Patent Publication Number: US-2020297780-A1

Title: Anti-inflammatory compositions, methods and uses thereof

Description:
RELATED APPLICATIONS 
     This application is a continuation of U.S. application Ser. No. 14/915,187 filed on Feb. 26, 2016 which is a U.S. National Phase Application of International Application No. PCT/NZ2014/000182, filed Aug. 29, 2014, which claims priority to and the benefit of New Zealand Patent Application No. 614912, filed on Aug. 30, 2013, the entire contents of each of which are incorporated herein by reference in their entirety. 
    
    
     TECHNICAL FIELD 
     Described herein are anti-inflammatory compositions, methods and uses thereof. More specifically, anti-inflammatory compounds, medicaments containing fractions and/or compounds, methods of fractionation, methods of use and methods of testing are described herein. 
     BACKGROUND ART 
     Immunostimulatory compounds are compounds that can encourage cytokine production and hence macrophage production, all being part of a normal immune system reaction observed in organisms. The main effects of immunostimulatory compounds result in the migration of macrophages to an inflamed area and an increase in (already existing) macrophage activity. 
     Anti-inflammatory compounds are compounds that have the opposite effect to the above effectively stopping or slowing the stimulation going too far and preventing the potential of a cascade in stimulation, in worst cases leading to systemic inflammatory response syndrome (SIRS), also related to sepsis. 
     Anti-inflammatories are well known and used in medicine, the aim being to calm the immune system. Inflammation relating to immune stimulation is often considered a negative reaction or a reaction to be avoided; particularly in the context of wound healing hence administration of an anti-inflammatory compound or compounds is a common form of treatment. 
     Honey is well known to have anti-microbial effects both due to the peroxide levels and so-called non-peroxide effects. By way of example regarding non-peroxide effects, some honeys such as those from the genus  Leptospermum  spp. have so called non-perodixe effects in part or in whole attributable to the presence of the compound methylglyoxal (MGO). Beyond the anti-microbial effects of honey there are also many other compounds in honey that have immune system modulating effects. 
     Honey derived arabinogallactan protein (AGP) compounds have been described in earlier patent applications by the applicant including WO2011/139168A1 and WO2013/157961A1 included herein by reference. These compounds have been identified in the applicant&#39;s research as having immune stimulation effects and as such may be useful in the production of medicaments, food supplements or cosmetics to stimulate the immune system. One practical use for these compounds may be to stimulate the immune system of a patient in a chronic slow healing wound so as to kick start the immune system into healing properly again. 
     Apisimin is one of three key functional proteins naturally found in royal jelly and is another compound identified by the applicant as having immune stimulation effects as noted in WO2013/157961A1. 
     Anti-inflammatory effects from honey have been suspected—this may be one reason for their use in medical dressings. The anti-inflammatory effects are somewhat forgotten in the art, the art focussing on the anti-microbial effects of honey—effects that are important, but this narrow focus does not always tell the full story of why honey is useful as a medicament. 
     One patent publication by the applicant published as WO2010/082846A1 first considered that anti-inflammatory effects might be present in honey. The publication teaches about concentrating the level of phenolic compounds in honey (particularly methoxylated phenolic compounds) in order to emphasise the honey anti-inflammatory activity. Other methods of enhancing the anti-inflammatory effects of honey described include aging the honey and the addition of tannase enzyme to the honey. A specific fraction of compounds or compounds other than phenolics in honey, were not identified. 
     Some art purports to have shown that selected glycoside compounds have anti-inflammatory effects. WO2003/047599 describes the glycoside catalepsoide as an anti-inflammatory and WO2013/061816 describes a honey derived compound termed leptosin as an anti-inflammatory compound. These publications describe the actions of a specific component for a specific biological action. Specifically, WO2013/061816 teaches about an anti-inflammatory effect of leptosin due to myeloperoxidase inhibition, this being only one form of anti-inflammatory action. More generalised anti-inflammatory effects as described herein from a wider fraction of compounds cannot be directly explained by the sole action of leptosin on myeloperoxidase. Similarly, WO2003/047599 concentrates on catalposide and again, a specific form of inflammatory inhibition is contemplated and not a generalised effect from potentially a number of compounds. 
     Two other publications, Gannabathula 2011 and Tonks et. al. 2007, discuss aspects about producing a low molecular weight fraction from honey but both do this from the perspective of showing inflammatory effects. Neither publication describes or even contemplates that a low molecular weight fraction of this nature would have anti-inflammatory effects. 
     It should be appreciated from the above that it would be useful to identify a specific fraction of compounds or specific compounds in a honey that may be isolated and used in various forms as an anti-inflammatory agent. Methods of testing honeys to identify highly anti-inflammatory honeys may also be of benefit or at least provide the public with a useful choice. 
     Further aspects and advantages of the anti-inflammatory fractions and compounds, medicaments containing the fractions and/or compounds, methods of fractionation, methods of use and methods of testing will become apparent from the ensuing description that is given by way of example only. 
     SUMMARY 
     Described herein are anti-inflammatory fractions and compounds, medicaments containing the fractions and/or compounds, methods of fractionation, methods of use and methods of testing. 
     The inventors have identified that a low molecular weight fraction from honey has strong and generalised anti-inflammatory effects and no immune-stimulatory effects. Being able to isolate compounds with anti-inflammatory activity allows the ability to produce medicaments for various uses including medical products, fortified foods, supplements and cosmetics. In addition, a generalised anti-inflammatory effect may be more useful than just a singular focus on one aspect of inflammation such as myeloperoxidase inhibition. 
     In a first aspect, there is provided a method of treating a skin condition on a subject in need thereof by the step of administering a medicament to an affected skin site on a subject in need thereof, the medicament having anti-inflammatory activity and comprising as an active, a less than or equal to 10 kDa fraction obtained from honey. 
     In a second aspect, there is provided a method of treating a stomach ulcer and/or a digestive condition in a subject in need thereof by the step of administering a medicament to the subject, the medicament having anti-inflammatory activity and comprising as an active, a less than or equal to 10 kDa fraction obtained from honey. 
     In a third aspect, there is provided the use of an anti-inflammatory activity less than or equal to 10 kDa fraction obtained from honey in the manufacture of a medicament for the treatment of a skin condition on a subject in need thereof. 
     In a fourth aspect, there is provided the use of an anti-inflammatory activity less than or equal to 10 kDa fraction obtained from honey in the manufacture of a medicament for the treatment of a stomach ulcer and/or digestive condition in a subject in need thereof. 
     In a fifth aspect there is provided a method of producing an anti-inflammatory activity fraction from honey substantially as described above by the steps of:
         (a) selecting a honey;   (b) diluting the honey in an aqueous solution and filtering the diluted honey via a less than or equal to 10 kDa filter;   (c) collecting a less than or equal to 10 kDa fraction.       

