Raul G Corredor MDÂ
Copyrigths: Purelife Scandinavia, Raul G Corredor 2007Â
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The advantages of an antioxidative diet are well accepted today. However, newÂ
research shows that the term antioxidant is far from being specific. ThoughtÂ
antioxidants are present in many foods including wines, fruits, nuts, olive oil,Â
cocoa, honey, some vegetables, green tea and cereals, dietary supplementsÂ
(including vitamins E, C or A), oligoelements (like zinc and selenium), andÂ
carotenoids (like beta carotene, lutein and zeaxanthin), new biological andÂ
chemical characteristics of this compounds have been discovered indicating thatÂ
there are different types of antioxidants, some of them with different free-radicalÂ
scavenging capacities (indicating their potency), and even more important, withÂ
different mechanisms of action. Â
Â
Description: One important family among antioxidants is the flavonoid group,Â
which comprise the most abundant group of plant polyphenols. The flavonoidÂ
group includes the anthocyanins, the flavonols, the flavones, the flavanones, theÂ
proanthocyanidines, the flavan-3-ols and isoflavones. From these, anthocyaninsÂ
have received special attention because a long tradition of beneficial effects.Â
Thought other antioxidants have been tested in clinical trials that have givenÂ
conflicting results; new research has been done recently and clinical trials areÂ
ongoing to test the specific effect of anthocyanins in vitro and in vivo. MEDOXÂ
(also identified as MP865) is a unique combination of anthocyanins obtained byÂ
purification from black currants (Ribes nigrum L.) and from bilberries (VacciniumÂ
myrtillus). The purification process (MEDOX is made in an in-house developed,Â
high tech., patented, chromatographic process) yields highly purifiedÂ
anthocyanines presented as capsules of 80 mg pure anthocyanins plus 115 mgÂ
polyphenols. Next, scientific evidence demonstrating important biological effectsÂ
of specific anthocyanins (as well as the synergistic effect of the naturalÂ
anthocyanin mixture) that compose MEDOX is presented. Â
Â
Absorption and metabolism: Anthocyanins are hydro-soluble plant pigmentsÂ
that usually have an attached sugar (glycosides) or les frequently, do not have itÂ
(aglycones). Both forms have particular characteristics in reference to absorptionÂ
and antioxidant capabilities. Although some generalizations are possible, newÂ
evidence suggest that the biological properties are different, and some timesÂ
unique, among different anthocyanines (for review see Prior et al. 2006). As anÂ
example, now it is accepted that anthocyanines can be absorbed intact asÂ
glycosides (in contraposition to other hydro-soluble compounds), though still theÂ
aglycones present easier absorption. Several mechanisms are involved inÂ
absorption to explain why anthocyanines can be detected in plasma as soon as 6Â
minutes after ingestion, and the maximum concentration in plasma (Cmax) canÂ
be reached 30 to 120 minutes after ingestion (Prior 2006). Surprisingly, one ofÂ
those mechanisms has been determined to be direct gastric absorption using aÂ
bilitraslocase-type enzyme (Passamonti 2003) at the gastric mucosa; the highestÂ
absorption seems to be at the jejunum. Thought the absorbed fraction of Â
anthocyanins, determined by measuring plasma levels and excretion, is aroundÂ
0.1 (1%), the process of absorption and metabolism is still under activeÂ
investigation. In particular, the fraction of anthocyanins that is collected in fecesÂ
after ingestion, has turned out to be very important because this fractionÂ
comprise intact anthocyanins and metabolized anthocyanins excreted in the bileÂ
together with phenolic acids which are products of bacterial degradation. ThisÂ
mixture is biologically active and is responsible for the reported protectiveÂ
