COMPOSITION COMPRISING ARABINOGALACTAN AND POLYPHENOLS
FROM LARCH TREES
The subject of the present invention is a composition comprising arabinogalactan
and polyphenols from larch trees for the use in prophylactic treatment of upper
respiratory tract infections.
Background of the invention
Each year, millions of people suffer from upper respiratory tract infections (URI or
URTI) predominantly caused by virus infections. About 30 to 40% of cases are
caused by rhinovirus infections. Other viruses include the coronavirus, para
influenza virus, adenovirus and enterovirus. Another source of infection is bacterial
attack, in part as second infection. URI involve the upper respiratory tract, i.e.
nose, sinuses, pharynx or larynx and commonly include diseases such as tonsillitis
(inflammation of the tonsils), otitis media, rhinitis (inflammation of the nasal
mucosa), rhinosinusitis or sinusitis (inflammation of the nares and paranasal
sinuses, including frontal, ethmoid, maxillary, and sphenoid), nasopharyngitis
(rhinopharyngitis or the common cold, causing inflammation of the nares, pharynx,
hypopharynx, uvula, and tonsils), pharyngitis (inflammation of the pharynx,
hypopharynx, uvula, and tonsils), epiglottitis or supraglottis, (inflammation of the
superior portion of the larynx and supraglottic area), laryngitis - Inflammation of the
larynx, laryngotracheitis (inflammation of the larynx, trachea, and subglottic area)
and tracheitis (inflammation of the trachea and subglottic area). More than 200
rhinoviruses are known for causing URI. Depending from the area, the normal risk
for developing URI ranges from less than 10 episodes per human individual per
year in most industrialized countries up to several hundred episodes per human
individual per year in some African an Asian countries. The overall risk in Central
America, Africa and Asia, is at about 100 episodes. In some areas, predominantly
at the eastern African coast and in Central Asia, the risk can reach a level of
approx. 200 episodes per year or more.
Viruses and bacteria causing URI are mainly spread from person to person
through airborne droplets that are sneezed out or coughed up by an infected
person. In some cases, viruses and bacteria can be spread when a person
touches an infected surface (e.g., doorknobs, countertops, telephones) and then
touches parts of the body comprising mucous membranes such as nose, mouth, or
eyes. As such, these diseases are most easily spread in crowded conditions such
as schools. Although most people recover fully, URI borne sick days cause an
enormous damage to the economy each year. Among high-risk populations, such
as those with other medical conditions (such as diabetes or cancer) or a weakened
immune system, seniors, or very young children, in rare cases even death can be
a consequence of URI. Peak times for colds are at the start of school and kinder
garden in the fall, in mid-winter, and again in early spring. In industrialized western
countries having a high medical and hygiene standard children catch
approximately up to 8 colds per year, adults catch roughly 4 colds per year, and
seniors about 2 colds per year. Total number of URI episodes might be a little bit
higher. People infected with an influenza or cold virus become contagious 24
hours after the virus enters the body (often before symptoms appear). Adults
remain infectious (can spread the virus to others) for about 6 days, and children
remain infectious for up to 10 days.
Common prevention means against URI's include simple frequent hand washing,
general behavior such as coughing or sneezing into sleeves, and vaccinations,
which are not recommended for children less than 6 months, people who have an
egg or chicken protein allergy, an allergy to any of the ingredients of the vaccine, a
history of allergic reactions to the flu vaccine, or in case of acute illness.
Thus, there is a need to provide further prevention means against URI's, preferably
against rhinovirus infections and more preferably against common cold.
Arabinogalactan, for example from Echinacea or larch, have been reported by Yale
et al. (Arch. Intern. Med. 2004, 164, 1237-1241) and Turner et al. {AAC, 2000, 44,
1708-1709) to stimulate the immune system without reference to consequences to
real diseases.
Nothing in the state of the art indicates that an arabinogalactan extract from larch
is capable of effectively reduce the risk in catching an URI, preferably a disease
caused by a rhinovirus or more preferably a common cold in real subjects.