     In a sixth aspect, there is provided a method of testing the anti-inflammatory potential of a honey by the steps of:
         (a) stimulating a cell line with a suitable stimulant to induce an inflammatory response in the cells;   (b) preparing a &lt;10 kDa fraction from a honey by diluting the honey sample and collecting a &lt;10 kDa fraction by subjecting the diluted honey to a filtration separation step;   (c) applying the filtered honey containing the &lt;10 kDa fraction to the inflamed cells;   (d) measuring the reduction in cytokine production and/or nitrogen oxide production to determine the anti-inflammatory potential of the honey sample wherein the greater the reduction in inflammation as measured via cytokine production and/or nitric oxide production, the greater the anti-inflammatory activity of the honey tested.       

     Advantages of the above anti-inflammatory fraction containing methods of use, methods of isolation and methods of analysis may be varied. The source of the active compounds is a naturally occurring product able to be manufactured on a sustainable basis. The fraction, at least in a concentrated form, is not anticipated to have side effects. The fraction may be formulated in a wide variety of ways for various methods of administration. Further the anti-inflammatory effects are significant and generalised suggesting good efficacy and a wide range of use. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       Further aspects of the fractions, compositions, methods and uses will become apparent from the following description that is given by way of example only and with reference to the accompanying drawings in which: 
         FIG. 1  illustrates a graph showing the cytotoxic effects crude honeys at varying dilutions have on the tested RAW 264.7 cell culture and how this effect is independent of sugar content; 
         FIG. 2  illustrates a graph showing the cytotoxicity effects of high and low molecular weight fractions from honey on the tested RAW 264.7 cell culture; 
         FIG. 3  illustrates a graph showing the immune stimulation effects of a crude honey on the tested cell culture as measured via nitric oxide production by the RAW 264.7 cells; 
         FIG. 4  illustrates a graph showing the immune stimulation effects of a crude honey on the tested cell culture as measured via TNF-α production by the RAW 264.7 cells; 
         FIG. 5  illustrates a graph showing the immune stimulation effects of a &gt;30 kDa fraction from honey on the tested cell culture as measured via nitric oxide production by the RAW 264.7 cells; 
         FIG. 6  illustrates a graph showing the immune stimulation effects of a &gt;30 kDa fraction from honey on the tested cell culture as measured via TNF-α production by the RAW 264.7 cells; 
         FIG. 7  illustrates a graph showing the immune stimulation effects of a &lt;10 kDa fraction from honey on the tested cell culture as measured via nitric oxide production by the RAW 264.7 cells; 
         FIG. 8  illustrates a graph showing the immune stimulation effects of a &lt;10 kDa fraction from honey on the tested cell culture as measured via TNF-α production by the RAW 264.7 cells; 
         FIG. 9  illustrates a graph showing the anti-inflammatory effects of a &lt;10 kDa fraction from honey as measured via the reduction in LPS induced production of nitric oxide from RAW 264.7 cells; 
         FIG. 10  illustrates a graph showing the anti-inflammatory effects of a &lt;10 kDa fraction from honey as measured via the reduction in LPS induced production of IL-6 production from RAW 264.7 cells; 
         FIG. 11  illustrates a graph showing the oxidative burst reaction in vitro as measured via superoxide production based on increased whole honey concentration; 
         FIG. 12  illustrates a graph showing the oxidative burst reaction in vitro as measured via superoxide production based on increased &gt;30 kDa honey fraction concentration; 
         FIG. 13  illustrates a graph showing the oxidative burst reaction in vitro as measured via superoxide production based on increased &lt;10 kDa honey fraction concentration; 
         FIG. 14  illustrates a graph showing the oxidative burst reaction in vitro as measured via superoxide production based on a purified &lt;10 kDa honey fraction concentration; 
         FIG. 15  illustrates a graph showing the oxidative burst reaction in vitro as measured via superoxide production based on a purified &lt;10 kDa honey fraction concentration; 
         FIG. 16  illustrates a graph showing the nitric oxide inhibition effects from a &lt;10 kDa fraction; and 
         FIG. 17  illustrates a graph showing the nitric oxide inhibition effects from a purified &lt;10 kDa fraction. 
     
