WO2021123280A1

WO2021123280A1 - Dietary supplement for lipedema patients

Info

Publication number: WO2021123280A1
Application number: PCT/EP2020/087181
Authority: WO
Inventors: Hannelore BAUER
Original assignee: Pantea Gmbh
Priority date: 2019-12-18
Filing date: 2020-12-18
Publication date: 2021-06-24

Abstract

The invention relates to a guggul extract enhanced in guggulsterone, a method for preparing the same and a composition comprising a guggul extract, a curcuma extract and/or black pepper extract as well as the use thereof. The composition of the present invention comprises phytonutrients and can be used as dietary support of lipedema patients. The compositions of the present invention may also be employed as food supplements, for example in support of diets and/or in support of amelioration of life style, also in healthy individuals.

Description

Dietary supplement for lipedema patients

The invention relates to a guggul extract enhanced in guggulsterone content, a method for preparing the same and a composition comprising a guggul extract, a curcuma extract and/or a black pepper extract as well as the use thereof. The composition of the present invention comprises phytonutrients and can be used as dietary support in the treatment of lipedema patients. The compositions of the present invention may also be employed as food supplements, for example in support of diets and/or in support of amelioration of life style, also in healthy individuals.

Progressive disorders of the adipose tissue are termed lipedema. Lipedema affects only women and is characterized by a disproportionate (mostly bilateral and symmetrical) accumulation of subcutaneous fat in the limbs, without affecting the feet and hands ^{K 2}. In addition to aesthetic deformity, women suffer from pain and tenderness to palpation, as well as easy bruising and progressive lymphedema. Typically, lipedema fat does not respond to weight loss modalities, like exercise and diet, or bariatric surgery ³- ⁴ Lipedema progresses through stages, varying greatly amongst patients ⁵· ⁶ An incidence of 11% has been reported for women and post-pubertal girls worldwide ⁷· ⁸. However, the exact number of people suffering from lipedema is unknown and is probably underestimated. Like other rare adipose disorders, lipedema is often misdiagnosed as obesity or lymphedema ⁵. One of the clear tell-tale signs of the disease is the painfulness of the accumulated subcutaneous fat.

The pathophysiology of lipedema is scarcely understood and appears to have a genetic component. A familial predisposition for lipedema has been reported for 60% of lipedema cases but is probably higher due to underdiagnosis ².

Decongestive therapy, including manual lymphatic drainage and the use of compression garments may help to ease the painful symptoms of lipedema. Nevertheless, the only proven therapy of lipedema is radical circular liposuction, ⁹- ¹⁰, which is associated with above-average costs that usually are not covered by health insurance companies.

Thus, there remains a need for other therapies, in particular non-surgical therapies.

A number of nutritional compounds have been shown to be active in general lipid metabolism. These supplements were shown to have a beneficial effect on adiposity, dyslipidemia and diabetes, collectively summarized under the term metabolic syndrome ^{n 15}. However, lipedema patients do not show dyslipidemia or diabetes above average prevalence ¹⁶, and adiposity may or may not develop as co-morbidity at advanced stages of the disease. Thus, dietary supplements for adiposity, diabetes, or dyslipidemia are not necessarily suitable for lipedema patients.

Currently, there is no dietary supplement or food supplement specifically for lipedema patients.

It was a long-standing interest of the inventor to develop novel non-surgical approaches to ameliorate lipedema patients' conditions. The inventor developed the composition(s) of the present invention, in particular for use as a food supplement or as a dietary supplement for, e.g. lipedema patients. The composition comprises a specific combination of phytonutrients, which are preferably derived from plant extracts. In a preferred embodiment, the composition comprises a guggul extract, a curcuma extract and/or black pepper and, optionally, rutin, a citrus extract, a grape seed extract, choline and/or a hop extract. The extracts as employed herein may also be used in their dried form, e.g. in form of powders. To achieve optimal effectiveness against lipedema adipose stem cell proliferation and adipogenesis, the novel phytonutrient composition combines ingredients which are known to exert inhibitory effects on adipose tissue but have not been suggest to be used in combination.

Moreover, the composition of the present invention has been shown to have surprising effects in vitro and in vivo. The inventors could surprisingly show that the composition of the present invention has a synergistic, i.e. over-additive effect in vitro. The phytonutrient composition of the present invention helps to decrease hypertrophy and hyperplasia of lipedema fat in vivo by specifically targeting the growth of lipedema adipose stem cells. The inventors focused on the control of adipose stem cell growth and the early stages of adipocyte development, processes that are currently best studied in vitro. Since adipose-tissue derived stem cells give rise to new populations of differentiated adipocytes, which, in turn, are capable of accumulating disproportionately large quantities of lipids, the inventors focused on a reduction of adipose stem cells in the combat against lipedemic hyperplasia (lipedema-associated hyperplasia of adipose cells).

The inventors showed in the appended Examples that the composition according to the present invention comprising a (i) guggul extract (preferably a “guggulsterone-enriched” guggul extract as defined herein below, namely comprising preferably, at least about 10 % w/w guggulsterone), a (ii) curcuma extract (rich in curcuminoids, in particular rich in curcumin), and/or (iii) a black paper extract (rich in piperine) is more effective than individual compounds in regulating lipedema adipose cell growth and lipid accumulation. This surprising over-additive effect (i.e. synergistic effect) is also illustrated by the unexpected effect of the inventive composition on human lipedema adipose tissue-derived stem cells.

Accordingly, the present invention relates in particular to a composition comprising, a guggul extract, a curcuma extract and/or a black pepper extract, preferably a guggul extract, a curcuma extract and a black pepper extract. In a more preferred embodiment of the inventive composition the guggul extract comprises guggulsterone, the curcuma extract comprises curcuminoids, more preferably the curcuma extract comprises curcumin, and the black pepper extract comprises piperine. The inventive composition may also comprise rutin. Furthermore, the inventive composition as also tested in the appended examples, optionally, comprise a citrus extract, a grape seed extract, choline and/or a hop extract. The person skilled in the art refers to an “extract”, in particular in context of the present invention, as product that is prepared form a given source, like from a plant or parts of a plant. The term “extract” describes in particular a composition that comprises essential constituents of a complex material, like of plant or of (a) part(s) of (a) plant(s). Such “extracts” may be soluble extracts/solutions, like solutions prepared by, e.g. alcoholic extractions. Yet, in context of this invention, such extracts may also comprise dried material, like powder illustratively; we refer herein to “guggul extract”, one important compound comprised in the inventive compositions. Accordingly, in context of the present invention, the term “(plant) extract” is employed interchangeably with the term ““(plant) powder” or “(plant) extract/powder”. “Guggul extract” is, inter alia, known as the oleo gum resin of Commiphora mukul, and it is a complex mixture of minerals, gum, terpenes, sterols, essential oils, sterones (guggulsterones), ferrulates, lignans, and flavonones. The present invention also provides for means and method how, inter alia, “guggulsterone-enriched guggul extract”/“guggulsterone-enriched powder”, may be prepared.

Similarly, also curcuma extracts/curcuma powders are employed in context of this invention.

Furthermore, the invention compositions may comprise black pepper extracts/black pepper powders.

The tested composition as provided in the appended examples, comprises a curcuma extract/powder, a guggul extract/powder, and/or a black pepper extract/powder. The inventive compositions may also comprise rutin, a citrus extract/powder, and a grape seed extract/powder. Further optional compounds comprised in the compositions of the invention are, inter alia, choline or hop/hop extract/powder. As discussed above, a preferred “guggul” composition of the present invention comprises guggul extract/powder and curcurma extract/powder, in one embodiment also additionally (black) pepper extract/powder. If all three extracts are comprised in a composition of the present invention, the guggul extract, the curcurma extract, and the (black) pepper extract may have a weight ratio of 0.5 to 1 to 0.01, respectively. Alternatively, and in another embodiment of the present invention, the inventive composition may comprise the guggul extract, the curcurma extract, and the (black) pepper extract at a weight ratio 1.5 to 1 to 0.05, respectively. Again the “extracts” may also and in particular be used in their dried form, e.g. as powders. Accordingly, also in the appended examples, dried material is employed, for example in the preparations of exemplified dosage forms (in a present case capsules). Preferably, the guggul extract is in context of the inventive compositions a “guggulsterone-enriched guggul extract”/” guggulsterone-enriched powder”. As will be discussed below and in context of the present invention, a “guggulsterone- enriched guggul extract’Vpowder is preferably a guggul extract comprising at least about 10 % w/w guggulsterone. Said guggul extract/" guggulsterone-enriched guggul extract” may also comprise at least about 12 % w/w, more preferably at least about 14 % w/w, about at least 16 % w/w, and most preferably at least about 18 % w/w guggulsterone. In context of the present invention such a “guggulsterone-enriched guggul extract” is to be employed in combination with curcuma extract/powder and/or black pepper extract/powder. Again, the compositions of the present invention may comprise additional constituents/substances/extracts/powders. For example, compositions of the present invention also comprise the illustrative Metabol capsules as provided herein. Such illustrative capsules comprise a curcuma extract, a guggul extract (preferably a “guggulsterone-enriched guggul extract”) and a black pepper extract, and additionally rutin, a citrus extract, a grape seed extract and, in one embodiment, a hop extract. Yet, it is also part of this invention that the “ Metabol ” capsules comprise a guggul extract (preferably a “guggulsterone- enriched guggul extract”), a curcuma extract, a black pepper extract. Said illustrative “Metabol” capsule, also comprises additionally, rutin, a citrus extract, a grape seed extract and, in one embodiment, hop/hope extract and in another embodiment, choline. The components of the composition comprise active phytonutrients: the guggul extract comprises guggulsterone, the curcuma extract comprises curcuminoids, preferably the curcuma extract comprises curcumin, the black pepper extract comprises piperine, the citrus extract comprises hesperidine, and the grape seed extract comprises oligomeric proanthocyanidins. The hop extract to be optionally employed comprises flavones, preferably the hop extract comprises xanthohumol. Thus, the tested composition as provided in the appended examples comprises the phytonutrients guggulsterone, curcuminoids (preferably curcumin), piperine, rutin, hesperidine, proanthocyanidins (preferably oligomeric proantocynidins) and, optionally, flavones (preferably xanthohumol). Another option is that the compositions of the invention may, optionally, comprise choline.

Furthermore, the present invention relates to a novel method for the preparation of a guggulestrone-enriched guggul extract.

Guggul extract is one of the most valued medicinal plant extracts in Ayurveda medicine and several pharmaceutical applications have been described for “guggul” ^17-19. The US Food and Drug Administration approved the use of this herbal extract as a dietary supplement in 1994. Guggul extract, the oleo gum resin of Commiphora mukul, is a complicated mixture of minerals, gum, terpenes, sterols, essential oils, sterones (guggulsterones), ferrulates, lignans, and flavonones ¹⁹. The main active compound in guggul extract is the phytonutrient guggulsterone. Guggulsterone is traditionally used to treat obesity, diabetes, hyperlipidemia, atherosclerosis, and osteoarthritis, possibly through an anti-inflammatory mechanism ²⁰· ²¹. Scientific studies have shown that the pharmacological properties associated with guggul are due to the E- and Z-guggulsterones, while other compounds may synergistically enhance its overall activity.

Curcuminoids are the main active component, i.e. phytonutrient of curcuma extract. The preferred curcuminoid is curcumin. The main curcuminoid in the curcuma extract is curcumin. Accordingly, the main active component of the curcuma extract is preferably curcumin. Curcumin is a hydrophobic polyphenol and constitutes about 2-5% of turmeric ²⁰ Curcumin exhibits a wide spectrum of biological and pharmacological activities, including antioxidant, anti-inflammatory, antibacterial, antiviral, antifungal, and anticancer activities ²². Experimental evidence suggests that curcumin supports weight loss and reduces the incidence of obesity-related diseases ²³. Curcuma extract is also known in the art as “turmeric (root) extract”.

Piperine is the primary pungent alkaloid derived from black pepper (Piper nigrum and piper longum) ²⁴. Piperine is the main active component, i.e. phytonutrient of the black pepper extract. Piperine is non-genotoxic and exhibits anti-mutagenic and anti-tumor properties ²⁵. In vivo, Piperine acts as an adjuvant-like substance to increase the bioavailability of curcumin, Piperine was shown to modulate permeability properties of the intestinal mucosa leading to increased absorption of nutrients ^{26 27 28}.

There are numerous studies about the effects of the individual components/compounds of the composition of the present invention on lipid metabolism and adipose tissue growth in vitro and in vivo. These are summarized in the following.