Arabino galactane (also referred to arabinogalactan, larch arabinogalactan,
galactoarabinin, larch fiber or larch gum; CAS: [9036-66-2]), is a highly branched
polysaccharide having a molecular weight between 15000 to 60000 Daltons that is
composed of galactose units and arabinose units (arabinogalactan) in the
approximate ratio of 6:1 (Scheme 1). Expediently, the botanical source is from
Larix laricina (eastern larch) or Larix occidentalis (western larch). Arabinogalactan
from larch usually contains a certain amount of polyphenols. Typically polyphenols
are present at approx. 1 to 4 wt-%, more preferably at approx. 2 wt-%. Larch
arabinogalactan is approved by the United States Food and Drug Administration
(FDA) as a GRAS (Generally Recognized As Safe) affirmed direct food additive. A
commercially available form of arabinogalactan is ResistAid™, which is an extract
from larch bark and/or wood (chips or sawdust) (Larix ssp.)
Structural formula:
Gal
I
Ara Gal Gal
I
Gal Gai Gal Ara Gal Ara
... - Gal - Gal- Gal - Gai Gal - Gal - Gal- Gal - Gal - Gal - Gal - Gal -
I J I
Ara Ara Gal Gal
Ara Gal
Ara = Arabinose I |
Gal = Galactose Ara Qal
Scheme 1: Chemical structure of arabinogalactan in ResistAid™
Disclosure of the invention
The technical problems laid out above are surprisingly solved by using a
composition containing arabinogalactan for enhancing the adaptive immune
response in subjects as defined in the claims.
We could demonstrate for the first time that daily administration of a composition
comprising arabinogalactan and polyphenols from larch trees can effectively be
used in prophylactic treatment of upper respiratory tract infections.
"Subjects" according to the claims are vertebrates, preferably mammals and birds,
more preferably humans, swine, poultry, beef cattle, dogs, cats, goats and horses,
most preferably humans.
"Arabinogalactan" according to the invention is to be understood as relating to any
compound that is composed of galactose units and arabinose units in the
approximate ratio of 100:1 to 1: 1 , preferably 6:1 , Specifically, arabinogalactan
according to the invention is preferably characterized by having a backbone of
2(13)-linked -D-galactopyranosyl units, each of which bears a substituent at the
C-6 position. Most of these side chains are galactobiosyl units containing a ( 16)-
-D-linkage as well as a-L-arabinofuranosyl units. However, the scope of the
present invention also encompasses arabinogalactan derivatives, e.g. where
arabinogalactan is in covalent association with varying amounts of protein
(arabinogalactan-proteins (AGPs) as described in Classen et al., Carbohydrate
Research, 2000, 327, 497-504). Other derivatives include quaternized or lipidated
forms of arabinogalactan.
According to the invention, preferably arabinogalactan and polyphenols from larch
trees are derived from larch trees (Larix spp.), especially from larix laricina
(eastern larch) or Larix occidentalis (western larch).
Claimed is a composition comprising arabinogalactan and polyphenols from larch
trees for the use in prophylactic treatment of upper respiratory tract infections.
Further claimed is a composition comprising arabinogalactan and polyphenols
from larch trees for the use in prophylactic treatment of diseases caused by
rhinoviruses.
Also galactopyranosyl claimed is a composition comprising arabinogalactan and
polyphenols from larch trees for the use in prophylactic treatment of common cold.
In accordance with the upper mentioned diseases we also furthermore claim a
composition for the use in prophylactic long term treatment of diseases selected
from the group consisting of upper respiratory tract infections, diseases caused by
rhinoviruses and common cold.
A composition according to any of claims 1 to 3, having prophylactic effects in
enhancing resistance against diseases selected from upper respiratory tract
infections, diseases caused by rhinoviruses and common cold.
In a preferred embodiment the composition mentioned above, said compositions
comprising arabinogalactan and polyphenols from larch trees, can be used for
treatment of subjects having increased risk for catching a disease selected from
upper respiratory tract infections, diseases caused by rhinoviruses, and common
cold, in order to reduce of number of disease events compared to untreated
subjects.
