Effect of vitamin E supplementation on oxidative stress in hemodialysis patients

Hemodialysis represents a chronic stress status for its recipients. Many hypotheses state that this may be associated with oxidative stress. Thus, there may be deficiency of antioxidants like erythrocytic superoxide dismutase, catalase, vitamin E or increased generation of free radicals like superoxide anions. A study was carried out to investigate oxidant and antioxidant status in chronic renal failure patients undergoing hemodialysis and effect of vitamin E supplementation on these two status. Blood samples were collected from patients before and after hemodialysis and from controls. The samples were analyzed for quantitation of MDA as index of lipid peroxide, nitric oxide, vitamin E, vitamin C and enzymatic antioxidants namely erythrocyte SOD and catalase. As compared to controls, the levels of serum MDA were significantly increased and activities of erythrocyte SOD and catalase, levels of serum nitric oxide, serum vitamin E and plasma vitamin C were significantly decreased both before and after hemodialysis. The efficiency of vitamin E therapy in hemodialysis patients was assessed by re-evaluating oxidant and antioxidant status of same patients after supplementation of vitamin E. Vitamin E supplementation caused decrease in serum MDA and increase in levels of serum nitric oxide, vitamin E, vitamin C and activities of erythrocytic SOD and catalase. Our results suggest the presence of oxidative stress and the possible preventive role of vitamin E therapy in hemodialysis patients.     

A case of vitamin B12 deficiency neurological syndrome in a young adult due to late-onset cobalamin C (CblC) deficiency: a diagnostic challenge

Vitamin B12 deficiency can present with neurologic and psychiatric symptoms without macrocytic anaemia. We describe a case of late-onset cobalamin C deficiency which typically presents with normal serum vitamin B12 concentrations, posing an additional diagnostic challenge. A 23-year-old woman with decreased muscle strength and hallucinations was diagnosed with ‘catatonic depression’ and admitted to a residential mental health facility. She was referred to our hospital for further investigation 3 months later. Heteroanamnesis revealed that the symptoms had been evolving progressively over several months. Magnetic resonance imaging (MRI) of the brain showed diffuse symmetrical white matter lesions in both hemispheres. Routine laboratory tests including vitamin B12 and folic acid were normal except for a slight normocytic, normochromic anaemia. Over the next 6 weeks her symptoms deteriorated, and she became unresponsive to stimuli. A new MRI scan showed progression of the white matter lesions. The neurologist requested plasma homocysteine (Hcys) which was more than 8 times the upper limit of normal. Further testing revealed increased methylmalonic acid and the patient was diagnosed with adult-onset cobalamin C deficiency. This case illustrates that Hcys and/or methylmalonic acid should be determined in patients presenting with neuropsychiatric symptoms suggestive of vitamin B12 deficiency with a normal serum vitamin B12 to rule out a late-onset cobalamin C deficiency.     

An analysis of the vitamin D overtesting in a tertiary healthcare centre

IntroductionVitamin D testing is excessively used in clinical practice, despite of the clinical guidelines statements against population screening for vitamin D deficiency. This study aimed to assess an annual number of performed 25-hydroxy vitamin D (25(OH)D) tests that were unsupported by the national guidelines for prevention, detection and therapy of vitamin D deficiency in adults and to calculate associated financial burden for the publicly funded healthcare.Materials and methodsA representative sample of requested 25(OH)D tests in 2018 (N = 474) was formed after selection and randomisation of data set (N = 5298) collected from the laboratory information system database of the Clinical Department for Laboratory Diagnostics, the Clinical Hospital Centre Rijeka. Records were classified in two groups depending on associated medical condition(s) according to the national guidelines. An annual cost of the total and group specific vitamin D testing was calculated on the base of a single test price reimbursed by the Croatian Healthcare Insurance Fund (CHIF).ResultsMedical conditions with high-risk for vitamin D deficiency were detected in 43% (206/474) of vitamin D requests (group 1). Conditions not associated with vitamin D deficiency were detected in 57% (268/474) requests (group 2). A total cost of 25(OH)D testing for the CHIF was 58,729.50 EUR (25,523.79 EUR in the group 1 and 33,205.71 EUR in the group 2).ConclusionsMore than half of all 25(OH)D tests performed in the clinical laboratory represent avoidable cost for the public healthcare. Prevention of population screening by vitamin D testing is needed.     