Guggul is considered a natural cholesterol lowering agent ²⁹. The main active compounds of gum guggul are inter-convertible isomeric forms (E and Z) of guggulsterone which are steroidal in nature ³⁰ Guggulsterone is both agonist and antagonist for various steroid receptors. Guggulsterone-treatment of 3T3-L1 adipocytes impairs differentiation and induces both lipolysis and apoptosis in mature adipocytes ³¹. Guggulsterone is a highly efficient antagonist of the farnesoid X receptor (FXR), a nuclear hormone receptor that is activated by bile salts ³². Binding of FXR to agonistic ligands promotes adipocyte differentiation in vitro, which is reversed by the FXR antagonist guggulsterone ³³. Guggulsterone is known to reduce adipogenesis (maturation) of preadipocytes by down-regulating adipocyte-specific transcription factors, which results in a decline of cytoplasmic lipid accumulation ³⁴ Guggulsterones, when administered to rats at the dose of 400 mg/kg body weight, were able to significantly limit body weight gain and to decrease plasma levels of ghrelin, glucose, and triglyceride levels and to increase plasma leptin ³⁵. Gugulipid, an organic extract of gum guggul resin, effectively lowers cholesterol, serum low- density lipoprotein and triglyceride levels in a rodent model ³⁶ An ethanolic extract of guggul was shown to exert a beneficiary effect on high fructose diet-induced abnormalities in rats ³⁷ Antihyperglycemic and antioxidant activities of an alcoholic extract of Commiphora mukul gum resin was demonstrated in STZ-induced diabetic rats ³⁸. Antidiabetic and antioxidant properties of an ethanolic extract of Commiphora mukul gum resin was shown in fructose-induced insulin resistant rats

Guggul and/or guggulsterone exert hepatoprotective, anti-inflammatory, thyroid-stimulatory, has hypolipidemic and anti-adipogenic effects and shows cardiovascular benefits. Guggul is beneficial for the treatment of hypercholesterolemia and hyperlipidemia ^{40 2} Guggulsterone is also beneficial for prevention and treatment of chronic diseases and cancer ⁴³. Guggul and guggulsterone show cardiovascular benefits ⁴⁴. Z-guggulsterone produces antidepressant-like effects in a mouse model, through activation of the BDNF signaling pathway ⁴⁵.

Several studies demonstrated the effect of curcumin on obesity using cell and animal models as well as human trials ¹³. Most of the studies were performed using the murine preadipocyte cell line 3T3-L1 and single components of phytonutrients. For in vitro studies, curcumin concentrations were preferably between 5 and 100 microM (mM). It was further shown that curcumin attenuates adipogenesis by inducing preadipocyte apoptosis and inhibiting differentiation of 3T3-L1 cellls ⁴⁶. Curcumin inhibits adipocyte differentiation through modulation of mitotic clonal expansion ⁴⁷. Curcumin inhibits adipogenesis and fat accumulation in 3T3-L1 adipocytes as well as angiogenesis and obesity in C57 mice ⁴⁸. Curcumin inhibits adipogenesis-induced by phthalates, a group of endocrine disrupting chemicals ⁴⁹. Curcumin was shown to repress adipogenic differentiation of human bone marrow mesenchymal stem cells ⁵⁰

Curcuma/Cur cumin reduces body fat; reduces hepatic and serum cholesterol; exerts a broad range of anti-oxidative and anti-inflammatory actions; suppresses angiogenesis in adipose tissue (thereby reducing growth of adipose tissue); reduces body weight and BMI; is supposed to increase basal metabolic rate; reduces vascular inflammation; reduces vascular hyperpermeability and can contribute to the prevention of vasogenic edema and tissue swelling. Curcumin is an antioxidative and anti-inflammatory agent. Its anti-inflammatory effects are mediated through downregulation of inflammatory transcription factors, enzymes and cytokines ^{51 53}. Curcumin reduces obesity by inhibiting synthesis and storage of lipids and by stimulating fatty acid degradation ⁵⁴ Curcumin lowers hepatic and serum cholesterol by suppressing the hepatic enzymes HMG-CoA reductase and Acyl Co A cholesteryl acyl transferase ⁵⁵. Curcumin upregulates fatty acid oxidation and suppresses angiogenesis in adipose tissue, leading to lower body fat and body weight gain ⁴⁸. Curcumin reduces lipid accumulation in adipocytes by downregulating expression of glycerol-3 - phosphate acyl transferase- 1 in a dose-dependent manner ⁴⁸. Curcumin downregulates the expression of key transcription factors of adipogenesis and lipogenesis, thereby reducing maturation and accumulation of adipose tissue ⁴⁸. Curcumin administration reduces body weight and BMI ⁵⁶· ⁵⁷ Curcumin may also reduce body weight by increasing the basal metabolic rate and the release of cytokines ⁵⁴ Curcumin reduces vascular inflammation in vivo and in vitro through activation of heme oxygenase- 1 (HO-1) ⁵⁸. Curcumin inhibits vascular hyperpermeability through its anti-oxidant properties ⁵⁹.

In vitro, piperine inhibits adipogenesis of murine preadipocytes (3T3-L1) and reduces mRNA expression of the master adipogenic transcription factors like PPARgamma by using epigenetic mechanisms ^{60, 61}.

Black pepper/piperine exerts lipid and glucose lowering effects; reduces of body weight; is anti inflammatory, has anti-oxidative effects, is analgesic; and has appetite lowering and satiety increasing effects. Piperine reduces triglyceride accumulation in liver and levels of glucose and lipid in the blood ⁶². Piperine reduces the damaging effects of a high-fat diet through its antioxidant activity in (animal model) ⁶³· ⁶⁴. Black pepper exerts analgesic and anti-inflammatory activities ⁶⁵. Piperine induces receptor desensitization of the human vanilloid/capsaicin receptor at a greater efficacy than capsaicin itself ⁶⁶. Desensitization of the vanilloid/capsaicin receptor interrupts the pain signaling transduction cascade induced by pain-producing chemical, thermal, and physical stimuli. Co-administration of piperine with curcumin suppresses a high fat diet- induced inflammation in a mouse model ⁶⁷. A clinical trial showed that curcuminoids plus piperine improve nonalcoholic fatty liver disease ⁶⁸. Curcumin and piperine supplementation modulates body fat and interleukin- IB in obese mice under caloric restriction ⁶⁷. Black pepper modulates appetite by lowering “hunger” and “desire to eat” and significantly increasing “satiety” and “fullness” ⁶⁹.

Rutin was shown to suppress adipogenesis in 3T3 cells ⁷⁰.

Citrus flavonoids, such as hesperidin, have emerged as potential therapeutics for the treatment of metabolic dysregulation ¹¹. Lipid-lowering and insulin-sensitizing properties have been attributed to hesperidine and its related compounds as shown in preclinical studies and clinical trials ⁷².

Grape seed extract (proanthocyanidins) supplementation has anti-hypertrophic effects in rats with established obesity ⁷³. Low doses of grape seed procyanidins reduces adipositiy and improves plasma lipid profiles in animal model ⁷⁴ Grape seed proanthocyanidin extract ameliorates inflammation and adiposity by modulating gut microbiota in high-fat diet mice ⁷⁵.

Xanthohumol, a prenylated polyphenole, was found to potentiate the activity of guggulsterone ⁷⁶. Xanthohumol is a flavone. The anti-obesity mechanisms of the hop extract xanthohumol were demonstrated by Kirkwood and Legette 2013 ⁷⁷ Hop extract (xanthohumol) was shown to lower body weight and fasting plasma glucose in obese male “Zucker fa/fa rats” ⁷⁸. Effects of a xanthohumol-rich extract from the hop on fatty acid Metabolism in rats fed a high-fat diet were reported ⁷⁹.

Choline plays an important role in lipid metabolism: Choline is responsible for the transport of fatty acids from the liver, in addition, choline forms one of the most important neurotransmitters, acetylcholine, and is therefore important for the transmission of nerve signals. Choline also contributes to normal liver function and normal homocysteine metabolism. Homocysteine, despite also being a natural amino acid may also be toxic and may damage cells. Choline occurs as a cation that forms various salts (like, choline hydrogen tartrate, choline bitartrate, choline chloride, and choline citrate. It may be employed as choline per se and/or as choline phospholipids, like phosphatidylcholine. Here, choline may be of additional use in context of the present invention in order to normalize said homocysteine metabolism. In two of the exemplified compositions of the present invention provided herein below, choline hydrogen tartrate is employed.

However, the prior art did not analyze the effects of the phytonutrients of the composition of the present invention in combination. The inventors analyzed the influence of components of the composition of the present invention comprising the relevant phytonutrients, in particular the guggul extract comprising guggulsterone, the curcuma extract comprising curcumin and the black pepper extract comprising piperine, on the growth of human lipedema adipose tissue-derived stem cells, isolated from human lipoaspirates following tumescent liposuction. Using these in vitro assays, the inventors have demonstrated that the composition inhibits proliferation of human lipedema and non-lipedema adipose stem cells. In addition to in vitro studies, the phytonutrient composition of the present invention is currently tested in a three-month randomized, placebo-controlled double-blind study with lipedema patients to prove the beneficial effect of the composition.

The inventor further shows in the appended in vitro examples that treatment with the preparations of the compositions of the present invention induces higher degradation (lipolysis) of cytoplasmic lipids in lipedema adipocytes than in control adipocytes originating from healthy donors. Thus, the compositions, in particular the compositions comprising guggul extract (comprising at least about 10 % w/w guggulsterone) and as provided herein is considered an effective ingredient of a phytonutrient composition for the dietary support of, inter alia, lipedema patients.

DETAILED DESCRIPTION OF THE INVENTION

The invention relates in one aspect to a novel guggul extract/powder comprising more than 11 % w/w guggulsterone. Preferably the guggul extract comprises at least about 12 % w/w, more preferably at least about 14 % w/w, more preferably at least about 16 % w/w, most preferably at least about 18 % w/w guggulsterone. Commercially Guggul extract/powders comprising about 10 % w/w guggulsterone are readily available and may also be employed successfully in context of the further aspect of the present invention, namely the compositions comprising (a) guggul extract/powder (rich in guggulsterone content, i.e at least about 10% w/w) and (b) a curcuma extract/powder and/or (c) a black pepper extract/powder Yet, the present invention also provides for means and methods to obtain guggul extracts/powders with higher guggulsterone content. Main active compound in the guggul extract is guggulsterone. Guggulsterone is a phytonutrient. The guggul extract/powder according to the present invention and/or employed in context of the present invention is also referred to as guggulsterone-enriched guggul extract/powder, enriched guggul fraction, ethanolic fraction, ethanolic guggul extract (also in its dried form, i.e. as “ethanolic” guggul powder). Guggulsterone-enriched guggul extract/powder, with considerably more than about 12% w/w guggulsterone is denoted herein as “guggul forte”. Guggulsterone is preferably E and Z guggulsterone.

The term “extract” as used herein also refers to dried forms, namely “powders”. This applies not only to the guggul extracts as employed and provided herein, but also to the other extracts employed in context of this invention, like curcuma extract (rich in curcuminoids, in particular rich in curcumin) and/or black paper extract (rich in piperine) but also for the hop extract, citrus extract, etc. as used in context of this invention.

The term “% w/w” as used herein means weight %.

As used herein, the term “about” preferably refers to ±10% of the indicated numerical value, more preferably to ±5% of the indicated numerical value, and in particular to the exact numerical value indicated. If the term “about” is used in connection with the endpoints of a range, it preferably refers to the range from the lower endpoint -10% of its indicated numerical value to the upper endpoint ±10% of its indicated numerical value, more preferably to the range from of the lower endpoint -5% to the upper endpoint ±5%, and even more preferably to the range defined by the exact numerical values of the lower endpoint and the upper endpoint. If the term “about” is used in connection with the endpoint of an open-ended range, it preferably refers to the corresponding range starting from the lower endpoint -10% or from the upper endpoint ±10%, more preferably to the range starting from the lower endpoint -5% or from the upper endpoint ±5%, and even more preferably to the open-ended range defined by the exact numerical value of the corresponding endpoint.

The guggul extract according to the present invention is preferably essentially free from ethanol- insoluble components. In one embodiment, the guggul extract is essentially free from ethanol- insoluble components and essentially free from water-insoluble components. “ Essentially free from ethanol-insoluble components ” according to the present invention means that the guggul extract comprises less than 5% w/w, preferably less than 3 % w/w, more preferably less than 1 % w/w and most preferably less than 0.1% w/w ethanol-insoluble components. “Essentially free from water-insoluble components ” according to the present invention means that the guggul extract comprises less than 5% w/w, preferably less than 3 % w/w, more preferably less than 1 % w/w and most preferably less than 0.1% w/w water-insoluble components.

The present invention further relates to a method for preparing the guggul extract/powder according to the present invention, comprising the following steps: a) dissolving a guggul extract comprising about 10 % w/w guggulsterone in 80 % v/v ethanol at a concentration of 200-300 mg/ml; b) removing ethanol-insoluble components; c) drying the supernatant obtained in step b) to obtain the guggul extract in a dried form (i..e in form of a powder); and d) optionally, dissolving the dried guggul extract (powder) obtained in step c) to obtain the guggul extract in a dissolved form.

The method can be used a protocol for the extraction of a guggulsterone-enriched ethanolic fraction from a commercially available guggul extract.

The guggul extract used in step a) is also referred to as “starting guggul extract”. A commercially available guggul extract can be used as a starting extract. The starting guggul extract comprises about 10% w/w guggulsterone, preferably 9.5-10.5 % w/w guggusterone, more preferably 10 % w/w guggulsterone. The guggul extract used in step a) can be a commercially available guggul extract comprising about 10% w/w guggulsterone, preferably 9.5-10.5 % w/w guggusterone, more preferably 10 % w/w guggulsterone. In one embodiment, the guggul extract obtained in step c) in dried form and/or the guggul extract obtained in step d) in dissolved form is a guggulsterone- enriched guggul extract. In a preferred embodiment, the guggulsterone-enriched guggul extract obtained by the method of the present invention comprises more guggulsterone compared to the starting guggul extract. The inventive guggulsterone-enriched guggul extract obtained in step c) or d) of the present invention preferably comprises at least 10 % w/w guggulsterone (when the starting material comprised less than 9,5% w/w guggulsterone), preferably at least about 12 % w/w, more preferably at least about 14 % w/w, more preferably at least about 16 % w/w, more preferably at least about 18 % w/w guggulsterone. One resulting guggulsterone-enriched extract/powder (termed herein “guggul forte”) in dried form most preferably comprises about 18% w/w guggulsterone (E and Z). Also Guggul forte in dried or dissolved form may directly be used for nutritional purposes. The guggulsterone-enriched extract obtained by the method of the present invention is the preferred guggul extract in the composition of the present invention. The guggulsterone-enriched extract refers to both the guggul extract in dried form obtained in step c) as well as the guggul extract in dissolved form obtained in step d).

