This application is related to Provisional U. S. Patent Application Serial No. 60/501,226, filed on September 9,2003, the disclosure of which is incorporated herein in its entirety by reference.

BACKGROUND OF THE INVENTION Obesity, the Metabolic Syndrome (also referred to as Syndrome X), and Type II Diabetes Mellitus, are very much interrelated.

Type II Diabetes Mellitus is caused by a combination of defective insulin secretion and insulin resistance. This results in elevated blood sugar, elevated blood pressure, increased blood lipids and obesity. This determines micro and macro vascular disease with cardiovascular accidents, renal insufficiencies, neuropathy, blindness and higher incidences of infections. Over 120 million people worldwide suffer from diabetes, and 90% of these are Type II Diabetes. Eighty percent of those with diabetes are obese. This has an enormous economic impact in

addition to the obvious personal impact on those suffering from this disease.

The Metabolic Syndrome is characterized by individuals having abdominal obesity, high triglycerides, low HDL cholesterol, high blood pressure and high fasting glucose levels. A diagnosis of Metabolic Syndrome is made when three or more of these factors are established.

It is believed that as many as 25% of the general population in the United States suffer from Metabolic Syndrome. In addition to being a direct cause of death, those suffering from Metabolic Syndrome have a significantly increased risk of developing Type II Diabetes with all of its complications, as well as other serious cardiovascular complications.

Finally, in the United States, over 61 % of the population is obese or overweight. Fifty-eight million people are overweight, forty million are characterized as obese, and three million are considered morbidly obese.

A somewhat related malady is polycystic ovary syndrome.

Polycystic ovary syndrome is characterized by anovulation (irregular or absent menstrual periods) and hyperandrogenism (elevated serum testosterone and androstenedione). Patients with this syndrome may complain of abnormal bleeding, infertility, obesity, excess hair growth, hair loss and acne. Insulin resistance, high blood pressure, high serum lipids, increased risk for cardiovascular disease and increased risk of developing Type II Diabetes are also important features.

Polycystic ovary syndrome is estimated to affect about half as many or approximately 10% of women.

One of the major biochemical features of polycystic ovary syndrome is insulin resistance accompanied by compensatory hyperinsulinemia (elevated fasting blood insulin levels). Hyperinsulinemia has also been associated with high blood pressure and increased clot formation and appears to be a major risk factor for the development of heart disease, stroke and Type II Diabetes.

The medical literature suggests that the endocrinopathy in most patients with polycystic ovary syndrome can be resolved with insulin lowering therapy.

Those people suffering from diabetes generally are treated with a number of different agents, in particular hypoglycemic agents, blood pressure medication, as well as cholesterol-lowering drugs. It is common to use multiple different drugs to treat Type II Diabetes. Several drug combinations have been produced.

Such drug combinations are disclosed in Ikeda U. S. patent 5,952, 356, Adjei U. S. patent 6,524, 621, Chaudhari U. S. pending application 2003/0219482 A1, Jaen et al U. S. application 2002/0037928 A1 ; Fine et al U. S. patent 6,376, 594, Pierson U. S. patent 6,693, 094, Whitcomb U. S. patent 6, 011, 049, Saho et al U. S. patent 6,645, 997; Chungi U. S. patent 6,669, 955; and Luskey U. S. patent 6,646, 004. Further, Liang et al U. S. patent 6,576, 256 discloses

a combination of a cholesterol-lowering agent, a renin-angiotensin system inhibitor and aspirin. Sethi et al U. S. patent 6,489, 345 discloses a combination of E vitamins and hypoglycemic drug, and Doebbner et al U. S. patent 5,847, 008 discloses a variety of combinations with acetyl phenols. Other pending applications include 2003/0149111 ; 2003/0114469 ; 2003/0149111 ; and 2003/0158090.

