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  • A23—FOODS OR FOODSTUFFS; TREATMENT THEREOF, NOT COVERED BY OTHER CLASSES
  • A23L—FOODS, FOODSTUFFS OR NON-ALCOHOLIC BEVERAGES, NOT OTHERWISE PROVIDED FOR; PREPARATION OR TREATMENT THEREOF
  • A23L33/00—Modifying nutritive qualities of foods; Dietetic products; Preparation or treatment thereof
  • A23L33/10—Modifying nutritive qualities of foods; Dietetic products; Preparation or treatment thereof using additives
• • A—HUMAN NECESSITIES
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  • A23L—FOODS, FOODSTUFFS OR NON-ALCOHOLIC BEVERAGES, NOT OTHERWISE PROVIDED FOR; PREPARATION OR TREATMENT THEREOF
  • A23L33/00—Modifying nutritive qualities of foods; Dietetic products; Preparation or treatment thereof
  • A23L33/10—Modifying nutritive qualities of foods; Dietetic products; Preparation or treatment thereof using additives
  • A23L33/105—Plant extracts, their artificial duplicates or their derivatives
• • A—HUMAN NECESSITIES
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  • A23L—FOODS, FOODSTUFFS OR NON-ALCOHOLIC BEVERAGES, NOT OTHERWISE PROVIDED FOR; PREPARATION OR TREATMENT THEREOF
  • A23L33/00—Modifying nutritive qualities of foods; Dietetic products; Preparation or treatment thereof
  • A23L33/10—Modifying nutritive qualities of foods; Dietetic products; Preparation or treatment thereof using additives
  • A23L33/115—Fatty acids or derivatives thereof; Fats or oils
• • A—HUMAN NECESSITIES
  • A23—FOODS OR FOODSTUFFS; TREATMENT THEREOF, NOT COVERED BY OTHER CLASSES
  • A23L—FOODS, FOODSTUFFS OR NON-ALCOHOLIC BEVERAGES, NOT OTHERWISE PROVIDED FOR; PREPARATION OR TREATMENT THEREOF
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• • A—HUMAN NECESSITIES
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  • A23L—FOODS, FOODSTUFFS OR NON-ALCOHOLIC BEVERAGES, NOT OTHERWISE PROVIDED FOR; PREPARATION OR TREATMENT THEREOF
  • A23L33/00—Modifying nutritive qualities of foods; Dietetic products; Preparation or treatment thereof
  • A23L33/10—Modifying nutritive qualities of foods; Dietetic products; Preparation or treatment thereof using additives
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  • A61K31/185—Acids; Anhydrides, halides or salts thereof, e.g. sulfur acids, imidic, hydrazonic or hydroximic acids
  • A61K31/19—Carboxylic acids, e.g. valproic acid
  • A61K31/195—Carboxylic acids, e.g. valproic acid having an amino group
  • A61K31/197—Carboxylic acids, e.g. valproic acid having an amino group the amino and the carboxyl groups being attached to the same acyclic carbon chain, e.g. gamma-aminobutyric acid [GABA], beta-alanine, epsilon-aminocaproic acid or pantothenic acid
• • A—HUMAN NECESSITIES
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  • A61K31/185—Acids; Anhydrides, halides or salts thereof, e.g. sulfur acids, imidic, hydrazonic or hydroximic acids
  • A61K31/19—Carboxylic acids, e.g. valproic acid
  • A61K31/20—Carboxylic acids, e.g. valproic acid having a carboxyl group bound to a chain of seven or more carbon atoms, e.g. stearic, palmitic, arachidic acids
  • A61K31/202—Carboxylic acids, e.g. valproic acid having a carboxyl group bound to a chain of seven or more carbon atoms, e.g. stearic, palmitic, arachidic acids having three or more double bonds, e.g. linolenic
• • A—HUMAN NECESSITIES
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  • A61K31/185—Acids; Anhydrides, halides or salts thereof, e.g. sulfur acids, imidic, hydrazonic or hydroximic acids
  • A61K31/205—Amine addition salts of organic acids; Inner quaternary ammonium salts, e.g. betaine, carnitine
• • A—HUMAN NECESSITIES
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  • A61K31/33—Heterocyclic compounds
  • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
  • A61K31/435—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
  • A61K31/44—Non condensed pyridines; Hydrogenated derivatives thereof
  • A61K31/4415—Pyridoxine, i.e. Vitamin B6
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  • A61K31/70—Carbohydrates; Sugars; Derivatives thereof
  • A61K31/7135—Compounds containing heavy metals
  • A61K31/714—Cobalamins, e.g. cyanocobalamin, i.e. vitamin B12
