WO2003043569A2

WO2003043569A2 - Trans-10, cis-12 conjugated linoleic acid isomer for the treatment of diseases

Info

Publication number: WO2003043569A2
Application number: PCT/US2002/036684
Authority: WO
Inventors: James R. Komorowski; Vijaya Juturu; Danielle Greenberg
Original assignee: Nutrition 21, Inc.
Priority date: 2001-11-16
Filing date: 2002-11-12
Publication date: 2003-05-30
Also published as: AU2002357729A1; WO2003043569A3; AU2002357729A8

Abstract

A composition for treating insulin- or non-insulin-dependent diabetes, reducing body fat, improving insulin sensitivity, reducing hyperglycemia, and reducing hypercholesterolemia with conjugated linoleic acid isomer trans-10, cis-12 alone, or in combination with any form of a trivalent chromium complex is disclosed. A method of treating a subject suffering from insulin-dependent diabetes by administering a composition that includes conjugated linoleic acid isomer trans-10, cis-12 alone, or in combination with any form of a trivalent chromium complex is similarly provided. The administration of a composition containing an effective dose of conjugated linoleic acid isomer trans-10, cis-12 alone, or in combination with any form of a trivalent chromium complex for the treatment of obesity is likewise provided.

Description

TRANS-10, CIS-12 CONJUGATED LINOLEIC ACID ISOMER FOR THE TREATMENT

OF DIABETES, THE REDUCTION OF BODY FAT, IMPROVEMENT OF INSULIN

SENSITIVITY, AND REDUCTION OF HYPERCHOLESTEROLEMLA, AND

TREATMENT OF ATHEROSCLEROSIS

Background of the Invention Field of the Invention

[0001] The disclosed invention relates to compositions and methods for the treatment of types 1 and 2 diabetes, reduction of body fat, improvement of insulin sensitivity, reduction of hyperglycemia, reduction of hypercholesterolemia, and the treatment of atherosclerosis. Compositions comprising the trans-10, cis-12 isomer of conjugated linoleic acid for the treatment of various disease states characterized or exacerbated by poor glucose tolerance are specifically provided.

Description of the Related Art Insulin Dependent Diabetes

[0002] Diabetes is a chronic metabolic disorder which afflicts 16 million people in the United States, over one and one half million of whom have its most severe form, childhood diabetes (also called juvenile, type 1, or insulin-dependent diabetes). Insulin-dependent diabetes appears suddenly, most often in children and young adults, and progresses rapidly. In this form, the pancreas ceases to manufacture insulin, a hormone necessary to convert the food we eat into energy for the body. In the United States, diabetes is the fourth leading cause of death, killing more than 162,000 people each year. Notably, the mortality rate of patients with insulin-dependent diabetes increases dramatically after 15 years of disease duration. In addition, every major organ system in the body is damaged by diabetes. Complications can include neuropathy, nephropathy, retinopathy, coronary heart disease, stroke, amputation of extremities (gangrene), early loss of teeth, high-risk pregnancies, and babies born with birth defects.

[0003] Insulin resistance is characterized by reductions of glucose uptake in skeletal muscle. Currently, insulin injection is the only treatment method available for the over 1.5 million type 1 diabetics and becomes the eventual course of treatment for many of the more than 16 million type 2 diabetics in the United States. Nutritional therapies that positively impact glucose uptake in the face of insulin insufficiency would have a major impact on the long term treatment costs associated with diabetes mellitus. Obesity

[0004] More than half of U.S . adults are overweight and nearly one-quarter of the U.S . adults are considered to be obese. The increasing prevalence of overweight and obesity is a major public health concern, since obesity is associated with several chronic diseases. For example, overweight and obesity are known risk factors for diabetes, heart disease, stroke, hypertension, gallbladder disease, osteoarthritis, sleep apnea, and some forms of cancer such as uterine, breast, colorectal, kidney, and gallbladder. Furthermore, obesity is associated with high cholesterol, insulin resistance, complications of pregnancy, menstrual irregularities, hirsutism, and increased surgical risk.

[0005] Drugs currently approved by the FDA for the treatment of obesity produce weight losses of about 10% of initial body weight at one year when used singly. Combination therapy with phentermine and fenfluramine produced weight losses of about 15% of initial body weight at one year. Phenylpropanolamine (PPA) is an over-the-counter drug that has not been tested for long term use and is recommended for use for only about 12 weeks. With the exception of PPA, all of these drugs require a physician's prescription and are generally quite expensive. Side effects occur with all these drugs. For example, the administration of fenfluramine and phentermine for the treatment of obesity resulted in cardiac valve damage in some patients and ultimately led to the withdrawal of fenfluramine from the market. Two of the newest drugs for the treatment of obesity have side effects that limit their use. Sibutramine increases blood pressure in a subset of patients, and orlistatmay have unpleasant gastrointestinal side effects.

[0006] Additional pharmacological treatments for disorders caused by or exacerbated by poor glucose uptake are needed. Specifically, compositions for the treatment of diabetes, arteriosclerosis, hypercholesterolemia, endothelial dysfunction, and obesity would be a great boon to subjects suffering from these disease states. A new, more effective, less expensive treatment for diabetes, atherosclerosis, hypercholesterolemia, and obesity with minimal side effects would be a great benefit to the treatment and prevention of obesity.

Summary of the Invention

[0007] The disclosed invention is directed to compositions and methods for treating insulin-dependent diabetes, non-insulin dependent diabetes, reduction of body fat, improvement of insulin sensitivity, reduction of hyperglycemia, improving endothelial function, and reduction of hypercholesterolemia with trans-10, cis-12 conjugated linoleic acid isomer.

[0008] In one aspect of the invention, the composition may additionally include a trivalent chromium complex. The chromium complex can be any form of trivalent chromium such as chromium picolinate, chromic tripicolinate, chromium nicotinate, chromic polynicotinate, chromium chloride, chromium histidinate, or chromium yeasts. Optionally, the composition may additionally include a chelating agent. The chelating agent may be picolinic acid, nicotinic acid, or both.

