Classifications

• • A—HUMAN NECESSITIES
  • A23—FOODS OR FOODSTUFFS; TREATMENT THEREOF, NOT COVERED BY OTHER CLASSES
  • A23J—PROTEIN COMPOSITIONS FOR FOODSTUFFS; WORKING-UP PROTEINS FOR FOODSTUFFS; PHOSPHATIDE COMPOSITIONS FOR FOODSTUFFS
  • A23J7/00—Phosphatide compositions for foodstuffs, e.g. lecithin
• • A—HUMAN NECESSITIES
  • A23—FOODS OR FOODSTUFFS; TREATMENT THEREOF, NOT COVERED BY OTHER CLASSES
  • A23L—FOODS, FOODSTUFFS OR NON-ALCOHOLIC BEVERAGES, NOT OTHERWISE PROVIDED FOR; PREPARATION OR TREATMENT THEREOF
  • A23L33/00—Modifying nutritive qualities of foods; Dietetic products; Preparation or treatment thereof
  • A23L33/10—Modifying nutritive qualities of foods; Dietetic products; Preparation or treatment thereof using additives
  • A23L33/115—Fatty acids or derivatives thereof; Fats or oils
  • A23L33/12—Fatty acids or derivatives thereof
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/185—Acids; Anhydrides, halides or salts thereof, e.g. sulfur acids, imidic, hydrazonic or hydroximic acids
  • A61K31/19—Carboxylic acids, e.g. valproic acid
  • A61K31/20—Carboxylic acids, e.g. valproic acid having a carboxyl group bound to a chain of seven or more carbon atoms, e.g. stearic, palmitic, arachidic acids
  • A61K31/202—Carboxylic acids, e.g. valproic acid having a carboxyl group bound to a chain of seven or more carbon atoms, e.g. stearic, palmitic, arachidic acids having three or more double bonds, e.g. linolenic
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/21—Esters, e.g. nitroglycerine, selenocyanates
  • A61K31/215—Esters, e.g. nitroglycerine, selenocyanates of carboxylic acids
  • A61K31/22—Esters, e.g. nitroglycerine, selenocyanates of carboxylic acids of acyclic acids, e.g. pravastatin
  • A61K31/23—Esters, e.g. nitroglycerine, selenocyanates of carboxylic acids of acyclic acids, e.g. pravastatin of acids having a carboxyl group bound to a chain of seven or more carbon atoms
  • A61K31/232—Esters, e.g. nitroglycerine, selenocyanates of carboxylic acids of acyclic acids, e.g. pravastatin of acids having a carboxyl group bound to a chain of seven or more carbon atoms having three or more double bonds, e.g. etretinate
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/557—Eicosanoids, e.g. leukotrienes or prostaglandins
  • A61K31/5575—Eicosanoids, e.g. leukotrienes or prostaglandins having a cyclopentane, e.g. prostaglandin E2, prostaglandin F2-alpha
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/557—Eicosanoids, e.g. leukotrienes or prostaglandins
  • A61K31/558—Eicosanoids, e.g. leukotrienes or prostaglandins having heterocyclic rings containing oxygen as the only ring hetero atom, e.g. thromboxanes
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/66—Phosphorus compounds
  • A61K31/683—Diesters of a phosphorus acid with two hydroxy compounds, e.g. phosphatidylinositols
  • A61K31/685—Diesters of a phosphorus acid with two hydroxy compounds, e.g. phosphatidylinositols one of the hydroxy compounds having nitrogen atoms, e.g. phosphatidylserine, lecithin
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K45/00—Medicinal preparations containing active ingredients not provided for in groups A61K31/00 - A61K41/00
  • A61K45/06—Mixtures of active ingredients without chemical characterisation, e.g. antiphlogistics and cardiaca
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K9/00—Medicinal preparations characterised by special physical form
  • A61K9/0012—Galenical forms characterised by the site of application
  • A61K9/0053—Mouth and digestive tract, i.e. intraoral and peroral administration
  • A61K9/0056—Mouth soluble or dispersible forms; Suckable, eatable, chewable coherent forms; Forms rapidly disintegrating in the mouth; Lozenges; Lollipops; Bite capsules; Baked products; Baits or other oral forms for animals
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K9/00—Medicinal preparations characterised by special physical form
  • A61K9/48—Preparations in capsules, e.g. of gelatin, of chocolate
  • A61K9/4816—Wall or shell material
  • A61K9/4825—Proteins, e.g. gelatin
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K9/00—Medicinal preparations characterised by special physical form
  • A61K9/48—Preparations in capsules, e.g. of gelatin, of chocolate
  • A61K9/4841—Filling excipients; Inactive ingredients
  • A61K9/4858—Organic compounds
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K9/00—Medicinal preparations characterised by special physical form
  • A61K9/48—Preparations in capsules, e.g. of gelatin, of chocolate
  • A61K9/4841—Filling excipients; Inactive ingredients
  • A61K9/4866—Organic macromolecular compounds
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P1/00—Drugs for disorders of the alimentary tract or the digestive system
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P11/00—Drugs for disorders of the respiratory system
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P13/00—Drugs for disorders of the urinary system
  • A61P13/12—Drugs for disorders of the urinary system of the kidneys
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P25/00—Drugs for disorders of the nervous system
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P35/00—Antineoplastic agents
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P7/00—Drugs for disorders of the blood or the extracellular fluid
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P9/00—Drugs for disorders of the cardiovascular system
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K2300/00—Mixtures or combinations of active ingredients, wherein at least one active ingredient is fully defined in groups A61K31/00 - A61K41/00

Definitions

• compositions comprising one or more polyunsaturated fatty acids or derivatives thereof, a source of phospholipid, and optionally one or more additional emulsifiers, as well as methods of using the same to treat various diseases.
• LR-EtEPA eicosapentaenoic acid ethyl ester
• composition comprising: (a) at least 15%, by weight, one or more polyunsaturated fatty acids (PUFAs) or derivatives thereof; and (b) 1 % to 85%, by weight, a source of phospholipid.
• PUFAs polyunsaturated fatty acids
• the composition further comprises (c) 1% to 20%, by weight, one or more emulsifiers.
• the one or more PUFAs or derivatives thereof are selected from the group consisting of linoleic acid (LA), gamma-linoleic acid (GLA), dihomo-gamma-linoleic acid (DGLA), arachidonic acid (AA), adrenic acid (AdA), omega-6 docosapentaenoic acid (DPA6), alpha-lineoleic acid (ALA), stearidonic acid (SDA), omega-3 eicosatetraenoic acid (ETA), eicosapentaenoic acid (EPA), docosapentaenoic acid (DPA), docosahexaenoic acid (DHA), an LA derivative, a GLA derivative, a DGLA derivative, an AA derivative, an AdA derivative, a DPA6 derivative, an ALA derivative, an SDA derivative, an ETA derivative, an EPA derivative, a DPA derivative, and a DHA
• the one or more PUFAs or derivatives thereof are selected from the group consisting of tetracosatetraenoic acid (TTE), tetracosapentaenoic acid (TPA), tetracosahexaenoic acid (THA), a TTE derivative, a TPA derivative, and a THA derivative.
• the PUFA derivative comprises an oxylipin.
• the one or more PUFAs or derivatives thereof comprises EPA in free acid form or a pharmaceutically acceptable ester, conjugate, or salt thereof.
• the EPA is eicosapentaenoic acid ethyl ester (EtEPA).
• the EPA or EtEPA comprises at least 66%, 75%, 80%, 90%, 95%, or 96%, by weight, of all PUFAs present in the composition.
• the composition comprises no more than 20%, by weight of all PUFAs present in the composition, one or more of the following: (a) one or more omega-6 PUFAs or derivatives thereof selected from the group consisting of LA, GLA, DGLA, AdA, DPA6, an LA derivative, a GLA derivative, a DGLA derivative, an AdA derivative, and a DPA6 derivative; (b) one or more omega-3 PUFAs or derivatives thereof selected from the group consisting of ALA, SDA, ETA, DPA, an ALA derivative, an SDA derivative, an ETA derivative, and a DPA derivative; and (c) one or more oxylipins.
• omega-6 PUFAs or derivatives thereof selected from the group consisting of LA, GLA, DGLA, AdA, DPA6, an LA derivative, a GLA derivative, a DGLA derivative, an AdA derivative, and a DPA6 derivative
• omega-3 PUFAs or derivatives thereof selected from the group consisting of ALA, SDA,
• the composition comprises about 500 mg to about 1 g of the EPA or EtEPA.
• the source of phospholipid comprises a glycerophospholipid, a lysophospholipid, or a mixture thereof.
• the source of phospholipid is lecithin.
• the lecithin comprises up to 40%, up to 60%, up to 80%, up to 90%, up to 95%, or up to 97%, by weight of the lecithin, phosphatidylethanolamine, and no more than 10%, no more than 5%, no more than 4%, no more than 3%, no more than 2%, or no more than 1 %, by weight of the lecithin, phosphatidylinositol.
• the lecithin comprises: (a) 19%-27%, by weight, phosphatidylcholine; (b) no more than 4%, by weight, lysophosphatidylcholine; (c) 16%- 22%, by weight, phosphatidylethanolamine; (d) 1 1%-18%, by weight, phosphatidylinositol; and (e) 1%-9%, by weight, phosphatidic acid.
• a weight ratio of the one or more PUFAs or derivatives thereof and the source of phospholipid ranges from about 5:1 to about 1 :5, from about 3.75:1 to about 1 :5, or from about 1 :1 to about 1 :5, or a weight ratio of the EPA or EtEPA and the source of phospholipid ranges from about 1 :1 to about 1 :5.
• the one or more emulsifiers comprise polysorbate 80, polyoxyl-35, or both.
• the one or more emulsifiers comprise one or more glycerol derivatives selected from the group consisting of triacylglycerol, diacylglycerol, and monoacylglycerol.
• the glycerol derivative is castor oil.
• the glycerol derivative is re-esterified triglyceride (rTG) enriched with the PUFA.
• kits comprising: (a) a first composition comprising one or more polyunsaturated fatty acids (PUFAs) or derivatives thereof; and (b) a second composition comprising a source of phospholipid.
• PUFAs polyunsaturated fatty acids
• the first and/or second composition further comprises one or more emulsifiers.
• a lymph-releasing eicosapentaenoic acid ethyl ester comprising: (a) at least 15%, by weight, EtEPA; and (b) 1% to 85%, by weight, a source of phospholipid.
• the LR-EtEPA composition further comprises (c) 1% to 20%, by weight, one or more emulsifiers.
• a method of treating or preventing a disease in a subject in need thereof comprising administering to the subject a therapeutically effective amount of a composition, kit, or LR-EtEPA composition according to various embodiments of the present technology.
• compositions, kit, or LR-EtEPA composition according to various embodiments of the present technology for use in a method of treating or preventing a disease in a subject in need thereof, wherein a therapeutically effective amount of the composition, kit, or LR-EtEPA composition is administered to the subject.
• the disease is a cardiovascular disease.
• the cardiovascular disease is selected from the group consisting of hypertriglyceridemia, hypercholesterolemia, mixed dyslipidemia, coronary heart disease, stroke, atherosclerosis, arrhythmia, hypertension, myocardial infarction, vasculitis, cardiomyopathy (e.g., viral cardiomyopathy including related to COVID-19), pericarditis, congestive heart failure, myocardial necrosis, vascular ischemia, vascular disease beyond the cardiopulmonary system, thrombotic disease, post-myocardial infarction cardiac remodeling, giant cell arteritis, polyarteritis nodosa, cryoglobulinemia, episodic small-vessel ischemia (Raynaud’s disease), deep venous thrombosis, disseminated intravascular coagulation, and erectile dysfunction.
• cardiomyopathy e.g., viral cardiomyopathy including related to COVID-19
• pericarditis congestive heart failure, my
• the subject has a fasting baseline triglyceride level of about 135 mg/dL to about 500 mg/dL.
• the subject has one or more of: a baseline non-high- density lipoprotein cholesterol (HDL-C) value of about 200 mg/dL to about 300 mg/dL; a baseline total cholesterol (TC) value of about 250 mg/dL to about 300 mg/dL; a baseline very low-density lipoprotein cholesterol (VLDL-C) value of about 140 mg/dL to about 200 mg/dL; a baseline HDL-C value of about 10 mg/dL to about 30 mg/dL; a baseline low-density lipoprotein cholesterol (LDL-C) value of about 40 mg/dL to about 100 mg/dL; and a baseline high-sensitivity C-reactive protein (hsCRP) level of about 2 mg/dL or less.
• HDL-C non-high- density lipoprotein cholesterol
• TC total cholesterol
• VLDL-C very low-density lipoprotein cholesterol
• LDL-C low-density lipoprotein cholesterol
• hsCRP baseline high-sensitivity C-
• the subject is on stable statin therapy.
• the stable statin therapy comprises a statin and optionally ezetimibe.
• the statin is selected from the group consisting of atorvastatin, fluvastatin, lovastatin, pitavastatin, pravastatin, rosuvastatin, and simvastatin.
• the disease is a pulmonary disease.
• the pulmonary disease is selected from the group consisting of community-acquired pneumonia, COVID-19 pneumonia, systemic inflammatory response syndrome (SIRS), sepsis, SIRS, acute respiratory distress syndrome (ARDS), pulmonary embolism, diffuse interstitial pneumonia, radiation pneumonitis, pleuritis, acute eosinophilic pneumonia, chronic eosinophilic pneumonia, Loftier syndrome, sarcoidosis, interstitial lung disease, chronic obstructive pulmonary disease (COPD), reactive airway disease, asthma, bronchiectasis, bronchiolitis, cystic fibrosis, bronchial carcinoid, pulmonary arterial hypertension, pulmonary vasculitis, microscopic polyangiitis, granulomatosis with polyangiitis (Wegener’s disease), eosinophilic granulomatosis with polyangiitis (Churg-Str
• the disease is a neurological disease.
• the neurological disease is selected from the group consisting of Huntington’s disease, sleep disorders, dementia, psychosis, anxiety, treatmentresistant depression, neuropathic pain, schizophrenia, bipolar disorder, dyslexia, dyspraxia, attention deficit hyperactivity disorder (ADHD), epilepsy, autism, Alzheimer’s disease, Parkinson’s Disease, senile dementia, multiple sclerosis, diabetes-induced neuropathy, macular degeneration, retinopathy of prematurity, amyotrophic lateral sclerosis (ALS), retinitis pigmentosa, cerebral palsy, muscular dystrophy, neurological cancer, cystic fibrosis, and neural tube defects.
• Huntington’s disease Huntington’s disease
• sleep disorders dementia
• psychosis anxiety
• treatmentresistant depression neuropathic pain
• schizophrenia bipolar disorder
• dyslexia dyspraxia
• ADHD attention deficit hyperactivity disorder
• ADHD attention deficit hyperactivity disorder
• epilepsy autism
• Alzheimer’s disease Parkinson’s Disease
• senile dementia
• the disease is cancer.
• the cancer is a hematological malignancy selected from the group consisting of monoclonal B cell lymphocytosis, multiple myeloma, myeloid neoplasm, myelodysplastic syndromes (MDS), myeloproliferative/myelodysplastic syndromes, acute lymphoid leukemia (ALL), chronic lymphocytic leukemia (CLL), acute myeloid leukemia (AML), chronic myelogenous leukemia (CML), blast crisis chronic myelogenous leukemia (bcCML), B cell acute lymphoid leukemia (B-ALL), T cell acute lymphoid leukemia (T-ALL), T cell lymphoma, and B cell lymphoma.
• ALL acute lymphoid leukemia
• CLL chronic lymphocytic leukemia
• AML acute myeloid leukemia
• CML chronic myelogenous leukemia
• BcCML blast crisis chronic myelog
• the cancer is a solid tumor selected from the group consisting of lung cancer, breast cancer, liver cancer, stomach cancer, colon cancer, rectal cancer, colorectal cancer, kidney cancer, gastric cancer, gallbladder cancer, cancer of the small intestine, esophageal cancer, melanoma, bone cancer, pancreatic cancer, skin cancer, uterine cancer, ovarian cancer, testicular cancer, cancer of the thyroid gland, cancer of the adrenal gland, bladder cancer, and glioma.
• the disease is a disease associated with kidney selected from the group consisting of post-infectious glomerulonephritis, IgA nephropathy (Berger’s disease), Henoch-Schonlein purpura, systemic IgA vasculitis, microscopic polyangiitis, granulomatosis with polyangiitis (Wegener’s), eosinophilic granulomatosis with polyangiitis (Churg-Strauss), polyarteritis, idiopathic crescentic glomerulonephritis, anti-GBM glomerulonephritis, Goodpasure syndrome, cryoglobulin- associated glomerulonephritis, idiopathic membranoproliferative glomerulopnephritis (MPGN), hepatitis C-associated glomerulonephritis, systemic lupus erythematosus (SLE) associated glomerulone
• MPGN idi
• the disease is a disease associated with pancreas selected from the group consisting of hyperglycemia, pre-diabetes, diabetes (Type 1 and/or Type 2), and pancreatitis.
• the disease is a disease associated with liver selected from the group consisting of chronic viral hepatitis, autoimmune hepatitis, alcoholic liver disease, non-alcoholic fatty liver disease, hemochromatosis, Wilson disease, primary biliary cholangitis, primary sclerosing cholangitis, and cholelithiasis.
• the disease is a disease associated with intestines selected from the group consisting of gastroesophageal reflux disease (GERD), gastritis, peptic ulcer disease, obesity, cachexia, intestinal angina, Crohn disease, ulcerative colitis, antibiotic-associated colitis, irritable bowel syndrome, colon cancer, colon polyposis, and carcinoid.
• GFD gastroesophageal reflux disease
• gastritis gastritis
• peptic ulcer disease obesity
• cachexia intestinal angina
• Crohn disease ulcerative colitis
• antibiotic-associated colitis antibiotic-associated colitis
• irritable bowel syndrome colon cancer
• colon polyposis colon polyposis
• carcinoid carcinoid
• the disease is a disease associated with blood cells selected from the group consisting of iron deficiency anemia, anemia of chronic disease, hemolytic anemia, thalassemia, polycythemia vera, sickle cell disease anemia, sickle cell disease pain, immune thrombocytopenia, leukemias, Non-Hodgkin lymphoma, and Hodgkin lymphoma.
• the disease is a disease associated with oxidative stress, glutathione (GSH) depletion, Nrf2 activation, and/or heme-oxygenase activation.
• the disease is anemia, sickle cell disease, and/or glomerulonephritis.
• the method further comprises administering to the subject a N-acetylcysteine (NAG) related agent.
• NAG N-acetylcysteine
• the NAG related agent is selected from the group consisting of cystine, methionine, N- acetylcysteine, and L-2-oxothiazolidine-4-carboxylate.
• the disease is oxidative stress, endothelial dysfunction, narrowing and/or thickening of arteries, and/or inflammation induced by inhalation of particulate matter.
• the disease is oxidative stress, endothelial dysfunction, narrowing and/or thickening of arteries, and/or inflammation induced by long-term and/or short-term exposure to air pollution.
• the composition, kit, or LR-EtEPA composition is administered to the subject to provide a daily dose of about 1 g to about 20 g of EtEPA, for example, about 4 g of EtEPA.
• the composition, kit, or LR-EtEPA composition is administered to the subject once or twice per day, with or without food.
• FIG. 1 A shows comparison of lymph-releasing eicosapentaenoic acid ethyl ester (LR-EtEPA) versus plain EtEPA at equal doses of EtEPA for tissue EPA enrichment in the lymph, heart, lungs, brain, and lung alveolar macrophages (AVMs). For each tissue, the fold equivalent of LR-EtEPA compared to plain EtEPA for EPA level and EPA:AA ratio is shown.
• LR-EtEPA lymph-releasing eicosapentaenoic acid ethyl ester
• FIG. 1 B shows preferred routing of EPA through the lymphatic system over the portal vein by co-administration of lymph-releasing compounds (e.g., lecithin (LC) and/or emulsifiers) with EtEPA, thereby avoiding visceral EPA loss (e.g., visceral adipose EPA sequestration and hepatic first pass EPA loss) and increasing systemic and tissue EPA levels, for example, in the kidney, jejunum, and pancreas. For each of the exemplary tissues, the percentage increases in EPA level and EPA:AA ratio by LR- EtEPA over plain EtEPA are shown.
• FIG. 1 B shows preferred routing of EPA through the lymphatic system over the portal vein by co-administration of lymph-releasing compounds (e.g., lecithin (LC) and/or emulsifiers) with EtEPA, thereby avoiding visceral EPA loss (e.g., visceral adipose EPA sequestration and hepatic first pass EPA loss
• LR-EtEPA is superior to plain EtEPA at enriching lymph fluid with EPA after a single dose, and such enrichment is more enhanced when the relative ratio of the lymph-releasing compounds to EtEPA (LC:EtEPA) is increased from 1 :4 to 1 :1.
• IPE icosapent ethyl, also referred to as EtEPA;
• FAME fatty acid methyl ester, which is an indicator of the total amount of a fatty acid measured (in this case it is EPA).
• FIGS. 3-4 show that LR-EtEPA is superior to EtEPA at increasing tissue EPA levels in the lung and heart (FIG. 3) and at improving EPA:AA ratio in lung immune cells (FIG. 4) after only 7 Days.
• FIG. 5 shows LR-EtEPA vs EtEPA for various phospholipid-EPA (PL-EPA) fractional amounts (FrAmt, 100th) on day 7 in cellular tissues.
• FIG. 6 shows LR-EtEPA:EtEPA ratio vs pool size, comparing various cellular PL-EPAs.
• FIGS. 7-12 show vector plots of LR-EtEPA:EtEPA ratio, comparing various PL-EPAs in the lungs (FIG. 7), AVMs (FIG. 8), heart (FIG. 9), blood matrix (FIG. 10), blood cells (FIG. 11 ), and liver (FIG. 12) at day 7.
• FIG. 13 shows LR-EtEPA vs EtEPA for various PL-EPA/ARA ratio fractional amounts (FrAmt, 100th) on day 7 in cellular tissues.
• FIG. 14 shows LR-EtEPA:EtEPA ratio vs pool size, comparing various cellular PL-EPA/ARA ratios at day 7.
• FIGS. 15-20 show vector plots of LR-EtEPA:EtEPA ratio, comparing various PL-EPA/ARA ratios in the lungs (FIG. 15), alveolar macrophages (FIG. 16), heart (FIG. 17), blood matrix (FIG. 18), blood cells (FIG. 19), and liver (FIG. 20) at day 7.
• FIG. 21 shows that LR-EtEPA (1 X (IPE+LC 4:1 )) is superior to plain EtEPA (IPE) in improving EPA:ARA ratio in lung immune cells after 7 days and after 21 days.
• OA oleic acid
• IPE icosapent ethyl, also referred to as EtEPA.
• FIG. 22 is a summary plot showing that at equal doses, LR-EtEPA outperforms plain EtEPA at increasing EPA in lymph, lungs, lung AVMs, heart, and brain in long-Evans rats after 7 and/or 21 days of multiple dosing.
• FIGS. 23A and 23B show potential mechanisms of different cell types as indicated in disease conditions including atherosclerosis, pulmonary diseases, renal diseases, and injury, as well as how EPA (and its derived oxylipins) may alleviate these disease conditions.
• FIGS. 24A-24E show dose response plots of EPA/AA (FIGS. 24A-24B), OXygenation-Promoters (OXP, including EPA, GLA, and DHA)/AA (FIGS. 24C-24D), and Medicinal Oxylipin Precursors (MOP, including DGLA, EPA, DPA, and DHA)/AA (FIG.
• OXP OXygenation-Promoters
• MOP Medicinal Oxylipin Precursors
• FIGS. 24A and 24C is a “violin” plot, while FIGS. 24B, 24D, and 24E show stacked dose response curve in untransformed (top panel) and semi-log (bottom panel) plots.
• ME methyl ester
• FAME fatty acid methyl ester, which measures the total amount of a fatty acid of interest
• Intercept interception
• Rel Potency
• Sigma represents residual standard error.
