Use of baicalein for treating muscle loss
Baicalein induces CYP27B1 expression to enhance vitamin D metabolism, addressing the limitations of supplementation studies and improving muscle health by promoting myotube formation and preventing muscle wasting.
Patent Information
- Authority / Receiving Office
- WO · WO
- Patent Type
- Applications
- Current Assignee / Owner
- THE CHINESE UNIVERSITY OF HONG KONG
- Filing Date
- 2026-01-12
- Publication Date
- 2026-07-23
AI Technical Summary
The inconsistent results from vitamin D supplementation studies and the decline in CYP27B1 expression in elderly individuals highlight the need for a targeted strategy to enhance vitamin D metabolism and prevent muscle wasting in sarcopenia.
The use of baicalein, a natural flavonoid, to induce CYP27B1 expression, thereby enhancing the conversion of 25-hydroxyvitamin D into its active form, 1, 25-dihydroxyvitamin D, promoting myotube formation and improving muscle structure and function.
Baicalein synergistically enhances the effectiveness of vitamin D supplementation by increasing local vitamin D activation, improving muscle repair, and preventing age-related muscle atrophy and functional decline.
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Figure CN2026071856_23072026_PF_FP_ABST
Abstract
Description
USE OF BAICALEIN FOR TREATING MUSCLE LOSSRELATED APPLICATIONS
[0001] This application claims priority to U. S. Provisional Patent Application No. 63 / 745, 265, filed January 14, 2025, the contents of which are hereby incorporated by reference in the entirety for all purposes.BACKGROUND OF THE INVENTION
[0002] The increasing prevalence of muscle wasting, particularly in the elderly, presents a significant public health challenge, often leading to conditions such as sarcopenia. Sarcopenia is characterized by a progressive decline in skeletal muscle mass and strength, which can severely impair mobility and overall quality of life. Vitamin D has emerged as a critical factor in maintaining muscle health, as it plays essential roles in calcium homeostasis, muscle protein synthesis, and cellular function within skeletal muscle tissue. Vitamin D deficiency is prevalent among older adults, contributing to the deterioration of muscle function and increased risk of falls and fractures. Studies have shown that low serum levels of 25-hydroxyvitamin D (25 (OH) D) are significantly associated with sarcopenia and reduced muscle strength. Notably, elderly individuals with insufficient vitamin D levels experience accelerated muscle loss and decreased physical performance, highlighting the need for effective interventions to enhance vitamin D metabolism and utilization.
[0003] Recent randomized controlled trials (RCTs) have focused on vitamin D supplementation for elderly individuals with sarcopenia due to the growing body of evidence linking vitamin D deficiency to muscle health deterioration. However, clinical trials investigating the efficacy of vitamin D supplementation in sarcopenic patients have produced mixed results, often due to variations in study design, dosages, and co-supplementation with other nutrients or exercise interventions. Notably, while some studies report improvements in muscle strength and function with vitamin D supplementation, others fail to demonstrate significant benefits when vitamin D is administered alone or in conjunction with other treatments. This inconsistency underscores the necessity for further research to clarify the role of vitamin D in preventing and treating sarcopenia, particularly in non-deficient populations.
[0004] A critical aspect of vitamin D metabolism is the conversion of 25 (OH) D into its active form, 1, 25-dihydroxyvitamin D (1, 25 (OH) 2D) , primarily through the action of the enzyme CYP27B1 (25-hydroxyvitamin D-1α-hydroxylase) . This enzyme is crucial for regulating calcium and phosphate homeostasis and has been shown to play a significant role in muscle function. In elderly individuals, the expression and activity of CYP27B1 may decline due to age-related factors, leading to insufficient conversion of 25 (OH) D into its active form.
[0005] The proposed invention involves small molecules designed to up-regulate CYP27B1 expression in skeletal muscles, thereby enhancing the effectiveness of vitamin D supplementation for elderly individuals suffering from sarcopenia. By increasing the bioavailability of active vitamin D within skeletal muscle tissues, this innovative approach aims to improve muscle health and combat muscle wasting effectively. This unique mechanism not only addresses the limitations observed in previous supplementation studies but also provides a targeted strategy for optimizing vitamin D metabolism in aging populations. BRIEF SUMMARY OF THE INVENTION
[0006] The present inventors have discovered that baicalein, a natural flavonoid, can induce the expression of CYP27B1, the enzyme responsible for converting 25-hydroxyvitamin D (25(OH) D) into its active form, 1, 25-dihydroxyvitamin D (1, 25 (OH)2D) . This induction creates a synergistic effect when combined with vitamin D or its metabolites, significantly promoting myotube formation and enhancing the myogenesis process in vitro and in vivo in mammalian skeletal muscle, including mouse model of age-related muscle loss. The baicalein-containing compositions disclosed herein provide a novel approach for addressing skeletal muscle atrophy by leveraging the unique ability of baicalein to induce the expression of CYP27B1 in myoblasts and mature myofibers, thereby improving muscle structure and function in mammals. This induction enhances the conversion of 25-hydroxyvitamin D (25(OH) D) into its active form, 1, 25-dihydroxyvitamin D (1, 25 (OH)2D) , thereby synergistically enhancing the effectiveness of vitamin D supplementation in promoting muscle repair upon injury and preventing age-related muscle atrophy and functional decline . By promoting myotube formation and improving muscle performance through this mechanism, baicalein optimizes the local vitamin D metabolic pathway necessary for muscle function, thus maintaining its metabolic activity.
[0007] In a first aspect, the present invention provides a composition that is useful for promoting the proliferation of myoblast cells and differentiation to myotube by leveraging the unique ability of baicalein to induce the expression of CYP27B1, thereby enhancing local vitamin D activation and improving skeletal muscle structure and function in vivo in mammals (e.g., mice, humans and other non-human mammals) . The composition comprises an effective amount of baicalein or a functional derivative thereof; and at least one physiologically acceptable excipient. In some embodiments, the composition further comprises one or more of vitamin D or its functional metabolites, for example, any one or more of cholecalciferol, calcifediol, or calcitriol. In some embodiments, the composition consists essentially of baicalein or a functional derivative thereof and one or more physiologically acceptable excipients. In some embodiments, the composition consists essentially of baicalein or a functional derivative thereof and one or more of 25 (OH) D plus one or more physiologically acceptable excipients. In some embodiments, the weight ratio of baicalein (or a functional derivative thereof) and calcitriol in the composition is between 100: 1 to 1: 100. In some embodiments, the composition as described above and herein targets to promote proliferation and differentiation of myoblast cells located within the body of a recipient (e.g., a person or an animal, especially a mammal) , and to attenuate or prevent skeletal muscle atrophy and functional loss associated with aging, disuse or metabolic disease in such mammals, as evidenced by improvements in muscle fiber cross-sectional area, grip strength and mitochondrial activity in treated mice. In some embodiments, the composition is formulated for oral ingestion, for example, it is in the form of a liquid, tablet or capsule, or fortified in food or beverage item. In some embodiments, the composition as described above and herein is formulated in a daily dosage comprising baicalein or a functional derivative thereof in the amount of about 0.1 to about 1,000 mg / kg bodyweight of the recipient, for example, about 0.1 mg / kg, about 1 mg / kg, about 10 mg / kg, about 100 mg / kg, and about 1 g / kg bodyweight of the recipient.
[0008] In the second aspect, the present invention provides a method for enhancing myogenesis or treating muscle atrophy in a subject (e.g., a person or an animal, especially a mammal) by administering to the subject an effective amount of the composition described above and herein, namely containing an effective amount of baicalein or a functional derivative thereof; and one or more physiologically acceptable excipients, optionally further including one or more of vitamin D or its functional metabolites, wherein such administration induces the upregulation of skeletal muscle CYP27B1 expression, enhances local calcitriol production, and improves muscle mass, strength, and mitochondrial activity as demonstrated in aged mice. In some embodiments, the method comprises administering to the subject (e.g., a person or an animal, especially a mammal) an effective amount of the composition described above and herein, so as to attenuate or prevent skeletal muscle atrophy and functional decline in mammals experiencing age-related, disuse-induced, or disease-associated muscle wasting. In some embodiments, the person is from 11 to 60 years or older. In some embodiments, the person is athletes or sedentary older adults. In some embodiments, the person is at risk for muscle atrophy. In some embodiments, the administering step comprises oral ingestion of the composition, for example, it is in the form of a liquid, tablet or capsule, or as supplement in fortified food or beverage item.
[0009] In a related aspect, the present invention provides a novel use of a composition for improving myogenesis and treating muscle wasting in a person in accordance with the method describe above and herein. The composition, containing an effective amount of baicalein or a functional derivative thereof, one or more physiologically acceptable excipients, optionally further including one or more of vitamin D or its functional metabolites, is use for the manufacturing of a medicament or a supplement for the purpose of treating and / or preventing muscle wasting in a patient (e.g., a human patient or an animal, especially a mammal) , including but not limited to aged mammals in which in vivo administration of the composition has been shown to increase muscle fiber cross-sectional area, enhance grip strength, and promote mitochondrial oxidative capacity. The medicament or supplement may be orally administered, for example, in the form of a liquid, a tablet or a capsule, or as supplement in fortified food or beverage item.