[0009] The recited composition may be incorporated into a pharmaceutically effective carrier. The pharmaceutically effective carrier may be a tablet, capsule, microbead, emulsion, powder, granule, suspension, syrup or elixir. Preferably, when the carrier is a microbead, the microbead is a sugar beadlet or microcrystalline cellulose beadlet. Advantageously, the trans-10, cis-12 conjugated linoleic acid isomer is coated on the beadlet. Optionally, the tablet, capsule, or microbead is coated with an enteric coating. [0010] Embodiments of the invention provide a method of treating type 1 and type 2 diabetes in a subject. The method of treatment includes administering to a subject a pharmaceutically effective dose of trans-10, cis-12 conjugated linoleic acid isomer. In some embodiments, a subject is also administered a trivalent chromium complex such as chromium picolinate, chromium nicotinate, chromic tripicolinate, chromic polynicotinate, chromium chloride, chromium histidinate, or chromium yeasts. Optionally, the composition further includes at least one chelating agent. The chelating agent may be picolinic acid, nicotinic acid, or both.

[0011] A method of treating obesity in a subject is similarly provided. The method of treatment includes administering to a subject a pharmaceutically effective dose of trans-10, cis-12 conjugated linoleic acid isomer. Optionally, the subject may be administered a chromium complex such as chromium picolinate, chromium nicotinate, chromic tripicolinate, chromic polynicotinate, chromium chloride, chromium histidinate, or chromium yeasts in addition to the trans-10, cis-12 conjugated linoleic acid isomer for the treatment of obesity. In some embodiments, the composition further includes at least one chelating agent. The chelating agent may be picolinic acid, nicotinic acid, or both.

[0012] In another aspect of the invention, a method of treating atherosclerosis in a subject is provided. The method includes administering to a subject a pharmaceutically effective dose of trans-10, cis-12 conjugated linoleic acid isomer. Optionally, the subject may be administered any form of a trivalent chromium complex such as chromium picolinate, chromium nicotinate, chromic tripicolinate, chromic polynicotinate, chromium chloride, chromium histidinate, or chromium yeasts in addition to the trans-10, cis-12 conjugated linoleic acid for the treatment of atherosclerosis.

Brief Description of the Drawings

[0013] FIGURE 1 is a graphical representation of the effects of the administration of isomers of conjugated linoleic acid on glucose uptake in human skeletal muscle cells in the absence of msulin stimulation.

[0014] FIGURE 2 is a graphical representation of the effects of the administration of isomers of conjugated linoleic acid in concert with chromium picolinate on glucose uptake in human muscle cells in the absence of msulin stimulation.

[0015] FIGURE 3 is a graphical representation of the effects of the administration of isomers of conjugated linoleic acid on glucose uptake in human muscle cells in the presence of insulin stimulation.

[0016] FIGURE 4 is a graphical representation of the effects of the administration of isomers of conjugated linoleic acid and chromium picolinate on glucose uptake in human muscle cells in the presence of insulin stimulation. Detailed Description of the Preferred Embodiment

[0017] The disclosed invention relates to compositions comprising trans-10, cis-12 conjugated linoleic acid isomer for the treatment of metabolic syndromes such as type 1 and type 2 diabetes, cardiovascular disease, hypercholesterolemia, and obesity, which are caused or exacerbated by poor glucose uptake. We have observed that selected conjugated linoleic acid (CLA) isomers, in particular the trans-10, cis-12 isomer, cause glucose uptake in human skeletal muscle with and without msulin stimulation. The compositions of the present invention can be administered to reduce or even eliminate the need for the administration of insulin in certain patients with type 1 diabetes. The invention also relates to the treatment of type 2 diabetics who require insulin. Additionally, methods for treating obesity and increasing lean body mass are likewise provided.

[0018] The terminology used in the description presented herein is not intended to be interpreted in any limited or restrictive manner, simply because it is being utilized in conjunction with a detailed description of certain specific embodiments of the invention. Furthermore, embodiments of the invention may include several novel features, no single one of which is solely responsible for its desirable attributes or which is essential to practicing the invention herein described.

[0019] A primary basis of the present invention is the novel and unexpected discovery that compositions comprising an effective dose of a particular isomer of conjugated linoleic acid, namely the trans-10, cis-12 isomer, acts to facilitate glucose uptake in a subject in need thereof. Additionally, the administration of trans-10, cis-12 conjugated linoleic acid has been shown to produce a weight loss effect.

[0020] Conjugated linoleic acid (CLA) has been reported in numerous publications to reduce fat gain in growing animals by 25%-70% (Park et al., 1997). Minimal studies have been performed on human subjects. In a preliminary study by Atldnson et al., there was no effect of CLA alone in obese subjects when added to standard diet and exercise. However, a subgroup of subjects who did not follow the diet and exercise program well, and who gained lean body mass, had a reduction in fat mass in the CLA subjects and an increase in fat mass in placebo subjects (Atkinson, communication, 2000). These data, along with the animal data, suggest that CLA is most effective in preventing fat accumulation rather than producing fat loss. Riserus et al. (2001) and Blankson et al. (2000) reported that CLA supplementation for four weeks in obese men with the metabolic syndrome decreased abdominal fat, without concomitant effects on overall obesity or other cardiovascular risk factors (Int. J. Obes. Relat Metab Disord, 25(8): 1129-1135 (2001); Blankson et al., J Nutr., 130(12): 2943-2848 (2000)). Two hypotheses have been advanced to explain the role of CLA in weight loss: 1) CLA may act as a β-3 agonist; and 2) CLA alters nutrient partitioning within muscles to promote fat oxidation rather than carbohydrate (CHO) oxidation (Park et al., 1999). [0021] Conjugated linoleic acid isomers have a number of beneficial effects. CLA is anticarcinogenic, anti-atherogenic, and acts to increase lean body mass while decreasing fat mass. We reported in co-pending U.S. Patent Application [number not yet assigned] filed on September 20, 2001 entitled "Methods and Compositions for the Treatment of Diabetes, the Reduction of Body Fat, Improvement of Insulin Sensitivity, Reduction of Hyperglycemia, and Reduction of Hypercholesterolemia with Chromium Complexes, Conjugated Fatty Acids, and/or Conjugated Fatty Alcohols", that a mixture of CLA isomers and chromium complexes significantly increased glucose uptake from the skeletal muscle. The present invention is based on the observation that the specific trans-10, cis-12 CLA isomer, either alone or in combination with a chromium complex such as chromium picolinate, effects whole body glucose tolerance, insulin action in skeletal muscle, and expression of genes important in glucose and lipid metabolism. Furthermore, CLA isomer trans-10, cis-12 either alone or in combination with a chromium complex may reduce adiposity, improve insulin stimulated glucose transport and glycogen synthase activity, and heighten glucose tolerance. Moreover, the disclosed compositions act to improve insulin action and to reduce the risk of diabetes, micro and macro vascular complications such as coronary heart disease, dyslipidemia, and hypertension, and obesity.