• • A—HUMAN NECESSITIES
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  • A61K33/24—Heavy metals; Compounds thereof
  • A61K33/30—Zinc; Compounds thereof
• • A—HUMAN NECESSITIES
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  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K36/00—Medicinal preparations of undetermined constitution containing material from algae, lichens, fungi or plants, or derivatives thereof, e.g. traditional herbal medicines
  • A61K36/16—Ginkgophyta, e.g. Ginkgoaceae (Ginkgo family)
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  • A61K36/18—Magnoliophyta (angiosperms)
  • A61K36/88—Liliopsida (monocotyledons)
  • A61K36/899—Poaceae or Gramineae (Grass family), e.g. bamboo, corn or sugar cane
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  • A61K45/06—Mixtures of active ingredients without chemical characterisation, e.g. antiphlogistics and cardiaca
• • A—HUMAN NECESSITIES
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  • A61K2236/10—Preparation or pretreatment of starting material
  • A61K2236/19—Preparation or pretreatment of starting material involving fermentation using yeast, bacteria or both; enzymatic treatment
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  • A61K36/062—Ascomycota

Definitions

• the present invention relates to a combination of active ingredients and to compositions containing this combination for the medical and nutritional use, in the preparation of medicines or food supplements useful for prophylaxis and/ or treatment of lipid metabolism disorders and their complications.
• the present invention relates to a composition
• a composition comprising as active ingredients (a) extract of rice fermented with Monascus purpureus; (b) at least one omega-3 fatty acid; (c) L-carnitine or a salt thereof; and one or more of the following active ingredients: (d) at least one policosanol or a natural extract containing policosanols; (e) resveratrol or a natural extract containing resveratrol; (f) Coenzyme Q 10; and (g) at least one vitamin.
• Cardiovascular diseases related to abnormal lipid metabolism are very frequent in industrialised countries. In Italy, for instance, they account for more than 40% of the overall mortality (Capocaccia R., Farchi G., Prati S. et al: La mortalita in Italia nell'anno 1989. Rapporto ISTISAN 1992/22).
• Our knowledge of the relationships between cholesterol and coronary heart disease stem from epidemiological studies conducted over the past few years. The conclusions reached in these studies indicate that the development of severe coronary atherosclerosis and coronary heart disease are closely correlated with serum cholesterol levels (McGill H.C. Jr. et at: The International Atherosclerosis Project. Lab. Invest. 18: 463- 653, 1968; Keys A.: Seven countries: Death and Coronary Heart Disease. Harvard University Press, Cambridge, 1980).
• Hypolipaemic drugs fall into two categories: those which above all reduce cholesterol and those which mainly reduce triglycerides.
• the former group of drugs includes the statins, probucol and resins, while the latter group includes the fibrates, nicotinic acid and fatty acids belonging to the omega-3 series.
• statins are inhibitors of hydroxy-methyl-glutaryl-coenzyme A (HMG-CoA) reductase. By inhibiting this enzyme, they reduce the hepatic synthesis of cholesterol (Lancet 1994; 334: 1383- 1389). To compensate for the reduction of intracellular cholesterol the liver cell produces several receptors for LDL and VLDL lipoproteins, which are thus removed from the bloodstream.
• HMG-CoA hydroxy-methyl-glutaryl-coenzyme A
• statins are drugs which are better tolerated than the other anticholesterolaemic agents, but are not without drawbacks, the side effects most commonly induced by these drugs being gastrointestinal disorders, skin rashes and headache.
• statins lead to a reduction in the number of deaths due to coronary heart disease, an increase has been observed, in treated patients, of deaths caused by other events such as tumours or trauma
• Davey-Smith G., Song F., Sheldon T.A. Cholesterol lowering and mortality: the importance of considering initial level at risk.