Many of these combinations do not include a hypoglycemic agent. Further, others will include hypoglycemic agents which are unsuitable for treatment of Metabolic Syndrome or obesity. The biguanides are used to treat diabetes, and can also be useful in treating obesity and Syndrome X. However, other hypoglycemic agent such as the sulfonylureas, the alpha glucosidase inhibitors, the glitazones, and the meglitinides will actually induce hypoglycemia in patients who are not suffering from Type II Diabetes. Biguanides have been combined with these other hypoglycemic agents for treatment of Type II Diabetes. Other combination therapies fail to adequately address all of the comorbidities associated with Type II Diabetes with one medicine. Compliance is a critical problem for proper treatment of diabetes. Only a fraction of patients with diabetes is compliant with prescribed regiments. Individuals required to take five or six different pills, either at once or at different times of the day, are less likely to do so. Thus, reducing the number of pills, or, in other words, combining drugs into a single dosage will greatly improve compliance.

SUMMARY OF THE INVENTION The present invention is premised on the realization that a combination therapy, that is, a metabolic pill, effective for treatment of diabetes, the Metabolic Syndrome and obesity as well. as their complications, is provided by utilizing a combination of a biguanide hypoglycemic agent with a lipid lowering agent, a blood pressure lowering agent, optionally an anti-platelet agent, and optionally a combination of vitamins and supplements which have been shown to prevent atherosclerosis and infections. In order to provide a single pharmaceutical that can treat all three of these maladies, the hypoglycemic agent cannot be used in combination with other types of hypoglycemic agents, such as the alpha-glucosidase inhibitors, and the like, because of the risk of inducing hypoglycemia. However, when the pharmaceutical is designed to treat only Type II Diabetes, additional hypoglycemic agents can be employed.

A preferred form of the present invention includes metformin as the hypoglycemic agent, simvastatin as the cholesterol lowering agent, and a renin-angiotensin system inhibitor such as lisinopril as the blood pressure lowering agent. The preferred anti-platelet agent is aspirin.

These may be combined with one or more of the following: a folate, vitamin B6, B12 and other supplements such as asparginin, beta- carotene, vitamins A, C, D, E, K, and polyunsaturated fatty acids.

The metabolic pill of the present invention can also improve the symptoms of polycystic ovary syndrome, reduce blood pressure, reduce blood lipids and reduce the incidence of developing Type II Diabetes and cardiovascular complications.

The objects and advantages of the present invention will be further appreciated in light of the following detailed description.

DETAILED DESCRIPTION OF THE INVENTION The present invention is a therapeutic composition, a metabolic pill or medicine intended to be administered in a single dose application, i. e., all of the pharmaceuticals combined in a single pill, capsule or liquid formulation, which includes a biguanide hypoglycemic agent in combination with additional pharmaceuticals including a cholesterol lowering agent, a blood pressure lowering agent and, optionally, an anti-platelet agent, vitamins and supplements. This composition can be used whenever clinically appropriate to treat Type II Diabetes and, when appropriate, the Metabolic Syndrome and obesity.

The primary component of the pharmaceutical of the present invention is a hypoglycemic drug and, in particular, a biguanide.

Metformin is the preferred oral hypoglycemic agent.

When used to treat Type II Diabetes, the biguanide hypoglycemic drug can be combined with other hypoglycemic drugs or replaced altogether by a separate hypoglycemic drug. Other suitable hypoglycemic drugs include sulfonylureas such as glyburide, alpha

glucosidase inhibitors such as acarbose, glitazones such as pioglitazone and rosiglitazone, and meglitinides such as repaglinide. Preferred hypoglycemic agents for treatment of Type II Diabetes would include metformin by itself, pioglitazone by itself, metformin in combination with glyburide, metformin in combination with acarbose, metformin in combination with pioglitazone, metformin in combination with pioglitazone and glyburide, and repaglinide plus pioglitazone.

The minimum effective adult dosage of metformin is about 250 mg, administered daily. The dosage is increased to a maximum dosage of 3.5 gm daily. The present combination drug is designed to maintain all of its components within individual drug therapeutic windows as the dosage is escalated from 1 capsule/pill (5 ml liquid) once a day to 5 capsules/pills (25 ml liquid) 3 times a day. A minimum dose is established for each of the individual components that is within the effective dose range for that component for at least a subgroup of patients. If a higher dosage is required, additional medication (i. e. , an additional pill) is taken. The dosage of the individual component is established to allow increasing the dosage without exceeding the maximum dosage of any component.

A variety of different blood pressure lowering agents can be used in the present invention. These include the renin angiotensin system inhibitors, beta-blockers such as atenolol, diuretics such as

hydrochlorothiazide, and calcium channel antagonists, for example, nifedipine.

