Method for lymph drainage

The present invention relates to a mixture of active ingredients consisting of Taraxacum officinalis, Fagopyrum esculentum, Ruscus aculeatus, Solidago virgaurea and Orthosiphon stamineus or extracts of said plants or from said plants and extracts thereof, a composition comprising such a mixture, and uses thereof.

This application is the U.S. national phase of International Application No. PCT/IB2016/050023, filed 4 Jan. 2016, which designated the U.S. and claims priority to Application No. IT RM2015A000005, filed 7 Jan. 2015; the entire contents of each of which are hereby incorporated by reference.

DESCRIPTION

The present invention relates to a mixture of active ingredients consisting ofTaraxacum officinalis, Fagopyrum esculentum, Ruscus aculeatus, Solidago virgaureaandOrthosiphon stamineusor from extracts of said plants or from said plants and extracts thereof, a composition comprising such a mixture, and uses thereof. The mixture and the composition of the invention promote the depurative physiological process in the body, and are indicated in particular for the treatment of the physiopathology of water retention in obese patients, particularly in order to restore the physiological permeability of the lymphatic endothelium. The invention also relates to uses of the composition of the invention and a treatment of the physiopathology of water retention in obese patients by means of administration of the composition of the invention.

PRIOR ART

The lymphatic system, in addition to maintaining the homeostasis of fluids in tissues, has a key role in immune defence and in the maintenance of the metabolism. It is therefore the interface between the organism and the surrounding environment, forming the physical basis of the immune system, which, by means of its channels and the lymph nodes, carries out the process of presentation and recognition of antigens and activation of the immune response.

The lymphatic system is therefore essential for the immune function, by means of the homeostasis of fluids in the tissues, by means of the absorption of fats in the intestine, and also by means of the removal of fats from the interstices in the majority of tissues.

The lymphatic system enables the absorption of fats originating from the diet, promoting the assimilation (absorption and accumulation) and the metabolism of ingested lipids, at the same time behaving as a sort of “dumping ground” in which the tissues heap dead cells, bacteria, proteins, matrix fragments, lipids and other macromolecules, which will be distributed to the organs intended for removal thereof, such as the liver, kidneys, skin, lungs and large intestine.

The lymphatic system has the following functions:

to maintain and regulate the immune system;

to absorb and re-circulate extracellular fluids in order to maintain the homeostasis of liquids;

to transport macromolecules.

In the human body, water and solutes and, in particular, proteins present in the blood circulation filter through the capillaries to the interstitial space, and in order to balance this flow the interstitial liquid and the proteins present therein re-enter the blood. Each day approximately 50% of the plasma proteins are filtered from the blood capillaries and are not re-absorbed by the venules, but are moved exclusively by the lymphatic system, which has the job of returning them to the systemic circulation. The extravascular accumulation of plasma proteins causes a flow of water from the blood vessel to the interstice, producing oedema. If the lymph present in the thoracic duct were diverted into a suitable receptacle instead of into the systemic circulation, all of the blood would be converted over a short time into lymph. This is life threatening and demonstrates the great importance of the lymphatic system in returning to the blood those proteins and fluids lost from the capillaries.

Interstitial liquid represents, in healthy individuals, approximately 20% of the body weight and is regulated by various temporary mechanisms, including structural changes, adjustment of the forces acting through the vessels (for example osmotic, oncotic and hydrostatic pressure) and the flow of lymph.

In the majority of tissues the lymphatic vessels collect the plasma and the proteins that exit from the blood capillaries. In addition to the fluids and proteins, the lymph in the mesenteric lymph nodes contains fats transported from the lumen of the intestine and collected by the central lymphatic capillaries (initial lymphatic capillaries) located in the intestinal villi.

The concentration of lipids in the intestinal lymph is approximately 1-2% and is highly dependent on the nutritional framework. The flow of intestinal lymph is significantly increased after eating fats. This action can be interpreted as an adjustment to the increased load of lipids and as an aid for leading them through the lymphatic vessels so as to be distributed throughout the body. Recent studies indicate a rise of the contractility of the mesenteric lymphatic vessels in the presence of oxidised low-density lipoproteins (ox-LDL), suggesting a direct effect of the lipids on lymphatic contractility. The mesenteric lymphatic vessels are therefore fundamental for removing the lipids absorbed by the intestine and for maintaining digestive homeostasis.

The rise of fluid in the interstitial space leads to changes, often significant changes, in the architecture of the skin and subcutaneous tissues. As the lymph stasis becomes chronic and due to the resultant oedema, there is a predisposition to have a growing number of fibroblasts, adipocytes and keratinocytes in the oedematous. Such changes in the composition of the tissue lead to a thickening of the skin and fibrosis of the subcutaneous tissue, however these events are not well understood. In the case of lymphedema, i.e. a stage successive to fibrosis, there is inflammation in addition to the lymph stasis and the disturbance of the tissue structure.

Test data recorded in the literature has shown that the loss of lymph in the tissues has an adipogenic and inflammatory effect.