• FIGS. 25A-25D show dose response plots of EPA/AA (FIGS. 25A-25B), OXP/AA (FIG. 25C), and MOP/AA (FIG. 25D) ratios in the AVMs in rats dosed with five treatment arms presented in the order of, from left to right: (1 ) OA; (2) EPA+GLA+DHA; (3) EtEPA; (4) 1X LR-EtEPA, and (5) 1.5X LR-EtEPA.
• FIGS. 26A-26D show dose response plots of EPA/AA (FIGS. 26A-26B), OXP/AA (FIG. 26C), and MOP/AA (FIG. 26D) ratios in the heart tissue in rats dosed with five treatment arms presented in the order of, from left to right: (1 ) OA; (2) EPA+GLA+DHA; (3) EtEPA; (4) 1X LR-EtEPA, and (5) 1.5X LR-EtEPA.
• FIGS. 27A-27D show dose response plots of EPA/AA (FIGS. 27A-27B), OXP/AA (FIG. 27C), and MOP/AA (FIG. 27D) ratios in the kidney tissue in rats dosed with five treatment arms presented in the order of, from left to right: (1 ) OA; (2) EPA+GLA+DHA; (3) EtEPA; (4) 1X LR-EtEPA, and (5) 1.5X LR-EtEPA.
• FIGS. 28A-28B show dose response plots of EPA/AA ratio in the brain tissue in rats dosed with five treatment arms presented in the order of, from left to right: (1 ) OA; (2) EPA+GLA+DHA; (3) EtEPA; (4) 1X LR-EtEPA, and (5) 1.5X LR-EtEPA.
• FIGS. 29A-29D show dose response plots of EPA/AA (FIGS. 29A-29B), OXP/AA (FIG. 29C), and MOP/AA (FIG.
• FIGS. 30A-30D show dose response plots of EPA/AA (FIGS. 30A-30B), OXP/AA (FIG. 30C), and MOP/AA (FIG. 30D) ratios in the jejunum tissue in rats dosed with five treatment arms presented in the order of, from left to right: (1 ) OA; (2) EPA+GLA+DHA; (3) EtEPA; (4) 1X LR-EtEPA, and (5) 1.5X LR-EtEPA.
• FIGS. 31 A-31 D show how EtEPA affects functional indices of key enzymes that convert LC-PUFAs to other LC-PUFAs, a process that is rate-limited by desaturase enzymes but is also facilitated by elongase enzymes.
• FIG. 31 A shows the functional impact of various treatments on A5-desaturation of the co-6 LC-PUFA DGLA (20:3co-6), yielding ARA (20:4co-6).
• the product/precursor ratio ARA:DGLA is called the A5- desaturation index at co-6 (A5D-I co-6).
• the x-axis is dose proportional to the EtEPA dose, ranging from 0 to 4.7 mmol EPA/kg/d.
• FIG. 31 B shows a contrasting, ascending progression for the functional impact of various treatments on A8- desaturation of the co-6 LC-PUFA eicosadienoic acid (EDA 20:2co-6) yielding DGLA (20:3co-6).
• the product/precursor ratio DGLA:EDA is called the A8-desaturation index at w-6 (A8D-I co-6).
• FIG. 31 C is a schematic that summarizes data on the mechanism by which EtEPA (IPE) alters DGLA kinetics thus raising the DGLA pool, in contrast to a key long chain PUFA composition Oxepa®, namely, GLA which is included in Oxepa® as a DGLA precursor.
• Oxepa® consists of three LC-PUFAs: (1 ) EPA, (2) GLA, and (3) DHA; in the experiment the combination of these three LC-PUFAs is referred to as EPA+GLA+DHA.
• EDA eicosadienoic acid
• ARA arachidonic acid
• FIG. 31 D shows a descending progression for the functional impact of various treatments on A5- elongation of the co-6 LC-PUFA eicosapentaenoic acid (EPA, 20:5w-6) yielding the longer omega-3 LC-PUFA DPA (22:5w-3).
• the product/precursor ratio DPA:EPA is called the A5-elongation index at co-3 (A5D-I co-3). As shown, EtEPA substantially suppresses A5D-I co-3 compared to EPA+GLA+DHA and oleic acid (OA) control.
• FIGS. 32A-32J show the effect on various formulations on oxylipins present in lung tissue.
• the oxylipins are listed in the graph titles, along with an arrow ( «— ) indicating the parent LC-PUFA that was oxygenated to yield said oxylipin.
• EtEPA not only raised several EPA-derived oxylipins considered to have therapeutic potential, but it also raised DGLA-derived oxylipins and oxylipins derived from linoleic acid (LA, 18:2w-6).
• Lung oxylipins were assayed from the rats with and without hydrolysis, thus yielding total oxylipins (i.e., free/non-esterified plus bound/esterified oxylipins) and free/non-esterified oxylipins. Bound/esterified oxylipins were determined by subtracting free/non-esterified oxylipins from total oxylipins. In many cases, esterified oxylipins are the dominant form, at times outnumbering free/non-esterified oxylipins by ten-fold. The oxylipin studies confirm that the large increases in tissue EPA achieved from LR-EtEPA vs. plain EtEPA vs.
• EPA+GLA+DHA translate into substantial increases in EPA-derived oxylipins of therapeutic potential. This reassures that the pharmacokinetic effects translate to pharmacodynamic effects. Not only so, but EPA also exerts functional effects on oxylipins derived from other LC-PUFAs, such as DGLA and LA shown here.
• FIG. 33 shows a model to determine whether the high relative potencies (0) seen across a spectrum of tissue perfusion rates would extend to tissues that typically have the lowest perfusion rates (e.g., inactive muscle and adipose).
• the left panel shows linear regression results for five tissues that are in the lower half of the tissue perfusion spectrum typical of a healthy human adult on the x-axis.
• the y-axis is the relative potency, 0, as determined by dose-response modeling, as detailed elsewhere.
• This line was used to model lower levels of tissue perfusion, shown in the right panel, whose x-axis includes lower-perfusion tissues.
• the 90% confidence intervals exclude 1 and the 0 remained close to 3x, reassuring that even lower-perfusion tissues are likely to exhibit a roughly 3-fold advantage for LR-EtEPA compared to plain EtEPA in 21 days. If the confidence intervals had included 1 , it would indicate that more time than 21 days might be required for a therapeutic effect to manifest in lower-perfusion tissues.
• FIG. 34A presents a schematic for how EtEPA induces the HMOX-1 gene, which promotes heme-oxygenase 1 protein (HO-1 ). Not shown is that upregulation of HMOX-1 is induced through the nuclear factor erythroid 2-related factor 2 (Nrf2) pathway. LC-PUFAs and their oxylipins, particularly EPA and its oxylipins stimulate Nrf2, an essential transcription factor, which regulates oxidative stress by inducing the antioxidant response element (ARE). In turn, ARE induces production of HMOX1 yielding HO-1 , NQ01 yielding NAD(P)H dehydrogenase [quinone] 1 , and GST yielding glutathione S-transferase.
• Nrf2 nuclear factor erythroid 2-related factor 2
• HO-1 vasodilatory, anti-inflammatory, anti-apoptotic, anti-thrombotic, and angiogenic effects, mediated by effects on carbon monoxide, the antioxidants biliverdin/bilirubin, and via antioxidant effects of ferritin.
• FIG. 34B presents results from a provoked-inflammation cell-culture study with proteomics outcomes, wherein endothelial cells from various tissues were exposed to the inflammatory cytokine IL-6 in the absence or presence of EPA.
• heme- oxygenase-1 was significantly increased in endothelial cells from pulmonary, vascular, and brain endothelial cells in the presence of EPA.
• proteins involved in the related antioxidant ferritin in vascular endothelial cells are also of interest.
• fatty acid desaturase 1 encodes the A5-desaturase enzyme
• FADS2 fatty acid desaturase 2
• FADS2 was significantly suppressed in vascular endothelial cells and brain endothelial cells, and FADS1 was significantly suppressed in brain endothelial cells, which protein suppression accords with functional results from Long-Evans rats discussed elsewhere, particularly showing functional suppression of A5-desaturase.
• FIGS. 34C-34D illustrate that endothelial nitric oxide bioavailability depends on eNOS coupling efficiency.
• FIG. 35 is a volcano plot of modulated proteins: IL-6 vs EPA + IL-6 (all points above the horizontal line are considered significant (p ⁇ 0.05)).
• FIG. 36 is a volcano Plot of modulated proteins: IL-6 vs DHA + IL-6 (all points above the horizontal line are considered significant (p ⁇ 0.05)).
• FIG. 38 illustrates air pollution particulate matters (PMs) cause multi-organ damage and systemic vascular inflammation associated with both the innate and adaptive immune responses. These vascular changes lead to increased cardiovascular risk and ischemic injury, including myocardial infarction and stroke.
• PMs air pollution particulate matters
• FIGS. 39A-39B show distribution of particulate size in urban particulate matter (FIG. 39A) and fine particulate matter (FIG. 39B).
• FIG. 40 is a schematic illustration of proteomic analysis protocol.
• FIG. 41 A is a volcano plot of all detected proteins from fine PMs vs EPA + fine PMs.
• FIG. 41 B is a volcano plot of all detected proteins from urban PMs vs EPA + urban PMs.
• FIGS. 42A-42C show effects of EPA on relative expression levels (Iog2 intensity) of inflammatory protein CXCL6 (FIG. 42A), HSP90B1 (FIG. 42B), and GSTP1 (FIG. 42C) following challenges with urban and fine PMs, respectively.
• ranges is intended as a continuous range including every value between the minimum and maximum values recited as well as any ranges that can be formed by such values. Also disclosed herein are any and all ratios (and ranges of any such ratios) that can be formed by dividing a recited numeric value into any other recited numeric value. Accordingly, the skilled person will appreciate that many such ratios, ranges, and ranges of ratios can be unambiguously derived from the numerical values presented herein and in all instances such ratios, ranges, and ranges of ratios represent various embodiments of the present invention.
• compositions comprising one or more polyunsaturated fatty acid (PUFA)s or derivatives thereof, and a source of phospholipid.
• the composition may further comprise one or more additional emulsifiers.
• the PUFAs or derivatives thereof can function as the active ingredient, and the phospholipid and/or additional emulsifiers can be referred to as additives or excipients.
• kits comprising a first composition comprising one or more PUFAs or derivatives thereof, and a second composition comprising a source of phospholipid.
• the first and/or second composition may further comprise one or more additional emulsifiers.
• the PUFA or derivative thereof comprises a long chain PUFA (LC-PUFA), which are typically fatty acids having at least 18 carbon atoms, or a derivative thereof.
• the PUFA or derivative thereof comprises a very long chain PUFA (VLC-PUFA), which are typically fatty acids having at least 24 carbon atoms, or a derivative thereof.
• the one or more PUFAs or derivatives thereof of the composition may be selected from the group consisting of omega-6 fatty acids including linoleic acid (FA 18:2w-6, or LA), y-linoleic acid (FA 18:3w-6, or GLA), dihomo-y-linoleic acid (FA 20:3w- 6, or DGLA), arachidonic acid (FA 20:4w-6, AA, or ARA), adrenic acid (FA 22:4w-6, or AdA, also known as docosatetraenoic acid, or DTA), and omega-6 docosapentaeinoic acid (FA 22:5w-6, or DPA6); and omega-3 fatty acids including a-linoleic acid (FA 18:3w3, or ALA), stearidonic acid (FA 18:4w-3, or SDA), omega-3-eicosatetraenoic acid (FA 20:4w-3, or ETA), eicosap
• a “PUFA” especially those written in short form refers to the PUFA in free acid form and/or a pharmaceutically acceptable ester, or conjugate, or salt thereof, or mixtures of any of the foregoing, as long as the acyl group or the carbon chain portion of the molecule remains intact.
• pharmaceutically acceptable in the present context means that the substance in question does not produce unacceptable toxicity to the subject or interaction with other components of the composition.
• EPA encompasses eicosapentaenoic acid and a pharmaceutically acceptable ester, conjugate, or salt thereof, or mixtures of any of the foregoing.
• a “derivative” of a PUFA include molecules where the acyl group or the carbon chain portion of the molecule has one or more modifications.
• the PUFA derivative is an oxylipin.
• Oxylipins are bioactive lipids generated from oxygenation of PUFAs by enzymes such as cyclooxygenases (COX), lipoxygenases (LOX), and cytochrome P450 epoxygenase (CYP), or by non-enzymatic processes. Oxylipins especially those derived from EPA may have vaso-protective activities, including protection from septic and hypertensive vascular diseases. See Newman et al., PLOS ONE (2014) 9:11 .
• major oxylipin classes include prostacyclins (potent vasodilators), thromboxanes (potent procoagulants and vasoconstrictors), prostaglandins (vasodilators), leukotrienes (inflammatory mediators), epoxides (potent vasodilators), and resolvins (potent inflammation resolvers).
• prostacyclins potent vasodilators
• thromboxanes potent procoagulants and vasoconstrictors
• prostaglandins vadilators
• leukotrienes inflammatory mediators
• epoxides potential vasodilators
• resolvins potent inflammation resolvers
• the PUFA derivative has at least one hydroxyl group, an epoxide group, a non-vicinal di-hydroxyl group, a vicinal di-hydroxyl group, a tri-hydroxyl group, and/or a ketone group.
• the LA derivative is at least one selected from the group consisting of 9-hydroperoxy-octadecadienoic acid (9-HpODE), 13-hydroperoxy- octadecadienoic acid (13-HpODE), 9-hydroxy-octadecadienoic acid (9-HODE), 13- hydroxy-octadecadienoic acid (13-HODE), 9,10,13 trihydroxy-octadecenoic acid (9,10,13 TriHOME), 9,12,13 trihydroxy-octadecenoic acid (9,12,13 TriHOME), 9-oxo- octadecadienoic acid (9-oxo-ODE), 13-oxo-octadecadienoic acid (13-oxo-ODE), 9,10- epoxy-octadecenoic acid (9,10-EpOME), 12,13-epoxy-octadecenoic acid (12
• selected LA derivatives may be used as therapeutics to promote vasodilation/arterial relaxation (e.g., one or more HpODEs, EpOMEs), inhibit platelet aggregation (e.g., one or more HODEs), induce peroxisome proliferator-activated receptor (PPAR) (e.g., one or more HODEs, oxo-ODEs), inhibit leukotriene production (e.g., one or more HODEs), suppress triglyceride-rich lipoproteins (TRLs) assembly and secretion (e.g., one or more HODEs), and/or suppress tumor cell adhesion or proliferation (e.g., one or more HODEs, EpOMEs).
• PPAR peroxisome proliferator-activated receptor
• TRLs suppress triglyceride-rich lipoproteins assembly and secretion
• TRLs suppress tumor cell adhesion or proliferation
• tumor cell adhesion or proliferation e
• the GLA derivative is at least one selected from the group consisting of 6-hydroxy-octatrienoic acid (6-HOTrE or 6-hydroxy-GLA), 7- hydroxy-octatrienoic acid (7-HOTrE or 7-hydroxy-GLA), 9-hydroxy-octatrienoic acid (9- HOTrE or 9-hydroxy-GLA), 10-hydroxy-octatrienoic acid (10-HOTrE or 10-hydroxy- GLA), 12-hydroxy-octatrienoic acid (12-HOTrE or 12-hydroxy-GLA), 13-hydroxy- octatrienoic acid (13-HOTrE or 13-hydroxy-GLA), 6,13-dihydroxy-octadienoic acid (6,13-DiHODE or 6,13-dihydroxy-GLA), and trihydroxy GLA derivatives (trihydroxy- GLAs).
• 6-hydroxy-octatrienoic acid (6-HOTrE or 6-hydroxy-GLA)
• selected GLA derivatives may be used as therapeutics to promote vasodilation (e.g., one or more HOTrEs, DiHODEs, trihydroxy- GLAs), suppress reactive oxygen species generation (e.g., one or more HOTrEs, DiHODEs, trihydroxy-GLAs), mitigate neurodegenerative conditions (e.g., one or more HOTrEs, DiHODEs, trihydroxy-GLAs), and/or as anti-inflammatory therapeutics, for example, to reduce the production of tumor necrosis factor-a (TNF-a), to reduce the migration of neutrophils and macrophages into a site of inflammation, to reduce interleukin-1 p (IL-1 ) production in the individual, and/or to reduce macrophage chemotactic protein-1 (MCP-1 ) (e.g., one or more HOTrEs, DiHODEs, trihydroxy- GLAs).
• TNF-a tumor necrosis factor-a
• IL-1 interleukin-1 p
• MCP-1
• the DGLA derivative is at least one selected from the group consisting of prostaglandin D1 (PGD1 ), prostaglandin E1 (PGE1 ), 15- hydroxy-PGE1 , 19-hydroxy-PGE1 , 13,14-dihydroxy-PGE1 , 13,14-dihydroxy-15-keto- PGE1 , prostaglandin F1 a (PGF1 a), 6-keto-PGF1 a, 15-keto-PGF1 a, 13,14-di hydro xy- PGF1 a, 15,19-dihydroxy-PGF1 a, 13,14-dihydroxy-15-keto PGF1 a, prostacyclin 11 (prostaglandin 11 or PGI1 ), thromboxane A1 (TXA1 ), thromboxane B1 (TXB1 ), leukotriene B3 (LTB3), leukotriene C3 (LTC3), leukotriene D
• PGI1 prostaglan
• selected DGLA derivatives may be used as therapeutics to promote vasodilation, including mitigating pulmonary hypertension or enhancing peripheral blood flow (e.g., one or more PGs or derivatives), inhibit platelet aggregation (e.g., one or more PGs or derivatives, HETrEs), alleviate neuropathy (e.g., one or more PGs or derivatives), promote wound healing (e.g., one or more PGs or derivatives), leukotriene production (e.g., one or more HETrEs), and/or suppress cellular hyperproliferation (e.g., one or more HETrEs).
• mitigating pulmonary hypertension or enhancing peripheral blood flow e.g., one or more PGs or derivatives
• inhibit platelet aggregation e.g., one or more PGs or derivatives, HETrEs
• alleviate neuropathy e.g., one or more PGs or derivatives
• promote wound healing e.
• the AA or ARA derivative is at least one selected from the group consisting of 6-keto-prostaglandin F1 alpha (6k-PGF1 a), thromboxane B2 (TXB2), 11 -dehydro-thromboxane B2 (11 -dTXB2), prostaglandin F2 alpha (PGF2a), prostaglandin E2 (PGE2), prostaglandin A2 (PGA2), prostaglandin D2 (PGD2), 2,3- dinor 11 beta-prostaglandin F2 alpha (2,3-dinor11 bPGF2a), prostaglandin J2 (PGJ2), 15-deoxy-delta-12,14-prostaglandin J2 (15d-PGJ2), leukotriene B4 (LTB4), 20- hydroxy-leukotriene B4 (20-OH-LTB4), leukotriene 04 (LTC4), leukotriene D4 (LTD4),
• selected AA derivatives may be used as therapeutics to promote vasodilation/arterial relaxation (e.g., one or more PGs or derivatives, HpETEs, HETEs, EpETrEs, DiHETrEs), promote angiogenesis (e.g., one or more HETEs , EpETrEs, DiHETrEs), lower intracranial or renal pressure (e.g., one or more HETEs), attenuate myocyte apoptosis following reperfusion (e.g., one or more EpETrEs), inhibit platelet aggregation (e.g., one or more PGs and derivatives, HpETEs), attenuate inflammation (e.g., one or more PGs and derivatives, HETEs, lipoxins), suppress reactive oxygen species generation/oxidative injury (e.g., one or more lipoxins), induce PPAR (e.g., one or more PG derivatives,
• the AdA or DTA derivative is at least one selected from the group consisting of dihomo-prostaglandin E2 (dihomo-PGE2), dihomoprostaglandin D2 (dihomo-PGD2), dihomo-prostaglandin F2a (dihomo-PGF2a), dihomo-prostacyclin I2 (dihomo-prostaglandin I2 or dihomo-PGI2), dihomothromboxane A2 (dihomo-TXA2), dihomo-thromboxane B2 (dihomo-TXB2), 7- hydroperoxy-docosatetraenoic acid (dihomo-7-HpETE), 10-hydroperoxy- docosatetraenoic acid (dihomo-10-HpETE), 1 1 -hydroperoxy-docosatetraenoic acid (dihomo-1 1 -HpETE), 13-hydr
• selected AdA derivatives may be used as therapeutics to promote vasodilation and/or oppose net vasoconstrictive properties from analogous oxylipins, especially in the kidney (e.g., one or more dihomo- PGs or derivatives, dihomo-thromboxanes, dihomo-HETEs, dihomo-DiHETEs dihomo- EpETrEs), suppress reactive oxygen species generation (e.g., one or more dihomo- HETEs, dihomo-DiHETEs), mitigate neurodegenerative conditions (e.g., one or more dihomo-HETEs, dihomo-DiHETEs), and as anti-inflammatory therapeutics, for example to reduce the production of tumor necrosis factor-a (TNF-a), to reduce the migration of neutrophils and macrophages into a site of inflammation, to reduce interleukin-1 p (IL- 1 ) production in the individual, and/or to reduce macrophage chemotactic
• TNF-a
• the DPA6 derivative is at least one selected from the group consisting of 7-hydroperoxy-DPA6, 8-hydroperoxy-DPA6, 10-hydroperoxy- DPA6, 11 -hydroperoxy-DPA6, 13-hydroperoxy-DPA6, 14-hydroperoxy-DPA6, 17- hydroperoxy-DPA6, 7-hydroxy-DPA6, 8-hydroxy-DPA6, 10-hydroxy-DPA6, 11 - hydroxy-DPA6, 13-hydroxy-DPA6, 14-hydroxy-DPA6, 17-hydroxy-DPA6, 4,5- dihydroxy-DPA6, 7,14-dihydroxy-DPA6, 7,17-dihydroxy-DPA6, 8,14-dihydroxy-DPA6, 10,17-dihydroxy-DPA6, 13,17-dihydroxy-DPA6, 16,17-dihydroxy-DPA6, 4,5,17- trihydroxy-DPA6, 7,16,17-trihydroxy-DPA6, and 10,13,17-trihydroxy-DPA6.
• selected DPA6 derivatives may be used as therapeutics to promote vasodilation (e.g., one or more hydroxy- DPA6s, dihydroxy-DPA6s), suppress reactive oxygen species generation (e.g., one or more hydroxy-DPA6s, dihydroxy-DPA6s), mitigate neurodegenerative conditions (e.g., one or more hydroxy- DPA6s, dihydroxy-DPA6s), and as anti-inflammatory therapeutics, for example to reduce the production of tumor necrosis factor-a (TNF-a), to reduce the migration of neutrophils and macrophages into a site of inflammation, to reduce interleukin-1 (IL- 1 P) production in the individual, and/or to reduce macrophage chemotactic protein-1 (MCP-1 ) (e.g., one or more hydroxy-DPA6s, dihydroxy-DPA6s).
• TNF-a tumor necrosis factor-a
• IL- 1 P interleukin-1
• MCP-1 macrophage chemotact
• the ALA derivative is at least one selected from the group consisting of 9-hydroperoxy-octatrienoic acid (9-HpOTrE), 13-hydroperoxy- octatrienoic acid (13-HpOTrE), 9-hydroxy-octatrienoic acid (9-HOTrE), 13-hydroxy- octatrienoic acid (13-HOTrE), 9,16-dihydroxy-octatrienoic acid (9,16-DiHOTrE), 9-oxo- octatrienoic acid (9-oxo-OTrE), 13-oxo-octatrienoic acid (13-oxo-OtrE), 9,10-epoxy- octadienoic acid (9,10-EpODE), 12,13-epoxy-octadienoic acid (9,10-EpODE), 12,13-epoxy-octadienoic acid (9,10-EpODE), 12,
• selected ALA derivatives may be used as therapeutics to inhibit platelet aggregation (e.g., one or more DiHOTrEs), attenuate inflammation (e.g., one or more HOTrEs), promote adipocyte differentiation (e.g., one or more oxo-OtrEs), attenuate COX activity (e.g., one or more DiHOTrEs), lower action potential in myocytes (e.g., one or more HpOTrEs), and/or increase glucose uptake (e.g., one or more oxo-OtrEs).
