Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K35/00—Medicinal preparations containing materials or reaction products thereof with undetermined constitution
  • A61K35/56—Materials from animals other than mammals
  • A61K35/60—Fish, e.g. seahorses; Fish eggs
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/28—Compounds containing heavy metals
  • A61K31/282—Platinum compounds
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/33—Heterocyclic compounds
  • A61K31/335—Heterocyclic compounds having oxygen as the only ring hetero atom, e.g. fungichromin
  • A61K31/337—Heterocyclic compounds having oxygen as the only ring hetero atom, e.g. fungichromin having four-membered rings, e.g. taxol
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • 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
  • A61K31/4409—Non condensed pyridines; Hydrogenated derivatives thereof only substituted in position 4, e.g. isoniazid, iproniazid
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/33—Heterocyclic compounds
  • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
  • A61K31/495—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with two or more nitrogen atoms as the only ring heteroatoms, e.g. piperazine or tetrazines
  • A61K31/505—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim
  • A61K31/517—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim ortho- or peri-condensed with carbocyclic ring systems, e.g. quinazoline, perimidine
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/33—Heterocyclic compounds
  • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
  • A61K31/495—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with two or more nitrogen atoms as the only ring heteroatoms, e.g. piperazine or tetrazines
  • A61K31/505—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim
  • A61K31/519—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim ortho- or peri-condensed with heterocyclic rings
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/33—Heterocyclic compounds
  • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
  • A61K31/535—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with at least one nitrogen and one oxygen as the ring hetero atoms, e.g. 1,2-oxazines
  • A61K31/5375—1,4-Oxazines, e.g. morpholine
  • A61K31/5377—1,4-Oxazines, e.g. morpholine not condensed and containing further heterocyclic rings, e.g. timolol
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/33—Heterocyclic compounds
  • A61K31/555—Heterocyclic compounds containing heavy metals, e.g. hemin, hematin, melarsoprol
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K33/00—Medicinal preparations containing inorganic active ingredients
  • A61K33/04—Sulfur, selenium or tellurium; Compounds thereof
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K33/00—Medicinal preparations containing inorganic active ingredients
  • A61K33/24—Heavy metals; Compounds thereof
  • A61K33/243—Platinum; Compounds thereof
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K45/00—Medicinal preparations containing active ingredients not provided for in groups A61K31/00 - A61K41/00
  • A61K45/06—Mixtures of active ingredients without chemical characterisation, e.g. antiphlogistics and cardiaca
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P35/00—Antineoplastic agents
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K2300/00—Mixtures or combinations of active ingredients, wherein at least one active ingredient is fully defined in groups A61K31/00 - A61K41/00

Definitions

• the field of the invention is cancer chemotherapy, in particular cancer chemotherapy in combination with a nutritional supplement.
• Chemotherapy protocols utilized in the treatment of cancer can clearly benefit patients, but can be ineffective or less effective with some cancers, particularly recurring or resistant tumors.
• chemotherapy is associated with significant side effects, including nausea, weight loss, hair loss, immunosuppression, and skin irritation.
• Mitigation of the side effects of chemotherapy is generally directed at providing symptomatic relief.
• antiemetics can be used to reduce nausea, along with diet modification and eating small, frequent meals that avoid certain foods.
• chemotherapeutic agents are selected to have reduced toxicity in order to reduce side effects, however such agents may also have reduced effectiveness against tumor cells.
• United States Patent No. 9095602 to Gleave et al, describes the use of anti- sense DNA to suppress TRPM-2 gene activity in order to enhance chemosensitivity in resistant cancers. Such an approach, however, requires a means of safely and selectively providing the anti-sense DNA to a tumor. In addition, it is not clear that such specific gene suppression will be effective across different cancer cell types and chemotherapeutic mechanisms.
• chemotherapeutic agents to improve treatment of cancer.
• a supplement containing fish oil and selenium (either alone or in combination with a chemotherapeutic drug) was found to reduce the number and size of tumor-associated blood vessels, indicating an anti-angiogenic effect. Certain chemotherapeutic drugs were also found to have previously undocumented anti- angiogenic effects when used alone. In addition to reductions in tumor size, use of such supplements (either alone or in combination with chemotherapeutic agents) was found to reduce indicators of tumor progression and the incidence of metastasis. Similarly, in a clinical setting use of a supplement containing fish oil and selenium was found to reduce the number of circulating tumor cells.
• FIG. 1 Histogram of the effect of treatment with Iressa (3 ⁇ to 9 ⁇ ) in combination with PBS or various supplements on proliferation of A549 lung tumor cells.
• FIG. 2 Histogram of the effect of treatment with Iressa (0.125 ⁇ to 1 ⁇ ) in combination with PBS or various supplements on proliferation of A549 lung tumor cells.
• FIG. 3 Histogram of the effect of treatment with Iressa (0. 5 ⁇ to 4 ⁇ ) in combination with PBS or various supplements on proliferation of A549 lung tumor cells.
• FIG. 4 Histogram of the effect of treatment with Tarceva (5 ⁇ to 20 ⁇ ) in combination with PBS or various supplements on proliferation of A549 lung tumor cells.
• FIG. 5 Histogram of the effect of treatment with Tarceva (0.625 ⁇ to 5 ⁇ ) in combination with PBS or various supplements on proliferation of A549 lung tumor cells.
• FIG. 6 Histogram of the effect of treatment with Alimta (0.125 ⁇ to 1 ⁇ ) in combination with PBS or various supplements on proliferation of A549 lung tumor cells.
• FIG. 7 Histogram of the effect of treatment with Cisplatin (0.125 ⁇ g/mL to 1 ⁇ g/mL) in combination with PBS or various supplements on proliferation of A549 lung tumor cells.
• FIG. 8 Histogram of the effect of treatment with Docetaxel (1.25 ⁇ to 5 ⁇ ) in combination with PBS or various supplements on proliferation of MDA-MB-231 breast cancer cells.
• FIG. 9 Histogram of the effect of treatment with Cisplatin (1.25 ⁇ g/mL to 10 ⁇ g/mL) in combination with PBS or various supplements on proliferation of MDA-MB-231 breast cancer cells.
• FIG. 10 Effect of a supplement containing selenium, a supplement containing fish oil, and a nutritional supplement containing both fish oil and selenium on proliferation of A549 cells in culture.
• FIG. 11 Graph showing the effect of a nutritional supplement containing fish oil and selenium and/or chemotherapeutic agents on expression of Ki-67.
• FIG. 12 Initial body weight of mice utilized in Tarceva and nutritional supplement containing fish oil and selenium studies.
• FIG. 13 Histogram showing weight of tumors in mice treated with Tarceva, a nutritional supplement containing fish oil and selenium, or a combination of these.
• FIG. 14 Histogram of the effect of a nutritional supplement containing fish oil and selenium and/or chemotherapeutic agents in mice implanted with human breast cancer cells
• FIG. 15 Graphical depiction of the effects by cotherapy with a nutritional supplement containing fish oil and selenium and chemotherapy on tumor volume and mass.
• FIG. 16 Histograms and photographs of the effect of treatment with Iressa and Iressa in combination with a nutritional supplement containing fish oil and selenium on weight and weight distribution of tumors produced by injection of lung cancer cells.