antioxidant effect over colonic mucosa mediated by inhibition of malignantÂ
transformation and/or invasion (Coates 2007, Cooke 2006, Prior 2006). The mostÂ
abundant anthocyanins in blackcurrants are Cyanidin-3-rutinoside, Delphinidin-3-Â
rutinoside, Delphinidin-3-glucoside and Cyanidin-3-glucoside and their aglyconesÂ
cyanidin and delphinidin (Slimestad and Solheim 2002, Prior 2006). The mostÂ
abundant anthocyanins in bilberries are, in order of percentage composition, Â
Delphinidin-3-galactoside, Delphinidin-3-glucoside, Delphinidin-3-arabinoside,Â
Cyanidin-3-glucoside, Cyanidin-3-galactoside, Cyanidin-3-arabinoside, Malvidin-Â
3-glucoside, Petunidin-3-glucoside, Malvidin-3-galactoside, Petunidin-3-Â
galactoside, Peonidin-3-glucoside, Petunidin-3-arabinoside, Malvidin-3-Â
arabinoside, Peonidin-3-galactoside and Peonidin-3-arabinoside (Rahman 2006,Â
Cooke 2006(b)). This composition gives MEDOX unique characteristics, not onlyÂ
for the highly purified amount of anthocyanins, but also because the superoxideÂ
radical-scavenging activity is synergic among different anthocyanins (RahmanÂ
2006). Anthocyanins from bilberries and black currants (which are the primeÂ
material in MEDOX) are rapidly absorbed after ingestion (facilitated by specificÂ
transporters and the aglycone part), Keep their antioxidant ability during theÂ
process (reinforced in part by the stability of the rutenoside compoundsÂ
(Rubinskiene 2005)), and have a longer half life in human plasma due to theÂ
presence of glycosides which are metabolized in part to anthocyanidins, whichÂ
are suspected to exert even more potent biological activities (Cooke 2006, CookeÂ
2006(b). The last feature is particularly important because is an in vivoÂ
demonstration about the presence of aglycones in human plasma which can thenÂ
undergo further biotransformation, asseveration that has been subject ofÂ
controversy. Â
Â
Antioxidant activity: The antioxidant properties of anthocyanins have beenÂ
extensively demonstrated in vivo and in vitro and only specific mechanisms areÂ
considered here. In addition to the higher superoxide-scavenging activity andÂ
peroxynitrite-scavenging activity in the natural or reconstituted mix ofÂ
anthocyanins (Rahman 2006); other biological effects of anthocyanins have beenÂ
demonstrated, some of which are not directly related to their antioxidant capacity.Â
Below, some of those effects will be described. Â
Â
Aging and exercise-induced oxidative stress: Starting with the generalÂ
antioxidant ability of anthocyanins, some human studies can be cited. In oneÂ
study, healthy volunteers received berry juice or the same juice afterÂ
anthocyanins-polyphenols extraction during three weeks; during intervention withÂ
the fruit juice blood and urine samples were collected; a decrease of oxidativeÂ
DNA damage (p<5×10(-4) (determined by the comet assay) and an increase ofÂ
reduced glutathione (p<5×10(-4)) and of glutathione status (p<0.05) wereÂ
observed (Weisel 2006). Elevation of glutathione S-transferase P1 (hGSTP1)Â
protein expression in human leucocytes of healthy volunteers has also beenÂ
demonstrated after two two-weeks period of berry juice consumption whenÂ
compared with controls; hGSTP1 has been shown to prevent DNA damage andÂ
mutagenesis (Hofmann 2006). Interestingly, in vitro polyphenol mixtures up-Â
regulated other biotransformation enzymes (e. g., members of the cytochromÂ
P450 and the sulphotransferase family) and treatment of leucocytes led to aÂ
modulated mRNA expression of selected genes, not directly related to oxidativeÂ
defense systems (Hofmann 2006). According to another study, this antioxidantÂ
protection seems to be extended in individuals performing physical exercise asÂ
determined by analyzing the levels of lipid peroxidation (TBARS) in bloodÂ
samples from rowers (with or without berry juice supplementation) performing aÂ
daily physical exercise during 1 month training camp. In the group supplementedÂ