The renin angiotensin system inhibitors include ACE inhibitors which inhibit the conversion of angiotensin I to angiotensin 11, angiotensin 11 receptor antagonists and renin inhibitors. The ACE inhibitors are preferred inhibitors of the renin angiotensin systems for use in the present invention. The ACE inhibitors include sulfhydryl containing ACE inhibitors including captopril and agents that are structurally related to captopril such as fentialpril, pivalopril, zofenopril, and alacepril. Other ACE inhibitors include the dicarboxyl-containing ACE inhibitors including <BR> <BR> amalopril, lisinopril, benazapril, quinapril, moexipril, ramipril, spirapril, perindopril, indolapril, pentopril, and cilazapril. Phosphorus-containing ACE inhibitors can also be used, such as fosinopril and ACE inhibitors structurally related thereto.

The preferred ACE inhibitors are captopril, silizopril, delapril, analopril, fentiapril, fosinopril, endolapril, lisinopril, perindopril, pivalopril, quinapril, ramipril, spirapirl, trandolapril and zofinopril. Particularly preferred are captopril, enalipril, fosinopril, lisinopril, quinapril, ramipril, and trandolapril. Most preferred are lisinopril and ramipril.

Examples of ACE/NEP inhibitors for use herein include, without limitation, those disclosed in U. S. patents 5,508, 272, 5,362, 727,5, 366,973, 5,225, 401,4, 722,810, 5,223, 516,5, 552,397, 4,749, 688,5, 504,080, 5,612, 359 and 5,525, 723, the disclosures of

which are hereby incorporated by reference in their entirety. Preferred are those ACE/NEP inhibitors that are designated as preferred in the above U. S. patents. Particularly preferred are the ACE/NEP inhibitors omapatrilat and MDL100240, disclosed in U. S. patent 5,430, 145.

A second type of renin-angiotensin system inhibitors are the angiotensin 11 receptor antagonists. Examples of angiotensin 11 receptor antagonists suitable for use herein are saralasin (including saralasin acetate), candesartan (including candesartan cilexetil), CGP-63170, EMD-66397, KT3-671, LRB/081, valsartan, A-81282, BIBR-363, BIBS-222, BMS-184698, CV11194, EXP-3174, KW-3433, L-161177, L-162154, LR-B/057, LY-235656, PD150304, U-96849, U-97018, UP-275-22, WAY-126227, WK-1492. 2K, YM-31472, losartan (including losartan potassium), E-4177, EMD-73495, eprosartan, HN-65021, irbesartan, L-159282, ME-3221, SL-91.0102, tasosartan, telmisartan, UP-269-6, YM-358, CGP-49870, GA-0056, L-159689, L-162234, L-162441, L-163007, PD-123177, A81988, BMS-180560, CGP-38560A, CGP-48369, DA-2079, DE-3489, DuP-167, EXP-063, EXP-6155, EXP-6803, EXP-7711, EXP-9270, FK-739, HR-720, ICI-D6888, ICI-D7155, ICI-D8731, isoteoline, KRI-1177, L-158809, L-158978, L-159874, LR B087, LY-285434, LY-302289, LY-315995, RG-13647, RWJ-38970, RWJ-46458, S-8307, S-8308, saprisartan, sarmesin, WK-1360, X-6803, ZD-6888, ZD-7155, ZD-8731, BIBS39, CI-996, DMP-81 1, DuP-532, EXP-929, L163017, LY-301875, XH-148,

XR-510, zolasartan, and PD-123319. These are disclosed in U. S. patent 6,576, 256, the disclosure of which is also incorporated herein by reference.

Preferred angiotensin 11 receptor antagonists include losartan (which is the prototype and best known angiotensin 11 receptor antagonist), irbesartan, eprosartan, candesartan, valsartan, telmisartan, zolasartan, and tasosartan. Particularly preferred is losartan.

A third type of angiotensin system inhibitor are the renin inhibitors, these are compounds that inhibit renin activity and include renin antibodies, analogues of prosegment of renin, analogs of pepstatin, and analogs of the renin substrate angiotensinogin. As most of these compounds are peptides, they tend to have low oral bioavailability. Non- peptide renin inhibitors are of the most interest. Preferred inhibitors are remikiren, A-72517, and A-74273, with remikiren being preferred.

