Lowering blood cholesterol levels using cellulose ethers

Abstract: A method for reducing the cholesterol level in mammalian blood by administering a water soluble cellulose ether thereto. The cellulose ethers have a viscosity, measured as a 2% aqueous solution at 20°C, of at least about 35 cps. Oral administration is preferred, and, in one embodiment the high viscosity water soluble cellulose ether is hydroxypropyl methylcellulose, contained in a nutritious foodstuff.

Description: FIELD OF THE INVENTION The present invention relates to the use of hydroxypropyl methyl cellulose for the manufacture of pharmaceuticals and foodstuffs useful in reducing total plasma cholesterol levels in mammals. BACKGROUND OF THE INVENTION Elevated total plasm cholesterol (TPC) levels, also referred to as serum cholesterol levels, are firmly established as a significant factor in the development of coronary heart disease. Consequently, there is a considerable interest in discovering and developing methods for reducing TPC levels. Although drugs are now available that can produce significant reductions in serum cholesterol, most if not all have undesirable side effects. A number of studies have been conducted on the role of dietary fiber in health and disease. Studies comparing the effects of various fiber sources on cholesterol concluded that different fiber sources affect TPC levels in mammals differently. According to these studies, fibers such as cellulose are not hypocholesterolemic in mammals. See CRC Handbook of Dietary Fiber in Human Nutrition , "Influence Of Dietary Fiber On Cholesterol Metabolism In Experimental Animals," by D. Kritchevsky and J.A. Story et al., Chapter 4.3 (1986 G. Spiller, Ed.). With respect to cellulose derivatives, D.L. Topping, et al., Brit. J. Nutr., Vol. 59, No. 1, January 1988, pp. 21-30 tested the cholesterol-lowering effect of methylcellulose of low, medium and high viscosity (25-1500 cps at 2% solution) in rats. They documented changes in carbohydrate and fatty acid metabolism and speculated that those changes are due to the slowed digestion and absorption of nutrients in the small intestine. However, plasma and liver cholesterol concentrations were not altered by these materials. Therefore, a continuing need exists for agents capable of reducing plasma cholesterol levels. SUMMARY OF THE INVENTION The present invention is concerned with the use of hydroxypropyl methyl cellulose in combination with a pharmaceutically acceptable carrier for the manufacture of a pharmaceutical unit dosage form for reducing total plasma cholesterol levels (TPC) in mammalian, i.e. human, blood, in need of such therapeutic application. The invention is further concerned with the use of a mixture of 2-20 weight percent of hydroxypropyl methyl cellulose having a viscosity, measured as a 2 weight percent aqueous solution of 20°C, of at least 50 cps, and a separate metabolizable food ingredient having a predetermined caloric content for the preparation of a nutritious foodstuff mixture capable of reducing total plasma cholesterol levels in mammals. A wide variety of cellulose ethers effective in the practice of the present method are commercially available, or can be readily obtained via conventional organic synthetic methodology. These materials are nontoxic, at the dosages administered, and are generally tasteless and essentially non-caloric. Although cellulose ethers have been used in a variety of foodstuffs to improve certain functional properties, such as emulsification, texture or moisture retention, the amounts used are usually less than 0.5% of the foodstuff. These levels are too low to have any significant physiological effect, such as the cholesterol lowering effect which is the basis of the present invention. Therefore, the present invention also provides processed foodstuffs intended for human ingestion which comprise water soluble hydroxypropyl methyl cellulose in an amount effective to lower TPC upon ingestion of an amount of the foodstuff, alone, or in combination with other foods used to meet the daily caloric requirements of the subject. In contrast to the small amounts conventionally employed in processed foodstuffs, the foodstuffs which are the subject of the present invention will preferably comprise about 2-20 wt-% of this water soluble cellulose ether, preferably about 5-15 wt-%. At these levels, about 1-30 g, preferably about 2-10 g, of cellulose ether will be ingested daily by the mammal, e.g., by a human, per 1000 kilocalories of total food consumed daily. Therefore, to achieve a useful