• platelet aggregation e.g., one or more DiHOTrEs
• attenuate inflammation e.g., one or more HOTrEs
• promote adipocyte differentiation e.g., one or more oxo-OtrEs
• attenuate COX activity e.g., one or more DiHOTrEs
• the SDA derivative is at least one selected from the group consisting of 6-hydroperoxy-octatetraenoic acid (6-HpOTE or 6- hydro peroxy -
• selected SDA derivatives may be used as therapeutics to promote vasodilation (e.g., one or more HOTEs, DiHOTrEs, DiHODEs, trihydroxy-SDAs), suppress reactive oxygen species generation (e.g., one or more HOTEs, DiHOTrEs, DiHODEs, trihydroxy-SDAs), mitigate neurodegenerative conditions (e.g., one or more HOTEs, DiHOTrEs, DiHODEs, trihydroxy-SDAs), and as anti-inflammatory therapeutics, for example to reduce the production of tumor necrosis factor-a (TNF-a), to reduce the migration of neutrophils and macrophages into a site of inflammation, to reduce interleukin-1 p (IL-1 ) production in the individual, and/or to reduce macrophage chemotactic protein-1 (MCP-1 ) (e.g., one or more HOTEs, DiHOTrEs, DiHODEs, trihydroxy-SDAs).
• TNF-a tumor necros
• the ETA derivative is at least one selected from the group consisting of A17,18 prostaglandin D1 (A17,18 PGD1 or co-3 PGD1 ), A17,18 prostaglandin E1 (A17,18 PGE1 or co-3 PGE1 ), and A17,18 prostaglandin F1 a (A17,18 PGF1 a or w-3 PGF1 a), A17,18 prostacyclin 11 (A17,18 PGI1 or w-3 PGE1 ), A17,18 12- hydroperoxy-eicosatetraenoic acid (A17,18 12-HpETE or co-3 12-HpETE), A17,18 15- hydroperoxy-eicosatetraenoic acid (A17,18 15-HpETE or co-3 15-HpETE), A16,17 18- hydroperoxy-eicosatetraenoic acid (A16,17 18-HpETE), A17,18 12-hydroxy- eicosate
• selected ETA derivatives may be used as therapeutics to inhibit COX and suppress conversion of AA into PGs and thromboxanes (e.g., one or more co-3 HETEs, co-3 DiHETrEs) and/or promote vasodilation or mitigate congestive heart failure (e.g., one or more co-3 HETEs, co-3 EpETrEs, co-3 DiHETrEs).
• the EPA derivative is at least one selected from the group consisting of 6-keto-prostaglandin F2 alpha (6k-PGF2a), thromboxane B3 (TXB3), 11 -dehydro-thromboxane B3 (11 -dTXB3), prostaglandin F3 alpha (PGF3a), prostaglandin E3 (PGE3), prostaglandin A3 (PGA3), prostaglandin D3 (PGD3), 2,3- dinor 11 beta-prostaglandin F3 alpha (2,3-dinor11 bPGF3a), prostaglandin J3 (PGJ3), 15-deoxy-delta-12,14-prostaglandin J3 (15d-PGJ3), leukotriene B5 (LTB5), 20- hydroxy-leukotriene B5 (20-OH-LTB5), leukotriene 05 (LTC5), leukotriene D5 (LTD5), leukotriene B5 (LTC5)
• selected EPA derivatives may be used as therapeutics to promote vasodilation/arterial relaxation (e.g., one or more PGs or derivatives, lipoxins, HEPEs, EpETEs), inhibit platelet aggregation in absolute terms or relative to AA-derived oxylipins (e.g., one or more PGs and derivatives, HpEPEs, HEPEs, EpETEs, DiHETEs), attenuate inflammation (e.g., one or more PGs and derivatives, LTs, HEPEs, oxo-EPEs, EpETEs, RvEs), promote adipocyte differentiation/raise adiponectin (e.g., one or more PGs and derivatives, HEPEs), attenuate cancer (e.g., one or more PGs or derivatives) , attenuate COX activity (e.g., one more LTs, HpEPEs), atten
• the DPA derivative is at least one selected from the group consisting of 7-hydroperoxy-docosapentaeonic acid (7-hydroperoxy-DPA), 10- hydroperoxy-docosapentaeonic acid (10-hydroperoxy-DPA), 11 -hydroperoxy- docosapentaeonic acid (11 -hydroperoxy-DPA), 13-hydroperoxy-docosapentaeonic acid (13-hydroperoxy-DPA), 14-hydroperoxy-docosapentaeonic acid (14-hydroperoxy- DPA), 16-hydroperoxy-docosapentaeonic acid (16-hydroperoxy-DPA), 17- hydroperoxy-docosapentaeonic acid (17-hydroperoxy-DPA), 7-hydroxy- docosapentaeonic acid (7-hydroxy-DPA), 10-hydroxy-docosapentaeonic acid (10- hydroxy-DPA), 10-hydroperoxy-
• selected DPA derivatives may be used as therapeutics to promote vasodilation (e.g., one or more hydroxy-DPAs, di hydroxy- DP As), suppress reactive oxygen species generation (e.g., one or more hydroxy-DPAs, di hydroxy- DP As), mitigate neurodegenerative conditions (e.g., one or more hydroxy-DPAs, dihydroxy- DPAs), and as anti-inflammatory therapeutics, for example to reduce the production of tumor necrosis factor-a (TNF-a), to reduce the migration of neutrophils and macrophages into a site of inflammation, to reduce interleukin-1 p (IL-1 ) production in the individual, and/or to reduce macrophage chemotactic protein-1 (MCP-1 ) (e.g., one or more hydroxy-DPAs, dihydroxy-DPAs).
• TNF-a tumor necrosis factor-a
• IL-1 interleukin-1 p
• MCP-1 macrophage chemotactic protein-1
• the DHA derivative is at least one selected from the group consisting of 4-hydroperoxy-docosahexaenoic acid (4-HpDoHE), 7-hydroperoxy- docosahexaenoic acid (7-HpDoHE), 8-hydroperoxy-docosahexaenoic acid (8- HpDoHE), 10-hydroperoxy-docosahexaenoic acid (10-HpDoHE), 11 -hydroperoxy- docosahexaenoic acid (11 -HpDoHE), 13-hydroperoxy-docosahexaenoic acid (13- HpDoHE), 14-hydroperoxy-docosahexaenoic acid (14-HpDoHE), 16-hydroperoxy- docosahexaenoic acid (16-HpDoHE), 17-hydroperoxy-docosahexaenoic acid (17- HpDoHE), 4-hydroxy-
• selected DHA derivatives may be used as therapeutics to promote vasodilation/arterial relaxation (e.g., one or more HDoHEs, EpDPEs, DiHDPEs), inhibit platelet aggregation (e.g., one or more HDoHE, EpEPE, DiHDPE, PDs), attenuate inflammation/inflammatory pain (e.g., one or more HDoHEs, DiHDoHEs, DiHDPEs, PDs, MaRs, RvDs, AT-RvDs), suppress reactive oxygen species generation/oxidative injury (e.g., one or more HDoHEs, PDs), induce PPAR (e.g., one or more HDoHEs), attenuate COX activity (e.g., one or more HDoHEs), attenuate LOX activity (e.g., one or more PDs), improve insulin sensitivity (e.g., one or more PDs), and/or promote wound healing (e.g.,
• the PUFAs or derivatives thereof of the composition may comprise tetracosatetraenoic acid (TTE, a 24-carbon omega-6 VLC-PUFA with four double bonds), tetracosapentaenoic acid (TPA, a 24-carbon omega-3 VLC-PUFA with five double bonds), tetracosahexaenoic acid (THA, a 24-carbon omega-3 VLC- PUFA with six double bonds), or another VLC-PUFA or derivative thereof.
• TTE tetracosatetraenoic acid
• TPA tetracosapentaenoic acid
• TMA tetracosahexaenoic acid
• TMA tetracosahexaenoic acid
• compositions of the present technology comprise EPA as an active ingredient.
• EPA refers to eicosapentaenoic acid (e.g., all-cis eicosa-5, 8,11 ,14,17-pentaenoic acid) in free acid form and/or a pharmaceutically acceptable ester, conjugate, or salt thereof, or mixtures of any of the foregoing.
• the EPA comprises eicosapentaenoic acid.
• the EPA is in the form of an eicosapentaenoic acid ester, for example, a C1 -C5 alkyl ester of eicosapentaenoic acid.
• the EPA comprises eicosapentaenoic acid ethyl ester (also referred to herein as ethyl eicosapentaenoic acid, ethyl eicosapentaenoate, icosapent ethyl, ethyl-EPA, EtEPA, IPE, E-EPA or EPA-E).
• the EPA comprises eicosapentaenoic acid methyl ester, eicosapentaenoic acid propyl ester, or eicosapentaenoic acid butyl ester.
• the EPA comprises lithium eicosapentaenoic acid, a mono-, di- or triglyceride of eicosapentaenoic acid, or any other ester or salt of eicosapentaenoic acid.
• the EPA comprises an EPA-fatty acid conjugate wherein EPA is conjugated to another molecule of EPA or to another fatty acid (or a derivative thereof).
• the EPA-fatty acid conjugate comprises a diester formed between EPA and EPA, or between EPA and a second fatty acid (or a derivative thereof), as shown in structures (I)
• R1 is an acyl group derived from EPA
• R2 is an acyl group derived from a 10 to 30 carbon fatty acid optionally with one or more cis or trans double bonds, or a derivative thereof, where R2 can be the same as or different from R1 ;
• R3 is an alkylene group with one or more hydrogens optionally substituted with an alkyl group, a hydroxyl group, an epoxy group, an aryl group, a phosphate group, or a phosphate group modified with small organic compound.
• R1 and R2 may both be acyl groups derived from EPA (i.e., EPA-EPA conjugate).
• R1 may be derived from EPA, and R2 from a different fatty acid or a derivative thereof (i.e., EPA-fatty acid conjugate), for example, an omega-6 fatty acid such as LA, GLA, DGLA, AA, AdA, and DPA6, or an omega-3 fatty acid such as ALA, SDA, ETA, DPA, and DHA, or a derivative thereof.
• Synthesis of a diester conjugate can be accomplished according to methods well known in the art, including for example, using metals, metal-chlorides, or organic acids as catalysts; using fatty acid chlorides such as EPA-chloride, LA-chloride, conjugated linoleic acid chloride (cLA-chloride), GLA-chloride, DGLA-chloride, AA- chloride, AdA-chloride, DPA6 ALA-chloride, SDA-chloride, ETA-chloride, DPA-chloride, and DHA-chloride.; and using immobilized enzymes as catalysts.
• fatty acid chlorides such as EPA-chloride, LA-chloride, conjugated linoleic acid chloride (cLA-chloride), GLA-chloride, DGLA-chloride, AA- chloride, AdA-chloride, DPA6 ALA-chloride, SDA-chloride, ETA-chloride,
• the EPA-fatty acid conjugate (e.g., EPA-fatty acid diester) comprises a phospholipid-EPA (PL-EPA) conjugate in which the fatty acid at the sn-1 and/or sn-2 position of the phospholipid molecule is replaced with EPA.
• EPA-fatty acid conjugate e.g., EPA-fatty acid diester
• PL-EPA phospholipid-EPA
• an acyl group derived from EPA and a second acyl group derived from EPA or a second fatty acid (or a derivative thereof), are attached to the sn-1 and sn-2 carbons of a phospholipid molecule, as shown in structures (II) where: each of R1 and R2 is an acyl group derived from a 10 to 30 carbon fatty acid optionally with one or more cis or trans double bonds, or a derivative thereof, wherein at least one of R1 and R2 is derived from EPA; and
• X is selected from the group consisting of anion, choline, ethanolamine, glycerol, inositol, and serine.
• the EPA-fatty acid conjugate (e.g., PL- EPA) can also serve as the source of phospholipid of the composition.
• Phospholipids e.g., glycerophospholipids
• a specific fatty acid composition e.g., enriched with EPA
• W02005/038037 Int. J. Mol. Sci. (2014) 15:15244-15258, and J. Oleo Sci. (2017) 66(11 ):1207-1215, the entire contents of each of which are incorporated by reference herein.
• EPA in the embodiments discussed above is illustrative, and the EPA in those embodiments can be replaced with another PUFA or a derivative thereof as disclosed herein, for example, an omega-6 fatty acid such as LA, GLA, DGLA, AA, AdA, and DPA6, or an omega-3 fatty acid such as ALA, SDA, ETA, DPA, and DHA, or a derivative thereof.
• an omega-6 fatty acid such as LA, GLA, DGLA, AA, AdA, and DPA6
• an omega-3 fatty acid such as ALA, SDA, ETA, DPA, and DHA
• the composition contains at least 5%, by weight of the composition, of the one or more PUFAs (e.g., EPA, as the term “EPA” is defined and exemplified herein) or derivatives thereof as disclosed herein, for example, at least 5%, at least 10%, at least 15%, at least 20%, at least 30%, at least 40%, at least 50%, at least 60%, at least 70%, at least 80%, at least 90%, at least 95%, at least 96%, at least 97%, at least 98%, or at least 99% of PUFAs or derivatives thereof, by weight of the composition.
• PUFAs e.g., EPA, as the term “EPA” is defined and exemplified herein
• the composition contains at least 5%, by weight of the composition, of the one or more PUFAs (e.g., EPA, as the term “EPA” is defined and exemplified herein) or derivatives thereof as disclosed herein, for example, at least 5%, at least 10%, at least 15%
• the composition contains a mixture of two or more PUFAs or derivatives thereof as disclosed herein.
• each PUFA or derivative thereof comprises at least 5%, by weight, of the composition, for example, at least 5%, at least 10%, at least 15%, at least 20%, at least 30%, at least 40%, or about 50%, by weight, of the composition.
• the composition contains at least 5%, by weight of the composition, EPA (as the term “EPA” is defined and exemplified herein) or a derivative thereof, for example, at least 5%, at least 10%, at least 15%, at least 20%, at least 30%, at least 40%, at least 50%, at least 60%, at least 70%, at least 80%, at least 90%, at least 95%, at least 96%, at least 97%, at least 98%, or at least 99% EPA or a derivative thereof, by weight of the composition.
• EPA as the term “EPA” is defined and exemplified herein
• the composition contains at least 5%, by weight of the composition, EPA-fatty acid conjugate, for example, at least 5%, at least 10%, at least 15%, at least 20%, at least 30%, at least 40%, at least 50%, at least 60%, at least 70%, at least 80%, at least 90%, at least 95%, at least 96%, at least 97%, at least 98%, or at least 99% EPA-fatty acid conjugate, by weight of the composition.
• EPA-fatty acid conjugate for example, at least 5%, at least 10%, at least 15%, at least 20%, at least 30%, at least 40%, at least 50%, at least 60%, at least 70%, at least 80%, at least 90%, at least 95%, at least 96%, at least 97%, at least 98%, or at least 99% EPA-fatty acid conjugate, by weight of the composition.
• the composition contains no more than 10%, no more than 9%, no more than 8%, no more than 7%, no more than 6%, no more than 5%, no more than 4%, no more than 3%, no more than 2%, no more than 1%, no more than 0.6%, no more than 0.5%, no more than 0.4%, no more than 0.3%, no more than 0.2, or no more than 0.1% of any EPA-fatty acid conjugate other than EPA-EPA diester, by weight of the composition.
• the composition contains a mixture of EPA-fatty acid conjugates, for example, EPA-fatty acid diesters. In some embodiments, the composition contains less than 20%, less than 15%, less than 10%, less than 9%, less than 8%, less than 7%, less than 6%, less than 5%, less than 4%, less than 3%, less than 2%, less than 1%, less than 0.5%, or less than 0.1 % EPA-DHA conjugate (e.g., EPA-DHA diester), by weight of the composition.
• EPA-DHA conjugate e.g., EPA-DHA diester
• EPA is present in the composition in an amount of about 50 mg to about 5000 mg, about 75 mg to about 2500 mg, or about 100 mg to about 1000 mg, for example, about 75 mg, about 100 mg, about 125 mg, about 150 mg, about 175 mg, about 200 mg, about 225 mg, about 250 mg, about 275 mg, about 300 mg, about 325 mg, about 350 mg, about 375 mg, about 400 mg, about 425 mg, about 450 mg, about 475 mg, about
• the composition is formulated for administration to a subject in an amount sufficient to provide a daily dose of EPA (as the term “EPA” is defined and exemplified herein) about 1 mg to about 20,000 mg, about 25 mg to about 10,000 mg, about 50 mg to about 5000 mg, about 75 mg to about 2500 mg, or about 100 mg to about 1000 mg, for example, about 25 mg, about 50 mg, about 75 mg, about 100 mg, about 125 mg, about 150 mg, about 175 mg, about 200 mg, about 225 mg, about 250 mg, about 275 mg, about 300 mg, about 325 mg, about 350 mg, about 375 mg, about 400 mg, about 425 mg, about 450 mg, about 475 mg, about 500 mg, about 525 mg, about 550 mg, about 575 mg, about 600 mg, about 625 mg, about 650 mg, about 675 mg, about 700 mg, about 725 mg, about 750 mg, about 775 mg, about 800 mg, about 825 mg, about 850 mg,
• EPA as the term “
• EPA represents at least 50%, by weight, of all fatty acids or PUFAs present in the composition, for example, at least 50%, at least 60%, at least 66%, at least 70%, at least 75%, at least 80%, at least 85%, at least 90%, at least 95%, at least 96%, at least 97%, at least 98%, at least 99%, or 100%, by weight, of all fatty acids or PUFAs present in the composition.
• the composition comprises ultra-pure EPA.
• ultra-pure as used herein with respect to EPA refers to a composition comprising at least 96%, by weight of the composition, EPA (as the term "EPA” is defined and exemplified herein).
• Ultra-pure EPA can comprise even higher purity EPA, for example, at least 97%, at least 98%, or at least 99%, by weight of the composition, EPA, wherein the EPA is any form of EPA as set forth herein.
• the composition contains no more than 20%, no more than 15%, no more than 10%, no more than 9%, no more than 8%, no more than 7%, no more than 6%, no more than 5%, no more than 4%, no more than 3%, no more than 2%, no more than 1 %, no more than 0.6%, no more than 0.5%, no more than 0.4%, no more than 0.3%, no more than 0.2, or no more than 0.1% of, by weight of total fatty acids or PUFAs present in the composition, of any PUFA or derivative thereof other than EPA.
• the composition contains no more than 20%, no more than 15%, no more than 10%, no more than 9%, no more than 8%, no more than 7%, no more than 6%, no more than 5%, no more than 4%, no more than 3%, no more than 2%, no more than 1 %, no more than 0.6%, no more than 0.5%, no more than 0.4%, no more than 0.3%, no more than 0.2, or no more than 0.1% of, by weight of total fatty acids or PUFAs present in the composition, DHA (e.g., ethyl-DHA or EDHA) or a derivative thereof, if any.
• the composition contains substantially no DHA (e.g., EDHA) or derivatives thereof.
• the composition contains no DHA (e.g., EDHA) or derivatives thereof.
• the composition contains less than 30%, less than 20%, less than 15%, less than 10%, less than 9%, less than 8%, less than 7%, less than 6%, less than 5%, less than 4%, less than 3%, less than 2%, less than 1%, less than 0.5%, or less than 0.25%, by weight of the composition, or by weight of all fatty acids or PUFAs present in the composition, of any PUFA or derivative thereof other than EPA.
• Illustrative examples of a “PUFA or derivative thereof other than EPA” include LA (e.g., ethyl-LA) or a derivative thereof, GLA (e.g., ethyl-GLA) or a derivative thereof, DGLA (e.g., ethyl-DGLA) or a derivative thereof, AA (e.g., ethyl-AA) or a derivative thereof, AdA (e.g., ethyl-AdA) or a derivative thereof, DPA6 (e.g., ethyl-DPA6) or a derivative thereof, ALA (e.g., ethyl-ALA) or a derivative thereof, SDA (e.g., ethyl- SDA) or a derivative thereof, ETA (e.g., ethyl-ETA) or a derivative thereof, DPA (ethyl- DPA) or a derivative thereof, and DHA (e.g., eth
• the source of phospholipid of the composition can comprise a glycerophospholipid, a lysophospholipid, or mixtures thereof.
• the source of phospholipid comprises a glycerophospholipid.
• Glycerophospholipids are glycerol-based phospholipids characterized by a glycerol backbone with a polar phosphodiester group attached to the sn-3 carbon and two fatty acid-derived acyl groups attached to the sn-1 and sn-2 carbons. Glycerophospholipids are the main component of biological membranes.
• Non-limiting examples of glycerophospholipids include phosphatidic acid or phosphatidate (PA), phosphatidylcholine (PC), phosphatidylethanolamine (PE), phosphatidylglycerol (PG), phosphatidylinositol (PI), and phosphatidylserine (PS).
• Glycerophospholipids may be obtained from krill oil, refined, and optionally enriched with a particular fatty acid such as EPA.
• the source of phospholipid comprises a lysophospholipid (LPL).
• LPLs are glycerophospholipids in which one acyl chain is lacking and only one hydroxyl group of the glycerol backbone is acylated. 1 - Lysophospholipids (1 -LPLs) maintain the acyl chain at the sn-2 position, whereas 2- lysophospholipids (2-LPLs) are only acylated at the sn-1 position.
• LPLs are small bioactive lipid molecules characterized by a single carbon chain and a polar head group.
• LPLs are bioactive signaling lipids that are generated from phospholipase-mediated hydrolyzation of membrane phospholipids and sphingolipids.
• Non-limiting examples of LPLs include sn-1 -acyl-glycerol-3-phosphate, sn-2-acyl-glycero-3-phosphate, lysophosphatidic acid (LPA or lysoPA), lysophosphatidylcholine (LPC or lysoPC), lysophosphatidylethanolamine (LPE or lysoPE), lysophosphatidylglycerol (LPG or lysoPG), lysophosphatidylinositol (IPI or lysoPI), and lysophosphatidylserine (LPS or lysoPS).
• the acyl chains of a glycerophospholipid or an LPL can be derived from any fatty acids, for example, ten to thirty long-chain hydrocarbon (C10-C30) fatty acids. These fatty acids can be straight-chained or branched, saturated or unsaturated (e.g., containing one or more cis or trans double bonds).
• the acyl chains can be derived from PUFAs or derivatives thereof as described herein, including, for example, LA, GLA, DGLA, AA, AdA, DPA6, ALA, SDA, ETA, EPA, DPA, DHA, or a derivative thereof.
• the source of phospholipid is lecithin.
• Lecithin is usually a mixture of glycerophospholipids including PA, PC, PE, PG, PI, PS, and LPLs. It has low solubility in water but can serve as an excellent emulsifier in aqueous solutions. Lecithin can be obtained from different sources, for example, soybean, milk, egg yolk, marine foods, rapeseed, cottonseed, and sunflower oil, with (purified and/or chemically modified) soybean lecithin being the most common commercially available form.
• the lecithin is soy lecithin, for example, MetarinTM P (Cargill, MN).
• the content of each glycerophospholipid and/or LPL within the mixture can vary.
• the ratio of PE:PI within the lecithin may be especially important, as certain PUFA favors certain phospholipid (e.g., EPA favors PE while AA favors PI), and thus the relative content of PE:PI within lecithin may affect the bioavailability of the PUFA component in vivo.
• the weight ratio of PE and PI in the source of phospholipid ranges from about 5:1 (favoring PE) to 1 :5 (favoring PI), for example, about 2:1 (favoring PE) to 1 :2 (favoring PI).
• the source of phospholipid (e.g., lecithin) is enriched with PE and/or restricted with PI.
• the source of phospholipid comprises up to 40%, up to 60%, up to 80%, up to 90%, up to 95%, or up to 97%, by weight of the source of phospholipid, PE, and no more than 5%, no more than 4%, no more than 3%, no more than 2%, or no more than 1 %, by weight of the source of phospholipid, PI.
• the source of phospholipid (e.g., lecithin) comprises up to 40%, up to 60%, up to 80%, or up to 85%, by weight of the source of phospholipid, PE, and no more than 10%, no more than 5%, no more than 4%, no more than 3%, no more than 2%, or no more than 1 %, by weight of the source of phospholipid, PI.
