© Borgis - New Medicine 1/2010, s. 12-17
Zbigniew Pietrzkowski1, Boris Nemzer2, Aneta Spórna3, Paweł Stalica3, Wayne Tresher2, Robert Keller4, Roxanna Jimenez4, Tadeusz Michałowski3, *Sławomir Wybraniec3
Influence of betalain-rich extract on reduction of discomfort associated with osteoarthritisa)
1Bio-Clinical Research, FutureCeuticals, Inc.
2Chemistry Research, FutureCeuticals, Inc.
3Department of Analytical Chemistry, Institute C-1, Faculty of Chemical Engineering and Technology, Cracow University of Technology
Introduction. Osteoarthritis (OA) subjects typically experience progressive discomfort related to pain, joint stiffness, and general tiredness. The most common treatment of these conditions includes use of non-steroidal anti-inflammatory drugs (NSAIDS). However, efficacy of NSAID treatment is generally not completely satisfactory. Therefore, further improvements in management of OA-associated discomfort are needed.
Aim. The aim was to verify whether a betalain-rich red beet extract at dose range of 35-100 mg twice per day could reduce discomfort associated with osteoarthritis (OA) conditions.
Materials and methods. Study participants experiencing OA symptoms were treated with red beet extract (RBE) twice per day for exactly ten days. McGill and Energy Score data were evaluated at days 1, 5 and 10. The serum levels of advanced oxidation protein products (AOPP) were measured using a commercial kit.
Sera from volunteers treated with RBE were subjected to a cytokines and chemokines array.
Results. Collected data showed that ingestion of RBE for 10 days reduced McGill scores in a time- and dose-dependent manner with maximum 33% reduction as compared to the first day of the treatment. Interestingly, due to the treatment, serum levels of TNF-alpha were reduced in subjects whose serum TNF-alpha was greater than 1 pg/mL prior to initiation of the treatment. It was also found that serum levels of AOPP (proteins oxidized by hypochlorous acid/hypochlorites) were reduced by up to 48% after 10 days of the treatment.
Conclusions. This study showed that ingestion of RBE, at dosages greater than 35 mg, had a beneficial effect on pain associated with OA conditions. RBE may act by inhibiting protein oxidation typically induced by hypochlorous acid released from active neutrophils.
Osteoarthritis (OA) subjects typically experience progressive discomfort related to pain, joint stiffness, and general tiredness (1, 2). The aetiology of this condition is complex and a number of factors are reported to contribute to development and progression of this condition (3). The most common treatments of these conditions include use of non-steroidal anti-inflammatory drugs (NSAIDS) (4). However, efficacy of NSAID treatment is generally not completely satisfactory. Therefore, further improvements in management of OA-associated discomfort are needed. Recently, it was reported by Steinbeck (5) that chlorinated peptides and elevated levels of myeloperoxidase (MPO) are associated with early OA conditions. Interestingly, Deberg published in 2008 a clinical observation showing that serum MPO was significantly reduced in OA patients after knee replacement (6). In 1991, it was shown by Katrantzis that the oxidant hypochlorite, a product of myeloperoxidase, degrades articular cartilage (7). In 2000, Bellometti followed changes in blood levels of nitric oxide, myeloperoxidase and glutathione peroxidase in OA patients subjected to mud baths. Interestingly, mud bath treatment was associated with reduced blood levels of MPO and nitric oxide (NO) (8). Altogether, these publications suggest a possible connection between OA conditions associated with damage of cartilage, and increased levels of chlorinated proteins and MPO.
Studies on OA treatment with natural formulations indicating a beneficial effect of ginger extract on the progress of osteoarthritis were recently discussed (9). Independently, red-violet betalains and yellow betaxanthins, the water-soluble nitrogenous pigments present in members of most families of the plant order Caryophyllales, were reported to reduce activity of neutrophil-derived myeloperoxidase. As described by Allegra et al. (10), betanin (one type of betalains) inhibits myeloperoxidase-mediated oxidation of low density lipoproteins and may also scavenge hypochlorous acid (11). Finally, in 2009, it was shown that beetroot juice may inhibit oxidative metabolism of neutrophils collected from obese subjects (12). Results presented recently (10-12) show that betalains may diminish activity of myeloperoxidase, resulting in reduced generation of hypochloric acid. Other independent research shows that betalains are well distributed in vivo after ingestion (13, 14). This characteristic favours the potential use of betalain-rich natural products for various health conditions associated with over-activation of neutrophils, and with involvement of myeloperoxidase and hypochlorous acid (as described above).
Following the above rationale, we hypothesized that ingestion of betalain-rich RBE containing 25% of total betalains may reduce general discomfort in subjects experiencing minor forms of OA. Consequently, this clinical exploratory study was designed to include measurements using the McGill scoring system and an Energy Score questionnaire in order to verify whether RBE may diminish OA discomfort. Study participants were divided into three experimental groups taking 35, 70 or 100 mg of RBE for 10 days only. Collected results are presented and discussed in this report.
