WO2023228062A1 - Nutraceutical or pharmaceutical composition for male infertility - Google Patents

Nutraceutical or pharmaceutical composition for male infertility Download PDF

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Publication number
WO2023228062A1
WO2023228062A1 PCT/IB2023/055270 IB2023055270W WO2023228062A1 WO 2023228062 A1 WO2023228062 A1 WO 2023228062A1 IB 2023055270 W IB2023055270 W IB 2023055270W WO 2023228062 A1 WO2023228062 A1 WO 2023228062A1
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Prior art keywords
calcium
nutraceutical
pharmaceutical composition
male infertility
preferably ranging
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PCT/IB2023/055270
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French (fr)
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Umberto DI MAIO
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Neilos S.r.l.
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Publication of WO2023228062A1 publication Critical patent/WO2023228062A1/en

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P15/00—Drugs for genital or sexual disorders; Contraceptives
    • A61P15/08—Drugs for genital or sexual disorders; Contraceptives for gonadal disorders or for enhancing fertility, e.g. inducers of ovulation or of spermatogenesis
    • A—HUMAN NECESSITIES
    • A23—FOODS OR FOODSTUFFS; TREATMENT THEREOF, NOT COVERED BY OTHER CLASSES
    • A23L—FOODS, FOODSTUFFS, OR NON-ALCOHOLIC BEVERAGES, NOT COVERED BY SUBCLASSES A21D OR A23B-A23J; THEIR PREPARATION OR TREATMENT, e.g. COOKING, MODIFICATION OF NUTRITIVE QUALITIES, PHYSICAL TREATMENT; PRESERVATION OF FOODS OR FOODSTUFFS, IN GENERAL
    • 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
    • A23L33/16—Inorganic salts, minerals or trace elements
    • 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
    • A61K31/195—Carboxylic acids, e.g. valproic acid having an amino group
    • A61K31/197—Carboxylic acids, e.g. valproic acid having an amino group the amino and the carboxyl groups being attached to the same acyclic carbon chain, e.g. gamma-aminobutyric acid [GABA], beta-alanine, epsilon-aminocaproic acid or pantothenic acid
    • A61K31/198—Alpha-amino acids, e.g. alanine or edetic acid [EDTA]
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K33/00—Medicinal preparations containing inorganic active ingredients
    • A61K33/06—Aluminium, calcium or magnesium; Compounds thereof, e.g. clay

Definitions

  • the present invention relates to a nutraceutical or pharmaceutical composition efficient in the prevention and/or treatment of male infertility both in humans and animals.
  • Male infertility is a pathology making a man unable to impregnate his partner after a period of free unprotected sex longer than a year.
  • the reduced reproductive ability in man derives from anomalies both in the quantity and in the quality of spermatozoa in the ejaculate.
  • azoospermia oligozoospermia
  • asthenozoospermia oligozoospermia
  • teratozoospermia necrospermia
  • aspermia aspermia
  • hypospermia hypospermia
  • leukospermia leukospermia
  • azoospermia means the pathologic condition in which there is total absence of spermatozoa in the ejaculate.
  • Oligozoospermia, asthenozoospermia and teratozoospermia are the more frequent conditions of male infertility and may occur even at the same time in the same patient.
  • Oligozoospermia is the reduced number of spermatozoa present in the sperm
  • asthenozoospermia is defined according to the poor motility of spermatozoa
  • teratozoospermia derives from structural alterations of the head and/or tail of male reproductive cells. Instead, necrospermia is the case when spermatozoa are produced but they are not vital and therefore are unable to fertilize the egg cell.
  • hypospermia is the case when the ejaculate has a volume lower than 1 .5 ml
  • leukospermia is the case when white blood cell concentration in the ejaculate is particularly high.
  • sperm production in infertile subjects may be divided into two main categories such as genetic and acquired ones.
  • Genetic causes may be congenital in nature when events such as cryptorchidism with testicle retention, lack of epididymis and anomalies of vasa deferentia occur.
  • Other genetic causes are often associated with mutations such as those characterizing cystic fibrosis transmembrane conductance regulator (CFTR) gene, Klinefelter syndrome, Kallmann syndrome and those resulting in chromosomal anomalies with consequent testicular dysfunction and chromosome Y microdeletions.
  • CTR cystic fibrosis transmembrane conductance regulator
  • Varicocele is due to an anomalous dilation of the veins of the pampiniform plexus of the sperm funnel which blocks the correct flow of spermatozoa in testicles, causing pain and burning both during urination and during the ejaculation process.
  • ROS reactive oxygen
  • RNS nitric oxide
  • said pathological event occurs when the main enzymes responsible for the endogenous antioxidant response, such as superoxide dismutase, catalase, glutathione S-transferase and nitric oxide synthase, are unable to control the increase of the ROS and RNS intracellular concentrations. Low concentrations of these molecules are required for the correct development of spermatozoa and for their consequent activation during the acrosomal reactions and in the capacitation processes close to the egg cell.
  • the main enzymes responsible for the endogenous antioxidant response such as superoxide dismutase, catalase, glutathione S-transferase and nitric oxide synthase
  • the symptoms occurring in infertile patients following the abovementioned different causes relate to swelling and pain sensation at testicles associated with the observed difficulty in urination and ejaculation processes.
  • male infertility may also be diagnosed as a function of the causes, thanks to different anatomical and biological analyses.
  • Eventual morphological anomalies of the male urogenital apparatus are identified by the urologist.
  • biological analyses are carried out by sperm withdrawal from infertile patients, to define the sperm parameters by analyzing the spermiogram.
  • the infertile patient can undergo two different treatments, such as ethiological or empirical treatment.