• a source of phospholipid enriched with PE and/or restricted with PI may be derived from a natural source or may be obtained by chemical processes known to a person skilled in the art, including, for example, separation by density and chemical precipitation.
• the composition contains 1 % to 85% of the source of phospholipid (e.g., lecithin), by weight of the composition, for example, at least 1 %, at least 2%, at least 3%, at least 4%, at least 5%, at least 10%, at least 15%, at least 20%, at least 25%, at least 30%, at least 35%, at least 40%, at least 45%, at least 50%, at least 55%, at least 60%, at least 65%, at least 70%, at least 75%, at least 80%, or 85% of the source of phospholipid, by weight of the composition.
• the source of phospholipid e.g., lecithin
• the composition contains no more than 85 %, no more than 80%, no more than 75%, no more than 70%, no more than 65%, no more than 60%, no more than 55%, no more than 50%, no more than 45%, no more than 40%, no more than 35%, no more than 30%, no more than 25%, no more than 20%, no more than 15%, no more than 10%, no more than 5%, or no more than 1% of the source of phospholipid, by weight of the composition.
• the composition optionally further comprises one or more additional emulsifiers.
• emulsifiers include polyoxyethylene hydrogenated castor oil, polyoxyethylene sorbitan fatty acid ester, polyoxyethylene castor oil, polyethylene glycol fatty acid ester, polyoxyethylene polyoxypropylene glycol, sucrose fatty acid ester, and lecithin.
• the emulsifier is polysorbate 80, polyoxyl-35, or both.
• the emulsifier comprises one or more glycerol derivatives selected from the group consisting of triacylglycerol, diacylglycerol, and monoacylglycerol.
• the glycerol derivative is castor oil.
• the glycerol derivative may also be a re-esterified triglyceride (rTG) enriched with the PUFA of the composition (e.g., EPA).
• rTG re-esterified triglyceride
• a “re-esterified triglyceride” is a chemically synthesized triglyceride.
• a re-esterified triglyceride enriched with EPA can be synthesized according to methods disclosed, for example, in J.
• the composition contains 1 % to 20%, by weight of the composition, of the one or more emulsifiers, for example, at least 1%, at least 2%, at least 3%, at least 4%, at least 5%, at least 6%, at least 7%, at least 8%, at least 9%, at least 10%, at least 11%, at least 12%, at least 13%, at least 14%, at least 15%, at least 16%, at least 17%, at least 18%, at least 19%, or 20% of the one or more emulsifiers, by weight of the composition.
• the one or more emulsifiers for example, at least 1%, at least 2%, at least 3%, at least 4%, at least 5%, at least 6%, at least 7%, at least 8%, at least 9%, at least 10%, at least 11%, at least 12%, at least 13%, at least 14%, at least 15%, at least 16%, at least 17%, at least 18%, at least 19%, or 20% of
• the composition contains no more than 20%, no more than 15%, no more than 10%, no more than 9%, no more than 8%, no more than 7%, no more than 6%, no more than 5%, no more than 4%, no more than 3%, no more than 2%, or no more than 1 % of the one or more emulsifiers, by weight of the composition.
• the composition contains 1 % to 85%, by weight of the composition, of additives (e.g., phospholipids and/or emulsifiers), for example, at least 1%, at least 2%, at least 3%, at least 4%, at least 5%, at least 10%, at least 15%, at least 20%, at least 25%, at least 30%, at least 35%, at least 40%, at least 45%, at least 50%, at least 55%, at least 60%, at least 65%, at least 70%, at least 75%, at least 80%, or 85% of the additives, by weight of the composition.
• additives e.g., phospholipids and/or emulsifiers
• the composition contains no more than 85%, no more than 80%, no more than 75%, no more than 70%, no more than 65%, no more than 60%, no more than 55%, no more than 50%, no more than 45%, no more than 40%, no more than 35%, no more than 30%, no more than 25%, no more than 20%, no more than 15%, no more than 10%, no more than 5%, or no more than 1 % of the additives, by weight of the composition.
• the composition contains a fixed dose of the PUFA (e.g., EPA) or derivative thereof, along with a varying dose of the source of phospholipid and a varying dose of the emulsifier compared to the PUFA or derivative thereof.
• PUFA e.g., EPA
• the weight ratio between the PUFA or derivative thereof and the source of phospholipid in the composition ranges from about 20:1 (favoring PUFA or derivative thereof) to about 1 :5 (favoring source of phospholipid), for example, about 5:1 (favoring PUFA or derivative thereof) to about 1 :5 (favoring source of phospholipid), about 3.75:1 (favoring PUFA or derivative thereof) to about 1 :5 (favoring source of phospholipid), or about 1 :1 to about 1 :5 (favoring source of phospholipid). In some embodiments, the weight ratio between the PUFA or derivative thereof and the emulsifier in the composition ranges from 10:1 (favoring PUFA or derivative thereof) to 1 :1.
• LR-EtEPA lymph-releasing EPA formulation
• EtEPA eicosapentaenoic acid ethyl ester
• IPE eicosapentaenoic acid ethyl ester
• the composition may optionally further comprise one or more emulsifiers, for example, polysorbate 80, polyoxyl-35, or both.
• co-formulation of EtEPA with phospholipids and/or emulsifiers facilitates the in vivo formation of an esterified EPA substrate upon administration, thus causing the EPA to be absorbed bound to the phospholipid and re-routing the EPA to the lymphatic system for delivery to target tissues.
• the phospholipids and/or emulsifiers in the LR-EtEPA formulation can also be referred to as LR compounds.
• the source of phospholipid is lecithin, for example, soy lecithin (e.g., MetarinTM P).
• lecithin for example, soy lecithin (e.g., MetarinTM P).
• the LR-EtEPA composition in the embodiments discussed above is illustrative, and a similar lymph-releasing composition may be formulated with another PUFA or a derivative thereof as disclosed herein, for example, an omega-6 fatty acid such as LA, GLA, DGLA, AA, AdA, and DPA6, or an omega-3 fatty acid such as ALA, SDA, ETA, DPA, and DHA, or a derivative thereof.
• an omega-6 fatty acid such as LA, GLA, DGLA, AA, AdA, and DPA6
• an omega-3 fatty acid such as ALA, SDA, ETA, DPA, and DHA
• the composition comprising one or more PUFAs or derivatives thereof, a source of phospholipid, and optionally one or more additional emulsifiers according to various embodiments disclosed herein can be formulated as one or more dosage units.
• dosage unit refers to a portion of a pharmaceutical composition that contains an amount of a therapeutic agent suitable for a single administration to provide a therapeutic effect.
• composition and “pharmaceutical composition” are used interchangeably.
• dosage units may be administered one to a plurality (i.e., 2, 3, 4, 5, or more) of times per day, or as many times as needed to elicit a therapeutic response.
• the composition is orally deliverable or in a form suitable for oral administration.
• oral administration includes any form of delivery of a pharmaceutical composition to a subject wherein the composition is placed in the mouth of the subject, whether or not the composition is swallowed.
• the dosage unit is a capsule, i.e., the composition is formulated in one or more capsules, for example, soft gelatin capsules.
• the one or more capsules may be packaged in a blister pack or a receptacle (e.g., bottle).
• the PUFAs e.g., EtEPA
• the source of phospholipid e.g., lecithin
• optionally one or more additional emulsifiers can be co-formulated in the same dosage unit or can be individually formulated in separate dosage units.
• EtEPA and the source of phospholipid e.g., lecithin
• the capsules containing EtEPA and the capsules containing the source of phospholipid may be packaged in separate bottles or blister packs; alternatively, they may be packaged in the same bottle or blister pack.
• the composition is formulated for administration alone or with food.
• the composition has injectable formulations, lyophilized formulations, or liquid formulations, depending on the routes of administration.
• the composition may have various formulations for injection and/or infusion, for example, intravenous injection, intraperitoneal injection, intertumoral injection, bone marrow injection, lymph node injection, subcutaneous injection, and cerebrospinal fluid injection.
• the composition can be provided in a ready-to-hang formulation for enteric use in, for example, the intensive care unit (ICU) setting to treat SIRS, sepsis, and/or ARDS.
• ICU intensive care unit
• lymph fluid shall be understood to encompass both the acellular and cellular components of lymph. Because the cellular compartment of lymph is predominantly lymphocytes, these embodiments may also involve enriching immune cells with the PUFA or derivative thereof and thereby encompass conditions affecting lymphocytes.
• therapeutically effective amount refers to an amount which is sufficient to effect treatment, as defined herein, when administered to a mammal in need of such treatment.
• the therapeutically effective amount will vary depending on the subject and disease state being treated, the severity of the affliction and the manner of administration, and may be determined routinely by one of ordinary skill in the art.
• EPA Long chain fatty acids like EPA can enter the circulation by two routes, the portal vein route and the lymphatic route. As shown in FIG. 1 A, once EPA is absorbed in the intestine, the EPA circulation is bifurcated, i.e., it can either travel down the lymphatic vessel and bypass the liver and visceral adipose entirely; or it can travel down the portal vein where (1 ) visceral adipose can sequester EPA, and (2) the liver takes up EPA, and the fatty acid is oxidized, modified, or allowed to pass through. EPA that travels down the portal vein undergoes significant adipose sequestration and hepatic first pass losses and the resulting circulation of EPA is diminished.
• EPA that travels down the lymphatic vessel can avoid visceral and hepatic first pass losses resulting in the enhanced delivery of EPA to the first tissue bed it encounters, which is the lung. Delivery of fat-soluble drugs to the lung benefits from high perfusion rate, as the lung get 100% of cardiac output. After the lung, the EPA is circulated through the aorta which supplies blood and nutrients to the coronary and carotid arteries and the rest of the body. EPA that bypasses visceral adipose and the liver (and any associated first pass losses) enhances cardiopulmonary and cerebrovascular EPA uptake including coronary, carotid, and vertebral arteries.
• phospholipids e.g., lecithin
• emulsifiers e.g., EtEPA
• preferred routing through the lymphatic system e.g., preferred routing through the lymphatic system
• bioavailability of active ingredient at tissue and cell levels e.g., preferred routing through the lymphatic system
• co-administration of EtEPA with phospholipids results in the in vivo formation of an esterified EPA substrate thus causing the EPA to be delivered as a phospholipid.
• composition of the present technology enters the small intestine, a cross-esterification process is believed to take place between EPA and the fatty acid component of the phospholipid molecule, giving rise to PL-EPA.
• Said EPA-phospholipid compound is primed for uptake by cells such as enterocytes because it is in a phospholipid matrix.
• enterocytes the EPA would get secreted from the enterocyte being bound to the phospholipid and/or to triglyceride.
• the presence of excess phospholipid substrate from administered phospholipids is expected to enhance incorporation into enterocyte-secreted lipoproteins as phospholipid-EPA in LR-EtEPA compared to plain EtEPA.
• phospholipid provision not only enhances absorption and uptake by the enterocyte, but it also promotes EPA re-assembly esterified to phospholipids, priming it for cellular uptake and integration into cell membranes. Not only so, but phospholipids also facilitate chylomicron and/or intestinal very-low density lipoprotein (l-VLDL) assembly and secretion by enterocytes. Because chylomicrons and l-VLDL are primarily secreted into the lymph, the composition of the present technology facilitates re-routing of EPA to the chylomicrons/l-VLDL and thence to the lymph, thereby avoiding hepatic and adipose first pass visceral loss associated with the portal vein route.
• l-VLDL very-low density lipoprotein
• This routing positions the heart and lungs as the first pass organs, thus increasing EPA concentrations and the EPA/AA ratio in various tissues (e.g., in lungs, heart, brain, kidney, intestines, and pancreas) (FIG. 1 B).
• visceral adipose traps about 50% of fatty acids that present to the portal vein. It is known that long chain polyunsaturated fatty acids (LC-PUFAs), including EPA, are taken up by adipose tissue in general, from studies of subcutaneous adipose. It is expected that visceral adipose incorporates EPA even more readily than subcutaneous adipose, since it is exposed to greater quantities of EPA in the alimentary form. Thus, visceral adipose may divert about half of the EPA presenting to the portal vein, by either storing it for an indeterminate amount of time or catabolizing it by betaoxidation in situ.
• LC-PUFAs long chain polyunsaturated fatty acids
• the 50% of fatty acids that bypass visceral adipose trapping present to the liver typically receives about 75% of its blood by the portal vein, and only 25% from the hepatic artery.
• Alimentary EPA presenting to the liver via the portal vein is subjected to first pass metabolism, which could include elongation and desaturation to form other LC-PUFAs, oxygenation to form oxylipins, or beta-oxidation for use as metabolic fuel.
• first pass metabolism could include elongation and desaturation to form other LC-PUFAs, oxygenation to form oxylipins, or beta-oxidation for use as metabolic fuel.
• the lymph-releasing EtEPA composition of the present technology (LR-EtEPA) more than doubles (2.4 times) lymph EPA levels compared to plain EtEPA composition given at equimolar doses of EtEPA (FIG. 1A).
• LR-EtEPA also significantly increases EPA levels in the first pass organs, the lungs (1.7 times) and heart (2.0 times), and in the brain (1.7 times), compared to EtEPA.
• EPA/AA ratios were also increased in the same tissues/organs by LR-EtEPA, including, for example, 2.6 times as much as the level from plain EtEPA for lungs, 2.0 times for the heart, 1 .8 times for the brain, and 2.9 times for AVMs.
• lymphreleasing effects, as well as the corresponding improved bioavailability in lymph and enhanced drug delivery to tissues, of the composition and its additives are expected to apply to other PUFAs and derivatives thereof.
• the present technology provides a superior formulation for delivering PUFAs and derivatives thereof to various tissues and cells of the body, which presents great therapeutic potential for a variety of diseases.
• the phospholipid of the composition need not be administered at the same rate as the fatty acid component, as intestinal absorption of fatty acids and subsequent delivery to the lymph can be discontinuous. Accordingly, in certain medical contexts, it may be advantageous to provide the phospholipid over a longer period than the fatty acid. This would also help to better distribute the volume load of the composition.
• a method of treating and/or preventing a cardiopulmonary, cardiovascular, and/or cerebrovascular disease in a subject in need thereof by administering to the subject a composition of the present technology e.g., the lymph-releasing EPA formulation (LR-EtEPA), excels at re-routing EPA to the lymphatic system and delivering EPA to tissues and cells including the heart, lungs, and brain.
• LR-EtEPA lymph-releasing EPA formulation
• LR- EtEPA is superior to EtEPA alone at enhancing coronary arteries with EPA, suggesting its therapeutic potential in diseases such as atherosclerosis and vasculitis affecting the coronary arteries, carotid arteries, vertebral arteries, and the cerebrovascular system in general. Due to the therapeutic effects of EPA, it is believed that the composition of the present technology is particularly useful for delivering EPA to target tissues and cells and treating diseases including those associated with the heart, lungs, and brain.
• treatment or “treating” in relation to a given disease or disorder includes, but is not limited to, inhibiting the disease or disorder, for example, arresting the development of the disease or disorder; relieving the disease or disorder, for example, causing regression of the disease or disorder; or relieving a condition caused by or resulting from the disease or disorder, for example, relieving, preventing or treating symptoms of the disease or disorder.
• prevention or “preventing” in relation to a given disease or disorder includes preventing the onset of disease development if none had occurred; preventing the disease or disorder from occurring in a subject that may be predisposed to the disorder or disease but has not yet been diagnosed as having the disorder or disease; and/or preventing further disease/disorder development if already present.
• a method of treating and/or preventing a cardiovascular and/or cerebrovascular disease, or reducing risks of a cardiovascular and/or cerebrovascular disease, in a subject in need thereof comprising administering to the subject a therapeutically effective amount of a composition comprising one or more PUFA or derivatives thereof and a source of phospholipid according to various embodiments disclosed herein.
• cardiovascular disease refers to any disease or disorder of the heart (cardiac diseases or disorders) or blood vessels (vascular diseases or disorders) or any symptom thereof.
• cardiovascular diseases include hypertriglyceridemia, hypercholesterolemia, mixed dyslipidemia, coronary heart disease, stroke, atherosclerosis, arrhythmia, hypertension, myocardial infarction, vasculitis, cardiomyopathy (e.g., viral cardiomyopathy including related to COVID-19), pericarditis, congestive heart failure, myocardial necrosis, vascular ischemia, vascular disease beyond the cardiopulmonary system, thrombotic disease, post-myocardial infarction cardiac remodeling, giant cell arteritis, polyarteritis nodosa, cryoglobulinemia, episodic small-vessel ischemia (Raynaud’s disease), deep venous thrombosis, disseminated intravascular coagulation, erectile dysfunction, and other cardiovascular or related diseases
• a “vascular disease beyond the cardiopulmonary system” includes vasculitis outside the cardiopulmonary system, including the carotid and vertebral arteries and branches therefrom and vasculitis affecting peripheral arteries (e.g., aortitis, renal vasculitis); and atherosclerosis outside the cardiopulmonary system, including the carotid, vertebral, and peripheral arteries and branches therefrom.
• a “thrombotic disease” includes disseminated intravascular coagulation, other diseases involving excessive platelet activation, venous thrombosis, and thrombotic events related to major adverse cardiovascular events.
• a method of delaying an onset of a cardiovascular and/or cerebrovascular event in a subject in need thereof comprising administering to the subject a therapeutically effective amount of a composition comprising PUFAs or derivatives thereof and a source of phospholipid according to various embodiments disclosed herein.
• the term “an onset of a cardiovascular and/or cerebrovascular event” refers to a first appearance of a sign and/or symptom of the cardiovascular and/or cerebrovascular event.
• delaying an onset of a cardiovascular and/or cerebrovascular event prevents the subject from experiencing the cardiovascular and/or cerebrovascular event and/or developing any further symptoms of the cardiovascular and/or cerebrovascular event.
• Non-limiting examples of cardiovascular and/or cerebrovascular events include non-fatal myocardial infarction, stroke, cardiovascular death, unstable angina, coronary revascularization, carotid revascularization, peripheral revascularization, cerebrovascular accident, transient ischemic attached, and hospitalization for unstable angina.
• the subject to be treated for a cardiopulmonary, cardiovascular, and/or cerebrovascular disease has a fasting baseline triglyceride level (or a median fasting baseline triglyceride level in the case of a subject group) of about 135 mg/dL to about 500 mg/dL, for example, about 135 mg/dL to less than 500 mg/dL, about 150 mg/dL to less than 500 mg/dL, about 200 mg/dL to less than 500 mg/dL, or about 200 mg/dL to about 499 mg/dL.
• a fasting baseline triglyceride level or a median fasting baseline triglyceride level in the case of a subject group
• the subject has a fasting baseline triglyceride level (or a median fasting baseline triglyceride level in the case of a subject group) of about 135 mg/dL, about 140 mg/dL, about 145 mg/dL, about 150 mg/dL, about 155 mg/dL, about 160 mg/dL, about 165 mg/dL, about 170 mg/dL, about 175 mg/dL, about 180 mg/dL, about 185 mg/dL, about 190 mg/dL, about 195 mg/dL, about 200 mg/dL, about 205 mg/dL, about 210 mg/dL, about 215 mg/dL, about 220 mg/dL, about 225 mg/dL, about 230 mg/dL, about 235 mg/dL, about 240 mg/dL, about 245 mg/dL, about 250 mg/dL, about 255 mg/dL, about 260 mg/dL, about 265 mg/dL,
• the subject has a fasting baseline triglyceride level (or a median fasting baseline triglyceride level in the case of a subject group) of about 135 mg/dL or higher, about 150 mg/dL or higher, about 200 mg/dL or higher.
• the subject has a fasting baseline triglyceride level (or a median fasting baseline triglyceride level in the case of a subject group) of about 500 mg/dL or higher.
• the subject has one or more of: a baseline non-high- density lipoprotein cholesterol (HDL-C) value of about 200 mg/dL to about 300 mg/dL; a baseline total cholesterol (TC) value of about 250 mg/dL to about 300 mg/dL; a baseline very low-density lipoprotein cholesterol (VLDL-C) value of about 140 mg/dL to about 200 mg/dL; a baseline HDL-C value of about 10 mg/dL to about 30 mg/dL; a baseline low-density lipoprotein cholesterol (LDL-C) value of about 40 mg/dL to about 100 mg/dL; and/or a baseline high-sensitivity C-reactive protein (hsCRP) level of about 2 mg/dL or less.
• HDL-C non-high- density lipoprotein cholesterol
• TC total cholesterol
• VLDL-C very low-density lipoprotein cholesterol
• LDL-C low-density lipoprotein cholesterol
• hsCRP baseline high-sensitivity
• the subject is on stable statin therapy, e.g., administered with a statin (with or without ezetimibe).
• the statin therapy may include one or more of: atorvastatin, fluvastatin, lovastatin, pitavastatin, pravastatin, rosuvastatin, and simvastatin.
• the statin therapy includes administration of a statin and ezetimibe.
• the statin therapy includes administration of a statin without ezetimibe.
• the subject upon administration of the composition, the subject exhibits one or more of:
• VEGF vascular endothelial growth factor
• TNF-a tumor necrosis factor-a
• MCP-1 monocyte chemoattractant protein-1
• IL-1 P interleukin-1 p
• slCAM-1 soluble intercellular adhesion molecule-1
• sVCAM-1 soluble vascular cellular adhesion molecule-1
• hsCRP high sensitivity reactive protein
• Lp-PLA2 lipoprotein-associated phospholipase A2
• a metabolic biomarker selected from the group consisting of total cholesterol, VLDL-C, remnant lipoprotein cholesterol, LDL-
• oxidative biomarker selected from the group consisting of lipid oxidation, lipid peroxidation, lipid hydroperoxidation, malondialdehyde, prostaglandin-2 alpha (PGF-2a), platelet-derived growth factor (PDGF), and antioxidant potential compared to baseline or control; and
• unstable angina e.g., unstable angina determined to be caused by myocardial ischemia by, for example, invasive or non-invasive testing, and requiring hospitalization
• cardiac arrest peripheral cardiovascular disease requiring intervention, angioplasty, bypass surgery or aneurysm repair
• death sudden cardiac death
• Parameters described herein can be measured in accordance with any clinically acceptable methodology.
• triglycerides, total cholesterol, HDL- C, and fasting blood sugar can be sampled from serum and analyzed using standard photometry techniques.
• VLDL-TG, LDL-C, and VLDL-C can be calculated or determined using serum lipoprotein fractionation by preparative ultracentrifugation and subsequent quantitative analysis by refractometry or by analytic ultracentrifugal methodology.
• Apo A-1 , Apo B, and hsCRP can be determined from serum using standard nephelometry techniques.
• LDL-C and remnant cholesterol can be determined by fast protein electrophoresis, ultracentrifugal methods, or immunolabeling methods. These techniques are described in detail in standard textbooks, for example, Tietz Fundamentals of Clinical Chemistry, 6th Ed. (Burtis, Ashwood and Borter Eds.), WB Saunders Company.
• Pulmonary disease including sepsis, SIPS, and/or APDS
• a method of treating and/or preventing a pulmonary disease in a subject in need thereof comprising administering to the subject a therapeutically effective amount of a composition comprising PUFAs or derivatives thereof and a source of phospholipid according to various embodiments disclosed herein.
• a “pulmonary disease” includes, but is not limited to, the following types of diseases: parenchymal diseases of the lung including acute inflammatory or thrombotic diseases (e.g., community-acquired pneumonia, COVID-19 pneumonia, sepsis, SIRS, ARDS, pulmonary embolism, diffuse interstitial pneumonia, radiation pneumonitis, pleuritis, acute eosinophilic pneumonia, chronic eosinophilic pneumonia, Loftier syndrome); chronic pulmonary diseases (e.g., sarcoidosis, interstitial lung disease, chronic obstructive pulmonary disease (COPD), reactive airway disease, asthma, bronchiectasis, bronchiolitis, cystic fibrosis, bronchial carcinoid); vascular diseases of the lung (e.g., pulmonary arterial hypertension, pulmonary vasculitis, microscopic polyangiitis, granulomatosis with polyangiitis (Wegener’s disease), eosinophil
• the lymph-releasing compositions of the present technology are superior at delivering fat-soluble drugs such as fatty acids to the lungs because the delivery is dependent on perfusion rate and lungs have the highest perfusion rate in the body, suggesting that the lymph-releasing compositions may be particularly useful for treating pulmonary diseases.