[0022] The effect of chromium picolinate with CLA isomers on glucose uptake from the skeletal muscle may be due to the activity of peroxisome-proliferator-activated receptor gamma (PPAR γ). The peroxisome-proliferator-activated receptor gamma is a member of the nuclear receptor superfamily and is a key transcriptional regulator of cell differentiation, glucose homeostasis, and lipid metabolism. It is a potential biological receptor for diabetes, obesity and atherosclerosis. Without being limited to a specific theory, we hypothesize that the administration of chromium picolinate and CLA isomer trans 10, cis-12 may influence the PPAR γ activity in reducing the risk of metabolic syndrome. Recent evidence indicates that peroxisome-proliferator- activated receptor gamma is expressed at high levels in macrophages, including the foam cells of atherosclerotic lesions. Oxidized low-density lipoprotein, which plays a central role in lesion development, can activate peroxisome-proliferator-activated receptor gamma by providing the cell with oxidized fatty acid ligands of the receptor. The elucidation of a peroxisome-proliferator- activated receptor gamma signaling pathway in macrophages provides a mechanism by which oxidized lipids may directly regulate gene expression in the context of the atherosclerotic lesions. A composition comprising the trans-10, cis-12 CLA isomer and a chromium complex may be particularly useful for the treatment of type 1 diabetes, type 1 diabetes with dyslipidemia, diabetes with endothelial dysfunction, coronary heart disease, type 2 diabetes mellitus, type 2 diabetes mellitus with dyslipidemia, hypertension, and other vascular complications. The significant beneficial effect of chromium complexes in reducing the blood sugar, coronary risk lipids, glycated hemoglobin and improving the insulin resistance aid in reducing the risk of metabolic disease. The trans-10, cis-12 CLA isomer activates the PPAR gamma and reduces the oxidation of lipids, lipogenesis, reduces inflammatory markers, and improves insulin action. Hence the combination of these nutrients may be efficacious in the management of metabolic syndrome. The net effect of peroxisome-proliferator-activated receptor gamma ligands on the atherogenic process is likely to reflect a balance between local effects in the artery wall and systemic effects on lipid metabolism.

[0023] In a preferred embodiment, the trans-10, cis-12 isomer constitutes at least 50% of the CLA in the composition. Preferably, the trans-10, cis-12 isomer constitutes at least 60%, 70%, or 80% of the CLA in the composition. More preferably, the trans-10, cis-12 isomer constitutes at least 90% of the CLA in the composition.

[0024] Advantageously, the composition of the disclosed invention will include the trans-10, cis-12 CLA isomer compound at a dose of at least 50% by weight of formulation. More preferably, the effective dose of the CLA isomer for a 70 kg human is between about 100 mg to about 10 grams. In a most preferred embodiment, the effective dose of the CLA isomer is 75 mg, 100 mg, 250 mg, 500 mg, 750 mg, 1000 mg, 2 g, 5 g, 7 g, or 10 g. CLA is commercially available from a variety of sources including Matreya, Inc. in Pleasant Gap, PA.

[0025] Uses of the compositions disclosed herein to treat metabolic diseases such as diabetes, cardiovascular disease (CVD), and/or obesity are provided. The administration of the trans-10, cis-12 CLA isomer provides a number of advantages over conventional pharmaceutical regimes for the treatment of diabetes, CVD, and promotion of weight loss. One advantage of the compositions described herein over conventional treatment regimes for diabetes (such as injection of insulin) and weight loss is that compositions comprising the trans-10, cis-12 CLA isomer have no known side effects while still providing efficacy in glucose uptake and weight loss.

[0026] The use of trans-10, cis-12 CLA isomer for the treatment of cardiovascular diseases is likewise provided. The vascular endothelium is a key regulator of controlling the activities of the intrinsic pathway, the fϊbrinolytic and protein-C anticoagulant pathways, as well as influencing platelet activation and adhesion. The administration of trans-10, cis-12 CLA improves endothelium-derived nitric oxide (NO), modulates the tone of underlying vascular smooth muscle, and inhibits several pro-atherogenic processes, including monocyte and platelet adhesion, oxidation of low density lipoproteins, synthesis of inflammatory cytokines, smooth muscle proliferation and migration, and platelet aggregation, thus exhibiting important anti-atherogenic effects. The administration of trans-10, cis-12 CLA alone or in combination with a chromium complex aids in controlling both macro and micro vascular complications.

[0027] Chromium enhances the activity of the trans-10, cis-12 CLA isomer.

Accordingly, in some embodiments, the compositions may additionally comprise an effective dose of a chromium complex for the treatment of any number of metabolic syndromes described above. As used herein, the terms "chromium complexes" or "chromium complex" include, without limitation, any form of trivalent chromium such as chromium picolinate, chromic tripicolinate, chromium nicotinate, chromic polynicotinate, chromium chloride, chromium histidinate, and chromium yeasts. Chromium picolinate, for example, has been shown to produce modest weight loss and changes in body composition (Kaats, 1998, Cefalu, 1999).

[0028] Chromium is a nutritionally essential trace element. The essentiality of chromium in the diet was established in 1959 by Schwartz, as cited in Present Knowledge in Nutrition, page 571, fifth edition (1984, the Nutrition Foundation, Washington, DC). Chromium depletion is characterized by the disturbance of glucose, lipid and protein metabolism, and a shortened lifespan. Chromium is essential for optimal insulin activity in all known insulin- dependent systems (Boyle et al., Southern Med. J. 70:1449-1453, 1977). Insufficient dietary chromium has been linked to both maturity-onset diabetes and to cardiovascular disease.

[0029] The principal energy sources for the body are glucose and fatty acids.