Subjects with increased risk for catching a common cold in the meaning of the
invention are for example people standing in highly infectious areas, people
lacking sleep, or people having a weakened immune system. More specifically,
such subjects with increased risk are for example elder people of 65 years old or
older, people living in a nursing home or chronic care facility, patients having lung
diseases (e.g. asthma, chronic obstructive pulmonary disease), patients having
low heart conditions (e.g. angina, congestive heart failure), patients having
diabetes, other metabolic diseases, kidney problems, blood disorders (e.g.,
anemia), having been diagnosed as suffering from morbid obesity or generally
having a weakened immune system (e.g., are taking steroid medications, have
cancer, or have HIV) and patients at high risk for complications, further people
which are traveling to areas where URI are common, children aged 6 months to 23
months, or aged 6 months to 18 years and are taking long-term medical therapy,
healthy children at 2 to 4 years of age, further people working in healthcare, such
as doctors, nurses, and pharmacists. Increased risk for animals occurs in largescale
or intensive livestock farming. People working in or living nearby such
animals are also potentially affected where viruses can be transferred from animal
to human and wee versa.
In another preferred embodiment the composition mentioned above, said
compositions comprising arabinogalactan and polyphenols from larch trees, can be
used for treatment of subjects having increased susceptibility for catching a
disease selected from upper respiratory tract infections, diseases caused by
rhinoviruses, and common cold, in order to reduce the number of disease events
compared to untreated subjects.
Subjects with increased susceptibility for URI are people from the group mentioned
above which already suffer from at least one other disease and/or having a
suboptimal health status.
In general, people with increased risk and/or susceptibility for catching a disease
selected from upper respiratory tract infections, diseases caused by rhinoviruses,
and common cold, preferably for catching a common cold, develop at least 3
common colds within 6 month in untreated status, preferably, children, such as
infants, young children, school kids, people with sleeping difficulties or sleep
deficits, stressed people, older people, people with poor nutritional status.
The instant composition comprising arabinogalactan and polyphenols from larch
trees, for example commercially available ResistAid™ from Lonza (Switzerland),
should be administered on a daily basis.
Expediently, the administration of the composition above starts prior to peak cold
season in spring and/or autumn, preferably starts 30 days prior to peak cold
season, more preferably 60 days prior to peak cold season. In general, preferably
the instant composition shall be administered as long term administration for at
least 30 days, more preferably for at least 60 days, even more preferably for at
least 12 weeks.
The instant composition expediently is administered in liquid or solid form. It can
be mixed with food and feed and any kind of beverage.
To reach a prophylactic effect the instant composition should be administered in a
daily amount of approx. 0.5 g to 15 g per subject, more preferably in an amount of
1.0 g to 7 g. Exceeding 15 g daily has no adverse effect on health on subjects,
especially not in humans. Preferably treatment is carried out with 1.5 g to 4.5 g
daily, most preferred at least 1.5 g daily. In another preferred embodiment the daily
dose is administered up to 3 times daily, more preferably each dose at approx.
1.5 g of the composition.
We also claim the use of a composition comprising arabinogalactan and
polyphenols from larch trees for preventing development of common cold.
Further claimed is the use of a composition above for the manufacture of a
medicament, preferably a medicament for preventing a disease selected from the
group consisting of upper respiratory tract infections, diseases caused by
rhinoviruses, and common cold.
We also claim the use of a composition comprising arabinogalactan and
polyphenols from larch trees for the manufacture of a nutritional product. The
nutritional product can be selected from the group consisting of foods, food
additives, food supplements, feeds, feed additives and feed supplements, each
suitable directly or indirectly for use in a method for treatment of the human or
animal body to proactively prevent development of upper respiratory tract
infections. Nutritional products also comprise functional beverages, functional
foods such as bars, breakfast cereals etc. or as dietary supplements such as
capsules, tablets, liquids (offered for example in ampules/phials), dry powder,
blends or premixes.
Finally, also claimed is a method for prophylactic treatment of a disease selected
from the group consisting of upper respiratory tract infections, diseases caused by
rhinoviruses, and common cold, characterized in administrating a composition
arabinogalactan and polyphenols from larch trees as mentioned above.
