Effects of Pycnogenol on endothelial function in patients with stable coronary artery disease: a double-blind, randomized, placebo-controlled, cross-over study.

AIMS: Extracts from pine tree bark containing a variety of flavonoids have been used in traditional medicine. Pycnogenol is a proprietary bark extract of the French maritime pine tree (Pinus pinaster ssp. atlantica) that exerts antioxidative, anti-inflammatory, and anti-platelet effects. However, the effects of Pycnogenol on endothelial dysfunction, a precursor of atherosclerosis and cardiovascular events, remain still elusive. METHODS AND RESULTS: Twenty-three patients with coronary artery disease (CAD) completed this randomized, double-blind, placebo-controlled cross-over study. Patients received Pycnogenol (200 mg/day) for 8 weeks followed by placebo or vice versa on top of standard cardiovascular therapy. Between the two treatment periods, a 2-week washout period was scheduled. At baseline and after each treatment period, endothelial function, non-invasively assessed by flow-mediated dilatation (FMD) of the brachial artery using high-resolution ultrasound, biomarkers of oxidative stress and inflammation, platelet adhesion, and 24 h blood pressure monitoring were evaluated. In CAD patients, Pycnogenol treatment was associated with an improvement of FMD from 5.3 ± 2.6 to 7.0 ± 3.1 (P < 0.0001), while no change was observed with placebo (5.4 ± 2.4 to 4.7 ± 2.0; P = 0.051). This difference between study groups was significant [estimated treatment effect 2.75; 95% confidence interval (CI): 1.75, 3.75, P < 0.0001]. 15-F(2t)-Isoprostane, an index of oxidative stress, significantly decreased from 0.71 ± 0.09 to 0.66 ± 0.13 after Pycnogenol treatment, while no change was observed in the placebo group (mean difference 0.06 pg/mL with an associated 95% CI (0.01, 0.11), P = 0.012]. Inflammation markers, platelet adhesion, and blood pressure did not change after treatment with Pycnogenol or placebo. CONCLUSION: This study provides the first evidence that the antioxidant Pycnogenol improves endothelial function in patients with CAD by reducing oxidative stress.

Analgesic and antiinflammatory activity of Morinda citrifolia L. (Noni) fruit.

M. citrifolia is a tropical plant with a long tradition of medicinal use in Polynesia and tropical parts of eastern Asia and Australia. One of its favorite uses is the treatment of painful inflammatory conditions, such as arthritis. The analgesic activity of Noni fruit puree on mice was investigated using the hot plate test. A 10% solution of freeze concentrated Noni fruit puree in the drinking water of mice reduced the pain sensitivity comparably to the central analgesic drug tramadol. This effect was only partly reversed by the application of the morphine antagonist naloxone. An alcohol extract of noni fruit puree also caused an inhibition of MMP-9 release from human monocytes after stimulation with LPS. This effect was comparable to hydrocortisone (10(-5) m). The findings suggest that preparations of noni fruits are effective in decreasing pain and joint destruction caused by arthritis.

Facilitated cellular uptake and suppression of inducible nitric oxide synthase by a metabolite of maritime pine bark extract (Pycnogenol).

Many natural products exhibit anti-inflammatory activity by suppressing excessive nitric oxide (NO) production by inducible NO synthase (iNOS). The maritime pine bark extract Pycnogenol has been formerly shown to decrease nitrite generation, taken as an index for NO, but so far it was not clear which constituent of the complex flavonoid mixture mediated this effect. The purpose of this study was to elucidate whether the in vivo generated Pycnogenol metabolite M1 (δ-(3,4-dihydroxyphenyl)-γ-valerolactone) displayed any activity in the context of induction of iNOS expression and excessive NO production. For the first time we show that M1 inhibited nitrite production (IC(50) 1.3 µg/ml, 95% CI 0.96-1.70) and iNOS expression (IC(50) 3.8 µg/ml, 95% CI 0.99-14.35) in a concentration-dependent fashion. This exemplifies bioactivation by metabolism because the M1 precursor molecule catechin is only weakly active. However, these effects required application of M1 in the low-micromolar range, which was not consistent with concentrations previously detected in human plasma samples after ingestion of maritime pine bark extract. Thus, we investigated a possible accumulation of M1 in cells and indeed observed high-capacity binding of this flavonoid metabolite to macrophages, monocytes, and endothelial cells. This binding was distinctly decreased in the presence of the influx inhibitor phloretin, suggesting the contribution of a facilitated M1 transport into cells. In fact, intracellular accumulation of M1 could explain why in vivo bioactivity can be observed with nanomolar plasma concentrations that typically fail to exhibit measurable activity in vitro.

Pitfalls and limitations in using 4,5-diaminofluorescein for evaluating the influence of polyphenols on nitric oxide release from endothelial cells.

The reagent 4,5-diaminofluorescein (DAF-2) is a widely utilized and sensitive fluorescent probe for real-time assessment of nitric oxide (NO) production. In this study we investigated the feasibility of using DAF-2 for detection of NO release from EA.hy 926 human endothelial cells stimulated with plant polyphenols. Flavonoids have recently gained much interest because of reported beneficial effects on vasodilatation, which have been ascribed to stimulation of endothelial NO production. DAF-2 shows moderate fluorescence, and because certain phenolic compounds quench fluorescence or fluoresce themselves, we utilized liquid chromatography to avoid interference. Our investigations with (+)-catechin and trans-resveratrol as test phenolic compounds revealed various previously undescribed principal methodologic pitfalls and limitations. Under assay conditions (+)-catechin displayed a highly significant increase in fluorescence intensity so that a control of test compound stability is advisable. Moreover, DAF-2 was subject to conversion to triazolofluorescein (DAF-2T) under certain assay and storage conditions; thus control of spontaneous reagent conversion is advisable. Finally, formation of DAF-2T was dose-dependently inhibited by polyphenols to a degree consistent with their free radical scavenging activity. The inhibition of DAF-2T generation seems to contradict previous reports on enhanced NO release from endothelial cells by (+)-catechin and resveratrol. Therefore, the planning of experiments involving NO measurement in biological systems and interpretation of results requires substantial scrutiny.