Chromium depletion results in biologically ineffective insulin and compromised glucose metabolism. Under these conditions, the body must rely primarily on lipid metabolism to meet its energy requirements, resulting in the production of excessive amounts of acetyl-CoA and ketone bodies. Some of the documented acetyl-CoA is diverted to increased cholesterol biosynthesis, resulting in hypercholesterolemia. Diabetes mellitus is characterized in large part by glycosuria, hypercholesterolemia, and often ketoacidosis. The accelerated atherosclerotic process seen in diabetics is associated with hypercholesterolemia (Boyle et al., supra.).

[0030] Dietary supplementation of chromium to normal individuals has been reported to lead to improvements in glucose tolerance, serum lipid concentrations, including high-density lipoprotein cholesterol, msulin and insulin binding (Anderson, Clin. Psychol. Biochem. 4:31-41, 1986). Supplemental chromium in the trivalent form, e.g. chromic picolinate, is associated with improvements of risk factors associated with adult-onset (type 2) diabetes and cardiovascular disease (Anderson, Nutrition, 15 (9): 720-722(1999); Diabetes Metab. 26(1): 22-27 (2000)).

[0031] Chromium functions as a cofactor for insulin. It binds to the insulin receptor and potentiates many, and perhaps all, of its functions (Boyle et al., supra.). These functions include, but are not limited to, the regulation of carbohydrate and lipid metabolism. (Present Knowledge in Nutrition, supra, at p. 573-577). The introduction of inorganic chromium compounds per se into individuals is not particularly beneficial. Chromium must be converted endogenously into an organic complex or must be consumed as a biologically active molecule. Only about 0.5% of ingested inorganic chromium is assimilated into the body {Recommended Daily Allowances, Ninth Revised Edition, The National Academy of Sciences, page 160, 1980). Only 1- 2% of most organic chromium compounds are assimilated into the body.

[0032] U.S. Patent No. Re. 33,988 discloses that when selected essential metals, including chromium, are administered to mammals as exogenously synthesized coordination complexes of picolinic acid, they are directly available for absorption without competition from other metals. This patent describes a composition and method for selectively supplementing the essential metals in the human diet and for facilitating absorption of these metals by intestinal cells. These complexes are safe, inexpensive, biocompatible and easy to produce. These exogenously synthesized essential metal coordination complexes of picolinic acid (pyridine-2-carboxylic acid) have the following structural formula:

wherein M represents the metallic cation and n is equal to the cation's valence. For example, when M is Cr and n=3, then the compound is chromic tripicolinate. Other chromium picolinates disclosed include chromic monopicolinate and chromic dipicolinate.

[0033] The U.S. Recommended Daily Intake (RDI) of chromium is 120 μg. U.S.

Patent No. 5,087,623, describes the administration of chromic tripicolinate for the treatment of adult-onset diabetes in doses ranging from 50 to 500 μg. International Patent Application No. W096/35421 discloses the use of high doses of chromic tripicolinate (providing 1,000-10,000 μg chromium/day) for reducing hyperglycemia and stabilizing the level of serum glucose in humans with type 2 diabetes. U.S. Patent No. 5,789,401 discloses a chromic tripicolinate-biotin composition and its use in lowering blood glucose levels in humans with type 2 diabetes.

[0034] U.S. Patent Nos. 5,087,623; 5,087,624; and 5,175,156, disclose the use of chromium tripicolinate for supplementing dietary chromium, reducing hyperglycemia and stabilizing serum glucose, increasing lean body mass and reducing body fat, and controlling blood serum lipid levels, including the lowering of undesirably high blood serum LDL-cholesteroI levels and the raising of blood serum HDL-cholesterol levels. U.S. Patent Nos. 4,954,492 and 5,194,615, describe a related complex, chromic nicotinate, which is also used for supplementing dietary chromium and lowering serum lipid levels.

[0035] The chromium complexes of the disclosed invention have the same uses as described for chromic tripicolinate in U.S. Patent Nos. 5,087,623, 5,087,624 and 5,174,156, namely supplementing dietary chromium, lowering blood glucose levels in diabetics, lowering serum lipid levels and increasing lean body mass. Additionally, the chromium complexes of the present invention act to treat symptoms associated with overweight and obesity.

[0036] Advantageously, the chromium complexes are synthetic. The synthesis and use of chromium picolinates is described in U.S. Patent Nos. Re. 33,988 and 5,087,623. Chromic tripicolinate is available from health food stores, drug stores and other commercial sources. The synthesis and use of chromic polynicotinate is described in U.S. Patent No. 5,194,615. [0037] Typically, the dosage range of chromium administered to an individual in the form of chromium picolinate, chromium nicotinate, or other chromium complex provides between about 50 and 10,000 micrograms per day of chromium; preferably between about 100 and 1,000 micrograms per day; more preferably, between about 200 and 500 micrograms per day.

[0038] Picolinic acid and nicotinic acid are position isomers having the following structures:

picolinic acid nicotinic acid

[0039] Nicotinic acid and picolinic acid form coordination complexes with monovalent, divalent and trivalent metal ions and facilitate the absorption of these metals by transporting them across intestinal cells and into the bloodstream. Chromium absorption in rats following oral administration of CrCl₃ was facilitated by the non-steroidal anti-inflammatory drugs (NSAIDs) aspirin and indomethacin (Davis et al, J. Nutrition Res. 15:202-210, 1995; Kamath et al., J. Nutrition 127:478-482, 1997). These drugs inhibit the enzyme cyclooxygenase which converts arachidonic acid to various prostaglandins, resulting in inhibition of intestinal mucus formation and lowering of intestinal pH which facilitates chromium absorption.

[0040] While the chromium complexes aid in the absorption of chromium by intestinal cells, in some embodiments, chelating agents are advantageously included in the compositions to facilitate absorption of other ingested chromium as well as other metals including, but not limited to, copper, iron, magnesium, manganese and zinc. Suitable chelating agents include picolinic acid, nicotinic acid, or both picolinic acid and nicotinic acid. Thus, the compositions of the disclosed invention are readily absorbable forms of chromium which also facilitate absorption of other essential metals in the human diet.