    
    
     DETAILED DESCRIPTION 
     As noted above, described herein are anti-inflammatory fractions and compounds, medicaments containing the fractions and/or compounds, methods of fractionation, methods of use and methods of testing. 
     For the purposes of this specification, the term ‘about’ or ‘approximately’ and grammatical variations thereof mean a quantity, level, degree, value, number, frequency, percentage, dimension, size, amount, weight or length that varies by as much as 30, 25, 20, 15, 10, 9, 8, 7, 6, 5, 4, 3, 2, or 1% to a reference quantity, level, degree, value, number, frequency, percentage, dimension, size, amount, weight or length. 
     The term ‘comprise’ and grammatical variations thereof shall have an inclusive meaning—i.e. that it will be taken to mean an inclusion of not only the listed components it directly references, but also other non-specified components or elements. 
     The term ‘substantially’ refers to at least about 50%, for example 75%, 85%, 95% or 98%. 
     The term ‘honey analogue’ refers to a mixture of 30-50% glucose, 30-50% fructose, 1-18% water and either or both of glucose oxidase enzyme and/or hydrogen peroxide. Where the analogue is used shortly after production, hydrogen peroxide itself may be used. Where the analogue may be stored for a period of time, the analogue by preference contains glucose oxidase enzyme. As may be appreciated, glucose oxidase enzyme converts sugars into hydrogen peroxide that also results in a lower pH. If hydrogen peroxide alone is used and then the analogue stored, it is possible that the peroxide level will decrease by normal reduction equilibrium and the pH level then increase. Using glucose oxidase enzyme ensures a steady level of hydrogen peroxide and hence steady pH. The quantities used are intended to approximate the composition of naturally produced honey. 
     The term ‘honey fraction’ refers to portion of a naturally produced honey. 
     The term ‘gelling agent’ or grammatical variations thereof refers to an agent that, in the absence of liquid is not a gel, but the agent is able to form a gel in the presence of liquid. 
     The term ‘dressing’ refers to any covering that may be applied to a lesion where lesions encompass infected and non-infected abrasions, cuts, bits, burns, wounds, ulcers, abscesses, surgical wounds, fungating tumours and pressure sores. 
     The term ‘therapeutically effective’ with reference to an amount or dosage of a composition or medicament noted refers to an amount of a composition that is sufficient to effectively suppress in part or in whole, stimulation the immune system of a subject. However, this term should not be seen as limiting as ‘therapeutically effective’ may refer to an amount or dosage of a composition or medicament that optimises the anti-inflammatory effects on a subject depending on desired application. 
     The term ‘isolate’ or grammatical variations thereof refers to a composition containing compounds separated or isolated from a honey. 
     The term ‘anti-inflammatory’ or grammatical variations thereof refer to the subject&#39;s immune system being quenched, calmed or suppressed to the extent that macrophage cells are either no longer present at a wound site or equivalent and/or where macrophage cells if present no longer produce or at least produced a reduced amount of cytokines consistent with an inflammatory response including but not limited to TNF-α, IL-6 and IL-10—the reduced amount being relative to the situation where no anti-inflammatory compound or compounds were added. 
     The term ‘generalised’ or grammatical variations thereof, in the context of inflammation described herein, refers to effects that influence several or a majority of all inflammatory reactions of an immune cell or organism. This is in contrast to specific anti-inflammatory effects in which one specific inflammatory response is inhibited. A generalised anti-inflammatory effect described herein will inhibit pathogen detection or inflammatory intra-cell and/or inter-cell signalling in such a way that several or all inflammatory responses are prevented or reduced. 
     The term ‘topical’ refers to placement on a body area of a subject such as skin as well as mucosal areas such as the oral cavity e.g. gums, the nasal cavity and the vaginal cavity. The term may also encompass the intestine wall. 
     The term ‘sensitive’ or grammatical variations thereof refer to a skin area that the subject finds particularly painful. 
     The term ‘medicament’ or grammatical variations thereof refers to medical products such as wound dressings, medicinal creams, gels or ointments. The term also encompasses fortified foods or supplements and cosmetic products. 
     In a first aspect, there is provided a method of treating a skin condition on a subject in need thereof by the step of administering a medicament to an affected skin site on a subject in need thereof, the medicament having anti-inflammatory activity and comprising as an active, a less than or equal to 10 kDa fraction obtained from honey. 
     In a second aspect, there is provided a method of treating a stomach ulcer and/or a digestive condition in a subject in need thereof by the step of administering a medicament to the subject, the medicament having anti-inflammatory activity and comprising as an active, a less than or equal to 10 kDa fraction obtained from honey. 
     In a third aspect, there is provided the use of an anti-inflammatory activity less than or equal to 10 kDa fraction obtained from honey in the manufacture of a medicament for the treatment of a skin condition on a subject in need thereof. 
     In a fourth aspect, there is provided the use of an anti-inflammatory activity less than or equal to 10 kDa fraction obtained from honey in the manufacture of a medicament for the treatment of a stomach ulcer and/or digestive condition in a subject in need thereof. 
     As noted above, the inventors have identified that a low molecular weight fraction from honey has strong anti-inflammatory effects and no immune-stimulatory effects. Being able to isolate compounds with anti-inflammatory activity allows the ability to produce medicaments for various uses including medical products, fortified foods, supplements and cosmetics. Anti-inflammatory activity may be useful in such medicaments to for example treat a sensitive topical wound and encourage healing whilst minimising pain. In an alternative illustrative example, the fraction may be formulated as a cream medicament applied to sunburnt skin as a means to calm the inflammation associated with the sunburn. 
     The anti-inflammatory effects noted above may be generalised. In very simple terms, the immune system may be characterised into three parts. One part consists of systems that detect pathogens, the second part signals this fact to other cells and the third part consists of the enzymes and antibodies that have a direct effect against the pathogen. Art that hints at a possible anti-inflammatory effect do not in the inventor&#39;s experience recognise or support a generalised effect. At best, art only supports a honey derived compound (not a fraction) having an inhibition effect on one enzyme in the third stage noted above. The art therefore at best only describes an inhibitory effect acting at the end of the inflammatory cascade and only highly specifically on one of the pathways. The inventors have observed anti-inflammatory effects in a more generalised form from the fraction noted. In one embodiment, the anti-inflammatory effects act on at least two effects (NOx and ROx) in neutrophils and monocytes. This indicates that the honey fraction effect or effects are due to one or several active components that affect the pathogen detection or signalling stage of the inflammatory response and therefore influence several of the pathways in the inflammatory reaction. This is quite different to the art that only supports or hints at a singular effect. 