with berry juice, glutathione peroxidase activity was lower in the samplesÂ
collected 1 min after the exercise test, superoxide dismutase activity was lower inÂ
the samples taken following a 24-h recovery, and TBARS were lower at bothÂ
times when compared to the subjects receiving placebo. The authors of thisÂ
study suggest that an increased intake of anthocyanins limits the exercise-Â
induced oxidative damage to red blood cells, most probably by enhancing theÂ
endogenous antioxidant defense (Pilaczynska-Szczesniak 2005). The protectionÂ
against exercise-induced oxidative damage is further supported by a double-Â
blind, placebo-controlled, crossover study that assesses peripheral circulationÂ
using near-infrared spectroscopy (NIRS). Forearm blood flow (FBF) is measuredÂ
after venous occlusion prior to and hourly for 4 h after ingestion of blackcurrantÂ
anthocyanins (BCA). FBF increases significantly 2 h after BCA ingestion [BCAÂ
1.22 (0.13)-fold increase relative to pre-values vs. placebo 0.83 (0.06) of pre-Â
values; P < 0.05] and then tended to increase for a further 3 h after ingestionÂ
[BCA 1.26 (0.15)-fold increase relative to pre-values vs. placebo 0.82 (0.07) ofÂ
pre-values; P = 0.078]. The protective effect is also observed if intermittentÂ
typing workload is performed for 30 min in order to induce acute shoulderÂ
stiffness. BCA intake prevented the decrease in oxy-Hb significantly (P < 0.05),Â
and also tended to alleviate the increase in root mean square (RMS) of the EMGÂ
during the typing workload and muscle stiffness after the workload, in this way,Â
reducing muscle fatigue (Matsumoto 2005).Â
Â
Anti-inflammatory activity: The mechanisms mediating the anti-inflammatoryÂ
effect of anthocyanins are under continuous investigation. It has been shownÂ
that anthocyanins have ability to inhibit cyclooxygenase-2 (COX-2) at the sameÂ
amount that NSAIDs do (Seeram 2001). Among the molecular mechanismsÂ
involved in this response it has been shown in murine lipopolysaccharide-Â
activated macrophages, that anthocyanidins, specially Delphinidin, suppressedÂ
COX-2 by blocking the mitogen-activated protein kinase (MAPK) pathway, withÂ
simultaneous modulation of the nuclear factor-kB (NF-kB) pathway, activatorÂ
protein-1 (AP-1) and C/EBP? (Hou 2005). Other related anti-inflammatoryÂ
mechanisms have been invoked, including inhibition of interleukin-6 related alsoÂ
with inhibition of the NF-kB pathway (Omoigui 2007); and the modulatory effect inÂ
tumor necrosis factor-? (TNF-?) (Xu J-W 2006). A clinical study showed thatÂ
proanthocyanidins reduced inflammation and oxidative stress plasma levels andÂ
adhesion molecules (ICAM-1, VCAM-1 and E-selectin) in systemic sclerosisÂ
(Kalin 2002).Â
Â
Cardiovascular System: In reference to the cardiovascular system it is clearÂ
now that atherosclerosis is an inflammatory disorder; also that lipid peroxidationÂ
as well as alterations in nitric oxide-mediated vasodilatation are relevantÂ
pathogenic events. This circumstances put anthocyanins in a privileged positionÂ
since they are able to positively influence all three factors. Xia et al. (Xia 2007)Â
reported a novel mechanism how anthocyanins can attenuate atheroscleroticÂ
plaque formation in apolipoprotein E (ApoE)-deficient mice. It has been publishedÂ
that hyperactivation of the pro-inflammatory CD40 receptor is greatly amplified byÂ
hipercholesterolemia and other pro-inflammatory stimulus including its ligation toÂ
CD40 ligand (CD40L) and traslocation of tumor necrosis factor receptor-Â
associated factors (TRAF-2) to the membrane (Lutgens 2000,Frolov and HuiÂ
2007); CD40 activation strongly depends on the cholesterol domain (raft)Â
structure of the cell plasma membrane. Xia et al showed that anthocyanins,Â
specifically Cyanidin-3-glucoside or peonidin-3-glucoside, reduced raftÂ
cholesterol levels by up-regulation of ABCA1-mediated cholesterol efflux to ApoÂ