  • a targeted treatment is operated to assure the reduction and/or the removal of the problem inducing male infertility.
  • Examples of ethiological treatments are hormonal therapy with the administration of gonadotropins to promote spermatogenesis or varicocelectomy, a surgery preventing blood reflux into the testicular veins in subjects suffering from varicocele.
  • the present invention relates to a nutraceutical or pharmaceutical composition useful for the prevention and/or treatment of male infertility both in humans and animals.
  • the composition object of the present invention comprises calcium, N-acetylcysteine (NAC) and arginine.
  • Calcium is a chemical element indicated with the symbol Ca and is the twentieth element of the periodic table, belonging to the alkaline-earth metal group. This mineral is the fifth more representative element of the chemical composition of earth’s crust and sea water, in addition to be the most abundant element in the human body.
  • plasmatic calcium concentration is 2.5 mM and almost 50% calcium is bound to blood proteins, including albumin which is its primary ligand. The remaining calcium is in free form and since it is an electrolyte, it is characterized by an electric charge, being than in ionized form. The extracellular concentration is 1.2 mM with calcium in ionized form. Blood calcium levels are regulated by the presence of two specific hormones such as parathyroid hormone and calcitonin.
  • Parathyroid hormone is a protein molecule produced by four small glands surrounding thyroid, called parathyroids. This hormone is mainly produced in higher quantities when there is blood calcium deficiency.
  • parathyroid hormone may stimulate calcium release from the bones, induce kidneys to reduce the mineral clearance by the urines, in addition to cause an increase of vitamin D production by the kidneys to uptake more calcium.
  • calcitonin is a peptide hormone produced by thyroid parafollicular cells, better known as thyroid C cells. Calcitonin production is induced by an excessive increase of calcium concentration in plasma.
  • calcitonin acts as a parathyroid hormone antagonist, reducing osteoclastic activity, promoting higher calcium re-uptake in the bones by osteoblasts and increasing renal excretion of the mineral.
  • the correct maintenance of normal calcium levels in the blood allows to prevent several pathologies such as osteoporosis, cardiovascular diseases, gastro-intestinal disorders and male infertility.
  • calcium plays a very important role in the steroidogenesis process made by Leydig cells.
  • the increase of calcium cell concentration is strictly related to an increase of testosterone production by calcium-stimulated Leydig cells.
  • Testosterone is responsible then for spermatogenesis regulation, so resulting in a correct production of spermatozoa.
  • calcium is essential for the correct functionality of spermatozoa tail, thereby affecting their motility degree. It is used for the production of adenosine triphosphate (ATP) molecules, which help to supply the energy required for the sperm cell movement.
  • ATP adenosine triphosphate
  • Calcium also allows to increase spermatozoa fertility grade, thanks to its involvement in acrosomal capacitation and reaction processes. In effect, calcium is able to modulate the sperm capacitation through the induction of tyrosine phosphorylation at the spermatozoa heads, so promoting the fertilization process of the egg cell.
  • the entry of calcium into the sperm cell induces the acrosomal reaction, allowing the release of the hydrolytic enzymes involved in the degradation process of the pellucid area of the egg, so promoting the entry of the spermatozoa.
  • Calcium intake may then represent an optimal tool to counteract male infertility, since this mineral regulates the formation and maturation process of spermatozoa, results in an increase of their motility thanks to ATP production and promotes the fertilization process by inducing the sperm capacitation and the consequent acrosomal reaction close to the egg cell.
  • Calcium salts which may be used as a source are: calcium carbonate, calcium citrate, calcium acetate, calcium ascorbate, calcium bisglycinate, calcium chloride, calcium citrate-malate, calcium gluconate, calcium glycerophosphate, calcium lactate, calcium pyruvate, calcium salts of orthophosphoric acid, calcium succinate, calcium lysinate, calcium pydolate, calcium malate, calcium treonate, calcium sulfate, calcium fluoride.
  • Acetylcysteine is also commonly known as N-acetylcysteine (NAC) and results from the addition of an acetyl group to the typical structure of L-cysteine amino acid. This molecule is an important reducing agent, present in several fruits and vegetables.
  • Such a molecule is considered also an important precursor of glutathione, antioxidant molecule produced by human organism to counteract the damages deriving from oxidative stress.
  • N-acetylcysteine acts according to different mechanisms since it is able to first induce the expression of glutathione S-transferase enzyme, involved in the production of glutathione molecules. Then, it acts also as cysteine donor for the enzyme itself, being one of the three amino acids present in the molecular structure of glutathione other than glutamate and glycine.
  • the antioxidant action is based on the ability of N-acetylcysteine to decrease cell concentrations of the reactive oxygen species (ROS) and reactive nitric oxide species (RNS).
  • ROS reactive oxygen species
  • RNS reactive nitric oxide species
  • N-acetylcysteine to regulate the inflammatory process by modulating the production of pro-inflammatory cytokines is associated with the antioxidant action.
  • this molecule is able to decrease the intracellular levels of tumor necrosis factor alpha (TNF-a), interleukin-ip (IL-1 p) and interleukin-6 (IL-6), as shown in a study carried out in vitro on mice.
  • TNF-a tumor necrosis factor alpha
  • IL-1 p interleukin-ip
  • IL-6 interleukin-6
  • N-acetylcysteine make it a useful cure in the treatment of several pathologies such as respiratory tract diseases, diabetes, intestinal disorders, hypertension, neurodegenerative diseases, polycystic ovary disease and male infertility.
  • spermiogram analyses of infertile patients often show as main cause of ROS action, an alteration of sperm parameters such as morphology, motility, concentration and sperm count.
  • N-acetylcysteine may be a very good tool to counteract the negative effects resulting from the free radical increase.