Vitamin D Deficiency and Insulin Resistance in Normal and Type 2 Diabetes Subjects

Vitamin D is recognized to serve a wide range of biological functions. The presence of vitamin D receptors on different tissues explains it’s diversity of actions. Reduced levels of vitamin D is associated with insulin resistance and increased diabetes risk. The study included 50 normal healthy individuals and 49 type 2 diabetes subjects. Fasting blood glucose, total cholesterol, triglycerides, HDLc, fasting insulin, parathyroid hormone, calcium, albumin and Homeostasis model for assessment of insulin resistance (HOMAIR) were measured in all the study participants. Type 2 diabetes subjects were divided into group 1 with 25 hydroxy vitamin D (25(OH)D) ≤20 ng/ml and group 2 with 25(OH)D >20 ng/ml. By the results of this study, the mean 25(OH)D level was low (20.09 ng/ml) in type 2 diabetes compared to controls (23.89 ng/ml) and the p value was 0.02. The estimated insulin resistance by HOMAIR was more in group 1 than in group 2 of diabetes with p value of 0.037. The Pearson’s correlation-coefficient was negative for 25(OH)D and insulin in type 2 diabetes (r = ?0.294), 25(OH)D was negatively correlated with HOMAIR in total subjects. Type 2 diabetes subjects had reduced levels of vitamin D than normal individuals. The insulin resistance was more in vitamin D deficiency state. Hence vitamin D has a role in glucose metabolism, deficiency can result in insulin resistance and diabetes.     

In vitro study of vitamin B6 status in cancer breast patients

There is ample evidence that vitamin status of an individual can have a profound influence on the resistance of Cancer. Pyridoxine is one of the water soluble vitamins playing an important role in various metabolic reactions. Aspartate aminotransferase and Alanine aminotransferase are pyridoxal phosphate requiring enzymes and their activities in erythrocytes have been used to assess the state of vitamin B₆ nutrition in man. We report here the erythrocyte transaminase levels in controls and patients with early and advanced cancer of breast. Thein vitro study of vitamin B₆ shows a marked difference in the per cent stimulation in patients as compared to the controls on addition of pyridoxal phosphate. The difference indicates a subclinical deficiency of vitamin B₆. The possibility exists that the rapid progression of the disease could be due to lack of host resistance caused by the deficiency of vitamin B₆. The possibility of an effective treatment response after enhancing the vitamin B₆ status is being looked into.     

The Role of 25-Hydroxy Vitamin D Deficiency in Iron Deficient Children of North India

Extensive data from animal and human studies indicate a role of vitamin D in erythropoiesis. Iron and vitamin D deficiencies are implicated with adverse health effects in children even if they are asymptomatic. The potential relationship between the two remains poorly understood. A cross-sectional study was performed in the period from 1st May 2012 through 30th April 2013 and subjects were classified into vitamin D deficiency (VDD), vitamin D insufficiency (VDI) and vitamin D sufficiency (VDS) groups according to their 25(OH) D levels. A total of 263 children were included in the analysis. Anaemia was present in 66 % of 25(OH) D deficient subjects compared with 35 % in vitamin D sufficient individuals (p < 0.0001). The association of breast feeding and development of VDD was also significant (p < 0.05). Serum levels of 25(OH) D were found lower in female sex and if the analysis was performed in the winter/spring season. Physicians should therefore assess vitamin D levels in all anaemic children and ensure adequate supplementation to prevent deficiencies.     

Breast cancer in developing population: A nutrition caveat

From January 1992-January 1998, 1404 patients attended the “Breast Clinic” of R.N.T. Medical College M.B. Hospital, Udaipur. Out of these, 11% and 81% patients had breast cancer (B.C.) and benign breast cancer (B.B.D.) respectively. The oxidative load in B.C. was 2.32 times higher than controls, but comparable to B.B.D. β-Carotene deficiency was uncommon in patients, whereas vitamin A deficiency was almost equally common in both B.C. and controls. Most of the patients had almost depleted levels of α-tocopherol and ascorbic acid but their TBAR levels were in normal range. The data in the present study when compared with B.B.D. and other local normal subjects point out: a) oxidative burden in B.C. is a consequence and not the cause of the disease, (b) oxidative stress could be one of the etiological factors in tumor expression, which need not to be malignant and c) α-tocopherol and ascorbic acid are not importantly responsible for higher oxidative burden in B.C.     