Lymphedema is an accumulation of lymphatic fluid in the interstitial tissues, which causes severe swelling particularly of the extremities, such as the arms and legs, and in rare cases also of other parts of the body. Lymphedema can be primary, that is to say is caused by a change in the lymphatic system itself, or can be secondary to the removal of lymph nodes following surgical interventions, such as a mastectomy, in which, in addition to the removal of the mammary tissue, satellite lymph nodes are also cut away.

In case of severe deterioration of the lymphatic system there is a strong accumulation of lymphatic fluids which will exceed the draining capability of the lymphatic system itself, giving rise to the subsequent recall of fluids rich in proteins which, if untreated, reduces the oxygenation of the tissues, interferes in scarring processes, and can provide terrain for bacterial growth, complicating the clinical picture in lymphangitis.
Lymphedema is different from oedema, which occurs in cases of venous insufficiency, but in this case too can develop into a disorder characterised by combined change of the venous system and also of the lymphatic system, if not correctly treated.

Lymphedema is a pathological condition characterised by the accumulation of fat above all at the lower extremities, and generally manifests itself downwards, that is to say establishes itself from the upper portion of the limbs, i.e. from the hips down, giving rise to the typical appearance of “riding jodhpurs”. Lymphedema can become worse with development of oedematous-fibrosclerotic panniculitis up to formation of subcutaneous nodules. In some cases medial adipose deposits can be seen at the knee joint.

Subjects with lymphedema often report that the tissue is painful and susceptible to bruising following small traumas.

A peripheral microangiopathy develops in the lymphedematous tissue and induces a rise of the permeability of the vessels with accumulation of liquid having a high protein content in the extracellular matrix. The accumulation of liquid induces dilation of the pre-lymphatic channels, reducing the outflow thereof. Morphological and functional changes of the lymphatic capillaries are also experienced, for example the formation of micro-aneurysms.

In addition to this, a disturbance of the motor activity of the lymphangion (which represents the anatomofunctional unit of the lymphatic collector, or the segment placed between one valve mechanism and the other) has been observed. The skin tends to lose tone and there is less action with regard to the vessels and the tissue, and in order to increase the interstitial pressure there is a need for a greater quantity of interstitial liquid. In this way the function of drainage of the lymph is also compromised and, as a result, there is a less significant passive mechanism of defence against the development of oedema.

Historical data and recent studies have demonstrated that the lymphatic system and the adipose tissue are anatomically and functionally related.

Lymphatic vascular insufficiency caused by anatomical anomalies, lesions, obstruction or infection gives rise to an accumulation of interstitial fluid and proteins and lipids in the diseased tissue.

In the case of both primary and secondary lymphedema, if not resolved chronic inflammation, fibrosis and accumulation of adipose tissue will set in, and even in the 19thcentury a German dermatologist affirmed that the stagnation of the fluids in the tissues is able to cause the accumulation of fat. In more recent times, studies on Chy mice have been carried out and have demonstrated that lymph is a potent stimulator of the differentiation of adipocytes and that lymph has a synergic effect with insulin when it comes to promoting adipogenesis. In addition, lymphatic stasis increases the expression of adiponectin, which is known to be increased during the periods of accumulation of fats and decreases during hypertrophy and tissue hypoxia.

The rise of lymphangiogenesis is also associated with inflammatory diseases such as psoriasis and chronic inflammation of the airways:

1—chronic inflammation could promote a rise of the adipose tissue mass for the purpose of satisfying the basic energy need caused by the activation of the immune cells during signalling events and

2—chronic inflammation could promote a greater adipogenesis by means of the stimulation of lymphangiogenesis, worsening the release of lymph in the diseased adipose tissue.

The schema shown inFIG. 10summarises the problems associated with water retention in obese individuals.

It is clear from the schema that obese subjects tend to accumulate fluids that worsen conditions, resulting in a decrease of the lymphatic drainage and a rise in the permeability of the lymphatic and blood vessels with subsequent deterioration of the extracellular matrix and subsequent inflammation and reduction of excretion of Na+ from the kidneys, also via a compromise of the renin-angiotensin-aldosterone system, present in obese individuals.

Although there are numerous products for the treatment of water retention and of oedema in obese individuals, new compositions that take into account the complex physiopathological picture associated with obesity are desirable.

SUMMARY OF THE INVENTION

The present invention provides a composition that

i) acts on the permeability of the blood vessels and of the lymphatic vessels of obese individuals, who therefore present inflammation of such tissues, reducing leakage (i.e. excessive discharge compared with physiological discharge) of the fluids from the lymphatic system and from the circulatory system, thus returning the lymphatic endothelium to a physiological state;

ii) restores a correct channelling in the lymphatic system, allowing a correct reabsorption of the fluids and of the inflammatory molecules therein, consequently also reducing the vicious circle linked with lymphatic adipogenesis;

iii) has a diuretic effect.

The composition of the present invention comprises extracts of plants that, individually, exert some beneficial effects and other negative effects and that, opportunely mixed, are able to exert a general effect that meets the above-mentioned demands.