[0041] The chelating agents such as picolinic acid and nicotinic acid are available from many commercial sources, including Sigma-Aldrich (St. Louis, MO) (picolinic acid; catalog No. P5503; nicotinic acid; catalog No. PN4126). Preferably, the ratio of the chromium complex to the chelating agent from about 10:1 to about 1:10 (w/w), more preferably from about 5:1 to about 1:5 (w/w).

[0042] In some embodiments, methods of increasing glucose uptake by cells or by organisms, such as mammals and humans, treating insulin-dependent diabetes, reducing body fat, improving insulin sensitivity, reducing hyperglycemia, and reducing hypercholesterolemia with the trans-10, cis-12 CLA isomer alone or in combination with a chromium complex are contemplated. Advantageously, a subject is administered a pharmaceutically effective dose of the trans-10, cis-12 isomer of CLA over a period of days, weeks, or months. In the case where both the trans-10, cis-12 CLA isomer and a chromium complex are administered to a subject, in one embodiment, the trans- 10, cis-12 CLA isomer is combined with the chromium complex in a capsule or other integrated form. In another embodiment, the trans-10, cis-12 CLA isomer is administered substantially simultaneously with the chromium complex. In an alternative embodiment, the chromium complex is administered first and then the trans-10, cis-12 CLA isomer is added second. In yet another embodiment, the trans-10, cis-12 CLA isomer is administered first. Preferably, the trans-10, cis-12 CLA isomer and chromium complex are administered to a subject within twenty-four hours of each other. In a particularly preferred embodiment, the trans-10, cis-12 CLA isomer and chromium complex are administered within an hour of each other.

[0043] A variety of delivery systems are available to deliver the compositions to a subject in need thereof. Preferably, the compositions of the disclosed invention are prepared by incorporating the components into a pharmaceutically acceptable carrier, including but not limited to tablets, capsules and microbeads, preferably sugar beadlets or microcrystalline cellulose.

[0044] For oral administration, the trans-10, cis-12 CLA isomer may be incorporated into a tablet, aqueous or oil suspension, dispersible powder or granule, microbead, emulsion, hard or soft capsule, syrup or elixir. The compositions may be prepared according to any method known in the art for the manufacture of pharmaceutically acceptable compositions and such compositions may contain one or more of the following agents: sweeteners, flavoring agents, coloring agents and preservatives. Tablets containing the active ingredients in admixture with non-toxic pharmaceutically acceptable excipients suitable for tablet manufacture are acceptable. "Pharmaceutically acceptable" means that the agent should be acceptable in the sense of being compatible with the other ingredients of the formulation (as well as non-injurious to the individual). Such excipients include inert diluents such as calcium carbonate, sodium carbonate, lactose, calcium phosphate or sodium phosphate; granulating and disintegrating agents, such as corn starch and alginic acid; binding agents such as starch, gelatin or acacia; and lubricating agents such as magnesium stearate, stearic acid or talc. Tablets may be uncoated or may be coated with lαiown techniques to delay disintegration and absorption in the gastrointestinal tract and thereby provide a sustained action over a longer period of time. For example, a time delay material such as glyceryl monostearate or glyceryl stearate alone or with a wax may be employed.

[0045] In another preferred embodiment, tablets, capsules or microbeads are coated with an enteric coating which prevents dissolution in the acidic environment of the stomach. Instead, this coating dissolves in the small intestine at a more neutral pH. Such enteric coated compositions are described by Bauer et al., Coated Pharmaceutical Dosage Forms: Fundamentals, Manufacturing Techniques, Biopharmaceutical Aspects, Test Methods and Raw Materials, CRC Press, Washington, DC, 1998. [0046] Formulations for oral use may also be presented as hard gelatin capsules wherein the active ingredient is mixed with an inert solid diluent, for example calcium carbonate, calcium phosphate or kaolin, or as soft gelatin capsules wherein the active ingredient is mixed with water or an oil medium, such as peanut oil, liquid paraffin or olive oil.

[0047] Aqueous suspensions may contain the trans-10, cis-12 CLA isomer of the invention in admixture with excipients for the manufacture of aqueous suspensions. Such excipients include suspending agents, dispersing or wetting agents, one or more preservatives, one or more coloring agents, one or more flavoring agents and one or more sweetening agents such as sucrose or saccharin.

[0048] Oil suspensions may be formulated by suspending the active ingredient in a vegetable oil, such as arachis oil, olive oil, sesame oil or coconut oil, or in a mineral oil such as liquid paraffin. The oil suspension may contain a thickening agent, such as beeswax, hard paraffin or cetyl alcohol. Sweetening agent, such as those set forth above, and flavoring agents may be added to provide a palatable oral preparation. These compositions may be preserved by an added antioxidant such as ascorbic acid. Dispersible powders and granules of the invention suitable for preparation of an aqueous suspension by the addition of water provide the active ingredient in admixture with a dispersing or wetting agent, a suspending agent, and one or more preservatives. Additional excipients, for example sweetening, flavoring and coloring agents, may also be present.

[0049] Syrups and elixirs may be formulated with sweetening agents, such as glycerol, sorbitol or sucrose. Such formulations may also contain a demulcent, a preservative, a flavoring or a coloring agent.

[0050] The oral formulations described above may also include aspirin (acetylsalicylic acid), other salicylates, or another NSAID such as indomethacin, ibuprofen, acetaminophen, naproxen or any drug capable of inhibiting the cyclooxygenase pathway leading to prostaglandin synthesis. This results in a decrease in intestinal mucus production and lower intestinal pH which facilitates absorption of the composition. The oral compositions may further include mucolytics such as guaifenesin and the like, to inhibit intestinal mucus production, and/or acids such as ascorbic acid, citric acid and the like to lower intestinal pH. There are two forms of cyclooxygenase (cox), coxl and cox2, which differ in their sensitivity to inhibition by NSAIDs. The cox2 isozyme promotes prostaglandin formation at sites of inflammation, but not at other sites such as the gastrointestinal tract. In contrast, relatively selective inhibition of coxl facilitates chromic tripicolinate and chromic polynicotinate absorption. Although the selective inhibition of coxl is desirable, any inhibitor or coxl or cox2 can be formulated with the trans-10, cis-12 CLA isomer of the invention. The amount of these drugs formulated with or coadministered with the trans-10, cis-12 CLA isomer of the invention are as follows: cox inhibitions, between about 50 mg and 500 mg; mucolytics, between about 10 mg and 250 mg; and acids, between about 50 mg and about 1,000 mg. [0051] The coadministration or formulation of salicylate-containing herbs with the compositions of the invention is also contemplated. Class I herbs, as documented in the American Herbal Products Association's Botanical Safety Handbook (herbs that can be safely consumed when used appropriately), such as Boswelia serrata (frankincense), Betula lenta (sweet birch), Betula pubescens (white birch), Filipendula ulmaria (meadowsweet), Gaultheria procumbens (wintergreens), Populus balsamifera and Populus jacldi (balm of Gilead), and Salix alba (white willow) are all salicin-containing plants with salicylate-like properties. These herbs suppress prostaglandin synthesis by cox inhibition, thereby improving absorption of the active ingredient, i.e. the trans-10, cis-12 isomer. These herbs are relatively free from gastric ulcerogenic effects (Singh et al., Agents and Actions 18:407-412, 1986). In addition, pre-clinical acute toxicity studies have shown that salicin-containing plants do not cause hematological disturbances (American Herbal Products Association, Botanical Safety Handbook, 1997).