Step a) of the method of the present invention is preferably carried out for 1-4 hours at a temperature of 18-22 °C, more preferably for 2 hours at 20°C. The concentration at which the guggul extract is dissolved in step a) of the method is preferably 250 mg/ml. The temperature of 18-22 °C is also referred to as room temperature. Dissolving of the guggul extract in step a) leads to a mixture of a liquid fraction and a solid fraction of the components of the starting guggul extract. The solid fraction comprises ethanol-insoluble components, and, optionally, water- insoluble components. The liquid fraction comprises guggulsterone. The guggulsterone-enriched guggul extract obtained in step c) or d) is preferably essentially free from ethanol-insoluble components and/or essentially free from water-insoluble components.

Removal of the ethanol-insoluble components in step b) of the method is preferably carried out by sedimentation for 2-3 hours a temperature of 18-22 °C, more preferably for 2.5 hours at a temperature of 20 °C. The supernatant obtained in step b) refers to the liquid fraction of the dissolved mixture and comprises guggulsterone. Step b) can also remove water-insoluble components.

Drying the supernatant obtained in step b), in step c) of the method is preferably carried out 35-45 °C for 8-14 hours, more preferably at 40 °C for 11 hours. After step c), the guggul extract is obtained in a dried form, i.e. it is essentially free from water and/or essentially free from ethanol. The guggul extract in dried form preferably comprises less than 1% w/w water and/or ethanol, preferably less than 0.1 %, more preferably less than 0.01%. The guggul extract in dried form preferably comprises at least 10.5 % w/w guggulsterone, more preferably at least 11% guggulsterone, more preferably at least about 12 % w/w, more preferably at least about 14 % w/w, more preferably at least about 16 % w/w, more preferably at least aboutl8 % w/w guggulsterone. Optionally, the dried guggul extract can be dissolved in step c) if a dissolved form of the extract is required. Dissolving is preferably carried out in ethanol or dimethylsulfoxide. The guggulsterone- enriched extract is preferably dissolved at a concentration of 0.1 -0.2% w/v, more preferably 0.3- 0.4 % w/v, even more preferably 0.4-0.5 % w/v.

The present invention further relates to a composition comprising a specific combination of plant extracts/powders. In a preferred embodiment, the composition of the present invention comprises a guggul extract/powder, a curcuma extract/powder and/or a black pepper extract/powder. Preferably, the composition comprises at least a guggul extract/powder and a curcuma extract/powder. More preferably, the composition comprises a guggul extract/powder, a curcuma extract/powder and a black pepper extract/powder. The composition can further comprise at least one selected from the group consisting of rutin, a citrus extract, a grape seed extract, choline and a hop extract. In one embodiment, the composition comprises a guggul extract, a curcuma extract, a black pepper extract, rutin, a citrus extract and a grape seed extract. In a particularly preferred embodiment, the composition comprises a guggul extract, a curcuma extract, a black pepper extract, rutin, a citrus extract, a grape seed extract and a hop extract. In another a particularly preferred embodiment, the composition comprises a guggul extract, a curcuma extract, a black pepper extract, rutin, a citrus extract, a grape seed extract and choline.

The extracts/powders to be employed in the compositions of the present invention each comprise at least one active component. The active components can be phytonutrients. Active components are preferably selected from the group consisting of guggulsterone, curcuminoids (in particular curcumin), piperine, citrus flavonoids such as hesperidine, proanthocyanidins (in particular oligomeric proanthocyanidins), flavones (in particular xanthohumol), and rutin. The guggul extract comprises guggulsterone. In a preferred embodiment, the guggul extract comprising at least 11 % w/w guggulsterone. Preferably the guggul extract comprises at least about 12 % w/w, more preferably at least about 14 % w/w, more preferably at least about 16 % w/w, more preferably at least about 18 % w/w guggulsterone. Such guggul extracts are considered in context of this invention as “guggulsterone-enriched guggul extracts”. Yet, it is of note that in form of “compositions of the present invention”, like the herein illustratively provided “Metabol” compositions, also commercially available guggul extracts/powders with about 10% w/w guggulsterone content may be employed without deferring from the additional gist of the present invention, namely the combined provision of a guggul extract, a curcuma extract and/or a black pepper extract for the medical use in the treatment of lipid disorders as discussed herein (e.g. lipedema) as well as for the non-medical use in, for example, in the amelioration of individual well-being, healthier and better mood and general better and healthier “shape’Vappearance, including weight loss and cardiovascular benefits and/or in the support of diets, like low-fat diates or low-card diets.

The curcuma extract to be employed in context of this invention comprises curcuminoids. Curcumin is the preferred curcuminoid. Thus, the curcuma extract preferably comprises curcumin. The black pepper extract comprises piperine. The citrus extract comprises citrus flavonoids such as hesperidine. The grape seed extract comprises proanthocyanidins, preferably oligomeric proanthocyanidins. The hop extract that may be employed in the context of the invention may comprise flavones, preferably xanthohumol. The choline that may also be optionally be used in the compositions of the present invention may be choline hydrogen tartrate, choline bitarate, choline chloride, and choline citrate. In context of the present invention, choline hydrogen tartrate, as obtained from KS Pharma GmbH (5211 Lengau, Austria), was employed.

The compositions of the present invention may also comprise other beneficial components, like, vitamins (e.g. riboflavin, vitamin B6, pantothenic acid etc.) or dietary supplements (like, e.g. zinc)

The components of the inventive compositions are readily available for the person skilled in the art and are commercially available. Accordingly, extracts/powders as well as individual components of the composition of the present invention can readily be obtained by the person skilled in the art. The components can for example be purchased from KS Pharma GmbH (Austria). None limiting resources comprise, accordingly, for guggul extracts/powders with about 10% guggulsterone: “K - W. Pfannenschmidt GmbH”, Habichthorst 34-36, 22459 Hamburg/Germany or “KS Pharma GmbH”, GewerbestraBe 32, 5211 Lengau/Austria. Curcuma extract/powder, also Curcuma extract/powder with about 90% curcuminoid and Black pepper extract/powder (also with about 94 to 95% piperine), are, inter alia, available from “Gonmisol fine chemicals/ingredients S.A.”, Cami de la Verneda, 47, 08930 Sant Adria de Besos, Barcelona/Spain. Citrus extract/powder (also with about 60% hesperidine) may be obtained from “Boavit Nutrition SL”, Muelle Costa s/n - P2 Puerto de, 08039 Barcelona/Spain. Rutin as well as hop extracts/powders is also available, inter alia, from “KS Pharma GmbH”. Grape seed extract/powder, also with about 50 % oligomeric proanthocyanidins (OPC), may be obtained from “K.-W. Pfannenschmidt GmbH”. Again, these resources are by no means meant to be limiting.

Preferably but without being limiting, the components, compounds and/or individual parts of the composition of the present invention (especially the plant extracts/plant powders) are veryfied and certified for example under the following commission regulations and guidelines: For guggul extracts/powders with about 10% guggulsterone (Not a hazardous substance ace. to EC reg. 1272/2008 and 1907/2006. MSDS not required; Product has not been subjected to irradiation; Free of BSE/TSE (Bovine/Transmissible Spongiforme Encephalopathy); No obligation of GMO labelling as defined in EC reg. 1829/2003 / 1830/2003; Conform to pesticides EC reg. 396/2005 and amendments; Conform to contaminants EC reg. 1881/2006 and amendments as far as applicable; Free of allergens subject to labelling ace. to ELI reg. 1169/2011; No obligation of nano material labelling as defined in ELI reg. 1169/2011; Conforms EC reg. 178/2002 for food raw materials cone food safety, traceability, hygiene management; Suitable for vegetarian and vegan food. Produced without the use of products of animal origin; Without use of palm oil and palm oil derivatives); For Curcuma extract/powder, also Curcuma extract/powder with about 90% curcuminoid as well as Black pepper extract/powder (also with about 94 to 95% piperine (Not a hazardous substance ace. to EC reg. 1272/2008 and 1907/2006. MSDS Section 2 and 3; According to directives 1992/2/EC and 1999/3/EC, it is confirmed, that the product is not made from irradiated/ionized raw materials or was irradiated/ionized; Free of BSE/TSE (Bovine/Transmissible Spongiforme Encephalopathy); No obligation of GMO labelling as defined in EC reg. 1829/2003 / 1830/2003; Conform to pesticides EC reg. 396/2005 and amendments; Conform to contaminants in accordance with the commission regulation (EC) No. 629/2008 and conform to Ochratoxin, a non dioxin-like PCBS and Melamine in accordance with the commission regulation (EC) No. 594/2012 amending regulation EC reg. 1881/2006 and further amendments as far as applicable; Free of allergens in accordance with the Directive 2003/89/EC and Council amending Directive 2000/13/EC and taking Directive 2005/26/EC, Directive 2005/63/EC and Directive 2006/142/EC of 22.12.2006 into consideration - subject to labelling ace. to ELI reg. 1169/2011; Free of nano material and no obligation of nano material labelling as defined in ELI reg. 1169/2011; Suitable for vegetarian and vegan food. Produced without the use of products of animal origin; The product meets with Directive 2009/32/EC of the European Parliament and of the Council of 23 April 2009 on the approximation of the laws of the Member States on extraction solvents used in the production of foodstuffs and food ingredients and Directive 2010/59/EU of 26 August 2010 amending Directive 2009/32/EC of the European Parliament and of the Council on the approximation of the laws of the Member States on extraction solvents used in the production of foodstuffs and food ingredients; As per the list of 2012 of the world anti-doping agency the ingredient is not a doping substance and not a combination of doping substances and does not contain any doping substance). For Black pepper extract/powder (also with about 94 to 95% piperine furthermore (the production complies with regulation (EC) No. 852/2004 of the European parliament on the hygiene of foodstuffs and all its amendments; the full traceability as mentioned in regulation (EC) No. 178/2002 of the European parliament and of the council of 28 January 2002 laying down the general principles and requirements of food law, establishing the European food safety authority and laying down procedures in matters of food safety; commission regulation (ELI) 2016/355 of 11 march 2016 amending Annex III to regulation (EC) No. 853/2004 of the European parliament and of the council as regards the specific requirements for gelatine, collagen and highly refined products of animal origin intended for human consumption).

Without being bound by theory, the phytonutrients of the composition of the present invention have following effects:

Guggulsterone has hepatoprotective effects, is anti-inflammatory, is thyroid stimulatory, has hypolipidemic and anti-adipogenic effects; and shows cardiovascular benefits.

Curcumin reduces body fat; reduces hepatic and serum cholesterol; exerts a broad range of anti- oxidative and anti-inflammatory actions; suppresses angiogenesis in adipose tissue, thereby reducing growth of adipose tissue; reduces body weight and BMI; is supposed to increase basal metabolic rate; reduces vascular inflammation; reduces vascular hyperpermeability; and/or can contribute to the prevention of vasogenic edema.

Piperine exerts lipid and glucose lowering effects; reduces body weight; has anti-inflammatory and anti-oxidative effects; and has analgesic, appetite lowering and satiety increasing effects. The guggul extract in the composition according to the present invention is preferably a guggulsterone-enriched guggul extract/powder as described herein. Yet, as is also evidenced herein below especially in context of the inventive compositions, also a readily available enriched guggul extract/powder with about 10 w/w guggulsterone may be used.

In one preferred embodiment of the composition according to the present invention (here termed Metabol I), the composition comprises 20-30 % w/w guggul extract with at least 10-18 % w/w guggulsterone, 45-55 % w/w curcuma extract with 85-95 % w/w curcuminoids (in particular 60-90 % w/w curcumin), 0.25-0.75 % w/w black pepper extract with 90-98 % w/w piperine. Additonally, this composition (“ Metabol F) comprises 4-6 % w/w rutin, 4.5-6.5 % w/w citrus extract with 50- 70 % w/w hesperidine, 8-12 % w/w grape seed extract with 45-55% w/w oligomeric proanthocyanidins and 2-3 % w/w hop extract with at least 3 % w/w flavones (in particular 05. -1.5 % w/w Xanthohumol). In a particularly preferred embodiment, the composition according to the present invention comprises about 25% ( e.g. 25.37 %) w/w guggul extract with about 10 to about 18.0 % w/w guggulsterone, about 50% ( e.g. 50.74 %) w/w curcuma extract with at least about 90 % w/w curcuminoids (in particular about 70 to about 80 % w/w curcumin), about 0.5% to about 1% ( e.g, 0.54 %) w/w black pepper extract with about 90% (e.g. 94.3 % w/w) piperine, about 6% ( e.g. 5.08 %) w/w rutin, about 6% (e.g. 5.58 %) w/w citrus extract with about 60 % w/w hesperidine, about 10 % (e.g. 10.15 %) w/w grape seed extract with about 50 % w/w oligomeric proanthocyanidins and about 2% to 3 % (e.g. 2.54 % w/w) hop extract with at least about 4 % w/w flavones (in particular about 1 % w/w Xanthohumol). The capsule comprising the particularly preferred composition is also referred to as Metabol I capsule as also discussed below. It is evident for the skilled artisan, that the concrete values provided above are merely meant as an illustrative example of one embodiment of the present invention.