The preferred dosage for each of these components obviously will depend on the particular pharmaceutical. The effective dosage ranges for these compounds are well known.

The third component of the present invention is a blood lipid lowering agent. There are many different blood lipid lowering agents.

These include, HMG CoA reductase inhibitors, bile acid sequestrants, probucol, and fibric acid agents. The HMG CoA reductase inhibitors include atorvastatin, cerivistatin, fluindostatin, fluvastatin, lovastatin, mevastatin, pravastatin, simvastatin, and velostatin. The preferred

HMG CoA reductase inhibitors are simvastatin pravastatin, lovastatin, and atorvastatin. The bile acid sequestrants include cholestyramine, colestipol, and colesevelam. The fibric acid agents include clofibrate, fenofibrate, and gemfibrozil.

Again, the dosage rate for each of these components will be determined by the particular lipid lowering agent selected. Generally, the minimum dose will be designed for individuals with normal to slightly raised lipid levels.

A further component of the present invention is preferably an anti-platelet drug. The preferred anti-platelet drug is aspirin. Other salicylates can be used such as magnesium salicylate. Further, there are other anti-platelet aggregating agents, such as anangrelide, dipyridamole, clopidogrel, and ticlopidine. Further, cyclooxygenase inhibitors can be used, including nonstearoidal anti-inflammatory drugs such as ibuprofen, sulindac, sulindac sulfide, sulindac sulfone, flurbiprofen, indomethacin, naproxen, meclafenamic acid, and piroxicam. These should be provided in a dosage effective to inhibit platelet degradation.

The invention further may include various vitamins and supplements shown to prevent atherosclerosis and to prevent infections.

One preferred vitamin is folic acid, a folate, or folinic acid, commonly referred to as a folate. Suitable folates include 5-methyl tetrahydrofolic acid, tetrahydrofolic acid, and 5-formyl tetrahydrofolic acid.

Vitamin B components should be included such as vitamin B6 (pyridoxine), and vitamin B12. Other vitamins and minerals include beta-carotine and other carotinoids, vitamin A, vitamin C, vitamin D, vitamin E, vitamin K, zinc, polyunsaturated fatty acids, arginin, as well as its isomers.

The individual components of the present invention are preferably combined to form an oral dosage form. This can include tablets, capsules, caplets, solutions, suspensions and/or syrups, as well as granules, beads, powders or pellets that may or may not be encapsulated. Suppository preparations and sublingual preparations, as well as transdermal patches, may also be used.

A preferred general formulation for the present invention would include : metformin 50-1500 mg simvastatin 1-80 mg lisinopril 1-40 mg Another preferred general formula includes : metformin 50-1500 mg simvastatin 1-80 mg lisinopril 1-40 mg aspirin 5-375 mg folic acid 0.5-1 mg vitamin B6 5-40 mg vitamin B12 0.05-1 mg

A preferred specific formula in capsule form includes: (Specific Formula 1) metformin 250 mg aspirin 12. 5 mg simvastatin 3.5 mg lisinopril 1. 66 mg folic acid 0. 166 mg vitamin B6 8.33 mg vitamin B12 0. 166 mg methocel E4M as an excipient (QS in gelatin capsule size 1) A liquid formulation would include : (Specific Formula 2) metformin 250 mg aspirin 12.5 mg simvastatin 3.5 mg lisinopril 1. 66 mg folic acid 0. 166 mg vitamin B6 8.33 mg vitamin B12 0. 166 mg in a fixed oil base comprising 200 mg of silica gel, 5 mg butylated hydroxyteluline, 6.25 mg stevia powder, 0.1 mi of flavor and olive oil forming 5 mi of medicine.

For the treatment of Diabetes Type II, the composition of the present invention will preferably include the biguanide hypoglycemic agent, a lipid lowering agent, blood pressure lowering agent, and, optionally vitamin B12 compounds, folic acid, vitamin C, arginin, as well as other supplements. Additional hypoglycemic agents can also be employed such as the sulfonylureas, alpha-glucosidase inhibitors, glitazones and meglitinides.