[0010] In a third aspect, the present invention provides a kit for promoting myogenesis by increasing or enhancing proliferation of myoblast cells, which may be present in vitro or in the body of a human or an animal (e.g., a mammal) , and for preventing or treating age-related muscle loss or sarcopenia by up-regulating CYP27B1 expression and thereby enhancing local production of calcitriol in skeletal muscle. The kit comprises a first container containing a composition comprising an effective amount of baicalein or a functional derivative thereof. In some embodiments, the kit further comprises a second container containing a second compositions comprising an effective amount of one or more of vitamin D or its functional metabolites, which serve as substrates for CYP27B1-mediated conversion to calcitriol in extra-renal tissues such as skeletal muscle. In some embodiments, the first and / or second compositions in the kit are formulated for oral ingestion, for example, in the form of a liquid, tablet or capsule, or as supplement in fortified food or beverage item.BRIEF DESCRIPTION OF THE DRAWINGS
[0011] Figure 1. Age-dependent change of Cyp27b1 genes and protein expression. (A) Analysis of Cyp27b1 genes expression in the Gastrocnemius (GA) muscles of C57BL / 6 mice at different ages from 1 month-old (mo) to 29 mo. (B) Analysis of Cyp27b1 protein expression normalized to beta-actin in the GA muscles of C57BL / 6 mice. n=5 per age group. (C) Absolute peak tetanic fore and twitch force of the GA muscles freshly isolated from C57BL / 6 mice at different ages. Quantitative data are presented as mean ± SD. Statistical analyses are performed using one-way ANOVA test, Tukey's multiple comparisons test, with significance set at P<0.05 a represents compared with 1 mo, b represents compared with 3 mo, c represents compared with 6 mo and, d represents compared with 12 mo.
[0012] Figure 2. Deletion of Cyp27b1 in GA muscle impairs myogenic and mitochondrial biogenesis markers, and alters muscle strength in 3 mo C57BL / 6 mice. (A-C) mRNA expression level of Cyp27b1, myogenic markers (Myod1, MyoG, Myf5, Acta1 and Mstn) and mitochondrial biogenesis markers (MuRF1, mt-TFA, Pgc1a and Sirt3) . In male C57BL / 6 mice, GA muscles were collected at day 0 (D0) or day 10 (D10) with (KD) or without (Con) cyp27b1 knockdown by the intramuscular injection of adeno-associated viruses (AAV) . (D) Ex-vivo GA muscle contraction test. N=5 per group. Statistical analyses are performed using one-way ANOVA test, Tukey post-hoc test, with significance set at P<0.05 (*P < 0.05, **P <0.01, ***P < 0.001, and ****P < 0.0001) .
[0013] Figure 3. The intramuscular injection of calcitriol for a 2-week treatment period resulted in significant improvement in various muscle functional parameters. (A) Whole body grip strength were measured every 2 days normalized to body weight. n=13 per group. (B) Rotarod performance test was measured at the end of 2-week treatment. n=6 per group. (C and D) Calcitriol treatment up-regulated myogenic markers in both mRNA and protein expression. Statistical analyses are performed using t-test, with significance set at P<0.05 (*:P<0.05, **: P<0.01, ***: P<0.001, ****: P<0.0001) .
[0014] Figure 4. Luciferase activity assay was used to screen and identify small molecules which could activate or repress the expression of Cyp27b1 and thus potentially promotion of myotube formation in subsequent cellular functional study. (A) Volcano plot indicating the luciferase activity in C2C12 cells upon treatment to various small molecular library. Among, baicalein was found to exhibit the highest activation activity (n=3) . (B) MTT assay was used to determine the cytotoxic effect of three days baicalein treatment on C2C12 cells (n=4) . EC20 and EC80 were determined to indicate the concentration of baicalein which could cause 20%and 80%of cell death, respectively. (C) Baicalein alone was shown to up-regulate the mRNA expression of Cyp27b1 in C2C12 at concentration-dependent manner. Quantitative data are presented as mean ± SD. Statistical analyses are performed using two-way ANOVA test, with significance set at P<0.05 (*: P<0.05, **: P<0.01, ***: P<0.005, ****: P<0.001) .
[0015] Figure 5. Synergistic effect of baicalein and 25 (OH) D on myotube formation and gene expression. (A) Myotube formation in C2C12 myoblasts upon various treatment conditions and MF20 (red) staining indicated myotube formation. (B) mRNA expression levels of Cyp27b1 in C2C12 cells under different treatment conditions. (C-C) mRNA expression levels of myogenic markers (MyoG, Myf5 and Myf6) and mitochondrial biogenesis markers (Pgk1, mt-TFA, Pgc1a and Pgc1β) in C2C12 cells following treatment with baicalein and 25 (OH) D. N=3 Statistical analyses are performed using one-way ANOVA test, Dunnett post-hoc test, with significance set at P<0.05 (*P < 0.05, **P < 0.01, ***P < 0.001, and ****P < 0.0001 indicate significance compared to negative control) .
[0016] Figure 6. Baicalein and its chemical derivatives BGG, 6BG, 7BG, MeBG, BGGlu, 6BS, and 7BS.
[0017] Figure 7. Combination effect of baicalein and control diet on aged mice. (A) Combined treatment of control diet + 10mg / kg baicalein significantly up-regulates cyp27b1 expression (orange line) . (B) Control diet + baicalein significantly improves grip strength and cross-sectional area (CSA) of gastrocnemius muscle. (D) Succinate dehydrogenase (SDH) staining reveals remarkable increased mitochondrial activity in both gastrocnemius (GA) and tibialis anterior (TA) muscles upon the combined treatment of control diet + baicalein. (E) D-loop and MT-ND1 are components of mitochondrial genome. Control diet + baicalein significantly up-regulates their mRNA expression in TA (right) muscles. N=3-5 per group. Statistical analyses are performed using one-way ANOVA test, Dunnett post-hoc test, with significance set at P<0.05 (*P < 0.05, **P < 0.01, ***P < 0.001, and ****P < 0.0001 indicate significance) . DEFINITIONS
[0018] As used herein, the term “baicalein” refers to a naturally occurring flavonoid, which is chemically known as 5, 6, 7-trihydroxyflavone. Baicalein exhibits a chemical structure shown below and is derived from the fundamental framework of 2-phenyl chromen-4-one (also known as 2-phenyl-1-benzopyran-4-one) , for example, following hydroxylation of baicalin to yield a biologically active aglycone. In addition to baicalein, its functional derivatives such as those shown in Figure 5 are also useful for the present invention.
[0019] The term “muscle wasting” or “muscle atrophy” is used in this disclosure to refer to the loss of skeletal muscle tissues in a person’s body as measured by the weakening of muscle strength and loss of muscle volume. Muscle wasting may be caused by a variety of diseases and conditions, such as (1) muscular Dystrophy: a group of genetic disorders characterized by progressive muscle weakness and degeneration, including: Duchenne Muscular Dystrophy; Becker Muscular Dystrophy; Facioscapulohumeral Muscular Dystrophy; Limb-Girdle Muscular Dystrophy; and Myotonic Dystrophy. (2) Sarcopenia: a condition characterized by age-related loss of muscle mass, strength, and function. (3) Cachexia: a severe wasting syndrome often associated with chronic diseases, such as cancer, AIDS, or chronic obstructive pulmonary disease (COPD) . (4) Neuromuscular Junction Disorders: conditions affecting the transmission of signals between muscles and nerves, such as Myasthenia Gravis and Lambert-Eaton Myasthenic Syndrome. (5) Peripheral Nerve Diseases: conditions affecting the motor and sensory nerves, leading to impaired sensations, movement, or other functions. (6) Motor Neuron Diseases: conditions characterized by progressive degeneration of motor neurons, leading to muscle weakness and paralysis, such as Amyotrophic Lateral Sclerosis (ALS) . (7) Muscle Atrophy: a condition characterized by the wasting or loss of muscle tissue, such as Physiologic Atrophy (due to disuse or inactivity) ; Pathologic Atrophy (due to disease, injury, or malnutrition) ; Neurogenic Atrophy (due to nerve damage or disease) . (8) Other Conditions: conditions that may involve muscle wasting as a symptom, such as Musculoskeletal disorders (e.g., polymyositis, dermatomyositis) ; Endocrine disorders (e.g., hypothyroidism, Cushing’s syndrome) ; and Metabolic disorders (e.g., diabetes, kidney disease) .