In another preferred embodiment, (here termed “ Metabol IA ”) the composition according to the present invention comprises 20-30 % w/w guggul extract with at least about 10 % w/w guggulsterone, 45-55 % w/w curcuma extract with 85-95 % w/w curcuminoids (in particular 60-90 % w/w curcumin), 0.25-0.75 % w/w black pepper extract with 90-98 % w/w piperine. This composition (“ Metabol IA ”) may also comprise 4-6 % w/w rutin, 4.5-6.5 % w/w citrus extract with 50-70 % w/w hesperidine, 8-12 % w/w grape seed extract with 45-55% w/w oligomeric proanthocyanidins and 2-3 % w/w hop extract with at least about 3 % w/w flavones (in particular about 05. -1.5 % w/w Xanthohumol). In a particularly preferred embodiment, the composition according to the present invention comprises about 25% ( e.g. 25.37 %) w/w guggul extract with about 10 % w/w guggulsterone, about 50% (e.g. 50.74 %) w/w curcuma extract with at least about 90 % w/w curcuminoids (in particular about 70-80 % w/w curcumin), about 0.5 to 1% (e.g. 0.54 %) w/w black pepper extract with about 90% (e.g. 94.3 %) w/w piperine, about 5% (e.g. 5.08 %) w/w rutin, about 5 to 6% (e.g. 5.58 %) w/w citrus extract with about 60 % w/w hesperidine, about 10 % (e.g 10.15 %) w/w grape seed extract with about 50 % w/w oligomeric proanthocyanidins and about 2% to 3 % (e.g. 2,54%) w/w hop extract with at least about 4 % w/w flavones (in particular 1 % w/w Xanthohumol). The capsule comprising this particularly preferred composition is also referred to as Metabol I A capsule as also discussed below. It is evident for the skilled artisan, that the concrete values provided above are merely meant as an illustrative example of one embodiment of the present invention.

In another preferred embodiment of the composition of the present invention (here termed “ Metabol II”), the composition comprises about 10% to about 20% w/w guggul extract with at least about 10 % w/w guggulsterone, about 5% to about 15% w/w curcuma extract with about 85% to about 95 % w/w curcuminoids (in particular about 60-90 % w/w curcumin), about 0.25% to about 0.75 % w/w black pepper extract with about 90% -98 % w/w piperine. Said composition (“ Metabol II”) may also comprise about 4% to about 6 % w/w rutin, about 4.5% to about 10.5% w/w citrus extract with about 50-70 % w/w hesperidine, about 10 to about 18% w/w grape seed extract with about 45% to about 55% w/w oligomeric proanthocyanidins and about 10% to about 18 % choline.

Accordingly, in this particularly preferred embodiment, the composition according to the present invention may comprise about 15% to about 16% (e.g. 15.4 %) w/w guggul extract with about 10% w/w guggulsterone, about about 10 to 12% (e.g. 10.3 %) w/w curcuma extract with at least about 90 % w/w curcuminoids (in particular about 70-80 % w/w curcumin), about 0.5 % w/w black pepper extract with about 90% to 95% (e.g. 94.3 %) w/w piperine, about 4,5% to about 5,5% (e.g. 5.1 %) w/w rutin, about 7,5% to about 9% (e.g. 8.2 %) w/w citrus extract with about 60 % w/w hesperidine, about 12% to about 17% (e.g. 15.4 %) w/w grape seed extract with about 50 % w/w oligomeric proanthocyanidins and about 12% to 16% (e.g. 15.4 %) w/w choline. Again, as discussed herein above for “ Metabol I and Metabol IA ”, also for the illustrative ‘Metabol IF embodiment of the present invention, it is evident for the skilled artisan, that the concrete values provided above are merely meant as an illustrative example of this embodiment of the present invention.

The composition of these embodiments may preferably be in a capsule as a dosage form, which is suitable for administration to a subject. The capsule comprising the particularly preferred composition may preferably be administered to a subject in need thereof 2 or 3 times daily (daily dosage).

Table 1A: List of ingredients of a preferred composition, yet illustrative, (exemplified Metabol /). which can be used as dietary supplement (or as a medicament) for lipedema patients or for other uses disclosed herein:

In one preferred embodiment, the weight ratio of the guggul extract, the curcurma extract, and the black pepper extract is 0.5 to 1 to 0.005-0.015, more preferably 0.5 to 1 to 0.01. The weight ratio of the active components in these extracts can be in the same range. Thus, in a further preferred embodiment, the composition comprises guggulsterone, curcuminoids and piperine at a ratio of 0.5 [guggulsterone] to 1 [curcuminoids] to 0.005-0.015 [piperine], more preferably 0.5 [guggulsterone] to 1 [curcuminoids] to 0.01 [piperine]. The preferred curcuminoid is curcumin. Thus, in one embodiment, the composition comprises guggulsterone, curcumin and piperine at a ratio of 0.5 [guggulsterone] to 1 [curcumin] to 0.005-0.015 [piperine], more preferably 0.5 [guggulsterone] to 1 [curcumin] to 0.01 [piperine]. The above ratios are mass ratios.

Table 1A.1: List of ingredients of a further preferred, yet illustrative, composition (exemplified Metabol IA T which can be used as dietary supplement (or as a medicament) for lipedema patients or for other uses disclosed herein

In one preferred embodiment, the weight ratio of the guggul extract/powder, the curcurma extract/powder, and the black pepper extract/powder is 0.5 to 1 to 0.005-0.015, more preferably 0.5 to 1 to 0.01. The weight ratio of the active components in these extracts/powders can be in the same range. Thus, in such a preferred embodiment, the composition of the invention comprises gugguel extract with about 10% guggulsterone, curcuminoids and piperine at a ratio of 0.5 [guggulsterone] to 1 [curcuminoids] to 0.005-0.015 [piperine], more preferably 0.5 [guggulsterone] to 1 [curcuminoids] to 0.01 [piperine]. The preferred curcuminoid is curcumin. Thus, in one embodiment, the composition comprises guggulsterone, curcumin and piperine at a ratio of 0.5 [guggulsterone] to 1 [curcumin] to 0.005-0.015 [piperine], more preferably 0.5 [guggulsterone] to 1 [curcumin] to 0.01 [piperine]. The above ratios are mass ratios.

Table IB: List of ingredients of a further preferred vet illustrative composition (exemplified Metabol ID . which can be used as dietary supplement (or as a medicament) for lipedema patients or for other uses disclosed herein:

This further preferred, yet not meant to be limiting, embodiment of the present invention the compositions may comprise other additives, like riboflavin, pantothenic acid, vitamin B6 or zinc. For example, the illustrative “ Metabol IF composition comprises additionally

In one preferred embodiment, the weight ratio of the guggul extract, the curcurma extract, and the black pepper extract is 1.5 to 1 to 0.025-0.075, more preferably 1.5 to 1 to 0.05. The weight ratio of the active components in these extracts can be in the same range. Thus, in another preferred embodiment, the composition comprises guggulsterone, curcuminoids and piperine at a ratio of 1.5 [guggulsterone] to 1 [curcuminoids] to 0.025-0.075 [piperine], more preferably 1.5 [guggulsterone] to 1 [curcuminoids] to 0.05 [piperine]. The preferred curcuminoid is cur cumin. Thus, in one embodiment, the composition comprises guggulsterone, curcumin and piperine at a ratio of 1.5 [guggulsterone] to 1 [curcumin] to 0.025-0.075 [piperine], more preferably 1.5 [guggulsterone] to 1 [curcumin] to 0.05 [piperine]. The above ratios are mass ratios.

In a another embodiment (e.g. Metabol I/Metabol I A), the composition of the present invention comprises 100 mg - 1000 mg guggul extract, 50 mg - 800 mg curcuma extract, 2 mg - 10 mg black pepper extract, 20 mg - 200 mg rutin, 40 mg - 200 mg citrus extract, 20 mg - 200 mg grape seed extract and 10 mg - 100 mg hop extract. Accordingly, herein exemplified is a particularly preferred embodiment, comprising about 250 mg guggul extract, about 500 mg curcuma extract, about 5.30 mg black pepper extract. In this particularly preferred embodiment, the composition comprises about 45mg ( Metabol 1)125 mg ( Metabol IA ) guggulsterone, about 450 mg curcuminoids, and about 5.00 mg piperine.

In an alternative embodiment (e.g. Metabol II) the composition of the present invention may also comprise 60 mg - 600 mg guggul extract, 10 mg -160 mg curcuma extract, 2 mg - 10 mg black pepper extract, 20 mg - 200 mg rutin, 40 mg - 200 mg citrus extract, 10 mg - 160 mg grape seed extract and 10 mg - 160 mg choline. A particularly preferred embodiment, composition of the present invention comprises about 150 mg guggul extract, about 100 mg curcuma extract, and about 5.00 mg black pepper extract. In this particularly preferred, alternative embodiment, the composition comprises about 15 mg guggulsterone, about 95 mg curcuminoids, and about about 5mg (e.g. 4.75 mg) piperine.

The guggul extract/powder may be a guggulsterone- enriched extract/powder as described herein and as obtainable by the means and methods disclosed and provided herein. Yet, for the compositions of the present invention, also commercially available guggul extract with about 10% guggulsterone may be employed.

The particularly preferred composition is preferably in a capsule as a dosage form, which is suitable for administration to a subject. The capsule comprising a particularly preferred compositions of the present invention is also referred to as Metabol I/IA or Metabol II (discussed herein below) capsule. Said capsule comprising the particularly preferred composition recited herein as Metabol I may preferably be administered to a subject in need thereof 2 or 3 times daily, preferably 3 times daily. Yet, also other dosages as well as other administration schemes are envisaged.

Table 2 A: Corresponding ingredient concentrations of a preferred composition ( Metabol I capsule)

*Guggulsterone content calculated for guggul extract containing about 18% guggulsterone

Table 2A.1: Corresponding ingredient concentrations of a preferred composition ( Metabol IA capsule)

*Guggulsterone content calculated for guggul extract containing about 10% guggulsterone

In the above table, the ratio of the guggul extract, the curcuma extract and the black pepper extract is 0.5 to 1 to 0.01.

In a particularly preferred embodiment, the composition of the present invention, illustrated here as “ Metabol I/IA ”, comprises about 250 mg guggul extract, about 500 mg curcuma extract, about 5.30 mg black pepper extract. In this particularly preferred embodiment, the composition comprises about 45mg or about 25mg guggulsterone, about 450 mg curcuminoids, and about 4.5 to 5.0 mg piperine, like e.g. 4.75 mg . These are the illustrative values for a (proposed) daily dosage of 3 “ Metabol I/IA ” capsules. Accordingly, one illustrative “ Metabol I/IA capsule” may comprise: about 15 mg or about 8.5 mg guggulsterone, about 150 mg curcuminoids, and about about l.Omg to about 2.0mg (e.g. 1.6 mg) piperine. The guggul extract can be a guggulsterone- enriched extract as described herein and as obtainable by the means and methods provided herein. Guggul extracts with about 10% guggulsterone are also readily available commercially, for example from KS Pharma GmbH (5211 Lengau, Austria). The compositions of the invention are preferably in a capsule as a dosage form, which is suitable for administration to a subject. Yet also other dosage forms, like tablets, pillules powder mixtures to be dissolved, solutions, suspensions are envisaged.

The dosage form comprising another particularly preferred composition is also referred herein as Metabol II ( for example in form of a capsule) and is illustrated below. Also this capsule comprising the particularly preferred composition recited herein as Metabol II may preferably be administered to a subject in need thereof 2 or 3 times daily, preferably 3 times daily. Again, also other dosages as well as other administration schemes are envisaged.

Table 2B: Corresponding ingredient concentrations of the further preferred composition ( Metabol II capsule)

In this illustrative embodiment ( Metabol II) the composition of the present invention comprises 60 mg - 600 mg guggul extract, 10 mg - 160 mg curcuma extract, 2 mg - 10 mg black pepper extract. In this embodiment, the composition of the invention may also comprise , 20 mg - 200 mg rutin, 40 mg - 200 mg citrus extract, 10 mg - 160 mg grape seed extract, and 10-160 mg cholin. Accordingly, in this illustrative and a particular embodiment, labeled herein as “ Metabol IF, the composition of the present invention comprises about 150 mg guggul extract, about 100 mg curcuma extract, about 5.0 to 5.5 mg black pepper extract. In this particularly preferred embodiment, the composition comprises about 15 mg guggulsterone, about 95 mg curcuminoids, and about 4.5 mg to 5.0 mg piperine, like e.g. 4.75 mg. These are the illustrative values for a daily dosage of 3 “ Metabol F capsules. Accordingly, one illustrative “ Metabol //’’capsule” may comprise about 5 mg guggulsterone, about 30 mg to about 35 mg ( e.g. about 31.7mg= curcuminoids, about l.Omg to about 2.0mg ( e.g. 1.6 to 1.7 mg) piperine.

