Protandim

Protandim is a patented dietary supplement marketed by LifeVantage Corporation (nasdaq: LFVN; formerly LifeLine Therapeutics, Lifeline Nutraceuticals, and Yaak River Resources, Inc), a Utah-based multilevel marketing company. The manufacturers of Protandim claim the product can indirectly increase antioxidant activity by upregulating endogenous antioxidant factors such as the enzymes superoxide dismutase (SOD) and catalase, as well as the tripeptide glutathione. Like all dietary supplements, Protandim has not been evaluated by the U.S. Food and Drug Administration (FDA) and "is not intended to diagnose, treat, cure, or prevent any disease."

Product history
In 2003, Lifeline Therapeutics, a privately held Denver-based nutraceutical licensing and marketing company, entered into a joint agreement with Massachusetts biotechnology company CereMedix for the rights to market CMX-1152, an experimental peptide-based compound, under the brand name "Protandim" (also sometimes referred to at that time as "Rholen," "Rejuven8r" and "ependymin"). CereMedix was a ten percent owner of Lifeline and members of the CereMedix management board served on Lifeline’s board of directors. CMX-1152 was claimed to upregulate the production of the endogenous antioxidant enzymes superoxide dismutase, catalase, and glutathione peroxidase, and to offset the ageing process, potentially allowing people to live up to the age of 120.

CMX-1152 was due to be marketed as an over the counter anti-aging pill in June 2004 after completing human clinical trials. However, plans to market the CMX-1152 version of Protandim fell through and in April 2004 Lifeline Therapeutics announced that it would instead be marketing a different (non-peptide) dietary supplement under the name “Protandim CF” (to distinguish it from the peptide version initially developed by Cermedix). The new version of Protandim, a combination of 5 common herbal ingredients including turmeric and green tea was invented following “months of extensive research and development” by Lifeline employees Paul Myhill and William Driscoll (a former oil company executive), who together hold the patent on the product, and it was officially launched in February 2005. Myhill and Driscoll resigned from the company later that year.

Like CMX-1152, the herbal version of Protandim that supplanted it was marketed by Lifeline as an "anti-aging" supplement that increases the body’s antioxidant defenses by upregulating superoxide dismutase, catalase, and glutathione peroxidase. According to the company, the product was initially sold through retail channels such as GNC; however, in 2009, after several consecutive years of multimillion dollar losses, the company, which by then was doing business under the name LifeVantage, stopped marketing Protandim through retailers and switched to multilevel marketing, selling it instead through a network of commissioned independent distributors exclusively. According to LifeVantage, the move from retail to multi-level marketing was prompted by the January 2008 hiring of David W. Brown, (formerly CEO and president of Metabolife) as the company's CEO and president.

Beginning in 2005, Protandim was produced under a manufacturing agreement with The Chemins Company of Colorado Springs, Colorado. In July 2008, LifeVantage entered into a new manufacturing agreement with Cornerstone Research & Development to produce Protandim, and with Wasatch Product Development to produce a Protandim-based skin cream (TrueScience).

Voluntary recall
In December 2012, LifeVantage issued a voluntary recall of select lots (10 lots in total comprising 247,896 bottles) of Protandim due to potential health risks arising from the possible inclusion of small metal fragments in the final product. In February 2013, the company announced that it was extending the recall to include additional lots of the product, estimating the total cost of the recall at $5.9 million.

Composition
Protandim consists mainly of a blend of 5 herbal ingredients (amounts per caplet listed in parentheses):

Additional ingredients include: calcium, croscarmellose sodium, magnesium stearate, microcrystalline cellulose, modified cellulose, silica, and stearic acid.
 * Milk thistle (Silybum marianum) extract (225 mg)
 * Bacopa (Bacopa monniera) extract (150 mg)
 * Ashwagandha (Withania somnifera) root (150 mg)
 * Green tea (Camellia sinensis) extract (75 mg)
 * Turmeric (Curcuma Ionga) extract (75 mg)

Side effects
The side effects of Protandim may include allergic responses, gastrointestinal disturbances (stomach ache, diarrhea, vomiting), headache, and rash of the hands and feet.

Overview
Thirteen peer-reviewed research studies of Protandim have been published as of 2012; all but two were conducted in in vitro or in vivo animal models. Eleven of the studies were conducted, authored, or co-authored and/or funded in whole or in part by LifeVantage and/or its employees, or by the company's predecessor, Lifeline Therapeutics.

LifeVantage advertises Protandim as a Nrf2 activator. A 2003 study showed that Nrf2 and heme oxygenase 1 are induced by low doses of curcumin, (a chemical constituent of turmeric and one of the principal ingredients in Protandim) in isolated kidney epithelial cells.

A 2008 review article noted that while many supplements are claimed to act as antioxidants, changes in the levels of TBARS and increases in the levels of antioxidant enzymes in response to a treatment do not provide a reliable indication that the treatment has an antioxidant effect, since the same responses are produced by pro-oxidant compounds that induce oxidative stress. The authors suggested that measurement of isoprostanes might be a better indication of lipid peroxidation and oxidative damage to DNA.