  • N-acetylcysteine may act as exogenous antioxidant molecule which decreases intracellular ROS levels, while maintaining the cell membrane morphology of spermatozoa as well as preserving the integrity of their genetic makeup, the primary target of the degradative ROS action.
  • N-acetylcysteine is also able to induce the expression of endogenous antioxidants such as glutathione S-transferase enzyme and, consequently, to increase glutathione production.
  • N-acetylcysteine as a very good ally to counteract oxidative stress, thanks to its antioxidant activity and its ability to both induce the expression of endogenous antioxidant enzymes and regulate the hormonal levels in order to promote the correct spermatogenesis process.
  • L-arginine is a polar amino acid, defined as basic amino acid because of the guanidino group which is its peculiar side chain bound to the chiral carbon.
  • L-arginine is considered a conditionally essential amino acid for humans, since the human organism is able to produce it into the cells, but whenever causes impairing the synthesis of this amino acid occurs, its intake through the food becomes necessary.
  • L-arginine may be absorbed by humans by eating red meat and nuts such as peanuts, almonds, walnuts and hazelnuts.
  • L-arginine biosynthesis mainly occurs within kidney proximal tubules and requires a molecule of L-citrulline, which is considered a nonessential amino acid for humans as well, as a precursor.
  • the so produced L-arginine is then the substrate of four different enzymes such as arginine decarboxylase, arginine-glycine amidinotransferase, arginase and nitric oxide synthase.
  • Arginine decarboxylase enzyme catalyzes the reaction for the formation of agmatine, a peculiar molecule involved in the regulation of the production of insulin, growth hormone (GH) and luteinizing hormone (LH).
  • the second enzyme is involved in the production of creatine, which is useful for the human energetic demand in addition to strengthen muscles.
  • arginase is the enzyme causing the production of L-ornithine and urea.
  • L- ornithine is the first amino acid starting the urea cycle following which L-citrulline, precursor of L-arginine, is produced.
  • Nitric oxide also called nitrogen monoxide, is able to stimulate the smooth muscle of blood vessels, resulting in vasodilation and maintaining the circulatory system homeostasis.
  • L-arginine is a precursor of several molecules which are useful at physiologic level, for the correct cell functioning.
  • a deficiency of such an amino acid may impair human organism wellness, resulting in the onset of renal disorders and cardiovascular diseases such as hypertension and atherosclerosis.
  • L-arginine may be a good therapeutic method useful for the treatment of male infertility, thanks to the ability of the amino acid to improve the sperm parameters of infertile patients.
  • Oxidative stress is also the primary cause of alteration in spermatozoa number, shape and movement, since reactive oxygen species (ROS) and reactive nitric oxide species (RNS) are unstable molecules which, at high concentrations within cells, make unstable the membrane double phospholipid layer by subtracting electrons.
  • ROS reactive oxygen species
  • RNS reactive nitric oxide species
  • L-arginine offers protection to spermatozoa cell membranes by acting as an antioxidant molecule and so reducing the damages due to oxidative stress deriving from an excess of free radicals.
  • L-arginine also induces an increase of glutathione expression in spermatozoa, which acts as endogenous antioxidant molecule. Therefore, the combined action of endogenous and exogenous antioxidant molecules allows to restore the normal cell levels of free radicals, so improving the spermatozoa morphology and concentration.
  • L-arginine acts as a precursor for NO biosynthesis, catalyzed by endothelial nitric oxide synthase (eNOS) enzyme.
  • eNOS endothelial nitric oxide synthase
  • NO is very important for spermatozoa motility, since this molecule acts as co-factor of guanylate cyclase enzyme. This latter is responsible for the formation of guanidine monophosphate cyclase (cGMP) which stimulates the ionic channels regulated by cyclic nucleotides (ONG channels) located in spermatozoa tail, inducing an increase of calcium uptake in sperm cells.
  • cGMP guanidine monophosphate cyclase
  • ONG channels cyclic nucleotides
  • calcium acts as a co-factor of ATPase enzyme which uses adenosine triphosphate (ATP) molecules to supply the energy required to increase the movement of spermatozoa tail.
  • ATP adenosine triphosphate
  • L-arginine which is involved in the decrease of cell concentration of pro-inflammatory molecules such as interleukin-6 (IL-6) and reactive C protein, is associated with a significant decrease of events of lipid peroxidation and fragmentation of cell DNA of spermatozoa.
  • nutraceutical or pharmaceutical composition according to the invention is as defined in the attached claim 1 .
  • nutraceutical or pharmaceutical composition of the present invention comprises calcium, N-acetylcysteine and arginine useful for the prevention and/or treatment of male infertility.
  • the present invention represents a prompt and efficient intervention useful for the prevention and/or treatment of male infertility.
  • Such effect is due to the combined action of the substances composing it.
  • Calcium is essential for the spermatozoa maturation process, takes part to capacitation process and acrosomal reaction;
  • N- acetylcysteine enhances the activity of endogenous antioxidants and contributes to balance the parameters related to sexual hormones;
  • arginine has a marked antiinflammatory activity in addition to antioxidant activity and NO production stimulating activity. All these mechanisms improve the various parameters related to male infertility optimizing spermatogenesis process and maintaining sperm parameters at optimal levels.
  • the synergetic activity of the above active ingredients can be studied by using in vitro and/or in vivo tests able to evaluate the activity of the compositions according to the present invention.
  • the first test is the spectrophotometric assay with DPPH (2,2-diphenyl- 1-picryl-hydrazyl). This free radical, when dissolved in solution, develops a purple color. The addition of an antioxidant molecule stabilizes DPPH and the solution turns to yellow from purple. This phenomenon is analyzed by spectrometry and the antioxidant activity of a specific substance can be assessed depending from the resultant absorbance value.