For treatment of Syndrome X, polycystic ovary syndrome, and/or obesity, the composition will include only the biguanide

hypoglycemic agent, preferably metformin, and no other type of hypoglycemic agent. The remainder of the formulation should remain the same as the above formulation for Type II Diabetes.

Additional examples of formulations encompassing the present invention are set forth below.

Formula A Metformin 250 mg, aspirin 12.5 mg, simvastatin 3.5 mg, lisinopril 1.66 mg, folic acid 0.166 mg, vitamin B6 8.33 mg and vitamin B12 0.166 mg for each capsule or, in a liquid, for each 5cc.

Formula B Metformin 50-1000 mg, simvastatin 1-40 mg, lisinopril 1-10 mg, aspirin 5-75 mg, vitamin B6 10-50 mg, vitamin B12 0.2-1 mg, plus folic acid 0. 2-1 mg.

Formula C Metformin 1000-3000 mg, simvastatin 20-40 mg, ramipril 0.6-1. 25 mg, aspirin 35-75 mg, plus polyunsaturated fatty acids 500-1000 mg.

Formula D Metformin extended release up to 3500 mg, repaglinide 2 mg (or glimepiride 2 mg), simvastatin 40 mg, lisinopril 10 mg; aspirin 175 mg, vitamin B6 50 mg, vitamin B12 1 mg, plus folic acid 1 mg.

Formula E Metformin 500-3500 mg, repaglinide 0.5 mg, simvastatin 40 mg, ramipril 2.5 mg, plus aspirin 81 mg.

Formula F Metformin 500-1000 bid or tid, glimepiride 2 mg, simvastatin 20-80 mg, lisinopril 10-30 mg, aspirin 75 mg, vitamin B6 50 mg, vitamin B12 1 mg, plus folic acid 2 mg.

Formula G Metformin ER 1000-3000 mg, simvastatin 40 mg, lisinopril 5 mg, atenolol 25 mg, hydrochlorothiazide 25 mg, aspirin 75 mg, vitamin B6 50 mg, vitamin B12 1 mg, plus folic acid 1 mg.

Formula H Metformin 1000-3000 mg, repaglinide 0.5 mg, simvastatin 40 mg, lisinopril 5 mg, atenolol 25 mg, hydrochlorothiazide 25 mg, aspirin 75 mg, vitamin B6 50 mg, vitamin B12 1 mg, plus folic acid 1 mg.

Formula I Metformin ER 1000-3000, simvastatin 40 mg, lisinopril 5 mg, atenolol 25 mg, hydrochlorothiazide 25 mg; aspirin 75 mg, vitamin B6 50 mg, vitamin B12 1 mg, plus folic acid 1 mg.

Formula L Metformin 1000-3000 mg, glimepiride 2 mg, simvastatin 40 mg, lisinopril 5 mg, atenolol 25 mg, hydrochlorothiazide 25 mg, aspirin 75 mg, vitamin B6 50 mg, vitamin B12 1 mg, plus folic acid 1 mg.

Formula M Metformin ER 3000 mg, simvastatin 40 mg, ramipril 10 mg, aspirin 75 mg, vitamin B6 25 mg, vitamin B12 1 mg, folic acid 0.8 mg, plus polyunsaturated fatty acids 1000 mg.

Formula N Pioglitazone 20 mg metformin 1000 mg, repaglinide 1.25 mg, simvastatin 40 mg, ramipril 10 mg; aspirin 75 mg, vitamin B6 50 mg, vitamin B12 1 mg, folic acid 1 mg, plus polyunsaturated fatty acids 1000 mg.

EXPERIMENTAL STUDY To determine preliminary toxicology, normal mice, with a starting weight range of 18.4-24. 4 grams, were randomly assigned to one of four treatment groups, ten mice for each group, and treated once a day for 7 days by gastric gavage with one of 0.2 ml normal saline, 0. 015 ml of a placebo comprising calcium carbonate and a fixed oil base in combination with 0.185 ml normal saline, or, 0.015 mi of specific formula 1, plus 0.185 mi normal saline, or, 0.03 mi of specific formula 1 plus 0.17 ml of normal saline. At the end of the treatment the animals

were weighed and sacrificed. Blood was obtained for biochemical and hormonal tests. Heart, liver and kidney were frozen at-70° C for further proteomic and enzymatic studies, and the liver was fixed for routine histological examination. On day 7, all animals appeared to be in good health. Biochemical tests did not show signs of liver or kidney toxicity.