• FIG. 17 Graph of the effect on tumor weight of addition of a nutritional supplement containing fish oil and selenium to Taxol and Adriamycin treatment regimes in an in vivo model of breast cancer.
• FIG. 18 Graph of the effect on tumor volume of addition of a nutritional supplement containing fish oil and selenium to Taxol and Adriamycin treatment regimes in an in vivo model of breast cancer.
• FIG. 19 Histogram of the effects of treatment with a nutritional supplement containing fish oil and selenium and Avastin on tumor volume.
• FIG. 20 Histogram of the effects of treatment with a nutritional supplement containing fish oil and selenium and Taxol on tumor volume.
• FIG. 21 Graphs of the effects of treatment with a nutritional supplement containing fish oil and selenium and/or chemotherapeutic agents on tumor volume and tumor weight.
• FIG. 22 Photographs and histograms of the effect of a prior art nutritional supplement and a nutritional supplement containing fish oil and selenium in combination with chemotherapy on tumor weight distribution and body weight gain.
• FIG. 23 Schematic depiction of a typical testing protocol for evaluating effects of treatment with a nutritional supplement containing fish oil and selenium in combination with Taxol or Adriamycin.
• FIG. 24 Photographs showing tumors and associated blood vessels in mice from an untreated control group.
• FIG. 25 Photographs showing tumors and associated blood vessels from mice treated with a nutritional supplement Photographs showing tumors.
• FIG. 26 Photographs showing tumors and associated blood vessels from mice treated with Taxol.
• FIG. 27 Photographs showing tumors and associated blood vessels from mice treated with a combination of Taxol and a nutritional supplement containing fish oil and selenium.
• FIG. 28 Comparative photographs showing tumors and associated blood vessels from mice treated with either Taxol or a combination of Taxol and a nutritional supplement containing fish oil and selenium.
• FIG. 29 Photographs showing tumors and associated blood vessels from mice treated with Adriamycin.
• FIG. 30 Photographs showing tumors and associated blood vessels from mice treated with a combination of Adriamycin and a nutritional supplement containing fish oil and selenium.
• FIG. 31 Comparative photographs showing tumors and associated blood vessels from mice treated with a combination of Adriamycin or a combination of Adriamycin and a nutritional supplement containing fish oil and selenium.
• FIG. 32 Western blots showing the effect of a nutritional supplement containing fish oil and selenium in combination with chemotherapeutic agents on tumor expression of oxidative stress (i.e. HIF-a) and angiogenesis (i.e. VEGF) markers in an in vivo model of human cancer. Actin is included as a control.
• oxidative stress i.e. HIF-a
• angiogenesis i.e. VEGF
• FIG. 33 Western blots showing the effect of a nutritional supplement containing fish oil and selenium in combination with chemotherapeutic agents on tumor expression of angiogenesis (i.e. CD31) and metastasis (i.e. MMP-9) markers in an in vivo model of human cancer. Actin is included as a control.
• FIG. 34 Distribution of cell cycle phases of A549 tumor cells treated with a
• chemotherapeutic agent (Alimta, 1 ⁇ or Tarceva, 5 ⁇ ) and a nutritional supplement containing fish oil and selenium.
• FIG. 35 Western blots showing the effect of a nutritional supplement containing fish oil and selenium in combination with chemotherapeutic agents on tumor expression of various apoptosis markers in an in vivo model of breast cancer. Actin is included as a control.
• FIG. 36 Western blots showing the effect of a nutritional supplement containing fish oil and selenium in combination with chemotherapeutic agents on tumor expression of Bcl-2, p-Bcl- 2, and Caspase 3 apoptosis markers in an in vivo model of breast cancer. Actin is included as a control
• FIG. 37 Western blots showing the effect of a nutritional supplement containing fish oil and selenium in combination with chemotherapeutic agents on tumor expression of Caspase 8 apoptosis marker in an in vivo model of breast cancer. Actin is included as a control.
• FIG. 38 Western blots showing the effect of a nutritional supplement containing fish oil and selenium in combination with chemotherapeutic agents on expression of Cytochrome C in an in vivo model of breast cancer. Actin is included as a control.
• FIG. 39 Photographs of cell culture plates showing apoptosis in A549 lung cancer cells treated with a supplement containing fish oil and selenium.
• FIG. 40 Trypan blue staining of A549 lung cancer cells treated with a supplement containing fish oil and selenium.
• FIG. 41 Histogram of the effect of a nutritional supplement containing fish oil and selenium in combination with chemotherapeutic agents on plasma concentrations of tumor MDA in an in vivo model of breast cancer.
• FIG. 42 Histogram of the effect of a nutritional supplement containing fish oil and selenium in combination with chemotherapeutic agents on concentrations of tumor MDA in an in vivo model of breast cancer.
• FIG. 43 Histogram of the effect of treatment with Iressa (0.625 ⁇ to 5 ⁇ ) in combination with PBS or various supplements on proliferation of A549 tumor sphere (i.e. stem) cells.
• FIG. 44 Histogram of the effect of treatment with Tarceva (1.25 ⁇ to 10 ⁇ ) in combination with PBS or various supplements on proliferation of A549 tumor sphere (i.e. stem) cells.
• FIG. 45 Histogram of the effect of treatment with Docetaxel (1.25 ⁇ to 5 ⁇ ) in combination with PBS or various supplements on proliferation of MDA-MB-231 tumor sphere (i.e. stem) cells.
• FIG. 46 Histogram of the effect of treatment with Cisplatin (1.25 ⁇ g/mL to 10 ⁇ g/mL) in combination with PBS or various supplements on proliferation of MDA-MB-231 tumor sphere (i.e. stem) cells.
• FIG. 47 Distribution of cell cycle phases of A549 tumor sphere cells (i.e. stem cells) treated with a chemotherapeutic agent (Alimta, 1 ⁇ or Tarceva, 5 ⁇ ) and a nutritional supplement containing fish oil and selenium.
• a chemotherapeutic agent Alimta, 1 ⁇ or Tarceva, 5 ⁇
• a nutritional supplement containing fish oil and selenium.
• FIG. 48 Western blots showing expression of various proteins in parental and sphere (i.e. stem) A549 cells.
• FIG. 49 Western blots showing elevated expression of stem-cell related proteins in A549 sphere (i.e. stem) cells.
• FIG. 50 Western blots showing a reduction of stem cell characteristics in A549 sphere (i.e. stem) cells treated with a nutritional supplement containing fish oil and selenium.
• FIG. 51 Western blots showing a reduction of stem cell characteristics in A549 sphere (i.e. stem) cells treated with a nutritional supplement containing fish oil and selenium.
• FIG. 52 Western blots showing a reduction of stem cell characteristics in A549 sphere (i.e. stem) cells treated with a nutritional supplement containing fish oil and selenium.
• FIG. 53 Western blots showing the effect of a nutritional supplement containing fish oil and selenium in combination with chemotherapeutic agents on cancer stem cell markers in an in vivo model of breast cancer. Actin is included as a control.
• FIG. 54 Photomicrographs of Iressa-resistant cancer cells treated with a nutritional supplement containing fish oil and selenium and/or Iressa.
• FIG. 55 Histograms of the response of HCC827 and resistant HCC827Gr cell lines to Iressa.
• FIG. 56 Western blots showing differences in expression of various markers between HCC827 and resistant HCC287Gr cells.