[0052] The compounds and herbs described above all effect gut physiology by inhibiting prostaglandin synthesis, decreasing mucus production, and lowering gastrointestinal pH. The inclusion of these compounds, as well as an enteric coating, into the trans-10, cis-12 CLA isomer-containing compositions of the invention results in a multicomponent delivery system which allows delivery of these agents to the gastrointestinal tract where they work in concert to facilitate absorption.

[0053] In a preferred embodiment, the trans-10, cis-12 CLA isomer is coated onto microbeads. In a particularly preferred embodiment, these microbeads are sugar beadlets of various sizes, also known as nonpareils, and are commercially available from, for example, SmithKline Beecham. If the microbeads are to be used to administer the compositions of the invention to diabetic patients, the administration of other types of microbeads, such as microcrystalline cellulose, is preferred. Microcrystalline cellulose is commercially available and can be processed into beadlets of various sizes by micronization, a technique well known in the art. The microbeads are essentially a carrier for the compositions of the invention. For a description of coated beadlets, see, for example, Carstensen, J. T., Pharmaceutical Principles of Solid Dosage Forms, Technonic Publishing Co., Inc., Lancaster, PA, pp. 228-230, 1993. Aqueous solutions containing the trans-10, cis-12 CLA isomer with or without chromium complexes and with or without the chelating agent components such as nicotinic acid and picolinic acid are sprayed onto the microbeads by well known methods such as by suspending the microbeads in an upcurrent of air and introducing a fine spray of the active ingredients which form a coating on the outside of the microbeads which is then allowed to dry. The desired trans-10, cis-12 isomer with or without the chromium complex components may be combined into one same solution or applied using separate solutions. Optionally, the coated microbeads can be further coated with a substance to protect the active ingredients coated onto the beads, such as latex. The microbeads may be placed in a capsule prior to administration. In another preferred embodiment, the capsule or the microbeads are coated with an enteric coating to delay dissolution until reaching the small intestine.

[0054] The following examples teach certain methods and compositions for treating diabetes and obesity through the administration of trans-10, cis-12 conjugated linoleic acid. The subject can advantageously be a vertebrate, a mammal, a bird, and is preferably a human, a cat, or a dog. As illustrated in the following examples, the composition may optionally include a chromium complex in combination with the trans-10, cis-12 conjugated linoleic acid compound. These examples are illustrative only and are not intended to limit the scope of the invention disclosed herein. The treatment methods described below can be optimized using empirical techniques well known to those of ordinary skill in the art. Moreover, artisans of skill would be able to use the teachings described in the following examples to practice the full scope of the invention disclosed herein.

EXAMPLE 1

EFFECT OF TRANS-10. CIS-12 CLA ISOMER ON 2-DEOXYGLUCOSE UPTAKE IN

HUMAN SKELETAL MUSCLE CELLS

[0055] The effect of trans-10, cis-12 CLA isomer (concentrations 0.05, 0.5, and 5 ng), either alone or in combination with a chromium complex, on glucose uptake in skeletal muscle cells was assessed. A standard assay of 2-deoxyglucose uptake in human skeletal muscle cells (HSMC) was performed to observe glycogen accumulation. Human Skeletal Muscle Culture

[0056] The primary culture of HSMC was carried out using modifications of the methods of Henry et al. Briefly, human skeletal muscles cells (Clonetic Labs) were placed in a 20 ml Ham's F-10 media and washed three times with Ham's F-10 media at 4°C. Cells were centrifuged at 600 g for four minutes at 37°C, and resuspended in fully supplemented human skeletal growth media (S GM Bullet kit) with 10% PBS, without insulin. Cells (approximately 3,000 cells/ml) were plated on 100 mm dishes and placed in an incubator containing 95% air/5% C0 . Media was changed every 3-4 days until 70-80% confluence was obtained (about 10-14 days). The concentrations tested were felt to represent physiologic or supraphysiologic levels in human plasma. 2-Deoxyglucose Uptake in Human Skeletal Muscle

[0057] The procedure for glucose uptake is a modification of the method described by

Klip et al. Human skeletal muscle cells from culture were grown in 24- well plates until they reached 70-80%) confluence. Cells were washed twice with warmed PBS, and incubated in serum- free KRP buffer (136 mM NaCl, 4.7 mM KC1, 10 mM NaP0₄, 0.9mM MgS0₄, and 0.9mM CaCl₂). containing 0.2% BSA at 37°C for 60-90 minutes. Glucose uptake was then performed in 0.45 ml KRP containing 0.2% BSA with or without 100 nM insulin for 14 minutes. At 10 minutes, 50 μl of 10X START (1 mM 2-deoxyglucose [5 uCi/ml][3_h]-2-deoxyglucose, final concentration of 2- deoxyglucose was O.lmM, DuPont, NEN) was added and incubated for four minutes at 37 °C. The dish was then quickly washed in ice-cold PBS three times. The glucose uptake was determined in triplicate at each point after lysis with 0.2N NaOH shaken at 200 rpm for 60 min. A 400 μl content was analyzed on a 50 μl aliquot of cells suspensions using the Bradford method. The value for 2- deoxyglucose uptake was subtracted to correct each sample for the contribution of the diffusion and trapping in presence of 10 μM of Cytochalasin B. Glucose uptake was expressed as pmol per mg protein 'min ¹. Results

The following tables illustrate the effects of the trans-10, cis-12 CLA isomer alone on glucose uptake with or without insulin stimulation as well as the effects the CLA isomer when administered in conjunction with a chromium complex such as chromium picolinate.