In accordance with the above, one composition of the present invention ( Metabol II ) comprise in particular and preferably about, 5mg to about 6 mg mg guggulsterone, about 30 mg 31 to about 150 mg (preferably about 30 mg to about 100 mg, more preferably about 30mg to about 40 mg) curcuminoids, and about 1.0 mg to about 2.0 mg ( e.g. 1.6 to 1.7 mg) piperine per single dose.

As discussed and documented above, in a preferred embodiment it is recommended that an individual takes 3 dosage daily, as reflected in the tables provided above.

The guggul extract/powder can be a guggulsterone-enriched extract/ guggulsterone-enriched powderas described herein and as obtainable by the means and methods provided herein. Guggul extracts/powders with about 10% guggulsterone are also readily available commercially, for example from KS Pharma GmbH (5211 Lengau, Austria).

The particularly preferred composition is preferably in a capsule as a dosage form, which is suitable for administration to a subject. As is also discussed below, also other dosage forms are feasible for the skilled artisan and are comprised in this invention. The composition according to the present invention can be for use in inhibiting lipedema adipose stem cells proliferation, inhibiting the generation of differentiated adipocytes, inhibiting the maturation of adipocytes, increasing the degradation of the lipid content in adipocytes, and/or preventing or reducing the hypertrophy of adipocytes. The composition is preferably for use in inhibiting lipedema adipose stem cells proliferation. The composition according the present invention can also be for use in the treatment, alleviation and/or prevention of lipedema, adipogenesis, adiposity, lipedema-associated hyperplasia of adipose cells, tenderness of legs and/or arms and/or pain associated with lipedema. In one preferred embodiment, the composition of the present invention is for use in the treatment, alleviation and/or prevention of lipedema. In a further preferred embodiment, the composition of the present invention is for use in the treatment, alleviation and/or prevention of pain associated with lipedema. The composition is preferably for use in the treatment and/or alleviation of lipedema, adipogenesis, adiposity, and/or lipedema-associated hyperplasia of adipose cells, even more preferably for use in the treatment and/or alleviation of lipedema and/or for use in the treatment and/or alleviation of pain associated with lipedema. The composition of the invention can, however also, be used for the amelioration of symptoms associated with these lipid metabolism disorders, in particular associated with lipedema. One of these symptoms is pain. The pain associated with lipedema can be a pressure pain or inflammatory pain, in particular a pressure pain. The pain associated with lipedema is normally not a heat pain, cold pain, a pain associated with a physical injury or a pain associated with muscle tension. The pain associated with lipedema can be evaluated as follows: In a questionnaire the patients are asked to assess their tenderness/pain level on a measurement scale of 1-10. Accordingly, the composition of the present invention can be used as an analgesic. Tenderness of legs and/or arms can be measured as described above. The composition of the inventive composition can also be for use in reducing the body fat weight and/or BMI; reducing hepatic and serum cholesterol; reducing oxidative and/or inflammatory processes, suppressing angiogenesis in adipose tissue, reducing the growth of adipose tissue; increasing the basal metabolic rate; reducing vascular hyperpermeability; preventing vasogenic edema; lowering lipid and glucose; reducing pain (i.e. being used as an analgesic); reducing the appetite and increasing satiety; inducing hepatoprotective effects; stimulating the thyroid; inducing hypolipidemic and anti-adipogenic effects; and/or inducing cardiovascular benefits. Accordingly, the present invention not only relates to the use of the compounds and/or compositions of the present invention in the treatment, alleviation and/or prevention of lipedema but also to the use of the compounds and/or compositions of the present invention in the in the treatment, alleviation and/or prevention of disorders and/or symptoms of associated and/or related to lipedema. Such lipedema-associated disorders and/or symptoms, may comprise but are not limited to lipedema-associated disorders and/or symptoms are preferably selected from the group consisting of hyperplasia of adipose cells, adipogenesis, adiposity, tenderness of the legs and/or arms, and pain associated with lipedema. In this context, it is of note that the present, inventive compounds and/or compositions may also be used in the treatment of adipogenesis, adiposity and/or hyperplasia of adipose cells. The present invention also provided for corresponding methods of treatment on a subject, preferably a human subject. In particular, it is envisaged that the inventive compounds and/or compositions of the present invention and as described herein may be employed in such treatment methods, in particular in the treatment of lipedema and/or lipedema-associated / lipedema-related disorders. The compounds/compositions described herein may also be employed in methods of treatments of disorders related to the lipid metabolism, for example in the treatment, alleviations and/or prevention of adipogenesis, adiposity and/or hyperplasia of adipose cells. Also provided herein are methods of treatment, alleviations and/or prevention of lipedema-associated symptoms, in particular and without being limiting the alleviation of tenderness of the legs and/or arms, and pain. It is evident that the compositions of the present invention can, therefore, also be employed to support a concurrent therapy, for example a medical intervention of lipedema. Such an supportive use, for example in form of a dietary supplement, of a food supplement, nutritional supplement, and/or of a non-medical/non- therapeutic nutriceutical. These uses are also considered in context of this invention as non- therapeutic uses.

For administration to a subject, the compounds/compositions of the present invention is preferably in a dosage form suitable for administration to a subject. Such a dosage form may, inter alia, be a capsule or a tablet, preferably a capsule. The subject is preferably a human, more preferably a patient suffering from lipedema and/or other adipose tissue disorders. Other adipose tissue disorders include, but are not limited to Dercum's disease, lipohypertrophy, Fatty-Acid Metabolism Disorder, and Morbus Madelung. In a further embodiment, the subject is a patient suffering from pain associated with lipedema, wherein the pain associated with lipedema is in particular a pressure pain or an inflammatory pain, preferably a pressure pain. Accordingly, the composition of the present invention can be used as an analgesic. In yet a further embodiment, the subject is a patient suffering from tenderness of legs and/or arms. The composition of the invention in a capsule is referred to as Metabol I/IA or capsule. In a particularly preferred

embodiment ( Metabol I/IA), the composition is in a capsule as a dosage form, which is suitable for administration to a subject and comprises 100 mg - 1000 mg guggul extract, 50 mg - 800 mg curcuma extract, 2 mg - 10 mg black pepper extract, 20 mg - 200 mg rutin, 40 mg - 200 mg citrus extract, 20 mg - 200 mg grape seed extract and 10 mg - 100 mg hop extract. The composition is preferably administered to a subject in need thereof daily, preferably 3 times daily. In a most preferred embodiment, the composition may be in a capsule as a dosage form, which is suitable for administration to a subject and comprises 100 mg - 1000 mg guggul extract, 50 mg - 800 mg curcuma extract, 2 mg - 10 mg black pepper extract, 20 mg - 200 mg rutin, 40 mg - 200 mg citrus extract, 20 mg - 200 mg grape seed extract and 10 mg - 100 mg hop extract, and may be administered to a human lipedema patient 2 to 3 times daily, preferably 3 times daily. In a another embodiment, said composition/dosage form of the invention, like the Metabol II capsule provided herein, may also comprise 60 mg - 600 mg guggul extract, 10 mg - 160 mg curcuma extract, 2 mg - 10 mg black pepper extract, 20 mg - 200 mg rutin, 40 mg - 200 mg citrus extract, 10 mg - 160 mg grape seed extract and lOmg to 160mg mg choline. Also this composition of the invention/capsule/dosage form may be administered to a human lipedema patient 2 to 3 times daily, preferably 3 times daily.

The composition according to the present invention can be used as a food or dietary supplement in the field of lipedema. The food or dietary supplement is administered to a subject in need thereof. The subject is preferably a human, more preferably a human suffering from lipedema and/or other adipose tissue disorders. Other adipose tissue disorders, which may be treated and/or ameliorated or even prevented with the compositions of the present invention include, but are not limited to Dercum's disease, lipohypertrophy, Fatty-Acid Metabolism Disorder, and Morbus Madelung.

In a further embodiment, the subject is a subject suffering from pain associated with lipedema, wherein the pain associated with lipedema is in particular a pressure pain or an inflammatory pain, preferably a pressure pain. In yet a further embodiment, the subject is a subject suffering from tenderness of legs and/or arms.

The present invention, as discussed below does not only relate to the provision of means and methods for the medical intervention of medical conditions like lipedema. Also provided herein are food and/or dietary products/supplements. These food and/or dietary products/supplements may be employed in (additional) support of any medical invention of, e.g. diseases/disorders of the lipid metabolism, in particular of lipedema. These food and/or dietary products/supplements of the present invention may also be employed in support of diets, like low-fat diets and/or low-carb diets and the like. The food or dietary supplement food and/or dietary product may preferably be given to an individual daily, daily, like in a dosing that involves preferably 2 to 3 times daily administrations of the compositions, like the capsules provided herein Like in the medical uses disclosed herein, also in the non-therapeutic uses of the present invention, the compositions od the present invention, like the capsules designated herein as “ Metabol F, “ Metabol IA ” or “ Metabol IF may preferably be provided in a form to be taken by the corresponding individual, 2 to 3 times daily, preferably 3 times daily. The composition according to the present invention is preferably for use in inhibiting lipedema adipose stem cells proliferation, inhibiting the generation of differentiated adipocytes, inhibiting the maturation of adipocytes, increasing the degradation of the lipid content in adipocytes, and/or preventing or reducing the hypertrophy of adipocytes, more preferably inhibiting lipedema adipose stem cells proliferation. Theses uses may also comprise non-therapeutic uses as disclosed herein.

Yet, as discussed herein, the present invention also relates to medical intervention and medical uses. Therefore, the compositions of the present invention can also be for use in the treatment and/or, alleviation of lipedema, adipogenesis, adiposity, lipedema-associated hyperplasia of adipose cells, tenderness of legs and/or arms, and/or pain associated with lipedema, preferably for use in the treatment, alleviation and/or prevention of lipedema and/or for use in the treatment, alleviation and/or prevention of pain associated with lipedema. The composition is preferably for use in the treatment and/or alleviation of lipedema, adipogenesis, adiposity, lipedema-associated hyperplasia of adipose cells, and/or for use in the treatment, alleviation and/or prevention of pain associated with lipedema, even more preferably for use in the treatment and/or alleviation of lipedema and/or alleviation and/or prevention of pain associated with lipedema. Accordingly, in one embodiment, the compositions of the present invention may also be used as an analgesic.

Yet, it of note that the present invention is not limited to medical uses of the compositions of the invention but also to non-therapeutic uses in healthy individuals or in support of further medical interventions for patients suffering in particular from a lipid-related disorder, like and in particular lipedema. As is evident from the above, the compositions of the present invention are also useful in support of diets, like low-carb and/or low-fat diets. In particular, the compounds of the repent invention may also be employed in support of such diets in healthy individuals but also in support of life style modifications. Accordingly, the present invention also relates to the non-medical use of a composition according to this invention in the support of diets in an individual being on said diet, in particular of low-fat diets. The dieting individual may be a healthy person or a person suffering from a lipid metabolism disorder, like lipedema, or a person suffering from symptoms related with lipid metabolism disorder, like lipedema -associated symptoms (pain, etc.). The invention also relates to a method for inhibiting lipedema adipose stem cells proliferation, inhibiting the generation of differentiated adipocytes, inhibiting the maturation of adipocytes, increasing the degradation of the lipid content in adipocytes, and/or preventing or reducing the hypertrophy of adipocytes, preferably for inhibiting lipedema adipose stem cells proliferation. Said method comprises administering a suitable amount of the composition of the present invention to a subject in need thereof. Preferably, the composition of the invention is administered 2 to 3 times daily, preferably 3 times daily. The subject is preferably a human, more preferably a patient suffering from lipedema and/or other adipose tissue disorders. Other adipose tissue disorders include, but are not limited to Dercum's disease, lipohypertrophy, Fatty-Acid Metabolism Disorder, and Morbus Madelung. In a further embodiment, the subject is a patient suffering from pain associated with lipedema, wherein the pain associated with lipedema is in particular a pressure pain or an inflammatory pain, preferably a pressure pain. In yet a further embodiment, the subject is a patient suffering from tenderness of legs and/or arms. The composition is preferably administered in a dosage form suitable for administration to a subject such as a capsule or a tablet, preferably a capsule.