The authors of the present invention have performed tests on the permeability of the endothelium in order to assess the effects of numerous plant extracts on the permeability of healthy cell cultures of lymphatic cells and blood vessel cells and on cell cultures of lymphatic cells and of blood vessel cells pre-treated with inflammatory agents such as IL-1β in order to mimic the condition of the lymphatic and venous vessels in obese individuals in which there is thus chronic inflammation of such tissues.

The data obtained shows that plants having desirable diuretic effects or effects stimulating the concentration of the lymphangion were not active in restoring the correct permeability of lymphatic cells or of blood vessels pre-treated with IL-1β (i.e. an increase of the permeability of the vessels compared with the physiological permeability observed with such types of cells treated with placebo), meaning that the use of such plants, considered individually, does not meet the above-listed requests.

The authors of the present invention, with the objective of providing a composition which meets the above demands, have identified a group of plants of which the mixed extracts meet the above demands, although extracts of the individual plants instead present effects that do not meet the demands identified above, such as a rise of the permeability of blood and/or lymphatic vessels in cells pre-treated with inflammatory agents such as IL-1β. In the mixture of active ingredients of the present invention, the authors of the present invention were able, by means of opportune mixing, to use some plants for some of the desired effects thereof and to limit the side effects thereof not meeting the demands identified above, thus providing a mixture able to return the lymphatic endothelium damaged by the inflammatory agents to a state of physiological permeability.

The present invention also relates to a composition comprising, as sole active ingredients, a mixture consisting ofTaraxacum officinalis, Fagopyrum esculentum, Ruscus aculeatus, Solidago virgaureaandOrthosiphon stamineusand at least one vehicle or excipient.

The invention also relates to a composition comprising, as sole active ingredients, a mixture consisting of extracts ofTaraxacum officinalis, Fagopyrum esculentum, Ruscus aculeatus, Solidago virgaureaandOrthosiphon stamineusand at least one vehicle or excipient.

The invention therefore relates to the use of the mixture or of the composition as defined above and as defined in greater detail hereinafter and in the claims in the treatment of pathologies associated with lymphatic hyperpermeability. In particular, the data obtained and reported demonstrates the suitability of the mixture or of the composition of the invention for use in pathologies associated with lymphatic hyperpermeability that present a deregulation of the integrity of the lymphatic endothelium.

However, the invention also relates to the mixture or the composition as described and claimed here for use in pathologies associated with lymphatic hyperpermeability in which said pathologies are selected from chronic inflammation, lymphedema, lipedema, and water retention pathology, in particular associated with obesity.

In other words, the invention also relates to said mixtures or said compositions for use in the treatment of the lymphatic endothelium subjected to the action of inflammatory agents, moreover in order to return the lymphatic endothelium to its physiological permeability.

The present invention also relates to a method for treating the physiopathology of water retention, in particular associated with obesity, said method comprising the administration, to subjects in need of this, of therapeutically effective amounts of a mixture consisting ofTaraxacum officinalis, Fagopyrum esculentum, Ruscus aculeatus, Solidago virgaureaandOrthosiphon stamineusor extracts thereof, or of said plants and extracts thereof, or of a composition comprising, as sole active ingredients, a mixture consisting ofTaraxacum officinalis, Fagopyrum esculentum, Ruscus aculeatus, Solidago virgaureaandOrthosiphon stamineus, or a mixture consisting of extracts ofTaraxacum officinalis, Fagopyrum esculentum, Ruscus aculeatus, Solidago virgaureaandOrthosiphon stamineusor a mixture consisting ofTaraxacum officinalis, Fagopyrum esculentum, Ruscus aculeatus Solidago virgaureaandOrthosiphon stamineusand extracts ofTaraxacum officinalis, Fagopyrum esculentum, Ruscus aculeatus Solidago virgaureaandOrthosiphon stamineusand at least one pharmaceutically acceptable vehicle and/or excipient.

As mentioned inFIGS. 2 to 9 and 11-14the result is the result of experiments carried out in triplicate for each tested compound.

Abbreviations Used in the Drawings and in the Text

DETAILED DESCRIPTION OF THE INVENTION

The authors of the present invention have used a cellular model of lymphatic vessels and of blood vessels exposed to inflammatory agents (such as those present in obese individuals produced by inflammatory adipocytes) in order to assess the effects of various plant extracts having desired activities, such as diuretic activities, for exampleTaraxacum officinalis, Fagopyrum esculentum, or activities of induction of the contraction of the base unit of the lymphatic vessels (lymphangion), for exampleRuscus aculeatus, on the permeability of lymphatic and blood vessels.

It is known in fact that in obese individuals there is observed a rise of the permeability of such vessels with a subsequent non-physiological discharge of liquids from such vessels and an inability thereof to reabsorb and correctly direct the fluids and the inflammatory molecules permeated from the blood and lymphatic vessels, with a subsequent adipogenic effect of the fluids discharged from the lymphatic vessels and the establishment therefore of a vicious circle linked to the physiopathology of water retention associated with obesity.

The authors of the present invention have therefore focused their attention on the effects on the permeability of the lymphatic vessels and blood vessels brought about by plant extracts which are potentially beneficial from the viewpoint of the stimulation of the contraction of the lymphangion (contraction of the lymphatic vessels and possible improvement of the channelling of the lymphatic fluids) or of diuresis.