• the resistant HCC287Gr cells show stem cell characteristics.
• FIG. 57 Histogram showing sensitization of resistant HCC827Gr cells to up to 1 ⁇ Iressa on cotreatment with a nutritional supplement containing fish oil and selenium.
• FIG. 58 Histogram showing sensitization of resistant HCC827Gr cells to up to 4 ⁇ Iressa on cotreatment with a nutritional supplement containing fish oil and selenium.
• FIG. 59 Inhibition of colony formation by resistant HCC827Gr cells by treatment with Iressa in combination with a nutritional supplement containing fish oil and selenium.
• FIG. 60 Histogram showing nhibition of colony formation by resistant HCC827Gr cells by treatment with Iressa in combination with a nutritional supplement containing fish oil and selenium.
• FIG. 61 Frequency distribution of cell cycle phases on treatment of Iressa-resistant HCC827GR cells with Iressa, a nutritional supplement containing fish oil and selenium, and combined treatment.
• FIG. 62 Frequency distribution of cell cycle phases following pre-treatment with a nutritional supplement of the inventive concept, with and without the addition of Iressa, in Iressa-resistant HCC827GR cells.
• FIG. 63 Frequency of lung cancer metastasis in animal models treated with a nutritional supplement containing fish oil and selenium and/or a chemotherapeutic agent.
• FIG. 64 Photomicrographs showing the results of immunohistochemical staining for cells bearing tumor markers in implanted mice treated with Tarceva, a nutritional supplement containing fish oil and selenium, and a combination of Tarceva and the supplement.
• FIG. 65 Graph of the effect of a nutritional supplement containing fish oil and selenium on metastatic tumor load when used in combination Taxol or Adriamycin in an in vivo breast cancer model.
• FIG. 66 Frequency of metastasis in tumor-bearing mice treated treated with a nutritional supplement containing fish oil and selenium and/or multiple chemotherapy drugs.
• FIG. 67 Western blots showing the effect of a nutritional supplement containing fish oil and selenium in combination with chemotherapeutic agents on tumor expression of MMP-9 in an in vivo model of breast cancer. Actin is included as a control.
• FIG. 68 Reduction in circulating tumor cells in a clinical patient treated with a nutritional supplement containing fish oil and selenium.
• FIG. 69 Western blots showing the effect of a nutritional supplement containing fish oil and selenium in combination with chemotherapeutic agents on immune checkpoint proteins CD279 and CD274 in an in vivo model of breast cancer. Actin is included as a control.
• FIG. 70 Western blots showing the effect of a nutritional supplement containing fish oil and selenium in combination with chemotherapeutic agents on primary tumor PD-L1 and T cell PD-1 in an in vivo model of human cancer. Actin is included as a control.
• FIG. 71 Western blots showing the effect of a nutritional supplement containing fish oil and selenium in combination with chemotherapeutic agents on metastatic tumor (i.e. mammary gland) PD-L1 and T cell PD-1 in an in vivo model of metastasized human cancer. Actin is included as a control.
• FIG. 72 Histograms and Western blots showing the effect of a nutritional supplement containing fish oil and selenium in combination with chemotherapeutic agents on tumor PD-L1 and T cell PD-1 in an in vivo model of human cancer. Actin is included as a control.
• FIG. 73 Graph showing CD4/CD8 ratios of breast cancer patients receiving a nutritional supplement containing fish oil and selenium.
• FIG. 74 Graph showing CD4/CD8 ratios of patients with lymphoma receiving a nutritional supplement containing fish oil and selenium.
• FIG. 75 Histogram of showing relative loss of adipose tissue and muscle mass in tumor implanted mice treated with a nutritional supplement containing fish oil and selenium and/or a chemotherapeutic agent.
• FIG. 76 Schematic depiction of the influence of tumor gene products on energy expenditure.
• FIG. 77 Histograms showing the effects of treatment with a nutritional supplement containing fish oil and selenium and co-treatment with such a supplement and a
• FIG. 78 Typical study design for characterizing the effects of cotherapy using a nutritional supplement containing fish oil and selenium with various chemotherapeutic drugs in tumor implanted mice.
• FIG. 79 Western blots, histograms, and photomicrographs showing expression of autophagy-related protein expression in tumor bearing mice treated with omega-3 fatty acid.
• FIG. 80 Histograms and photomicrographs showing retention of adipose tissues in tumor-bearing mice treated with a nutritional supplement containing fish oil and selenium and/or chemotherapeutic agents.
• FIG. 81 Histograms showing effects of treatment with a nutritional supplement containing fish oil and selenium and/or chemotherapeutic agents on retention of white and brown adipose tissue in tumor-bearing mice.
• FIG. 82 Histograms showing effects of treatment with a nutritional supplement containing fish oil and selenium and/or chemotherapeutic agents on retention of gastrocnemius muscle mass in tumor-bearing mice.
• FIG. 83 Histograms showing effects of treatment with a nutritional supplement containing fish oil and selenium and/or chemotherapeutic agents on retention of gastrocnemius muscle mass and total skeletal muscle mass in tumor-bearing mice.
• FIG. 84 Histograms showing effects of treatment with a nutritional supplement containing fish oil and selenium and/or chemotherapeutic agents on brain weight and liver weight in tumor-bearing mice.
• FIG. 85 Histograms showing effects of treatment with a nutritional supplement containing fish oil and selenium and/or chemotherapeutic agents on heart weight and spleen weight in tumor-bearing mice.
• FIG. 86 Histograms showing effects of treatment with a nutritional supplement containing fish oil and selenium and/or chemotherapeutic agents on lung weight and metastasis- free mammary gland weight in tumor-bearing mice.
• FIG. 87 Western blots showing the effect of a nutritional supplement containing fish oil and selenium in combination with chemotherapeutic agents on muscle mitochondrial and inflammation (i.e. IL6) markers in an in vivo model of breast cancer.
• GAPDH is included as a control.
• FIG. 88 Western blots showing the effect of a nutritional supplement containing fish oil and selenium in combination with chemotherapeutic agents on Complex III and Complex IV mitochondrial complex proteins in an in vivo model of human cancer. GAPDH is included as a control.
• FIG. 89 Results of rtPCR and Western blot studies of IL-6, PTHrP, UCP- 1 , ATGL, and HSL expression in animal models of human cancer.
• FIG. 90 Graphs showing reductions in cachexia in patients with head and neck cancers using a nutritional supplement containing fish oil and selenium.
• the left panel shows mean changes in body weight for patients treated with a nutritional supplement containing fish oil and selenium (squares) and a generic supplement (triangles).
• the right panel shows mean changes in body weight for patients having a BMI less than or equal to 19 who were treated with a nutritional supplement containing fish oil and selenium (squares), mean changes in body weight for patients having a BMI >19 who were treated with a nutritional supplement containing fish oil and selenium (open circles), patients with a BMI less than or equal to 19 treated with a generic supplement (triangles), and patients with a BMI greater than 19 treated with a generic supplement (filled circles).
• FIG. 91 Graph of the effect of a nutritional supplement containing fish oil and selenium in combination with chemotherapeutic agents on feed intake in an in vivo model of human cancer.
• FIG. 92 Graph of the effect of a nutritional supplement containing fish oil and selenium in combination with chemotherapeutic agents on plasma concentrations of VEGF in an in vivo model of breast cancer.