[0058] With reference to the Figures, the term "9(Z), 11(E)" corresponds with the cis-

9, trans-11 CLA isomer. The term "10(E),12(Z)" corresponds with the trans-10, cis-12 isomer of CLA. The term "CLA(2x)" refers to a composition comprising both the cis-9, trans-11 CLA isomer. "CP" refers to chromium picolinate. Hence, the phrase "CP+9(Z), 11(E)" refers to a composition comprising chromium picolinate and the cis-9, trans-11 isomer of CLA. Similarly "CP+10(E),12(Z)" refers to a composition comprising both chromium picolinate and the trans-10, cis-12 isomer of CLA. "CP+CLA(2X)" refers to chromium picolinate in combination with both isomers of CLA. The term "basal", as used with reference to the Figures, refers to an environment in the absence of insulin stimulation. The concentrations of the CLA isomers tested with or without chromium picolinate, as indicated in the figures, include 0.05 ng of isomer, 0.5 ng of isomer, and 5 ng of isomer.

[0059] Turning to specifically to Figure 1, Figure 1 demonstrates the effect of the trans-10, cis-12 CLA isomer alone on glucose uptake in the absence of insulin stimulation. The trans-10, cis-12 isomer of CLA showed significant increases in glucose uptake in HSMC (p<0.05) while the 9, 11 isomer of CLA and the mixed isomers showed no effect.

[0060] Figure 2 reflects the effect of chromium picolinate and CLA on glucose uptake in HSMC in the absence of insulin (basal). Notably, a more significant increase in glucose uptake was also observed when chromium picolinate was combined with the trans-10, cis-12 CLA isomer (p<0.05).

[0061] Figures 3 and 4 below reflect the effect of CLA alone and in combination with a chromium complex on glucose uptake in the presence of insulin stimulation. Again, the 10, 12 isomer of CLA demonstrated a marked increase in glucose uptake as compared to mixed isomers of CLA and had no effect with the cis-9, trans- 11 CLA isomer. Similarly, the addition of a chromium complex such as chromium picolinate significantly enhanced the glucose uptake activity of the trans-10, cis-12 CLA isomer (p<0.05). [0062] The results of our studies demonstrate that the trans-10, cis-12 isomer of CLA causes glucose uptake in human skeletal muscle with and without insulin stimulation. The addition of a chromium complex further enhanced glucose uptake. Thus, compositions comprising trans-10, cis-12 CLA isomer, alone or in combination with a chromium complex, may be employed to reduce or even eliminate the need for the administration of insulin in certain patients with type I diabetes, and a combination may also help for individuals with type II diabetes to maintain their blood glucose levels.

EXAMPLE 2

EFFECT OF TRANS-10. CIS-12 CLA ISOMER ON GLYCOGEN UPTAKE IN HUMAN

SKELETAL MUSCLE CELLS

Glycogen Accumulation in Human Skeletal Muscle Culture

[0063] Human skeletal muscle from primary culture is grown in 24-well plates and washed twice with PBS (20mM, pH 7.4, 300 μl/well) and all liquid is removed. The plates are frozen in liquid nitrogen and stored at -20°C until use. Enzymatic glycogen hydrolysis is performed according to modification of methods described by Keppler et al. and Gomez-Lechon et al. A volume of 300 μl/well of 250 μl/well glucoamylase in 0.2M sodium acetate buffer, pH 4.8, is added and plates are incubated for 2 hours at 40°C with shaking. The hydrolyzed cell suspension are transferred to microcentrifuge tubes and spun at 2500 rpm for five minutes.

[0064] For the glucose assay, 50 μl/well aliquots of the above supernatants are transferred to another 96-well plate. Glucose is determined in the supernatants by the colorimetric glucose oxidase method by adding 200 μl of reaction solution, which contains 1 μ/L peroxidase, >10 μ/L glucose oxidase, and 1 mg/ml ABTS in 100 mM phosphate buffer, pH 6. Samples are measured at 405 nm using a microplate reader. A blank of the reaction is performed by incubation of cell monolayers without glucoamylase; this value represents the free glucose content and has to be subtracted from the total glucose obtained after enzymatic hydrolysis. A calibration curve is constructed with known amounts of glucose in 50 μl/well and processed as test samples. Protein content of each well is measured in a 50 μl aliquot of hydrolyzed cell suspension by the Bradford method. Glycogen content is expressed by nM glucose/mg protein.

[0065] An increase in glycogen uptake is observed in human skeletal muscles treated with the trans-10, cis-12 isomer of CLA with and without insulin stimulation. The addition of a chromium complex further enhances glycogen uptake.

EXAMPLE 3

TREATMENT OF OBESE SUBJECT WITH TRANS-10. CIS-12 ISOMER OF CLA AND A

TRIVALENT CHROMD M COMPLEX

[0066] An obese adult human subject is identified. The subject is orally administered a tablet comprising 2.5 grams of trans-10, cis-12 conjugated linoleic acid twice a day. The tablet additionally includes ibuprofen in a pharmaceutically effective dose of 200 mg. Over the course of several weeks, a decrease in body mass is observed. The conjugated linoleic acid isomer reduces the subject's body mass, resulting in weight loss.

EXAMPLE 4

TREATMENT OF INSULIN-DEPENDENT DIABETES WITH TRANS-10. CIS-12 ISOMER OF CLA AND A TRIVALENT CHROMIUM COMPLEX

[0067] A subject suffering from insulin-dependent diabetes is identified. The subject is orally administered a daily dose of one tablet containing about 500 μg chromium as chromium picolinate and 500 mg trans-10, cis-12 conjugated linoleic acid. Over the course of several days, an improvement in glucose uptake in the subject is observed and insulin dependence is reduced. The chromium picolinate in combination with conjugated linoleic acid isomer act synergistically to improve the subject's glucose tolerance and to treat the subject's diabetes.

