"USE OF EXTRACT OF VEGETATION WATERS FOR TREATING DAMAGE TO THE CARDIOVASCULAR SYSTEM"

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The present invention relates to a phytocomplex or natural concentrate, rich in polyphenol compounds, such as hydroxytyrosol and Oleuropein- aglycone di-aldehyde (3,4-DHPA-EDA), derived from the pressing waters of oil olives and/or from pomace from the olive grinding process, for use in the prevention and/or treatment of damage to the cardiovascular system, preferably in subjects affected by/suffering from hypertension, cardiac decompensation, arrhythmia, heart attacks or those subjected to chemotherapy.

PRIOR ART

With the extension of the average life expectancy of the population, especially in developed countries, the risk of developing degenerative diseases affecting the cardiovascular system has therefore increased. Furthermore, such risk is often also increased by incorrect dietary habits and by an unhealthy lifestyle (stress, smoking, obesity, etc.). Subjects affected by hypertension, cardiac decompensation, arrhythmia, heart attacks or those subjected to chemotherapy are therefore the application target of the present invention.

While at one time the role of cardiovascular toxicity associated with antineoplastic therapies had a reduced impact on life expectancy with respect to the gain in survival guaranteed by the antineoplastic therapies themselves, there is currently an increase in the frequency of cardiovascular events in patients subjected to treatment with anti-cancer drugs or therapies; cardiovascular events therefore now represent an important risk factor in the course of cancer treatments.

Useful substances in cardiovascular protection particularly, but not exclusively, during the course of an antineoplastic treatment include beta blockers, ACE inhibitors, statins, anti-coagulants, whose use is now known and traditional, but recently compounds such as dexrazoxane, N-acetyl-L- cysteine (NAC), zinc, selenium, melatonin, L-carnitine, glutathione and coenzyme Q10 have started to gain ground, as per reference (Albini A. et al, JNCI 2009, PMID:20007921 ). Furthermore, substances of natural origin are being studied, in particular deriving from plants such as, for example, extracts of ginkgo biloba, red wine, grape, green tea, but also curry and chilli.

It is known that the incidence rate of cardiovascular diseases is substantially reduced in populations that adopt a Mediterranean diet based on the consumption of olive oil. This scientific evidence has provided an incentive for the study of olive oil in order to define the composition thereof and, in particular, in order to identify the substances with medical/pharmacological potential.

A characteristic of olive oil that has aroused particular interest has been the high polyphenol content contained therein. These compounds are natural antioxidants, of vegetable origin, able to inhibit the formation of free radicals.

The beneficial properties of olive oil have led to a substantial increase, especially in Italy, in the growing of olive trees and the production of oil, with a consequent increase in the production of collateral derivatives of olive oil, mainly vegetation waters and pomace, which are characterized by a high pollutant load and therefore generate a substantial environmental impact.

The disposal of this material is rigorously regulated both at national and regional level and the actuation of the legislation (Law 574 of 1 1/1996) implies large expense for growers who cannot gain any advantage from these waste products which are however rich in molecules with high medical/pharmaceutical potential.

Although a lot of research has been performed on vegetation waters, there is still a strongly felt need to identify new properties that can give value to these waste products which would otherwise exclusively represent a high cost for the grower and environmental contamination. There is a particularly felt need to identify new nutritional and/or medical/pharmaceutical properties to make use of this waste product.

On that point, the Applicant has surprisingly found that vegetation waters are able to perform a protective effect on the cardiovascular system (cardioprotection or cardioprevention effect), in particular the protection is performed on the cells of the heart muscle or myocardium - the cardiomyocytes, as demonstrated by experiments performed in vivo on zebrafish embryos {Danio rerio).

Specifically, the authors have demonstrated how, by concentrating the permeate of the vegetation water subjected to microfiltration through reverse osmosis, a phytocomplex is obtained that is rich in polyphenol compounds able to protect - in vivo - the cardiovascular system, in particular the cardiomyocytes.