• LC-PUFAs long-chain PUFAs
• LC-PUFAs are intimately involved in the tissue injury response, as LC-PUFAs within cell membrane phospholipids are liberated as one of the earliest steps of the inflammatory cascade.
• LC-PUFAs are fatty acids having at least 18 carbon atoms. Once liberated from membrane phospholipids, LC-PUFAs, especially those that are 18 or 20 carbons long, are oxidized by several enzymes yielding a variety of bioactive metabolites known as oxylipins.
• Enzymes facilitating 18-, 20-, and 22-carbon LC-PUFA oxygenation include cyclooxygenase (COX), lipoxygenase (LOX), and cytochrome P450 epoxygenase (CYP).
• COX cyclooxygenase
• LOX lipoxygenase
• CYP cytochrome P450 epoxygenase
• the best-known exemplar of this process is arachidonic acid (AA or ARA, also known as omega-6 eicosatetraenoic acid), a 20-carbon LC-PUFA bearing four double bonds, the last of which is in the omega-6 position.
• the oxidation enzymes yield numerous bioactive compounds that influence the ensuing inflammatory, thrombotic, vasoconstrictive and bronchoconstrictive responses, including a series of prostanoids (e.g., prostaglandins and prostacyclin), thromboxanes, leukotrienes, and a proliferation of mono-, di-, and tri-alcohols, epoxides, ketones, and related compounds.
• prostanoids e.g., prostaglandins and prostacyclin
• oxygenation cascade also being called the “eicosanoid” cascade, referring to its strong association with 20-carbon LC-PUFAs, despite that oxygenated metabolites of 18-carbon PUFAs (octadecosanoids) typically comprise the majority of oxylipins under unbiased oxylipinomics screening. Indeed, other LC-PUFAs are also oxidized by these same enzymes to a similar or lesser extent, including oxygenated metabolites of 22-carbon PUFAs (docosanoids). However, absent exogenous dosing of the parent fatty acids, few are present at levels comparable to AA.
• the oxidative metabolites of other LC-PUFAs may not have the same or any biological effects compared to those from AA. Nor are their levels easily predicted from levels of their parent fatty acid, owing to differences in oxygenating enzyme action. Given the pro-inflammatory, pro- thrombotic, vasoconstrictive, and bronchoconstrictive roles of AA-derived oxylipins, to the extent that these other octadecosanoids, eicosanoids, and docosanoids displace AA, one skilled in the art would appreciate that this could provide a therapeutic advantage at curbing the inflammatory, thrombotic, vasoconstrictive, and bronchoconstrictive responses.
• EPA is a particularly strong contender for distinct therapeutic advantages. Not simply an LC-PUFA, EPA is a 20- carbon PUFA like AA, and only differs from the latter insofar as it has one more double bond, toward the end of the molecule (i.e., at the omega-3 position vs the omega-6 position in AA). As such, EPA interacts with the same suite of enzymes that oxidize AA, and its metabolic byproducts (e.g., oxylipins) are analogous to those of AA. At the same time, the shape of the EPA-derived metabolites differs from those of AA by the presence of the “extra” double bond at the end.
• the oxylipins formed from EPA vary in their bioactivity compared to those from AA.
• thromboxanes originating from EPA are less thrombotic, and therefore less likely to propagate runaway thrombosis.
• prostanoids originating from EPA are less apt to stimulate the inflammatory and vasoconstrictive cascades and attendant ischemia.
• leukotrienes originating from EPA are less apt to stimulate the inflammatory and bronchospastic/bronchoconstrictive cascades.
• DPA a 22-carbon LC-PUFA with five double bonds
• DHA a 22-carbon LC-PUFA with six double bonds
• DGLA a 20-carbon LC-PUFA with three double bonds
• fatty acids can vary considerably in terms of their affinity to the oxygenation enzymes. Accordingly, DPA and DHA not only have more double bonds than AA, but they also have two additional carbons in the PUFA chain. In that regard, DHA is farther afield than EPA owing to the “extra” carbons and two “extra” double bonds compared to AA.
• DGLA features 20 carbons and has one fewer double bond than AA. Its precursor, GLA (a 18-carbon LC-PUFA with 3 double bonds), can be given orally and is enriched in certain food (e.g., borage oil).
• GLA a 18-carbon LC-PUFA with 3 double bonds
• DGLA is itself converted to AA in vivo. This raises the possibility that the GLA/DGLA approach would undermine its own efficacy by increasing AA levels in vivo.
• EPA does not share this problem, as EPA is not converted to AA as part of its metabolism. Rather, EPA is more likely to be oxidized in parallel with AA and can also be elongated into DPA and DHA.
• compositions with high purity of EPA are expected to moderate the ill effects of over-exuberant AA oxygenation and activation seen in conditions such as SIRS, sepsis, and ARDS in a manner superior to other pharmaceutical compositions that employ a mixture of fatty acids.
• Oxepa® is one such pharmaceutical composition used to treat sepsis and ARDS containing a variety of excipients and mixture of fatty acids (e.g., EPA, GLA, and DHA), some of which can turn into AA in vivo and thus raise AA levels and contribute to the body’s inflammatory cascade (FIG. 31 C).
• Oxepa® also contains numerous other fatty acids, which could “dilute” the impact of the product in mitigating the ill effects of AA’s oxylipins. Namely, other fatty acids in Oxepa® would naturally compete with GLA, EPA, and DHA for transport and especially for residence in cell membranes and tissue delivery.
• LR-EtEPA would be dosed opposite dietary fat loads to avoid diluting its efficacy by providing competing fatty acids.
• a composition of high purity EPA and substantially no contamination from other fatty acids will likely not raise AA levels in vivo and instead compete with AA to mitigate its inflammatory effects.
• E+G+D itself was often superior to the referent therapy, an equimolar dose of oleic acid (OA); thus, E+G+D demonstrated efficacy at displacing AA by raising the fatty acids comprising OXP.
• OA oleic acid
• oxylipins from EPA, DGLA, and DHA to thereby improve ARDS, namely, by diminishing tissue AA levels in favor of fatty acids whose oxylipins are less inflammatory, thrombotic, vasoconstrictive, and most especially, bronchoconstrictive.
• superiority of plain EtEPA and especially LR-EtEPA imply that that these would improve upon EPA+GLA+DHA, and in the case of LR-EtEPA, by a several-fold improvement in AA-displacement by medicinal oxylipin precursors.
• EPA might further decrease AA levels by altering A8-desaturase (D8D) and A5-desaturase (D5D) enzymes, which respectively facilitate DGLA synthesis and suppress subsequent catabolism yielding AA in the omega-6 PUFA pathway (FIG. 2).
• D8D A8-desaturase
• D5D A5-desaturase
• EPA could effectively reduce AA levels and increase metabolites that compete with AA.
• fatty acids other than EPA not only “dilute” the anti-inflammatory effect of EPA, but they may also compete with EPA for the cross-esterification process with the phospholipids of the composition, thereby reducing the absorption and bioavailability of EPA in lymph and at tissue level. Therefore, it is contemplated that the lymph-releasing EPA composition of the present technology (LR-EtEPA) is especially valuable and useful to treat diseases involving inflammation, vasoconstriction, and bronchoconstriction from AA-derived oxylipins through the pulmonary route, and it would have an advantage over plain EtEPA, and both would have an advantage over compositions of mixture of fatty acids such as Oxepa®.
• LR-EtEPA lymph-releasing EPA composition of the present technology
• a method of treating and/or preventing SIRS, sepsis, and/or ARDS in a subject in need thereof comprising administering to the subject a therapeutically effective amount of a composition comprising PUFAs or derivatives thereof and a source of phospholipid according to various embodiments disclosed herein.
• PUFAs e.g., EtEPA
• additives including phospholipids and/or additional emulsifiers facilitates in vivo absorption of the fatty acid in the form of phospholipid conjugate.
• PUFAs e.g., EtEPA
• additives including phospholipids and/or additional emulsifiers facilitates in vivo absorption of the fatty acid in the form of phospholipid conjugate.
• phospholipids are a major component of cell membrane, but it is also expected to have a higher efficiency as crossing the blood-brain barrier (BBB), thereby delivering the fatty acid which is the active ingredient of the composition to the brain.
• BBB blood-brain barrier
• the BBB can be a roadblock for pharmaceutical agents to access their therapeutic target in the brain or reach a sufficient level inside the brain.
• the lymphreleasing formulation of the present technology may provide a novel strategy and platform for delivering fatty acids across the BBB for them to exert their antiinflammatory, pro-cognitive, and/or other neuroprotective effects useful in the treatment of a variety of neurological diseases and disorders.
• PUFAs including EPA are important in the regulation of phospholipase A2 (PLA2), which is an enzyme that catalyzes the cleavage of fatty acids from the sn-2 position of phospholipids and is implicated in PUFA and oxylipin pathways.
• PLA2 is present in the central nervous system (CNS) and is associated with neurodegenerative diseases due to its role in inflammatory responses. EPA can inhibit PLA2 and prevent production of pro-inflammatory eicosanoids. Additionally, EPA’s inhibitory effect on A5-desaturase and A5-elongase as discussed above may also contribute to its anti-inflammatory function in a variety of pathological conditions of the CNS.
• a method of treating and/or preventing a neurological disease in a subject in need thereof comprising administering to the subject a therapeutically effective amount of a composition comprising PUFAs or derivatives thereof and a source of phospholipid according to various embodiments disclosed herein.
• the neurological disease comprises chorea/Huntington’s chorea, sleep disorders, dementia, psychosis, anxiety, treatmentresistant depression, neuropathic pain, schizophrenia (especially in patients with tardive dyskinesia), bipolar disorder, dyslexia, dyspraxia, attention deficit hyperactivity disorder (ADHD), epilepsy, autism, Alzheimer’s disease, Parkinson’s Disease, senile dementia, multiple sclerosis, diabetes-induced neuropathy, macular degeneration, retinopathy of prematurity, amyotrophic lateral sclerosis (ALS), retinitis pigmentosa, cerebral palsy, muscular dystrophy, neurological cancer, cystic fibrosis, and/or neural tube defects.
• EPA is currently in clinical trials for treatment of cancer including colorectal cancer (see NCT01070355).
• the composition of the present technology for example, the LR-EtEPA formulation, results in greater EPA uptake in various tissues and thus could present a preferred option of cancer treatment.
• a method of treating and/or preventing cancer in a subject in need thereof comprising administering to the subject a therapeutically effective amount of a composition comprising PUFAs or derivatives thereof and a source of phospholipid according to various embodiments disclosed herein.
• the cancer is a hematological malignancy.
• Nonlimiting exemplary hematological malignancies include monoclonal B cell lymphocytosis, multiple myeloma, myeloid neoplasm, myelodysplastic syndromes (MDS), myeloproliferative/myelodysplastic syndromes, acute lymphoid leukemia (ALL), chronic lymphocytic leukemia (CLL), acute myeloid leukemia (AML), chronic myelogenous leukemia (CML), blast crisis chronic myelogenous leukemia (bcCML), B cell acute lymphoid leukemia (B-ALL), T cell acute lymphoid leukemia (T-ALL), T cell lymphoma, and B cell lymphoma.
• ALL acute lymphoid leukemia
• CLL chronic lymphocytic leukemia
• AML acute myeloid leukemia
• CML chronic myelogenous leukemia
• BcCML blast crisis chronic mye
• the cancer is a solid tumor.
• Non-limiting exemplary solid tumors include lung cancer, breast cancer, liver cancer, stomach cancer, colon cancer, rectal cancer, colorectal cancer, kidney cancer, gastric cancer, gallbladder cancer, cancer of the small intestine, esophageal cancer, melanoma, bone cancer, pancreatic cancer, skin cancer, uterine cancer, ovarian cancer, testicular cancer, cancer of the thyroid gland, cancer of the adrenal gland, bladder cancer, and glioma.
• kidneys pancreas, liver, intestines, blood cells, lymph, and the musculoskeletal system
• a method of treating and/or preventing a disease associated with a tissue or organ in a subject in need thereof comprising administering to the subject a therapeutically effective amount of a composition comprising PUFAs or derivatives thereof and a source of phospholipid according to various embodiments disclosed herein, wherein the tissue or organ is selected from the group consisting of kidney, the endocrine system, pancreas, liver, intestines, blood cells, and the musculoskeletal system.
• the lymph-releasing compositions of the present technology are superior at delivering fatty acids (e.g., EPA) to various tissues of the body including the kidney, pancreas, and intestines, where the fatty acids (e.g., EPA) can mitigate injury from inflammation, vasoconstriction, bronchospasm, and/or thrombosis, potentially by displacing, competing with, or reducing harmful oxylipins.
• EPA and its oxylipins are very complementary to steroids; both work by limiting oxylipin production.
• EPA could be used as a steroid-sparing agent. Steroids themselves have lots of adverse events, but EPA has few known adverse events.
• the disease associated with kidney comprises post- infectious glomerulonephritis, IgA nephropathy (Berger’s disease), Henoch-Schbnlein purpura, systemic IgA vasculitis, microscopic polyangiitis, granulomatosis with polyangiitis (Wegener’s), eosinophilic granulomatosis with polyangiitis (Churg-Strauss), polyarteritis, idiopathic crescentic glomerulonephritis, anti-GBM glomerulonephritis, Goodpasure syndrome, cryoglobulin-associated glomerulonephritis, idiopathic membranoproliferative glomerulopnephritis (MPGN), hepatitis C-associated glomerulonephritis, systemic lupus erythematosus (SLE) associated glomerulonephritis, minimal change disease (nill)
• the disease associated with the endocrine system comprises hypopituitarism, thyroiditis, and/or Paget’s disease.
• the disease associated with pancreas comprises hyperglycemia, pre-diabetes, diabetes (Type 1 and/or Type 2), and/or pancreatitis.
• the disease associated with liver comprises chronic viral hepatitis, autoimmune hepatitis, alcoholic liver disease, non-alcoholic fatty liver disease, hemochromatosis, Wilson disease, primary biliary cholangitis, primary sclerosing cholangitis, and/or cholelithiasis.
• the disease associated with intestines comprises digestive conditions include gastroesophageal reflux disease (GERD) (by mitigating esophageal reflux via oxylipin effects), gastritis, peptic ulcer disease, obesity (mitigated obesity by inducing satiety), and cachexia (mitigated by limiting inflammation); intestinal disease conditions include intestinal angina, inflammatory bowel disease (e.g., Crohn disease, ulcerative colitis), antibiotic-associated colitis, irritable bowel syndrome, colon cancer, colon polyposis, and/or carcinoid.
• GID gastroesophageal reflux disease
• gastritis gastritis
• peptic ulcer disease obesity
• obesity mitigated obesity by inducing satiety
• cachexia mitigated by limiting inflammation
• intestinal disease conditions include intestinal angina, inflammatory bowel disease (e.g., Crohn disease, ulcerative colitis), antibiotic-associated colitis, irritable bowel syndrome, colon cancer, colon polyposis, and/or carcinoid.
• the disease associated with blood cells comprises iron deficiency anemia, anemia of chronic disease, hemolytic anemia, thalassemia, polycythemia vera, sickle cell disease anemia, and sickle cell disease pain/crisis; platelet disorders include immune thrombocytopenia, and pro-thrombotic conditions; white cell disorders conditions include leukemias, Non-Hodgkin lymphomas, and/or Hodgkin lymphoma.
• the disease associated with lymph comprises lymphedema.
• the disease associated with the musculoskeletal system comprises muscle conditions include statin myopathy, rhabdomyolysis, polymyalgia rheumatica, polychondritis, and Behcet syndrome; bone conditions include gouty arthritis, calcium pyrophosphate deposition, rheumatoid arthritis, Still disease, ankylosing spondylitis, psoriatic arthritis, and reactive arthritis; systemic conditions include systemic lupus erythematosus (SLE), antiphospholipid syndrome, systemic sclerosis (scleroderma), polymoysitis, dermatomyositis, Sjogren syndrome, and lgG4- related disease.
• statin myopathy rhabdomyolysis
• polymyalgia rheumatica polychondritis
• Behcet syndrome bone conditions include gouty arthritis, calcium pyrophosphate deposition, rheumatoid arthritis, Still disease, ankylosing spondylitis,
• a method of treating and/or preventing a disease or disorder associated with oxidative stress, glutathione (GSH) depletion, Nrf2 activation, and/or heme-oxygenase activation (including cell lysis, hemolysis, other blood cell lysis, or conditions involving exposure to free heme during tissue injury) in a subject in need thereof, the method comprising administering to the subject a therapeutically effective amount of a composition comprising PUFAs or derivatives thereof and a source of phospholipid according to various embodiments disclosed herein.
• GSH glutathione
• Endothelial nitric oxide is produced by the NO synthase (eNOS) dimer which couples oxidation of L-arginine with the reduction of molecular oxygen (FIGS. 34C-34D).
• eNOS NO synthase dimer
• Fbrstermann and Sessa Euro Heart J. (2011 ) 33:829-837, which is incorporated herein by reference in its entirety.
• oxidative stress i.e., high glucose, smoking, hypertension
• there is eNOS “uncoupling” that favors production of superoxide (O2-) which reacts with NO to form peroxynitrite (ONOO-), a cytotoxic radical.
• the ratio of [NO]/[ONOO-] is a key indicator of eNOS coupling efficiency, while loss of NO bioavailability is associated with atherothrombotic risk. It is known that EPA has favorable effects on eNOS coupling in vascular endothelial cells (ECs) compared to DHA. The benefits of EPA were associated with an improved EPA/AA ratio. See Sherratt et al., Prostaglandins Leukot Essent Fatty Acids. (2021 ) 173, incorporated herein by reference in its entirety. The effects of EPA on NO release were enhanced in combination with a high-intensity statin. See Mason et al., Biomed Pharmacother.
• EPA administered as icosapent ethyl is the first FDA and EMA approved drug to reduce cardiovascular risk among patients with elevated triglyceride levels as an add-on to maximally tolerated statin therapy.
• the REDUCE-IT trial showed that treatment with high dose IPE (4 g/day) reduced composite cardiovascular events by 25% in statin-treated patients with elevated baseline triglyceride levels. See Bhatt et al., N Engl J Med. (2019) 380:11 -22, incorporated herein by reference in its entirety.
• the benefits of IPE were independent of baseline triglyceride levels but positively correlated with plasma levels of EPA.
• GSH is an antioxidant capable of preventing damage to important cellular components caused by sources such as ROS, free radicals, peroxides, and heavy metals.
• GSR glutathione reductase
• HO-1 heme oxygenase-1
• ARE antioxidant response element
• GST glutathione S-transferases
• the composition of the present technology comprising EPA may exhibit a particularly robust effect on the overall antioxidant effects by enhancing GSH metabolism.
• the composition may show a broad effect on treating or preventing tissue injuries caused by diseases including, but not limited to, pulmonary inflammation, anemia, sickle cell disease, and glomerulonephritis.
• the composition may also treat diseases/conditions related to GSH deficiency, such as kwashiorkor, seizure, Alzheimer’s disease, Parkinson’s disease, liver disease, cystic fibrosis, anemia, sickle cell disease, human immunodeficiency virus (HIV) infection/acquired immunodeficiency syndrome (AIDS), cancer, heart attack, stroke, and diabetes.
• diseases/conditions related to GSH deficiency such as kwashiorkor, seizure, Alzheimer’s disease, Parkinson’s disease, liver disease, cystic fibrosis, anemia, sickle cell disease, human immunodeficiency virus (HIV) infection/acquired immunodeficiency syndrome (
• a method of treating and/or preventing pulmonary inflammation, anemia, sickle cell disease, and/or glomerulonephritis in a subject in need thereof comprising administering to the subject a therapeutically effective amount of a composition comprising PUFAs or derivatives thereof and a source of phospholipid according to various embodiments disclosed herein.
• a method of treating and/or preventing a disease or disorder associated with GSH depletion in a subject in need thereof comprising administering to the subject a therapeutically effective amount of a composition comprising PUFAs or derivatives thereof and a source of phospholipid according to various embodiments disclosed herein.
• the disease or disorder associated with GSH depletion is at least one selected from the group consisting of a neurodegenerative disorder, a pulmonary disease, an immune disease, a cardiovascular disease, a renal disease, a liver disease, an endocrine disease, a red blood cell disease, a gastrointestinal disease, a rheumatologic and/or musculoskeletal disorder, a dermatologic disease, an obstetric and/or gynecological disease, and an age-related disorder.
• the neurodegenerative disorder comprises Alzheimer’s disease, Parkinson’s disease, Huntington’s disease, amyotrophic lateral sclerosis (ALS), and/or Friedreich’s ataxia.
• the pulmonary disease comprises community- acquired pneumonia, sepsis, SIRS, ARDS, chronic obstructive pulmonary disease (COPD), asthma, interstitial lung disease, cystic fibrosis, pulmonary vasculitis (e.g., granulomatosis with polyangiitis (GP), eosinophilic granulomatosis with polyangiitis (EGPA), microscopic polyangiitis (MPA)), pulmonary-renal vasculitis (e.g., Goodpasture’s syndrome, cryoglobulinemia, systemic lupus erythematosus (SLE), systemic sclerosis, antiphospholipid syndrome), pulmonary inflammation, non-small cell lung cancer (especially COX-2 over-expressing cancer), and/or chronic/episodic hemolytic anemia (e.g., hereditary spherocytosis, thalassemia, secondary hemolysis from other diseases, and transfusion reactions).
• COX-2 over-expressing cancer especially COX-2 over
• the immune disease is an autoimmune disease and/or HIV infection/AIDS.
• autoimmune diseases include type 1 diabetes, lupus, systemic lupus erythematosus, rheumatoid arthritis, psoriasis, psoriatic arthritis, multiple sclerosis, inflammatory bowel disease, Crohn’s disease, ulcerative colitis, Addison’s disease, Graves’ disease, Sjogren’s syndrome, Hashimoto’s thyroiditis, myasthenia gravis, autoimmune vasculitis, pernicious anemia, and celiac disease.
• the cardiovascular disease comprises hypertension, myocardial infarction, and/or cholesterol oxidation.
• the renal disease comprises renal vasculitis (e.g., Berger’s disease), proteinuria, chronic kidney disease (CKD), and/or end stage renal disease (ESRD).
• renal vasculitis e.g., Berger’s disease
• proteinuria e.g., chronic kidney disease (CKD)
• CKD chronic kidney disease
• ESRD end stage renal disease
• the liver disease comprises non-alcoholic fatty liver disease.
• the endocrine disease comprises hyperglycemia, pre-diabetes, and/or Paget’s disease.
• the red blood cell disease comprises anemia and/or sickle cell disease.
• the gastrointestinal disease comprises pancreatitis, inflammatory bowel disease, irritable bowel syndrome, obesity, cachexia, esophageal reflux, and/or biliary cirrhosis.
• the rheumatologic and/or musculoskeletal disorder comprises statin myopathy.
• the dermatologic disease comprises allergic dermatitis, general dermatitis, menopausal hot flush, and/or medicinal hot flush.
• the obstetric and/or gynecological disease comprises menorrhagia, preeclampsia, and/or dysmenorrhea.
• the age-related disorder comprises cataracts, macular degeneration, hearing impairment, and/or glaucoma.
• the method further comprised administering to the subject a A/-acetylcysteine (NAC) related agent that can raise GSH.
• NAC related agents include cystine, methionine, A/-acetylcysteine, and L- 2-oxothiazolidine-4-carboxylate. Using one of these NAC related agents with the presently disclosed composition comprising EPA may further potentiate GSH raising.
• the subject upon administration of the composition, the subject exhibits an increase in GSR activity.
• the subject upon administration of the composition, the subject exhibits an increase in GST activity.
• a method of treating and/or preventing oxidative stress, endothelial dysfunction, narrowing and/or thickening of arteries, and/or inflammation induced by inhalation of particulate matter in a subject in need thereof comprising administering to the subject a therapeutically effective amount of a composition comprising PUFAs or derivatives thereof and a source of phospholipid according to various embodiments disclosed herein.