[0020] “Vitamin D” is a group of fat-soluble secosteroids supporting numerous biological functions. For humans, the most significant compounds within this group are vitamin D3 (cholecalciferol) and vitamin D2 (ergocalciferol) . Cholecalciferol is converted in the liver to calcifediol (also known as calcidiol or 25-hydroxycholecalciferol) , while ergocalciferol is converted to ercalcidiol (25-hydroxyergocalciferol) . These two vitamin D metabolites, collectively referred to as 25-hydroxyvitamin D or 25 (OH) D, are measured in serum to assess a person's vitamin D status. Calcifediol is further hydroxylated by the kidneys and certain immune cells to form calcitriol (1, 25-dihydroxycholecalciferol) or 1, 25 (OH) 2D, the biologically active form of vitamin D. The compounds mentioned above are collectively referred to as “vitamin D or its functional metabolites. ”
[0021] The term "inhibiting"or "inhibition, "as used herein, refers to any detectable negative effect on a target biological process, such as RNA / protein expression of a target gene, the biological activity of a target protein, cellular signal transduction, cell proliferation, presence / level of an organism especially a micro-organism, any measurable biomarker, bio-parameter, or symptom in a subject, and the like. Typically, an inhibition is reflected in a decrease of at least 10%, 20%, 30%, 40%, 50%, 60%, 70%, 80%, 90%or greater in the target process, or any one of the downstream parameters of the target process, when compared to a control. “Inhibition” further includes a 100%reduction, i.e., a complete elimination, prevention, or abolition of a target biological process or signal. The other relative terms such as “suppressing, ” “suppression, ” “reducing, ” and “reduction” are used in a similar fashion in this disclosure to refer to decreases to different levels (e.g., at least 10%, 20%, 30%, 40%, 50%, 60%, 70%, 80%, 90%or greater decrease compared to a control level) up to complete elimination of a target biological process or signal. On the other hand, terms such as “activate, ” “activating, ” “activation, ” “increase, ” “increasing, ” “promote, ” “promoting, ” “enhance, ” “enhancing, ” or “enhancement” are used in this disclosure to encompass positive changes at different levels (e.g., at least about 5%, 10%, 20%, 30%, 40%, 50%, 60%, 70%, 80%, 90%, 100%, 200%, or greater such as 3, 5, 8, 10, 20-fold increase compared to a control level in a target process, signal, or parameter.
[0022] As used herein, the term "treatment"or "treating"includes both therapeutic and preventative measures taken to address the presence of a disease or condition or the risk of developing such disease or condition at a later time. It encompasses therapeutic or preventive measures for alleviating ongoing symptoms, inhibiting or slowing disease progression, delaying of onset of symptoms, or eliminating or reducing side-effects caused by such disease or condition. A preventive measure in this context and its variations do not require 100%elimination of the occurrence of an event; rather, they refer to a suppression or reduction in the likelihood or severity of such occurrence or a delay in such occurrence.
[0023] The term “severity” of a disease refers to the level and extent to which a disease progresses to cause detrimental effects on the well-being and health of a patient suffering from the disease, such as short-term and long-term physical, mental, and psychological disability, up to and including death of the patient. Severity of a disease can be reflected in the nature and quantity of the necessary therapeutic and maintenance measures, the time duration required for patient recovery, the extent of possible recovery, the percentage of patient full recovery, the percentage of patients in need of long-term care, and mortality rate.
[0024] A “patient” or “subject” receiving the composition or treatment method of this invention is a human, including both adult and juvenile human, of any age, gender, and ethnic background, who may or may not have been diagnosed with any particular disease or disorder (e.g., may or may not have received a positive diagnosis of a disease involving muscle atrophy) but is in need of enhancing skeletal muscle strength or volume (e.g., to treat, prevent, or reverse muscle atrophy, and / or to reduce or eliminate risk for muscle atrophy) . Typically, the patient or subject receiving treatment according to the method of this invention to improve muscle strength / volume or to treat muscle wasting is not otherwise in need of treatment by the same therapeutic agent (s) . For example, if a subject is receiving the therapeutic composition according to the claimed method, the subject is not suffering from any disease that was previously known to be treated by the same therapeutic agents. Although a patient may be of any age, in some cases the patient is at least 40, 45, 50, 55, 60, 65, 70, 75, 80, or 85 years of age; in some cases, a patient may be between 40 and 45 years old, or between 50 and 65 years of age, or between 65 and 85 years of age. A “child” subject is one under the age of 18 years, e.g., about 5-17, 9 or 10-17, or 12-17 years old, including an “infant, ” who is younger than about 12 months old, e.g., younger than about 10, 8, 6, 4, or 2 months old, whereas an “adult” subject is one who is 18 years or older. In some cases, a patient may be suffering from muscle wasting due to immobility from a physical injury (e.g., neurological damage) or its related medical treatment (e.g., prolonged hospitalization) , even though it is not age-related (e.g., patient being under the age of 40 years) .
[0025] The term “effective amount, ” as used herein, refers to an amount that produces intended (e.g., therapeutic or prophylactic) effects for which a therapeutic agent is administered. The effects include the prevention, correction, or inhibition of progression of the symptoms of a particular disease / condition and related complications to any detectable extent, e.g., incidence of disease, morbidity or mortality rate, level of loss in muscle strength or volume. The exact amount will depend on the purpose of the treatment, and will be ascertainable by one skilled in the art using known techniques (see, e.g., Lieberman, Pharmaceutical Dosage Forms (vols. 1-3, 1992) ; Lloyd, The Art, Science and Technology of Pharmaceutical Compounding (1999) ; and Pickar, Dosage Calculations (1999)) .
[0026] The term “about” when used in reference to a given value denotes a range encompassing ±10%of the value.
[0027] A "pharmaceutically acceptable"or "pharmacologically acceptable"excipient is a substance that is not biologically harmful or otherwise undesirable, i.e., the excipient may be administered to an individual along with a bioactive agent without causing any undesirable biological effects. Neither would the excipient interact in a deleterious manner with any of the components of the composition in which it is contained.
[0028] The term "excipient"refers to any essentially accessory substance that may be present in the finished dosage form of the composition of this invention. For example, the term "excipient"includes vehicles, binders, disintegrants, fillers (diluents) , lubricants, glidants (flow enhancers) , compression aids, colors, sweeteners, preservatives, suspending / dispersing agents, film formers / coatings, flavors and printing inks.
[0029] The term “consisting essentially of, ” when used in the context of describing a composition containing an active ingredient or multiple active ingredients, refer to the fact that the composition does not contain other ingredients possessing any similar or relevant biological activity of the active ingredient (s) or capable of enhancing or suppressing the activity, whereas one or more inactive ingredients such as physiological or pharmaceutically acceptable excipients may be present in the composition. For example, a composition consisting essentially of active agents (for instance, a combination of baicalein and one of vitamin D or its functional metabolites, such as cholecalciferol, calcifediol, or calcitriol) effective for enhancing myogenesis or treating muscle atrophy in a subject is a composition that does not contain any other agents that may have any detectable positive or negative effect on the same target process (e.g., myoblast cell proliferation or myogenesis) or that may increase or decrease to any measurable extent of the muscle wasting severity among the receiving subjects.DETAILED DESCRIPTION OF THE INVENTIONI. Introduction
[0030] Most adult humans achieve peak muscle mass sometime during their early 40s. After that point, a gradual deterioration begins. The progressive loss of skeletal muscle mass that accompanies aging (sarcopenia) and disease (cachexia) can impair muscle performance, physical function and whole-body metabolism. The declines in physical function and mobility associated with sarcopenia and cachexia can lead to falls, loss of independence, institutionalization, and even death. Given the severity of these outcomes, current research seeks to gain a better understanding of the biology of sarcopenia and cachexia and initiate development of therapeutic interventions to prevent, slow, or reverse their progression. The biological mechanisms underlying sarcopenia and cachexia are not well-understood, although multiple factors have been established to play a role, including age-associated hormone changes, sex steroids, physical inactivity, inflammation, and comorbid conditions such as heart failure, cancer, and diabetes. Among these mechanisms, mitochondrial dysfunction has emerged as a central factor. Mitochondria play a vital role in energy production and cellular homeostasis, and their decline in function is closely linked to muscle deterioration. Concurrently, vitamin D, a nutrient essential for bone health, has been shown to significantly influence muscle metabolism and mitochondrial function. Mitochondrial Dysfunction in muscle atrophy
[0031] Previous clinical and preclinical animal studies demonstrated links between increased mitochondrial damage and poor skeletal muscle health [1-3] . Mitochondrial dysfunction refers to abnormalities or impairments in mitochondrial function, which can occur due to various factors such as aging, genetic mutations, vitamin D deficiencies, oxidative stress, or certain diseases. When mitochondria are dysfunctional, they are less efficient in producing ATP, the primary energy source that empower muscle contraction and enables various cellular processes. The reduction in ATP production due to mitochondrial dysfunction hampers energy-dependent processes essential for muscle contraction, such as the cycling of actin and myosin cross-bridges [4] . This can lead to muscle weakness, fatigue, and a reduced ability to generate force. Clinical studies have corroborated these findings. Choi et al. used 31P magnetic resonance spectroscopy and found that reduced mitochondrial oxidative capacity was associated with slower gait speed in older adults from the Baltimore Longitudinal Study of Aging, highlighting the link between mitochondrial impairment and physical function decline [5] . Another study from the same cohort by Tian et al. demonstrated that muscle mitochondrial energetics predicted mobility decline in well-functioning older adults [6] . The decreased ATP production can also impair muscle regeneration by affecting the rate of protein synthesis [7, 8] .