A-I, in this way, inhibiting the formation of a CD40/TRAF-2 complex (formed afterÂ
traslocation of TRAF-2 to the lipid raft) able to activate NF-kB and inhibiting alsoÂ
subsequent up-regulation of pro-inflammatory citokines IL-1, IL-8 and monocyteÂ
chemoattractant protein-1 (MCP-1) in human endothelial cells. Te authorsÂ
conclude that anthocyanin protects from CD40-induced proinflammatoryÂ
signaling by preventing TRAF-2 translocation to lipid rafts through regulation ofÂ
cholesterol distribution (Xia 2007). A positive role of anthocyanins in preventingÂ
endothelial cell death has been also demonstrated. TNF-? is involved inÂ
inflammation-mediated vascular damage by inducing apoptosis (associated withÂ
cleaved caspase-3 and cleaved poly(ADP-ribose) polymerase) of endothelialÂ
cells. Anthocyanins inhibit this effect of TNF-? through multiple signalingÂ
pathways which include elevation of endothelial nitric oxide synthase (eNOS) andÂ
thioredoxin (Trx); this is related to activation of AKT, decrease in lipidÂ
peroxidation products and modulation of the tumor suppressor gene P53 (Xu J-WÂ
2006). It is well accepted that eNOS promote endothelium-dependent relaxationÂ
of blood vessels, and this is consistent with the vasodilatation produced byÂ
anthocyanins. Lazze et al (Lazze 2006) showed that anthocyanidins (aglyconesÂ
delphinidin and cyanidin) at the physiological concentration that could beÂ
observed in vivo, decreased endothelin-1 production and increased endothelialÂ
nitric oxide synthase in cultured human endothelial cells. As an example ofÂ
anthocyanins diversity, Bell et al (Bell 2006) applied extracts from three differentÂ
berries (bilberry, chokeberry or elderberry) to coronary arterial rings isolated fromÂ
64 pigs. Bilberry and chokeberry extracts, but not elderberry extract, producedÂ
dose and endothelium-dependent vasorelaxation; at lower concentration bilberryÂ
and chokeberry extracts did not induce vasorelaxation but protected againstÂ
ROS-induced (pyrogallol-induced) vasoconstricition. Â
Â
Prevention of malignant transformation: Anthocyanins prevent cellularÂ
malignant transformation. Moreover, anthocyanins have been probed to induceÂ
apoptosis in some malignant cells. This characteristic is extremely importantÂ
since, as was shown above, anthocyanins are protective for normal cells. AÂ
recent publication from Feng et al (Feng 2007) brings light over this apparentÂ
contradiction and reinforces the selectivity of anthocyanins anti-tumorous activity.Â
Feng found that Cyanidin-3-rutenoside selectively kills leukemic cells (HL-60Â
cells) by induction of oxidative stress. Anthocyanins induce peroxideÂ
accumulation and apoptosis in HL-60 cells. In addition, cyanidin-3-rutinosideÂ
treatment resulted in reactiveÂ
oxygen species (ROS)-dependent activation of p38 MAPK and c-jun NH2-Â
terminal kinase (JNK), which contributed to cell death by activating theÂ
mitochondrial pathway mediated by Bim. Notably, cyanidin-3-rutinoside treatmentÂ
did not lead toÂ
Increased ROS accumulation in normal human peripheral blood mononuclearÂ
cells and had no cytotoxic effects on these cells (Feng 2007). MolecularÂ
mechanisms behind the chemoprotective effects of anthocyanins can be inferredÂ
from all the biological effects already mentioned. Hou et al (Hou 2004) proposedÂ
similar mechanisms including modulation of MAPK pathway, AP-1 factor, NF-kBÂ
pathway, Cyclooxigenase-2 gene and JNK-mediated caspase activation. ThoughÂ
more information is available every day; the current information should beÂ
enough to support the use of anthocyanines. Block et al (Block 2007) performedÂ
a systematic review of the literature in order to compile results from randomizedÂ
trials that evaluate concurrent use of antioxidants with chemotherapy.Â
Anthocyanins were not used in any of this trials. Still, Block et al. concluded thatÂ