The invention further relates to use of the composition of the invention for inhibiting lipedema adipose stem cells proliferation, inhibiting the generation of differentiated adipocytes, inhibiting the maturation of adipocytes, increasing the degradation of the lipid content in adipocytes, and/or preventing or reducing the hypertrophy of adipocytes, preferably for inhibiting lipedema adipose stem cells proliferation. Further uses include the treatment, alleviation and/or prevention of lipedema, adipogenesis, adiposity, lipedema-associated hyperplasia of adipose cells, tenderness or legs and/or arms, and/or pain associated with lipedema, in particular lipedema and/or pain associated with lipedema. More preferably the uses include the treatment and/or alleviation of lipedema, adipogenesis, adiposity, lipedema-associated hyperplasia of adipose cells, tenderness of legs and/or arms, and/or pain associated with lipedema, in particular lipedema and/or pain associated with lipedema. Accordingly, one embodiment is the use of the composition of the present invention as an analgesic. Even more uses include: reducing the body fat weight and/or BMI; reducing hepatic and serum cholesterol; reducing oxidative and/or inflammatory processes, suppressing angiogenesis in adipose tissue, reducing the growth of adipose tissue; increasing the basal metabolic rate; reducing vascular hyperpermeabilit; preventing vasogenic edema; lowering lipid and glucose; reducing pain (i.e. being used as an analgesic); reducing the appetite and increasing satiety; inducing hepatoprotective effects; stimulating the thyroid; inducing hypolipidemic and anti-adipogenic effects; and/or inducing cardiovascular benefits. A non-medical or non-therapeutic use of (a) composition(s) according to the present invention, also comprises, besides the non-medical uses described herein above, the use as a cosmetic and/or as a nutrient supplement, Further disclosed is a non-medical/ non-therapeutic use of (an) inventive composition(s) for a slimmer physical appearance, improved appearance of the skin, and/or reduction of cellulite. The slimmer physical appearance can be a reduction in the circumference of the ankles, calves and/or thighs. The reduction in the circumference of the ankles, calves and/or thighs can be determined by measuring the circumferences of the ankles, calves and/or thighs. The slimmer physical appearance can also be an alteration in the leg and/or arm volume. A slimmer physical appearance, due to an alteration in the leg and/or arm volume, can be measured by using a 3D optical imaging system developed by LymphaTech, Inc. (Atlanta, GA). In particular, the alteration in the leg and/or arm volumes can be measure by using a 3D optical imaging system developed by LymphaTech, Inc. (Atlanta, GA). An improved appearance of the skin can be a reduction in cellulite. An improved appearance of the skin can be measured by using a thermal camera, ultrasound imaging and/or biometric evaluation. AS discussed herein above, one of the non-therapeutic/non-medical uses may also comprise the use of the composition(s) of the present invention as food and/or dietary products/supplements. These inventive (food) supplements/ dietary products may be, accordingly, also be used in non-medical/non-therapeutic settings. Yet, these inventive (food) supplements/ dietary products, comprising the “guggul- preparations”/”guggul-compositions” of the present invention may slo be used in support of medical interventions that are warranted, like the medical intervention for lipedema. Accordingly, the compositions of the present invention may also be employed in support of medical intervention, without being a “medicament” themselves i.e. as (supporting) dietary supplement or non-medical food preparation. Such non-medical compositions of the present invention may be useful in support of modification of life styles or amelioration of an unhealthy life style, like diets. Accordingly, the compounds of the present invention may also be used in order to support, life style changes, like diets. These diets may comprise (without being limiting) low-fat or low-carb diets. In accordance with the foregoing, the present invention also provides for food stuff, foods, beverages, supplements, dietary supplements which comprise (a) composition(s) of the present invention. These food stuffs, foods, beverages, supplements, dietary supplements may also be employed on and by healthy individuals, for example in humans that are under a diet/dietary regimen. Yet, as a case study provided in the appended examples documents, the compound(s) of the present invention are also for use in individuals that do not change their diet. The non- therapeutic compositions of the present invention may also be useful to improve the general well being of an individual, like a healthier and better mood and general better and healthier shapeVappearance, including weight loss and cardiovascular benefits. Furthermore, and in this context, the compositions of the present invention may also be employed in management of pain. This is also illustrated in the appended “case study” provided in the non-limiting examples.

The present invention further relates to a method for inhibiting lipedema adipose stem cells proliferation, inhibiting the generation of differentiated adipocytes, inhibiting the maturation of adipocytes, increasing the degradation of the lipid content in adipocytes, and/or preventing or reducing the hypertrophy of adipocytes, preferably for inhibiting lipedema adipose stem cells proliferation.

The invention also relates to an agent for inhibiting lipedema adipose stem cells proliferation, inhibiting the generation of differentiated adipocytes, inhibiting the maturation of adipocytes, increasing the degradation of the lipid content in adipocytes, and/or preventing or reducing the hypertrophy of adipocytes, in preferably for inhibiting lipedema adipose stem cells proliferation, said agent comprising the inventive composition. The agent comprising the inventive composition can also be for reducing adipose stem cells, increasing lipolysis of an adipocytic lipid content, reducing inflammation (preferably vascular inflammation), reducing swelling, and/or relieving pain associated with lipedema. The agent comprising the inventive composition can further be used for reducing the body fat weight and/or BMI; reducing hepatic and serum cholesterol; reducing oxidative and/or inflammatory processes, suppressing angiogenesis in adipose tissue, reducing the growth of adipose tissue; increasing the basal metabolic rate; reducing vascular hyperpermeabilit; preventing vasogenic edema; lowering lipid and glucose; reducing pain (i.e. being used as an analgesic); reducing the appetite and increasing satiety; inducing hepatoprotective effects; stimulating the thyroid; inducing hypolipidemic and anti-adipogenic effects; and/or inducing cardiovascular benefits.

It has surprisingly been shown in the enclosed experiments that a composition comprising a guggul extract, a curcuma extract and a black pepper extract has a suppressive synergistic effect on lipedema adipose stem cell viability and proliferation, thereby limiting the generation of differentiated adipocytes. In particular the apoptosis of human lipedema adipose stem cells (ADSCs) was synergistically increased (Example 1, Figure 1).

The inventors showed in the enclosed examples that the guggulsterone-enriched guggul extract prepared by the method of the present invention has a surprising effect on lipedema adipose stem cell proliferation, limiting the pool of adipose precursor cells for differentiation into mature adipocytes. In particular the viability of human lipedema adipose stem cells (ADSCs) was markedly decreased following treatment with the enriched guggul extract (guggul forte). This was surprising, since commercially available guggul extract exerts only minor effects at comparable physiological concentrations (Example 2, Figure 2 B, C).

The phytonutrient composition of the present invention is currently tested in a three-month randomized, placebo-controlled double-blind study with lipedema patients to prove the beneficial effect of the composition (Example 3).

The present invention is also illustrated by the appended, non-limiting Figures.

FIGURE LEGENDS Figure 1

Potentiating effect of a 3-ingredient combination of phytonutrients on apoptosis of human lipedema adipose stem cells (ADSCs)

The guggul extract (G), the curcuma extract (C) and the black pepper extract (P) were dissolved in DMSO, diluted with culture medium and added to confluent ADSC cultures at a concentration of 0.1% each. DMSO concentration was below 0.1% v/v. Cells were cultured for 2, 6 and 18 hours, respectively. Results from treatment with the G+C+P combination show that the effects of the individual ingredients are not merely additive but supra-additive. A representative experiment is shown. Complete: Cells were treated with a combination of all ingredients of the metabol composition. Figure 2

In vitro tests showing that the ethanolic extract from guggul ( guggul forte) is highly active in reducing viability and increasing apoptosis in lipedema and non-lipedema adipose stem cells.

(A) Preparation of a guggulsterone-enriched fraction ( guggul forte ) comprising at least 18% guggulsterone (GS). The biologic activity of the starting material (guggul), the ethanol-soluble fraction ( guggul forte ) and the ethanol-insoluble fraction (sediment) was tested in vitro using human lipedema adipose stem cells (ADSCs).

(B) Dose-dependent response of cultured human lipedema ADSCs to treatment with guggul forte for 24 hours. Culture medium consisted of DMEM high glucose (4,5g/l) supplemented with 10% FBS and 1% antibiotics/antimycotics. (a) Control, with culture medium only (b) 0.25% ethanol- insoluble fraction, (c) 0.1% guggul forte (corresponding to 29 mM GS); (d) 0.2 % guggul forte (corresponding to 58 mM GS). Three independent experiments were performed in triplicates. Mean and SD are shown.

(C) Comparison of guggul and guggul forte activity on cultured human lipedema ADSCs. Culture medium consisted of DMEM high glucose (4,5g/l) supplemented with 10% FBS and 1% antibiotics/antimycotics. Guggul and guggul forte were dissolved in 80% ethanol and added to the ADSC cultures at a concentration of 0.2% each (corresponding to 32 and 59 mM GS, resp.). Cells were cultured for up to 24 hours.

Upon treatment with guggul, cell viability was decreased to 87% ±12% (12h), and 80% ± 11% (24h), while guggul forte diminished cell viability to 58% ±12% (12h), and 19% ±9% (24h). Three independent experiments were performed in triplicates. Mean and SD are shown.

(D) Comparison of guggul forte activity on cultured lipedema and non-lipedema ADSCs. Guggul forte was dissolved in 80% ethanol and applied at a concentration of 0.2% (corresponding to 58 mM GS). Cells were cultured for up to 24 hours. Viability of lipedeama and non-lipedema cells did not differ significantly in following treatment with guggul forte. Figure 3

Comparison of lipolysis following guggul forte treatment of lipedema and non-lipedema human ADSCs. Comparison of morphology and lipid droplet storage of differentiated lipedema and non- lipedema ADSCs following treatment with guggul forte for 24 hours. Pictures were taken with a Zeiss™ inverse microscope (magnif. 400x).

The following examples exemplify the invention and are not considered limiting.

EXAMPLES

Example 1: Effects of combined ingredients of the composition on lipid metabolism and adipose tissue growth in vivo and in vitro

Following administration of a natural supplement (“Kepar”; Rikrea, Italy), containing 160 mg C. longa, 24 mg guggul lipids and chlorogenic acid, a significant reduction in BMI and other parameters was reported by patients suffering from metabolic syndrome ⁿ. However, there is no effect of “Kepar” evident on the growth and differentiation of human adipocytes and preadipocytesFurthermore, lipedema is not part of the metabolic syndrome Accordingly, lipedema patients do not show dyslipidemia or diabetes as patient suffering from metabolic syndrome. Thus, dietary supplements for adiposity, diabetes, or dyslipidemia are not necessarily suitable for lipedema patients since no effect of these dietary supplements has been documented on lipedema- derived cells. In contrast, as is documented herein below, the present invention provides for inventive compositions that are documented as inhibiting (lipedema) adipose stem cells proliferation, inhibiting the generation of differentiated adipocytes, inhibiting the maturation of adipocytes, increasing the degradation of the lipid content in adipocytes, and preventing or reducing the hypertrophy of adipocytes. These in vitro effects as documented herein also translate in the amelioration of symptoms associated with lipid disorders, in particular with lipedema, as evidenced by the in vivo case study herein below (Example 3). Methods Cell Culture

Human adult adipose tissue-derived stem cells (hADSCs) were isolated from lipoaspirates from lipedema patients. In particular, these hADSCs were isolated from lipoaspirates taken during routine medical interventions (i.e. liposuctions) with patients' informed consent. Liposuctions were performed at various independent clinical and private practices in Austria and Germany. Cells were also obtained from the individual of the following case study under Example 3.

For expansion, human lipedema ADSC were cultured in Dulbecco's modified Eagle's medium (DMEM 4.5 g/1 D-glucose), supplemented with 1% GlutaMAX™, 10% fetal bovine serum (FBS), and 1% antibiotic/ antimycotic solution. In the following, this medium will be referred to as basic medium. All cells were grown in culture flasks at 37°C under normoxic conditions and 5% CO2. The culture medium was changed every third day until confluency had been reached. Cells were then transferred to 6- or 96-well plates (Falcon, Nunc) depending on the experiments undertaken.

For splitting, culture medium was removed from the flasks and the cells were washed with sterile- filtered Ca/Mg-free phosphate buffered saline (PBS ) (1.73 M NaCl, 27 mM KC1, lOOmM Na2HP04, 18 mM KH2PO4, adjusted to pH 7.4). Cells were detached with 0.25% Trypsin-EDTA and spun down at 200 x g for 5 minutes. Cell pellets were resuspended in culture medium and transferred to new flasks or plates at a density of 5000/cm². Counting was performed with Trypan Blue staining using a Neubauer™ counting chamber and a standard inverse light microscope (Zeiss Axiovert™).

Incubation with phytonutrients

Human lipedema ADSCs were seeded in 6-well plates and cultured for three days until confluency. Various compositions of phytonutrients were added to the culture medium and the cells were incubated for up to 24 hours. Three main ingredients were chosen (guggul, curcuma, and black pepper extract/Piperine). Stock solutions of the phytonutrients were prepared with DMSO (Dimethyl sulfoxide) and added to the cell cultures at a final concentration of 0.1% or 0.2%, resp.

The list of phytonutrients etc. is summarized described in following appended table of “suppliers information”.

Concentrations used for the in vitro experiments:

Guggul: 16 mM (0.1%) to 32 mM (0.2%)

Guggul forte: 28.8 mM (0.1%) to 57.6 mM (0.2%)

Curcumin: 27 mM (0.1%)

Piperine: 33 mM (0.1%)

Table I: Concentrations tested (in mM):

Cell counting

To evaluate the degree of cell damage and/or cell loss and to discriminate between adhering (healthy/dividing), damaged (adherent, non-dividing) and detached (floating, non-dividing) human lipedema adipose stem cells, counting was done manually as described previously. Pictures were taken at various time points using a standard inverse microcope (Zeiss Axiovert™) Cells were counted using Image J (FIJI). Results from representative single experiments are shown.

DAPI staining was performed for cell counting of fluorescently labeled nuclei and evaluation of apoptotic cells. Following treatment with phytonutrients, cells are washed with phosphate buffered saline (PBS) and incubated for 10 min at RT with PBS/0.1% Triton-x-100. Then cells are fixed with 4% PFA for 15 min, at RT. After washing with PBS, cells were incubated for 5 min with 300 nM DAPI (4',6-Diamidin-2-phenylindol) in the dark, washed with PBS and covered with a mounting coverslip. Fluorescently labeled cell nuclei were inspected and counted using an inverse fluorescence microcope (Zeiss).