This effect is particularly advantageous for human health as it guarantees effective cardioprotection action in particular, but not exclusively, in subjects exposed to cardiovascular risk such as subjects affected by hypertension, cardiac decompensation, arrhythmia, heart attacks or those subjected to chemotherapy. In particular, vegetation waters are able to exert a cardioprotection effect on the heart tissue, which may be damaged by treatment with antineoplastic agents, whose cardiovascular toxicity is known.

BRIEF DESCRIPTION OF THE FIGURES

Further advantages of the present invention will be highlighted in the following detailed description and appended figures, in particular:

- Figure 1 shows the effects of the combined treatment of A009+Doxorubicin on the viability of zebrafish embryos, 72 hours post- fertilization (hpf). The embryos were treated with the polyphenol concentrate of the present invention (sample A009), at the dilutions 1 :100 and 1 :500, alone or in association with Doxorubicin (3 μg/mL). A pre- treatment was performed with A009, followed by administration of Doxorubicin and A009+Doxorubicin co-treatment. NT = not-treated cells. ⁰⁰⁰ = p<0.0001 with respect to not-treated embryos; ^*** = p<0.001 with respect to embryos treated with doxorubicin alone;

- Figure 2 shows the effects of the combined treatment (48 hours) of A009+Doxorubicin on the heart rate of zebrafish embryos. The embryos were treated with the polyphenol concentrate of the present invention (sample A009), at the dilutions 1 :100 and 1 :500, alone or in association with Doxorubicin (3 μg/mL). A pre-treatment was performed with A009, followed by administration of Doxorubicin and A009+Doxorubicin co- treatment. NT = not-treated cells. ⁰⁰⁰ = p<0.0001 with respect to not- treated embryos; ^*** = p<0.001 with respect to embryos treated with doxorubicin alone;

- Figure 3 shows the effects of the combined treatment (72 hours) of A009+Doxorubicin on the heart rate of zebrafish embryos. The embryos were treated with the polyphenol concentrate of the present invention (sample A009), at the dilutions 1 :100 and 1 :500, alone or in association with Doxorubicin (3 μg/mL). A pre-treatment was performed with A009, followed by administration of Doxorubicin and A009+Doxorubicin co- treatment. NT = not-treated cells. ⁰⁰⁰ = p<0.0001 with respect to not- treated embryos; ^*** = p<0.001 with respect to embryos treated with doxorubicin alone.

DETAILED DESCRIPTION OF THE INVENTION

A first aspect of the invention regards a phytocomplex or concentrate of vegetation waters and/or pomace comprising polyphenol compounds, preferably hydroxytyrosol and/or 3,4-DHPA-EDA, for use in the prevention and/or treatment of damage to the cardiovascular system (tissues/related organs), preferably the damage due to the intake of drugs associated with toxicity phenomena on the cardiovascular compartment, preferably chemotherapy-related. In other words, the phytocomplex or concentrate of vegetation waters and/or pomace of the present invention is used for preventive and/or protective purposes, in particular for cardioprotection or cardioprevention, or for therapeutic purposes for treating damage to the cardiovascular system caused by/associated with the pharmacological treatment, preferably chemotherapy and/or radiotherapy and/or any pharmacological treatment associated with side effects that involve the cardiovascular compartment.

Any drug and/or chemotherapy agent having a cardiotoxic effect is included in the present invention, preferably said drug and/or chemotherapy agent such as, for example, anthracycline, capecitabine, citabine, 5-fluorouracil, third-generation aromatase inhibitors, cyclophosphamide, Imatinib, Sorafenib, Sunitinib, SERMs, Trastuzumab, Bevacizumab, specific COX-2 inhibitors (Albini A. et al, JNCI 2009, PMID:20007921 ).

Reference will be made below to this phytocomplex or concentrate simply with the term "concentrate" or "polyphenol concentrate". In fact, as will be demonstrated in more detail in the example of the present description on the zebrafish animal model, the concentrate of vegetation waters and/or pomace has demonstrated therapeutically significant efficacy in the reduction and/or prevention of damage to the cardiovascular system, in particular heart damage, both in terms of reducing mortality and normalizing the heart rate. In particular, in the example the induction of cardiotoxic damage was used through doxorubicin chemotherapy that imitates the cardiac damage induced by drugs able to induce phenotypic, biochemical and functional alterations to the heart muscle.