cholesterol-lowering effect (≧ 5-10%) in accord with the present method, an adult man would ingest about 2.5-10 g/day, preferably about 4-8 g/day, and an adult woman would ingest about 2-8 g/day, preferably about 3-7.5 g/day of a cellulose ether, such as a medium to high viscosity hydroxypropyl methyl cellulose. However, dosages as high as 30-35 g/day may be indicated for some human patients with highly elevated TPC. BRIEF DESCRIPTION OF THE FIGURES Fig. 1 is a plot of the relationship between in vitro viscosity of cellulose (a) and hydroxypropyl methylcellulose, and plasma total cholesterol in hamsters. Fig. 2 is a plot of the relationship between the ex-vivo contents viscosity of cellulose (a) and HPMC, and plasma total cholesterol in hamsters. DESCRIPTION OF THE PREFERRED EMBODIMENTS The cellulose ether compounds of the invention contain hydroxypropyloxyl groups. Cellulose ethers of this type, are described in U.S. Patents 4,900,573, 4,734,285, 4,704,285, and in Kirk-Othmer-Concise Encyclopedia of Chemical Technology , M. Grayson, ed., Wiley-Interscience NY (1985) at pages 231-232. The viscosities reported herein are measured in centipoises (cps or cP), as measured in a 1 or 2% by weight aqueous solution of the cellulose ether at 20°C using a rotational viscometer. The viscosity of 2% aqueous solutions of the cellulose ether employed in the invention is desirably in range of 50-200,000 cps, and preferably in the range of 75-100,000 cps, most preferably within the range of 100-10,000 cps. A "high viscosity" cellulose ether possesses a viscosity of at least about 10,000 cps. "Water soluble" for purposes of this application means that 2 grams of powdered cellulose ether can be dispersed by stirring into 100 grams of water at a temperature between 0°C-100°C to provide a substantially clear, stable aqueous composition or dispersion (when the dispersion is brought to 20°C). Cellulose ethers may be made by the reaction of cellulose pulp with various chemical reactants in the presence of caustic soda. For example, methylcellulose ether may be made by using chloromethane as the chemical reactant and HPMC may be made using propylene oxide and chloromethane as reactants. For example, see C.R. Noller, Chemistry of Organic Compounds , W.B. Saunders Co., London (2d ed. 1957) at pages 404-405. The apparent viscosity of aqueous solutions of the cellulose ether compounds of this invention is proportional to the molecular weight or chain length of the compound. The number average molecular weight of water soluble high viscosity cellulose ethers useful in lowering the TPC levels in mammals is desirably at least about 100,000 daltons and preferably ranges from 100,000 to 250,000 daltons. The weight average molecular weight will be 3-10 times the number average molecular weight. The cellulose ethers employed in this invention are further characterized in that they are non-toxic, non-ionic, noncaloric, biologically inert and edible. The method for reducing the TPC level in the blood of mammals according to the present invention comprises administering an effective amount of a water soluble cellulose ether to the digestive tract of a mammal. One type of water soluble cellulose ether may be administered or a mixture of cellulose ethers may be administered. Preferably, the ether or ethers are administered in combination with a pharmaceutically-acceptable carrier, i.e., in one or more pharmaceutical unit dosage forms, such as tablets, gelatin capsules, pre-measured solutions intended for ingestion, and the like. While the method of administration may vary, the cellulose ethers are desirably administered orally and preferably are ingested by a human as an ingredient of his/her daily diet, i.e., in combination with a liquid vehicle, such as water, milk, vegetable oil, juice and the like, or in an ingestible solid or semi-solid matrix, such as in combination with conventional tabletting excipients, or in capsule fills such as polyethylene glycols, natural gels, and the like. The cellulose ether can be administered directly (preferably in solution) or in powder form, or may be combined with other food ingredients. A number of foodstuffs which are generally compatible with cellulose ethers are disclosed by M.K. Weibel et al. (U.S. Patent No. 4,923,981), the disclosure of which is incorporated by reference herein. For example, it may be mixed into foods such as shakes (i.e., milk shakes), breakfast drinks, juices and flavored drinks, yogurt, puddings, ice cream, ice milk, frozen yogurt, cheesecake filling, candy bars, including "health