Study of Serum Homocysteine, Folic Acid and Vitamin B12 in Patients with Preeclampsia

The present study was carried out to evaluate the occurrence of association between homocysteine, folic acid and vitamin B(12) in patients with preeclampsia. Fifty preeclamptic patients from gynecology ward were studied for estimation of serum homocysteine, folic acid and vitamin B(12) over a period of October 2007 to June 2010. Serum homocysteine and folic acid, and vitamin B(12) were determined by means of Immulite 1000 analyzer. The statistical analysis of study group of preeclampsia compared with normotensive control group, showed significant alterations in serum homocysteine, folic acid and vitamin B(12) concentrations in preeclampsia. Inverse association between serum homocysteine and folic acid, and vitamin B(12) levels were observed in preeclampsia. The present study found hyperhomocysteinemia and deficiency of folic acid and vitamin B(12) along with increased blood pressure as a risk factor for cardiovascular disease (CVD) in preeclampsia.     

Serum Vitamin D Levels in Indian Patients with Multiple Sclerosis

Low serum vitamin D level has an increased association with risk of multiple sclerosis (MS).There has been no published data on the levels of this vitamin in Indian population with MS. Hence we decided to undertake this study to document if there is evidence of vitamin D deficiency in patients with MS in our population. 26 patients with diagnosis of MS by modified Mc Donald’s criteria were enrolled in this study. Serum vitamin D (1,25 hydroxy) levels were measured by electro-chemiluminescence in our biochemistry lab. An age-matched control group of 202 patients who did not have a diagnosis of MS were included. In our study group 76.9 % had vitamin D level less than 20 ng/ml compared to 65.5 % of control group (p value of 0.019). Our study revealed a trend towards low vitamin D values in Indian MS patients.     

Effect of vitamin C and E activity on surgically removed cataractous human lens epithelium cells

Oxidative stress has been proposed as a common underlying mechanism of cataractogenesis. Experimental and observational data suggest that micronutrients like vitamin C and vitamin E with antioxidant capabilities may retard the development of age-related cataract. Effect of these factors on lens epithelium cells, center of lens metabolic activities, is not completely elucidated. The aim of present study was to examine the effect of vitamin C and E on surgically removed lens epithelium cells of patients with cataract. Capsulorhexis samples were collected from 170 patients, admitted for cataract surgery. Catalase specific activity was estimated in lens epithelium cells with and without vitamin (C or E) treatment at different concentration for different time duration. Student’s t-test was employed for data analysis. We observed that in ex-vivo condition, a) both vitamin C and E bring about a decrease in catalase activity in lens epithelial cells. b) vitamin C showed toxic effect at high concentration. c) 100μM was the optimum concentration at which both vitamins showed maximum antioxidant activity. It was concluded that both vitamin C and E has direct effect on lens epithelium cells. At optimum concentration, they can reduce oxidative stress in these cells thus can support to prevent or delay cataract development.     

低钾胁迫对不同基因型杂交水稻氮代谢的影响

通过在低钾胁迫下对杂交水稻耐低钾基因型威优３５及不耐低钾基因型汕优６号的比较研究,表明低钾胁迫会显著增加不耐低钾基因型植株地上部分的氮含量和叶片总游离氨基本酸含量,降低籽粒粗蛋白含量,显著影响叶片脯氨酸含量的变化;而对耐低钾基因型的影响较小。低钾胁迫还引起两基因型其它主要游离氨基酸的不同变化,籽粒产量也有明显差异,说明耐低钾基因型水稻在氮代谢方面具有特异性。     

Biotin metabolism defect - A case report

Defects in biotin metabolism are mainly associated with either the enzyme Biotinidase or Holocarboxylase synthetase. Defects in either enzymes depletes biotin utilization by the cells. Holocarboxylase synthetase deficiency is an inherited disorder in which the body is unable to use the vitamin biotin effectively. This condition is inherited in an autosomal recessive pattern. We present a case of a 9 year old girl with atypical symptomology as a case holocarboxylase synthetase deficiency, who demonstrated an increased excretion of propionic and methyl malonic acids, with her biotinidase activity being normal. She demonstrated remarkable improvement on biotin supplementation.     