     The skin condition in the above methods may be selected from: a burn, sunburn, bee sting, spider bite, eczema, psoriasis, localised inflammation skin or subcutaneous, a wound, and combinations thereof. Alternatively, the skin condition may be a cosmetic skin treatment. 
     In the above aspects, the subject may be human. Alternatively, the subject may be a non-human animal. As should be appreciated, humans and animals can equally be treated using the anti-inflammatory composition, as the physiology of an anti-inflammatory response may be similar between humans and at least mammals. Non-limiting examples of animals to which the composition may be administered includes horses, livestock including cattle, sheep and deer and companion animals such as cats and dogs. 
     The medicament may be formulated as: a cream, an ointment, a dressing, a spray, a gel, and an emulsion. 
     The honey from which the fraction is obtained may have a naturally higher concentration of phenolic compounds. In one embodiment, the honey may be of a floral origin substantially from the genus selected from:  Leptospermum, Kunzea, Trifolium, Knightea, Weinmannia, Metrosideros, Fagus, Myrtaceae  and combinations thereof. In selected embodiments, the honey from which the fraction is obtained may be substantially derived from  L. scoparium, K. ericoides, Trifolium repens, Knightea excelsa , and combinations thereof. The inventors have found that many honeys have at least some anti-inflammatory effects deriving from compounds in the &lt;10 kDa fraction, even honeys such as clover that are known to contain few phenolic based compounds. These findings are surprising since honeys like clover ( Trifolium  genus) and others tend to only be used for culinary purposes and not for medicament applications. Despite the above finding that all honeys have some anti-inflammatory activity deriving from the &lt;10 kDa fraction, some honeys have stronger anti-inflammatory effects than others most likely due to the different chemical profiles of these honeys based on floral origin and perhaps also geographical origin as well. Floral origin honeys that appear to have a slightly higher anti-inflammatory effects include manuka ( L. scoparium ), kanuka ( K. ericoides ) honeys and rewarewa honeys. 
     Further processing may occur to the &lt;10 kDa fraction isolated from honey. In one embodiment, any residual saccharides in the less than or equal to 10 kDa fraction may also be removed. One example of a further processing step may be by processing the fraction via a solid phase extraction on C18 columns. 
     In one embodiment, the medicament itself may be a medical grade honey and the less than or equal to 10 kDa fraction may be obtained from another honey and added to the medical grade honey. An example product exemplifying this embodiment may be a medical honey based wound dressing with an enhanced anti-inflammatory activity, the dressing being used in wounds where there is minimal if any microbial infection and the wound is in a healing phase. In a variation to the above, the medical grade honey used may be pre-selected based on that medical grade honey having an inherently higher natural concentration of less than or equal to 10 kDa compounds and the addition of further compounds from an isolated fraction acts to enhance the already pre-existing compounds. The medical grade honey used may also be further pre-selected based on that honey having a lower concentration of immune stimulatory compounds. The immune stimulatory compounds may have a size greater than or equal to 30 kDa. The immune stimulatory compounds may be selected from arabinogallactan proteins and/or apisimin protein. 
     In an alternative embodiment, the medical honey in the above embodiment may be substituted by use of a honey analogue solution and the fraction is added to the analogue to create an anti-inflammatory medicament. 
     The medicament described above may be formulated for topical administration. Example medicaments for topical administration may include wound dressings, putties, sheets, gels, creams, liquids, and ointments. 
     The medicament may be for treatment of wounds and be substantially incorporated into a dressing. As should be appreciated, wound dressings and aqueous based medicaments incorporating honey are well known and researched. Examples include those described in at least U.S. Pat. Nos. 7,714,183, 6,956,144, U.S. Ser. No. 11/106,473, U.S. Ser. No. 12/091,897 and U.S. Ser. No. 12/301,931. The anti-inflammatory effects of the fraction from honey described herein have considerable power to improve current wound dressings and medicaments (both those including honey and not including honey). 
     The dressing or aqueous based medicament may include at least one gelling agent. As noted above and in the art, gelling agents are advantageous for use with honey for wound applications. In particular, the gelling agents reduce the tackiness of the honey, yet provide a more cohesive structure such as a sheet structure or viscous gel that is easier to apply to a wound, skin region or mucosal lining. Gelling agents also have the advantage that they may be absorbent and work to move exudate away from a wound environment. This consequently avoids dilution of the honey fraction at the site. 
     The gelling agent may be selected from: an absorbent synthetic polymer, an absorbent natural based polymer, and combinations thereof. 
     The absorbent synthetic polymer may be selected from: any cross-linked sodium polyacrylate, polyacrylamide copolymer, ethylene maleic anhydride copolymer, carboxymethyl cellulose, polyvinyl alcohol copolymer, isobutylene-maleic anhydride copolymer, cross-linked polyethylene oxide, starch grafted copolymer or polyacrylonitrile, gauze, and combinations thereof. 
     The absorbent natural based polymer may be selected from: alginate, agar, natural based gums, and combinations thereof. 
     In the above embodiment where alginate is used, the alginate may be selected from: calcium alginate, sodium alginate, and combinations thereof. 
     The medicament may alternatively be formulated for oral administration. Example medicaments for oral administration include lozenges, elixirs, tablets, liquids, capsules, sprays, gels, ointments and fortified foods. 
     In a fifth aspect there is provided a method of producing an anti-inflammatory activity fraction substantially as described above from honey by the steps of:
         (a) selecting a honey;   (b) diluting the honey in an aqueous solution and filtering the diluted honey via a less than or equal to 10 kDa filter;   (c) collecting a less than or equal to 10 kDa fraction wherein this fraction has anti-inflammatory activity.       

