Lipoprotein(a) Patents

Promotional literature for the Linus Pauling Heart Foundation, ca. 1992.

Promotional literature for the Linus Pauling Heart Foundation, ca. 1992.

[Part 2 of 2]

With the results of their Lipoprotein(a) [LP(a)] experiments in hand, Linus Pauling and Matthias Rath decided to create a treatment and try to patent it. Their treatment relied on three main ideas: First, that increased Vitamin C levels in the bloodstream would prevent the creation of lesions to which Lp(a) might bind. Second, that lipoprotein binding inhibitors would detach any plaque that had already built up. And lastly, that Vitamin C would then also help the body to filter out Lp(a). In this way, it could be used to both treat and prevent cardiovascular disease (CVD) and other related cardiovascular problems.

The duo also saw great potential use for their research in surgery – specifically angiopathy, bypass surgery, organ transplantation, and hemodialysis. Lysine or other similar chemicals naturally help to speed the healing process and also act as blood clotting agents, therefore reducing the risk of blood loss during surgery. Also, patients undergoing organ transplant surgery, bypass surgery, and hemodialysis often suffer strong recurrences of CVD, which Pauling and Rath felt was due to depleted Vitamin C levels from blood loss. Similarly, diabetics often suffer from both inhibited Vitamin C absorption and higher levels of Lp(a), leading Pauling and Rath to hope that their work could help to treat diabetes-related CVD as well.

When living patients were using their treatment, the mixture was designed to be taken orally in pill or liquid form, or injected intravenously. Pauling also wondered if the mixture could be taken subcutaneously (injected into the deepest level of skin), percutaneously (injected into internal organs), or intramuscularly (injected into the muscle). When being used as preparation for transplant surgery, the organs to be transplanted were to be soaked in the mixture. Later research done by other scientists showed that Vitamin C is not absorbed into the bloodstream like it was thought, and that there are specific Vitamin C carrier molecules in the digestive tract, therefore limiting the amount of Vitamin C a person can absorb when taken orally. As such, injection is a much more effective method of getting Vitamin C into the bloodstream.

Pauling and Rath’s work was polarizing, if not unprecedented. As far back as the early 1970s, enthusiastic support for Vitamin C by Pauling and others had been a point of extreme controversy. Now, even with this latest batch of research, many scientists and doctors seemed to think that their conclusions were grossly incorrect, and in some cases even dangerous for people. Pauling, Rath, and their supporters felt that the harsh criticism emerged, at least in part, from pharmaceutical companies concerned about losing revenue if people stopped buying their expensive medications and instead bought inexpensive, common Vitamin C. On the flip side, many of the people who felt that their research was correct were absolutely steadfast in their support.

The controversy surprised Pauling. He repeatedly expressed these feelings, pointing out that he was not the first to make claims about the benefits of Vitamin C nor even the most extreme, and yet he was viewed as a controversial figure espousing fringe medicine. The Pauling-Rath team was not the only organization researching and promoting the positive effects of Vitamin C. Other groups, such as that led by Dr. Valentin Fuster of Harvard Medical School, were conducting similar experiments. Pauling and Rath attempted to collaborate with them where possible, often with success. But more generally the duo had to rely heavily upon individual case histories to support their research, largely because they were unable to convince major American institutions to conduct their own studies or to sponsor the Linus Pauling Institute of Science and Medicine’s studies.

Figure 1 from Pauling and Rath's July 1990 patent application.

Figure 1 from Pauling and Rath’s July 1990 patent application.

On July 27, 1993, Pauling and Rath were awarded a patent for the application filed in April 1990. On January 11, 1994, they received a second patent for the application filed in July 1990. Shortly afterward, in March 1994, the two filed a third application, following similar grounds, titled “Therapeutic Lysine Salt Composition and Method of Use.” The compound they were patenting was a mixture of ascorbate, nicotinic acid (also known as Vitamin B3 or niacin) and lysine, or a lysine derivative. The mixture was to be combined at a ratio of 4:1:1, and include a minimum of 400 mg of ascorbate, 100 mg niacin and 100 mg lysine. The mixture functioned more or less identically to the previous two patents, the major difference being the inclusion of Vitamin B3 for its antioxidant properties. Pauling and Rath also encouraged the inclusion of additional antioxidant vitamins.

