Melissa J. L. Bonorden

About one-fourth of the global population is either overweight or obese, both of which increase the risk of insulin resistance, cardiovascular diseases, and infections. In obesity, both immune cells and adipocytes produce an excess of pro-inflammatory cytokines that may play a significant role in disease progression. In the recent coronavirus disease 2019 (COVID-19) pandemic, important pathological characteristics such as involvement of the renin-angiotensin-aldosterone system, endothelial injury, and pro-inflammatory cytokine release have been shown to be connected with obesity and associated sequelae such as insulin resistance/type 2 diabetes and hypertension. This pathological connection may explain the severity of COVID-19 in patients with metabolic disorders. Many studies have also reported an association between type 2 diabetes and persistent viral infections. Similarly, diabetes favors the growth of various microorganisms including protozoal pathogens as well as opportunistic bacteria and fungi. Furthermore, diabetes is a risk factor for a number of prion-like diseases. There is also an interesting relationship between helminths and type 2 diabetes; helminthiasis may reduce the pro-inflammatory state, but is also associated with type 2 diabetes or even neoplastic processes. Several studies have also documented altered circulating levels of neutrophils, lymphocytes, and monocytes in obesity, which likely modifies vaccine effectiveness. Timely monitoring of inflammatory markers (e.g., C-reactive protein) and energy homeostasis markers (e.g., leptin) could be helpful in preventing many obesity-related diseases.

Watercress is an excellent source of phenethyl isothiocyanate (PEITC), shown in many studies to enhance carcinogen and toxicant detoxification and to inhibit carcinogenesis. Based on a previous observation that PEITC can enhance the detoxification of common environmental pollutants such as acrolein, crotonaldehyde, benzene, and 1,3-butadiene, we designed a clinical trial testing the hypothesis that daily consumption of a drink containing freeze-dried watercress, an abundant source of PEITC, would have a similar effect, particularly observed in subjects who were null in certain glutathione S-transferase genes. This manuscript describes the preparation of nearly 100 pounds of freeze-dried watercress for this trial, starting with laboratory-scale pilot studies and proceeding to industrial-scale production of the fully validated product in compliance with all food safety requirements. Initial results validating subject compliance in the clinical trial are also presented. Prevention Relevance: This study describes the preparation of a beverage containing freeze-dried watercress suitable for consumption in a clinical trial to determine whether a constituent of this beverage–PEITC, which has cancer prevention properties–can enhance detoxification of common environmental carcinogens and toxicants such as benzene, which may have a role in environmentally induced cancer. See related Spotlight, p. 139