bars" such as granola and fruit bars, gums, hard candy, pastry fillings such as fruit fillings, cereals, breads, prepared stuffings and instant potatoes. Effective amounts of the present cellulose ethers can also be used as fat replacers in salad dressings, frosting, soups, sauces, gravies, mayonnaise and other spreads. Also, the cellulose ethers may be formulated as tablets, granules, capsules and the like. Therefore, "food ingredients," as the term is used herein, includes those ingredients commonly employed in recipes for the above foodstuffs, including flour, fruits, milk, eggs, starch, soy protein, sugar, sugar syrups, vegetable oils, butter, emulsifying agents such as lecithin, and the like. Preferably, the water soluble cellulose ethers are partially or fully hydrated before they are orally ingested. For example, the cellulose ethers may be dispersed in sufficient water to make a syrupy liquid which then is mixed with one or more food ingredients such as flours and other cereal products to made a paste or dough, the latter being subsequently treated by such known food-preparing means as baking, extruding, and the like, to provide edible foodstuffs. Of course, colorings and flavorings may be added as may be appropriate to add to the attractiveness of the foodstuff. Food ingredients with which the cellulose ethers may be combined are metabolizable and have predetermined caloric values, and the amounts of such food ingredients that are used may be measured by their caloric content. A functionally effective amount of the cellulose ether is employed. That amount is at least the minimum amount required to provide a significant reduction of the TPC levels in mammalian, e.g., human blood. Accordingly, the desired dosage or amount of water soluble cellulose ethers which should be included in the diet will vary depending on the size and sex of the human patient as well as the patient's TPC levels. For example, the foodstuffs described above will typically be formulated to comprise from 2 to 20% of total cellulose ethers, depending on the viscosity grade of cellulose ether used and the type of foodstuff. Combinations of concentration and viscosity would have to be determined experimentally to some extent. For example, in a milk shake or pudding, the weight-% can be 10-20%. However, in baked goods, a range of only 2-5 wt-% might be possible, without deleteriously effecting the rheological characteristics of the product. Of course, the amount of cellulose ether incorporated into a pharmaceutical unit dosage form can be much higher, since taste and rheology are not primary considerations, e.g., from about 20-98%, preferably about 50-80% of cellulose ether can be used. Ingestion of from approximately 2 grams per 1,000 kilocalories (kcal) of total food consumed daily to approximately 30 grams per 1,000 kcal is appropriate in most circumstances. Preferably 10 to 20 grams per 1,000 kcal will be consumed daily. The present invention is further described by the following non-limiting examples. Example 1 The ability of high and low viscosity preparations of HPMC to lower the total plasma cholesterol levels of hamsters was determined by comparing the total plasma cholesterol levels of animals fed diets which included the HPMC preparations compared to animals which were fed diets including high and low viscosity preparations of guar gum. Guar gum, which herein is used for comparative tests, is the most widely known polysaccharide used for lowering cholesterol levels. HPMC was obtained having a viscosity of approximately 100,000 cps for a 2% aqueous solution at 20°C measured using a rotational viscometer. A Wells-Brookfield Viscometer model LVTD, cone and plate method was used as described in D.D. Gallaher et al., "The Effect Of Dietary Fiber Type On Glycated Hemoglobin And Renal Hypertrophy In The Adult Diabetic Rat", Nutrition Research , 10 , 1311-1323 (1990), the teachings of which are herein incorporated by reference. The high viscosity HPMC used in this Example was obtained from The Dow Chemical Company (METHOCEL™ K100LV Premium Grade, Lot #MM90041321K, sodium chloride content 0.6% by weight). The low viscosity HPMC had a viscosity of approximately 100 cps as a 2% aqueous solution at 20° measured using a Wells-Brookfield Viscometer as described above. Guar gum is commercially available and is naturally viscous. The high viscosity guar gum used in this Example was obtained from the Sigma Chemical Company and had a 2% by weight aqueous solution viscosity of approximately 100,000 cps at 20°C, determined as described above. The