Examples:
The instant invention will be further described in the following, non-limiting
examples and study outcomes.
Example 1: Double-blind study
1.1 STUDY OBJECTIVE
The goal of this double-blind, randomized, placebo-controlled multi-center clinical
study conducted by analyse&realize (a&r, Berlin, Germany) was to demonstrate
the prophylactic effect of ResistAid™ in subjects with increased susceptibility to
upper respiratory tract infections.
Primary end point was the reduction of number of cold episodes in comparison
between ResistAid™ and placebo study arms.
Secondary end points were the reduction of episode duration and episode
intensity.
Safety and further parameters included the global evaluation of efficacy and
tolerability assessed by both the investigators and the subjects and the
assessment of adverse events, safety laboratory parameters, special laboratory
parameters (leukocyte differentiation) and eating habits.
1.2 STUDY SUBJECTS
The full analysis set (FAS) population consisted of 199 subjects, 12 subjects were
excluded from the per protocol (PP) set resulting in 187 subjects. All subjects were
healthy at the beginning and at the end of the study, as ascertained by physical
examination as well as blood analysis.
1.3 STUDY DESIGN
The clinical study was directed to be applicable to subjects with increased
susceptibility to upper respiratory tract infections.
During the study period of 12 weeks, 101/97 subjects (FAS/PP) had to take
investigational study product (ResistAid™) and further 98/90 subjects (FAS/PP)
placebo (Maltodextrin) once daily. The subjects were instructed to dissolve the
content of a sachet with the investigational product (4.5 g of powder) in approx.
100 to 150 ml_ of liquid and take the prepared drink at breakfast. All other eating
habits were kept unchanged.
A total of 3 basic visits were performed: Visit 1 at study start (= baseline), Control
Visit after 6 weeks and Termination Visit after 12 weeks. Additionally, an Episode
Visit was performed at start and on the 5th day of each cold episode. The exact
day of the cold episode was recorded in the CRF.
Between Visit 1 and the Control Visit as well as between Control Visit and the
Termination Visit, one or more cold episodes could occur. During an episode, the
subjects recorded and assessed their cold symptoms in the subject diary, for a
period of 14 days. The diaries were checked by the investigators at the second
Episode Visit of each visit.
At study end (Termination Visit), the investigators and the subjects assessed the
global efficacy and tolerability of the investigational product. At the start and end of
the study, subjects recorded their eating habits in a diet diary. Further, the safety
laboratory parameters as well as special laboratory parameters (leukocyte
differentiation) were assessed.
The investigators handed out the investigational product including a back-up
quantity for 8 additional days to the subjects at Visit 1 and Control Visit,
respectively. The unused sachets were returned to the investigators at both the
Control and the Termination Visit for compliance assessment.
1.4 ANALYSES
The primary endpoint was defined as the reduction of the number of cold episodes
after 12-week study period in verum group compared to placebo. Thus, the primary
parameter was the number of cold episodes NumberCE.
Therefore the statistical null hypothesis HO implied the statement that there is no
difference between the mean number of cold episodes of both groups, thus to
following can be made:
HO: NumberCE (verum) = NumberCE (placebo)
The null hypothesis was to be tested as opposed to the alternative hypothesis HA
HA: NumberCE (verum) NumberCE (placebo) (two-tailed test)
and
HA: NumberCE (verum) < NumberCE (placebo) (one-tailed test), respectively.
The non-parametric Mann-Whitney U test had to be used so that this hypothesis
could be proven by the rank sums. All tests were to be performed with a
significance level (type I error) of 5.0% (two-tailed test) or of 2.5% (one-tailed test).
Secondary endpoints (reduction in duration and intensity of individual cold
episodes) and safety and further parameters (global assessment of efficacy and
tolerability, number of AEs, laboratory parameters and eating habits) should be
evaluated primarily by using non-parametric procedures. Mann-Whitney U test
should be used for between-groups comparison and Wilcoxon test for within-group
(pre/post) comparison. Further, Friedman test should be used for comparison of
dependent samples and Chi2 test for assessment of proportional values. In case of
small samples size (e.g. subgroups) exact tests should be used. Parametric
procedures supplement the analysis if the scale of the observed values justifies
this kind of test.