• FIG. 93 Histogram of the effect of a nutritional supplement containing fish oil and selenium in combination with Taxol, Adriamycin, or Avastin agents on plasma concentrations of VEGF in an in vivo model of breast cancer.
• FIG. 94 Graph the effect of a nutritional supplement containing fish oil and selenium in combination with chemotherapeutic agents on plasma concentrations of TNF-a in an in vivo model of breast cancer.
• FIG. 95 Histograms of the effect of a nutritional supplement containing fish oil and selenium in combination with Taxol, Adriamycin, or Avastin agents on plasma concentrations of TNF-a and IL6 in an in vivo model of breast cancer.
• FIG. 96 Graphs of the effect of a nutritional supplement containing fish oil and selenium alone and in combination with Taxol, Adriamycin, or Avastin on plasma concentrations of ILl- ⁇ and IL-10 in an in vivo models of human cancer.
• FIG. 97 Graph of the effect of a nutritional supplement containing fish oil and selenium in combination with chemotherapeutic agents on plasma concentrations of ILl- ⁇ in an in vivo model of breast cancer.
• FIG. 98 Graph of the effect of a nutritional supplement containing fish oil and selenium in combination with chemotherapeutic agents on plasma concentrations of IL6 in an in vivo model of breast cancer.
• FIG. 99 Graph of the effect of a nutritional supplement containing fish oil and selenium in combination with chemotherapeutic agents on plasma concentrations of IL2 in an in vivo model of breast cancer.
• FIG. 100 Histograms of the effect of a nutritional supplement containing fish oil and selenium in combination with chemotherapeutic agents on plasma concentrations of IFN- ⁇ and IL-2 in an in vivo model of breast cancer.
• FIG. 101 Graph of the effect of a nutritional supplement containing fish oil and selenium in combination with chemotherapeutic agents on plasma concentrations of IL10 in an in vivo model of breast cancer.
• FIG. 102 Graph of the effect of a nutritional supplement containing fish oil and selenium in combination with chemotherapeutic agents on plasma concentrations of IFN- ⁇ in an in vivo model of breast cancer.
• FIG. 103 Schematic depiction of AXL signaling and factors influencing tumor progression.
• FIG. 104 Western blot of AXL and p-MET expression in HCC827 and HCC827GR (Iressa-resistant) cells.
• FIG. 105 Western blot of the combined effect of selenium (Nutrient A) and fish oil (Nutrient B) on AXL expression in drug (Iressa)-resistant HCC827GR cells. GAPDH is provided as a control.
• FIG. 106 Schematic depiction of the pathway for AXL protein expression, which provides various points for regulation of AXL expression.
• FIG. 107 Western blot of the expression of HSP90 and AXL in drug (Iressa)- resistant cells HCC827GR cells and in non-resistant parent HCC827 cells. GAPDH is provided as a control.
• FIG. 108 Western blot showing reduction in AXL and HSP90 expression in drug (Iressa)-resistant tumor cells using a combination of selenium (Nutrient A) and fish oil (Nutrient B).
• FIG. 109 Schematic depiction of the mTOR pathway.
• FIG. 110 Western blot showing reduction in AXL, HSP90, and p-mTOR expression in drug (Iressa)-resistant tumor cells using a combination of selenium (Nutrient A) and fish oil (Nutrient B).
• FIG. Ill Western blot showing the effects of treatment with a nutritional supplement containing fish oil and selenium alone and in combination with chemotherapeutic compounds on heat shock protein (HSP90) in tumor cells from in vivo models of human cancer.
• HSP90 heat shock protein
• FIG. 112 Western blot showing the effects of treatment with a nutritional supplement containing fish oil and selenium alone and in combination with chemotherapeutic compounds on p-AXL in tumor cells from in vivo models of human cancer.
• FIG. 113 Graph of two year survival rates of patients with head and neck cancers using a nutritional supplement containing fish oil and selenium and a generic prior art supplement.
• the inventive subject matter provides compositions and methods in which a nutritional supplement (such as a supplement that includes fish oil, selenium in the form of selenium yeast, chromium, and certain plant-derived materials (NutraWell) and/or a supplement that includes a selenium and fish oil) is used in combination with chemotherapy.
• a nutritional supplement such as a supplement that includes fish oil, selenium in the form of selenium yeast, chromium, and certain plant-derived materials (NutraWell) and/or a supplement that includes a selenium and fish oil
• Combination therapy with chemotherapeutic agents and the supplement surprisingly provides a significant synergistic effect in reduction of tumor size and/or reducing cell proliferation.
• side effects of radiotherapy are mitigated and expression of genes related to apoptosis is modulated in tumor cells.
• supplements of the inventive concept were also found to increase the sensitivity of resistant cancer cells to chemotherapeutic agents.
• inventive subject matter provides many example embodiments of the inventive subject matter. Although each embodiment represents a single combination of inventive elements, the inventive subject matter is considered to include all possible combinations of the disclosed elements. Thus if one embodiment comprises elements A, B, and C, and a second embodiment comprises elements B and D, then the inventive subject matter is also considered to include other remaining combinations of A, B, C, or D, even if not explicitly disclosed.
• the numbers expressing quantities of ingredients, properties such as concentration, reaction conditions, and so forth, used to describe and claim certain embodiments of the invention are to be understood as being modified in some instances by the term "about.” Accordingly, in some embodiments, the numerical parameters set forth in the written description and attached claims are approximations that can vary depending upon the desired properties sought to be obtained by a particular embodiment. In some embodiments, the numerical parameters should be construed in light of the number of reported significant digits and by applying ordinary rounding techniques. Notwithstanding that the numerical ranges and parameters setting forth the broad scope of some embodiments of the invention are
• the nutritional supplement formulation provided in Table 1 incorporates fish oil and selenium.
• the selenium is preferably provided as selenium yeast or components thereof (such as peptides and/or amino acids prepared from selenium yeast).
• NutraWell has been found to have a high level of acceptance and to have unanticipated beneficial anti-tumor activity in combination with conventional therapies.
• such a nutritional supplement also shows striking beneficial effects when used in combination with one or more chemo therapeutic agents.
• Vitamin D3 25 5000 IU
• Vitamin A Acetate 500 100000 IU
• the composition shown in Table 1 includes components in addition to selenium and fish oil that have various physiological and biochemical effects, including anti-inflammatory activity, lowering of blood glucose levels, lowering of cholesterol, and anti-tumor activity.
• the nutritional supplement includes at least three components as represented in Table 1.
• Such additional components provide supplementation of necessary vitamins, minerals, and amino acids at elevated levels.
• Other components e.g. enzymes, lecithin
• the combination of these complementary activities provides a synergistic effect that exceeds the simple additive effect of individual components.
• the composition shown in Table 1 also includes certain flavorants (e.g. brown sugar, honey, vanilla flavor and masking agent) that serve to improve palatability and acceptance.
• Certain components can provide both flavor and caloric energy.
• the Inventor has found that the combination of flavorants described above is effective in providing compliance with consumption of the nutritional supplement in effective amounts. In some embodiments, such flavorants can be excluded without negatively impacting the effectiveness of the nutritional supplement.