The authors have therefore used a model, shown schematically inFIG. 1, to study the effects of various plant extracts on endothelia of blood or lymphatic vessels. As shown inFIG. 1, the exposure of the endothelial cells to cytokine (as under conditions of inflammation present in obese individuals) changes the integrity of the vascular endothelium, which becomes more permeable to the passage of fluids. The degree of permeability has been determined by way of experiment by measuring the amount of fluorescent probe that crosses the endothelial barrier separating the two compartments representing, respectively, the lumen of the vessel (above the semi-permeable membrane) and the interstice (below the semi-permeable membrane).

Increasing amounts of extracts of various plants were introduced in the medium above the semi-permeable membrane, and the effect thereof on endothelial permeability was examined. The same experiment was performed with the mixture of the invention. Setting as permeability value equal to 100% a value equal to that observed in healthy cells, not exposed to cytokine, it could be seen that onlyOrtosiphon stamineuswas successful in reducing the permeability of the lymphatic endothelium at least to 100% at a concentration of 10 μg/ml (FIG. 3), whereas at higher doses this permeability even decreased too much, whereas when co-extracted withSolidago virgaureait had a non-positive effect on the permeability of the lymphatic endothelium (FIG. 5), and that no other single extract is able to return the permeability to 100% (FIGS. 2, 4, 6 and 7). The data obtained by the authors of the present invention shows how, instead, surprisingly, the mixture of the present invention (in whichOrtosiphon stamineusandSolidago virgaureaare present also as co-extracts) is able to return the lymphatic endothelial permeability to 100% at any tested concentration (FIG. 8andFIG. 9E).

In other words, the authors of the invention have demonstrated that the mixture of the invention is able to reduce the hyperpermeability of the lymphatic endothelium at any tested concentration in a manner superior to that of any component tested individually, indicating that the selected combination protects the correct permeability of the lymphatic endothelium optimally and in a constant manner. The authors have also demonstrated how, in contrast to the majority of single extracts, the mixture of the invention does not bring about any modifications in the lymphatic endothelial permeability in the absence of the cytokine inflammatory agent, indicating how such a mixture therefore would not have undesirable side effects on healthy endothelia.

The authors of the present invention have also found that the co-extraction ofOrtosiphon stamineusandSolidago virgaureaprovides a co-extract having better diuretic activities compared with those resulting from a simple addition of the single extracts of the two plants.

In addition, the authors of the invention have demonstrated that the mixture selected by them, as described and claimed here, provides its effect on cellular permeability by promoting the integrity of the tight junctions, and that said mixture also reduces the expression of inflammatory elements, such as inducible nitric oxide synthase (i NOS) and cyclooxygenase 2 (COX-2), without changing the endothelial NOS (e NOS), demonstrating therefore how the mixture is also useful in improving modified lymphatic circulation conditions and in supporting the physiological functionality of the lymphatic endothelium.

The selection of extracts performed by the authors of the present invention thus provides a mixture that therefore satisfies all the requests listed below, that is to say it

i) acts on the permeability of the blood vessels and of the lymphatic vessels of obese individuals, who therefore present inflammation of such tissues, reducing leakage (that is to say excessive discharge compared with physiological discharge) of the fluids from the lymphatic system and from the circulatory system;

ii) restores a correct channelling in the lymphatic system, allowing a correct reabsorption of the fluids and of the inflammatory molecules therein, subsequently also reducing the vicious circle associated with lymphatic adipogenesis;

iii) has a diuretic effect

and at the same time does not have the undesirable side effects associated with the single extracts of the plants that form the mixture of the present invention, particularly with regard to the permeability of the lymphatic endothelium.

The present invention thus relates to a mixture consisting ofTaraxacum officinalis, Fagopyrum esculentum, Ruscus aculeatus, Solidago virgaureaandOrthosiphon stamineusor a mixture consisting of extracts of said plants or a mixture consisting of said plants and from extracts of said plants.

For the purposes of the present invention the termTaraxacum officinalismeans the roots of said plant or the term extract ofTaraxacum officinalismeans a hydroalcoholic extract (such as ethanol/water 40-70%, for example 60%) of roots ofTaraxacum officinalis.

For the purposes of the present invention the termFagopyrum esculentummeans the leaves of said plant or the term extract ofFagopyrum esculentummeans a hydroalcoholic extract (such as ethanol/water 40-80%, for example 70%) of leaves ofFagopyrum esculentum.

For the purposes of the present invention the termSolidago virgaureameans the tops of said plant or the term extract ofSolidago virgaurea, means an extract (such as ethanol/water 30-60%, for example 40%) of tops ofSolidago virgaurea.

For the purposes of the present invention the termOrthosiphon stamineusmeans the leaves of said plant or the term extract ofOrthosiphon stamineus, means an extract (such as ethanol/water 40-70%, for example 50%) of leaves ofOrthosiphon stamineus.

For the purposes of the present invention the termRuscus aculeatusmeans the root stock and/or roots of said plant or the term extract ofRuscus aculeatus, means an extract (such as ethanol/water 40-80%, for example 70%) of root stock or root ofRuscus aculeatus.

