IL102708A - Pharmaceutical compositions containing cinnamon extract for inhibiting growth of helicobacter pylori - Google Patents

Description

102,708/2 9 2 4 8 "PHARMACEUTICAL COMPOSITIONS CONTAINING CINNAMON EXTRACT FOR INHIBITING GROWTH OF HELICOBACTER PYLORI" ϋ Jl'SDJl D'7'DDn D· »O IN-iDID D'TBOJl" -»Di7 ij7» n 7¾» n»a nyio ml |i»3»i7 " · 11 ' · D THE APPLICANTS: TECHNION RESEARCH & DEVELOPMENT ni7nD 11 · jDon TO ID FOUNDATION Ltd. Technion City, , 11 ■ 3Don-n»ii7 , o"vn n i nD i Haifa 32000. .32000 HD'n THE INVENTORS: 1. Prof. Itzhak NEEMAN . |ON3 |7Π.' ' D I ID .1 2. Dr. Nina TABAK. .{720 tU'l T'T .2 3. Dr. Robert ARMON. . I ID1N 0Ί2Π T'T .3 - 1 - 102, 708/2 The present invention relates to a new therapeutic application of particular chemical compounds or an extract of a plant containing them, to prepare a pharmaceutical composition useful to inhibit the growth of pathogenic bacteria. More particularly, the invention relates to the use of said compounds or said extract, to prepare a pharmaceutical composition useful to inhibit the growth of Helicobacter pylori and urease activity of Helicobacter pylori .

BACKGROUND OF THE INVENTION Helicobacter pylori, a bacteria isolated in 1982 from the stomach of patients with gastritis lesions and peptic ulceration, is a genus which formerly was related to Camphylobacter . Helicobacter pylori bacteria is the most common known cause of peptic ulcers and accounts for the majority of cases. It has been found in the antrum of more than 95% of patients with duodenal ulcers and in at least 75% of those with gastric ulcers. It is now generally accepted that this bacteria is associated with chronic and peptic ulcer disease and even possible with gastric cancer gastritis (Gabriele Geisel et al, Journal of Clinical Microbiology, May, 1990, 930-2). It also does produce urease in large amounts, which increases the pH in the microenvironment of the bacteria. - 2 - 102,708/2 Helicobacter pylori appears as a curved or S shaped gram-negative bacteria, its cell wall being smooth adhering closely to the cytoplasmic membrane. To-day, it is well recognized that the grade of Helicobacter pylori colonisation is , associated with chronic gastritis and peptic ulceration.lt is the general conclusion that the presence of Helicobacter pylori colonisation is of great importance in both the development and chronicity of peptic gastric ulcer disease. According to Marshall B.J. et al (Med .J.Aust . 1985, 439-443), more than 80% of cases of chronic gastritis and duodenal ulcer are associated with coexisting Helicobacter pylori infection and both have a relationship to the development of the ulcer disease. The routine treatment against Helicobacter pylori, is based on the use of bismuth subcitrate and antibiotics. However, this method does not eradicate Helicobacter pylori infection , and after a period of time the infection reoccurs.

Bismuth preparations were successfully used to combat various gastrointestinal disorders .The most commonly used are bismuth subsalicylate and colloidal bismuth subcitrate. Later on, combinations of bismuth salts with antibiotics, such as amoxycillin and metrodinazole , were also suggested. It was demonstrated that colloidal bismuth subcitrate improved dyspepsia by clearing the bacteria - 3 - 102,708/2 and not by any other effect of the drug on the gastrointestinal tract. To-day, it is considered that a triple therapy comprising: (1) a bismuth compound; (2) a n itroimidazol e antibiotic; and (3) tetracycline or amoxycillin, is effective in eradicating Helicobacter pylori infection in most patients (George L.L.et al, Med .J. Austral ian , 1990, 153, 145-9). However, as the authors pointed out, long-term follow-up is required in order to determine whether a recurrence of histologic gastritis symptoms will not appear. In any case, the authors pointed out that some diarrhea effects were reported due to Clostridium difficile colitis. On the other hand, some complaints of constipat ons were also reported after treatments with bismuth subcitrate alone.