The cardiovascular system or apparatus is comprised of a muscular pump (the heart) and a series of conduits (the blood vessels) in which a fluid (blood) moves, which is pumped all over the body. The heart and vessels are indicated overall as the circulatory/cardiocirculatory system or apparatus. The task of the blood that moves in the circulatory apparatus is to transport and transfer respiratory gases, nutrients, waste products, hormones, cells and molecules of the immune system and heat from one tissue to another. All these functions are essential in order to guarantee a stable internal environment and communication between cells.

In the context of the present invention, damage to the cardiovascular system as defined above also means a lesion, a reaction or a side effect. In the context of the present invention, cardiovascular damage as defined above means any phenotypic and/or anatomical and/or functional alteration to the cardiovascular system, preferably to the heart muscle (myocardium) and/or blood vessels (vascular system). Preferably, said damage is caused/provoked by or associated with one or more reasons, preferably selected from: pathological conditions, advanced age, harmful lifestyles and taking medicines. Preferably, said damage is caused/provoked by chemotherapy and/or radiotherapy or is a damage due to cardiotoxicity. Preferably, said damage is selected from: hypertensive crisis, pulse alterations, arrhythmia, ischemia, preferably caused by vasospasm and/or by thromboembolic phenomena, fibrosis, loss of contractile activity for the cardiac counterpart, cell senescence, production of reactive oxygen species and autophagy, both for the cardiac component and the vascular one.

According to a preferred aspect of the invention, said damage affects the cardiomyocytes and/or the endothelial cells of the cardiovascular system, preferably those of the blood vessels.

According to a preferred aspect of the invention, said concentrate is used during and/or following, and/or prior to radiotherapy treatment and/or treatment with drugs, preferably drugs having a cardiotoxic action, preferably antineoplastic drugs, for which there is a known correlation with the onset of vascular and/or cardiac lesions. In other words, the concentrate of the invention can perform a cardioprotection action, i.e. protection against the adverse effects associated with/caused by radiotherapy and/or drugs, preferably chemotherapy agents, therefore it is used in the cardio-oncology sector. In any case, the polyphenol concentrate described herein can also be used for preventing and/or treating damage to the cardiocirculatory system deriving from other conditions, other than treatment with drugs, preferably advanced age, acute or chronic cardiovascular pathologies or harmful lifestyles.

Vegetation waters preferably derive from an olive grinding process with three phases (oil, vegetation waters and pomace) and/or two phases (oil and pomace + vegetation waters).

According to a preferred aspect of the invention, the vegetation waters generated by the oil mill can be treated with a solution with acidic pH that preferably varies between 3 and 5, more preferably the pH is about 4/5. The pH is preferably optimized by adding a strong acid and/or pectolytic enzymes, or enzymes that hydrolyze the cellulosic matrix of olive skin. According to a preferred embodiment of the invention, the pomace is stoned, diluted and/or prefiltered. The pomace preferably has a size that ranges from 0.5 to 1 millimetre (mm), more preferably of about 0.7 mm. An example of the size is that obtained with vibrating screen type sieving. The stoned pomace is possibly dissolved and/or dispersed in an aqueous matrix with pH preferably comprised between 3 and 5, more preferably between 3.5 and 4.

The dissolving step has the aim of dissolving the polyphenols that would otherwise remain trapped in the solid matrix of the olive skins.

In a preferred embodiment of the invention, the concentrate further comprises: at least one further phenol compound preferably selected from: tyrosol, chlorogenic acid, β-hydroxyverbascoide, rutin, verbascoide, and luteolin; and/or at least one metal preferably selected from: sodium, calcium, magnesium and potassium; and/or at least an anion preferably selected from: chlorides, sulphates, phosphates and nitrates; and/or at least one carbohydrate selected from: glucose, fructose, mannitol and sucrose. In a further embodiment of the invention the concentrate comprises nitrogenous substances (proteins, aminoacids), preferably in a quantity comprised between 15 and 60 mg/kg, more preferably between 20 and 40 mg/kg (mg of nitrogen per litre of active solution).

In any case the phenol compounds contained in the highest quantity in the concentrate are hydroxytyrosol and 3,4-DHPA-EDA.