• a composition comprising PUFAs or derivatives thereof and a source of phospholipid according to various embodiments disclosed herein.
• the term “particulate matter” refers to a mixture of species generated from numerous emission sources. The particulate matter may be emitted directly into the air in the form of soot, smoke, and/or dust. The particulate matter can be formed in the atmosphere from the reactions of gases including by not limited to nitric oxides (NOx), sulfur oxides (SOx), reactive organic gases (ROG), and/or ammonia.
• oxidative stress refers to the increased formation of reactive oxygenated species (ROS) and/or decreased antioxidative potential (i.e., capacity to reduce or impair the generation of ROS) in an afflicted person.
• ROS reactive oxygenated species
• endothelial dysfunction refers to damage or degradation of the endothelial lining caused by numerous factors, including but not limited to, high blood pressure, high blood glucose levels, and/or increased blood lipid levels. Endothelial dysfunction can then lead to reduced function in endothelium-dependent vasodilation, pro-coagulation, and proinflammatory response.
• narrowing of arteries refers to a condition characterized by a decreased or a complete reduction in blood flow and oxygen transport to target tissues and organs of an afflicted person that occurs, for example, from the formation of plaque within the arterial wall and/or as a result of inflammation causing a swelling of the arterial wall.
• An occlusion (i.e., blockage) of the arteries prevents sufficient blood flow and thereby, oxygen transport to target tissues and organs, which can lead to a wide range of illness such as, but not limited to, hypoxia, myocardial infraction, stroke, and/or pulmonary embolism.
• thickening of arteries refers to an actual thickening of the arterial wall (i.e., an increase in the ratio of the wall thickness-to-radius of the artery) and/or an actual enlargement of the arterial wall (i.e., dilatation).
• the thickening of the arterial wall can lead to a weakened and narrowed arterial wall, which overtime can cause irregular blood flow and oxygen transport.
• the thickening of the arterial wall can result in an actual rupture of the wall, preventing blood flow and oxygen transport. Both a partial and complete block in blood flow and oxygen transport to target tissues can result in subsequent organ and tissue damage and/or death.
• the narrowing and thickening of the arterial wall can occur independently or dependently of each other.
• inflammation refers to individual tissue (e.g., pulmonary) and/or systemic inflammation.
• pulmonary inflammation is characterized by inflammation of the pulmonary system, resulting in restricted oxygen flow due to a narrowing of the air passageways of an afflicted person.
• pulmonary system refers to those organs and/or structures responsible for taking in oxygen into and/or expelling carbon dioxide from the body.
• the organs and/or structures include, but are not limited to, those associated with the nasal, pharyngeal, and laryngeal passageways, the trachea, bronchi, bronchioles, and/or alveoli.
• the alveoli in the lungs become inflamed, which can decrease the follow of oxygen through the alveoli to the bloodstream.
• the narrowing of the air passageways causes episodic dyspnea, coughing, and/or wheezing, all of which are associated with asthma, and in severe cases, causes death.
• Systemic inflammation is characterized by the widespread inflammation throughout the body of an afflicted person. Systemic inflammation leads to the degradation of both the structure and function of essential organs, such as the muscle, heart, and liver, compromises the immune system, and also causes multi-organ failure and death.
• a method of treating and/or preventing oxidative stress, endothelial dysfunction, narrowing and/or thickening of arteries, and/or inflammation induced by long-term and/or short-term exposure to air pollution in a subject in need thereof comprising administering to the subject a therapeutically effective amount of a composition comprising PUFAs or derivatives thereof and a source of phospholipid according to various embodiments disclosed herein.
• a composition comprising PUFAs or derivatives thereof and a source of phospholipid according to various embodiments disclosed herein.
• long-term in the present context refers to exposure to air pollution for a period of time greater than or equal to one year.
• short-term refers to exposure to air pollution for a period of time less than one year.
• a method of treating and/or preventing an atherosclerotic cardiovascular disease, or reducing the risk of an atherosclerotic cardiovascular disease, in a subject in need thereof comprising administering to the subject a therapeutically effective amount of a composition comprising PUFAs or derivatives thereof and a source of phospholipid according to various embodiments disclosed herein.
• atherosclerotic cardiovascular disease refers to any condition characterized by plaque accumulation on vessel walls and vascular inflammation.
• Polluted air contains particulate matter, which can be a mixture of particulates of varying sizes.
• the various sizes of particulate matter are classified as coarse, fine, and ultrafine.
• coarse particulate matter refers to particulates having a mean or median diameter, on a volume basis, less than about 10 pm and greater than about 2.5 pm (PM2.5-10).
• fine particulate matter refers to particulates having a mean or median diameter, on a volume basis, of about 2.5 pm (PM2.5).
• ultrafine particulate matter refers to particulates having a mean or median diameter, on a volume basis, less than about 0.1 pm (PM0.1 ).
• the particulate matter described in any of the embodiments herein may be less than about 10 pm and greater than about 2.5 pm in diameter, less than or equal to about 2.5 pm in diameter, or less than about 0.1 pm in diameter.
• the subject upon administration of the composition of the composition described herein in any of its embodiments, may exhibit beneficial effects in heart rate and/or rhythm following administration.
• the beneficial effects include a reduction in arrhythmia suppression levels, ventricular arrhythmia rates, or heart rate, or an increase in heart rate variability.
• the disclosure provides a method of suppressing an inflammatory response caused by the inhalation of particulate matter in the lungs.
• the inflammatory response is observed in not only the lungs, but also other organs, to included but not limited to the brain, heart, coronaries, liver, kidneys, spleen, pancreas, and intestine.
• the therapeutically effective dose of the composition of the present technology is between 1 mg and 20 g of EPA (as the term “EPA” is defined and exemplified herein) per day, for example, about 50 mg, about 100 mg, about 500 mg, about 750 mg, about 1 g, about 2 g, about 3 g, about 4 g, about 5 g, about 6 g, about 7 g, about 8 g, about 9 g, about 10 g, about 11 g, about 12 g, about 13 g, about 14 g, about 15 g, about 16 g, about 17 g, about 18 g, about 19 g, or about 20 g of EPA per day.
• EPA as the term “EPA” is defined and exemplified herein
• the therapeutically effective dose is between 2 g and 12 g of EPA per day. In some embodiments, the therapeutically effective dose is between 4 g and 6 g of EPA per day. In another embodiment, the therapeutically effective dose is 4 g of EPA per day.
• the composition administered to the subject in an amount sufficient to provide a daily dose of EPA (as the term “EPA” is defined and exemplified herein) about 1 mg to about 20,000 mg, about 25 mg to about 10,000 mg, about 50 mg to about 5000 mg, about 75 mg to about 2500 mg, or about 100 mg to about 1000 mg, for example, about 25 mg, about 50 mg, about 75 mg, about 100 mg, about 125 mg, about 150 mg, about 175 mg, about 200 mg, about 225 mg, about 250 mg, about 275 mg, about 300 mg, about 325 mg, about 350 mg, about 375 mg, about 400 mg, about 425 mg, about 450 mg, about 475 mg, about 500 mg, about 525 mg, about 550 mg, about 575 mg, about 600 mg, about 625 mg, about 650 mg, about 675 mg, about 700 mg, about 725 mg, about 750 mg, about 775 mg, about 800 mg, about 825 mg, about 850 mg, about 875 mg,
• the composition is administered to the subject for a period of time between about 3 days to about 1 year, for example, about 3 days, about 4 days, about 5 days, about 6 days, about 1 week, about 1 .5 weeks, about 2 weeks, about 2.5 weeks, about 3 weeks, about 1 month, about 2 months, about 3 months, about 4 months, about 5 months, about 6 months, about 7 months, about 8 months, about 9 months, about 10 months, about 11 months, or about 1 year.
• the composition is administered to the subject once a day, twice a day, three times a day, or four times a day for a period of about 3 days, about 5 days, about 7 days, about 10 days, about 2 weeks, about 3 weeks, about 4 weeks, about 1 month, about 2 months, about 3 months, about 4 months, about 5 months, about 6 months, about 7 months, about 8 months, about 9 months, about 10 months, about 1 1 months, about 1 year, about 1 .25 years, about 1 .5 years, about 1 .75 years, about 2 years, about 2.25 years, about 2.5 years, about 2.75 years, about 3 years, about 3.25 years, about 3.5 years, about 3.75 years, about 4 years, about 4.25 years, about 4.5 years, about 4.75 years, about 5 years, or more than about 5 years.
• the composition is administered to the subject once or more times (e.g., twice, three times, four times, or more) a day.
• the composition is administered to the subject every day, every other day, every third day, weekly, biweekly (i.e., every other week), every third week, monthly, every other month, or every third month.
• the composition can be administered continuously or intermittently, for example, in one or more cycles. In those embodiments, within each cycle, the composition can be administered at various lengths and/or frequencies as described above.
• the composition may be administered over a predetermined time. Alternatively, the composition may be administered until a particular therapeutic benchmark is reached.
• the methods provided herein include a step of evaluating one or more therapeutic benchmarks in a biological sample, such as, but not limited to, a lipid biomarker, a metabolic biomarker, an inflammatory biomarker, a cancer biomarker, to determine whether to continue administration of the composition.
• the composition may be administered in various routes as determined by one skilled in the art as suitable for an indication of interest.
• the composition is administered by oral or enteric administration, intravenous injection, intraperitoneal injection, intertumoral injection, bone marrow injection, lymph node injection, subcutaneous injection, and/or cerebrospinal fluid injection.
• the composition is administered with or without food.
• the composition is administered to a subject in a fasting state, for example, having not consumed any food in the preceding 12 hours, 8 hours, 4 hours, or 2 hours.
• the composition is administered to a subject in a fed state, for example, within 2 hours, 1 hour, 45 minutes, or 30 minutes of having a meal.
• Example 1 Exemplary Lymph-releasing (LR) EtEPA (LR-EtEPA) Composition
• This example provides an exemplary LR-EtEPA composition, which is formulated as 1 g soft gelatin capsules, with EtEPA being the active ingredient and soy lecithin being the source of phospholipid.
• Polysorbate 80 and polyoxyl-35 are included as emulsifiers. The content of each component is listed in Table 1 :
• Soy lecithin (MetarinTM P) is a mixture of phospholipids, the minimum/maximum contents of each of which are specified in Table 2:
• the model indicates that further increases in the lecithin ratio to EtEPA are likely to continue to increase the amount of EPA delivered to the lymph, consistent with the very large capacity of chylomicrons and intestinal VLDL to accommodate large boluses of fat. Accordingly, the 1 :1 ratio of EtEPA:Excipients given in the single-dose experiment (i.e. 1 :3.75 LC:EtEPA) likely represent the low end of the potential for LR- EtEPA to enrich lymph with EPA, and thence, pulmonary, cardiac, and brain tissue, as well as systemic tissues.
• the present experiment was a single-dose study where equal molar doses of eicosapentaenoic acid ethyl ester (EtEPA) and the lymph-releasing EtEPA formulation (LR-EtEPA) were administered to Sprague-Dawley rats to compare their bioavailability in various tissues after dosing.
• the rats had catheters placed in the mesenteric lymph vessel and the portal vein for sampling during the day of dosing. Rats were allowed to recover, and on the day of dosing, were dosed by gavage with equimolar doses of EtEPA at1 .55 mg/kg body weight.
• the LR compounds i.e., phospholipids and/or emulsifiers used in this experiment are shown in Example 1 . Lymph and portal vein blood were collected before dosing and then hourly for 6 hours, whereupon the animals were sacrificed, and other tissues collected.
• Results were analyzed by non-parametric pharmacokinetic (PK) parameters, and the chief comparison between groups was incremental (i.e., net) area under the curve (incAUC).
• PK pharmacokinetic
• levels of EPA and other fatty acids of interest were determined by mass spectrometry protocols optimized for the type of lipid studied.
• Phospholipid esters were assayed by UPLC-Qoadrupole/Orbitrap Q Exactive MS. Cholesteryl esters were assayed by tandem MS (LC-MS/MS).
• Triacylglycerol esters were assayed by GC-High Resolution MS.
• Fatty acid methyl esters were assayed by GC-MS.
• This experiment consisted of multiple-daily dosing of Long-Evans rats by gavage in two cohorts that varied by length of exposure: (1 ) a 7-day exposure, and (2) a 21 -day exposure. Rats were randomized to the following treatment groups to receive equimolar amounts of interventional fatty acids (3.1265 mmol FA/kg/day):
• Ethyl-GLA, ethyl-EPA, and ethyl-DHA (GLA+EPA+DHA or G+E+D): 3.1265 mmol total FA/kg/day;
• Ethyl-EPA (EtEPA, E-EPA, or IPE): 3.1265 mmol EPA/kg/day;
• Ethyl-EPA+lecithin (LC) at a 4:1 weight ratio EPA+LC 4:1 , LR-EtEPA, or 1 X LR-EtEPA: 3.1265 mmol EPA/kg/day;
• LR-EtEPA was superior to plain EtEPA in enriching lung and heart tissues with EPA at equimolar doses of IPE.
• the lung after 7 days of daily dosing by gavage, there is a 76% increase in total EPA favoring LR-EtEPA which is statistically significant (FIG. 3), and there's a 41% increase in the EPA to arachidonic acid (AA) ratio (data not shown).
• the heart had a statistically significant 19% increase in EPA uptake (FIG. 3), and there was a 30% increase in the EPA to AA ratio (data not shown).
• LR-EtEPA also raised the EPA/AA ratio in lung alveolar macrophages (AVMs) compared to an equimolar dose of plain EtEPA (FIG. 4).
• AFMs lung alveolar macrophages
• FEMs plain EtEPA
• Macrophages are a key immune cell in the lung and plays an important role in inflammatory diseases, including but not limited to, SIRS, sepsis, ARDS, interstitial lung disease, and pneumonia.
• LR-EtEPA robustly increased the EPA to AA ratio in the immune cells after 7 days (FIG. 4). EPA levels were slightly decreased but there was a much greater decrease in AA. Without wishing to be bound by theory, EPA appears to be displacing AA from the immune cells resulting in a higher EPA to AA ratio. One skilled in the art would expect this result to be very favorable for treating inflammatory diseases of the lung such as SIRS, sepsis, ARDS, and pneumonia.
• the phospholipid-EPA (PL-EPA) composition can be subdivided into phospholipid levels according to the six classic types, including phosphatidylcholine and phosphatidylethanolamine, which are the two most abundant of the phospholipids in cell membranes in mammals. Most of the uptake is as phospholipids in the membranes.
• the data is represented in a “heat map” (FIG. 5).
• the heat map is using intensity of color to express greater differences for LR-EtEPA versus EtEPA.
• FIG. 5 represents the percent increase or decrease for LR-EtEPA and the second column of the heat map is looking at p-values. The most robust findings have the darkest color in both of the columns.
• PE phosphatidylethanolamine
• the five types of cellular PL-EPA were represented in a vector plot. Specifically, the five cellular PL-EPA types are lung-PL, AVM-PL, heart-PL, blood cell- PL, and liver-PL.
• the ratio of LR-EtEPA to EtEPA was plotted on the y axis. If the ratio is above 1 .25, it is considered evidence of LR-EtEPA’s biological superiority. If the ratio is between 0.8 and 1 .25, LR-EtEPA is considered to be non-inferior. Most of the phospholipids are in the range of analytical superiority. Phosphatidylcholine is lagging behind at 7 days.
• FIG. 14 is a vector plot illustrating the ratio of EPA to AA (or ARA). The plot demonstrates the very robust benefits favoring biological superiority of LR-EtEPA for a variety of cells. At Day 7, PC lags behind but due to the strong relationship between the pool size of the phospholipids, one might expect that PC will eventually “catch up” after 7 days. See also FIGS. 15-20.
• the EPA:ARA ratio in lung AVMs at 21 days is several folds higher on LR-EtEPA vs IPE alone, even more so compared to at 7 days, supporting the superior therapeutic effects of the claimed composition/methods.
• tripling the exposure duration has shown to increase AVM EPA:ARA in the LR-EtEPA groups (1 X and 1.5X).
• the AVM EPA:ARA went from 0.3 at 7 days to 0.64 at 21 days.
• FIG. 22 summarizes the results from the study that compares LR-EtEPA to EtEPA in rats to (i) understand the delivery route to plasma and tissue for both drugs, and (ii) confirm superior cell/tissue uptake of LR-EtEPA compared to plain EtEPA. It shows that despite dosing EPA at equimolar doses, LR-EtEPA generally doubles EPA by the lungs, alveolar macrophages, heart, and brain.
• LR-EtPA is biologically superior to EtEPA as a pharmaceutical composition for achieving EPA uptake.
• Biological superiority is herein assessed by the FDA analytical criteria.
• analytical non-inferiority is defined as a ratio between 0.8 on the low end and 1 .25 on the high end. If a 90% confidence interval is outside of that range, the result is supportive of either analytical superiority or inferiority. If the 90% confidence interval is within that range, the result is on only supportive of analytical noninferiority.
• each “violin” plot (e.g., FIG. 24A for the lung tissue)
• the rectangles inside each violin represent box plots of the interquartile range (IQR, 25 th and 75 th percentiles) with median as an uncolored dot within the IQR.
• the whiskers of the box plots represent 10 th and 90 th percentiles, and the dots to the right of the box plots are individual subject responses.
• the curved region outside the box plots represents the density of the distribution (a kernel density plot).
• the x-axis is proportional to the EtEPA dose given, so that OA is zero, 1 .5X LR-EtEPA 1 is 4.7 mmol EPA/kg/day, and the other treatments fall in between at appropriate distances.
• the primary finding from these violin plots is therefore whether LR-EtEPA and plain EtEPA are distinguishable. Since the x-axis also represents the dose as a continuous variable, the violin plots are also dose-response plots. A key secondary finding is whether the outcome is altered going from left to right; if so, this is evidence for a dose response. A key tertiary finding is whether the dose response is continuous vs there is a discontinuity. The y-axis is the EPA:ARA ratio in Long-Evans rat lung tissue after daily treatment by gavage for 21 days.
• y mx + b, where y is outcome, m is slope, x is EtEPA dose, and b is y-intercept.
• To model the discontinuity simply involves including a multiplier to the slope which is only operative for the lymph-releasing formulations (A).
• A lymph-releasing formulations
• the dose response curve is recast in the corresponding dose response curve for each tissue examined (e.g., FIG. 24B from the lung tissue) to present IPE equivalent EPA dose (mmol/kg/day) instead of actual dose.
• Vascepa® capsules on the graph.
• the usual human dose for Vascepa® is four capsules daily. Again, for illustration only, if one took four capsules of LR-EtEPA 1 x to raise the EPA/ARA, one would have to take ⁇ 3.3-fold that amount in Plain EtEPA capsules to raise EPA/ARA the same amount. Thus, 4x3.264-13 capsules are shown so the reader can compare to the four capsules of the new formulation.
• the typical human dose is shown here because the human equivalent dose the rats received would results in many more capsules depicted (e.g., 33 capsules for Plain EtEPA vs. 10 capsules for LR-EtEPA, a dose of LC-PUFAs that would be optimal to treat ARDS). Stated another way, taking four capsules of LR-EtEPA would be equivalent to taking 33 capsules of Plain EtEPA to raise EPA/ARA the same amount.
• Table 4 below shows the relative potency (0) for several tissues assessed by EPA/ARA, OXP/ARA (i.e., [EPA+DGLA+DHA]/ARA), and MOP/ARA (i.e., [EPA+DPA+DGLA+DHA]/ARA).
• OXP/ARA i.e., [EPA+DGLA+DHA]/ARA
• MOP/ARA i.e., [EPA+DPA+DGLA+DHA]/ARA
• MOP/ARA Jejunum 2.359 (1.879, 3.023) [0259] Remarkably, the relative potency was routinely well above one for all tissues examined, including lungs, AVMs, heart, kidney, brain, pancreas, and jejunum, and was often several fold the slope for the plain EtEPA formulations, and for several configurations of LC-PUFAs compared to ARA.
• the relative potency for EPA/ARA in the brain was almost 3-fold, indicating one would need to take 3 times the dose of plain EtEPA as LR-EtEPA to raise brain EPA/ARA as much as LR-EtEPA did. Note that it is not always the case that a line can be fit for the dose-response, as was the case for brain OXP/ARA and MOP/ARA (data not shown).
• tissue perfusion The six tissues shown here were selected because they represent the spectrum of tissue perfusion. Fatty acids are distributed in accordance with the tissue perfusion rates of various organs, so sampling across the range of perfusion rates would allow us to understand and model how LR-EtEPA would fare with different tissues. Surprisingly, across a range of tissue perfusion rates, the relative potency remained considerably higher than one. Indeed, the lowest was 1 .8, which is still almost double the relative potency of plain EtEPA. In this list, the brain is toward the low end of the perfusion spectrum, typically receiving 0.5 mL/min per mL of tissue in a 70-kg adult male.
• EPA/ARA 95% Cl 3.594 to 5.423.
• the LR-EtEPA formulation is capable of raising EPA/ARA more than four-fold the same amount of EtEPA given as plain EtEPA.
• the LR-EtEPA formulation is suitable for tissues that range in perfusion rates between 0.01 mL/min per mL of tissue to >10 mL/min per mL of tissue in a healthy adult male. Accordingly, LR-EtEPA is suitable to raise EPA/ARA across this range of tissues, if not OXP/ARA and MOP/ARA among conditions that could benefit from lessened inflammation, thrombosis, vasoconstriction, and tissue-specific benefits mentioned in the section above detailing oxylipins. Insofar as the lymph-releasing properties of the composition apply to several LC-PUFAs and oxygenated LC-PUFAs, the technology would be suitable beyond EPA therapy per se.
• DGLA was one of the fatty acids evaluated.
• formulations containing equimolar amounts of EtEPA did not differ from E+G+D in their effect on DGLA (data not shown). This was unexpected because E+G+D included DGLA precursor, GLA; one would expect E+G+D to therefore prove superior to EtEPA in raising DGLA.
• the conversion of DGLA to AA is facilitated by the A5-desaturase enzyme (c.f., FADS1 , the fatty acid desaturase 1 gene).
• A5-desaturase enzyme c.f., FADS1 , the fatty acid desaturase 1 gene.
• FADS1 the fatty acid desaturase 1 gene
• LC-PUFAs are converted to other PUFAs, this occurs by both elongation (adding carbon units) and desaturation (i.e., adding new double bonds).
• desaturation represents the rate-limiting steps vs. elongation. Therefore, the conversion of fatty acids is largely a matter of the activity of a series of desaturase enzymes. Accordingly, the AA/DGLA ratio is a functional A5-desaturase index for these omega-6 fatty acids (A5D-l-w6).
• A5D-l-w6 in a separate experiment involving a provocative inflammatory challenge (by IL-6 administration), EPA strongly suppressed A5-desaturase, that is, the protein product of fatty acid desaturase 1 (FADS1 ), in endothelial cells (FIG. 34B). Similarly, EPA strongly suppressed A6-desaturase, that is, the protein product of fatty acid desaturase 2 (FADS2) in endothelial cells (FIG. 34B).
• the A8-desaturates enzyme is important (c.f., FADS2, the fatty acid desaturase 2 gene).
• the A8-desaturase enzyme catalyzes DGLA synthesis from the precursor eicosadienoic acid (EDA, a 20-carbon omega-6 LC-PUFA with 2 double bonds).
• EDA eicosadienoic acid
• A8-desaturase index for these omega-6 fatty acids is a functional index of enzyme activity.
• the isolated EPA formulations actually raised A8D-l-w6, consistent with sufficient induction to raise DGLA synthesis (FIG. 31 B).
• EPA is capable of raising the DGLA pool “coming and going,” meaning it promotes DGLA synthesis and suppresses its catabolism by conversion to AA. This would be a boon for treating conditions involving pathological levels of deleterious AA oxylipins, because not only would the supply of AA be diminished as an oxylipin precursor, but the greater DGLA pool would provide competing oxylipins that are less detrimental. Beyond disadvantaging AA by substrate competition by DGLA for oxygenating enzymes, specific DGLA oxylipins inhibit COX and LOX enzymes that oxygenate AA into oxylipins (e.g., PGE1 and 15-HETrE).