     The honey in step (a) may be selected based on an elevated natural concentration of less than or equal to 10 kDa compounds compared to a standard baseline level for that floral origin of honey. 
     Selection in step (a) may be completed by techniques selected from: gas chromatography, HPLC, nitrogen oxide production from an in vitro assay, and/or the absence or reduction in pro-inflammatory cytokine production in an in vitro assay. 
     Filtration in step (b) may occur via: ultrafiltration, diafiltration, and combinations thereof. 
     In a sixth aspect, there is provided a method of testing the anti-inflammatory potential of a honey by the steps of:
         (a) stimulating a cell line with a suitable stimulant to induce an inflammatory response in the cells;   (b) preparing a &lt;10 kDa fraction from a honey by diluting the honey sample and collecting a &lt;10 kDa fraction by subjecting the diluted honey to a filtration separation step;   (c) applying the filtered honey containing the &lt;10 kDa fraction to the inflamed cells;   (d) measuring the reduction in cytokine production and/or nitrogen oxide production to determine the anti-inflammatory potential of the honey sample wherein the greater the reduction in inflammation as measured via cytokine production and/or nitric oxide production, the greater the anti-inflammatory activity of the honey tested.       

     The above method was developed by the inventors and provides a simple but effective way of screening honeys for the anti-inflammatory potential and then making decisions based on those findings regarding how the honey is subsequently used. 
     The stimulant used in step (a) may be the endotoxin lipopolysaccharide, LPS. LPS is known to elicit a strong and generalised immune response in animals and is used extensively in at least in-vitro cell cultures to stimulate cells and provide a control measure of stimulation. 
     Filtration in step (b) may be via ultra-filtration. 
     The cytokines measured in step (d) may be TNF-α, IL-6, and combinations thereof. 
     Advantages of the above anti-inflammatory medicaments, methods of isolation, methods of use and methods of analysis are varied. The source of the active compounds is a naturally occurring product able to be manufactured on a sustainable basis. The fraction is not anticipated to have side effects. The fraction may be formulated in a wide variety of ways for various methods of administration. Further the anti-inflammatory effects are significant and generalised suggesting good efficacy and a potentially broad range of applications/uses. 
     The embodiments described above may also be said broadly to consist in the parts, elements and features referred to or indicated in the specification of the application, individually or collectively, and any or all combinations of any two or more said parts, elements or features, and where specific integers are mentioned herein which have known equivalents in the art to which the embodiments relates, such known equivalents are deemed to be incorporated herein as of individually set forth. 
     Where specific integers are mentioned herein which have known equivalents in the art to which this invention relates, such known equivalents are deemed to be incorporated herein as if individually set forth. 
     WORKING EXAMPLES 
     The above described fractions, methods and uses are now described by reference to specific examples. 
     Example 1 
     In this example, an experiment is described that was used to determine the presence of an anti-inflammatory effect from honey and what fraction is responsible for this effect. 
     Methods and Materials Used 
     Firstly a cell line was established that would provide the in vitro test assay for stimulation and anti-inflammatory effects. 
     Four different floral origin honeys were selected for the experiment including, manuka, kanuka, clover and rewarewa honey were selected for the study. While no honey can be 100% from the stated origin, the honeys tested were known to be at least 80% of the floral origin indicated based on phenolic and other chemical profiling analysis. 
     A control honey analogue solution comprising a mixture of approximately 30-50% glucose, 30-50% fructose and approximately 18% water was also tested. 
     Samples of crude honey (unfractionated), as well as fractions of honey obtained by dilution and ultrafiltration were used to investigate the immuno-modulatory effect of honey. 
     Three size fractions were tested being molecular weight cut offs of greater than 30 kDa (&gt;30 kDa) and less than 10 kDa (&lt;10 kDa). 
     The type of cell that was cultured are the cells involved in the acute inflammatory response, white blood cells such as macrophages. In order to maintain reproducibility a continuous, immortalised cell line, called RAW 264.7 was used for the experiments 
     Although inflammation is readily appreciated at a human level via for example redness, pain or fever, inflammation can be also characterised at a cellular level. Cellular inflammation may be characterised by production of various inflammatory mediators such as cytokines, chemokines or reactive nitrogen and oxygen species. 
     In this experiment, inflammation at a cellular level was studied in an in vitro system by culturing cells in artificial media and exposing them to microbes or microbial components followed by measuring the inflammatory mediators that are released into the medium. 