The parts of the plant can be fresh or dried.

For the purposes of the present invention the term co-extract ofSolidago virgaureaandOrthosiphon stamineusmeans an extract of the tops ofSolidago virgaureaand of leaves ofOrthosiphon stamineusproduced by placing the suitable parts of each plant in the same solvent, for example leaves ofSolidago virgaureaand leaves ofOrthosiphonin a ratio of 1:1 or 2:1 or of 3:1 and proceeding with the extraction in accordance with standard methodology so as to obtain a hydroalcoholic extract (such as ethanol/water 40-70%, for example 50%).

Each of the above-mentioned extracts can be in lyophilised form.

In a preferred embodiment the invention relates to a mixture consisting of extracts ofTaraxacum officinalis, Fagopyrum esculentum, Ruscus aculeatus Solidago virgaureaandOrthosiphon stamineus, in another embodiment the invention relates to a mixture consisting ofTaraxacum officinalis, Fagopyrum esculentum, Ruscus aculeatus, Orthosiphon stamineus, andSolidago virgaurea, and in yet another embodiment the invention relates to a mixture consisting ofTaraxacum officinalis, Fagopyrum esculentum, Ruscus aculeatus Solidago virgaureaandOrthosiphon stamineusand from extracts ofTaraxacum officinalis, Fagopyrum esculentum, Ruscus aculeatus, Orthosiphon stamineus, andSolidago virgaureain which all three mixtures are for use in the treatment of pathologies associated with lymphatic hyperpermeability. In particular, the data obtained and reported shows the suitability of the mixture of the invention for use in pathologies associated with lymphatic hyperpermeability, in particular for pathologies that present a deregulation of the integrity of the lymphatic endothelium and that can be selected, for example, from chronic inflammation, lymphedema, lipedema, and water retention physiopathology, in particular in cases in which said physiopathology is associated with circulatory stasis, lymphedema, and/or inflammation of the tissues, for example in obese individuals. In one embodiment of the invention the mixture is intended for use in the treatment of the lymphatic endothelium subjected to the action of inflammatory agents so as to return said endothelium to a state of permeability similar or equal to that of healthy (physiological) lymphatic endothelium.

In accordance with the present invention, when reference is made to the fact that a certain component consists of from x % to y % of the mixture of the invention, this means that said component consists of from x % to y % by weight of the mixture of the invention, preferably dry weight.

In one embodimentTaraxacum officinalisconsists of from 12% to 33% of the mixture of the inventionRuscus aculeatusconsists of from 6% to 25% of the mixture of the invention, andSolidago virgaureaandOrthosiphonconsist of, on the whole, from 35% to 55% of the mixture of the invention.

Solidago virgaureaeOrthosiphon stamineusare preferably in a ratio of 1:1, 2:1 or of 3:1 or of 4:1, more preferably in a ratio of 3:1.

In one embodiment of the invention said extract ofTaraxacum officinalisconsists of from 23% to 33% of the mixture of the invention, said extract ofFagopyrum esculentumconsists of from 12 to 25% of the mixture of the invention, said extract ofRuscus aculeatusconsists of from 6% to 12% of the mixture of the invention, and said extracts ofSolidago virgaureaandOrthosiphonconsist of, on the whole, from 35% to 55% of the mixture of the invention. In a preferred embodiment of the invention the extract ofSolidago virgaureaandOrthosiphon stamineusis provided by placing the suitable parts of each plant in the same solvent, for example leaves ofSolidago virgaureaand leaves ofOrthosiphon stamineusin a ratio of 1:1, 2:1 or of 3:1 and by proceeding with the extraction in accordance with standard methodology as described above. In this case the extract as described is also defined here, in the present invention, as co-extract ofSolidago virgaureaandOrthosiphon stamineus.

However, in one embodiment of the invention said extract ofTaraxacum officinalisconsists of from 23% to 33% of the mixture of the invention, said extract ofFagopyrum esculentumconsists of from 12 to 25% of the mixture of the invention, said extract ofRuscus aculeatusconsists of from 6% to 12% of the mixture of the invention, and said extracts ofSolidago virgaureaandOrthosiphon stamineusare in the form of a co-extract forming from 35% to 55% of the mixture of the invention.

In a further embodiment the active ingredients may comprise the mixture of plants as indicated above and the mixture of extracts as indicated above.

In accordance with the present description, the values indicated as a percentage range include, precisely, all whole numbers and all decimals from one end to the other of the range, inclusive of extremes. Thus, when reference is made in the present description of the invention to “from 23% to 33%”, this means at any point of the description and in any embodiment of the mixture or of the composition comprising the mixture: 23%; 23.5%; 24%; 24.5%; 25%; 25.5%; 26%; 26.5%; 27%; 27.5%; 28%; 28.5%; 29%; 29.5%; 30%; 30.5%; 31%; 31.5%; 32%; 32.5%; 33%; and also the other decimals comprised therebetween.