[0032] Mitochondrial dysfunction has been implicated as a key contributor to muscle atrophy, including the age-related loss of muscle mass and strength observed in sarcopenia. Clinical studies have provided evidence linking mitochondrial impairments to increased oxidative stress, oxidative damage to cellular components, and activation of proteolytic pathways that drive muscle atrophy. Mecocci et al. reported age-dependent increases in markers of oxidative damage to DNA 8-hydroxy-2'-deoxyguanosine (8-OHdG) , lipids (MDA) , and proteins (protein carbonyls) in human muscle biopsies, with the DNA and lipid damage markers being significantly correlated. These findings suggest a role for oxidative stress and damage in contributing to age-related muscle deterioration [9] . Further clinical evidence comes from Pansarasa et al., who observed age-related decreases in antioxidant enzymes like superoxide dismutase (SOD) and increases in oxidative stress markers like lipid peroxidation and oxidized glutathione levels in human muscle samples across different age groups ranging from 17 to 91 years. The accumulation of oxidative damage was more pronounced in elderly males, indicating potential sex differences in susceptibility to oxidative stress-induced muscle aging
[0010] . Collectively, these clinical studies demonstrate that mitochondrial dysfunction and the consequent increase in ROS production can lead to oxidative damage of cellular components like DNA, lipids, and proteins in skeletal muscle. This oxidative stress likely contributes to muscle atrophy by dysregulating proteolytic pathways and impairing muscle regenerative capacity. The Role of Vitamin D in Muscle Health
[0033] Recently, there has been a growing interest in the role of vitamin D as a critical factor in mitigating sarcopenia, highlighting its potential to enhance muscle strength and function, making it a key area of research in this field. Numerous studies have established a significant correlation between low serum vitamin D levels and an increased risk of sarcopenia. For instance, a paired case-control study indicated that vitamin D deficiency (defined as serum 25 (OH) D < 20 ng / mL) was associated with a sevenfold increase in the risk of sarcopenia among community-dwelling older adults (OR = 7.75, 95%CI: 1.96–30.71)
[0011] . This relationship underscores the need for further investigation into the mechanisms by which vitamin D influences muscle health.
[0034] Vitamin D plays a crucial role in the body and has pleiotropic effects, particularly in maintaining skeletal muscle health and function. While it is primarily known for its impact on bone health, emerging evidence suggests that it also significantly influences muscle metabolism and performance. Vitamin D is a fat-soluble vitamin that exists in two major forms: D2 (ergocalciferol) and D3 (cholecalciferol) . The body's conversion of vitamin D to its active form involves two key enzymatic steps: 25-hydroxylation in the liver, primarily by CYP2R1, and 1α-hydroxylation by the enzyme CYP27B1 in the kidneys and other tissues, including skeletal muscle. CYP27B1 is critical for converting the inactive form of vitamin D (calcidiol) into its active form (calcitriol) . This enzyme is not only present in the kidneys but also in various tissues, including skeletal muscle, where it plays a role in local vitamin D metabolism. The expression of CYP27B1 in muscle cells enables them to produce active vitamin D locally, which can then influence muscle function and metabolism directly, suggesting an autocrine / paracrine signaling mechanism. Prevalence of Vitamin D Deficiency in the Elderly
[0035] Studies have shown that vitamin D is associated with muscle strength, mass, and overall physical performance. Vitamin D deficiency is now recognized as a world-wide problem and can lead to various symptoms and health problems
[0012] . Vitamin D deficiency has been associated with increased risk of various chronic conditions like osteoporosis, cancer, autoimmune diseases, and cardiovascular diseases, highlighting its importance beyond bone health [13-15] . Given its significant role in muscle health, vitamin D supplementation has been explored as a potential intervention to improve muscle function and combat sarcopenia. Despite the established role of vitamin D in muscle health, randomized controlled trials (RCTs) have produced conflicting results regarding the efficacy of 25 (OH) D supplementation. Some studies report beneficial effects on muscle strength and function, while others indicate minimal or no significant improvements.
[0036] Two observational studies generally report vitamin D deficiency may exacerbate muscle atrophy / weakness in elderly subjects [16, 17] . A systematic review and meta-analysis of randomized controlled trials of RCTs by Sist er al. found that there is not a statistically significant effect of vitamin D supplementation on improving maximum strength and power in 436 young athletes from 11 years old to 27 years old
[0018] . A review shown interventional studies suggest that frail, elderly subjects may benefit from vitamin D supplementation by displaying reduced falls, improved muscle function and increased muscle fibre size
[0019] . A systematic review and meta-analysis of RCTs by Beaudart et al. found that vitamin D supplementation resulted in a small but significant improvement in global muscle strength in people aged 65 years or older. However, no significant effects were observed on muscle mass or power
[0020] . The study by Hangelbroek et al. found no effect of vitamin D supplementation on the skeletal muscle transcriptome (gene expression) in vitamin D deficient frail older adults
[0021] . A review by Girgis et al. mentions that a meta-analysis found vitamin D supplementation did not consistently improve measures of muscle strength like grip strength or back muscle strength in postmenopausal women; however, some studies showed vitamin D supplementation improved muscle strength, especially in those with severe deficiency (<30 ng / mL)
[0022] . The Lancet article states that vitamin D supplementation among people with prediabetes has the potential to prevent the onset of sarcopenia via increasing skeletal muscle volume and strength, which might lead to a substantial risk reduction of falls
[0023] . The task force, International Clinical Practice Guidelines for Sarcopenia (ICFSR) , found insufficient evidence to recommend vitamin D supplementation alone for treating sarcopenia in older adults, despite its association with low muscle mass and strength. While some trials showed benefits when combined with other interventions, the overall evidence was graded as very low certainty due to ambiguous results and small sample sizes
[0024] . To summarize, inconsistent and often conflicting evidence from clinical trials evaluating the effects of vitamin D supplementation on muscle health and physical function highlights critical gaps in our understanding of vitamin D metabolism and action within skeletal muscle. While some studies report benefits in improving muscle strength, mass, and performance, particularly in deficient individuals, others show no significant effects. The Role of CYP27B1 in Vitamin D Metabolism
[0037] The metabolism of vitamin D involves several key enzymes, one of which is CYP27B1 (cytochrome P450 27B1) . This enzyme plays a critical role in converting inactive forms of vitamin D into its active form, calcitriol (1, 25-dihydroxyvitamin D) . Calcitriol is responsible for mediating many of the physiological effects attributed to vitamin D, including those related to muscle health.
[0038] In older adults, the expression and activity of CYP27B1 are often diminished. This reduction can further exacerbate vitamin D deficiency by impairing the conversion process necessary for producing active vitamin D. Consequently, even if an elderly individual has adequate levels of dietary or supplemental vitamin D, low CYP27B1 activity may prevent sufficient conversion to calcitriol. This situation creates a vicious cycle: inadequate active vitamin D leads to impaired muscle function and strength while simultaneously promoting further decline in CYP27B1 expression due to reduced physical activity and other age-related factors. Interplay Between Vitamin D and Mitochondrial Function
[0039] Vitamin D plays a crucial role in maintaining skeletal health and calcium homeostasis, but emerging evidence suggests that it may also have effects on mitochondrial function. Mitochondrial dysfunction has been implicated in various diseases and aging processes. Studies have suggested that vitamin D may influence mitochondrial function through several mechanisms, including regulation of mitochondrial functions [25-27] , antioxidant defense
[0028] , and calcium homeostasis. Emerging evidence suggests that vitamin D influence the expression of genes regulating mitochondrial biogenesis, impacting mitochondrial respiratory chain activity and overall cellular energy production
[0026] . Studies have shown that vitamin D deficiency is associated with impaired mitochondrial oxidative function and reduced mitochondrial biogenesis markers in skeletal muscle and further associated with muscle atrophy [27, 29] . Previous study showed that vitamin D could stimulate the expression of genes and transcription factors involved in mitochondrial biogenesis, such as PGC-1α and nuclear respiratory factors (NRFs) , promoting mitochondrial health in skeletal muscle dysfunction in patients with COPD
[0030] . Furthermore, administration of active form of vitamin D (calcitriol) could regulate mitochondrial function, dynamics, and enzyme function, which are likely to influence muscle strength
[0031] . Furthermore, vitamin D enhances the expression of enzymes involved in oxidative phosphorylation, crucial for ATP synthesis. [32, 33] . Overall, preventing vitamin D deficiency may help maintain muscle performance and reduce the risk of muscle-related diseases like sarcopenia. Further research is needed to clarify the interplay between vitamin D metabolism, mitochondrial function, and related pathways. The Vicious Cycle of Sarcopenia and Vitamin D Deficiency
[0040] The interplay between sarcopenia and mitochondrial dysfunction creates a vicious cycle that significantly impacts elderly individuals' quality of life. As sarcopenia progresses, Cyp27b1 levels tend to decline. This reduction further limits vitamin D synthesis while also contributing to lower levels of circulating vitamin D. Additionally, compromised mitochondrial function leads to increased oxidative stress within muscles, which can further impair muscle regeneration and repair processes. The accumulation of damaged mitochondria not only affects energy production but also triggers inflammatory responses that can exacerbate muscle degradation over time. As this cycle continues unchecked, older adults may experience accelerated declines in strength and mobility, increasing their vulnerability to falls and other health complications. Potential Interventions: Up-Regulating CYP27B1 Expression
[0041] Given the critical role that CYP27B1 plays in converting inactive vitamin D into its active form-and its diminished expression in older adults-researchers are exploring potential interventions aimed at enhancing CYP27B1 activity. We are the first to discover small molecules that act as CYP27B1 inducers, which could significantly improve the effectiveness of both dietary and supplemental vitamin D in elderly individuals suffering from muscle wasting. By increasing the expression or activity of CYP27B1, these small molecules could enhance the effectiveness of both dietary and supplemental vitamin D for elderly individuals suffering from sarcopenia. Improved conversion rates would lead to higher levels of active vitamin D within the body, potentially reversing some aspects of sarcopenia by promoting muscle protein synthesis and improving overall muscle function. Preclinical studies have shown encouraging results regarding compounds that can modulate CYP27B1 expression. These findings suggest that targeted therapies could provide a novel strategy for addressing vitamin D deficiency-related sarcopenia among older adults.