The condition of normal distributed values was not to be checked but discrepancy
between non-parametric and parametric, if occurred, should be discussed.
All primary and secondary endpoints as well as safety and other variables were
descriptively assessed in addition to an explorative examination. For the metric
data (continuous data) the statistical characteristics are given (number, mean,
standard deviation, median, extremes, and quartiles). For ordinal data (discrete
data) the frequency distributions were performed. All nominal data (categorical
data) are summarized using frequency tables. Where appropriate, the values of
metric data were merged into ordinal classes according to clinical criteria to
determine their frequency distribution. Data collected at repeated visits were
examined using methods of multivariate analysis with repeat measurements.
Laboratory parameters should be evaluated as metric parameters; additionally the
deviations from the reference ranges should be evaluated.
All tests should be performed with a significance level (type I error) of 5.0% (two
tailed test) or of 2.5% for the one-tailed test at 80% power. 95% confidence
intervals should be determined.
All p-values from statistical tests in connection with the explorative analyses that
exceed the testing of the primary endpoint should be described tentatively.
All statistical analyses should be performed on the full analysis set population
(FAS). At least for the primary end point an additional analysis should be
performed in the valid case analysis set (VCAS). The results of both populations
should be compared and any differences discussed.
The FAS population consists of all subjects who received at least one dose of
investigational product (intent to treat). The VCAS population consists of all
subjects from the FAS group who completed the clinical investigation according to
the clinical investigation plan (CIP) with no major protocol violations. The
assignment to the FAS and the VCAS population should be performed before
unblinding the data. Analyses of any subgroups based on further criteria may be
performed as appropriate, applying the above rules stated for the planned
statistical analyses.
For the assessment of episodes, it should be considered that the observed values
could be independent (episodes from different subjects) and dependent (episodes
of the same subject). Thus, parameters related to an episode could be analyzed
either based on the number of affected subjects (regardless of the number of
episodes per subject) or based on the number of episodes (regardless if a subject
had more than one episode); the respective basis of the analyses should be
stated.
1.5 RESULTS
In total, 19 1 cold episodes were documented in the CRF, affecting a total of 132
subjects (66.3 % of 199 subjects). Thereof, 3 episodes were regarded as invalid as
preceded by a flu vaccination (symptoms similar to common cold).
Thus, a total of 188 episodes, affecting 130 subjects (65.3%) were analyzed.
There was a difference between the study arms regarding the number of subjects
affected by a cold episode: V-group 58.4% (59 of 101) vs. P-group 72.4% (71 of
98); pChi = 0.038.
Taking into account all episodes (including those preceded by a flu vaccination), a
total of 191 episodes, affecting 132 subjects were analyzed. There was a
difference between the study arms regarding the number of subjects affected by a
cold episode: V-group 60.3% (61 of 101) vs. P-group 72.4% (71 of 98);
pChi = 0.072.
1.6 EFFICACY ENDPOINTS
Intake of ResistAid™ resulted in a reduced mean number of cold episodes (PP set
- verum: 0.85±0.82 vs. placebo: 1.10±0.85; Pu = 0.040). The total number of
episodes showed a statistically significant difference in the ResistAid™ group
compared to the placebo group (PP set - verum: 82 [n=97] vs. placebo: 99 [n=90]).
The percentage of subjects who suffered from one or more episodes was
significantly higher in the placebo compared to the active group (PP set - verum:
59.8% vs. placebo: 74.4%, PChi = 0.033).
1.7 CONCLUSIONS AND DISCUSSION
This randomized, double-blind, placebo-controlled, parallel-group study showed
that consumption of ResistAid™ was associated with a significant reduction of the
number of common cold episodes in comparison with placebo. Only approx. 25%
of the untreated subjects didn't develop a cold, whereas approx. 40% of the
treated subjects didn't develop a cold. Thus, the number of subjects which didn't
develop a cold was increased by 63%. The supplementation of the
arabinogalactan preparation reduced the number of common cold episodes by
23%, which indicates the potential of ResistAid™ to modulate the immune
response to invading pathogens. The present study demonstrated an excellent
safely profile of ResistAid™.