• the results of experiments in animals and human subjects have suggested that, to reduce cholesterol levels, pharmacological treatment with statins should be given only to patients at high risk for coronary disease in the short term (JAMA, 1996; 275: 55-60).
• Red yeast rice is the product of yeast (Monascus purpureus) grown on rice, and is served as a dietary staple in some Asian countries. It contains several compounds collectively known as monacolins, substances known to inhibit cholesterol synthesis. One of these, “monacolin K,” is a potent inhibitor of HMG-CoA reductase.
• omega-3 fatty acids are known for their triglyceride-lowering effects and for their effects in raising the levels of high-density lipoproteins (HDL).
• HDL high-density lipoproteins
• the policosanols are long-chain aliphatic alcohols. Examples of policosanols are triacontanol, hexacosanol, hexacontanol, ecocontanol, tetracosanol, dotriacontanol, and tetracontanol.
• the policosonol can be present as such or in the form of extract from natural products that contain it, e.g. wheat or rice germs, the waxy cuticle of sugar cane, or Ginkgo biloba leaves. Policosanols are widely used in the medical and nutritional field.
• Resveratrol (trans-3,4',5,-trihydroxystilbene) is a polyphenol molecule found in many plant species including grapes and others.
• Coenzyme Q 10 is now so well known in its human use that it requires no particular explanation and the substance is available on the market. Experts in the sector can refer to the patent documents filed by the present applicant, where this substance is amply described.
• Vitamin Be is a water-soluble vitamin and is part of the vitamin B complex group widely used in the medical and nutritional field.
• pyridoxal phosphate PLP
• PLP pyridoxal phosphate
• Vitamin B12 also called cobalamin, is a water soluble vitamin with a key role in the normal functioning of the brain and nervous system, and for the formation of blood. It is one of the eight B vitamins. It is normally involved in the metabolism of every cell of the human body, especially affecting DNA synthesis and regulation, but also fatty acid synthesis and energy production. As the largest and most structurally complicated vitamin, it can be produced industrially only through bacterial fermentation-synthesis.
• Vitamin B12 is widely used in the medical and nutritional field.
• L-carnitine is a quaternary ammonium compound biosynthesized from the amino acids lysine and methionine. In living cells, it is required for the transport of fatty acids from the cytosol into the mitochondria during the breakdown of lipids (fats) for the generation of metabolic energy.
• L-carnitine is useful for increasing the HDL cholesterol and for treating diseases liked to high cholesterol level.
• composition comprising as active ingredients (a) extract of rice fermented with Monascus purpureus; (b) at least one omega-3 fatty acid; (c) L-carnitine or a salt thereof; and one or more of the following active ingredients: (d) at least one policosanol or a natural extract containing policosanols; (e) resveratrol or a natural extract containing resveratrol; (f) Coenzyme Q 10; and (g) at least one vitamin; enables an enhanced effect on the anticholesterolaemic and antitriglyceridaemic action to be achieved as compared to the separate, independent administration of the active ingredients or their minimal combination.
• synergistic combination composition comprising as active ingredients: (a) extract of rice fermented with Monascus purpureus; (b) at least one omega-3 fatty acid; (c) L-carnitine or a salt thereof; and one or more of the following active ingredients: (d) at least one policosanol or a natural extract containing policosanols; (e) resveratrol or a natural extract containing resveratrol; (f) Coenzyme Q 10; and (g) at least one vitamin.
• synergistic composition comprising as active ingredients: (a) extract of rice fermented with Monascus purpureus; (b) at least one omega-3 fatty acid; (c) L- carnitine or a salt thereof; (d) at least one policosanol or a natural extract containing policosanols; (e) resveratrol or a natural extract containing resveratrol; (f) Coenzyme Q IO; and optionally (g) at least one vitamin.
