A Randomised, Double-Blind, Placebo Controlled, Dose Ranging Study to Investigate the Safety & Efficacy of Candida Rugosa Lipase on Reduction of Serum Triglyceride

According to the World Health Organization, ischemic heart diseases and stroke were the leading causes of death globally in 2019, accounting for 16% and 11% of the world's total deaths, respectively. The American Heart Association reported in 2020 that approximately 87% of all strokes are ischemic strokes, in which blood flow to the brain is blocked (Virani et al). That blockage is typically caused by an accumulation of fatty deposits inside triglycerides (atherosclerosis). Higher levels of serum triglycerides are linked to an increased risk of ischemic stroke in men and women. Researchers tracked 7,579 women and 6,372 men whose triglyceride and cholesterol measurements were taken in the late 1970s. Subjects were followed for up to 33 years. During the follow-up period, 837 women and 837 men developed ischemic stroke. Both men and women had a higher risk of stroke with high levels of triglycerides, in particular triglyceride levels of 5 mmol/L (443 mg/dL or 5.0 mmol/L) or more. These individuals carried four-fold greater stroke risk than those with lower levels (Varbo et al).

Each of the current treatments for hypertriglyceridemia has negative side effects and therefore many individuals that suffer from this condition decline treatment to reduce stroke risk. Oral supplementation with a fungal lipase preparation from Candida cylindracea (formerly rugosa), commonly found in dietary supplements for digestive health, is a candidate strategy to lower triglycerides without side effects.

During digestion, each of lingual, gastric, and pancreatic lipases combine to remove the outer 2 fatty acids from ingested, dietary triglycerides, thus forming monoglycerides and 2 free fatty acids. Following uptake by intestinal enterocytes, the free fatty acids are re-esterified with the monoglycerides to reform triglycerides before release in to the bloodstream. Overconsumption of dietary fats can thus lead to elevated levels of serum triglycerides.

Candida cylindracea (formerly rugosa) lipase, however, hydrolyzes all three fatty acids from dietary triglycerides to release free fatty acids and the glycerol backbone. It is predicted that most of these free fatty acids and glycerol molecules enter the bloodstream without reformation to triglycerides by the major metabolic pathway to reform the triglycerides from monoglycerides. Nonetheless, an alternate metabolic pathway to generate triglycerides from free fatty acids alone does exist in enterocytes.

The investigators tested the hypothesis that fungal lipase-mediated lowering of dietary monoglycerides would lower serum triglyceride levels in a randomized, double-blind, placebo controlled parallel arm clinical trial of 39 subjects with elevated serum triglyceride levels. Subjects were between 18 and 75 years of age, with good general health and mildly elevated serum triglycerides (150 mg/dL to 500 mg/dL, or 1.7 mmol/L to 5.6 mmol/L). The study included 4 study site visits over a 13 to 16 week period (including baseline period).