Similarly, when reference is made in the present description of the invention to “from 12% to 25%”, this means at any point of the description and in any embodiment of the mixture or of the composition comprising the mixture: 12%; 12.5%; 13%; 13.5%; 14%; 14.5%; 15%; 15.5%; 16%; 16.5%; 17%; 17.5%; 18%; 18.5%; 19%; 19.5%; 20%; 20.5%; 21%; 21.5%; 22%; 22.5%; 23%; 23.5%; 24%; 24.5%; 25% and also the other decimals comprised therebetween.
When reference is made in the present description of the invention to “from 6% to 12%”, this means at any point of the description and in any embodiment of the mixture or of the composition comprising the mixture: 6%; 6.5%; 7%; 7.5%; 8%; 8.5%; 9%; 9.5%; 10%; 10.5%; 11%; 11.5%; 12%; and also the other decimals comprised therebetween.
Lastly, when reference is made in the present description of the invention to “from 35% to 55%, this means at any point of the description and in any embodiment of the mixture or of the composition comprising the mixture: 35%; 35.5%; 36%; 36.5%; 37%; 37.5%; 38%; 38.5%; 39%; 39.5%; 40%; 40.5%; 41%; 41.5%; 42%; 42.5%; 43%; 43.5%; 44%; 44.5%; 45%; 45.5%; 46%; 46.5%; 47%; 47.5%; 48%; 48.5%; 49%; 39.5%; 50%; 50.5%; 51%; 51.5%; 52%; 52.5%; 53%; 53.5%; 54%; 54.5%; 55 and also the other decimals comprised therebetween.
The present invention, as already mentioned, also relates to a composition comprising, as sole active ingredients, a mixture, in accordance with any one of the embodiments described above, consisting of extracts ofTaraxacum officinalis, Fagopyrum esculentum, Ruscus aculeatus, Orthosiphon stamineusandSolidago virgaureaand at least one vehicle or excipient, in an alternative embodiment the present invention also relates to a mixture consisting ofTaraxacum officinalis, Fagopyrum esculentum, Ruscus aculeatus, Orthosiphon stamineusandSolidago virgaureaand at least one vehicle or excipient, and in a further embodiment the present invention relates to a mixture consisting ofTaraxacum officinalis, Fagopyrum esculentum, Solidago virgaurea, Orthosiphon stamineusandRuscus aculeatusand extracts ofTaraxacum officinalis, Fagopyrum esculentum, Solidago virgaurea, Orthosiphon stamineusandRuscus aculeatus.

Such a composition therefore comprises, as sole active ingredients, the plants or extracts that form the mixture of the invention, and also in the composition of the invention the extract ofOrthosiphon stamineusandSolidago virgaureamay be in the form of a co-extract.

As described above for the mixture, the composition of the invention is suitable for use in the treatment of pathologies associated with lymphatic hyperpermeability. In particular, the data obtained and reported shows the suitability of the mixture of the invention for use in pathologies associated with lymphatic hyperpermeability, in particular for pathologies that present a deregulation of the integrity of the lymphatic endothelium and that can be selected, for example, from chronic inflammation, lymphedema, lipedema, and water retention physiopathology, in particular in cases in which said physiopathology is associated with circulatory stasis, lymphedema, and/or inflammation of the tissues, for example in obese individuals.

In one embodiment of the invention the composition as described and claimed is therefore suitable for use in the treatment of the physiopathology of water retention associated with obesity. The composition of the invention, similarly to the mixture of the invention, is aimed in particular at overweight/obese individuals who wish to assist the physiological process of weight loss by rebalancing the correct functionality of the processes of tissue drainage and in particular of the lymphatic system involved in the water retention physiopathology linked to obesity caused also by inflammation of the lymphatic endothelium and by the increase of permeability thereof caused by the fissuration (hyperpermeability) thereof as a result of inflammatory agents.

The composition according to the invention may be, for example, a phytopharmaceutical composition, a food for special medical purposes, or a dietary supplement.

In accordance with the invention the composition of the invention may therefore be a composition in which said extract ofTaraxacum officinalisconsists of from 23% to 33% of the mixture of active ingredients, said extract ofFagopyrum esculentumconsists of from 12 to 25% of the mixture of active ingredients, said extract ofRuscus aculeatusconsists of from 6% to 12% of the mixture of active ingredients, and said extracts ofSolidago virgaureaandOrthosiphonconsist of, on the whole, from 35% to 55% of the mixture of active ingredients. As already mentioned above, said extracts ofSolidago virgaureaandOrthosiphoncan be in the form of a co-extract forming from 35% to 55% of the mixture of the invention.
Still in accordance with the invention, the composition may be a composition in which saidTaraxacum officinalisconsists of from 12% to 33% of said mixture, saidFagopyrum esculentumconsists of from 12 to 25% of said mixture, saidRuscus aculeatusconsists of from 6% to 25% of said mixture, and saidSolidago virgaureaandOrthosiphon stamineusconsist of, on the whole, from 35% to 55% of said mixture.

In a preferred embodiment said composition is suitable for oral administration and is in the form of a fluid, herb tea, decoction, macerated material, suspension, solution, granulate, powder, tablet, operculum, solid gelatin, soft gelatin.

In accordance with a further embodiment, the composition of the invention is suitable for topical use and may therefore be in the form of a fluid, vaporisable solution, cream, ointment, gel, or emulsion.