• a synergistic composition comprising as active ingredients: (a) extract of rice fermented with Monascus purpureus in a dose of from 1 mg to 3000 mg, preferred doses is of from 10 mg to 2000 mg, the most preferred dose is 200 mg; (b) at least one omega-3 fatty acid in a dose of from 1 mg to 2000 mg, preferred doses is of from 10 mg to 1000 mg, the most preferred dose is 600 mg; (c) L-carnitine or a salt thereof in a dose of from 1 mg to 3000 mg, preferred doses is of from 10 mg to 1000 mg, the most preferred dose is 100 mg as inner salt; (d) at least one policosanol or a natural extract containing policosanols in a dose of from 0.1 mg to 1000 mg, preferred doses is of from 1 mg to 100 mg, the most preferred dose is 10 mg; (e) resveratrol or a natural extract containing resveratrol in a dose of
• compositions mentioned above for use as anticholesterolaemic and antitriglyceridaemic agents, and for increasing HDL cholesterol.
• compositions mentioned above for use for the prevention or treatment of altered lipid metabolism and complications thereof, in which said complications are selected from the group consisting of cardiovascular, atherosclerotic and/ or thromboembolic diseases.
• compositions mentioned above for preparing a medicament for the prevention or treatment of altered lipid metabolism and complications thereof, in which said complications are selected from the group consisting of cardiovascular, atherosclerotic and/ or thromboembolic diseases.
• compositions mentioned above for preparing a dietary supplement for the prevention or treatment of altered lipid metabolism and complications thereof, in which said complications are selected from the group consisting of cardiovascular, atherosclerotic and/ or thromboembolic diseases.
• compositions of the invention may further comprise other vitamins, co-enzymes, mineral substances and antioxidants; or further active ingredients useful for treating lipid dismetabolism.
• salt of L-carnitine is any salt of the latter with an acid that does not give rise to toxic or side effects.
• Non-limiting examples of such salts are: chloride, bromide, orotate, aspartate, acid aspartate, acid citrate, magnesium citrate, phosphate, acid phosphate, fumarate and acid fumarate, magnesium fumarate, lactate, maleate and acid maleate, oxalate, acid oxalate, pamoate, acid pamoate, sulphate, acid sulphate, glucose phosphate, tartrate and acid tartrate, glycerophosphate, mucate, magnesium tartrate, 2-amino- ethanesulphonate, magnesium 2-amino-ethanesulphonate, methanesulphonate, choline tartrate, trichloroacetate, and trifluoroacetate .
• the Monascus purpureus used according to the invention is extract of red rice (Oryza sativa) fermented with red yeast (Monascus purpureus) having a title of 1.5% in monacolin K.
• the omega-3 fatty acid according to the present invention can possibly be esterified or salified, These fatty acids can be obtained by synthesis or, preferably, from fish oil. In that case, it is possible to use various mixtures of omega-3 fatty acids depending on their characteristics.
• the omega-3 fatty acids are the long-chain ones (from 20 to 22 carbon atoms). The ones most preferred are 5,8, 1 1 , 14, 17- eicosapentanoic acid (EPA) and cis 0, 13, 16, 19-docosahexanoic acid (DHA).
• EPA eicosapentanoic acid
• DHA cis 0, 13, 16, 19-docosahexanoic acid
• These omega-3 fatty acids can possibly be esterified or salified to pharmaceutically acceptable derivatives, with alcohols or bases, respectively.
• the omega-3 fatty acids, or their esters or salts, alone or in mixtures thereof, can be procured on the market, or can be prepared by known methods. The mixtures can be specifically
• the policosanols according to the present invention are long-chain aliphatic alcohols.
• Examples of policosanols are triacontanol, hexacosanol, hexacontanol, ecocontanol, tetracosanol, dotriacontanol, and tetracontanol.
• the policosonal can be present as such or in the form of extract from natural products that contain it, e.g. wheat or rice germs, the waxy cuticle of sugar cane, or Ginkgo biloba leaves.
• Resveratrol according to the present invention is a polyphenol molecule found in many plant species including grapes and others.
• Polyphenols, including flavonoids, flavonols, catechins, and stilbenes are present in the human diet in plant materials, where they act as antioxidants and protect the plant from damage by bacteria, fungi, and ultraviolet radiation. Since resveratrol is present in wine, it has been postulated that it might be the reason for the "French Paradox," the epidemiological phenomenon in which the French population has a significantly lower incidence of cardiovascular disease, even though the French consume a diet higher in fat than other populations.