• Components shown in Table 1 can be provided as a single formulation (for example, as a pill, tablet, capsule, powder, liquid, suspension, etc.) or can be segregated into different formulations (for example, as pills, tablets, capsules, powders, liquids, suspensions, or combinations thereof).
• the amounts shown in Table 1 are exemplary, and represent typical daily dosages provided to an adult of normal stature and otherwise normal health. These amounts can be adjusted to account for differences in body mass, gender, medical condition, etc. For example, a relatively small patient weighing 40 kilos or less may receive benefit from dosages provided at or below the low end of the ranges provided, whereas a relatively large patient weighing 100 kilograms or more may require dosages provided at the high end of the ranges noted (or more).
• such a daily dose can be distributed as multiple doses throughout the day.
• the composition of each of such distributed doses can be identical. In other embodiments the composition of such distributed doses can be different, provided the summation of such doses provides the required supplementation.
• FIG. 1 shows the effect of treatment of various cancer cell lines with chemotherapeutic agents and a fish oil supplement, a selenium peptide supplement, and a supplement made by combining fish oil and the selenium peptide.
• FIG. 1 shows the effect of treatment of various cancer cell lines with chemotherapeutic agents and a fish oil supplement, a selenium peptide supplement, and a supplement made by combining fish oil and the selenium peptide.
• FIG. 2 shows the effects of treatment with Iressa in combination with PBS or various supplements on proliferation of A549 lung tumor cells.
• the use of a supplement containing both fish oil and selenium reduces A549 cell proliferation, and the combination also provides an unexpected synergistic effect in reducing A549 cell proliferation when used in combination with Iressa.
• Similar effects are seen in FIG. 4 and FIG. 5 when such a nutritional supplement is used in combination with Tarceva to treat A549 cancer cells.
• the effects of a nutritional supplement containing both fish oil and selenium in combination with on the proliferation of A549 cancer cells in combination with Alimta is shown in FIG. 6, while the effects of such a nutritional supplement in combination with Cisplatin on proliferation of A549 cancer cells is shown in FIG. 7.
• Synergistic effects for the combination of a nutritional supplement containing fish oil and selenium and the chemotherapeutic agent are notable in many instances, particularly at lower drug concentrations.
• chemotherapeutic agents and a fish oil/selenium peptide supplement also provides similar effects in an unrelated triple- negative breast cancer cell line (MDA-MB-231).
• MDA-MB-2331 unrelated triple- negative breast cancer cell line
• Typical results of co-treatment of these cells with Docetaxel and fish oil/selenium supplement for 72 hours on cell proliferation are shown in FIG. 8. While this chemotherapeutic agent and the supplement containing fish oil and selenium both provided a reduction in proliferation, a surprising synergistic effect is noted when they are used in combination. Similar effects are seen when MDA-MB-231 cells are treated with nutritional supplements containing fish oil, selenium, fish oil and selenium in combination, and Cisplatin.
• treatment with the fish oil/selenium supplement reduces the number of positive cells (indicating a reduction in proliferative index) as does treatment with chemotherapeutic agents (Taxol, Adriamycin.
• Treatment with a combination of both the nutritional supplement and a chemotherapeutic agent provided an even greater reduction in proliferative index.
• a nutritional supplement that includes fish oil and selenium (for example, in the form of selenium yeast or yeast products) can reduce proliferation in a variety of tumor cell types, and can provide a synergistic effect when used in combination with a variety of different chemotherapeutic agents. The effect is seen both in cell culture and in in vivo animal models of human disease.
• a nutritional supplement that includes fish oil and selenium reduces tumor size in in vivo animal models of human disease, and surprisingly can do so in a synergistic manner when used in combination with chemotherapeutic drugs.
• 8FIG8A provides an example of a typical testing protocol for such a nutritional supplement ("Nutrawell”) and the chemotherapeutic drug Tarceva.
• Initial body weights of mice used in such studies, which can be used to calculate tumor weight, are shown in FIG. 12.
• Results of studies of tumor weight (upper panel) and tumor weight distribution (lower panel) are shown in FIG. 13. As shown, 28 days after tumor implantation mice were sacrificed and the tumor characterized. Untreated mice all developed large (>5g) tumors.
• mice treated with either Tarceva or NutraWell still showed a significant number of such large tumors.
• Mice treated with a combination of Tarceva and a fish oil/selenium nutritional supplement did not show any large tumors and had a significant proportion of small ( ⁇ 3g) tumors.
• FIG. 14 shows an exemplary treatment protocol (upper panel) and the results of tumor volume studies (lower panel) performed on control (untreated) mice, mice treated with a fish oil/selenium nutritional supplement, and mice treated with various chemotherapeutic agents with and without co-treatment with a fish oil/selenium nutritional supplement. Tumor volume was recorded at two different time periods, and shows the effect on growth. Untreated (control) mice show an approximately 120mm increase in tumor volume over 4 days.
• the chemotherapeutic drugs Taxol, Adiamycin, and/or Avastin used in combination with a fish oil/selenium nutritional supplement show a significantly decreased rate of tumor growth relative to the use of these chemotherapeutic agents alone. It should also be appreciated that the fish oil/selenium nutritional supplement alone provided a reduction in tumor growth.
• FIG. 16 The effects of cotreatment with a nutritional supplement containing fish oil and selenium and the chemotherapeutic drug Iressa on tumor weight in mice implanted with lung cancer cells can be seen in FIG. 16.
• treatment with Iressa alone provides only a marginal reduction in tumor weight (top left panel), while cotreatment with Iressa and a nutritional supplement containing fish oil and selenium reduced tumor weight by more 50% relative to untreated control mice.
• Weight distribution (top right panel) also shows a modest reduction in tumor weight on treatment with the chemotherapeutic agent (with most of the mice having >6 gram tumors), while cotreatment with a nutritional supplement containing fish oil and selenium resulted in all tumors having a weight of less than 6 grams and many having a weight of less than 3 grams.
• Photographs of typical examples of tumors obtained from mice in the control and treated groups is shown in the lower panel of FIG. 16.
• FIG. 17 and FIG. 18 show typical data for tumor weight and volume (respectively) in the test groups of mice implanted with breast cancer cells as described in Table 2.
• a nutritional supplement containing fish oil and selenium to treatment regimes utilizing Taxol or Adriamycin results in a significant reduction in tumor weight relative to use of these chemotherapeutic agents alone.
• Similar studies were performed to determine the effect of a nutritional supplement of the inventive concept in combination with Avastin or Taxol.
• a nutritional supplement containing fish oil and selenium was provided at 0.4g twice per day to mice implanted with tumor cells, where Avastin or Taxol was provided interperitoneally at 5 mg/kg every 4 days.
• mice treated with a nutritional supplement containing fish oil and selenium and Avastin can be seen in FIG. 19.
• the effect on tumor volume in mice treated with a nutritional supplement containing fish oil and selenium and Taxol can be seen in FIG. 20.
• An improvement in reduction in tumor volume is seen with co-treatment with the nutritional supplement with both Avastin and Taxol.
• angiogenesis/neovascularization effects for some chemotherapeutic agents alone.
• the Inventor believes that such a reduction in neovacularization induces oxidative stress in tumors and/or renders tumors so treated more susceptible to oxidative stress.