In accordance with the present invention one or more of the following ingredients can be used as excipients and/or vehicles: natural gums, such as gum arabic, guar gum, xanthan gum; natural and artificial sweeteners (honey, brown sugar and refined sugar); polysaccharides (cellulose, rice starch, potato starch, corn starch); natural waxes, including carnauba wax, beeswax, natural oils such as sweet almond oil, sunflower oil, emulsions of natural origin (sucrose esters, esters of stearic acid), and any other excipient that could be chosen from the prior art by a person skilled in the art without exercising inventive skill.

In addition, the composition of the invention, in accordance with any one of the described embodiments, may also comprise at least one neutral flavouring and/or natural preservative.

Said natural flavouring and/or said natural preservative can be any natural flavouring and/or preservative known to a person skilled in the art to be suitable for providing compositions for oral use, and could be selected for example, but with no limitation, from natural orange flavouring, natural blackberry flavouring, liquorice extract, orange peel, orange juice, tangerine juice, juice, grape juice, blackberry juice, elderflower juice, blueberry juice, pineapple juice, grapefruit juice, currant juice, raspberry juice, apple juice, lemon juice.

That which has been described thus far for the mixture of the invention clearly therefore applies, mutatis mutandis, for the composition of the invention.

EXAMPLES AND METHODS

Non-limiting examples of embodiments of the composition of the invention and of suitable dosages for administration thereof will be provided here.

The natural flavourings and/or preservatives in the composition above can be, for example, one or more from orange juice, grape juice, apple juice, lemon juice (optionally one or more of said juices can be concentrated), natural flavouring in the form of orange powder, blackberry powder, lemon powder, tangerine powder, citrus powder, pineapple powder, strawberry powder, cherry powder, blackberry, mixed berry powder.

The daily dose for such a product is equal to 10-20 grams.

Alternatively, the above-described composition may comprise a mixture of an extract ofSolidago virgaureaand an extract ofOrthosiphon stamineusin a ratio of approximately 3:1.

Prepared by infusion with roughly chopped parts of used plants, 1.5-2.5 g of single dose.

Composition 2 may optionally comprise approximately from 2% to 8% of a mixture of extracts according to the present description.

The natural flavourings and/or preservatives in the composition above can be, for example, one or more from orange peel, liquorice roots, lemon peel.

The daily does for such a product is equal to 1.5-2.5 grams.

In the form of an oral solid (powder, granulate, capsule, tablet), 80-100 mg of single dose.

The natural flavourings and/or preservatives in the composition above can be, for example, one or more from natural flavouring in the form of orange powder, blackberry powder, lemon powder.

The daily dose for such a product is equal to 1.0-1.4 grams

The data obtained in the experiments reported below and shown in the figures shows how, in addition to maintaining the correct permeability, the treatment of the lymphatic endothelium with the mixture of the invention positively regulates all the characteristics providing protection of the endothelium, whilst the key enzymes involved in cellular damage and in activation towards an inflammatory phenotype are sub-regulated by the mixture, thus preparing the lymphatic endothelium to react to the inflammatory attack.

4. Vascular Permeability Test

Materials and Methods in Detail

Cell Cultures

Lymphatic endothelial cells (derma) and blood vessels obtained from commercial sources (available from PromoCell, Germany “Human Dermal Lymphatic Endothelial Cells (HDLEC)” and “Human Dermal Blood Endothelial Cells (HDBEC)”) were used. The cells were cultivated and kept in culture as recommended by the vendor with FBS 10% in complete endothelial cell basal medium MV2 (Promocell, Heidelberg, Germany) at 37° C. in CO25% and divided 1:3 twice a week up to the 10th time.

Treatment

The samples were assessed in 2-3 concentrations vs. vehicle alone on the cell cultures, untreated and treated with IL1beta (10 ng/ml), to understand if they have any effect in themselves on undamaged cells and if the tested substances are able to reverse the rise in permeability induced by IL1beta.

Thus, for each cell culture and each extract, the points to be assessed were as follows: untreated control, control with vehicle, extract dose A, extract dose B, IL1beta, IL1beta+dose A, IL1beta+dose B, each repeated 3 times.

The endothelial cells, held in plates with complete medium (10% serum), were separated, with trypsin/EDTA, and plated in transwell plates, in PET with pores having a diameter of 0.4 micron accommodated in a 12-well multi-plate, at a density of 8×104cells/transwell. The cells were left to grow for 72 h so as to form a complete monolayer that could be assessed under inverted microscope. Once confluence had been reached, the medium was removed and the extracts were added for 18 h. Without changing the cell medium, IL1beta (10 ng/ml, 1 h) was added where indicated by the protocol. Once the stimulation time had elapsed the medium was removed and 500 μl of FITCH-dextran (3 kDa, 10 μM diluted in PBS) were added in the transwell, whilst 1.5 ml of PBS were introduced into the well of the multi-plate below. Every 15 minutes, 100 μl×3 (triplicate) were sampled from the well of the multi-plate and a fluorescence spectrophotometry reading was taken (485 nm excitation, 535 nm emission). This makes it possible to measure the FITC-dextran that has passed through the barrier formed by the endothelial cells. The results are expressed as a relative value of measured fluorescence.