• Monascus purpureus, omega-3 fatty acid, policosanol, resveratrol, Coenzyme Q IO, Vitamin B6, Vitamin B12 and L-carnitine according to the present invention can be administrated in a "co-ordinated manner".
• "co-ordinated manner" of the aforesaid compounds is, indifferently, either the co-administration, i.e.
• composition of the present invention is administered orally, in any suitable form.
• An example of form of administration is in a liquid, semi-liquid or solid form in sachets, pills, vials, ointment, gel or liposome.
• Monascus purpureus, omega-3 fatty acids, policosanols, resveratrol, Coenzyme Q 10, Vitamin B6, Vitamin B12 and L-carnitine according to the present invention are known compounds easily available on the market.
• composition according to the present invention is composed of active ingredients which are familiar to operators in the medical field and already in use. Said active ingredients are not endowed with the side effects of the antilipemic drugs known in the art (statins, probucol, resins and fibrates).
• the therapeutically effective dose can be estimated initially either in cell culture assays or in animal models, usually mice or rats.
• the animal model may also be used to determine the appropriate concentration range and route of administration. Such information can then be used to determine useful doses and routes for administration in humans.
• the precise effective dose for a human subject will depend upon the severity of the disease state, general health of the subject, age, weight, and gender of the subject, diet, time and frequency of administration, drug combination(s), reaction sensitivities, and tolerance/ response to therapy. This implies that, apart from the consideration of the synergistic effect demonstrated here below, the dosages and ratios of the individual components can be determined by the expert in the sector with normal preclinical and clinical trials, or with the usual considerations regarding the formulation of a dietetic product.
• compositions covered by the present invention are entirely conventional and are obtained with methods that are common practice in the pharmaceutical industry.
• the compositions according to the present invention contain, along with the active ingredient, at least one pharmaceutically acceptable vehicle or excipient.
• Particularly useful may be formulation adjuvants such as, for example, solubilising agents, dispersing agents, suspension agents and emulsifying agents.
• formulation adjuvants such as, for example, solubilising agents, dispersing agents, suspension agents and emulsifying agents.
• a general reference work is Remington's Pharmaceutical Sciences Handbook, latest edition.
• mice on a high-cholesterol diet Male CD 1 mice on a high-cholesterol diet (DP/ 104, Altromin-Rieper) for about 25 days were used. An acclimatization period of seven days was allowed before the start of the high-cholesterol diet.
• mice were housed inside cages with stainless steel cover-feed and sterilized and dust-free bedding cobs. Animals were housed under a light- dark cycle, keeping temperature and humidity constant. Parameters of the animal rooms are assessed as follows: 22 ⁇ 2°C temperature, 55 ⁇ 10% relative humidity, about 15-20 filtered air changes/ hour and 12 hours circadian cycle of artificial light (7 a.m., 7 p.m.). The environmental conditions were monitored.
• mice were divided into groups (10 mice per group) and treated orally (1 mL) twice daily with the compounds of the invention or their combinations at the doses reported in the following:
• Hexacosanol 25 mg/kg (dissolved in ethanol);
• Vitamin B6 0.3 mg/kg (dissolved in water);
• Vitamin B12 0.25 mg/kg (dissolved in water);
• L-carnitine 20 mg/kg (dissolved in water).
• the body weight of the animals was checked and monitoring of the animals' consumption of water and feed was scheduled.
• Jelco 22G catheter (Johnson and Johnson) in post-absorption conditions (fasting from 9 a.m. to 4.30 p.m.) and 7.30 hours after the last treatment.
• Plasma total cholesterol levels in male CD 1 mice (ten mice for each group) on high-cholesterol diet orally treated with the compounds of the invention or their combinations, or vehicle, twice a day for 17 days and one time on day 18.
• Blood collection in post-absorptive state (fasting: 9:00 a.m. -5:00 p.m.), at 8 h from last treatment.
• Plasma HDL-cholesterol levels in male CD l mice (ten mice for each group) on high-cholesterol diet orally treated with the compounds of the invention or their combinations, or vehicle, twice a day for 17 days and one time on day 18.
• Blood collection in post-absorptive state (fasting: 9:00 a.m. -5:00 p.m.), at 8 h from last treatment.

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