This was the last patent that Pauling and Rath would file together. Shortly afterward the two experienced a falling out and Rath left LPISM.  A few months later, on August 19, 1994, Linus Pauling passed away from cancer.

The third patent application was approved and awarded to Pauling and Rath in 1997. The two hadn’t made any profit off of the previous patents to speak of, and research that followed in the later 1990s and after 2000 showed that Vitamin C appeared to have no real effect on Lp(a). The discrepancy between the Pauling-Rath trials and subsequent tests seem to be attributable to the major differences between the two test subjects – humans and guinea pigs. However, other trials have shown that large doses of Vitamin C are useful in fighting cardiovascular disease – for reasons other than Lp(a) levels – and also work to combat stroke, decrease blood pressure and provide other health benefits.

Additional studies in the wake of Pauling and Rath have also revealed the complexity of Lp(a).  The compound is today regarded to be somewhat of a mystery in terms of function, as scientists aren’t very clear on what it does in the human body. Also, “normal” levels of Lp(a) vary massively on an individual basis, a trait that seems to trend along racial lines. As a result, choosing Lp(a) as a target for medication has proven to be extremely difficult.

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Experimenting with Lipoprotein(a)

lpa

[Part 1 of 2]

In the late 1980s into early 1990, Linus Pauling and a colleague, Matthias Rath, worked intensively on the health benefits of Vitamin C and Lipoprotein(a) binding inhibitors. In 1990 they applied for two patents related to that research. The first, applied for in April, was titled “Use of ascorbate and tranexamic acid solution for organ and blood vessel treatment prior to transplantation.” The second, submitted in July, was titled “Prevention and treatment of occlusive cardiovascular disease with ascorbate and substances that inhibit the binding of lipoprotein (A).”

The technique that Pauling and Rath were attempting to patent in April was both a method and a pharmaceutical agent designed to prevent and treat fatty plaque buildup in arteries and organs and also prevent blood loss during surgery by introducing into a patient (or organ) a mixture of ascorbate and lipoprotein(a) [Lp(a)] binding inhibitors, such as tranexamic acid.

Tranexamic acid is a synthetic version of Lysine, and ascorbate is the shortened name for L-ascorbic acid, or more commonly, Vitamin C. Lp(a) is a biochemical compound of lipids and proteins which binds to fibrin and fibrogen in the walls of arteries and other organs, which causes plaque buildup, which in turn often results in atherosclerosis – the thickening and embrittling of arterial walls – and cardiovascular disease (CVD), one of the most common causes of death in the United States. The second patent described effectively the same method, but focused more on CVD and less on surgery.

Pauling and Rath noticed that humans and a select few other animals are the only creatures that suffer from heart attacks and other issues associated with the buildup of plaque in the circulatory system. One common link between all of these creatures is the fact that they do not naturally produce Vitamin C, and therefore must obtain it solely through diet. The duo hypothesized that the cause of Lp(a) buildup was due to a lack of Vitamin C, and that if Vitamin C intake was increased, it would help the body filter out Lp(a) and therefore decrease the amount of Lp(a) in the bloodstream. They decided to run tests on Hartley guinea pigs, since they are one of the few other animals that don’t synthesize their own Vitamin C.

rath

The first test was run on three female guinea pigs, each about a year old and weighing 800 grams. The animals were all fed a diet devoid of ascorbate (e.g., a hypoascorbate diet), and given an injection daily of ascorbate so that Pauling and Rath could easily monitor and control their intake. The first pig was given ascorbate at a ratio equivalent to 1 mg per kilogram of body weight (1 mg/kg BW). The second pig was given 4 mg/kg BW, and the third was given 40 mg/kg BW.