  • ROS reactive oxygen species
  • RNS reactive nitric oxide species
  • the second test is carried out on cells in the presence of dichloro-fluorescein diacetate (DCFH-DA).
  • DCFH-DA is absorbed by cells through passive diffusion and then is de-acylated to prevent its cell leakage.
  • DCFH produces a fluorescence signal.
  • an antioxidant molecule inhibits the oxidation of DCFH, decreases the produced fluorescence and assesses its activity, for instance, by spectrofluorimetry.
  • oxidative stress can be observed by analyzing the action of endogenous antioxidant molecules contained into the seminal fluid such as superoxide dismutase (SOD) and catalase (CAT).
  • SOD superoxide dismutase
  • CAT catalase
  • SOD activity is evaluated, for example, as a function of pyrogallol oxidation.
  • Pyrogallol is a phenol which oxidizes in the presence of superoxide anion. This latter may be dissociated into molecular oxygen and hydrogen peroxide thanks to the action of SOD at alkaline pH.
  • the inhibition of pyrogallol oxidation results in an increase of absorbance at 420 nm, measured by spectrophotometer and expressed as units per minute per liter of seminal fluid.
  • CAT antioxidant activity is determined on the basis of the decrease of hydrogen peroxide concentration.
  • the enzyme causes the cleavage of hydrogen peroxide molecules into molecular oxygen and water. This phenomenon is analyzed through spectrophotometric assay by measuring the absorbance value at 240 nm and CAT activity is expressed as specific activity equal to enzymatic activity per minute per milliliter of seminal fluid.
  • MDA malonaldheyde
  • sperm fluid By using patient’s sperm fluid, its quality can be evaluated after the treatment with the composition object of the present invention as: spermatozoa number, motility, morphology, ejaculate volume and its viscosity, presence of white blood cells. Other methods known to the skilled in the art may be used as well to prove the efficacy of the composition object of the present invention for male infertility.
  • nutraceutical or pharmaceutical composition of the present invention is included into a pharmaceutical product or a food supplement, which is formulated in a suitable dosage form, which composition and preparation falls within the expertise of a skilled in the art.
  • calcium is present in the nutraceutical or pharmaceutical composition of the invention in an amount ranging from 1 mg to 7000 mg, preferably ranging from 5 mg to 5000 mg, still more preferably ranging from 10 mg to 3500 mg per single dosage unit.
  • N-acetylcysteine is present in an amount ranging from 1 mg to 7000 mg, preferably ranging from 10 mg to 5000 mg, still more preferably ranging from 20 mg to 3000 mg per single dosage unit.
  • Arginine is present in the nutraceutical or pharmaceutical composition of the invention in an amount ranging from 1 mg to 7000 mg, preferably ranging from 10 mg to 5000 mg, still more preferably ranging from 20 mg to 3000 mg per single dosage unit.
  • the pharmaceutical product or the food supplement comprising the nutraceutical or pharmaceutical composition of the invention is formulated in a preferably oral pharmaceutical form, which can be solid, semisolid or liquid.
  • a powder, an orosoluble powder, a granulate, a hard capsule, a soft-gel capsule, a tablet, a sachet, a solution, a syrup, a suspension or an emulsion can be cited as an example.
  • nutraceutical or pharmaceutical compositions object of the present invention are provided hereinafter. As above indicated, these nutraceutical or pharmaceutical compositions are formulated as pharmaceutical products or food supplements and administered in a suitable oral dosage form.

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Abstract

The present invention relates to a composition of substances, efficient in the prevention and/or treatment of male infertility. The composition of the invention comprises calcium, N-acetylcysteine (NAC) and arginine. The composition of the invention is prepared in a solid, semi-solid or liquid pharmaceutical dosage form, preferably for oral administration.

Description

“Nutraceutical or pharmaceutical composition for male infertility” *************
DESCRIPTION
The present invention relates to a nutraceutical or pharmaceutical composition efficient in the prevention and/or treatment of male infertility both in humans and animals.
Background of the invention
Male infertility is a pathology making a man unable to impregnate his partner after a period of free unprotected sex longer than a year.
Epidemiological studies carried out on a high number of patients show that about 30% of infertility cases derives from male infertility, 35% of cases is associated with female infertility, 20% of cases is caused by couple infertility while 15% of cases derives from idiopathic infertility due to unknown causes.
The reduced reproductive ability in man derives from anomalies both in the quantity and in the quality of spermatozoa in the ejaculate.
On this basis, several types of male infertility such as azoospermia, oligozoospermia, asthenozoospermia, teratozoospermia, necrospermia, aspermia, hypospermia, leukospermia may be identified.
The term azoospermia means the pathologic condition in which there is total absence of spermatozoa in the ejaculate. Oligozoospermia, asthenozoospermia and teratozoospermia are the more frequent conditions of male infertility and may occur even at the same time in the same patient. Oligozoospermia is the reduced number of spermatozoa present in the sperm, while asthenozoospermia is defined according to the poor motility of spermatozoa and finally teratozoospermia derives from structural alterations of the head and/or tail of male reproductive cells. Instead, necrospermia is the case when spermatozoa are produced but they are not vital and therefore are unable to fertilize the egg cell.
Aspermia is the complete lack of sperm, hypospermia is the case when the ejaculate has a volume lower than 1 .5 ml, while leukospermia is the case when white blood cell concentration in the ejaculate is particularly high.