1.8 SAFETY
During the study period of 12 weeks, a total of 3 basic visits were performed: Visit
1 (study start), Control Visit (at 6 weeks) and Termination Visit (at 12 weeks).
Additionally, Episode Visits were scheduled at start and on the 5th day of each
cold episode. The number of Episode Visits per subject varied, depending on the
number of episodes occurred during the study.
During an episode, the subjects recorded and assessed their cold symptoms in the
subject diary, for a period of 14 days. At Termination Visit, the investigators and
the subjects assessed the global efficacy and tolerability of the investigational
product. At the start and end of the study, subjects recorded their eating habits in a
diet diary and the safety laboratory parameters / special laboratory parameters
(leukocyte differentiation) were assessed. Use of analgesics and antibiotics was
recorded in the CRF and the subject diary. Any episodes treated with antibiotics
were not included in the evaluation of the relevant variables.
1.9 ABBREVIATIONS
CRF Case Report Form
FAS Full analysis set
GRAS Generally Recognized As Safe
P Placebo
pChi Chi2 test p value
PP per protocol (completed study)
Pu Mann-Whitney U test p value
URI or URTI Upper respiratory tract infections
V Verum; Visit
VCAS Valid Case Analysis Set
Example 2: Simplified Test Study
10 Healthy subjects were instructed to dissolve the content of a 1.5 g sachet of the
investigational product in approx. 50 mL of liquid and take the prepared drink once
daily. Although the sample group was small, a reduction of cold episodes could
also be observed in view of the placebo group of example 1.
Claims
1. A composition comprising arabinogalactan and polyphenols from larch trees
for the use in prophylactic treatment of upper respiratory tract infections.
2. A composition comprising arabinogalactan and polyphenols from larch trees
for the use in prophylactic treatment of diseases caused by rhinoviruses.
3. A composition comprising arabinogalactan and polyphenols from larch trees
for the use in prophylactic treatment of common cold.
4 . A composition according to any of claims 1 to 3 for the use in prophylactic
long term treatment of diseases selected from upper respiratory tract
infections, diseases caused by rhinoviruses and common cold.
5. A composition according to any of claims 1 to 4 , having prophylactic effects
in enhancing resistance against diseases selected from upper respiratory
tract infections, diseases caused by rhinoviruses and common cold.
6. The composition of any of claims 1 to 5 for treatment of subjects having
increased risk for catching a disease selected from upper respiratory tract
infections, diseases caused by rhinoviruses, and common cold, in order to
reduce the number of disease events compared to untreated subjects.
7 . The composition of any of claims 1 to 6 for treatment of subjects having
increased susceptibility for catching a disease selected from upper
respiratory tract infections, diseases causes by rhinoviruses, and common
cold, in order to reduce of number of disease events compared to untreated
subjects.
8. The composition according to any of claims 1 to 7, whereby the
administration is applied on a daily basis.
9. The composition according to any of claims 1 to 8, whereby the
administration starts prior to peak cold season in spring and/or autumn,
preferably starts 30 days prior to peak cold season, more preferably 60
days prior to peak cold season.
10. The composition according to any of claims 1 to 9, whereby said
composition is administered in liquid or solid form.
11. The composition according to any of claims 1 to 10, whereby said
composition is administered in a daily amount of 0.5 g to 15 g per subject,
more preferably in an amount of 1.0 g to 7 g.
12. Use of a composition comprising arabinogalactan and polyphenols
according to any of claims 1 to 1 for preventing development of common
cold.
13. Use of a composition according to any of claims 1 to 12 for the manufacture
of a medicament.
14. Use of a composition according to any of claims 1 to 12 for the manufacture
of a nutritional product.
15. A method for prophylactic treatment of a disease selected from upper
respiratory tract infections, diseases caused by rhinoviruses, and common
cold, characterized in administrating a composition according to any of
claims 1 to 14.