According to a very recent report (Rosberg K. et al. Scand. J.Gastroenterol 1991, 26 p. 1179-1187) tests which were carried out on pigs show that a good correlation exists between adhesion of Helicobacter pylori to the gastric epithelium and gastritis, in-vivo and in-vitro infected specimens, using the same bacterial strains. This is a very important finding considering the fact that the adhesion of Helicobacter pylori to pig gastric mucosal specimen is quite similar to the human condition. - 4 - 102,708/2 In another recent paper (Desai H.G.et al. Scand J.Gastroenterol 1991, 26, 1205-8) it is reported that there is a relationship between the two reservoirs of Helicobacter pylori, i.e. dental plaque and the stomach. Using the Camphy lobacter- 1 i ke organism test , Hel i cobacter pylori was detected in dental plaque and in gastric antral and body mucosa of a number of patients with dyspepsia. It was found that the density of Helicobacter pylori is heaviest in dental plaque and less in the body mucosa of the stomach. The treatment by the triple drug system (bismuth, nitroimidazole and amoxycillin) shows that the bacteria was eliminated from the gastric mucosa, in all the 24 patients treated, but persisted in dental plaque in all of them. The authors concluded that the dental plaque is a major reservoir of Helicobacter pylori, being greater in thei number than in the stomach and may be responsible for the reoccurence of infection after cessation of therapy in the body mucosa of the stomach. However, there are many reports which mention that "patients treated with antibiotics had side effects". Indeed, two recent reports publ i shed. ' in The New England Journal of Medicine (Vol. 322, No. 13, p.909-915) concern the eradication of Helicobacter pylori bacteria and discuss the disadvantages of bismuth and antibiotics.

According to the U.S. Patent No. 4,477,361, cinnamic compounds, such as cinnamic aldehyde, hydroci namalde-hyde and cinnanmic acid are mentioned to be used in the form of a fatty soap as antimicrobial surfactant. The compositions contain between 1% to 5% by weight of a free fatty acid or 5% to 45% by weight of an emollient. These compositions as well as the use thereof, differ completely from the present invention disease.

The above brief review clearly illustrates the potential diseases imparted by the Helicobacter pylori and the various approaches suggested to combat this bacteria, which unfortunately have not been successful in meeting that need.

It is an object of the present invention to provide a chemical composition or pharmaceutical extract to inhibit the growth of Helicobacter pylori bacteria. It is another object of the present invention to provide a chemical compound or a pharmaceutical extract to inhibit the growth of Helicobacter pylori without utilizing any of the known drugs or antibiotics. It is yet another object of the present invention to provide a chemical compound or a pharmaceutical extract for inhibiting the growth of Helicobacter pylori bacteria, which does not impart any undesi red effects.

BRIEF DESCRIPTION OF THE INVENTION.

The invention relates to the use of ci nnamaldehyde or methoxycinnamaldehyde to prepare a pharmaceutical composition useful to inhibit the growth of Helicobacter pylori (hereafter referred to H. pylori) in a host containing same, in an amount which is sufficient to inhibit said growth. It was also found, that the above treatment is also useful to inhibit the activity of urease H. pylori both with the whole cells and the enzyme.

BRIEF DESCRIPTION OF THE FIGURES ■ Figure 1, shows the inhibition effect of alcohol Cinnamon extracts on three isolates of H. pylori.

Figure 2, illustrates the sensitivity of H. pylori to several antibiotics and Cinnamon plant extracts. Figure 3, illustrates the growth of H. pylori on Egg Yolk Emulsion agar with an organic extract of Ci nnamon .

Figure 4, illustrates the growth of two isolates of H. pylori in liquid medium with an organic extract of Cinnamon.

Figure 5, illustrates the inhibition kinetics of H. pylori urease with whole cells and enzyme by an alcohol extract of Cinnamon.

DETAILED DESCRIPTION OF THE INVENTION AND FIGURES .

According to a first aspect, the invention relates to the use of ci nnamaldehyde and methoxyci nnamaldehyde and any mixture thereof to prepare a pharmaceutical composition useful to inhibit the growth of H. pylori in a host containing same.