All these types of male infertility derive from different causes which negatively affect sperm production in infertile subjects and may be divided into two main categories such as genetic and acquired ones. Genetic causes may be congenital in nature when events such as cryptorchidism with testicle retention, lack of epididymis and anomalies of vasa deferentia occur. Other genetic causes are often associated with mutations such as those characterizing cystic fibrosis transmembrane conductance regulator (CFTR) gene, Klinefelter syndrome, Kallmann syndrome and those resulting in chromosomal anomalies with consequent testicular dysfunction and chromosome Y microdeletions.
In spite of this, the acquired causes are the most representative in male infertility cases and are often associated with varicocele and oxidative stress cases.
Varicocele is due to an anomalous dilation of the veins of the pampiniform plexus of the sperm funnel which blocks the correct flow of spermatozoa in testicles, causing pain and burning both during urination and during the ejaculation process.
In addition, the exposure to toxic chemicals, obesity or an improper life style with drug, smoke and alcohol abuse may result in the production of reactive oxygen (ROS) and nitric oxide (RNS) species causing oxidative stress.
In particular, said pathological event occurs when the main enzymes responsible for the endogenous antioxidant response, such as superoxide dismutase, catalase, glutathione S-transferase and nitric oxide synthase, are unable to control the increase of the ROS and RNS intracellular concentrations. Low concentrations of these molecules are required for the correct development of spermatozoa and for their consequent activation during the acrosomal reactions and in the capacitation processes close to the egg cell.
However, at high concentrations these molecules become unstable and steal electrons from the lipids of the spermatozoa cell membranes inducing lipid peroxidation and impairing their motility and morphology. A prolonged exposure to ROS and RSN may cause severe damages also to the spermatozoa nucleus, resulting in the partial or total fragmentation of their DNA.
The symptoms occurring in infertile patients following the abovementioned different causes relate to swelling and pain sensation at testicles associated with the observed difficulty in urination and ejaculation processes.
In addition, male infertility may also be diagnosed as a function of the causes, thanks to different anatomical and biological analyses. Eventual morphological anomalies of the male urogenital apparatus are identified by the urologist. Thereafter, biological analyses are carried out by sperm withdrawal from infertile patients, to define the sperm parameters by analyzing the spermiogram. After a well-detailed clinical picture is obtained, the infertile patient can undergo two different treatments, such as ethiological or empirical treatment.
When the cause is known, a targeted treatment is operated to assure the reduction and/or the removal of the problem inducing male infertility.
Examples of ethiological treatments are hormonal therapy with the administration of gonadotropins to promote spermatogenesis or varicocelectomy, a surgery preventing blood reflux into the testicular veins in subjects suffering from varicocele.
When the male infertility cause cannot be diagnosed, an empirical treatment is used trying to improve the lifestyle of the infertile patient through a correct feeding and decreasing the causes coming from environmental and psychological stress.
Also the use of food supplements, which are a very good tool to improve the health conditions of infertile patients, may be associated with all the above. In fact, these latter may restore the normal intracellular levels of ROS and RNS, induce the expression of endogenous antioxidants which are present at low concentrations and so reduce the damages from oxidative stress both at cell membranes and DNA of spermatozoa.
The present invention relates to a nutraceutical or pharmaceutical composition useful for the prevention and/or treatment of male infertility both in humans and animals. The composition object of the present invention comprises calcium, N-acetylcysteine (NAC) and arginine.
DETAILED DESCRIPTION OF THE INVENTION
Calcium is a chemical element indicated with the symbol Ca and is the twentieth element of the periodic table, belonging to the alkaline-earth metal group. This mineral is the fifth more representative element of the chemical composition of earth’s crust and sea water, in addition to be the most abundant element in the human body.
In fact, in humans, there is about one kilogram of calcium mainly within bones where it combines with phosphorus to make hydroxyapatite. The remaining calcium is present in the plasma and in the extracellular fluid at different concentrations.
In particular, plasmatic calcium concentration is 2.5 mM and almost 50% calcium is bound to blood proteins, including albumin which is its primary ligand. The remaining calcium is in free form and since it is an electrolyte, it is characterized by an electric charge, being than in ionized form. The extracellular concentration is 1.2 mM with calcium in ionized form. Blood calcium levels are regulated by the presence of two specific hormones such as parathyroid hormone and calcitonin.
Parathyroid hormone is a protein molecule produced by four small glands surrounding thyroid, called parathyroids. This hormone is mainly produced in higher quantities when there is blood calcium deficiency.
With reference to this, parathyroid hormone may stimulate calcium release from the bones, induce kidneys to reduce the mineral clearance by the urines, in addition to cause an increase of vitamin D production by the kidneys to uptake more calcium.
Instead, calcitonin is a peptide hormone produced by thyroid parafollicular cells, better known as thyroid C cells. Calcitonin production is induced by an excessive increase of calcium concentration in plasma.
In fact, calcitonin acts as a parathyroid hormone antagonist, reducing osteoclastic activity, promoting higher calcium re-uptake in the bones by osteoblasts and increasing renal excretion of the mineral.
The correct maintenance of normal calcium levels in the blood allows to prevent several pathologies such as osteoporosis, cardiovascular diseases, gastro-intestinal disorders and male infertility.
In the specific case of male infertility, analyses carried out on the seminal fluid of infertile patients showed a remarkable decrease of calcium levels. Such a decrease is related to alterations of spermatozoa morphology, motility and concentration in patients suffering from idiopathic infertility.
Scientific studies showed that calcium is an essential element for several factors affecting spermatozoa production and functionality.
In particular, calcium plays a very important role in the steroidogenesis process made by Leydig cells. In fact, the increase of calcium cell concentration is strictly related to an increase of testosterone production by calcium-stimulated Leydig cells. Testosterone is responsible then for spermatogenesis regulation, so resulting in a correct production of spermatozoa.