low viscosity guar gum used in this invention was obtained from The Dow Chemical Company. Its viscosity (as a 2% by weight aqueous solution at 20°C) was about 64 cps at a shear rate of 6 reciprocal seconds, using a Wells-Brookfield Viscometer model LVTD. The low viscosity guar gum was prepared by reducing the viscosity of the natural guar gum by limited acid hydrolysis according to well known acid hydrolysis techniques. Each of the high and low viscosity preparations of HPMC and of guar gum were blended with the various other ingredients of the animal's diet described below in a Hobart A-120 vertical mixer. The diet containing the above-described preparations was fed to four sets each containing 16 male Golden Syrian hamsters for a six-week period. The hamsters ranged in weight from 79 to 121 grams. The diet used contained the ingredients listed on Table 1, below: INGREDIENT AMOUNT OF g/kg/ DIET Casein, 85% protein, commercially obtained 200 DL-Methionine 3 Cornstarch 497.8 Sucrose 100 HPMC or Guar Gum 50 Palm oil 100 AIN Mineral Mix 35 AIN Vitamin Mix 10 Choline bitartrate 2 Vitamin K 1.33(mg) BHT 1 Cholesterol 1.2 Each hamster ingested approximately 8 g of the feed each day. After six weeks, the hamsters were sacrificed to obtain plasma samples. The TPC levels were measured enzymatically using a modification of the method of C.A. Allain et al, "Enzymatic Determination of Total Serum Cholesterol," Chin. Chem. , 20 , 470 (1974), the teachings of which are incorporated herein by reference. Briefly, cholesterol esters in the sample were hydrolyzed by cholesterol esterase to cholesterol which was then oxidized by cholesterol oxidase to cholest-4-en-3-one and hydrogen peroxide. The latter was then coupled with the chromogen, 4-aminobenzenesulfonate in the presence of peroxidase to yield a quinoneimine dye which has an absorbance maximum of 500 nm. The intensity of the color that is produced of 500 nm. The intensity of the color that is produced is directly proportional to the total cholesterol concentration in the sample. The amounts of free cholesterol ester in the liver was calculated as follows. A 1 g portion of each liver was obtained and combined with a chloroform:methanol solvent (2:1) to extract the lipids using well known lipid extraction techniques. The mixture was filtered, aliquots of filtrate were taken to dryness, brought up in a non-ionic detergent, dried and then the cholesterol levels were determined enzymatically. To determine the level of free cholesterol level in a sample the enzyme assay described above was modified according to the method described in Clin. Chem. , 28 , 1379 (1982), to leave out the step of combining the sample with esterase. The rest of the procedure was unchanged. The intensity of color that is produced is directly proportional to the free cholesterol concentration in the sample. In order to determine the level of cholesterol ester, the total cholesterol level of the liver sample was determined according to the method described above. The concentration of cholesterol ester present in the sample was determined by subtracting the free cholesterol concentration from the total cholesterol concentration. The results are shown below on Table 2. Diet (n=16) Plasma (mg/dl) C Liver (mg/g wet wt) Free C C Ester LG 214.5±10.2 a 2.8±0.2 ab 20.2±2.2 a LM 223.3±11.7 a 3.2±0.3 ab 20.2±1.8 a HG 170.1±7.8 b 2.4±0.1 b 13.2±1.4 b HM 151.9±7.9 b 2.4±0.1 b 4.8±0.6 c Values are mean±SEM. Values in a column with different superscripts are different (P<0.05). LG - Low viscosity guar gum LM - Low viscosity HPMC HG - High viscosity guar gum HM - High viscosity HPMC Total plasma cholesterol was statistically significantly lower in the high viscosity guar gum and high viscosity HPMC groups compared to the low viscosity guar gum and low viscosity HPMC groups. Liver cholesterol esters were lowest in the high viscosity HM group, followed by the high viscosity guar gum group. Similarly, free cholesterol in the liver was lower in animals which ingested the high viscosity compounds. Example 2. Effect of HPMC of Varying Viscosity Grades Male golden Syrian Hamsters (Harlan Sprague Dawley Inc., Indianapolis, IN), initially weighing 80-100 g were housed individually in stainless steel mesh cages and were fed a commercial rat ration (Rodent Laboratory Chow 5001, Purina Laboratories) and water ad libitum for 3 days to allow adaptation to the environment. The purified experimental diet was prepared according to Example 1, except that cellulose and four different viscosity grades of hydroxypropyl methylcellulose (HPMC) (Type K METHOCEL®, Dow, U.S.A., Midland, MI) (19-24% methoxy; 4-12% hydroxypropoxy) were used as dietary fiber sources. HPMC formulations were mixed in the diet as follows: extremely high viscosity (EV) HPMC was K100M (100,000 cps viscosity), high viscosity (HV) HPMC was made from a mixture of 60% (w/w) of K100M and 40% of K15M (15,000 cps viscosity), moderate viscosity (MV) HPMC was made by a mixture of 65% (w/w) of K15M and 35% of K4M (4,000 cps viscosity), and low viscosity (LV) HPMC was K100 LV (100 cps viscosity). Commercial designations of METHOCEL® products are based on viscosity values (±20%) determined in water at 20°C with a concentration of 2% METHOCEL®. The viscosities were measured again at 1% solution in water at 37°C (see below). In the experimental protocol, hamsters were randomly divided into 5 treatment groups; food intake and body weight were estimated weekly. Food intake was corrected for spillage. After 3 weeks of ad libitum feeding, intestinal contents viscosity and total plasma cholesterol concentration were measured. Apparent viscosity measurements were based on the ASTM monograph D1347 and D2363 (DOW U.S.A.). Heated water (80-90°C) was added to HPMC powder to make a 1% solution. The solution was stirred for 10 minutes and placed in an ice bath, stirred, and allowed to remain in the ice bath for 40 minutes to ensure that hydration and solution were complete. The solution was centrifuged to expel any entrapped air. The temperature of the solution was adjusted to 37°C and the viscosity was measured at several shear rates by using a Wells-Brookfield cone/plate viscometer (Brookfield Engineering, Stoughton, MA). Aqueous solutions of HPMC exhibit pseudoplastic flow behavior where apparent viscosity decreases with increasing rate of shear. The plot of shear rate versus viscosity on log-log paper was almost a straight line, and therefore could be used for prediction of viscosity at a certain shear rate. For purposes of comparison, values were obtained for a fixed rate of shear by extrapolation. After 3 weeks of feeding the diets, hamsters were anesthetized with ether and blood was collected by cardiac puncture in tubes containing ethylenediamine tetraacetic acid (EDTA) (1 mg/ml blood) for total plasma cholesterol analysis (Sigma Diagnostics, St. Louis, MO). The small intestine and cecum were removed and the cecum weighed. The small intestine was stripped carefully to collect the contents; the contents were centrifuged at 30,000 x g in a J2-21 high speed centrifuge using a JA 20.1 rotor (Beckman Instruments, Spinco Div, Palo Alto, CA) for 30 min at 4°C. The volume of supernatant was recorded and the viscosity of the supernatant (presumed to be a non-Newtonian liquid) was measured as described above. Viscosity was expressed as centipoise (cP). Values were analyzed by one-way analysis of variance. Differences among means were inspected using Ducan's multiple-range test. Means were considered to be significant at p<0.05. The apparent viscosities of the aqueous solutions (1%) of cellulose and of HPMC are shown in Table 3. Apparent (in vitro) viscosity of dietary additives and ex-vivo viscosity of intestinal contents of hamsters fed the experimental diets. Dietary Additive Viscosity (cP) Additive Intestinal contents (1% soln) (2% soln) Cellulose 1 10 2 ± 0.3 LV 14 100 47 ± 9.5 MV 305 10³ 111 ± 21.9 HV 1059 10⁴ 257 ± 122.8 EV 1698 10⁵ 557 ± 127.5 Viscosities of 1% aqueous solution of HPMC are manufacturer's values. In vitro viscosity of cellulose is arbitrary. Values of the intestinal contents viscosity (ex-vivo) represent means ± SEM of 10-12 samples (a few were pooled). Means in the last column with different superscript letters are significantly different at p<0.05. There was found to be a positive linear relationship between in vitro and ex-vivo viscosity (r²=0.952) of HPMC. This suggests that, under the conditions of this experiment, ex-vivo viscosities may be predicted from in vitro viscosities. HPMC is a carbohydrate polymer which dissolves in water by swelling and subsequent hydration. As expected, the liquid volume of intestinal contents was increased with increasing ex-vivo viscosity. Liquid volume seems to reach a plateau after about 250 cP of ex-vivo viscosity. The weight of the cecum as determined with its contents tended to be heavier in hamsters fed high viscosity HPMC. The effect of in vitro and ex-vivo viscosity of cellulose and HPMC on total plasma cholesterol is shown in Figs. 1 and 2, respectively, wherein each point in Fig. 1 represents the in vitro viscosity (cP=centipoise) of