Induction of adipogenic differentiation

For induction of in vitro adipogenesis, the basic medium is replaced by differentiation medium consisting of DMEM 4.5 g/L D-glucose, 10% FBS, 2 mmol/L Glutamax, 100 U/mL antibiotic/antimycotic solution, 1 pmol/L dexamethasone, 0.5 pmol/L 3 -isobutyl- 1 -methylxanthine (IBMX), 10 pg/mL (167 nmol/L) insulin and 100 mhioI/L indomethacin. Cells are grown in differentiation medium for 48 hours under normoxic conditions, as described above. Control cells are fed with basic medium only. After 48 hours, the differentiation medium is replaced by maintenance medium (DMEM 4.5 g/1 D-glucose, 10% FBS, 2mmol/L GlutaMAX™, 100 U/ml antibiotic/antimycotic solution, 1 pg/ml insulin). Cells are cultivated in maintenance medium for another 48 hours. Differentiation/maintenance cycles are repeated 2-3 times until >80% of the cells are differentiated, as evidenced by the accumulation of cytoplasmic lipid droplets.

Qualitative proof of lipid accumulation

In vitro adipogenesis is being evaluated by measuring the augmentation of lipids/triglycerides in cultured adipose stem cells. For the qualitative proof of lipid accumulation, cells are grown in 6- well plates and Oil Red O staining is being performed as described previously ⁸⁰. In brief, cells are washed twice with PBS-, and fixed with 4% paraformaldehyde (PFA) for 15 minutes. After removal of the fixative, cells are rinsed with PBS and air dried. Oil Red O staining solution is applied to the cells for 15 minutes and removed by washing with double distilled FhO. Microscopic analysis is done with a standard inverse light microscope (Zeiss Axiovert™). Differentiated cells are counted using ImageJ (FIJI).

Results and interpretation

In order to develop a dietary supplement for lipedema patients, a beneficial composition consisting of phytonutrients has been developed. This beneficial and surprisingly active composition is in particular useful in the medical and non-medical intervention of individuals suffering form lipedema/lipoedema. Table P: Minimum amounts for detection of supra-additive effects in vitro:

The main ingredients of the inventive composition are guggul extract (comprising guggulsterone), curcuma extract (comprising curcuminoids, in particular curcumin) and a black peper extract (comprising piperine). Optionally but preferred, the inventive composition comprises guggul extract (comprising guggulsterone), curcuma extract (comprising curcuminoids, in particular curcumin) and a black pepper extract (comprising piperine) together with grape seed extract, citrus extract, rutin, and hop extract (Table 1A) and Table 1A.1 of general description. In a most preferred embodiment of the present invention, the composition for medical and/or non-medical use of the inventive supplement/inventive composition comprises 100 mg - 1000 mg guggul extract, 50 mg - 800 mg curcuma extract, 2 mg - 10 mg black pepper extract, 20 mg - 200 mg rutin, 40 mg - 200 mg citrus extract, 20 mg - 200 mg grape seed extract and 10 mg - 100 mg hop extract ( Metabol I/IA). A second composition is provided as another preferred embodiment of the invention, whereby this second composition comprises 60 mg - 600 mg guggul extract, 10 mg - 160 mg curcuma extract, 2 mg - 10 mg black pepper extract, 20 mg - 200 mg rutin, 40 mg - 200 mg citrus extract, 10 mg - 160 mg grape seed extract and 10-160 mg choline. The most preferred composition is preferably in a capsule as a dosage form, which is suitable for administration to a subject. The capsules comprising the particularly preferred compositions are also referred to as Metabol capsule(s). The capsule comprising the particularly preferred composition is preferably administered to a subject in need thereof 3 times daily.

The ingredients of the novel composition were tested for their biological activity on human lipedema and non-lipedema ADSCs. In particular, the guggul extract, the curcuma extract, the black pepper extract, rutin and the citrus extract were tested. Among the single components of the composition, the guggul extract, and the curcuma extract showed substantial effects while the other ingredients showed only minor effects on ADSCs in culture. Surprisingly, a combination of curcuma, guggul and piperine resulted in a clear over-additive effect on ADSCs. The over-additive effect was demonstrated using the following combinations:

2-ingredient compositions: a guggul extract comprising guggulstertone + a curcuma extract comprising curcuminoids (in particular curcumin) (G+C); a guggul extract comprising guggulsterone + a black pepper extract comprising piperine (G+P); a curcuma extract comprising curcuminoids (in particular curcumin) + a black pepper extract comprising piperine (C+P).

3 -ingredient compositions: a guggul extract comprising guggulsterone + a curcuma extract comprising curcuminoids (in particular curcumin) + a black pepper extract comprising piperine (G+C+P).

The guggul extract comprising guggulsterone and the curcuma extract comprising curcuminoids (in particular curcumin), the guggul extract comprising guggulsterone and the black pepper extract comprising piperine, as well as the black pepper extract comprising piperine and the curcuma extract comprising curcuminoids (in particular curcumin) increased apoptosis and decreased viability of human ADSCs to a minor extent after 6 hours of treatment (Fig. 1, G+P, G+C, P+C).

Guggul and curcuma elicited a stronger decrease of cell viability after 18 hours of treatment, suggesting that these phytonutrients act synergistically (Fig. 1, G+C).

Surprisingly, the combination of curcuma, guggul and piperine resulted in a supra-additive effect on viability and apoptosis after 18 hours of treatment (Fig. 1, G+C+P).

This effect was further potentiated by addition of all other ingredients present in the novel phytonutrient composition (Fig. 1, complete).

There is striking evidence that guggul forte acts differently on the lipolysis in lipedema and non lipedema ADSCs. After treatment with guggul forte differentiated adipocytes from lipedema patients and from a control group have been inspected for their cellular morphology with light microscopy. Adipocytes from both groups showed an increase in the amount of secretory vesicles and lysosomal/peroxysomal vesicles around the nucleus and in other parts of the cytoplasm (Fig. 3). However, following treatment with guggul forte, adipocytes derived from lipoaspirates of lipedema patients showed significantly higher amounts of lysosomal vesicles and the Oil Red O staining appeared dispersed, suggesting that lipid droplets had been partly dissolved. In contrast, lipid droplets of control ADSCs appeared unaffected (Fig. 3).

Experiments to elucidate this phenomenon are in progress with the use of electron microscopy and immunostaining to further analyze the structure and content of the lysosomal and peroxysomal vesicles.

It is tempting to speculate that this finding may be due to a different metabolic answer of the two adipocyte cell groups after guggul treatment. It is known that adipocytes from lipedema and non- lipedema donors exhibit a different protein expression profile concerning adipogenesis and lipogenesis, which may be reflected by a different metabolic activity.

Hypertrophia is one of the major signs of lipedema fat. It is characterized by adipocytes containing increased amounts of lipids, which are apparently degraded too slowly. To stimulate lipolysis would therefore be paramount to reduce lipedema fat.

Thus, it is expected and envisaged that the fortification of the inventive composition by addition of “guggul forte” (Experiment 2) will further improve the herein disclosed specific dietary nutritional supplement which is of high benefit in the medical of lipoedema/lipedema. and in non-medical uses, like in non-clinical/non-medical support of (other therapies, like medical interventions in lipidemias/lipid disorders or lipedema) and/or in support of lifestyle improvements and in amelioration of general well-being. One intended use (non-limiting) is the supportive use of the guggul/guggul extract compositions provided in context of this invention and comprising guggulsterone in diets, like low-fat diets or low-carb diets, preferably low-fat diets.

The Metabol I/IA capsule

The most preferred embodiment of the invention is the Metabol 1/IA capsule. In this most preferred embodiment of the present invention, the composition for medical and/or non-medical use of the inventive supplement comprises 100 mg - 1000 mg guggul extract, 50 mg - 800 mg curcuma extract, 2 mg - 10 mg black pepper extract, 20 mg - 200 mg rutin, 40 mg - 200 mg citrus extract, 20 mg - 200 mg grape seed extract and 10 mg - 100 mg hop extract, in a capsule as a dosage form, which is suitable for administration to a subject. The capsule comprising the particularly preferred composition is preferably intended to be administered to a subject in need thereof 2 to 3 times daily, preferably 3 times daily.

The alternative embodiment of the invention is the Metabol II capsule. In this embodiment of the present invention, the composition for medical and/or non-medical use of the inventive supplement comprises 60 mg - 600 mg guggul extract, 10 mg - 160 mg curcuma extract, 2 mg - 10 mg black pepper extract, 20 mg - 200 mg rutin, 40 mg - 200 mg citrus extract, 10 mg - 160 mg grape seed extract and 10-160 mg choline, in a capsule as a dosage form, which is suitable for administration to a subject. The capsule comprising the particularly preferred composition is preferably intended to administer to a subject in need thereof 2 to 3 times daily, preferably 3 times daily.

The capsule comprising the particularly preferred composition is preferably intended to administer to a subject in need thereof 2 to 3 times daily, preferably 3 times daily. For the experiments, the extracts and components were, inter alia purchased from KS Pharma GmbH (5211 Lengau, Austria). Further sources are listed herein below. The extracts are in form of a powder. Specifically, a guggul extract in form of a powder comprising at least 10% w/w guggulsterone from KS Pharma; a curcuma longa extract (95 % w/w) in form of a powder comprising at least 90% w/w curcuminoids (in particular comprising at 70-80 % w/w curcumin); a black pepper extract (piper nigrum) (95 % w/w) in form of a powder comprising 95% w/w piperine from KS Pharma; rutin NF11 in form of a powder from KS Pharma; citrus bioflavonoide 60 % w/w in form of a powder from KS Pharma; a grape seed extract 95 % w/w in form of a powder from KS Pharma and a hop extract comprising at least 4 % w/w flavones (in particular at least 1% xanthohumol) were used in the Examples. Example 2: Preparation of a guggulsterone-enriched fraction ( guggul forte)

Standard extraction protocol

For preparation of a guggulsterone-enriched fraction ( guggul forte), commercially available guggul extract (purchased from Capsumed pharm GmbH, Mattsee, Austria/ KS Pharma GmbH, Lengau, Austria), which contained 10% guggulsterone, was dissolved in 80% ethanol to separate the ethanol-soluble ingredients from ethanol-insoluble ingredients. Ethanol-insoluble ingredients were sedimented (lg) for two hours at room temperature and collected to be tested for their activity on lipedema and non-lipedema adipose stem cells in culture. The supernatant, containing the ethanol-soluble ingredients, was collected and gently dried overnight at mild temperature (40°C) (with optional us of a vacuum desiccator). After complete evaporation of the ethanol, the dried material was collected, weighed and stored for further use. Aliquots were taken for the subsequent determination of guggulsterone content by HPLC and Mass- Spectrometry (MS).

Analysis of “ Guggul forte”

Dried guggul sample derived from the extraction steps described above, were dissolved in ETOH (lmg/ml). 5ul of this extract was dissolved in 195ul of the mobile phase of HPLC and MS.

HPLC:

For the analysis the 1260 Infinity Quaternary LC system was used (Agilent Technologies). Column: Phenomenex Luna Pentafluorophenyl (150 mm; ID 2 mm; 5 um). Mobile phase: a.bidest/ ammoniumformiat (2mM)/ formic acid (0.2%) as solvent A and acetonitril/ammoniumformiat (2mM)/formic acid (0.2%) as solvent B. Elution: from an initial 90:10 (A:B) ratio to a 10:90 (A:B) ratio in 10 min with a flow rate of 0.5 ml/min.

MS:

A 3200 Q Trap (AB Sciex) was used for analysis. Electrospray ionization (positive mode), dwell time: 1000ms, source temperature: 630°C, spray voltage: 5500V, ion source gas 1:45, ion source gas 2: 90, curtain gas: 35. Q1 multiple ions: m/z 313.2 according to the literature ⁸¹

In each sample 2 large signals at RT of 7.6 min (guggulsterone 1 sample) and at RT 7.84 min (guggulsterone 2 sample) were found. A separation in E and Z-guggulsterone was not undertaken, because this was not a goal of the analysis. Quantification of guggulsterone was done using the signal areas. For the calculation of the amount of extracted samples the base line of 10% guggulsterone contained in the starting material was taken. Comparing the signal intensity of the samples with that of the starting material the following amounts of guggulsterone were determined:

The sample (fraction), containing the highest Guggulsterone concentrations (was termed Guggul forte and was used for most of the foiling the experiments.

All samples had been tested for their biological activity.

Results and interpretation

Fortification of the newly developed phytonutrient composition is done by addition of a guggulsterone-enriched ethanol-soluble extract.

We have successfully developed and applied an easy two-step protocol for isolation of a guggulsterone-enriched fraction (termed guggul forte ) from a commercially available guggul extract Figure 2, A). The resulting ethanol-soluble fraction contained > about 18% guggulsterone (E and Z) and was shown to be highly active on cultured human adipose stem cells (Fig. 2 B-D).

Guggul forte elicited a significantly higher reduction of cell viability and induced apoptosis of human lipedema and non-lipedema ADSCs, compared to commercially available guggul extract (Fig. 2C).

We are the first to demonstrate that a guggulsterone-enriched fraction reduces substantially the growth and viability of human lipedema adipose stem cells in vitro (Fig. 2A, D).

Example 3: Intended Study on Patient Groups and one Individual Case Study

A three-month randomized, placebo-controlled double-blind study is currently intended to be conducted. The study is designed to evaluate the efficacy of a novel composition of phytonutrients to reduce lipedema-associated symptoms. Thereby, the composition (Metabol I/IA or II as provided illustratively herein as “guggul-comprising composition of the invention”) is one out of three different compositions administered to the patients. “Metabol” as provided as a composition of the present invention is considered the lipid/fat-lowering composition, while two other compositions are designed to contribute to a mild drainage and to support the body with vitamins and antioxidants.