Preferably, the quantity of hydroxytyrosol ranges between 1 and 10 grams per litre of vegetation waters (g/L), more preferably between 1 .5 and 5 g/L, even more preferably between 2 and 3 g/L.

Preferably the quantity of 3,4-DHPA-EDA is comprised between 0.5 and 8 g/L, more preferably between 1 and 6 g/L, even more preferably between 1 .5 and 2.5 g/L.

Preferably the quantity of tyrosol is comprised between 0.1 and 0.4 g/L, more preferably between 0.15 g/L and 0.25 g/L.

Preferably the quantity of chlorogenic acid is comprised between 0.06 and 0.24 g/L, more preferably between 0.8 and 0.16 g/L.

Preferably the quantity of β-hydroxyverbascoide is comprised between 0.3 and 1 .5, more preferably between 0.5 and 1 g/L.

Preferably the quantity of rutin is comprised between 0.05 and 0.2 g/L, more preferably between 0.08 and 0.15 g/L.

Preferably the quantity of verbascoide is comprised between 0.4 and 1 .7 g/L, more preferably between 0.6 and 1 g/L.

Preferably the quantity of luteolin is comprised between 0.1 and 0.5 g/L, more preferably between 0.15 and 0.28 g/L.

Preferably the quantity of sodium is comprised between 75 and 300 mg/L, more preferably between 120 and 180 mg/L.

Preferably the quantity of calcium is comprised between 5 and 10 g/L, more preferably between 2 and 5 g/L.

Preferably the quantity of magnesium is comprised between 220 and 900 mg/L, more preferably between 400 and 500 mg/L. Preferably the quantity of potassium is comprised between 3 and 15 g/L, more preferably between 6 and 9 g/L.

Preferably the quantity of chlorides is comprised between 1 .5 and 7 g/L, more preferably between 2.5 and 4.5 g/L.

Preferably the quantity of sulphates is comprised between 12 and 45 g/L, more preferably between 18 and 28 g/L.

Preferably the quantity of phosphates is comprised between 1 .5 and 7 g/L, more preferably between 2.5 and 5 g/L.

Preferably the quantity of nitrates is comprised between 12 and 50 mg/L, more preferably between 18 and 30 mg/L.

Preferably the quantity of glucose is comprised between 15 and 60 g/L, more preferably between 25 and 35 g/L.

Preferably the quantity of fructose is comprised between 3.5 and 15 g/L, more preferably between 5 and 9 g/L.

Preferably the quantity of mannitol is comprised between 1 and 4 g/L, more preferably between 1 .5 and 3 g/L.

Preferably the quantity of sucrose is comprised between 4 and 16 g/L, more preferably between 6 and 10 g/L.

In a preferred embodiment of the invention the concentrate is obtained/obtainable through a process comprising the steps of:

(i) microfiltering a sample of the vegetation waters and/or pomace so as to obtain a concentrate and a permeate of microfiltration; and

(ii) concentrating by reverse osmosis the microfiltration permeate obtained in step (i).

According to a preferred aspect of the invention, microfiltration is performed after the dissolving step as described above.

Microfiltration has the purpose of separating a concentrate, i.e. the concentrated fraction of the suspended content of the vegetation waters/pomace, e.g. micro-fragments, fibres and corpuscular material such as cells and bacteria. It is performed under standard conditions for this type of matrix. As well as the concentrate, following the microfiltration step a permeate is obtained, i.e. a clear fraction, characterized by a colour that varies according to the starting material and that contains the dissolved components of the vegetation waters/pomace, e.g. proteins, sugars, salts, polyphenols, organic acids and various soluble organic molecules.

Preferably the microfiltration is performed with at least one, preferably two, ceramic membranes(s). The membrane is characterized by a preferably tubular shape. In a preferred embodiment the membrane is made of alumina oxide and zirconia.

