by the foregoing description.
This patent application is a divisional of now pending U.S. patent application Ser. No. 10/717,746, filed Nov. 20, 2003 and entitled CONTROL OF CANCER WITH ANNONACEOUS EXTRACTS, which claims benefit to U.S. Provisional Patent Application Ser. No. 60/428,602, filed on Nov. 22, 2002, all of which are incorporated herein by reference.
| Number | Date | Country | |
|---|---|---|---|
| 60428602 | Nov 2002 | US |
| Number | Date | Country | |
|---|---|---|---|
| Parent | 10717746 | Nov 2003 | US |
| Child | 12353853 | US |