[0042] This invention describes the use of baicalein, optionally in further combination with another active ingredient (such as one of vitamin D or its functional metabolites) , for enhancing myogenesis and therefore treating skeletal muscle atrophy in a subject, especially when the subject is a human being suffering from a condition involving muscle wasting, including advanced aging and various debilitating diseases. The practical use of the invention includes development and manufacturing of commercial food products or health supplements, for example, it is in the form of a liquid, tablet or capsule, or as supplement in fortified food or beverage item, especially in connection with other myogenesis-promoting efforts at or around the same time. II. Pharmaceutical Compositions and Administration
[0043] The present invention provides pharmaceutical compositions comprising an effective amount of baicalein, optionally in further combination with one or more of vitamin D or its functional metabolites for enhancing myogenesis in a person to reduce the risk and ill effects of muscle wasting such as sarcopenia among the older population. Pharmaceutical compositions of the invention are suitable for use in a variety of drug delivery systems. Suitable formulations for use in the present invention are found in Remington's Pharmaceutical Sciences, Mack Publishing Company, Philadelphia, PA, 17th ed. (1985) . For a brief review of methods for drug delivery, see, Langer, Science 249: 1527-1533 (1990) .
[0044] The pharmaceutical compositions of the present invention can be administered by various routes, e.g., systemic administration via oral ingestion. The preferred route of administering the pharmaceutical compositions is oral administration at daily doses of about 5 mg to about 100 grams baicalein, optionally in combination with one or more of vitamin D or its functional metabolites (such as cholecalciferol, calcifediol, or calcitriol) at a weight ratio of about 1, 10, 100, 500, 1000 (baicalein) to about 1 (vitamin D) . Baicalein and the one or more of vitamin D or its functional metabolites are administered to the subject either in one single composition or in multiple compositions. Typically, baicalein and vitamin D / its functional metabolite may be present in the composition in the weight ratio of about 1, 10, 100, 200, 500, 1,000, or up to 2,000 to 1. Additionally, the composition (s) may be formulated in a daily dosage format comprising baicalein in the amount ranging from about 0.05 to about 5,000 mg / kg, about 0.1 to about 2, 500 mg / kg, about 1 to about 200 mg / kg, or about 2 to about 100 mg / kg bodyweight of the subject. For example, baicalein may be present in the amount of about 1 mg to about 5 grams, about 10 mg to about 2 grams, about 100 mg to about 1 gram, in a daily administered dose, at about 0.1, 1, 10, 100, or 1,000 mg / kg recipient bodyweight. The appropriate dose may be administered in a single daily dose or as divided doses presented at appropriate intervals, for example as two, three, four, or more subdoses per day. The duration of administration may range from about 2 months to about 60 months, e.g., about 6 months to about 24 months, following the diagnosis of a disease or condition involving muscle wasting, and can be for the remainder of a patient’s life.
[0045] For preparing pharmaceutical compositions containing baicalein, optionally in combination with a vitamin D or a functional metabolite baicalein (such as cholecalciferol, calcifediol, or calcitriol) , one or more inert and pharmaceutically acceptable carriers are used. The pharmaceutical carrier can be either solid or liquid. Solid form preparations include, for example, powders, tablets, dispersible granules, capsules, cachets, and suppositories. A solid carrier can be one or more substances that can also act as diluents, flavoring agents, solubilizers, lubricants, suspending agents, binders, or tablet disintegrating agents; it can also be an encapsulating material.
[0046] In powders, the carrier is generally a finely divided solid that is in a mixture with the finely divided active component, e.g., baicalein, optionally in combination with one or more of vitamin D or its functional metabolites (such as cholecalciferol, calcifediol, or calcitriol) . In tablets, the active ingredient is mixed with the carrier having the necessary binding properties in suitable proportions and compacted in the shape and size desired.
[0047] For preparing pharmaceutical compositions in the form of a cream, paste, ointment, or powder for topical application, a low-melting wax such as a mixture of fatty acid glycerides and cocoa butter is first melted and the active ingredient is dispersed therein by, for example, stirring. The molten homogeneous mixture is then poured into convenient-sized molds and allowed to cool and solidify.
[0048] Powders and tablets preferably contain between about 5%to about 100%by weight of the active ingredient (s) (e.g., baicalein, optionally in combination with one or more of vitamin D or its functional metabolites, such as cholecalciferol, calcifediol, or calcitriol) . Suitable carriers include, for example, magnesium carbonate, magnesium stearate, talc, lactose, sugar, pectin, dextrin, starch, tragacanth, methyl cellulose, sodium carboxymethyl cellulose, a low-melting wax, cocoa butter, and the like.
[0049] The pharmaceutical compositions can include the formulation of the active ingredient (s) e.g., baicalein, optionally in combination with one or more of vitamin D or its functional metabolites, such as cholecalciferol, calcifediol, or calcitriol, with encapsulating material as a carrier providing a capsule in which the active ingredient (s) (with or without other carriers) is surrounded by the carrier, such that the carrier is thus in association with the active ingredient (s) . In a similar manner, sachets can also be included. Tablets, powders, sachets, and capsules can be used as solid dosage forms suitable for oral administration.
[0050] Liquid pharmaceutical compositions include, for example, solutions suitable for oral administration or local delivery, suspensions, and emulsions suitable for oral administration. Sterile water solutions of the active component (e.g., baicalein, optionally in combination with one or more of vitamin D or its functional metabolites) or sterile solutions of the active component in solvents comprising water, buffered water, saline, PBS, ethanol, or propylene glycol are examples of liquid or semi-liquid compositions suitable for oral administration or local delivery such as by way of topical application. Typically, the compositions may contain pharmaceutically acceptable auxiliary substances as required to approximate physiological conditions, such as pH adjusting and buffering agents, tonicity adjusting agents, wetting agents, detergents, and the like.
[0051] Sterile solutions can be prepared by dissolving the active component (e.g., baicalein, optionally in combination with one or more of vitamin D or its functional metabolites, such as cholecalciferol, calcifediol, or calcitriol) in the desired solvent system, and then passing the resulting solution through a membrane filter to sterilize it or, alternatively, by dissolving the sterile active component in a previously sterilized solvent under sterile conditions. The resulting aqueous solutions may be packaged for use as is, or lyophilized, the lyophilized preparation being combined with a sterile aqueous carrier prior to administration. The pH of the preparations typically will be between 3 and 11, more preferably from 5 to 9, and most preferably from 7 to 8.
[0052] Single or multiple administrations of the compositions can be carried out with dose levels and pattern being selected by the treating physician. In any event, the pharmaceutical formulations should provide a quantity of an active agent sufficient to effectively enhance the myogenesis process and therefore to stop, prevent, or reverse muscle wasting as well as it undesirable effects on a patient.
[0053] The baicalein-containing composition of this invention is effective for treating muscle atrophy caused by a variety of physiological or pathological conditions, including aging, diseases, or injuries. In addition to sarcopenia, the conditions may be treated include muscular dystrophy, cachexia, neuromuscular junction disorders, peripheral nerve diseases, motor neuron diseases, muscle atrophy, and miscellaneous conditions stemmed from various musculoskeletal disorders, endocrine disorders, and metabolic disorders. On the other hand, the patient receiving the baicalein-based therapeutic composition for treating muscle wasting is not otherwise in need of baicalein treatment such as for treating cancer, a microbial (e.g., viral, bacterial, or fungal) infection, chronic metabolic disorder (such as metabolic syndrome and type II diabetes) , respiratory disease (such as asthma, acute lung injury, and pulmonary fibrosis) , inflammatory condition (such as colitis and allergy including food allergy) , cardiovascular disease (such as atherosclerosis, myocardial fibrosis, and myocardial ischemia) , age-related neurodegenerative disorder (including for improving learning ability, memory performance, and / or cognitive deficiency) , and cerebral ischemia-reperfusion injury. III. Additional Therapeutic Agents
[0054] Additional known therapeutic agent or agents may be used in combination with an active agent such as baicalein, optionally further in combination with one or more of vitamin D or its functional metabolites (such as cholecalciferol, calcifediol, or calcitriol) , in the practice of the present invention for the purpose of enhancing myogenesis and therefore treating muscle loss among patients suffering from or at risk for a relevant condition such as sarcopenia. In such applications, one or more of these previously known effective prophylactic / therapeutic agents can be administered to patients concurrently with an effective amount of the active agent (s) either together in a single composition or separately in two or more different compositions.