• chemotherapeutic agents e.g. taxol, adriamycin, avastin
• FIG. 24 provides photographs of typical tumors and associated blood vessels in mice in the untreated control group. Several relatively large diameter blood vessels can be seen associated with the tumors.
• FIG. 25 provides similar photographs taken of mice in a group treated only with the nutritional supplement. The number of blood vessels associated with the tumors is reduced relative to those of the untreated control group, as is their diameter.
• FIG. 26 and FIG. 27 provide photographs of typical tumors taken from mice in a group treated with Taxol and treated with Taxol in combination with a nutritional supplement containing fish oil and selenium (“N"), respectively.
• a nutritional supplement containing fish oil and selenium N
• FIG. 29 and FIG. 30 provide photographs of typical tumors taken from mice in a group treated with Adriamycin and with Adriamycin in combination with a nutritional containing fish oil and selenium, respectively, in a similar study. Similar results were found in separate but similar studies on the effects of a nutritional supplement containing fish oil and selenium in combination with either Adriamycin or Avastin, as shown in FIG. 31. In all instances treatment with a nutritional supplement containing fish oil and selenium significantly reduced
• nutritional supplements can reduce vascularization of solid tumors, and can enhance the reduction in vascularization of solid tumors seen in treatment with conventional chemotherapeutic agents.
• VEGF and CD31 are markers related to tumor angiogenesis, via the HIF-a pathway.
• FIG. 32 shows a Western blot of HIF-a and VEGF in tumors treated with a nutritional supplement containing fish oil and selenium ("N"), Taxol, Adriamycin, Avastin, and the nutritional supplement in combination with these chemotherapeutic agents. As shown, the nutritional supplement reduces HIF-a levels, where chemotherapeutic agents have relatively little effect.
• the concentration of fish oil represents its DHA content.
• Each gram offish ol contains 220 mg DHA aii ⁇ ! 330 rsig EPA
• sub-Gl phase is associated with apoptosis; as such combined therapy with a chemotherapeutic drug and a supplement containing fish oil and selenium can be useful in inducing apoptosis and/or apoptic events in cancer cells.
• FIG. 35 shows the effect of use of such a nutritional supplement, chemotherapeutic agents Taxol, Avastin, or Adriamycin, and these chemotherapeutic agents in combination with the nutritional supplement on expression of apoptosis markers (specifically VEGF, p53, and HIF-a) in advanced tumors in mouse injected with breast cancer cells.
• apoptosis markers specifically VEGF, p53, and HIF-a
• the use of the nutritional supplement increases the expression of p53, while decreasing the expression of VEGF and HIF-a. This effect is seen when the nutritional supplement is used alone or in combination with a chemotherapeutic agent, with combination providing an enhanced effect.
• FIG. 36 results of similar studies directed to Bcl-2, p-Bcl-2, and Caspase 3 are shown in FIG. 36; results for similar studies directed to Caspase 8 are shown in FIG. 37.
• use of a nutritional supplement containing fish oil and selenium decreases expression of Bcl-2 and increases expression of p-Bcl-2 and Caspase 3, both when used in isolation and when used in combination with chemotherapeutic drugs.
• Expression of Caspase 8 is reduced, both when used in isolation and when used in combination with chemotherapeutic drugs.
• FIG. 38 shows the effects treatment with a nutritional supplement containing fish oil and selenium ("N"), Taxol, Adriamycin, Avastin, and combined treatment on Cytochrome C.
• treatment with the supplement provides a slight increase in Cytochrome C, with little to no increase found on treatment with Taxol or with Adriamycin.
• apoptic effects can be observed directly. For example, as shown in FIG. 39, growth of A549 cells in culture is slightly impacted by exposure to a supplement containing selenium or a supplement containing fish oil, but is dramatically impacted by a supplement containing both fish oil and selenium. Similarly, trypan blue staining of A549 cells in culture show only slight effects in inducing cell death when exposed to a supplement containing selenium or a supplement containing fish oil, but shows a dramatic increase in cell death when exposed to a supplement containing both fish oil and selenium, as shown in FIG. 40. While either of selenium or fish oil shows some effect the effects of these in combination is clearly greater than additive (i.e. synergistic).
• Oxidative stress/Hypoxia [00153] The Inventor have found that nutritional supplements of the inventive concept are effective in enhancing oxidative stress of tumors in in vivo models for breast cancer (e.g.
• FIG. 41 shows the effect of use of a nutritional supplement containing fish oil and selenium, chemotherapeutic agents Taxol or Adriamycin, and these chemotherapeutic agents in combination with the nutritional supplement on levels of malondialdehyde (MDA) in tumors of mice injected with breast cancer cells.
• MDA malondialdehyde
• use of the nutritional supplement is effective in increasing the relative concentration of MDA, indicating an enhancement of oxidative stress in the tumor.
• Avastin see FIG. 42.
• a synergistic effect for example, when the nutritional supplement is used in combination with Adriamycin is also found. This is consistent with the results found for HIF-a, which is a marker for hypoxia, as shown in FIG. 32. It should be appreciated that such effects are complementary to the reduction in neovascularization described above and shown in FIGs. 24 and 25.
• chemotherapeutic drugs It should be appreciated that sphere cells that form in cell culture are thought to replicate, at least in part, the development of cancer stem cells in vivo.
• A549 sphere cells are relatively resistant to treatment with Iressa, but show decreased proliferation in the presence of a supplement containing fish oil and selenium. When Iressa and the supplement are used in combination the effect is enhanced, and can be synergistic (for example, at higher Iressa concentrations).
• A549 lung cancer sphere cells are similarly resistant to Tarceva, with a synergistic reduction in proliferation being observed when the cells are treated with a combination of Tarceva (for example, at 10 ⁇ ) and a supplement containing fish oil and selenium (see FIG. 44).
• a similar effect is observed in MDA-MB-231 breast cancer sphere cells. As shown in FIG.
• MDA-MB-231 breast cancer sphere cells are relatively resistant to both Cisplatin and a supplement containing fish oil and selenium, however a large decrease in proliferation is found when Cisplatin and such a supplement are used in combination (see FIG. 46).
• the concentration of fish oil re presents its DHA content.
• sub-Gl is associated with apoptosis.
• the Inventor believes that use of a combination of a supplement containing fish oil and selenium in combination with a chemotherapeutic agent can be effective in inducing apoptosis in cancer sphere or stem cells, even when such cells are resistant to the chemotherapeutic agent.
• biochemical markers associate with cancer sphere or stem cells can modify expression of biochemical markers associate with cancer sphere or stem cells, bringing them into accordance with levels associated with non-stem cancer cells.
• expression of various biochemical markers notably CD133, C-myc, IL-6, and CD44
• FIG. 49 shows expression levels of markers associated with stem cells (i.e. associated with "sternness") in such A549 sphere cells, notably E-cadherin (an epithelial marker) and Vimentin (a mesenchymal marker), relative to parental A549 cells.
• A549 sphere cells notably ⁇ - ⁇ , p- mTOR, and Vimentin. It should be appreciated that p-mTOR and Vimentin are elevated in A549 sphere cells, and reduced to levels similar to those of the parental A549 cells on exposure to a supplement containing both fish oil and selenium, indicating a reduction in stem cell
• FIG. 51 shows an increase in LC3-I and LC3II on exposure to a supplement containing both fish oil and selenium.