• COX and LOX enzymes that oxygenate AA into oxylipins
• the DGLA-oxylipin 15- HETrE was assessed as total oxylipins, non-esterified oxylipins, and as esterified oxylipins.
• total and esterified 12-HETrE is derived from DGLA, and total and esterified 12-HETrE were significantly greater than E+G+D and compared to plain EtEPA.
• the OXP/AA index indicates the LR-EtEPA is superior to both plain EtEPA and E+G+D in raising the LC-PUFAs that drive the mechanism of action of Oxepa®.
• the MOP/AA index is broadly applicable to several other diseases, including diseases outside of the pulmonary system.
• MOP incorporates several LC-PUFAs proposed to be medically beneficial as medicinal oxylipin precursors: EPA+DGLA+DPA+DHA.
• the MOP/AA ratio indicates the ability of E+G+D, pain EtEPA, and especially LR-EtEPA to exert therapeutic effects by limiting the “damage” from AA and its detrimental oxylipins in conditions that are worsened by the inability to regulate said oxylipins.
• the MOP/AA ratio was higher in plain EtEPA vs. E+G+D, and more importantly, LR-EtEPA was superior to plain EtEPA (FIG. 24E).
• the relative potency for LR formulations was 2.3-fold that of plain EtEPA (95% Cl 2.1 to 2.6) for lung tissue (FIG. 24E) and was 2.4-fold (95% Cl 2.0 to 2.8) for alveolar macrophages (FIG. 25D).
• Oxepa® for treating ARDS. These data indicate several advantages over Oxepa® for treating ARDS. These include (1 ) the ability to limit fatty acids to medicinal oxylipin precursors by timing doses opposite of diets featuring other, “competing” fatty acids, so the benefits of MOPs are not diluted by said fatty acids, (2) the ability to limit deleterious conversion of DGLA to AA by withholding GLA, (3) the ability to increase the lecithin portion, especially for critical care applications, such as the 1 :1 ratio of excipients to EtEPA shown in FIG. 3, which significantly raised EPA, and did so quickly (i.e.
• LC-PUFAs often results in suppression of certain enzymes that facilitate conversion of one LC-PUFA to its canonical metabolite LC- PUFAs. These conversions are facilitated by two broad categories of enzymes: (1 ) desaturase enzymes, which add double bonds (rendering the LC-PUFA less saturated/more desaturated); and (2) elongase enzymes (rendering the LC-PUFA longer, usually by two carbon units). Of these enzyme families, the desaturases are thought to catalyze the rate-limiting steps.
• EPA is synthesized from omega-3 eicosatetraenoic acid (ETA, a 20-carbon omega-3 LC-PUFA with four double bonds), which conversion is catalyzed by A5-desaturase.
• EPA is converted to omega-3 docosapentaenoic acid (DPA, a 22-carbon omega-3 LC-PUFA with five double bonds), which conversion is catalyzed by A5-elongase (regulated by elements of the ELOVL gene family).
• DPA docosapentaenoic acid
• A5-elongase regulated by elements of the ELOVL gene family.
• a functional index of the efficiency of EPA conversion to DPA is the product/precursor ratio, the A5-elongase index for omega-3’s (A5EI-w3).
• LR-EtEPA is consistently suppressed compared to plain EtEPA and E+G+D; more broadly, there is an unmistakable, if unexpected, dose-response trend across the ascending doses of EtEPA represented by the five groups from left to right on the figure.
• the differences between LR-EtEPA and plain EtEPA arise despite that they both involve the same molar dose of EtEPA given; therefore, the differences in A5EI-co3 must be attributable to the different composition of LR-EtEPA.
• the significant of A5-elongase suppression is that this would tend to increase the amount of EPA in the tissues, for example, in the LC-PUFA reservoir in the cell membrane.
• Example 4 A Provoked-inflammation Model to Elucidate the Effects of Icosapent Ethyl on Tissue Heme Oxygenase Expression
• IPE cosapent ethyl
• ethyl-EPA ethyl-EPA
• EtEPA ethyl-EPA
• EPA- E eicosapentaenoic acid
• Vascepa® a highly purified form of IPE, Vascepa®, is used to treat hypertriglyceridemia and prevent major atherosclerotic vascular events (MACE).
• HMOX1 heme oxygenase 1 gene
• HO-1 heme oxygenase 1 gene
• HO-1 has important antioxidant, anti-inflammatory, antiapoptotic, and immunomodulatory effects in vascular cells and tissues, whereby HO-1 can mitigate adverse tissue injury responses. These effects are distinct from beneficial effects from oxylipins and are mediated by protein products whose gene expression is induced by Nrf2, rather than mediated directly by fatty acid products derived from LC-PUFAs.
• the antioxidant, anti-inflammatory, antiapoptotic, and immunomodulatory effects in vascular cells and other tissues from HO-1 and/or other Nrf2-induced antioxidants are distinct from beneficial effects from oxlylipins, and constitute a separate mechanism of action.
• the antioxidant effects of HO-1 and co-regulated antioxidant gene products comprise a distinct mechanism from EtEPA and derivatives therefrom which moderate cellular injury and thereby improve disease.
• LC-PUFAs LC-PUFAs to protect from free-heme toxicity and from antioxidant effects from HO-1 itself and other antioxidants co-regulated on demand by Nrf2.
• Nrf2 antioxidants co-regulated on demand by Nrf2.
• several LC-PUFAs and their oxylipins likely promote this injury response by activating Nrf2, including other omega-3 LC-PUFAs besides EPA, such as DHA.
• LC-PUFAs would benefit from a multi-fold improvement in delivering said LC-PUFA to the site of cellular injury, as happens with the lymph-releasing formulation, aided by the rapid integration of PL-EPA into cell membranes.
• the optimal choice may be the LC-PUFA that produces the suite of oxylipins that best competes with the ill effects of ARA-derived oxylipins. This is because cellular injury, including injury from free heme, is accompanied by the inflammatory and pro- thrombotic cascades.
• EPA may well be in a superior position to leverage HO- 1 benefits owing to its ability to (1 ) strongly suppress ARA synthesis by inhibiting A5- desaturase, (2) enhance the DGLA pool and its attendant oxylipins by inhibiting A5- desaturase as well as inducing DGLA production by A8-desaturase, and (3) by limiting EPA loss/conversion to DPA by inhibiting A5-elongase, and (4) by promoting production of oxylipins from other LC-PUFAs, such as HODEs from LA, all of which would limit the ill effects of ARA-derived oxylipins by (1 ) suppressing ARA synthesis, (2) introducing substrates that compete with ARA for oxygenating enzymes, and (3) producing oxylipins that inhibit oxygenation enzymes.
• EPA and DGLA are particularly well suited to compete with ARA owing to their 20-carbon structure, whereas longer LC- PUFAs may be farther afield and may produce a more limited variety of oxylipins.
• EPA compared to the 22-carbon DHA, EPA has a greater complement of anti-thrombotic oxylipins, as it produces copious amounts of prostanoids, particularly, thromboxanes that are less apt to cause thrombosis vs. thromboxanes from ARA, prostacyclins, and prostaglandins.
• EPA produces leukotrienes that can offset the ill-effects of leukotrienes from ARA.
• HMOX1 is an inducible gene coding HO-1 , induced by a variety of cell-injury and other stimuli.
• Other experiments suggest EPA free acid can upregulate HMOX1 and HO-1 (FIG. 34A). To the extent that IPE also induces HMOX1 , this itself could mediate some of IPE’s benefits, particularly for preventing MACE.
• LR-EtEPA could be particularly useful in diseases affecting these organs, including MACE and lung diseases, and any disease involving cellular lysis, including hemolysis or lysis of other blood cells, or lysis associated with organ infarction or cancer.
• HMOX2 heme oxygenase 2 gene
• HMOX2 is a separate gene with different regulators and encodes the protein heme oxygenase-2 (HO-2).
• HMOX2 is thought to be produced constitutively, and few molecules have been found that alter its expression.
• a notable exception to this is that HMOX2 is induced by corticosteroids. Steroid-induction might be mediated by suppressing COX and LOX, and thereby strongly suppresses arachidonic acid (AA) oxidation, in turn, limiting exposure to bioactive AA-derived oxylipins, a canonical steroid effect.
• AA arachidonic acid
• LR-EtEPA suppresses AA and raises EPA and EPA/AA, which effects are analogous to those of steroids, insofar as the net effect of to diminish AA oxidation.
• This is achieved as EPA competes with arachidonic acid and is metabolized to distinct, analogous oxylipins, many of which have anti-inflammatory effects.
• large-dose IPE is expected to have anti-inflammatory effects via oxylipin metabolites that resemble critical aspects of corticosteroid effects.
• IPE may offer an alternative to steroids to induce HMOX2, or may act as a steroid-sparing agent.
• COX2 is an enzyme involved in converting EPA into bioactive oxylipins that may be less inflammatory compared to analogous oxylipins originating from AA.
• Angiotensin-converting enzyme ACE is produced in the lungs and regulates angiotensin I to the vasoconstrictive angiotensin II, thereby affecting blood pressure.
• ACE was inhibited by EPA (FIG. 34B).
• FADS2 fatty acid desaturase 2
• FADS1 fatty acid desaturase 1
• the proteomics results not only affirm the ability of EPA to promote HO-1 , but also confirm the ability of EPA to inhibit A5-, and A6-desaturases, corroborating the aforementioned ability of EtEPA to suppress the A5-desaturase index, for example.
• AA-derived oxylipins (2) by inhibiting synthesis of AA from DGLA by suppressing FADS2 and A5-desaturase, (3) by promoting synthesis of DGLA by inducing FADS1 and A8-desaturase, (4) by diminishing AA-derived oxylipins and/or augmenting DGLA-derived oxylipins from both (2) and (3) above, (5) by diminishing AA-derived oxylipins and augmenting EPA-derived oxylipins by providing copious amounts of EPA, and particular to the HO-1 example in this section, (6) by inducing the antioxidant response element and other pathways that induce HM0X1 and/or HM0X2, NQ01 , GST, and GHS.
• Example 5 EPA Increased Endothelial Nitric Oxide Synthase (eNOS) Levels and Proteins Associated with Cellular Responses to Oxidative Stress During Inflammation
• eNOS Endothelial Nitric Oxide Synthase
• the objective of this study is to measure and compare the effects of EPA and DHA on eNOS levels and expression of proteins that regulate ROS in human vascular ECs under conditions of inflammation.
• HUVECs Human umbilical vein endothelial cells
• Clonetics San Diego, California
• proliferating cells All cell culture donors were healthy, with no pregnancy or prenatal complications.
• the cultured cells were incubated in 95% air/5% CO2 at 37 Q C and passaged by an enzymatic (trypsin) procedure.
• the confluent cells (4 to 5 x 10 5 cells/35 mm dish) were placed with minimum essential medium containing 3 mM L- arginine and 0.1 mM BH4 [(6R)-5,6,7,8-tetrahydrobiopterin], Before experimental use, the cells (from second or third passage) were rinsed twice with Tyrode-HEPES buffer with 1 .8 mM CaCl2.
• EPA and DHA were purchased from Sigma-Aldrich (St. Louis, MO) and prepared initially in redistilled ethanol. Primary and secondary stock solutions were prepared and stored under nitrogen at -20°C.
• HUVECs were treated with vehicle, EPA, or DHA (10 pM) for 2 hours, and then challenged with IL-6 (12 ng/mL) for 24 h hours. After incubation, cells were pelleted and frozen at -80°C until proteomic analysis was performed.
• Relative protein expression levels among the various treatments were measured using LC/MS proteomic techniques. Following protein digest, peptides are separated over a reverse phase column and then identified based on their mass. [0278] Cell pellets were lysed using methanol/chloroform extraction. Proteins were denatured, reduced, alkylated, and trypsin digested. Samples were then prepared for Tandem Mass Tag (TMT) 10plex labeling. A bicinchoninic acid (BCA) assay was performed on each sample to quantify the total protein in each sample, which is important to confirm equal amounts of each sample are added to the multiplex sample. Each peptide in a sample was given a unique, low molecular weight (typically 126-130 Da), and then the samples were combined.
• TMT Tandem Mass Tag
• BCA bicinchoninic acid
• Each multiplexed sample was then fractionated to increase the overall protein coverage using high pH reversed phase fractionation and analyzed by LC/MS using a Dionex UltiMate 3000 RSLC in tandem with a Q-Exactive/Lumos Orbitrap Mass Spectrometer.
• the chromatography was performed using a 2-hour gradient on a Thermo Pepmap C18 column (100 A pore size, 3.0 pm particle size, 100 pM x 150 mm) set at 50°C.
• Mobile phase A was water with 0.1 % formic acid
• mobile phase B was acetonitrile with 0.1 % formic acid.
• GSR glutathione reductase
• TXN thioredoxin
• PRDX peroxiredoxin
• Example 6 EPA Modulates Expression of Inflammatory Proteins in Pulmonary Endothelial Cells following Exposure to Air Pollution Particle Matter
• EPA administered as icosapent ethyl is the first FDA approved drug to reduce cardiovascular risk among patients with elevated triglyceride levels as an addon to maximally tolerated statin therapy.
• the REDUCE-IT trial showed that treatment with high dose IPE (4 g/day) reduced composite cardiovascular events by 25% in statin- treated patients with elevated baseline triglyceride levels. See Bhatt et al., N. Engl. J. Med. (2019) 380:11 -22, incorporated herein by reference in its entirety.
• the benefits of IPE were independent of baseline triglyceride levels but positively correlated with plasma levels of EPA.
• This example evaluated the ability of EPA to modulate expression of inflammatory proteins and related pathways, including neutrophil degranulation, in pulmonary endothelial cells following exposure to air pollution PMs of different sizes.
• HMVEC-Ls Primary human lung microvascular endothelial cells
• PECs Primary human lung microvascular endothelial cells
• HMVEC-Ls Primary human lung microvascular endothelial cells
• Lonza Manassas, VA
• Cells were cultured in complete endothelial cell growth medium and maintained at 37°C in a 95% air/5% CO2 humidified incubator. Cells were supplied with fresh medium every other day and propagated by an enzymatic (trypsin) procedure. Cell culture medium also contained 2% FBS to facilitate fatty acid treatment.
• EPA was purchased from Sigma-Aldrich (Saint Louis, MO) and solubilized in redistilled ethanol under nitrogen atmosphere and stored at -20°C.
• FIGS. 39A-39B show particle size distribution for SRM 1648a and SRM2786 after 10-minute and 1 -hour sonication in water, respectively. Solid line represents the volume in % (see NIST Certificate of Analysis, SRM1648a and NIST Certificate of Analysis, SRM2786).
• PECs were pre-treated with EPA (40 pM) for 2 hours in 2% FBS-containing medium and then challenged with urban particulate matter (50 pg/mL) for 2 hours. After 2 hours, media was washed out and HBSS buffer was added. After incubation, cells were pelleted and frozen at -80°C until proteomic analysis was performed. Relative protein expression levels among the various treatments were measured using LC/MS proteomic techniques (FIG. 40).
• Each multiplexed sample was then fractionated to increase the overall protein coverage using high pH reversed phase fractionation and analyzed by LC/MS using a Dionex UltiMate 3000 RSLC in tandem with a Q-Exactive/Lumos Orbitrap Mass Spectrometer.
• Proteins that showed a fold change >1 .0 and p ⁇ 0.05 for the relevant comparisons were considered significant and further analyzed.
• a ComBat function was applied to all mass spectrometry intensity data to correct for batch effects.
• the bioinformatic package Differential Enrichment analysis of Proteomics data (DEP) was used to process proteomic data and generate the figures.
• the protein increases/decreases are determined based on the treatment effects (i.e., the 2nd treatment in each comparison).
• the present technology includes, but is not limited to, the following specific embodiments:
• a composition comprising: (a) at least 15%, by weight, one or more polyunsaturated fatty acids (PUFAs) or derivatives thereof; and (b) 1% to 85%, by weight, a source of phospholipid.
• PUFAs polyunsaturated fatty acids
• composition of embodiment 1 further comprising (c) 1% to
• PUFAs or derivatives thereof are selected from the group consisting of linoleic acid (LA), gamma-linoleic acid (GLA), dihomo-gamma-linoleic acid (DGLA), arachidonic acid (AA), adrenic acid (AdA), omega-6 docosapentaenoic acid (DPA6), alpha-lineoleic acid (ALA), stearidonic acid (SDA), omega-3 eicosatetraenoic acid (ETA), eicosapentaenoic acid (EPA), docosapentaenoic acid (DPA), docosahexaenoic acid (DHA), an LA derivative, a GLA derivative, a DGLA derivative, an AA derivative, an AdA derivative, a DPA6 derivative, an ALA derivative, an SDA derivative, an ETA derivative, an EPA derivative, a DPA derivative, and a DHA derivative.
• LA linoleic acid
• PUFA derivative comprises an oxylipin.
• composition of embodiment 3, wherein the LA derivative is selected from the group consisting of 9-hydroperoxy-octadecadienoic acid (9-HpODE), 13-hydroperoxy-octadecadienoic acid (13-HpODE), 9-hydroxy-octadecadienoic acid (9-HODE), 13-hydroxy-octadecadienoic acid (13-HODE), 9,10,13 trihydroxyoctadecenoic acid (9,10,13 TriHOME), 9,12,13 trihydroxy-octadecenoic acid (9,12,13 TriHOME), 9-oxo-octadecadienoic acid (9-oxo-ODE), 13-oxo-octadecadienoic acid (13- oxo-ODE), 9,10-epoxy-octadecenoic acid (9,10-EpOME), 12,13-epoxy-octadecenoic acid (12,
• composition of embodiment 3, wherein the GLA derivative is selected from the group consisting of 6-hydroxy-octatrienoic acid (6-HOTrE or 6- hydroxy-GLA), 7-hydroxy-octatrienoic acid (7-HOTrE or 7-hydroxy-GLA), 9-hydroxy- octatrienoic acid (9-HOTrE or 9-hydroxy-GLA), 10-hydroxy-octatrienoic acid (10-HOTrE or 10-hydroxy-GLA), 12-hydroxy-octatrienoic acid (12-HOTrE or 12-hydroxy-GLA), 13- hydroxy-octatrienoic acid (13-HOTrE or 13-hydroxy-GLA), 6,13-dihydroxy-octadienoic acid (6,13-DiHODE or 6,13-d i hydro xy-G LA), and trihydroxy GLA derivatives (trihydroxy- GLAs).
• 6-hydroxy-octatrienoic acid (6-HOTrE or 6- hydroxy-GLA)
• composition of embodiment 3, wherein the DGLA derivative is selected from the group consisting of prostaglandin D1 (PGD1 ), prostaglandin E1 (PGE1 ), 15-hydroxy-PGE1 , 19-hydroxy-PGE1 , 13,14-dihydroxy-PGE1 , 13,14- dihydroxy-15-keto-PGE1 , prostaglandin F1 a (PGF1 a), 6-keto-PGF1 a, 15-keto-PGF1 a, 13,14-dihydroxy-PGF1 a, 15,19-dihydroxy-PGF1 a, 13,14-dihydroxy-15-keto PGF1 a, prostacyclin 11 (prostaglandin 11 or PGI1 ), thromboxane A1 (TXA1 ), thromboxane B1 (TXB1 ), leukotriene B3 (LTB3), leukotriene C3 (LTC3), leukotriene D3 (LTD3)
• composition of embodiment 3, wherein the AA derivative is selected from the group consisting of 6-keto-prostaglandin F1 alpha (6k-PGF1 a), thromboxane B2 (TXB2), 11 -dehydro-thromboxane B2 (1 1 -dTXB2), prostaglandin F2 alpha (PGF2a), prostaglandin E2 (PGE2), prostaglandin A2 (PGA2), prostaglandin D2 (PGD2), 2,3-dinor 11 beta-prostaglandin F2 alpha (2,3-dinor1 1 bPGF2a), prostaglandin J2 (PGJ2), 15-deoxy-delta-12,14-prostaglandin J2 (15d-PGJ2), leukotriene B4 (LTB4), 20-hydroxy-leukotriene B4 (20-OH-LTB4), leukotriene 04 (LTC4), leukotriene D4 (LTD4), leukotriene
• composition of embodiment 3, wherein the AdA derivative is selected from the group consisting of dihomo-prostaglandin E2 (dihomo-PGE2), dihomo-prostaglandin D2 (dihomo-PGD2), dihomo-prostaglandin F2a (dihomo- PGF2a), dihomo-prostacyclin I2 (dihomo-prostaglandin I2 or dihomo-PGI2), dihomothromboxane A2 (dihomo-TXA2), dihomo-thromboxane B2 (dihomo-TXB2), 7- hydroperoxy-docosatetraenoic acid (dihomo-7-HpETE), 10-hydroperoxy- docosatetraenoic acid (dihomo-10-HpETE), 1 1 -hydroperoxy-docosatetraenoic acid (dihomo-1 1 -HpETE), 13-hydroper
• composition of embodiment 3, wherein the DPA6 derivative is selected from the group consisting of 7-hydroperoxy-DPA6, 8-hydroperoxy-DPA6, 10- hydroperoxy-DPA6, 11 -hydroperoxy-DPA6, 13-hydroperoxy-DPA6, 14-hydroperoxy- DPA6, 17-hydroperoxy-DPA6, 7-hydroxy-DPA6, 8- hydroxy- DP A6, 10-hydroxy-DPA6, 11 -hydroxy-DPA6, 13-hydroxy-DPA6, 14-hydroxy-DPA6, 17-hydroxy-DPA6, 4,5- dihydroxy-DPA6, 7,14-dihydroxy-DPA6, 7,17-dihydroxy-DPA6, 8,14-dihydroxy-DPA6, 10,17-dihydroxy-DPA6, 13,17-dihydroxy-DPA6, 16,17-dihydroxy-DPA6, 4,5,17- trihydroxy-DPA6, 7,16,17-trihydroxy-DPA6, and 10,13,17-trihydroxy-DPA6.