In addition, calcium is essential for the correct functionality of spermatozoa tail, thereby affecting their motility degree. It is used for the production of adenosine triphosphate (ATP) molecules, which help to supply the energy required for the sperm cell movement.
Calcium also allows to increase spermatozoa fertility grade, thanks to its involvement in acrosomal capacitation and reaction processes. In effect, calcium is able to modulate the sperm capacitation through the induction of tyrosine phosphorylation at the spermatozoa heads, so promoting the fertilization process of the egg cell.
Furthermore, the entry of calcium into the sperm cell induces the acrosomal reaction, allowing the release of the hydrolytic enzymes involved in the degradation process of the pellucid area of the egg, so promoting the entry of the spermatozoa.
Calcium intake may then represent an optimal tool to counteract male infertility, since this mineral regulates the formation and maturation process of spermatozoa, results in an increase of their motility thanks to ATP production and promotes the fertilization process by inducing the sperm capacitation and the consequent acrosomal reaction close to the egg cell.
Calcium salts which may be used as a source are: calcium carbonate, calcium citrate, calcium acetate, calcium ascorbate, calcium bisglycinate, calcium chloride, calcium citrate-malate, calcium gluconate, calcium glycerophosphate, calcium lactate, calcium pyruvate, calcium salts of orthophosphoric acid, calcium succinate, calcium lysinate, calcium pydolate, calcium malate, calcium treonate, calcium sulfate, calcium fluoride. Acetylcysteine is also commonly known as N-acetylcysteine (NAC) and results from the addition of an acetyl group to the typical structure of L-cysteine amino acid. This molecule is an important reducing agent, present in several fruits and vegetables.
Such a molecule is considered also an important precursor of glutathione, antioxidant molecule produced by human organism to counteract the damages deriving from oxidative stress.
In particular, N-acetylcysteine acts according to different mechanisms since it is able to first induce the expression of glutathione S-transferase enzyme, involved in the production of glutathione molecules. Then, it acts also as cysteine donor for the enzyme itself, being one of the three amino acids present in the molecular structure of glutathione other than glutamate and glycine.
Scientific studies carried out on N-acetylcysteine highlightened in particular its antioxidant and antiinflammatory properties.
The antioxidant action is based on the ability of N-acetylcysteine to decrease cell concentrations of the reactive oxygen species (ROS) and reactive nitric oxide species (RNS). In particular, the presence of a thiol group on its molecular structure allows to neutralize the free radicals produced in excess within the cells, so limiting the damages of DNA, proteins and lipid composition of cell membranes.
In addition, the high ability of N-acetylcysteine to regulate the inflammatory process by modulating the production of pro-inflammatory cytokines is associated with the antioxidant action. In fact, this molecule is able to decrease the intracellular levels of tumor necrosis factor alpha (TNF-a), interleukin-ip (IL-1 p) and interleukin-6 (IL-6), as shown in a study carried out in vitro on mice.
Then, the antioxidant and antiinflammatory properties of N-acetylcysteine make it a useful cure in the treatment of several pathologies such as respiratory tract diseases, diabetes, intestinal disorders, hypertension, neurodegenerative diseases, polycystic ovary disease and male infertility.
In male infertility, it has been found that an increase of ROS and RNS concentration results in severe damages of the cell membrane structure of spermatozoa due to lipid peroxidation processes.
In particular, the spermiogram analyses of infertile patients often show as main cause of ROS action, an alteration of sperm parameters such as morphology, motility, concentration and sperm count.
In this respect, the antioxidant action of N-acetylcysteine may be a very good tool to counteract the negative effects resulting from the free radical increase.
In fact, N-acetylcysteine may act as exogenous antioxidant molecule which decreases intracellular ROS levels, while maintaining the cell membrane morphology of spermatozoa as well as preserving the integrity of their genetic makeup, the primary target of the degradative ROS action.
N-acetylcysteine is also able to induce the expression of endogenous antioxidants such as glutathione S-transferase enzyme and, consequently, to increase glutathione production.
Then, the synergetic action of N-acetylcysteine with the endogenous antioxidant enzymes allows to protect spermatozoa from ROS, resulting in an improvement of morphology, motility, concentration and sperm count.
Furthermore, a clinical study carried out on infertile patients receiving 600 mg N- acetylcysteine daily showed also that the consumption of such a molecule allows to decrease the cell concentration of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) and to increase blood testosterone levels, so promoting the correct production of sperm cells.
All these experimental evidences allow then to consider N-acetylcysteine as a very good ally to counteract oxidative stress, thanks to its antioxidant activity and its ability to both induce the expression of endogenous antioxidant enzymes and regulate the hormonal levels in order to promote the correct spermatogenesis process.
L-arginine is a polar amino acid, defined as basic amino acid because of the guanidino group which is its peculiar side chain bound to the chiral carbon.
L-arginine is considered a conditionally essential amino acid for humans, since the human organism is able to produce it into the cells, but whenever causes impairing the synthesis of this amino acid occurs, its intake through the food becomes necessary.
In fact, L-arginine may be absorbed by humans by eating red meat and nuts such as peanuts, almonds, walnuts and hazelnuts.
L-arginine biosynthesis mainly occurs within kidney proximal tubules and requires a molecule of L-citrulline, which is considered a nonessential amino acid for humans as well, as a precursor. The so produced L-arginine is then the substrate of four different enzymes such as arginine decarboxylase, arginine-glycine amidinotransferase, arginase and nitric oxide synthase.
Arginine decarboxylase enzyme catalyzes the reaction for the formation of agmatine, a peculiar molecule involved in the regulation of the production of insulin, growth hormone (GH) and luteinizing hormone (LH).