[0055] For example, drugs and supplements that are known to be effective for use to prevent or treat muscle wasting include vitamin D (its functional metabolites) , selenium, magnesium, omega-3 fatty acids, and a high protein diet. Also, appropriate physical therapy and regular exercise, especially weight-bearing / resistance exercise and aerobic exercise, are effective for preventing, slowing, or reversing the loss of skeletal muscle strength and volume. These remedies may be used in combination with the active agents (such as baicalein, optionally in combination with one or more of vitamin D or its functional metabolites, such as cholecalciferol, calcifediol, or calcitriol) of the present invention to enhance the effectiveness of a treatment plan to address muscle atrophy so as to reduce or eliminate an individual’s risk of suffering from bad outcomes such as impaired bodily functions, reduced quality of life, susceptibility to hospitalization, and higher mortality. Thus, these known drug / supplement or nutritheutical compositions can be used in the method of this invention along with the active component of baicalein, optionally together with a vitamin D or one of its functional metabolites, e.g., cholecalciferol, calcifediol, or calcitriol. IV. Kits
[0056] The invention also provides kits for promoting myoblast cell proliferation and myogenesis, thus effective for treating an individual for muscle atrophy or reducing the risk of muscle atrophy, according to the methods disclosed above and herein. Typically, the kit includes a first container containing a first composition, which comprises an effective amount of baicalein. Often, the kit includes a plurality of containers, which in addition to the first container also include a second container containing a composition comprising an effective amount of one or more of vitamin D or its functional metabolites, such as cholecalciferol, calcifediol, or calcitriol. Optionally, additional container (s) may be included in the kit providing composition (s) comprising one or more of known therapeutics, supplements, or nutritheutical compositions, for example, selenium, magnesium, omega-3 fatty acids, and the like. The plurality of containers of the kit each may contain a different active agent / drug or a distinct combination of two or more of the active agents or drugs. The compositions in the kit are typically formulated for oral administration, often in daily dosages. In some cases, the composition may be presented in the form of food or beverage additives and can be consumed by patients with their food or drinks. The kit may further include informational material providing instructions on how to dispense the pharmaceutical composition (s) , including description of the type of patients who may be treated (e.g., human patients who have been diagnosed or deemed as with high risk of suffering from a disease or condition leading to skeletal muscle wasting, for example, due to advanced aging or a distinct disease or physical injury, but have not received a diagnosis of any condition / disease previously known as treatable by baicalein) , the dosage, frequency, and manner of administration, and the like. EXAMPLES
[0057] The following examples are provided by way of illustration only and not by way of limitation. Those of skill in the art will readily recognize a variety of non-critical parameters that could be changed or modified to yield essentially the same or similar results. Using Baicalein as a CYP27B1 Inducer in Combination with 25 (OH) D3 to Treat Sarcopenia in Older Adults
[0058] Sarcopenia, the age-related decline in muscle mass and strength, poses significant health risks for older adults, including increased frailty and a higher likelihood of falls. Recent research has highlighted the role of vitamin D in muscle health, particularly through its active form, calcitriol, which is produced by the enzyme CYP27B1. Given that CYP27B1 expression often decreases with age, enhancing its activity presents a promising strategy for addressing sarcopenia.
[0059] Baicalein, a flavonoid derived from the Scutellaria baicalensis plant, has been identified as a potential inducer of CYP27B1. By up-regulating CYP27B1 expression in skeletal muscle tissues, baicalein can enhance the conversion of 25-hydroxyvitamin D (25(OH) D3) into its active form. This increased conversion may lead to elevated levels of active vitamin D, promoting muscle protein synthesis and improving overall muscle function.
[0060] Research indicates that vitamin D deficiency is closely associated with impaired mitochondrial function and reduced muscle mass in older adults. Studies using Cyp27b1 global knockout mice have demonstrated that the absence of this enzyme results in decreased muscle mass and grip strength
[0034] , underscoring the importance of CYP27B1 in maintaining muscle integrity. Furthermore, vitamin D deficiency leads to oxidative stress and cellular senescence in skeletal muscle, contributing to sarcopenia. Baicalein’s ability to induce CYP27B1 expression may counteract these detrimental effects by enhancing mitochondrial biogenesis and function.
[0061] Vitamin D has been shown to stimulate the expression of genes involved in mitochondrial health, such as PGC-1α and nuclear respiratory factors (NRFs) , which are essential for energy production and muscle function. By improving mitochondrial activity through increased levels of active vitamin D, baicalein may help mitigate the decline in muscle performance associated with aging. The combination of baicalein as a CYP27B1 inducer with 25 (OH) D3 supplementation offers a novel therapeutic approach for treating sarcopenia in older adults. By optimizing vitamin D metabolism through enhanced CYP27B1 activity, this strategy could significantly improve the effectiveness of vitamin D supplementation. This is particularly relevant given that many older adults have suboptimal levels of vitamin D, which are linked to an increased risk of sarcopenia. This suggests that targeted therapies could provide a viable strategy for addressing vitamin D deficiency-related sarcopenia among older populations. Integrating baicalein into treatment regimens alongside 25(OH) D3 supplementation may enhance muscle health and function in elderly individuals. METHOD Animals
[0062] The experimental procedures were conducted in accordance with the guidelines of the approved by the Animal Experimentation Ethics Committee of The Chinese University of Hong Kong (AEEC approval number: 19-159-MIS) . All mice were on a 100%C57BL / 6 background. To assess the impact of aging on muscle qualities and functions, male C57BL / 6 mice (1-, 3-, 6-, 12-, 20-and 29-mo) were used. 1 mo was considered as young mice, 3-, and 6-mo mice were considered as mature adult mice. 12 mo mice were considered as middle-aged mice while 20-and 29-mo mice were considered as aged mice defined by The Jackson Laboratory. At desired time points, mice were euthanized by injection of ketamine (100 mg / kg) and xylazine (16 mg / kg) , blood was collected. The left GA muscle was dissected for RNA / protein isolation, histology, and the right GA was used for ex vivo function tests. To knockdown the Cyp27b1 in gastrocnemius, in vivo Cyp27b1 knockdown was induced in male Cyp27b1 floxed mice (3.5 months old) via bilateral intra-muscular injection of AAV9-CMV-CRE-GFP virus (100 μl, 2 x 1012 vg / ml) into GA muscles. After 10 days, GA muscles were collected for analysis. Calcitriol treatment
[0063] C57BL / 6 male mice (24 mo, body weight of 30–50 g) were obtained from LASEC, CUHK and Centralized Animal Facility, Shenzhen, The Hong Kong Polytechnic University. Mice were then randomized into two groups receiving an intramuscular injection in the GA of 10 μg / kg of calcitriol (n=13) or saline containing 0.1%DMSO (n=13) , and injections were subsequently performed three times a week for 2 weeks. Mice were housed in cages at 21℃and constant humidity with a standard 12: 12 h light / dark cycle. Ethics approval was obtained for this animal experiment from the Ethics Committee of the Chinese University of Hong Kong (AEEC Ref No. 22–014-MIS) and Animal Subjects Ethics Sub-committee in SZRI PolyU (21-22 / 69-ABCT-R-OTHERS) . Baicalein treatment
[0064] C57BL / 6 male mice (19 mo, body weight of 30–50 g) were obtained from GemPharmatech Co., Ltd. Mice were first fed a vitamin D-deficient (VDD) diet for 7 weeks to induce vitamin D deficiency. After this depletion phase, the animals were randomly divided into four treatment groups (n = 3-5 per group) and treated three times per week for an additional 7 weeks: (1) VDD diet + vehicle, (2) VDD diet + baicalein (10 mg / kg) , (3) control diet + vehicle, and (4) control diet + baicalein (10 mg / kg) . Baicalein and vehicle treatments were administered via intraperitoneal injection. Control diet groups received a vitamin D-sufficient chow matched for macronutrient composition. Mice were housed in cages at 21℃and constant humidity with a standard 12: 12 h light / dark cycle. Ethics approval was obtained for this animal experiment from the Ethics Committee of the Chinese University of Hong Kong (AEEC Ref No. 22–014-MIS) . Whole body grip strength test
[0065] A grip strength meter (Ugo Basile, Cat. 47200) was used to measure whole-body grip strength. The mouse was made to grasp the grasping-grids; the peak tension in gram-force (gf) was recorded on a digital force transducer. The gauge was reset to 0 gf prior to measurement. Peak tension was recorded by the gauge at the time the mouse released its whole-body limbs from the grids. Each mouse was measured three times, and the average of the three measurements was calculated. To minimize measurement error, three measurements were performed by the same assessor. The grip strength data were normalized against the body weight of mice on the day of measurement. Rotarod