The experiment only lasted three weeks, because Pauling and Rath didn’t want to inflict scurvy upon the guinea pigs. Creatures deprived of Vitamin C for prolonged periods develop scurvy, an incredibly painful condition where the victim becomes lethargic and begins to suffer skin color and texture changes, easy bruising, brittle and painful bones, poor wound healing, neuropathy, fever and eventually death.

The guinea pigs had their blood drawn at the start of the test, then once again after ten days. At the end of three weeks, the animals were anesthetized and euthanized, then dissected. Their results showed that the hypoascorbate guinea pigs had noticeably higher plaque buildup and general amounts of Lp(a) in their bloodstream. Upon closer analysis of the organs and the arterial wall, the researchers discovered that the guinea pigs had also developed lesions along the walls of their arteries, to which Lp(a) was binding even more than normal.

Pauling and Rath then ran a more expansive second test, with a test time of seven weeks and a test group of thirty-three male Hartley guinea pigs, each approximately five months old and weighing 550g. At the outset, the subjects were split into multiple groups. Group A consisted of eight guinea pigs and was given 40 mg/kg BW of ascorbate daily, while Group B consisted of 16 guinea pigs given 2 mg/kg BW daily. At five weeks all of Group A was euthanized and studied, as was half of Group B. The second half of Group B then had their daily dosage increased to 1.3 g/kg BW for two weeks before being euthanized.

Once again, it was observed that the hypoascorbate guinea pigs had developed lesions in their arterial walls and organs, as well as increased plaque buildup and Lp(a) levels. On the same token, the second half of Group B showed decreased levels of Lp(a) in their blood and decreased amounts of plaque after their ascorbate intake was dramatically increased.

Pauling and Rath felt that their research was confirming their hypothesis, and wanted to see how it would function on humans. Their method here was to obtain post-mortem pieces of human arterial wall. They cut the pieces into smaller sections, and for one minute placed a piece weighing 100 mg into a glass potter containing 2.5 ml of a mixture of ascorbate and tranexamic acid. Compared to the other pieces, the portions in the mixture released sizable amount of Lp(a).

This promising data in hand, Pauling and Rath then began to think about patenting and marketing their work.

Formulas, Pictures and Sports Drinks: The Pauling Chalkboard, Part III

Linus Pauling, 1985.

(Part 3 of 3)

While much of the real estate on Linus Pauling’s chalkboard is consumed by lists of names, a number of additional annotations, when examined, prove to be of keen interest.

Metabolic Profiling

On the right side of the board, below the last column of names, is the following text:

NSF – Mol. Str. 21 Mar.

Library 3000 21 Mar.

Aging – NIH Nutrition

American Cancer Society – Dr. Neville

Sample Bank

Mass Spectrometer

Muscular Dystrophy

Aging Patterns in mice

This particular sample of notes relates to the metabolic profiling program carried out for some time at the Linus Pauling Institute of Science and Medicine. As mentioned in part II of this series, a large number of names on the board were involved with the metabolic profiling program, and this particular column of text ties many of the names together. Pauling was working with numerous people from diverse backgrounds and professions. He was in contact with researchers at, among other organizations, the Institute on Aging and the American Cancer Society.

The words “sample bank” refer to urine and blood samples that were to be kept refrigerated for, potentially, decades, and ultimately to be analyzed by mass spectrometry. This particular undertaking was very ambitious, and could have provided a great deal of material for practical study. Unfortunately, the chronically underfunded Institute had trouble with their refrigeration units, and the project was eventually abandoned. (Despite the setbacks, some results of this program of research, headed by Pauling and Arthur Robinson, can be found in articles published at Stanford University as well as in certain of the Institute’s early news releases.)

A New Sports Drink

Another interesting bit of text can be found towards the lower right hand corner of the board:

C + glycine

dextrose

The text is likely the basic outline of a carbonated “sports drink” being worked on by the Institute in the 1980s. The drink was to be infused with vitamins, and the Institute was developing acids that would provide alternative sweeteners. Production and research eventually halted, but it is interesting to think about what may have resulted from a successfully marketed “Paulingaide.”