the 1% cellulose or HPMC solutions shown in Table 3 and plasma total cholesterol concentration (mg/100 ml) after feeding the diets for 3 weeks. Each plasma total cholesterol concentration value represents mean ± SEM of 12-13 animals. Means of the plasma cholesterol not sharing a common superscript are significantly different (p<0.05). Each point in Fig. 2 represents the viscosity (ex-vivo) of intestinal content and plasma total cholesterol concentration (mg/dl) after feeding the diet for 3 weeks. Each plasma total cholesterol concentration value and ex-vivo viscosity value represents mean ± SEM of 12-13 animals and 10 to 12 animals, respectively. Values of the plasma cholesterol not sharing a common superscript are significantly different (p<0.05). The two figures show a very similar relationship due to the high correlation between in vitro and ex-vivo viscosity. This finding suggests that, under these conditions, in vitro viscosities may be useful to predict the cholesterol lowering capability of a cellulose ether. The total plasma cholesterol of all HPMC treatments was markedly lower compared to cellulose control (point superscript a in each figure). Although the total plasma cholesterol-lowering effect appeared to be somewhat greater in HPMC with higher viscosity, the difference was statistically significant only between LV and MV HPMC. Total plasma cholesterol was reduced dramatically as ex-vivo viscosities of the 1% solutions increased to about 150 cP. Further increases in ex-vivo viscosities produced no additional hypocholesterolemic response. When these data are plotted on a logarithmic scale, there is a highly linear relationship between plasma cholesterol and ex-vivo viscosity (r²=0.982) (data not shown).

Claims: A use of hydroxypropyl methyl cellulose in combination with a pharmaceutically acceptable carrier for the manufacture of a pharmaceutical unit dosage form for reducing total plasma cholesterol levels in a human in need of such therapeutic application. The use of claim 1, wherein the hydroxypropyl methyl cellulose has a viscosity, measured as a 2 weight percent aqueous solution at 20° C, of at least about 50 cps. The use of claim 2, wherein the viscosity of said hydroxypropyl methyl cellulose is about 100-50,000 cps. The use of claim 3, wherein the viscosity of said hydroxypropyl methyl cellulose is at least about 10,000 cps. The use of claim 1, wherein the pharmaceutical unit dosage form is adapted for oral ingestion. The use of claim 5, wherein the pharmaceutically acceptable carrier is a liquid or a liquid vehicle. The use of claim 1, wherein the hydroxypropyl methyl cellulose is a powder. The use of claim 1, wherein the hydroxypropyl methyl cellulose is at least partially hydrated. The use of claim 6, wherein the liquid is water. The use of claim 1 which comprises a tablet or a capsule. The use of a mixture of about 2-20 weight percent of hydroxypropyl methyl cellulose having a viscosity, measured as a 2 weight percent aqueous solution of 20° C, of at least about 50 cps, and a separate metabolizable food ingredient having a predetermined caloric content for the preparation of a nutritious foodstuff mixture capable of reducing total plasma cholesterol levels in mammals. The use of claim 11, wherein the hydroxypropyl methyl cellulose has a viscosity, measured as a 2 % aqueous solution at 20° C, of at least about 100 cps. The use of claim 11, wherein the hydroxypropyl methyl cellulose has a viscosity, measured as a 2 % aqueous solution at 20° C, of at least about 10,000 cps. The use of claim 11, wherein the foodstuff includes sufficient water to moisten and expand the hydroxypropyl methyl cellulose. The use of claim 11, wherein the nutritious foodstuff mixture includes a mixture of about 2-15 weight percent of hydroxypropyl methyl cellulose formed by combining a powdered, water-soluble hydropropyl methyl cellulose having a viscosity, measured as a 2 weight percent aqueous solution at 20° C, of at least about 50-100,000 cps, with sufficient water to cause the cellulose ether to expand, and a separate metabolizable food ingredient having a predetermined caloric content, so that ingestion of the foodstuff provides from 2 to 10 grams of said hydroxypropyl methyl cellulose per each 1,000 kcal of total food consumed daily.

Inventors: GALLAHER DANIEL D, HASSEL CRAIG A, LEE KYUNG-JAE, GALLAHER, DANIEL D., HASSEL, CRAIG A., LEE, KYUNG-JAE
Applicants: UNIV MINNESOTA, THE REGENTS OF THE UNIVERSITY OF MINNESOTA
Application year: 1992
Main classification: A61K31
IPC codes: A61K31, A61P3, A23L1