[0066] Mice were placed on a rotarod (Ugo Basile, Italy) that was programmed to accelerate from 4 to 44 rpm in 3 min and then hold at constant speed for another 2 min. The latency of the mice to fall off the rod was recorded over a maximum observation period of 5 min. Animals were given a session consisting of 3 trials constant speed training sessions before recording. Data from 3 trials were averaged. Quantitative polymerase chain reaction (qPCR)
[0067] Freshly isolated GA muscles were frozen in liquid nitrogen and stored in -80oC prior to processing. Pestles and TRIzol (Invitrogen, #15596018) were used for total RNA extraction according to the manufacturer’s protocol. The total RNA concentration was determined using Nanodrop 2000 (Thermo Scientific, #ND-2000) . cDNA was synthesized using 1 μg RNA with reverse transcriptase (Takara Bio, #RR036A) . Gene expression was analyzed by qPCR with Power SYBR Green (Thermo Fisher Scientific, #4367659) in a 10 μl reaction system (for 384-well plate) using corresponding primers (Table 3.2) . The relative expression level of target gene was normalized to that of β-actin and was analyzed by the 2-ΔΔCT method. Western blot
[0068] RIPA buffer (IST Scientific, #SOL-R0010-100ML) with protease / phosphatase inhibitor (Thermo Scientific, #1861821) was used to extract proteins from GA muscle samples. Protein concentration was measured by using PierceTM BCA Protein Assay Kit (Thermo Scientific, #23225) . Samples were separated in 12%SDS–polyacrylamide gel and transferred to PVDF membranes at 100 V for 1.5 h. Membranes were then blocked in 5%BSA at room temperature and incubated with primary antibodies at 4℃ overnight, followed by secondary antibodies incubation at room temperature for 1 h. Chemiluminescent substrate (Millipore, #WBLUF0500) was added, and membranes were placed in chemiluminescence imaging system (GeneGnome XRQ) for signals detection. ImageJ software was used for image data analysis. Small Molecule Library
[0069] Selleck natural product library was purchased from Selleck Chemicals (Harris County, TX, USA) . This collection contains 143 active compounds of nature product selected by a team of medicinal chemists and pharmacists for their high structural and pharmacological diversity, high cell permeability and effective bioavailability and reliable safety. The compounds were supplied as DMSO solution at the concentration of 10 mM. Plasmids, transfection, and luciferase Activity Screening
[0070] A high-throughput luciferase activity screening method was applied to screen out the putative natural products which regulate promoter luciferase activities. Truncated promoters of Cyp27b1 were cloned into the pGL3 basic plasmid. The Cyp27b1 promoter activity assay was carried out in C2C12 cells by using LipofectamineTM3000 transfection reagent according to the manufacturer’s instruction. Cells in 96-well plates were co-transfected with 500 ng of each of the luciferase containing plasmids together with 100 ng of a control pRL-TK plasmid (Renilla luciferase) as an internal control. Blank pGL3 basic plasmids served as negative controls. After 4 h of transfection, medium containing plasmid was changed to normal growth medium and cells were incubated for another 18 h. The cells were then treated with chemicals from Selleck small product chemical library at the final concentration of 10 μM for 24 h. Cells were harvested and luciferase assay was performed by using the Dual Reporter assay system (Promega, #E1910) according to the manufacturer’s instruction. Briefly, cells were lysed with 25 μl of Passive Lysis Buffer, and luciferase activities were measured with VICTOR X Series Multilabel Plate Readers (PerkinElmer, Waltham, USA) . The ratio of firefly luciferase to renilla activity in each sample was revealed as a measurement of the normalized luciferase activity. Duplicated experiments were performed. Cell viability assay
[0071] The effect of baicalein on the viability of C2C12 cells were measured by using 3-(4,5-Dimethylthiazol-2-yl) -2, 5-diphenyltetrazolium bromide (MTT) assay. In brief, C2C12 cells (2 × 103 / well) were seeded in 96-well plate and cultured overnight. The cells were then treated with various concentrations of baicalein for 72 h. After that, 10 μL of 0.5 mg / mL MTT was applied into each well and incubate at 37 ℃ for additional 4 h. After incubation, the supernatant was discarded and 100 μL DMSO was applied for solubilization of formazan crystals. The light absorbance at 570 nm was measured with a Spectramax Gemini dual-scanning microplate reader (Molecular Devices, San Jose, CA, USA) . Myotube staining of C2C12
[0072] Cells were fixed with 100%methanol followed by permeabilization with 0.1%Triton X-100 (Sigma-Aldrich) in PBS (TaKaRa) . 5%BSA (Sigma-Aldrich) in Phosphate buffered saline with Tween-20 (PBST) was used for blocking. Cells were then incubated with anti-sarcomere primary antibody (1: 20 diluted; MF20, DSHB) overnight at 4 ℃, followed by incubation with secondary antibody (1: 500 diluted; Abcam, #ab150115) at room temperature for 1 h. Nuclei were counterstained with ProLongTM Gold Antifade DAPI (Thermo Fisher Scientific, #P36934) . Images were taken under 100x with Leica DM5500 system. Baicalein in differentiation study and synergetic effect with 25 (OH) VD3
[0073] To determine the effect of Baicalein on differentiation ability, baicalein (2.5 μM, 5 μM and 10 μM, #B20571, Shanghai yuanye Bio-Technology) or 0.1%DMSO treated cells were added in normal growth medium or differentiation medium for 7 days. After that, 10 μM baicalein and 100 nM 25 (OH) VD3 were added together in normal growth medium or differentiation medium for 7 days. Then the cells were harvested for qPCR analysis and myotube staining. Histology and immunostaining
[0074] In brief, the GA was dissected and then coated with talcum powder evenly for 20 s without scratching. OCT was added to the groove of the aluminum foil. The aluminum foil is plunged into liquid nitrogen immediately after placing the muscle tissue into the OCT. Frozen sections were taken out of the -80℃ refrigerator to room temperature. The slides were rinsed in hematoxylin solution for 10 min. The rack holding the slides was placed in running water for 1 min to remove excessive hematoxylin, dipped in acid alcohol for 1 s, and then transferred back into running water for another 1 min to remove acid alcohol. The slides were then put in Scott’s tap water for 3 min for bluing of hematoxylin and rinsed with distilled water to remove Scott’s tap water. After that, the slides were put into a 1%eosin Y solution for 5 min. After staining, the slides were dehydrated sequentially with distilled water (5 s) , 70%ethanol (5 s) , 80%ethanol (5 s) , 90%ethanol (10 s) , 100%ethanol (3 min) , 100%ethanol (5 min) , and clear ethanol in xylene for 8 min. To mount the slides, a drop of DPX mountant (Signma-Aldrich, Cat. 06522) was placed over the tissue section and a coverslip was put on the top of the section to fully seal it. For succinate dehydrogenase (SDH) staining, 8 micrograms of frozen sections of GA and TA were stained for SDH activity using a Succinate Dehydrogenase Stain Kit (Solarbio, G2000) . The average intensity from five sections of one sample represented the integrated intensity for one mouse. RESULTS Age-related change of enzyme CYP27B1 and muscle force production
[0075] The qPCR analysis revealed distinct expression patterns of key genes involved in vitamin D metabolism. The expression of Cyp27b1 peaked at 12 mo, indicating a significant upregulation at this age point (Figure 1A) . Additionally, the western blot results provided further insights into the protein expression levels of these genes. The protein expression of CYP27B1 peaked at 6 mo, indicating a notable increase in protein levels at this age (Figure 1B). To test the skeletal muscle contractile properties, freshly isolated GA muscle were used for the ex vivo functional test (Figure 1C and D) . Electric stimulation of the GA muscles demonstrated that the twitch force peaked at 6 months of age (Figure 1C) , followed by a decline from 12 mo to 29 mo compared to the peak value. This decline indicates an age-related impairment in the muscle's ability to generate maximal twitch force beyond the 6-month-old. Similarly, the tetanic force also reached its peak at 6 mo, and start to decline at 12 mo to 29 mo from the peak. These findings, illustrated in Figures 1C and D, highlight the progressive decrease in muscle force generation as age increases. Importantly, the muscle contractile properties exhibited an age-related trajectory, with peak performance observed at 6 mo, followed by a decline starting around 12 mo, and reaching the lowest levels at 29 mo. Cyp27b1 knockdown in GA muscle impairs myogenic markers expression and mitochondrial function
[0076] Cyp27b1 floxed mice were generated to investigate the role of Cyp27b1 in skeletal muscle function and regeneration. The successful knockdown of Cyp27b1 was confirmed by significantly suppressed mRNA and protein expression levels 10 days after virus injection (Figure 2A) , referred to as D10 KD (Day 10 Knockdown) group. The study also included the following control groups: D0 con (baseline control) , and D10 con v (Day 10 control virus) . In the D10 KD group, the expression of genes involved in myogenic markers (Myod1, Myog, Myf5, and Acta1) , and mitochondrial biogenesis markers (mt-TFA, Pgc1a and Sirt3) was significantly downregulated compared to the both D0 con and D10 con v group (Figure 2B and C) . In contrast, myogenic degradation genes (Mstn and MuRF1) were significant up-regulated after 10 days of knockdown. Ex vivo muscle functional tests revealed impaired force production upon electrical stimulation in the D10 KD group. Compared to the D10 con v group, the D10 KD muscle produced approximately 23.4%less twitch force and approximately 33.8%less tetanic force (Figure 2D) Calcitriol treatment leads to increase in muscle strength in aged mice