The above composition which is administered to the host contains the ci nnamaldehyde or methoxyci nnamaldehyde or an organic extract solution of the plant Cinnamon, being in an amount that is suffficient to inhibit growth of the bacteria in the host. The solution of ci nnamaldehyde or methoxyci nnamaldehyde or said organic extract is provided either in the form of a drink or a capsule.

Cinnamon is a well known plant growing in many places. It was surprisingly found that many other plants which are known as medical plants and are quite similar to Cinnamon such as Camomile, Garlic, Olive rape, do not possess at all this property, or only to a very limited extent. Furthermore it should be pointed out that extracts of the above medical plants are mentioned in the literature to possess a medicinal property and are even suggested against disturbances in the digestion system.

In our European published Application No. 577,481 it was described a pharmaceutical composition containing an aqueous or organic extract of the plant Thyme for the same purpose. It was surprisingly found according to the present invention, that only an organic extract of Cinnamon, is useful for preventing the growth of H. pylori bacteria in addition to the ci nnamaldehyde and methoxyci nnamaldehyde which are the main constituents of the Cinnamon plant.

According to a second aspect, the invention relates to a method to inhibit in-vitro the growth of H. pylori bacteria by contacting said bacteria with an organic extract - 8 - 102,708/2 solution of the plant Cinnamon and said main constituents of the plant.

According to a third aspect, the invention relates to the use of the main chemical constituents present in the Cinnamon plant and most preferably cinnamaldehyde and methoxycinnamaldehyde, as a composition useful to inhibit the growth of H.pylori in a host containinig same, in an amount which is sufficient to inhibit said growth.

The method was tested in-vitro on the various isolates of Helicobacter pylori , isolated from various patients, which were mentioned as:I,j, I2 and Ig, and with all of them the same beneficial effect of growth inhibition was found. This appears in a clear manner from Figure 1, where the inhibition effect of the alcohol extract of Cinnamon is illustrated towards three main isolates of Helicobacter pylori. This is an additional advantage over certain antibiotics which are not active to all these bacteria.

The inhibition activity of an organic extract of Cinnamon was tested on three isolates of Helicobacter pylori (I15 and I^) obtained from various patients and significant inhibition effects were noticed for the three isolates substantially at the same extent. On the other hand, it can be noticed in the Table 1, that some of these types of bacteria were not found to be affected by some known antibiotics substances. - 9 - 102, 708/2 TABLE 1 : Behaviour of antibiotic substances to three isolates of Helicobacter pylori.

Isolate of H.pylori Sensitive to Not affected by. ampicyllin ceptarin 12 nalidixic acid erytromycin 13 erytromycin nalidixic acid As can be noticed, these isolates of bacteria were found not to be affected by some antibiotic substances , a Ithough they are known to be affected by others.

The inhibition effect was determined in-vitro, using the "Filter paper disc diffusion method" as described by Laura L. Zaika, (Journal of Food Safety 9, 1988, p .97-118) . According to the method used, an extract of the plant. was deposited on a small filter paper disc having a diameter of 0.5 cm and then placed in the center of a Petri plate containing agar growth medium inoculated with the test microorganism. The plate was incubated under microaero-philic conditions in anaerobic jars at 37°C for 3 to 4 days and observed for microbial growth. If the extract of Cinnamon exerts antimicrobial activity, the microorganism will not grow in an area surrounding the filter paper disc. This clear area, defined as "zone of inhibition" was measured and recorded in mm. This method is well-known also for determining the activity of an antibiotic - 10 - 102, 708/2 compound, by measuring the zone of inhibition arround a disc containing a sample of the antibacterial compound to be tested.

The assays used for the bacterial growth inhibition were as fol lows : Two organic Cinnamon extracts, methylene chloride and ethanol in concentrations of 0.05 mg and 0.1 mg respectively were spotted on standard discs and placed on Egg Yolk Emulsion agar plate center which was previously layered with 0,1 ml of a bacterial suspension having a concentration of 107CFU ml.

After the required incubation, the inhibition zone was recorded. In Figure 2, there are presented the sensitivity of Helicobacter pylori, as determined by the inhibition diameter, using two organic extracts of Cinnamon (0,05 mg and 0.1 mg dry weight) compared with antibiotics: ampicillin (0.01 mg), tetracycline (0.03mg), erythromy-cine (0.015mg) nalidixic acid (0.03 mg ) , cotrimoxazole (0.025mg). In these tests, two isolates of H. pylori were used .