According to a preferred aspect of the invention, the membrane has the following characteristics:

- an outer diameter that ranges from about 30 to about 40 mm, preferably about 25 mm; and/or

- a length that ranges from about 500 to about 1500 mm, preferably about 1200 mm; and/or

- a series of channels with diameter, preferably hydraulic, that ranges from about 2.5 to about 5 mm, preferably about 3.5 mm; and/or

- a filtering surface area that ranges from about 0.15 to about 0.7 m ² , preferably about 0.35 m ² ; and/or

- a molecular size that ranges from about 0.1 micron to about 300 kDa.

The reverse osmosis step, for concentrating the permeate obtained from the microfiltration of the vegetation waters/pomace as described above, is performed under standard conditions for this type of matrix, preferably through the use of a polymeric membrane, more preferably polyamide. Preferably, the membrane has a wound spiral shape and/or a molecular size with high salt rejection, i.e. able to reject the sodium chloride molecule with a percentage of 99.9%. This means that the osmosis membrane retains the molecules of biomedical interest and only lets through the water molecule. Preferably, the polymeric membrane has a filtering surface area that ranges from about 5 to about 15 m ² , preferably about 7 m ² .

The reverse osmosis step allows the permeate obtained from microfiltration to be concentrated preferably about 4 times, which means that from 100 L of microfiltration permeate, 25 L of concentrate are obtained. In this case the volume concentration ratio (VCR) is 4 i.e. 100/25.

The VCR can change based on the starting matrix (vegetation waters) and especially based on its salt content, as the reverse osmosis process must counterbalance the osmotic pressure of the matrix that is to be concentrated.

Further subject matter of the present invention is constituted by a concentrate (or phytocomplex) of vegetation waters/pomace obtainable/obtained with the process described above.

Preferably said concentrate comprises the substances specified above in the relative quantities, in particular it is hydroxytyrosol and 3,4-DHPA-EDA, where the quantity of 3,4-DHPA-EDA is preferably comprised between 0.5 and 8 g/L, more preferably between 1 and 6 g/L, even more preferably between 1 .5 and 2.5 g/L and/or the quantity of tyrosol is preferably comprised between 0.1 and 0.4 g/L, more preferably between 0.15 g/L and 0.25 g/L. In other words, the concentrate preferably has the composition described above in relation to the content of phenol compounds, and/or metals and/or carbohydrates, and/or anions and/or nitrogen.

A further aspect of the present invention relates to a pharmaceutical composition comprising said concentrate and further excipients/pharmacologically accepted ingredients.

A further aspect of the present invention relates to a composition comprising the concentrate as described above and further excipients/pharmacologically accepted ingredients and the use thereof in the prevention and/or treatment of damage to the cardiovascular system (tissues/related organs), preferably damage from chemotherapy and/or radiotherapy as described above.

According to a further aspect of the invention, said concentrate and/or composition is/are used, alone or in combination with other substances, compounds, drugs or compositions with a protective and/or curative action for damage to cardiovascular tissue, preferably selected from: beta blockers, ACE-inhibitors, anticoagulant statins, dexrazoxane, N-acetyl-l- cysteine(NAC), zinc, selenium, melatonin, L-carnitine, glutathione and coenzyme Q10 (Albini A. et al, JNCI 2009, PMID:20007921 ).

Therefore, the concentrate can be applied for preventive purposes to prevent lesions/damage and/or for curative purposes for treating lesions/damage affecting the heart tissue and/or the vascular tissue.

In one embodiment, the treatment of the tissue coating the blood vessels is of particular interest, or the endothelial cells and/or the vascular support cells, such as pericytes and/or smooth muscular cells, and/or of the tissue coating the pericardium and/or endocardium muscle. In a particularly preferred embodiment, it is possible to use the concentrate and/or composition described herein for the purpose of preventing and/or treating lesions on the tissue coating the blood vessels and the heart muscle in patients subjected to pharmacological treatment, in particular treatment with antineoplastic agents; in fact it is known that treatment with such drugs for curing cancer cells can weaken the blood vessel walls and the heart muscle itself, with a consequent increase in cardiovascular risk in patients subjected to chemotherapy.

The concentrate of vegetation waters and/or pomace and/or the composition for the uses described in detail above is/are preferably formulated for oral intake, preferably as a beverage. Said beverage as well as the concentrate and/or composition according to the invention comprises one or more possible excipients normally contained in the formulation of various types of beverages. Preferably, the beverage may be based on water and/or fruit and/or milk. In a particularly preferred embodiment of the invention, the beverage is based on fruit, preferably based on grapes. In particular, grape juice and/or must is preferred, preferably of organic grapes.