     At a cellular level, macrophages detect inflammatory stimuli through pattern recognition receptors, including toll like receptors. This is followed by intracellular signalling and leads to the production of inflammatory mediators such as pro-inflammatory cytokines (e.g. TNF-α, IL-6) and reactive nitrogen species (nitric oxide). 
     Cytotoxicity 
     Before commencing use of honey in the trial, it was first necessary to find the highest usable concentration of honey and its fractions. Naturally, as honey concentration increases, cell death occurs. Hence, to see an effect from a part of honey, a dilution must be established where the cells are reactive but not completely overwhelmed. 
     To test various dilutions, RAW cells were incubated with honey or honey fractions with/of various concentrations for 24 hours followed by propidium iodide staining. 
     The viability of the cells was assessed as the ratio of positive stained (dead cells) over unstained (viable) cells and a viability of more than 95% was considered as non-toxic. 
     As anticipated and as shown in  FIG. 1 , crude honey has a cytotoxic effect when used at high concentrations. Interestingly this cytotoxic effect is independent of the honey sugar content, as artificial honey is non-cytotoxic at any concentration. 
     In contrast, honey fractions, obtained with ultrafiltration of the crude honey, are non-cytotoxic at any used concentration as shown in  FIG. 2 . 
     Results—Crude Honey 
     RAW cells produce inflammatory mediators such as nitric oxide and tumour necrosis factor alpha (TNF-α) in response to stimulating agonists such as lipopolysaccharide (LPS). 
     In order to investigate the honey immune-modulating effects, RAW cells were treated with increasing concentrations of crude honey for 24 hours and the production of nitric oxide and TNF-α was measured in comparison to LPS induced production of nitric oxide and TNF-α. 
     As shown in  FIG. 3  and  FIG. 4  crude honeys stimulate the immune system leading to production of nitric oxide and TNF-α in RAW cells. The stimulatory effect occurs for all of the honeys tested albeit with variation in stimulation levels however, artificial honey has no stimulating effect on the production of nitric oxide and TNF-α. Crude honey therefore has immune-stimulating or pro-inflammatory effects that are independent from its high sugar content—this effect supports earlier work by the applicant as published in earlier patents attributing such stimulatory effects to compounds such as arabinogalactan (AG) proteins. 
     Results—Greater than 30 kDa Fraction 
     The RAW cells were treated with a high (&gt;30 kDa) molecular weight fraction from the tested honeys in various concentrations for 24 hours and production of nitric oxide and TNF-α was measured and compared to a positive control LPS induced production of nitric oxide and TNF-α. 
     The high molecular weight fraction was anticipated to stimulate the production of nitric oxide and TNF-α given stimulating compounds would be in this fraction such as AG proteins. As shown in  FIG. 5  and  FIG. 6 , stimulation did occur from this &gt;30 kDa fraction and the degree of stimulation were in a dose dependent manner 
     Results—Less than 10 kDa Fraction 
     The RAW cells were treated with a low (&lt;10 kDa) molecular weight fraction from the tested honeys in various concentrations for 24 hours and production of nitric oxide and TNF-α was measured and compared to a positive control LPS induced production of nitric oxide and TNF-α. 
     In this case, and as shown in  FIG. 7  and  FIG. 8 , the &lt;10 kDa fraction has no stimulating effect on the production of nitric oxide and TNF-α showing that this fraction has no immune stimulation activity unlike the larger fraction. 
     Results—Less than 10 kDa Fraction Anti-Inflammatory Effects 
     In the above example, an absence of immune stimulation activity was observed for the &lt;10 kDa fraction. To confirm that the &lt;10 kDa fraction was not simply an inert fraction, a further trial was completed. 
     RAW cells were treated with the low molecular weight fraction of honey in various concentrations for 24 hours after stimulation with LPS. If the &lt;10 kDa fraction was anti-inflammatory, the inflammation markers observed for LPS should reduce. Nitric oxide and IL-6 were used as inflammatory markers and their levels measured in comparison with LPS induced production of nitric oxide and IL-6. 
     As shown in  FIG. 9  and  FIG. 10 , the &lt;10 kDa fraction of honey reduces LPS induced production of nitric oxide and IL-6 in a dose dependent manner hence showing that the low molecular weight fraction has, not only a non-stimulating but also, an anti-inflammatory effect on the production of inflammatory mediators. 
     Example 2 
     As noted above, one method of measuring the potential anti-inflammatory activity of a honey is to measure the ability of the honey or fraction thereof in suppressing the production of nitric oxide from cells in an in-vitro cell culture. This example explains in detail, one method of completing this form of measurement. 
     Initial steps comprise:
         Seeding 5×10 5  cells/200 μl in a 96 well plate;   Letting the cells grow for approximately 24 hours or until confluent;   Treating the grown cells with a stimulant compound (dissolved in supplemented Dulbecco&#39;s Modified Eagel Medium (DMEM));   Add honey or honey fractions in a concentration range from 0-5% (w/v) diluted in media;   Subsequently sampling the cell supernatant and measuring the nitric oxide levels in the supernatant.       