A 2011 blog by Harriet A. Hall in Science-Based Medicine stated, "We simply don’t know enough at this point to recommend Protandim for treatment or prevention of any disease, for anti-aging, for making people feel healthier or more energetic, or for anything else."

Human clinical studies
Two studies of Protandim have been conducted in human subjects. One of these studies, a non-randomized, non-controlled trial, reported that Protandim increased the levels of the antioxidant enzymes SOD and catalase in red blood cells while reducing TBAR levels in blood plasma.

The second study, a double-blinded, randomized, placebo-controlled trial published by McCord and colleagues in 2012, examined the effect of Protandim on pulmonary oxidative stress and alveolar epithelial permeability in 30 recovering alcoholics. Protandim (14 subjects at a dose of 1350 mg/day; double the daily dose recommended by the manufacturer) or placebo (in 16 subjects) were administered for 7 days. Relative to placebo-treatment, Protandim had no significant effects on alveolar epithelial permeability or on oxidative stress, epithelial growth factor, fibroblast growth factor, interleukin-1β, and interleukin-10 levels in bronchoalveolar lavage fluid. Treatment with placebo, however, produced a significant reduction in plasma levels of TBARS, a marker of oxidative stress (i.e., lipid peroxidation).

In vitro and animal studies
In studies published by LifeVantage executive Joe McCord and colleagues, it was reported that Protandim increased glutathione levels in isolated cells and that intraperitoneal injection of an alcohol-based extract of Protandim could suppress skin tumor incidence in an experimental model in mice and result in suppression of p53 and induction of MnSOD in isolated mouse epidermal cells in vitro.

An in vitro gene expression microarray study published by Dr. McCord and associates in 2011 examined the effect of Protandim on gene expression profiles in human primary vascular endothelial cells and a SK-N-MC human neuroblastoma-derived cell line. Protandim was found to upregulate Nrf-2 and to modulate the expression of a variety of other genes. Similarly, an alcohol-based extract of Protandim was found to induce Nrf2 nuclear localization, phase II antioxidant enzyme expression, and Nrf2-dependent protection from hydrogen peroxide-mediated oxidative stress in isolated human coronary artery endothelial cells and mouse cardiomyocytes in vitro.

Another study conducted by Dr. McCord and associates investigated the effect of intraperitoneal injection of an alcohol-based extract of Protandim in an experimental model of pulmonary hypertension in rats. It was reported that the extract induced myocardial nuclear factor E2-related factor 2 and heme oxygenase 1, prevented a loss of myocardial capillaries, minimized fibrosis and preserved RV function.

Other studies by McCord and colleagues have examined the effects of Protandim on fibrosis in a rodent model of Duchenne muscular dystrophy (DMD) the effects of Protandim in an in vivo model of high altitude cerebral vascular leak, and the effects of an alcohol extract of Protandim in an in vitro saphenous vein graft model. In a study investigating the effects of various agents on skeletal muscle tissue function in an in vitro model of DMD, compounds used clinically for DMD treatment, such as the glucocorticoids, were found to produce a potentially beneficial increase in muscular contractile force, while Protandim produced the opposite effect, significantly inhibiting contractile force.

Legal issues
In 2009, LifeVantage was sued by Utah-based Zrii LLC, a marketer of nutritional fruit drinks endorsed by Deepak Chopra, based on allegations that LifeVantage had conspired with former Zrii executives to “ruin the company” and take it over “on the cheap” following a “mass exodus”. The case was closed in December 2009 following LifeVantage’s settlement payment of $400,000 to Zrii.

On October 14, 2011, Burke Hedges, a former high-level LifeVantage distributor, filed a lawsuit with the Utah District Court against LifeVantage and its executives, seeking $3 million in punitive damages over allegations of wrongful termination and tortious interference.

Advertising and sponsorship
LifeVantage commissioned a Denver-based public relations firm to secure product placement for Protandim on various radio and TV programs including two segments of the television program Today. One of the segments featured nutritionist Elizabeth Somer, who was hired as a consultant/spokesperson for Protandim.

On June 20, 2007, LifeVantage announced that it had entered into a 3-year agreement with TV personality Montel Williams to act as a spokesperson for the company’s products. On September 15, 2011, LifeVantage entered into a similar 2-year agreement with entertainer Donny Osmond, stipulating that the company would pay Osmond for various promotional appearances and video recordings and commissions for sales of LifeVantage products.

Product development
As recently as July 21, 2011, LifeVantage credited McCord as the creator of Protandim on its website. At a 2011 conference for LifeVantage distributors, McCord stated, "I was presented with a list of 41 potential ingredients for a product they wanted to call Protandim, and I went through the list and penciled out, rapidly, about 36 of those ingredients," leaving the 5 ingredients in the current formulation of Protandim. In March 2009, former LifeLine Therapeutics executive, Paul Myhill stated, "We initially decided to hide that fact [that Myhill derived the core composition for Protandim] for marketing purposes and instead rely on the impeccable background of Dr. McCord." In April, 2005, Myhill produced a signed letter from McCord in which McCord stated, "I do not honestly feel that I have made contributions to the intellectual property, up to this point, that would qualify me as an inventor... I must congratulate you and Paul for having framed the concept of Protandim so close to its final embodiment, prior to the beginnings of our association."