[0077] The intramuscular injection of calcitriol for a 2-week treatment period resulted in notable improvements in various functional parameters. Following the treatment, there was a significant increase ~75%in whole-body grip strength, indicating enhanced muscular strength and function (Figure 3A) . The treated mice exhibited an increase in rotarod running distance (increased by ~76.2cm) , suggesting improved motor coordination and endurance. Additionally, the treated mice showed a prolonged latency to fall (increased by ~61.6%) , indicating enhanced balance and motor control capabilities (Figure 3B) . The qPCR and Western blot analyses following calcitriol treatment revealed significant changes in key markers associated with muscle health. Higher expression levels of myogenic markers such as MyoD, Myf6, Pax7, and Myog were observed post-treatment, indicating an upregulation of genes involved in muscle development and regeneration (Figure 3C) . Increased protein levels of Desmin, PAX3, and MYOD1 further support the upregulation of myogenic markers at the protein level, highlighting enhanced muscle repair and growth potential (Figure 3D) . Identification of baicalein as an inducer of Cyp27b1
[0078] A cell-based luciferase activity assay was applied to identify compounds that modulate Cyp27b1 expression simultaneously that could then be used in pharmacological proof of concept studies in vivo. To identify small molecules that could potentially stimulate Cyp27b1, we designed a high-throughput screening system that allowed us to measure the luciferase activity of Cyp27b1. The luciferase activities of Cyp27b1 response element (RE) vectors upon treatment of small molecules were plotted (Figure 4A) . We further tested the ability of baicalein to promote C2C12 cell proliferation by activating the Cyp27b1. The viability of C2C12 treated with baicalein revealed no significant effects at concentration ranging from 1 to 50 μM (Figure 4B) . After selecting baicalein as a potential target, we confirmed that Cyp27b1 RE luciferase activity were increased upon baicalein in treatment in a concentration dependent manner (Figure 4C) . These results indicated that baicalein had the capability of inducing Cyp27b1 expression in vitro and made it a potential candidate for inducing Cyp27b1 and then myogenesis in vivo. Combination effect of baicalein co-treatment with calcifediol
[0079] C2C12 cells differentiated the highest level of multinucleated myotubes under myogenic induction culture medium for seven days (Figure 5A) . In stark contrast, the negative control group showed no myotube formation. Treatment with baicalein alone resulted in minimal myotube formation. While some differentiation was observed, it was significantly lower than that seen in the positive control group, indicating that baicalein alone is not sufficient to induce substantial myotube development. The addition of 25 (OH) D led to an increased number of myotubes compared to the negative control and baicalein alone. This suggests that 25 (OH) D plays a beneficial role in promoting muscle cell differentiation. Notable, the combination treatment of baicalein and 25 (OH) D3 resulted in a significant increase in myotube formation, with levels comparable to those observed in the positive control group. This finding indicates a synergistic effect between baicalein and 25 (OH) D3, enhancing myogenic differentiation and suggesting that this combination may be an effective strategy for promoting muscle health. In mRNA expression level of Cyp27b1, combination of baicalein and 25 (OH) 3 resulted in increased level of Cyp27b1 (Figure 5B) . These findings were further validated by qPCR analysis on myogenic markers, as well as mitochondrial markers, which showed a similar pattern (Figure 5C and D) . This suggests that the effects of baicalein and 25 (OH) 3 on myotube formation are consistent with their impact on myogenic (Myog, Myf5 and Myf6) and mitochondrial markers (Pgk1, mt-TFA, Pgc1a and Pgc1b) . Combination effect of baicalein co-treatment with control diet significantly up-regulates cyp27b1 expression and improve muscle function in aged mice
[0080] Aged mice exhibited markedly reduced skeletal muscle cyp27b1 expression compared with young mice, indicating an age-related decline in local vitamin D–activating capacity in muscle. Combined treatment with control diet and baicalein significantly increased cyp27b1 expression in skeletal muscle, suggesting that baicalein restores this enzyme in aged muscle (Figure 7A) . Consistent with improved vitamin D signaling, control diet + baicalein significantly enhanced wholebody grip strength and increased the cross-sectional area of gastrocnemius myofibers, indicating attenuation of sarcopenia-like muscle atrophy (Figure 7B and C) . In parallel, succinate dehydrogenase staining showed a pronounced increase in oxidative myofibers capacity and mitochondrial enzymatic activity in both gastrocnemius and tibialis anterior muscles following combined control diet and baicalein treatment (Figure 7D) . Moreover, the mRNA levels of D-loop, the major non-coding regulatory region of mitochondrial DNA, and MT-ND1, a mitochondrial-encoded component of complex I, were significantly up-regulated in tibialis anterior muscles, consistent with enhanced mitochondrial biogenesis and mitochondrial genome activity under control diet + baicalein treatment (Figure 7E) . (N = 3-5 per group) . REFERENCES 1. Joseph, A. M., P. J. Adhihetty, and C. Leeuwenburgh, Beneficial effects of exercise on age-related mitochondrial dysfunction and oxidative stress in skeletal muscle. J Physiol, 2016.594 (18) : p. 5105-23. 2. Gan, Z., et al., Skeletal muscle mitochondrial remodeling in exercise and diseases. Cell Res, 2018.28 (10) : p. 969-980. 3. Gan, Z., et al., Skeletal muscle mitochondrial remodeling in exercise and diseases. Cell Research, 2018.28 (10) : p. 969-980. 4. Sundberg, C. W. and R. H. Fitts, Bioenergetic basis of skeletal muscle fatigue. Curr Opin Physiol, 2019.10: p. 118-127. 5. 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[0081] All patents, patent applications, and other publications, including GenBank Accession Numbers and equivalents, cited in this application are incorporated by reference in the entirety for all purposes.
Claims
1.A composition for use in promoting myoblast cell proliferation and / or improving skeletal muscle mass and function in a subject, comprising (1) an effective amount of baicalein or a functional derivative thereof; and (2) a physiologically acceptable excipient.2.The composition of claim 1, further comprising one or more of vitamin D or its functional metabolites.3.The composition of claim 2, wherein the one or more of vitamin D or its functional metabolites comprise cholecalciferol, calcifediol, or calcitriol.4.The composition of claim 1, consisting essentially of baicalein and one or more physiologically acceptable excipients.5.The composition of claim 3, consisting essentially of baicalein, calcitriol, and one or more physiologically acceptable excipients.6.The composition of claim 5, wherein the weight ratio of baicalein and calcitriol is between 100: 1 to 1: 1.7.The composition of any one of claims 1-6, wherein the myoblast cell is located within a person’s body.8.The composition of claim 7, which is formulated for oral ingestion.9.The composition of claim 8, which is in the form of a food or beverage item.10.The composition of claim 8 or 9, which is formulated in a daily dosage comprising baicalein in the amount of about 0.1 to about 1,000 mg / kg bodyweight of the person.11.A method for promoting myogenesis and / or treating or preventing skeletal muscle atrophy in a person, comprising administering to the person an effective amount of the composition of any one of claims 1-10.12.The method of claim 11, wherein the person is 60 years or older.13.The method of claim 11, wherein the person is at risk for muscle atrophy.14.The method of any one of claims 11-13, wherein the administering step comprises oral ingestion of the composition.15.A kit for promoting myogenesis and / or improving skeletal muscle mass, strength, or mitochondrial function in a subject, comprising a first container containing a composition comprising an effective amount of baicalein or a functional derivative thereof.16.The kit of claim 15, further comprising a second container containing a second compositions comprising an effective amount of one or more of vitamin D or its functional metabolites.17.The kit of claim 15 or 16, wherein the first and / or second compositions are in the form of a powder, liquid, paste, cream, tablet, or capsule.18.The composition of any one of claims 1–6, wherein administration to an aged mammalian subject increases skeletal muscle CYP27B1 expression, enhances local calcitriol production, and results in increased muscle fiber cross sectional area and improved grip strength.19.The method of any one of claims 11–14, wherein administration of the composition to an aged mammalian subject enhances mitochondrial oxidative enzyme activity in skeletal muscle.20.The method of any one of claims 11–14, wherein the subject is a non human mammal selected from mouse, rat, dog, cat, horse, cow, or pig.