• Similar studies show a reduction in GRP78, N-cadherin, and ⁇ -catenin (see FIG. 52).
• FIG. 53 shows the results of studies characterizing expression of CD29 and CD24 in tumors of animals treated with a nutritional supplement containing fish oil and selenium ("N"), Taxol, Adriamycin, Avastin, and these chemotherapeutic agents in combination with the nutritional supplement.
• N fish oil and selenium
• Taxol a nutritional supplement containing fish oil and selenium
• Adriamycin a chemotherapeutic agent
• Avastin chemotherapeutic agents
• HCC827Gr cells are human lung cancer-derived cells that have developed resistance to chemotherapeutic agents, such as Iressa.
• Iressa chemotherapeutic agents
• FIG. 54 The result of exposure of such cells in culture to Iressa in the presence and absence of a selenium + fish oil supplement are shown in FIG. 54.
• FIG. 54 exposure to Iressa does not significantly decrease the number of viable resistant HCC827Gr cells, however a significant reduction in the number of viable cells is found when Iressa is used in combination with a selenium + fish oil supplement.
• FIG. 57 and FIG. 58 show the effects of cotreatment of resistant HCC827Gr cells with Iressa with a selenium, fish oil, or selenium and fish oil containing supplement.
• Iressa produces, at most, only a 20% reduction in cell proliferation.
• Treatment with a supplement containing both fish oil and selenium results in a modest reduction in proliferation (about 50%).
• Treatment with a supplement containing both selenium and fish oil reduces cell proliferation to levels similar to those seen with the sensitive HCC827 parental cell line (i.e. approximately 20% of untreated control). It is apparent that use of a supplement containing fish oil and selenium is effective in sensitizing drug-resistant cancer cells to chemotherapeutic drugs, including drugs to which they have demonstrated resistance.
• HCC827Gr cells HCC827Gr cells
• selenium + fish oil supplement in suppressing colony formation by these resistant cancer cells is apparent, as colony formation is reduced to below that of cells treated with the selenium + fish oil supplement alone.
• Inventors have found, surprisingly, that pre-treatment of chemotherapy resistant cells (such as HCC827GR) with a nutritional supplement containing fish oil and selenium yeast can have the effect of sensitizing these resistant cells to subsequent exposure to a chemotherapeutic agent to which they have demonstrated resistance.
• XFIG4 shows the results of pre-treatment of Iressa-resistant HCC827GR cells with a nutritional supplement containing fish oil and selenium for 72 hours prior to exposure of the cells to Iressa. As shown, such pre-treated cells show a significant decrease in cell proliferation relative to cells pre-treated with PBS.
• pre-treatment with a nutritional supplement containing fish oil and selenium yeast alters the cell cycle phase distribution of these Iressa-resistant cells towards a significantly higher proportion of SubGl and S phase cells.
• Application of Iressa to such pre-treated cells provides a still higher percentage of cells in Sub-Gl phase. It should be appreciated that the sub-Gl phase is associated with apoptosis.
• a supplement containing fish oil and selenium can effectively reduce tumor metastasis and/or progression, particularly when used in combination with a chemotherapeutic agent.
• Inventors have found that use of a nutritional supplement containing fish oil and selenium in combination with a chemotherapeutic agent can reduce metastasis from a primary tumor site.
• FIG. 63 untreated mice show extensive metastasis of tumor cells from the implantation site of lung cancer cells. Metastatic sites are indicated by arrows in the upper panel of FIG. 63, whereas findings are enumerated in the lower panel.
• TTN Tarceva
• TN supplement containing fish oil and selenium
• TTN a combination of the two
• the Inventors believe that this may be due to sensitization of cancer stem cells to the effects of Tarceva by the supplement containing fish oil and selenium, and/or by a reduction in stem cell characteristics that facilitate metastasis.
• This reduction in metastasis can also be seen on a microscopic level in the reduction in the number of cells identified by immunohistochemistry as expressing EGFR and VEGF, which is characteristic of the implanted tumor cells. As shown in FIG.
• chemotherapeutic drugs can also reduce the incidence of metastasis relative to the use of chemotherapeutic drugs alone.
• Cotherapy with a nutritional supplement containing fish oil and selenium (“Nutra”) reduced the incidence of lung metastasis by 40% relative to untreated control mice.
• chemotherapeutic agents have long been used in treating cancer, more recently immunological approaches have been explored. Often such approaches are directed to the modulation of immune checkpoint molecules, providing activation of components of the immune system and/or inhibition of components that reduce immune response to tumor cells.
• a nutritional supplement containing fish oil and selenium can modify the expression of such immune checkpoint molecules.
• nutritional supplements containing fish oil and selenium are effective in reducing immune checkpoint proteins (e.g. CD279, CD274), and are also capable of doing so when used in combination with conventional chemotherapy drugs (e.g. Taxol ("tax"),
• Adriamycin ("adyri"), Avastin
• FIG. 69 Modulation of PD-L1 in tumor cells and PD-1 in T cells in animal models treated with a nutritional supplement containing fish oil and selenium, either alone or in combination with various chemotherapeutic agents (Taxol, Adriamycin, Avastin) is shown for lung cancer cells in FIG. 70 and breast cancer in FIG. 71.
• tumor associated PD-L1 is reduced to some extent by treatment with the nutritional supplement and each of the chemotherapeutic agents, but is dramatically reduced by their use in combination (indicating a synergistic effect).
• PD-1 expression in T cells of the same animals can also be modulated by treatment with a supplement containing fish oil and selenium, with the effects being enhanced by cotherapy with chemotherapeutic agents.
• Results of similar studies using a nutritional supplement containing fish oil and selenium ("N") in combination with Iressa ("I") or Tarceva (“T") are shown in FIG. 72.
• PD-1 expression in T cells (left panel) is marginally reduced by treatment with Iressa or Tarceva (TI and TT, respectively), but returned to approximately normal levels by cotherapy with the nutritional supplement (TIN and TTN, respectively).
• Clinical data demonstrate improved immune function in cancer patients receiving a nutritional supplement containing fish oil and selenium. For example, as shown in FIG. 73 and FIG. 74, CD4/CD8 ratios in breast cancer patients and lymphoma patients so treated are improved over patients receiving a placebo.
• WAT white adipose tissue
• BAT brown adipose tissue
• gastroc muscle mass
• tumor cells can express gene products (such as PTHrP and IL-6) that can result in excessive cellular energy expenditure and waste. Some of these gene products (such as IL-6) are also associated with inflammation. These processes are thought to be associated with the development of cachexis. As shown in FIG. 77, treatment with a
• chemotherapy agent such as Tarceva can actually increase expression of such gene products.
• treatment or chemotherapy-cotreatment with a nutritional supplement that includes fish oil and selenium (“Nutrawell”) reduces the expression of such genes. This reduction in excess energy expenditure can beneficially help reduce inflammation and wasting, and provide more energy for recovery and immune response to a tumor.
• ⁇ 3, ⁇ 6 can inhibit the expression of proteins associated with autophagy (such as LC3B- 1 and/or LC3B-III) in tumor- bearing mice.
• autophagy proteins associated with autophagy
• Such a reduction in autophagy can be associated with retention of body mass and body tissues in tumor bearing mice, particularly during chemotherapy.