     Reagents:
         Sulfanilamide solution (1% sulphanilamide in 5% phosphoric acid);   NED solution (N-1-naphylethylendiamine dihydrochloride in water);   Nitrite standard (0.1 M sodium nitrite).       

     Prepare a nitrite standard reference curve as follows:
         Add 1 ml of a 100 μM nitrite solution into a DMEM medium;   Dilute the standard (=0.1 M sodium nitrite in milliQ water) 1:1000;   Dispense 50 μl of medium into the wells in rows B-H;   Add 100 μl of the 100 μM nitrite solution into wells in row A;   Perform 6 serial twofold dilutions (50 μl/well) and discard 50 μl from the 1.56 μM set of wells (not nitrite in the last set of wells).       

     Nitrite Measurement (Griess Reaction):
         Sulphanilamide solution and NED solution should be at room temperature (15-30 mins);   Add 50 μl of each experimental sample to wells in duplicate or triplicate (supernatant medium from cells treated with honey, LPS, PMA etc.);   Dispense 50 μl of sulphanilamide solution to all experimental samples and wells for nitrite standard curve;   Incubate 5-10 mins at room temperature, protected from light;   Add 50 μl of NED solution to all wells;   Incubate at room temperature for 5-10 mins, protected from light (purple/,magenta) colour will begin to from immediately);   Measure absorbance within 30 mins, plate reader with filter between 520 nm and 550 nm.       

     Example 3 
     A protocol is provided below for measurement of the cytokines TNF-α and IL-6 via cytometric bead assays (CBA). 
     1) Reconstitute standards
         transfer lyophilized sphere (10000 pg/ml) of assay protein into eppendorf tube;   reconstitute with 100 μl assay diluent (100000 pg/ml);   allow equilibration for at least 15 mins at room temperature;   gently mix by pipetting up and down;   aliquot out 8 μl in PCR tubes and freeze down at −20° C.       

     2) Prepare standards in eppendorf tubes
         thaw out aliquot with prepared standard (100000 pg/ml);   take 5 μl of each reconstituted standard and top up to 100 μl with Assay Diluent (standard is now 5000 pg/ml)-&gt;5 μl of TNF-α standard+5 μl of IL-6 standard+90 μl assay diluent;   make serial dilution (50 μl of mixed standards+5 μl of assay diluent);   allow each dilution to equilibrate for 2 mins until preparing the next dilution:       

     
       
         
           
               
               
               
             
               
                   
               
               
                 Well label 
                 Standard dilution 
                 con. pg/ml 
               
               
                   
               
             
            
               
                   
               
            
           
           
               
               
               
            
               
                 1 
                 0    
                 0 
               
               
                 2 
                 1:512 
                 10 
               
               
                 3 
                 1:256 
                 20 
               
               
                 4 
                 1:128 
                 40 
               
               
                 5 
                 1:64  
                 80 
               
               
                 6 
                 1:32  
                 156 
               
               
                 7 
                 1:16  
                 312.5 
               
               
                 8 
                 1:8  
                 625 
               
               
                 9 
                 1:4  
                 1250 
               
               
                 10 
                 1:2  
                 2500 
               
               
                 11 
                 Top standard 
                 5000 
               
               
                   
               
            
           
         
       
     
     3) Prepare protein capture beads:
         vortex capture bead stock vial for at least 15 s;   2541 per well, 0.2541 for each capture bead;   48 samples, 11 standard dilutions, 5 extra;   volume of capture bead diluent=(64×25 μl)−(16 μl×2)=1568 μl;   16 μl of TNF-α beads+16 μl of IL-6 beads+1568 μl of diluent;   pipette the capture beads and the diluent together for each cytokine (tube labelled mixed capture beads);   store at 4° C., wrapped in tinfoil until use (leave 50 μl for flow cytometry setup).       