the review “ provides suggestive evidence that antioxidant supplementation helpsÂ
reduce some adverse reactions including neurotoxicity, thrombocytopenia,Â
diarrhea, thusÂ
enabling increased or uninterrupted dosing in patients who otherwise mayÂ
discontinue treatment due to side effectsâ€. The review did not detect diminishedÂ
chemotherapeutic efficacy in patients receiving antioxidant supplementation inÂ
randomized trials and suggest that “the clinical application of antioxidantÂ
supplementationÂ
during chemotherapy should be further explored†(Block 2007). The link betweenÂ
the inhibitory effect of anthocyanins over the epidermal growth factor receptorÂ
(EGFR) and their effect on phosphodiesterase modulation, was proposed byÂ
Marko et al (Marko 2004) to be the common end point modulation of the MAPKÂ
pathway that regulates cell proliferation.Â
Â
The visual system: The eye is a biological system relying significantly inÂ
pigment function, and it seems that the anthocyanin pigments have importantÂ
beneficial effects in the eye. It has been shown that bilberry anthocyanins protectÂ
human retinal pigment ephitelial cells in culture (ARPE-19 cells) from pyridiniumÂ
bisretinoid (A2E) photooxidation and membrane permeabilization; A2E is aÂ
pigment that accumulates in retinal pigment epithelial cells with age and also inÂ
“Stargardt†and “Best†retinal disorders, A2E mediate a detergent-likeÂ
permeabilization of cell membranes and light-induced damage. AnthocyaninesÂ
quenched singlet oxygen which mediated the photooxidation process andÂ
improved survival of RPE cells by 60% (Jang 2005). The effects of anthocyanin-Â
enriched bilberry extracts were also analyzed in ARPE-19 cells oxidativelyÂ
challenged with hydrogen peroxide. The same extract after phenolic removal wasÂ
used as control. Anthocyanines from bilberry up-regulated the oxidative stressÂ
defensive enzymes Heme Oxygenase-1 and Glutation S-Transferase-pi.Â
Indicating this way, that anthocyanins have effect in gene expression of cell-Â
endogenous antioxidant mediators (Milbury 2007). In the rd1 mouse model ofÂ
retinitis pigmentosa (RP) a cocktail of antioxidants (not including anthocyanins)Â
was administered. Carbonyl adducts andÂ
immunohistochemical staining for acrolein were measured as markers forÂ
oxidative damage. “the staining for acrolein in remaining cones at day 35 of lifeÂ
was eliminated in antioxidant-treated rd1 mice, confirming that the treatmentÂ
markedly reduced oxidative damage in cones; this was accompanied by a 2-foldÂ
increase in cone cell density and a 50% increase in medium-wavelength coneÂ
opsin mRNA. Antioxidants also caused some preservation of cone functionÂ
based upon photopic electroretinogramsâ€(Komeima 2006).Â
Â
Neuroprotection: Finally, it is important to mention the possible role ofÂ
anthocyanins in the brain. 6-hydroxy dopamine is a neurotoxic metabolite ofÂ
dopamine. Both can be oxidized to generate ROS, which has been implicated inÂ
dopaminergic neurodegeneration; this could be also related to abnormal redoxÂ
state and cytoplasmic release of cytocrhome c (Cytc) leading to neuronalÂ
apoptosis. Purified anthocyanins and Vaccinium extracts were tested for theirÂ
effect to protect against Cytc-enhanced 6-hydroxy DA oxidation. The most potentÂ
protector was Vaccinium myrtillus (bilberry) with a 50% inhibition (Yao 2007).Â
This study provide strong support for testing anthocyanins as neuronal andÂ
mitochondrial protectors.Â
Â
At this point, it could be undoubtedly concluded that there is a big amount ofÂ
evidence about the biological mechanisms mediating the beneficial effects of theÂ
anthocyanins that compose MEDOX. MEDOX provides a unique opportunity toÂ
supplement high quality anthocyanins. Â
Â
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Â
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Copyrigths: Purelife Scandinavia, Raul G Corredor 2007Â