EXAMPLE 5

ADMINISTRATION OF TRANS-10. CIS-12 ISOMER OF CONJUGATED LINOLEIC ACH) FOR THE IMPROVEMENT OF INSULIN SENSITIVITY

[0068] An individual presenting with poor insulin sensitivity is identified. The individual is orally administered a pharmaceutically effective amount of the trans-10, cis-12 isomer of conjugated linoleic acid for a period of several weeks. Blood analyses reveal an improvement in insulin sensitivity as compared with blood drawn prior to the administration of the trans-10, cis-12 isomer of conjugated linoleic acid.

EXAMPLE 6 REDUCTION OF HYPERGLYCEMIA

[0069] A subject suffering from hyperglycemia is identified. The subject is administered a composition which includes an effective amount of the trans-10, cis-12 isomer of conjugated linoleic acid, chromium nicotinate, and a chelating agent. Once a week, blood is drawn to ascertain whether the subject is hyperglycemic. After several weeks, a reduction in hyperglycemia is observed.

EXAMPLE 7

TREATMENT OF HYPERCHOLESTEROLEMIA WITH TRANS-10.

CIS-12 CLA TSOMER

[0070] An individual presenting with hypercholesterolemia is identified. The individual is administered a pharmaceutically effective amount of the trans-10, cis-12 isomer of conjugated linoleic acid. Over time, a lowering of serum cholesterol is observed.

[0071] It will be appreciated that although specific embodiments of the invention have been described herein for the purposes of illustration, various modifications may be made without deviating from the spirit and scope of the invention. Accordingly, the invention is not limited except as by the appended claims.

Claims

WHAT IS CLAIMED IS:

1. Use of a composition comprising an effective dose of a trans-10, cis-12 isomer of conjugated linoleic acid for the manufacture of a medicament for the treatment of Type 1 diabetes, wherein said effective dose of trans-10, cis-12 isomer of conjugated linoleic acid increases glucose uptake without insulin stimulation.

2. The use of claim 1, wherein said composition further comprises an effective dose of at least one trivalent chromium complex.

3. The use of claim 2, wherein said at least one trivalent chromium complex is selected from the group consisting of chromium picolinate, chromium nicotinate, chromic tripicolinate, chromic polynicotinate, chromium chloride, chromium histidinate, and chromium yeasts.

4. The use of claim 2, wherein said composition further comprises at least one uncomplexed chelating agent.

5. The use of claim 4, wherein said chelating agent is picolinic acid, nicotinic acid, or both.

6. Use of a composition comprising a pharmaceutically effective dose of a trans-10, cis-12 isomer of conjugated linoleic acid for the manufacture of a medicament for the treatment of type 2 diabetes, wherein said effective dose of trans-10, cis-12 isomer of conjugated linoleic acid increases glucose uptake without insulin stimulation.

- 7. The use of claim 6, wherein said composition further comprises an effective dose of at least one trivalent chromium complex.

8. The use of claim 7, wherein said at least one trivalent chromium complex is selected from the group consisting of chromium picolinate, chromium nicotinate, chromic tripicolinate, chromic polynicotinate, chromium chloride, chromium histidinate, and chromium yeasts.

9. The use of claim 7, wherein said composition further comprises at least one uncomplexed chelating agent.

10. The use of claim 9, wherein said chelating agent is picolinic acid, nicotinic acid, or both.

11. Use of a composition comprising a pharmaceutically effective dose of a trans-10, cis-12 isomer of conjugated linoleic acid for the manufacture of a medicament for the reduction of body fat in an individual in need thereof.

12. The use of claim 11, wherein said composition further comprises an effective dose of at least one trivalent chromium complex.

13. The use of claim 12, wherein said at least one trivalent chromium complex is selected from the group consisting of chromium picolinate, chromium nicotinate, chromic tripicolinate, chromic polynicotinate, chromium chloride, chromium histidinate, and chromium yeasts.

14. The use of claim 12, wherein said composition further comprises at least one uncomplexed chelating agent.

15. The use of claim 14, wherein said chelating agent is picolinic acid, nicotinic acid, or both.

16. Use of a composition comprising a pharmaceutically effective dose of a trans-10, cis-12 isomer of conjugated linoleic acid for the manufacture of a medicament for improving insulin sensitivity.

17. The use of claim 16, wherein said composition further comprises at least one trivalent chromium complex.

18. The use of claim 17, wherein said at least one trivalent chromium complex is selected from the group consisting of chromium picolinate, chromium nicotinate, chromic tripicolinate, chromic polynicotinate, chromium chloride, chromium histidinate, and chromium yeasts.

19. The use of claim 17, wherein said composition further comprises at least one uncomplexed chelating agent.

20. The use of claim 19, wherein said chelating agent is picolinic acid, nicotinic acid, or both.

21. Use of a composition comprising a pharmaceutically effective dose of a trans- 10, cis- 12 isomer of conjugated linoleic acid for the manufacture of a medicament for reducing hyperglycemia in a subject in need thereof.

22. The use of claim 21, wherein said composition further comprises at least one trivalent chromium complex.

23. The use of claim 22, wherein said at least one trivalent chromium complex is selected from the group consisting of chromium picolinate, chromium nicotinate, chromic tripicolinate, chromic polynicotinate, chromium chloride, chromium histidinate, and chromium yeasts.

24. The use of claim 23, wherein said composition further comprises at least one uncomplexed chelating agent.

25. The use of claim 24, wherein said chelating agent is picolinic acid, nicotinic acid, or both.

26. Use of a composition comprising a pharmaceutically effective dose of a trans-10, cis-12 isomer of conjugated linoleic acid for the manufacture of a medicament for reducing hypercholesterolemia in a subject in need thereof.

27. The use of claim 26, wherein said composition further comprises at least one trivalent chromium complex.

28. The use of claim 27, wherein said at least one trivalent chromium complex is selected from the group consisting of chromium picolinate, chromium nicotinate, chromic tripicolinate, chromic polynicotinate, chromium chloride, chromium histidinate, and chromium yeasts.

29. The use of claim 27, wherein said composition further comprises at least one uncomplexed chelating agent.

30. The use of claim 29, wherein said chelating agent is picolinic acid, nicotinic acid, or both..