It was surprisingly found that the inhibition of H.pylori growth is obtained only with an organic extract of Cinnamon and this effect is not obtained with organic extracts of other plants which are known by their medicinal potential activity. In the following Table 2, there are 102,708/2 summarized the results of inhibition of said bacteria by some plants.

TABLE 2: Inhibition of Helicobacter pylori by various plant extracts.

Inhibition zone (in mm) Plant extract type water extract alcohol extract ajorane 22 18 Inula 5 12 Rosemary 10 8 Licorice 11 14 Camomille 5 5 Cinnamon 9 47 Laurel 8 8 MQli sa 18 14 Thyme 24 19 Sage 10 9 Garlic 5 7 As appears from the above Table, in none of the extracts of the plants other than Cinnamon, there is a significant inhibition of the bacteria. It can also be noticed, that only with an organic extract of Cinnamon, this inhibition exists, being much higher than that resulted with an - 12 - 102,708/2 aqueous extract. Also it clearly appears, that the inhibition zone of an aqueous extract of this plant is. quite similar to the other aqueous and organic extracts of plants without possessing this activity.

The solvent used for the extraction of Cinnamon may be selected from a polar or non-polar solvent such as: ethanol, methylene dichloride, petrol ether, etc. In particular suitable will be the ethanol extract which can be taken as a drink, with or without any additional flavouring ingredients , added in order to improve the taste. When the solvent used is methylene dichloride or petroleum ether, it is suggested to evaporate all the solvent from the extract and subsequently to extract the dry matter by ethanol.

In the following Table 3,there are summarized the results on the inhibition of H. pylori growth, obtained by various concentrations of two Cinnamon extracts: Extract 1 (methylene chloride and after its removal add-adding ethanol) and Extract 2 (ethanol).

The tests were carried out on Egg Yolk Emulsion agar plate, the Cinnamon concentrations on disk were in the range of 12 mg to 800 mg . - 13 - 102, 708/2 Inhibition of Helicobacter pylori growth by various concentrations of two Cinnamon extracts Inhibition Zone (mm) Concentration (jjg) Extract 1 Extract 2 12 20 0 25 41 0 50 71 0 100 80 19 200 >90* 49 400 >90* 63 800 >90* 90 indicates that a substantial complete inhibition occurred.

As appears from the above Table 3, a methylene extract with a concentration of 100 pg and above provides a complete inhibition of H. pylori.

A Cinnamon extract was incorporated in a growth medium consisting of - a solid form, Egg Yolk Emulsion agar, and - a liquid form, Brain Heart Infusion Broth (BHIB) with 10% Fetal Calf Serum (FCS). - 14 - 102, 708/2 The Minimal Inhibitory Concentration (MIC) for different isolates was 0.005 mg , while in the range of 0.015 to 0.05 mg , a complete ihibition was achieved. This appears in a clear manner from the attached Figures 3 and 4.

One may also conceive to prepare the Cinnamon dry plant pressed in the form of a capsule, which also will impart the same inhibition diameter effect.

As mentioned above, instead of using an organic extract of Cinnamon plant, it was found that the main constituent of this plant, cinnamaldehyde and to a smaller extent methoxycinna aldehyde , are producing also a significant inhibition of the H. pylori growth. The results obtained with some main constituents, are presented in the following Table 4. - 15 - 102, 708/2 Inhibition of H. ylori growth by some of the main chemical constituents of Cinnamon plant Chemical constituent Concentration Inhibition (mg/disk) (mm) Cinnamaldehyde 0.05 45 0.1 60 0.2 >90* Methoxycinnamaldehyde 0.2 44 " 0.4 57 " 0.6 68 Terpinen-4-ol 2.0 22 Alpha-pinene 2.0 18 Alpha-terpinene 2.0 17 Benzyl-benzoate 2.0 17 Cinnamic alcohol 0.2 12 " " 0.4 20 (* indicates that a substantial complete inhibition occurred).

As appears from the results of the inhibition zones as shown above, onl the cinnamaldehyde even with a concentration of 0.2 mg/disk, produces a substantial complete inhibition. Methoxycinnamaldehyde also has a beneficial effect on the inhibition but with a higher concentration.