• composition of embodiment 3, wherein the ALA derivative is selected from the group consisting of 9-hydroperoxy-octatrienoic acid (9-HpOTrE), 13- hydroperoxy-octatrienoic acid (13-HpOTrE), 9-hydroxy-octatrienoic acid (9-HOTrE), 13- hydroxy-octatrienoic acid (13-HOTrE), 9,16-dihydroxy-octatrienoic acid (9,16- DiHOTrE), 9-oxo-octatrienoic acid (9-oxo-OTrE), 13-oxo-octatrienoic acid (13-oxo- OtrE), 9,10-epoxy-octadienoic acid (9,10-EpODE), 12,13-epoxy-octadienoic acid (12,13-EpODE), 15,16-epoxy-octadienoic acid (15,16-E
• composition of embodiment 3, wherein the SDA derivative is selected from the group consisting of 6-hydroperoxy-octatetraenoic acid (6-HpOTE or
• composition of embodiment 3, wherein the ETA derivative is selected from the group consisting of A17,18 prostaglandin D1 (A17,18 PGD1 or co-3 PGD1 ), A17,18 prostaglandin E1 (A17,18 PGE1 or co-3 PGE1 ), and A17,18 prostaglandin F1 a (A17, 18 PGF1 a or co-3 PGF1 a), A17,18 prostacyclin 11 (A17,18 PG 11 or w-3 PGE1 ), A17,18 12-hydroperoxy-eicosatetraenoic acid (A17,18 12-HpETE or co- 3 12-HpETE), A17, 18 15-hydroperoxy-eicosatetraenoic acid (A17,18 15-HpETE or co-3 15-HpETE), A16,17 18-hydroperoxy-eicosatetraenoic acid (A16,17 18-HpETE), A17,18 12-hydroxy-eicoico
• composition of embodiment 3, wherein the EPA derivative is selected from the group consisting of 6-keto-prostaglandin F2 alpha (6k-PGF2a), thromboxane B3 (TXB3), 1 1 -dehydro-thromboxane B3 (1 1 -dTXB3), prostaglandin F3 alpha (PGF3a), prostaglandin E3 (PGE3), prostaglandin A3 (PGA3), prostaglandin D3 (PGD3), 2,3-dinor 1 1 beta-prostaglandin F3 alpha (2,3-dinor1 1 bPGF3a), prostaglandin J3 (PGJ3), 15-deoxy-delta-12,14-prostaglandin J3 (15d-PGJ3), leukotriene B5 (LTB5), 20-hydroxy-leukotriene B5 (20-OH-LTB5), leukotriene 05 (LTC5), leukotriene D5 (LTD5), leukotriene B
• composition of embodiment 3, wherein the DPA derivative is selected from the group consisting of 7-hydroperoxy-docosapentaeonic acid (7- hydroperoxy-DPA), 10-hydroperoxy-docosapentaeonic acid (10-hydroperoxy-DPA), 11 -hydroperoxy-docosapentaeonic acid (1 1 -hydroperoxy-DPA), 13-hydroperoxy- docosapentaeonic acid (13-hydroperoxy-DPA), 14-hydroperoxy-docosapentaeonic acid (14-hydroperoxy-DPA), 16-hydroperoxy-docosapentaeonic acid (16-hydroperoxy- DPA), 17-hydroperoxy-docosapentaeonic acid (17-hydroperoxy-DPA), 7-hydroxy- docosapentaeonic acid (7-hydroxy-DPA), 10-hydroxy-docosapentaeonic acid (10- hydroxy-hydroxy-DPA),
• composition of embodiment 3, wherein the DHA derivative is selected from the group consisting of 4-hydroperoxy-docosahexaenoic acid (4- HpDoHE), 7-hydroperoxy-docosahexaenoic acid (7-HpDoHE), 8-hydroperoxy- docosahexaenoic acid (8-HpDoHE), 10-hydroperoxy-docosahexaenoic acid (10- HpDoHE), 11 -hydroperoxy-docosahexaenoic acid (1 1 -HpDoHE), 13-hydroperoxy- docosahexaenoic acid (13-HpDoHE), 14-hydroperoxy-docosahexaenoic acid (14- HpDoHE), 16-hydroperoxy-docosahexaenoic acid (16-HpDoHE), 17-hydroperoxy- docosahexaenoic acid (17-HpDoHE), 4-hydroxy-
• PUFAs or derivatives thereof are selected from the group consisting of tetracosatetraenoic acid (TTE), tetracosapentaenoic acid (TPA), tetracosahexaenoic acid (THA), a TTE derivative, a TPA derivative, and a THA derivative.
• PUFAs or derivatives thereof comprises EPA in free acid form or a pharmaceutically acceptable ester, conjugate, or salt thereof.
• EtEPA comprises at least 66%, 75%, 80%, 90%, 95%, or 96%, by weight, of all PUFAs present in the composition.
• omega-6 PUFAs or derivatives thereof selected from the group consisting of LA, GLA, DGLA, AdA, DPA6, an LA derivative, a GLA derivative, a DGLA derivative, an AdA derivative, and a DPA6 derivative
• omega-3 PUFAs or derivatives thereof selected from the group consisting
• composition of any one of embodiments 18-21 wherein the composition comprises about 500 mg to about 1 g of the EPA or EtEPA.
• composition any one of embodiments 1 -22, wherein the source of phospholipid comprises a glycerophospholipid, a lysophospholipid, or a mixture thereof.
• the source of phospholipid is lecithin.
• composition of embodiment 24, wherein the lecithin comprises up to 40%, up to 60%, up to 80%, up to 90%, up to 95%, or up to 97%, by weight of the lecithin, phosphatidylethanolamine, and no more than 10%, no more than 5%, no more than 4%, no more than 3%, no more than 2%, or no more than 1%, by weight of the lecithin, phosphatidylinositol.
• composition of embodiment 24, wherein the lecithin comprises: (a) 19%-27%, by weight, phosphatidylcholine; (b) no more than 4%, by weight, lysophosphatidylcholine; (c) 16%-22%, by weight, phosphatidylethanolamine; (d) 11%-18%, by weight, phosphatidylinositol; and (e) 1%-9%, by weight, phosphatidic acid.
• composition of any one of embodiments 1 -26, wherein a weight ratio of the one or more PUFAs or derivatives thereof and the source of phospholipid ranges from about 5:1 to about 1 :5, from about 3.75:1 to about 1 :5, or from about 1 :1 to about 1 :5.
• EPA or EtEPA ranges from about 1 :1 to about 1 :5.
• composition of embodiment 30, wherein the glycerol derivative is castor oil.
• composition of embodiment 30, wherein the glycerol derivative is re-esterified triglyceride (rTG) enriched with the PUFA.
• a kit comprising: (a) a first composition comprising one or more polyunsaturated fatty acids (PUFAs) or derivatives thereof; and (b) a second composition comprising a source of phospholipid.
• PUFAs polyunsaturated fatty acids
• 34 The kit of embodiment 33, wherein the first and/or second composition further comprises one or more emulsifiers.
• kits of embodiment 33 or 34 wherein the one or more PUFAs or derivatives thereof are selected from the group consisting of linoleic acid (LA), gamma-linoleic acid (GLA), dihomo-gamma-linoleic acid (DGLA), arachidonic acid (AA), adrenic acid (AdA), omega-6 docosapentaenoic acid (DPA6), alpha-lineoleic acid (ALA), stearidonic acid (SDA), omega-3 eicosatetraenoic acid (ETA), eicosapentaenoic acid (EPA), docosapentaenoic acid (DPA), docosahexaenoic acid (DHA), an LA derivative, a GLA derivative, a DGLA derivative, an AA derivative, an AdA derivative, a DPA6 derivative, an ALA derivative, an SDA derivative, an ETA derivative, an EPA derivative, a DPA
• kits of embodiment 33 or 34, wherein the one or more PUFAs or derivatives thereof are selected from the group consisting of tetracosatetraenoic acid (TTE), tetracosapentaenoic acid (TPA), tetracosahexaenoic acid (TH A), a TTE derivative, a TPA derivative, and a THA derivative.
• TTE tetracosatetraenoic acid
• TPA tetracosapentaenoic acid
• TH A tetracosahexaenoic acid
• kits of embodiment 33 or 34, wherein the one or more PUFAs or derivatives thereof comprises EPA in free acid form or a pharmaceutically acceptable ester, conjugate, or salt thereof.
• omega-6 PUFAs or derivatives thereof selected from the group consisting of LA, GLA, DGLA, AdA, DPA6, an LA derivative, a GLA derivative, a DGLA derivative, an AdA derivative, and a DPA6 derivative
• omega-3 PUFAs or derivatives thereof selected from
• kits any one of embodiments 33-42, wherein the source of phospholipid comprises a glycerophospholipid, a lysophospholipid, or a mixture thereof.
• phosphatidylcholine 27%, by weight, phosphatidylcholine; (b) no more than 4%, by weight, lysophosphatidylcholine; (c) 16%-22%, by weight, phosphatidylethanolamine; (d) 11%- 18%, by weight, phosphatidylinositol; and (e) 1 %-9%, by weight, phosphatidic acid.
• kits of any one of embodiments 33-46, wherein a weight ratio of the one or more PUFAs or derivatives thereof and the source of phospholipid ranges from about 5:1 to about 1 :5, from about 3.75:1 to about 1 :5, or from about 1 :1 to about 1 :5.
• EtEPA and the source of phospholipid ranges from about 1 :1 to about 1 :5.
• a lymph-releasing eicosapentaenoic acid ethyl ester (LR-EtEPA) composition comprising: (a) at least 15%, by weight, EtEPA; and (b) 1 % to 85%, by weight, a source of phospholipid.
• EtEPA comprises at least 66%, 75%, 80%, 90%, 95%, or 96%, by weight, of all fatty acids present in the composition.
• the LR-EtEPA composition any one of embodiments 53-56, wherein the source of phospholipid comprises a glycerophospholipid, a lysophospholipid, or a mixture thereof.
• the LR-EtEPA composition of embodiment 58, wherein the lecithin comprises: (a) 19%-27%, by weight, phosphatidylcholine; (b) no more than 4%, by weight, lysophosphatidylcholine; (c) 16%-22%, by weight, phosphatidylethanolamine;
• 61 The LR-EtEPA composition of any one of embodiments 53-60, wherein a weight ratio of the EtEPA and the source of phospholipid ranges from about 5:1 to about 1 :5, from about 3.75:1 to about 1 :5, or from about 1 :1 to about 1 :5.
• 62 The LR-EtEPA composition of any one of embodiments 54-61 , wherein the one or more emulsifiers comprise polysorbate 80, polyoxyl-35, or both.
• LR-EtEPA composition of any one of embodiments 54-61 , wherein the one or more emulsifiers comprise one or more glycerol derivatives selected from the group consisting of triacylglycerol, diacylglycerol, and monoacylglycerol.
• a method of treating or preventing a disease in a subject in need thereof comprising administering to the subject a therapeutically effective amount of the composition of any one of embodiments 1 -32, the kit of any one of embodiments 33-52, or the LR-EtEPA composition of any one of embodiments 53-67.
• cardiovascular disease is selected from the group consisting of hypertriglyceridemia, hypercholesterolemia, mixed dyslipidemia, coronary heart disease, stroke, atherosclerosis, arrhythmia, hypertension, myocardial infarction, vasculitis, cardiomyopathy (e.g., viral cardiomyopathy including related to COVID-19), pericarditis, congestive heart failure, myocardial necrosis, vascular ischemia, vascular disease beyond the cardiopulmonary system, thrombotic disease, post-myocardial infarction cardiac remodeling, giant cell arteritis, polyarteritis nodosa, cryoglobulinemia, episodic small-vessel ischemia (Raynaud’s disease), deep venous thrombosis, disseminated intravascular coagulation, and erectile dysfunction.
• cardiomyopathy e.g., viral cardiomyopathy including related to COVID-19
• pericarditis congestive heart failure
• myocardial necrosis vascular isch
• HDL-C non-high-density lipoprotein cholesterol
• TC total cholesterol
• VLDL-C very low-density lipoprotein cholesterol
• LDL- C low-density lipoprotein cholesterol
• statin is selected from the group consisting of atorvastatin, fluvastatin, lovastatin, pitavastatin, pravastatin, rosuvastatin, and simvastatin.
• pulmonary disease is selected from the group consisting of community-acquired pneumonia, COVID-19 pneumonia, systemic inflammatory response syndrome (SIRS), sepsis, SIRS, acute respiratory distress syndrome (ARDS), pulmonary embolism, diffuse interstitial pneumonia, radiation pneumonitis, pleuritis, acute eosinophilic pneumonia, chronic eosinophilic pneumonia, Loftier syndrome, sarcoidosis, interstitial lung disease, chronic obstructive pulmonary disease (COPD), reactive airway disease, asthma, bronchiectasis, bronchiolitis, cystic fibrosis, bronchial carcinoid, pulmonary arterial hypertension, pulmonary vasculitis, microscopic polyangiitis, granulomatosis with polyangiitis (Wegener’s disease), eosinophilic granulomatosis with polyangiitis (Churg- Strauss), nas
• the neurological disease is selected from the group consisting of Huntington’s disease, sleep disorders, dementia, psychosis, anxiety, treatment-resistant depression, neuropathic pain, schizophrenia, bipolar disorder, dyslexia, dyspraxia, attention deficit hyperactivity disorder (ADHD), epilepsy, autism, Alzheimer’s disease, Parkinson’s Disease, senile dementia, multiple sclerosis, diabetes-induced neuropathy, macular degeneration, retinopathy of prematurity, amyotrophic lateral sclerosis (ALS), retinitis pigmentosa, cerebral palsy, muscular dystrophy, neurological cancer, cystic fibrosis, and neural tube defects.
• Huntington’s disease Huntington’s disease
• sleep disorders dementia
• psychosis anxiety
• treatment-resistant depression neuropathic pain
• schizophrenia bipolar disorder
• dyslexia dyspraxia
• ADHD attention deficit hyperactivity disorder
• ADHD attention deficit hyperactivity disorder
• epilepsy autism
• Alzheimer’s disease Parkinson’s Disease
• senile dementia multiple sclerosis
• cancer is a hematological malignancy selected from the group consisting of monoclonal B cell lymphocytosis, multiple myeloma, myeloid neoplasm, myelodysplastic syndromes (MDS), myeloproliferative/myelodysplastic syndromes, acute lymphoid leukemia (ALL), chronic lymphocytic leukemia (CLL), acute myeloid leukemia (AML), chronic myelogenous leukemia (CML), blast crisis chronic myelogenous leukemia (bcCML), B cell acute lymphoid leukemia (B-ALL), T cell acute lymphoid leukemia (T-ALL), T cell lymphoma, and B cell lymphoma.
• ALL acute lymphoid leukemia
• CLL chronic lymphocytic leukemia
• AML acute myeloid leukemia
• CML chronic myelogenous leukemia
• BcCML blast crisis chronic myelogenous leukemia
• cancer is a solid tumor selected from the group consisting of lung cancer, breast cancer, liver cancer, stomach cancer, colon cancer, rectal cancer, colorectal cancer, kidney cancer, gastric cancer, gallbladder cancer, cancer of the small intestine, esophageal cancer, melanoma, bone cancer, pancreatic cancer, skin cancer, uterine cancer, ovarian cancer, testicular cancer, cancer of the thyroid gland, cancer of the adrenal gland, bladder cancer, and glioma.
• lung cancer breast cancer, liver cancer, stomach cancer, colon cancer, rectal cancer, colorectal cancer, kidney cancer, gastric cancer, gallbladder cancer, cancer of the small intestine, esophageal cancer, melanoma, bone cancer, pancreatic cancer, skin cancer, uterine cancer, ovarian cancer, testicular cancer, cancer of the thyroid gland, cancer of the adrenal gland, bladder cancer, and glioma.
• the disease is a disease associated with kidney selected from the group consisting of post-infectious glomerulonephritis, IgA nephropathy (Berger’s disease), Henoch-Schbnlein purpura, systemic IgA vasculitis, microscopic polyangiitis, granulomatosis with polyangiitis (Wegener’s), eosinophilic granulomatosis with polyangiitis (Churg-Strauss), polyarteritis, idiopathic crescentic glomerulonephritis, anti-GBM glomerulonephritis, Goodpasure syndrome, cryoglobulin-associated glomerulonephritis, idiopathic membranoproliferative glomerulopnephritis (MPGN), hepatitis C-associated glomerulonephritis, systemic lupus erythematosus (MPGN), hepatitis C-associated glomerulone
• the disease is a disease associated with liver selected from the group consisting of chronic viral hepatitis, autoimmune hepatitis, alcoholic liver disease, non-alcoholic fatty liver disease, hemochromatosis, Wilson disease, primary biliary cholangitis, primary sclerosing cholangitis, and cholelithiasis.
• the disease is a disease associated with blood cells selected from the group consisting of iron deficiency anemia, anemia of chronic disease, hemolytic anemia, thalassemia, polycythemia vera, sickle cell disease anemia, sickle cell disease pain, immune thrombocytopenia, leukemias, Non-Hodgkin lymphoma, and Hodgkin lymphoma.
• NAC related agent is selected from the group consisting of cystine, methionine, N-acetylcysteine, and L-2- oxothiazolidine-4-carboxylate.
• EtEPA composition is administered to the subject to provide a daily dose of about 4 g of EtEPA.
• a therapeutically effective amount of the composition, kit, or LR-EtEPA composition is administered to the subject.
• composition, kit, or LR-EtEPA composition of embodiment 99 wherein the cardiovascular disease is selected from the group consisting of hypertriglyceridemia, hypercholesterolemia, mixed dyslipidemia, coronary heart disease, stroke, atherosclerosis, arrhythmia, hypertension, myocardial infarction, vasculitis, cardiomyopathy (e.g., viral cardiomyopathy including related to COVID-19), pericarditis, congestive heart failure, myocardial necrosis, vascular ischemia, vascular disease beyond the cardiopulmonary system, thrombotic disease, post-myocardial infarction cardiac remodeling, giant cell arteritis, polyarteritis nodosa, cryoglobulinemia, episodic small-vessel ischemia (Raynaud’s disease), deep venous thrombosis, disseminated intravascular coagulation, and erectile dysfunction.
• cardiomyopathy e.g., viral cardiomyopathy including related to COVID-19
• pericarditis
• composition, kit, or LR-EtEPA composition of any one of embodiments 99-101 wherein the subject has one or more of: a baseline non-high- density lipoprotein cholesterol (HDL-C) value of about 200 mg/dL to about 300 mg/dL; a baseline total cholesterol (TC) value of about 250 mg/dL to about 300 mg/dL; a baseline very low-density lipoprotein cholesterol (VLDL-C) value of about 140 mg/dL to about 200 mg/dL; a baseline HDL-C value of about 10 mg/dL to about 30 mg/dL; a baseline low-density lipoprotein cholesterol (LDL-C) value of about 40 mg/dL to about 100 mg/dL; and a baseline high-sensitivity C-reactive protein (hsCRP) level of about 2 mg/dL or less.
• HDL-C non-high- density lipoprotein cholesterol
• TC total cholesterol
• VLDL-C very low-density lipoprotein cholesterol
• the stable statin therapy comprises a statin and optionally ezetimibe.
• statin is selected from the group consisting of atorvastatin, fluvastatin, lovastatin, pitavastatin, pravastatin, rosuvastatin, and simvastatin.
• statin is selected from the group consisting of atorvastatin, fluvastatin, lovastatin, pitavastatin, pravastatin, rosuvastatin, and simvastatin.
• pulmonary disease is selected from the group consisting of community-acquired pneumonia, COVID-19 pneumonia, systemic inflammatory response syndrome (SIRS), sepsis, SIRS, acute respiratory distress syndrome (ARDS), pulmonary embolism, diffuse interstitial pneumonia, radiation pneumonitis, pleuritis, acute eosinophilic pneumonia, chronic eosinophilic pneumonia, Loftier syndrome, sarcoidosis, interstitial lung disease, chronic obstructive pulmonary disease (COPD), reactive airway disease, asthma, bronchiectasis, bronchiolitis, cystic fibrosis, bronchial carcinoid, pulmonary arterial hypertension, pulmonary vasculitis, microscopic polyangiitis, granulomatosis with polyangiitis (Wegener’s disease), eosinophilic granulomatosis with polyangiitis (Churg-Strauss), nasopharyngitis, Goodpasture’s
• SIRS
• the neurological disease is selected from the group consisting of Huntington’s disease, sleep disorders, dementia, psychosis, anxiety, treatmentresistant depression, neuropathic pain, schizophrenia, bipolar disorder, dyslexia, dyspraxia, attention deficit hyperactivity disorder (ADHD), epilepsy, autism, Alzheimer’s disease, Parkinson’s Disease, senile dementia, multiple sclerosis, diabetes-induced neuropathy, macular degeneration, retinopathy of prematurity, amyotrophic lateral sclerosis (ALS), retinitis pigmentosa, cerebral palsy, muscular dystrophy, neurological cancer, cystic fibrosis, and neural tube defects.
• Huntington’s disease Huntington’s disease
• sleep disorders dementia
• psychosis anxiety
• treatmentresistant depression neuropathic pain
• schizophrenia bipolar disorder
• dyslexia dyspraxia
• ADHD attention deficit hyperactivity disorder
• ADHD attention deficit hyperactivity disorder
• epilepsy autism
• Alzheimer’s disease Parkinson’s Disease
• senile dementia multiple sclerosis
• composition, kit, or LR-EtEPA composition of embodiment 98, wherein the disease is cancer.
• the cancer is a hematological malignancy selected from the group consisting of monoclonal B cell lymphocytosis, multiple myeloma, myeloid neoplasm, myelodysplastic syndromes (MDS), myeloproliferative/myelodysplastic syndromes, acute lymphoid leukemia (ALL), chronic lymphocytic leukemia (CLL), acute myeloid leukemia (AML), chronic myelogenous leukemia (CML), blast crisis chronic myelogenous leukemia (bcCML), B cell acute lymphoid leukemia (B-ALL), T cell acute lymphoid leukemia (T-ALL), T cell lymphoma, and B cell lymphoma.
• ALL acute lymphoid leukemia
• CLL chronic lymphocytic leukemia
• AML acute myeloid leukemia
• CML chronic myelogenous leukemia
• BcCML blast crisis chronic myelogenous leukemia
• the cancer is a solid tumor selected from the group consisting of lung cancer, breast cancer, liver cancer, stomach cancer, colon cancer, rectal cancer, colorectal cancer, kidney cancer, gastric cancer, gallbladder cancer, cancer of the small intestine, esophageal cancer, melanoma, bone cancer, pancreatic cancer, skin cancer, uterine cancer, ovarian cancer, testicular cancer, cancer of the thyroid gland, cancer of the adrenal gland, bladder cancer, and glioma.
• composition, kit, or LR-EtEPA composition of embodiment 98 wherein the disease is a disease associated with pancreas selected from the group consisting of hyperglycemia, pre-diabetes, diabetes (Type 1 and/or Type 2), and pancreatitis.
• composition, kit, or LR-EtEPA composition of embodiment 98 wherein the disease is a disease associated with liver selected from the group consisting of chronic viral hepatitis, autoimmune hepatitis, alcoholic liver disease, nonalcoholic fatty liver disease, hemochromatosis, Wilson disease, primary biliary cholangitis, primary sclerosing cholangitis, and cholelithiasis.
• the disease is a disease associated with liver selected from the group consisting of chronic viral hepatitis, autoimmune hepatitis, alcoholic liver disease, nonalcoholic fatty liver disease, hemochromatosis, Wilson disease, primary biliary cholangitis, primary sclerosing cholangitis, and cholelithiasis.
• composition, kit, or LR-EtEPA composition of embodiment 98 wherein the disease is a disease associated with intestines selected from the group consisting of gastroesophageal reflux disease (GERD), gastritis, peptic ulcer disease, obesity, cachexia, intestinal angina, Crohn disease, ulcerative colitis, antibiotic- associated colitis, irritable bowel syndrome, colon cancer, colon polyposis, and carcinoid.
• gastroesophageal reflux disease GUD
• gastritis gastritis
• peptic ulcer disease obesity
• cachexia intestinal angina
• Crohn disease ulcerative colitis
• antibiotic- associated colitis antibiotic- associated colitis
• irritable bowel syndrome colon cancer
• colon polyposis colon polyposis
• carcinoid carcinoid
• composition, kit, or LR-EtEPA composition of embodiment 98 wherein the disease is a disease associated with blood cells selected from the group consisting of iron deficiency anemia, anemia of chronic disease, hemolytic anemia, thalassemia, polycythemia vera, sickle cell disease anemia, sickle cell disease pain, immune thrombocytopenia, leukemias, Non-Hodgkin lymphoma, and Hodgkin lymphoma.
• GSH glutathione
• the disease is anemia, sickle cell disease, and/or glomerulonephritis.
• composition, kit, or LR-EtEPA composition of embodiment 118 or 119 wherein the method further comprises administering to the subject a N- acetylcysteine (NAG) related agent.
• NAG N- acetylcysteine
• NAG related agent is selected from the group consisting of cystine, methionine, N-acetylcysteine, and L-2-oxothiazolidine-4-carboxylate.
• composition, kit, or LR-EtEPA composition of embodiment 98 wherein the disease is oxidative stress, endothelial dysfunction, narrowing and/or thickening of arteries, and/or inflammation induced by inhalation of particulate matter.
• composition, kit, or LR-EtEPA composition of embodiment 98 wherein the disease is oxidative stress, endothelial dysfunction, narrowing and/or thickening of arteries, and/or inflammation induced by long-term and/or short-term exposure to air pollution.
• composition, kit, or LR-EtEPA composition of any one of embodiments 98-123, wherein the composition, kit, or LR-EtEPA composition is administered to the subject to provide a daily dose of about 1 g to about 20 g of EtEPA.
• compositions, kit, or LR-EtEPA composition is administered to the subject to provide a daily dose of about 4 g of EtEPA.
• composition, kit, or LR-EtEPA composition of any one of embodiments 98-125, wherein the composition, kit, or LR-EtEPA composition is administered to the subject once or twice per day.
• composition, kit, or LR-EtEPA composition of any one of embodiments 98-126, wherein the composition, kit, or LR-EtEPA composition is administered to the subject with or without food.

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