The test as described above was carried out for each plant forming the mixture of the invention, using extracts of each plant and co-extract ofSolidago virgaureaandOrthosiphon stamineusin the ratio 3:1.

The test was also carried out with the mixture of extracts according to the invention.

The data obtained, shown inFIGS. 2 to 9, shows how the permeability of the lymphatic vessels exposed to cytokine remains greater than that of healthy endothelium (therefore negative effect) with all the single extracts apart fromOrthosiphon stamineus(FIG. 3) at the lowest tested concentration, which at a higher concentration, however, reduces the level of permeability below the basal value, andFagopyrum esculentum(FIG. 9A), which returns the permeability to values close to basal levels only at the highest tested concentration, demonstrating a weaker protective effect compared with the mixture of the invention. The permeability of the lymphatic vessels is instead held at levels equal to those of healthy endothelium by the mixture of the invention. The data shows, in addition, that the mixture of the invention does not have any undesirable effects on the endothelium not exposed to the tested inflammatory agents.

In particular,FIGS. 8 and 9E, provided with a mixture that comprises co-extractSolidago virgaureaandOrthosiphon stamineus, show how the selection of the components of the mixture of the invention makes it possible to obtain an optimal synergic effect on holding the vascular permeability at levels similar to that of healthy lymphatic endothelium.

5. Diuretic Activity Test

The animals were housed in metabolic cages (three mice/cage) and were allowed free access to food and drinking water (commercial oligomineral water). In order to obtain similar physiological states of hydration, gavage of oligomineral water of 2.5% body weight was administered to all groups of animals 2 hours before the experiment.

The animals were then divided randomly into groups (9 mice/group) in accordance with the following treatment schema:

3. Furosemide: 100 microl/mouse of furosemide were administered at 10 mg/kg in oligomineral water by means of gastric probe at t=0 (positive control)

4—Goldenrod: 100 microl/mouse of goldenrod extract (200 mg/kg body weight in oligomineral water) were administered by means of gastric probe at t=0

5—Orthosiphon: 100 microl/mouse of extract of orthosiphon (200 mg/kg body weight in oligomineral water) were administered a t=0

In order to assess the diuretic activity of the compounds, samples of urine were collected in graduated cylinders, and the volume thereof was recorded at intervals of 2 h up to a total of 8 hours.

The urinary excretion, independently of the weight of the animals, was calculated as total diuresis divided by the volume of total liquid administered.

Urinary excretion=volume of total urine (ml/100 g BW)/total liquid consumed.

The data obtained shows a urinary excretion after 8 hours equal to 2 ml with 200 mg/kg of goldenrod, 2.25 ml with 200 mg/kg of orthosiphon and 3 ml with 200 mg/kg goldenrod+orthosiphon co-extracted in the ratio 3:1.

The urinary excretion in untreated mice was approximately 1.9 ml, in the mice treated with only oligomineral water it was approximately 2.25 ml, and in the mice treated with 10 mg/kg of furosemide it was approximately 3.9 ml.

The ROS analysis was carried out by placing the HDLEC cells 1.5×103in 96-well plates, said cells, after adhesion, being pre-treated with 10 μg/ml of the mixture of the invention for 18 hours and then with IL-1β (10 ng/ml for 1 hour) in medium without phenol red. DCFH2-DA (2.7-dichlorodihydrofluorescein diacetate Invitrogen, Milan, Italy) was added in an amount of 10 μM for 30 minutes, and the intracellular levels of ROS were photometrically assessed using a microplate reader (excitation/emission 495/527, SpectraFluor, Tecan). The results were recorded as RFU (relative fluorescence unit) corrected for the number of cells contacted.

The proteins of occluding tight junction and zona occludens 1 (ZO-1) expressed on the cell surface were visualised using confocal analysis. The cells were plated 5×104on 1 cm circular glass slides. After 24 hours the cells were washed and treated with the mentioned stimulants. The immunofluorescence analysis was carried out as reported in the materials and methods of Monti et al, Pharmacol Res 2013; 76:171-81.

Cells (3×105/plate 6 cm), 90% confluence, were treated or not with the mixture of the invention (10 μg/ml, 18 hours). The expression of the markers of the inflammatory pathways (iNOS, eNOS, COX-2) and of the anti-oxidant/pro-oxidant enzymatic systems (SOD-1, catalase, p22 phox) was assessed by means of western blot as described in the materials and methods of Terzuoli et al. 2014. PLoS One 9: e84358, Monti et al., 2014 J Pharmacol Exp Ther.; 351(3):500-9. The data was recorded as arbitrary densitometry unit (A.D.U.) of the target protein compared with the beta-actin used as control.

Materials and Reagents

Analysis of the Data and Statistical Procedures

The results were representative of, or averaged over at least three independent experiments performed in triplicate for each sample. The statistical analysis was carried out using the ANOVA test followed by the Bonferroni and student t tests when appropriate (GraphPad). P<0.05 was considered to be statistically significant.