The weight was lower in both treatment groups 3 and 4 compared to the placebo groups 1 and 2. Leptin levels were decreased in the treatment groups compared to placebos. Glucose and triglycerides were lower and insulin levels were higher in the treatment group. Set forth below are the starting and ending weights of the respective mice, broken down by groups.

GROUP 1 : NS Starting weight (grams) Ending weight (grams) 22.6 22 22.2 21. 3 20.8 22 19 10 21.2 20 21 18.9 22 18.7 20. 6 21 21.8 22. 3 22. 3 23 GROUP 2: VEHICLE

Starting weight (grams) Ending weight (grams) 23.5 22.9 21. 8 20.9 20.3 18.4 21.7 18.6 20.4 18.9 21.8 20 22.2 22.6 21.3 22.3 20.8 21 23. 9 23 GROUP 3: MTDMO 0.1 mi Starting weight (grams) Ending weight (grams) 20.7 16.7 20.9 16.2 20.4 15.2 23.5 15 20. 6 18 23 16.1 21.1 16. 1 20.8 15 24. 4 16.6 21. 1 16. 9 GROUP 4: MTDMO 0.2 mi

Starting weight (grams) Ending weight (grams) 20.6 16.3 19.6 15.1 21 12 21.9 14.9 18.7 15.1 21.8 15.9 19.7 13. 4 19.2 14.2 23.6 16.3 21. 2 14. 1 As can be seen, Groups 3 and 4 lost substantially more weight than the placebo groups.

The compositions of the present invention are designed to significantly improve compliance, and lower costs. Compliance is often a primary issue, especially as drug regimens become more complex.

Type II Diabetes and the Metabolic Syndrome X and obesity, when not responsive to diet and exercise, require complex drug regimen for optimal treatment and prevention of the complications. Improvement of compliance is the primary goal of all effective treatments, especially important with complex regimens. A combination pill such as this will reduce costs and significantly increase the likelihood of compliance.

Particularly for patients with Type II Diabetes, multiple drugs are required. Based on the recommendations of the American Diabetes Association, the cholesterol lowering agent is indicated even if cholesterol level is normal, and an inhibitor of a renin angiotensin system is indicated even if the blood pressure is normal. Aspirin is indicated in patients with Type II Diabetes, even in the absence of previous cardiovascular events.

One prescription, such as the above, would cover both diabetes control and prevention of complications improving patients compliance. The availability of one formulation which contains all of the ingredients needed by patients with diabetes will help physicians correctly prescribe for their patients. Furthermore, the cost of a single pill will significantly lower costs compared to the cost of the different pharmaceuticals taken separately.

All the above combinations can be used in combination with insulin. Insulin is frequently required in patients with long standing diabetes mellitus, and oral hypoglycemic agents may lower the insulin requirements. Insulin at high doses may have a proatherogenic effect.

The combination drug will, therefore, have multiple benefits compared to insulin alone.

With respect to Metabolic Syndrome, which is not responsive to diet and exercise, the above formulation can slow the evolution toward diabetes, particularly utilizing metformin and the ACE inhibitor. Further, the composition will decrease body weight, using the

metformin, and lower the risk of cardiovascular complications employing basically all of the components.

Further, with respect to treatment of obesity, the above composition has been effective to provide weight loss in experimental work. Obese patients are at high risk for diabetes and cardiovascular complications. Metformin and the ACE inhibitors can prevent the development of diabetes. All the above components will help prevent cardiovascular complications. The biguanide hypoglycemic agents, particularly metformin, is the hypoglycemic agent of choice. Metformin does not cause hypoglycemia and is, therefore, the drug of choice for prevention of diabetes in patients and with Metabolic Syndrome and obesity not responding to diet and exercise.

The formulation of the present invention, aside from treating diabetes, Syndrome X and obesity, can be used to treat other maladies such as polycystic ovary syndrome.

This has been a description of the present invention along with the preferred method of practicing the present invention. However, the invention itself should only be defined by the appended claims, WHEREIN WE CLAIM :