It is a functional beverage, i.e. to be used as a food supplement because of the therapeutic effects found and described herein.

Alternatively, the concentrate of vegetation waters and/or pomace described herein and/or the composition can be prepared in the form of oral formulations of various kinds, such as sweets, pills, tablets or granules.

Practically the beverage or oral formulation can be taken as a food supplement, in particular for the purpose of preventing and/or treating damage or lesions to the cardiac and or/vascular tissue. In a preferred embodiment, the beverage or oral formulation is taken as a food supplement in order to prevent and/or treat damage or lesions to the cardiac and/or vascular tissue in patients subjected to cardiotoxic pharmacological therapies, more in particular in oncology patients subjected to chemotherapy treatment with antineoplastic drugs.

Possibly said oral formulation can be taken in association with one or more further substances, compounds, drugs or compositions with a protective action against damage to the cardiovascular system.

Alternatively, the concentrate of vegetation waters and/or pomace and/or the composition for the uses described in detail above is/are formulated, preferably for topical application, as a cream, oil, ointment, aerosol, shampoo, detergent, gel, ovule or mouthwash. The concentrate and/or composition can also be in the form of powder, granules, for example following a drying and/or freeze drying process. Such product can be used for preventing and/or treating cardiovascular damage, also topically, in particular in the case of preventing and/or treating the vascular tissue. In a preferred embodiment, the above product can therefore be used to protect or regenerate the vascular tissue with a topical action. Therefore, a further aspect of the present invention relates to a support comprising the concentrate and/or the composition of the present invention. Said support is preferably a patch, bandage, gauze, spray, solution or cardiac device such as, for example, a stent, comprising the concentrate and/or the composition of the present invention. The concentrate and/or composition on said support and/or powder may comprise further agents/molecules characterised by a biologically relevant function for the purposes of the prevention and/or treatment of cardiovascular damage.

EXAMPLE

Evaluation of the effect of the polyphenol concentrate on the viability of zebrafish (Danio rerio) embryos and on their heart rate.

To evaluate the cardioprotective effect of the polyphenol concentrate of the invention, the zebrafish was used in vivo as the animal model to study. In particular the experiments were performed on zebrafish {Danio rerio) embryos incubated for 24, 48 and 72 hours after fertilization.

For the purpose of inducing cardiotoxicity the drug doxorubicin was used, a commonly used chemotherapy agent, whose cardiotoxic effects are known, and having a similar biochemical/molecular base to the one found for other drugs with cardiotoxic potential, not necessarily of the chemotherapy type.

With reference to Fig.1 , it is observed that the treatment of zebrafish embryo with doxorubicin (3 μg/ml) significantly reduces their viability between 24 and 72 hours post-fertilization (hpf). In detail, 10 embryos are used for experimental conditions (compound concentration and unit of time of the treatment). The viability was evaluated by counting the number of dead embryos (per concentration and unit of time). The embryo is considered dead in its "coagulated" state i.e. with a black/brown colour (presence of necrosis).

The results show that concomitant or preventive treatment with the polyphenol concentrate of the invention (at the dilutions 1 :500 and 1 :1000) significantly reduces the damage induced by doxorubicin. The effect of the polyphenol concentrate is only displayed as a result of cardiac damage as the polyphenol concentrate alone does not alter the viability of the embryos, as can be noted from Fig.1 .

Furthermore, it has been observed that the treatment of zebrafish embryos with doxorubicin (3 μ9/ιηΙ) significantly reduces their heart rate at 48 hours (Fig. 2) and 72 hours (Fig.3). On this point, the results show that concomitant or previous treatment with the polyphenol concentrate of the invention (at the dilutions 1 :500 and 1 :1000) can reverse the cardiotoxic effect and restore the heart rate. Also in this case, it was noted that the effect of the polyphenol concentrate is only displayed as a result of cardiac damage as the polyphenol concentrate alone does not alter the heart rate of the embryos (Fig.2 and 3).