The second enzyme is involved in the production of creatine, which is useful for the human energetic demand in addition to strengthen muscles.
Instead, arginase is the enzyme causing the production of L-ornithine and urea. L- ornithine is the first amino acid starting the urea cycle following which L-citrulline, precursor of L-arginine, is produced.
Finally, the fourth enzyme is responsible for the production of nitric oxide starting from L-arginine. Nitric oxide (NO), also called nitrogen monoxide, is able to stimulate the smooth muscle of blood vessels, resulting in vasodilation and maintaining the circulatory system homeostasis.
Then, L-arginine is a precursor of several molecules which are useful at physiologic level, for the correct cell functioning. A deficiency of such an amino acid may impair human organism wellness, resulting in the onset of renal disorders and cardiovascular diseases such as hypertension and atherosclerosis.
In the last years, it has been observed that the consumption of L-arginine may be a good therapeutic method useful for the treatment of male infertility, thanks to the ability of the amino acid to improve the sperm parameters of infertile patients.
In the literature, it has been reported that oral administration of L-arginine in infertile patients results in an improvement of sperm morphology, motility and count. Such experimental evidences result from the antioxidant and antiinflammatory activity of the amino acid.
Oxidative stress is also the primary cause of alteration in spermatozoa number, shape and movement, since reactive oxygen species (ROS) and reactive nitric oxide species (RNS) are unstable molecules which, at high concentrations within cells, make unstable the membrane double phospholipid layer by subtracting electrons.
In this case, L-arginine offers protection to spermatozoa cell membranes by acting as an antioxidant molecule and so reducing the damages due to oxidative stress deriving from an excess of free radicals. In particular, L-arginine also induces an increase of glutathione expression in spermatozoa, which acts as endogenous antioxidant molecule. Therefore, the combined action of endogenous and exogenous antioxidant molecules allows to restore the normal cell levels of free radicals, so improving the spermatozoa morphology and concentration.
Moreover, it has been also observed that the intake of L-arginine in infertile patients results in an increase of sperm cell motility. In particular, L-arginine acts as a precursor for NO biosynthesis, catalyzed by endothelial nitric oxide synthase (eNOS) enzyme.
NO is very important for spermatozoa motility, since this molecule acts as co-factor of guanylate cyclase enzyme. This latter is responsible for the formation of guanidine monophosphate cyclase (cGMP) which stimulates the ionic channels regulated by cyclic nucleotides (ONG channels) located in spermatozoa tail, inducing an increase of calcium uptake in sperm cells.
Then, calcium acts as a co-factor of ATPase enzyme which uses adenosine triphosphate (ATP) molecules to supply the energy required to increase the movement of spermatozoa tail.
Furthermore, a good antiinflammatory activity of L-arginine, which is involved in the decrease of cell concentration of pro-inflammatory molecules such as interleukin-6 (IL-6) and reactive C protein, is associated with a significant decrease of events of lipid peroxidation and fragmentation of cell DNA of spermatozoa.
Then, all these experimental data allow to consider L-arginine amino acid as a good ally in counteracting oxidative stress damages thanks to its antioxidant activity associated with its good antiinflammatory activity, in order to improve sperm parameters in patients suffering from male infertility.
The nutraceutical or pharmaceutical composition according to the invention is as defined in the attached claim 1 .
Further features and advantages of the invention are defined in the dependent claims. Claims are integral part of the present description.
A detailed description of some preferred embodiments of the invention is provided hereinafter.
As indicated, the nutraceutical or pharmaceutical composition of the present invention comprises calcium, N-acetylcysteine and arginine useful for the prevention and/or treatment of male infertility.
The present invention represents a prompt and efficient intervention useful for the prevention and/or treatment of male infertility. Such effect is due to the combined action of the substances composing it. Calcium is essential for the spermatozoa maturation process, takes part to capacitation process and acrosomal reaction; N- acetylcysteine enhances the activity of endogenous antioxidants and contributes to balance the parameters related to sexual hormones; arginine has a marked antiinflammatory activity in addition to antioxidant activity and NO production stimulating activity. All these mechanisms improve the various parameters related to male infertility optimizing spermatogenesis process and maintaining sperm parameters at optimal levels.
The synergetic activity of the above active ingredients can be studied by using in vitro and/or in vivo tests able to evaluate the activity of the compositions according to the present invention.
In order to evaluate the antioxidant action of the single substances and their combinations in decreasing the concentration of reactive oxygen species (ROS) and reactive nitric oxide species (RNS), so preventing lipid peroxidation of cell membranes and consequent fragmentation of cell DNA, several in vitro tests can be carried out. For example, the first test is the spectrophotometric assay with DPPH (2,2-diphenyl- 1-picryl-hydrazyl). This free radical, when dissolved in solution, develops a purple color. The addition of an antioxidant molecule stabilizes DPPH and the solution turns to yellow from purple. This phenomenon is analyzed by spectrometry and the antioxidant activity of a specific substance can be assessed depending from the resultant absorbance value.
The second test is carried out on cells in the presence of dichloro-fluorescein diacetate (DCFH-DA). DCFH-DA is absorbed by cells through passive diffusion and then is de-acylated to prevent its cell leakage. In the presence of free radicals, DCFH produces a fluorescence signal. The addition of an antioxidant molecule inhibits the oxidation of DCFH, decreases the produced fluorescence and assesses its activity, for instance, by spectrofluorimetry.
Furthermore, a decrease in oxidative stress can be observed by analyzing the action of endogenous antioxidant molecules contained into the seminal fluid such as superoxide dismutase (SOD) and catalase (CAT).