Aim of the study

Clinical case studies have shown that limited intake of carbohydrates is suitable for persons with metabolic disorders. It improves insulin sensitivity, blood pressure, microvascular function, and cellular adhesion markers. Anti-inflammatory diet seems to be a possible approach to reduce chronic inflammation in the adipose tissue. To pursue an anti-inflammatory diet, processed foods, artificial sugar and fried foods should be avoided.

Since lipedema is thought to be a chronic, inflammatory disease, the approach of this study focuses on anti-inflammatory nutrition of both types - low fat and low carb, in addition to the administration of phytonutrients such as turmeric, guggulsterone and other supplements listed below.

First, the study is designed to investigate whether the previously accepted dogmatic thesis, according to which lipedema patients are unable to lose weight in their specifically affected anatomical areas, is true. For this purpose, the most objective measuring method currently available is being used by means of a 3D volumetric measurement (Lympha tech®) before and after the treatment.

Secondly, the study aims to find out if lipedema patients benefit more from a low carb or a low fat diet. Again, neither guidelines from the German Society for Nutrition, nor any other guideline exists regarding nutritional recommendations for lipedema patients.

Study design

The number of participants is limited to about 300. Patients of all ages had already been diagnosed externally or internally with stage I-III lipedema. Patient's age, the stage of the disease and potential pre-operations were taken into account. Patients are measured (volume and diameter) and patients’ histories were noted. Two groups are formed by randomization, receiving either low fat or low carb diet. Supplements were given to both groups in a placebo controlled manner. After completion of the 3 -month study, the measurements were taken again and follow up life quality questionnaires were filled out. The calculated delta compared with that of the control group and significant differences were examined.

Another objective of the study focuses on the question whether or not the administration of micronutrients may increase the beneficiary effect of a normal diet.

Blood samples are to be taken from 50 people before and after the 3 months trial and checked for differences in inflammation markers, cholesterol level and sexual hormones.

Clinical parameters intended to be tested

• Weight (kg)

• Volume reduction (ml)

• Scopes at 10 defined measuring points with Lmyphatech® (cm)

• Waist / hip ratio (cm)

• Pain (visual analogue scale)

• Quality of life (sleep, mobility, fatigue, sexuality)

• Blood test parameters

Individual Case Study

Study design

The aim of this in vitro case study was to investigate the impact of “guggulsterone compositions /guggul-compositions” as described in context of the present invention on various parameters, including weight loss, pain, circumference reduction and reduction of tenderness in the legs in a human individual. A single individual (age 30, female, non-smoker, healthy, BMI 22,0) was chosen for the study. The adult individual had been diagnosed with lipedema five years ago at the start of the case study. In a first step, the height and weight of the individual as well as the tenderness and pain (VAS) of the disease were recorded. In addition to the weight, defined circumferences of the legs and the leg volumes were measured. The specified stage was checked and defined based on the leg volumes. The weight was measured with the SOEHNLE Silver Sense bathroom scales. The measurement of the leg circumference at seven defined points (Ankle, Base Calf, Calf, Popliteal, Knee, Mid Thigh, Gluteal Fold) and the measurement of the leg volumes were carried out using 3D scans. The structure sensor™ 3D scanner (Technologyoutlet) and an iPad were used. The 3D body scans, were converted into the circumference and volume of the body regions by the LymphaTech® software.

The Metabole I/IA/II capsules as described herein were administered (3 capsules a day) over a period of 3 months time. Accordingly, the individual revived a composition that comprises a guggul extract, a curcurma extract, and a black pepper extract have a weight ratio of 0.5 to 1 to 0.01, respectively, or (b) wherein the guggul extract, the curcurma extract, and the black pepper extract have a weight ratio 1.5 to 1 to 0.05, respectively.

Results and Conclusions

A highly significant weight loss was observed with weight reduction of 5.1 kg after 3 months time without any diet change.

Despite the highly significant weight loss, there were no significant changes in the circumference of the upper legs but in the calves (-2 cm). A reduction of tenderness and pain about (-2 VAS stages) could be measured and the patient seemed to be healthier in a better mood and shape. No adverse side effects were detected and recorded. It was shown that contrary to the prevailing opinion, weight loss in lipedema patients is possible under standardized conditions. In addition, the dietary supplements of the invention had a positive effect on leg/calves circumference, tenderness and pain. Dietary supplements such as turmeric and commiphora mukul have been reported to provide for a positive effect on girth reduction. The change in leg circumference was shown to be disproportionate to the percentage of weight reduction, which could be an indication of the resistance of lipedema fat. The quality of life of the tested individual patient changed significantly for the better within the 90 days. Example 4: Further experimental set-ups and supplier’s data

The following experiments are currently conducted.

Induction of adipogenic differentiation

For induction of in vitro adipogenesis, the basic medium is replaced by differentiation medium consisting of DMEM 4.5 g/L D-glucose, 10% FBS, 2 mmol/L Glutamax, 100 U/mL antibiotic/antimycotic solution, 1 pmol/L dexamethasone, 0.5 pmol/L 3 -isobutyl- 1 -methylxanthine (IBMX), 10 pg/mL (167 nmol/L) insulin and 100 pmol/L indomethacin. Cells are grown in differentiation medium for 48 hours under normoxic conditions, as described above. Control cells are fed with basic medium only. After 48 hours, the differentiation medium is replaced by maintenance medium (DMEM 4.5 g/1 D-glucose, 10% FBS, 2mmol/L GlutaMAX™, 100 U/ml antibiotic/antimycotic solution, 1 pg/ml insulin). Cells are cultivated in maintenance medium for another 48 hours. Differentiation/maintenance cycles are repeated 2-3 times until >80% of the cells are differentiated, as evidenced by the accumulation of cytoplasmic lipid droplets.

Qualitative proof of lipid accumulation

In vitro adipogenesis is being evaluated by measuring the augmentation of bpids/triglycerides in cultured adipose stem cells. For the qualitative proof of lipid accumulation, cells are grown in 6- well plates and Oil Red O staining is being performed as described previously ⁸⁰. In brief, cells are washed twice with PBS-, and fixed with 4% paraformaldehyde (PFA) for 15 minutes. After removal of the fixative, cells are rinsed with PBS and air dried. Oil Red O staining solution is applied to the cells for 15 minutes and removed by washing with double distilled FhO. Microscopic analysis is done with a standard inverse light microscope (Zeiss Axiovert™). Differentiated cells are counted using ImageJ (FIJI).

Quantitative proof of lipid accumulation

Following adiogenic differentiation, cells are stained with Oil Red O staining solution, washed with PBS and air dried. Subsequently, isopropanol is added to the cells and Oil Red O is dissolved during permanent shaking. Optical density is measured at 500nm in a plate reader (MULTISCAN GO™ microplate reader, Thermo Scientific). Data are normalized to DNA contents.

DNA quantification

DNA contents are measured photometrically. For DNA isolation, the QIAamp Mini Kit™ (QIAGEN) is used according to the manufacturer’s protocol and absorbance is measured at 260 nm. To determine the concentration of the DNA in the samples, the following equation is applied: Concentration (pg/ml) = (A260 reading - A320 reading) x dilution factor x 50pg/ml.

MTS cell viability/proliferation assay

Human lipedema ADSCs and murine 3T3-L1 cells are seeded at a density of 5000 cells/well in 96 well plates and cultured for 40 hours. Then 20 mΐ of the MTS solution are added to each well and the plate is incubated in the CO2 incubator for three hours. Protein contents and corresponding cell numbers are read off the standard curve provided by the manufacturers and average proliferation rates are calculated.

Caspase-3/7 activity assay

The caspase-3/7 activity luminescent assay is being performed in 96-well plates using the caspase- Glo 3/7 reagent (Promega). Human lipedema ADSCs are grown to sub-confluency and adipogenic differentiation is induced as described above. Fully differentiated adipocytes are treated with the caspase-Glo 3/9 reagent for lh and assayed according to the manufacturer's protocol.

Lipolysis assay

Differentiated human lipedema ADSCs are treated with effector substances for up to 24 hours in DMEM lg/L glucose, containing FFA (free fatty acid)-free BSA. After the incubation period, the conditioned medium is collected and used for measurements of free glycerol using a free glycerol fluorimetric assay kit (Abeam) and a microplate reader. Supplier information

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Claims

1. Guggul extract comprising, preferably at least 12 % w/w, more preferably at least 14 % w/w, more preferably at least 16 % w/w, most preferably at least 18 % w/w guggulsterone.

2. Guggul extract according to claim 1, which is essentially free from ethanol-insoluble components, and, optionally essentially free from water-insoluble components.

3. Method for preparing the guggul extract according claim 1 or 2, comprising the following steps:

(a) dissolving a guggul extract comprising about 10 % w/w guggulsterone in 80 % v/v ethanol at a concentration of 200-300 mg/ml, preferably for 1-4 hours at a temperature of 18-22 °C;

(b) removing ethanol-insoluble components, preferably by sedimentation for 2-3 hours a temperature of 18-22 °C, to obtain a supernatant;

(c) drying the supernatant obtained in step b), preferably at 35-45 °C for 8-14 hours, to obtain the guggul extract in a dried form; and

(d) optionally, dissolving the dried guggul extract obtained in step c), preferably in ethanol or dimethylsulfoxide, to obtain the guggul extract in a dissolved form.

4. Composition comprising, a guggul extract, a curcuma extract and/or a black pepper extract, preferably a guggul extract, a curcuma extract and a black pepper extract.

5. Composition according to claim 4, wherein the guggul extract comprises guggulsterone, the curcuma extract comprises curcuminoids such as curcumin, and the black pepper extract comprises piperine.

6. Composition according to claim 4 or 5, wherein (a) the guggul extract, the curcurma extract, and the black pepper extract have a weight ratio of 0.5 to 1 to 0.01, respectively, or (b) wherein the guggul extract, the curcurma extract, and the black pepper extract have a weight ratio 1.5 to 1 to 0.05, respectively.

7. Composition according to any of claims 4 to 6 further comprising at least one selected from the group consisting of rutin, a citrus extract, a grape seed extract, choline and a hop extract.

8. Composition according to claim 7, wherein the citrus extract comprises citrus flavonoids such as hesperidine, the grape seed extract comprises proanthocyanidins, and the hop extract comprising flavones such as xanthohumol.

9. Composition according to any claims 4 to 8, wherein the guggul extract is a guggul extract according to claim 1 or 2, or a guggul extract prepared according to the method of claim 3.

10. Composition according to any of the claims 4 to 9 for use in inhibiting lipedema adipose stem cells proliferation, inhibiting the generation of differentiated adipocytes, and/or inhibiting the maturation of adipocytes.

11. Composition according to any of the claims 4 to 9 for use in the treatment, alleviation and/or prevention of lipedema or the treatment of lipedema-associated disorders and/or symptoms, whereby said lipdema-associated disorders and/or symptoms are preferably selected from the group consisting of lipedema-associated hyperplasia of adipose cells, adipogenesis, adiposity, tenderness of the legs and/or arms, and pain associated with lipedema

12. Composition according to any of claims 4 to 9 or the composition for use of claim 10 or 11, wherein said composition is in a dosage form suitable for administration to a subject such as a capsule or a tablet.

13. Use of a composition according to any of claims 4 to 9 for use in inhibiting lipedema adipose stem cells proliferation, inhibiting the generation of differentiated adipocytes, inhibiting the maturation of adipocytes, increasing the degradation of the lipid content in adipocytes, and/or preventing or reducing the hypertrophy of adipocytes.

14. Use of a composition according to any of claims 4 to 9 for use in the treatment, alleviation and/or prevention of lipedema, adipogenesis, adiposity, lipedema-associated hyperplasia of adipose cells, tenderness of the legs and/or arms, and/or pain associated with lipedema, preferably for use in the treatment, alleviation and/or prevention of lipedema.

15. Method for inhibiting lipedema adipose stem cells proliferation, inhibiting the generation of differentiated adipocytes, inhibiting the maturation of adipocytes, increasing the degradation of the lipid content in adipocytes, and/or preventing or reducing the hypertrophy of adipocytes.

16. Food and/or dietary supplement comprising a composition according to any of claims 4 to 9.

17. Non-medical use of a composition according to any of claims 4 to 9, preferably as a cosmetic.

18. Non-medical use of a composition according to any of claims 4 to 9 for a slimmer physical appearance, improved appearance of the skin, and/or reduction of cellulite.

19. Non-medical use of a composition according to any of claims 4 to 9 in the support of diets in an individual being on said diet, in particular of low- fat diets.

20. The non- medical use of claim 19, wherein said dieting individual is a healthy person or a person suffering from lipedema or from lipedema-associated disorders and/or lipedema - associated symptoms.

21. An agent for inhibiting lipedema adipose stem cells proliferation, inhibiting the generation of differentiated adipocytes, inhibiting the maturation of adipocytes, increasing the degradation of the lipid content in adipocytes, and/or preventing or reducing the hypertrophy of adipocytes, said agent comprising the composition according to any of claims 4 to 9.

22. An agent for reducing adipose stem cells, increasing lipolysis of an adipocytic lipid content, reducing inflammation, reducing swelling, reducing the tenderness of the legs and/or arms, and/or relieving pain associated with lipedema, said agent comprising the composition according to any of claims 4 to 9.