Vitamin C, Cancer and Heart Disease

The following words, located in the upper right portion of the column ark, have perhaps the most basic and relevant connections to Pauling’s work.

Ascorbate

stimulates

Production of Lymphocytes

The order simply implies that ascorbate, or vitamin C, stimulates the production of lymphocytes, the major cellular components of the body’s immune system. Several studies have shown that increased levels of ascorbate generally correlate with increased levels of lymphocyte production. If nothing else, this is the most centrally relevant theme of Pauling’s work with vitamin C, and the fact that it maintained such a substantial place on his overcrowded board underlines the significance that he himself placed upon it.

In the middle of the board towards its top, is the diagram of a mystery molecule that was crafted by Pauling. Mention of the molecule (given the name “2-azido-5,8-dihydroxy-1,3,4,5,7,9,9b-heptaazaphenalene”) appeared in an article titled “A Prized Collection: Pauling Memorabilia,” published in Chemical and Engineering News in August 2000.

In a 1977 interview, Pauling was asked about his chalkboard and, in particular, about the mystery molecule.  He reponded

I had an idea in the field of organic chemistry about 40 years ago. It involved this unusual compound. Benzine has a six-membered ring of carbon atoms and this compound has three six-membered rings consisting of six carbon atoms and seven nitrogen atoms and then it has these hydroxyl groups attached. It is known that the similar substance with only one ring can be made into certain derivatives that have anti-cancer activity. And I thought that this substance with only three rings might well operate in the same way and that we should study it.

In other words, Pauling was still actively contemplating an idea that had occurred to him 40 years prior – an idea that managed to stay on his chalkboard through his death in 1994. Indeed the mystery molecule exemplifies the function of Pauling’s chalkboard, not only as a mnemonic device, but as a place holder for people and ideas that span decades.

Linus Pauling, 1991.

Left of the mystery molecule towards the top of the board, one finds a series of words written one above the other. The seemingly haphazard placement of the words diverts attention from their historical significance in terms of the latter portion of Linus Pauling’s life.

LDL

Cholesterol

Lipoprotein a

The words almost certainly refer to research that Pauling began supporting in conjunction with a German physician named Matthias Rath, which investigated the possibility of a link between vitamin C and heart disease. Over the final years of his life, Pauling spoke of the relationship between vitamin C and heart disease in much the same way that he talked about vitamin C in terms of colds and cancer.

This writing was likely one of the last times that Pauling touched chalk to his board, as his collaboration with Rath did not develop until the early 1990s. The three words both acknowledge and hide the significance of the interaction between Rath and Pauling – a mercurial relationship for much of its duration.

Sandbox

Beneath an ark of name columns, adorned with the mystery molecule at its pinnacle, is a half-circle filled with pictures, figures and chemistry formulas. This area is likely where Pauling exercised the least concern for preservation, and it is supposed that this area of the board was used to aide in his discussions with visitors to his office. The space likely represents over two decades of personal interactions between Pauling and others, a spot on the board where he could explain theories and manifest abstract ideas. In essence, this half circle is where Pauling used the board in a more traditional sense – writing and erasing as suited his needs.


Linus Pauling’s chalkboard is covered in historical significance. It functioned as an important tool for a very busy man, and has preserved a telling aspect of both the history of the Linus Pauling Institute and the character of Pauling himself, in part reflecting the organization of his consciousness.

 

To be sure, the board is merely a fragment of Linus Pauling and his research, but it is unique and intriguing in a very personal sense. The names, pictures and diagrams on the board all represent important aspects of Pauling’s professional life. Not only does it make a valuable contribution to a room dedicated to the man’s work, it preserves the living memory of Pauling by displaying an intimate demonstration of his method.

Pauling's chalkboard, as preserved in the OSU Libraries Special Collections.