MATERIALS AND METHODS
Betalain-rich red beet extract (RBE). A novel and proprietary food-based extract ProLain prepared from red beet roots was obtained from FutureCeuticals, Inc. USA, where it was produced using a patent-pending technology that does not require use of organic solvents and that significantly reduces amounts of sugar in the final material.
Betalain analysis. Quantification of betalains was performed by a spectrophotometric multiple-component method of Nilsson (15). Betalain profile analysis was performed according to Wybraniec (16).
Clinical study description and design. This study was designed to be an open type clinical discovery rather than a clinical efficacy study. The primary goal was to verify whether RBE may improve pain and fatigue associated with osteoarthritis conditions. The secondary goal of this study was to identify the minimum effective dose (MED). Therefore, we employed a multiple fixed-dose type study with three time points: day 1, 5, 10. There were 8 subjects per experimental group. Each group was treated with 100 mg (Group 1), 70 mg (Group 2) or 35 mg (Group 3) twice per day. All participants were asked to take one capsule of RBE 30 min prior to eating a meal.
Subjects for this study were selected randomly from a group of people who had been previously diagnosed with osteoarthritis and who had reported symptoms characteristic of OA such as joint pain, limited joint flexibility, and feeling energy-depleted due to chronic pain and joint problems. We used McGill pain score system and Energy Score system questionnaires at day 1, 5 and 10 as a means of quantifying symptoms.
Recruitment of subjects, treatments, blood sampling at day 1, 5 and 10, McGill and Energy Score tests and blood chemistry were performed by NutraClinical, Inc. (San Diego, California, USA). Measurements of human cytokines and chemokines in collected sera were provided by Quensys, Inc. on a research service basis. AOPP testing was performed on sera collected from subjects at day 1 and 10 days after the treatment in FutureCeuticals' lab using a commercially available kit (Cell Biolabs, Inc, USA).
Betalain composition. Red beet ( Beta vulgaris L.) is commonly consumed as a food product and FutureCeuticals' RBE is a specially processed extract obtained from this material. Due to FutureCeuticals' RBE production process, this material is depleted of sugars and enriched in total betalains up to 25%. The relative betalain composition in RBE was approximately expressed by chromatographic signal values of main analysed pigments measured at their λmax: betanin (12.6), isobetanin (15.6), 17-decarboxy-betanin (0.60), 17-decarboxy-isobetanin (0.44) and neobetanin (3.9).
Effect of RBE on pain feelings as measured using McGill test. This study was performed to verify our hypothesis that betalain-rich food-grade material RBE may reduce discomforts associated with painful and swollen joints in people suffering osteoarthritis.
Collected results show that all subjects reported reduced pain level in a dose-dependent manner as measured by using the McGill Questionnaire. Detailed data are provided in table 1. Following these data, it is clearly noticeable that treatment with RBE resulted in a significant improvement of the sensory part of the questionnaire.
Table 1. Effect of RBE on McGill score after 5 and 10 days of treatment of OA subjects.
|Sensory Part||Affective Part||Evaluative Part|
|Day 1||Day 5||Day 10||Day 1||Day 5||Day 10||Day 1||Day 5||Day 10|
|Group 1-100 mg|
|McGill Score||Day 1: 79.36; Day 5: 60.24; Day 10: 58.12|
|Group 2-70 mg|
|McGill Score||Day 1: 77.37; Day 5: 59.74 Day 10: 52.00|
|Group 3-35 mg|
|McGill Score||Day 1: 87.37; Day 5: 78.49; Day 10: 78.84|
*Sum of all values in the group
Less improvement was observed for the affective aspects, and no effect was observed for the evaluative part of the questionnaire. Following this trend, treatment with 70 mg of RBE resulted in 41% reduction of pain as evaluated by the sensory part, but the total score for the McGill Questionnaire in this experimental group yielded a 33% reduction after day 10. It is also interesting to note that 5 days of treatment with 70 mg of RBE already resulted in 33% reduction of pain (total McGill score). This indicates that treatment with RBE may provide a moderately rapid effect (although not as acute as the effects of painkiller drugs such as NSAIDS). Exit interviews of study participants revealed that the first subjective improvements in pain were noticed after 3 days of the treatment. This observation strongly suggests that a 3-day period should be included in any future RBE clinical efficacy study protocol to follow rapid activity and effect on improvement of OA pain-related conditions.
Blood chemistry analysis. Standard serum biochemistry analysis was performed on each serum collected at day 1 and day 10. No unusual changes were noted in any parameters. All parameters were within the normal range (data not shown).
Subjective energy tests. In parallel to the McGill Questionnaire, all participants were required to answer 4 questions pertaining to their energy feeling rate (Q1), awareness rate (Q2), endurance rate (Q3) and mood rate (Q4). Rates for all these questions were scaled 1-4. This questionnaire (described in this article as Energy Score) was performed at day 1, 5 and 10. The highest number indicated a generally elevated level of the feeling rate.
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