Some other chemical constituents, such as cinnamic alco- - 16 - 102,708/2 ho1 , or al pha-terpinene , produce only a lower inhibition zone even with a much higher concentration.

Another factor involved in the pathogenic mechanism of the bacteria, is urease of Hel icobacter pylori . As known, the hydrolysis of urea and formation of ammonia enables the bacteria to resist the acidity which prevails in the stomach. The urease of Helicobacter pylori is well-known as a pathogenic factor and therefore its inhibition is indeed a long-felt need.There are known several chemicals which are described in the literature to possess an inhibition effect against urease of Helicobacter pylori. Among these chemicals the following reagents can be mentioned: aceto-hydroxamic acid, hydroxyurea, ethylene diamine tetraacetic acid and Lysine hydroxamate, none of them being present in the Cinnamon plant.

The organic extracts of Cinnamon were also found to be useful to possess the ability for inhibition of the activity of urease Helicobacter pylori, both with the whole cells and the enzyme. Even an alcoholic extract of 3.8 mg/ml Cinnamon, was found to inhibit up to 52.6% of increase activity of whole bacterial cells and at the same extent of bacterial lysate. This was determined using a modified method of Conway as follows: - 17 - 102, 708/2 The reaction mixture contained: 2.0 ml of phosphate buffer (3mM), pH = 6.8; 0.4 ml of urea (330 mM), and 0.1 ml of a suspension of whole cells (107CFU/ml)) or a solution of enzyme (special activity 483 ug NH^/min/mg protein) Cinnamon extracts were added to the reaction mixture at different concentrations. The reaction was continued for 30 minutes. After the addition of a saturated solution of potassium carbonate, the ammonia evolved was absorbed by boric acid and final ly. detected according to the method using the Bertholet reaction. - 18 - 102,708/2 TABLE 5: Inhibition of Helicobacter pylori urease by Cinnamon extracts.

Concentration of extracts Urease activity (¾). reaction mixture Who1 e cells Enzyme mg/ml 0.00 100.00 100.00 1.9 7.90 3.8 52.6 5.99 7.6 41.36 11.4 5.42 15.2 30.92 22.8 22.17 38.0 8.00 In the attached Figure 5, there are presented the graphs of inhibition kinetics of H. pylori urease, with whole cells and enzyme by an alcohol extract of Cinnamon.

Cinnamon extracts were added to the reaction mixture in concentrations of 8 mg/ml for whole cells and 2 mg/ml for the enzyme solution (on dry substance). The reaction time was 60 minutes .After the addition of a saturated solution of potassium carbonate, ammonia was absorbed by a solution of boric acid and detected according to Bertholet react- - 19 - 102,708/2 ion. As can be observed, it clearly appears that the alcohol extract of Cinnamon imparts a much higher inhibition for enzyme than that corresponding to the whole cells.

Claims (8)

- 20 - 102,708/3

1. C L A I S:- 1. A pharmaceutical composition useful to inhibit the growth of Helicobacter pylori in a host containing same, selected from a compound selected from cinnamaldehyde and methoxyci nnamal dehyde and any mixture thereof, in an amount sufficient to inhibit said growth.

2. The pharmaceutical compositions according to Claim 1 to be used as a drink.

3. The pharmaceutical compositions according to Claims 1 or 2 wherein additional flavoring ingredients are added to said drink in order to impart a desired taste.

4. The pharmaceutical composition according to Claims 1 to 3, to be administered in the form of a capsule.

5. A pharmaceutical composition useful to inhibit the activity of urease Helicobacter pylori, comprising a compound selected from cinnamaldehyde and methoxyci nnamal dehyde and mixtures thereof, in an amount which is sufficient to inhibit said activity.

6. The pharmaceutical composition according to Claim 5, wherein said inhibition is achieved with whole cells and enzyme. - 21 - 102,708/3

7. The pharmaceutical compositions useful to inhibit the growth of Helicobacter pylori in a host containing same substantially as described in the specification and in any one of Claims 1 to 4.

8. The pharmaceutical compositions useful to to inhibit the activity of urease Helicobacter pylori, substantially as described in the specification and in Claims 5 and 6.