     4) Dilute the samples in eppendorf tubes:
         dilute collected supernatants 1:10 with assay diluent;   5 μl of sample with 45 μl of assay diluent;   → start assay:   transfer 25 μl of standard or sample into 96 well plate (leave at least one free row between each set of samples and the standard row to prevent spilling);   vortex bead mix, add 25 μl to each well;   wrap plate in tinfoil and incubate for 1 h on a shaker at 150 rpm (room temperature):       

     
       
         
           
               
               
               
               
               
               
               
               
               
               
               
               
               
             
               
                   
               
             
            
               
                 A (standard) 
                 0 
                 10 
                 20 
                 40 
                 80 
                 156 
                 321.5 
                 625 
                 1250 
                 2500 
                 5000 
                   
               
               
                 B (samples) 
                 most 
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
                 lowest 
               
               
                   
                 conc. 
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
                 conc. 
               
               
                 C repeat 
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
               
               
                 D (samples) 
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
               
               
                 E repeat 
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
               
               
                 F 
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
               
               
                 G 
               
               
                   
               
            
           
         
       
     
     5) Prepare PE detection reagents:
         detection reagents have to be protected from light, wrap in tinfoil;   volume of detection reagent diluent=(64×25 μl)−(16 μl×2)=15641;   16 μl of TNF-α detection reagent+16 μl of IL-6 detection reagent+1568 μl of diluent;   pipette the detection reagents and detection reagent diluent into a tube (mixed PE detection reagents);   wrap in tinfoil and incubate/store at 4° C. until use.       

     6) after incubation 5):
         add 25 μl of mixed PE detection reagent to each well:   wrap plate in tinfoil and incubate for at least 1.5 h on a shaker at 150 rpm (room temperature).       

     7) Do instrument setup:
         after incubation, spin plate at 1300 rpm for 5 mins;   flick off supernatant;   add 12 μl of wash buffer;   spin plate at 1300 rpm for 5 mins;   discard supernatant;   resuspend samples in 100 μl of wash buffer;   transfer into FACS tubes.       

     8) On the machine:
         vortex each sample before putting into the FACS;   make sure the sample you want to measure is highlighted in the program;   click load, as soon as it starts acquiring, click record data;   after the run is finished click unload and carry on;   in case of air bubbles, turn off the stream and turn in on again;   in case of forgetting to switch to the next sample on the screen before running the next sample, click next sample as soon as it acquires data (it automatically stops), then start the run by clicking acquire and record data;   always check if stopping gate: singlet and events to record: 900 (number depends on how many cytokines are measured).       

     Example 4 
     A further experiment was completed whereby human neutrophils were stimulated with PMA and exposed to honey or honey fractions and the oxidative burst reaction (production of superoxide) measured with the detection agent WST-1. As shown in  FIG. 11 , all honeys tested (rewarewa, kanuka and manuka-based Medihoney™ honey) showed an anti-inflammatory effect, by decreasing superoxide production with increased honey concentration. 
     Honeys were then size fractioned by ultrafiltration and the larger than 30 kDa fraction and the smaller than 10 kDa fraction were tested. As shown in  FIG. 12  and  FIG. 13 , the large fraction as anticipated in earlier work, showed no anti-inflammatory effect, while the small molecular weight fraction contains nearly all of the antiinflammatory effect observed for the whole honey. 
     Honey fractions were further purified with solid phase extraction on C18 columns. These columns bind phenolic components and molecules with a phenolic moiety. The extract should therefore be rich in honey phenolics. The samples were tested as described above. The highly purified honey phenolics show a strong inhibition of the superoxide production as illustrated in  FIG. 14  and  FIG. 15  which strongly suggests that phenolic compounds in the &lt;10 kDa fraction may be a main contributor to honey anti-inflammatory potential. 
     In a further test, RAW 264.4 cells were stimulated and the nitric oxide (NOx) production (another inflammatory reaction) was measured in the presence of varying honey fraction concentrations. As shown in  FIG. 16  and  FIG. 17 , the smaller than 10 kDa fraction showed an inhibitory effect on the NOx production, while the purified extract from the above C18 column extraction showed an even stronger effect, suggesting that honey phenolics act on superoxide and nitric oxide production simultaneously. 
     Aspects of the anti-inflammatory fractions and compounds, medicaments, methods and uses have been described by way of example only and it should be appreciated that modifications and additions may be made thereto without departing from the scope of the claims herein.