• treatment of tumor bearing mice with chemotherapeutic agents reduces adipose tissue weight beyond the effect of the tumor alone.
• Combination of such chemotherapy with a nutritional supplement that includes fish oil and selenium (“Nutra”) provides a dramatic improvement in adipose tissue weight.
• cotherapy with a nutritional supplement that includes fish oil and selenium can also relieve muscle wasting (in this instance characterized by mass of the gastrocnemius muscle). Similar data was obtained for both gastrocnemius muscle weight and total skeletal muscle weight (see FIG. 83). As shown, cotherapy with a nutritional supplement that includes fish oil and selenium (“N”) and chemotherapeutic drugs (Alimta/Cisplatin or AC, Tarceva or T) provides an improvement in the retention of muscle mass relative to that found with unsupplemented chemotherapeutic drug treatment.
• N fish oil and selenium
• chemotherapeutic drugs Alimta/Cisplatin or AC, Tarceva or T
• FIG. 87 shows expression of muscle-related proteins found in mitochondria (UCP3, UCP2) and an inflammation-related cytokine in cytosol (IL6).
• 88 shows expression of another set of mitochondrial muscle markers, Complex IV and Complex III.
• Use of a nutritional supplement that includes fish oil and selenium resulted in a marked increase in mitochondrial proteins, whether used in isolation or in combination with Taxol, Adriamycin, or Avastin.
• inflammation in muscle tissue was reduced, as indicated by a reduction in IL6, whether used in isolation or in combination with Taxol,
• chemotherapeutic agent which actually increased expression when used alone (TT), was used in cotherapy (TTN). This indicates that supplements containing fish oil and selenium can be useful in treating mineral imbalance in cancer patients.
• cytokines can also be involved in other tumor-related processes, such as angiogenesis.
• a nutritional supplement that includes fish oil and selenium can modulate levels of various cytokines, particularly when used in combination with chemotherapeutic drugs.
• chemotherapeutic agents Taxol, pr "tax”, and Adriamycin, or "adria", in this example
• FIG. 93 use of such a nutritional supplement in combination with chemotherapeutic agents (Taxol, pr "tax”, and Adriamycin, or "adria”, in this example) in in vivo models of breast cancer was found to reduce plasma VEGF concentrations, indicating that it can provide an anti-inflammatory and anti-angiogenesis effect. Similar results are seen with Avastin (see FIG. 93). The effect is seen with the supplement alone, and cotherapy with such a supplement enhances the VEGF-lowering effects of chemotherapeutic drugs.
• FIG. 94 and FIG. 95 show similar effects in the reduction of TNF-a, which is associated with tumor angiogenesis, growth, and metastasis, in an in vivo breast cancer model. Similar effects are seen in the reduction of ILl- ⁇ (see also FIG. 96, left panel), which is associated with tumor angiogenesis, growth, and metastasis.
• the effects of a nutritional supplement containing fish oil and selenium in combination, both alone and in combination with chemotherapy drugs, on plasma IL- ⁇ in an in vivo model of breast cancer is shown in FIG. 97. Similar studies (see FIG. 98 and FIG.
• Plasma concentrations of IL-10 are similarly reduced (in some instances to nondetectable levels) in such in vivo tumor models treated with a supplement that includes fish oil and selenium (N), both alone and when used in combination with
• IL2 is considered an immunotherapeutic drug for the treatment of some cancers.
• FIG. 101 Plasma concentration of IFN- ⁇ , another immune-activating cytokine, are also observed in such studies as shown in FIG. 102 and FIG. 100 (left panel).
• cytokines concentration of such cytokines when used in the absence of such a supplement, and that the reduction is potentiated by cotherapy (indicating a synergistic effect).
• use of such a supplement can result in increased plasma concentrations of immune-activating cytokines, both when used as a monotherapy and when used in combination with one or more chemotherapeutic drugs.
• AXL signaling in tumors is associated with a wide variety of downstream effects that promote tumor progression.
• AXL signaling within the tumor microenvironment can promote immunosuppression, the development of cancer stem cell phenotypes, resistance to various anti-cancer therapies (including anti-cancer drugs), tumor cell proliferation, resistance to apoptosis and/or autophagy, epithelial to mesenchymal transition, and metastatis.
• regulation of AXL signaling for example, returning the cell to a state more closely resembling that of a normal cell
• a nutritional supplement that includes fish oil and selenium is particularly effective in modifying AXL signaling in cells, particularly drug resistant tumor cells.
• drug (Iressa)-resistant HCC827GR cells express elevated levels of both AXL and p-MET proteins relative to susceptible parent HCC827 cells.
• Inventors have found that a combination of selenium yeast (Nutrient A) and fish oil (Nutrient B) dramatically reduces AXL expression in drug resistant HCC827GR (see FIG. 105). It should be appreciated that treatment with ⁇ Iressa had no effect.
• FIG. 106 depicts the pathway of AXL expression, various points of which can be targeted to modulate AXL expression.
• AXL is dependent on heat shock protein 90 (HSP90) for proper folding. Improper protein folding can lead to increased rates of degradation.
• HSP90 heat shock protein 90
• both AXL and HSP90 protein levels are significantly elevated in drug (Iressa)-resistant HCC827GR tumor cells relative to non-resistant parent HCC827 cells.
• the mTOR pathway has also been implicated in drug resistance in tumor cells. As shown in FIG. 109, mTOR can be phosphorylated in response to growth factors to impact cell growth and proliferation. Surprisingly, the Inventor has found that use of a supplement that combines selenium yeast (Nutrient A) and fish oil (Nutrient B) can reduce levels of p-mTOR in drug (Iressa)-resistant HCC827GR cells, both in the absence and the presence of the drug (see FIG. 110). Even more surprising, the combined nutritional supplement is able to reverse elevated p-mTOR levels in drug resistant cells that are treated with the chemotherapeutic agent.
• FIG. 112 shows the results of similar studies where p-AXL content of the tumor is characterized. As shown, p-AXL is evident in untreated tumors, and is surprisingly reduced on treatment with only a nutritional supplement containing fish oil and selenium. Treatment with Taxol alone reduces p-AXL expression, and this is reduced to almost non-detectable amounts by cotherapy with Taxol and a nutritional supplement containing fish oil and selenium (indicating a synergistic effect). Treatment with Adriamycin or Avastin alone provided little to no apparent reduction in p-AXL expression, where cotherapy of each of these drugs with such a supplement provided a large decrease in expression.
• a nutritional supplement containing fish oil and selenium can be effective in modifying AXL signaling (e.g. reducing expression of p-AXL and HSP90), and that such a supplement can be used in cotherapy with various chemotherapeutic drugs to achieve a synergistic effect in modifying such AXL signaling.
• a nutritional supplement containing fish oil and selenium has numerous beneficial effects in regards to treatment of cancer, including reduction in tumor cell proliferation, tumor size and vascularization, resistance to chemotherapy, and metastasis. These effects are potentiated in a synergistic fashion by cotherapy with one or more chemotherapeutic agents.
• such supplements are able to reduce or reverse symptoms of cachexia associated with cancer, as well as modify plasma cytokine concentrations. Such benefits directly address many quality of life issues for persons living with cancer.
• the Inventor has found that use of a nutritional supplement containing fish oil and selenium also provide a direct benefit in regards to survival rate. As shown in FIG.

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