SOD activity is evaluated, for example, as a function of pyrogallol oxidation. Pyrogallol is a phenol which oxidizes in the presence of superoxide anion. This latter may be dissociated into molecular oxygen and hydrogen peroxide thanks to the action of SOD at alkaline pH. The inhibition of pyrogallol oxidation results in an increase of absorbance at 420 nm, measured by spectrophotometer and expressed as units per minute per liter of seminal fluid.
CAT antioxidant activity is determined on the basis of the decrease of hydrogen peroxide concentration. The enzyme causes the cleavage of hydrogen peroxide molecules into molecular oxygen and water. This phenomenon is analyzed through spectrophotometric assay by measuring the absorbance value at 240 nm and CAT activity is expressed as specific activity equal to enzymatic activity per minute per milliliter of seminal fluid.
Finally, the lipid peroxidation phenomenon can be analyzed through TBARS (thiobarbituric acid reactive species) assay, which measures the formation of malonaldheyde (MDA). In fact, MDA production can be determined as a function of the reaction with thiobarbituric acid, in order to generate a new product which absorbs light at 535 nm and its concentration is expressed as nanomoles per milliliter of seminal fluid.
By using patient’s sperm fluid, its quality can be evaluated after the treatment with the composition object of the present invention as: spermatozoa number, motility, morphology, ejaculate volume and its viscosity, presence of white blood cells. Other methods known to the skilled in the art may be used as well to prove the efficacy of the composition object of the present invention for male infertility.
As previously indicated, the nutraceutical or pharmaceutical composition of the present invention is included into a pharmaceutical product or a food supplement, which is formulated in a suitable dosage form, which composition and preparation falls within the expertise of a skilled in the art.
In a preferred embodiment, calcium is present in the nutraceutical or pharmaceutical composition of the invention in an amount ranging from 1 mg to 7000 mg, preferably ranging from 5 mg to 5000 mg, still more preferably ranging from 10 mg to 3500 mg per single dosage unit.
N-acetylcysteine is present in an amount ranging from 1 mg to 7000 mg, preferably ranging from 10 mg to 5000 mg, still more preferably ranging from 20 mg to 3000 mg per single dosage unit.
Arginine is present in the nutraceutical or pharmaceutical composition of the invention in an amount ranging from 1 mg to 7000 mg, preferably ranging from 10 mg to 5000 mg, still more preferably ranging from 20 mg to 3000 mg per single dosage unit.
All the abovementioned preferred embodiments can be combined each other.
The pharmaceutical product or the food supplement comprising the nutraceutical or pharmaceutical composition of the invention is formulated in a preferably oral pharmaceutical form, which can be solid, semisolid or liquid.
A powder, an orosoluble powder, a granulate, a hard capsule, a soft-gel capsule, a tablet, a sachet, a solution, a syrup, a suspension or an emulsion can be cited as an example.
Some non-limiting examples of nutraceutical or pharmaceutical compositions object of the present invention are provided hereinafter. As above indicated, these nutraceutical or pharmaceutical compositions are formulated as pharmaceutical products or food supplements and administered in a suitable oral dosage form.
The following examples are provided for illustrative purposes only and they are not limiting the scope of the invention as defined by the attached claims.
EXAMPLES
EXAMPLE 1
Granulate
Figure imgf000013_0001
EXAMPLE 2 Granulate
Figure imgf000013_0002
EXAMPLE 3
Tablet
Figure imgf000013_0003

Claims

1. Nutraceutical or pharmaceutical composition comprising the combination of calcium, N-acetylcysteine (NAC) and arginine.
2. Nutraceutical or pharmaceutical composition according to claim 1 , for the use in the prevention and/or the treatment of male infertility in both humans and animals.
3. Nutraceutical or pharmaceutical composition according to claims 1 and 2, in which male infertility is associated with: azoospermia and/or oligozoospermia and/or asthenozoospermia and/or teratozoospermia and or necrospermia and/or aspermia and/or hypospermia and/or leukospermia.
4. Nutraceutical or pharmaceutical composition according to claims 1 to 3, wherein the source of calcium is selected from: calcium carbonate, calcium citrate, calcium acetate, calcium ascorbate, calcium bisglycinate, calcium chloride, calcium citrate malate, calcium gluconate, calcium glycerophosphate, calcium lactate, calcium pyruvate, calcium salts of orthophosphoric acid, calcium succinate, calcium lysinate, calcium pidolate, calcium malate, calcium threonate, calcium sulfate, calcium fluoride.
5. Nutraceutical or pharmaceutical composition for the use according to claims 1 to 4, comprising an amount of calcium ranging from 1 mg to 7000 mg, preferably ranging from 5 mg to 5000 mg, still more preferably ranging from 10 mg to 3500 mg for a single dosage unit.
6. Nutraceutical or pharmaceutical composition for the use according to any one of claims 1 to 5, comprising N-acetylcysteine (NAC) in an amount ranging from 1 mg to 7000 mg, preferably ranging from 10 mg to 5000 mg, still more preferably ranging from 20 mg to 3000 mg for a single dosage unit.
7. Nutraceutical or pharmaceutical composition for the use according to any one of claims 1 to 6, comprising arginine in an amount ranging from 1 mg to 7000 mg, preferably ranging from 10 mg to 5000 mg, still more preferably ranging from 20 mg to 3000 mg for a single dosage unit.
8. Nutraceutical or pharmaceutical composition for the use according to any one of claims 1 to 7, formulated in a liquid, semi-solid or solid oral dosage form.
9. Nutraceutical or pharmaceutical composition for the use according to claim 8, in which the dosage form is a powder, an orosoluble powder, a granulate, a hard capsule, a soft-gel capsule, a tablet, a sachet, a solution, a syrup a suspension or an emulsion.
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