Evaluation of comparative and combined antimutagenic potential of vitamin C and vitamin E using histidine mutant <Emphasis Type="Italic">Salmonella typhimurium</Emphasis> strains

Chemoprevention represents a new intervention strategy to control some type of carcinogenesis especially in subjects at high risk for cancer development. Experimental and epidemiological data indicate that a variety of nutritional factors including vitamin C and E are effective to lower the risk of some types of cancer. However large prospective studies have failed to find such significant association. A comparative and combined in vitro antimutagenic potential of two antioxidant vitamins ascorbic acid (vitamin C) and α-tocopherol (vitamin E) were evaluated using Ame’s Salmonella typhimurium test assay. Directly acting mutagens such as sodium azide (NaN₃) and 4-Nitro-o-phenylenediamine (NPDA), and N-methyl-N′-nitro-N-nitrosoguanidine (MNNG) were used to induce mutation in salmonella strains TA 98 and TA 100. Vitamin C significantly (P < 0.01) and dose dependently inhibited the mutagenicity induced by all the three mutagens. The percent inhibitions of vitamin C at 15 mg/plate were 33.8% (NaN₃), 52.5 % (MNNG) and 55.4 % (NPDA). Vitamin E (15 mg/plate) was effective to inhibit mutagenicity induced by NaN3 and MNNG but did not inhibit mutation induced by NPDA. Combination of vitamins (vitamin C plus vitamin E) produced only an additive antimutagenic activity when compared to their activity at 5 mg/plate. The results of the study concluded that vitamin C is a better antimutagenic agent than vitamin E and combination of vitamins did not produce any synergistic activity.     

Evaluation of antioxidant profile and activity of amalaki (Emblica officinalis), spirulina and wheat grass

Aqueous and alcoholic extracts of amalki (Emblica officinalis), spirulina and wheatgrass were prepared and analyzed for antioxidant vitamin content (vitamin C and E), total phenolic compounds. Antioxidant status, reducing power and effect on glutathione S-transferase (GST) activity were evaluated in vitro. Vitamin C content of crude amalaki powder was found to be 5.38 mg/g, while very less amount 0.22 mg/g was detected in wheat grass. Amalki was rich in vitamin E like activity, total phenolic content, reducing power and antioxidant activity. Total antioxidant activity of aqueous extract of amalki, spirulina and wheat grass at 1mg/ml concentration were 7.78, 1.33 and 0.278 mmol/l respectively. At similar concentrations the total antioxidant activity of alcoholic extract of amalaki, spirulina and wheat grass was 6.67, 1.73 and 0.380 mmol/l respectively. Amalki was also found to be rich source of phenolic compounds (241mg/g gallic acid equivalent). Alcoholic extract of wheat grass showed 50 % inhibition in FeCl₂- ascorbic acid induced lipid peroxidation of rat liver homogenates in vitro. Both aqueous and alcoholic extracts of amalaki inhibited activity of rat liver glutathione S-transferase (GST) in vitro in dose dependant manner. Since GST acts as powerful drug metabolizing enzyme its inhibition by amalaki offers possibility of its use for lowering therapeutic dose of herbal preparations. The aqueous extracts of both amalki and spirulina also showed protection against t-BOOH induced cytotoxicity and production of ROS in cultured C₆ glial cells.     

Vitamin C in Disease Prevention and Cure: An Overview

The recognition of vitamin C is associated with a history of an unrelenting search for the cause of the ancient haemorrhagic disease scurvy. Isolated in 1928, vitamin C is essential for the development and maintenance of connective tissues. It plays an important role in bone formation, wound healing and the maintenance of healthy gums. Vitamin C plays an important role in a number of metabolic functions including the activation of the B vitamin, folic acid, the conversion of cholesterol to bile acids and the conversion of the amino acid, tryptophan, to the neurotransmitter, serotonin. It is an antioxidant that protects body from free radical damage. It is used as therapeutic agent in many diseases and disorders. Vitamin C protects the immune system, reduces the severity of allergic reactions and helps to fight off infections. However the significance and beneficial effect of vitamin C in respect to human disease such as cancer, atherosclerosis, diabetes, neurodegenerative disease and metal toxicity however remains equivocal. Thus further continuous uninterrupted efforts may open new vistas to understand its significance in disease management.     

Lipid peroxidation and antioxidant vitamins in urolithasis

The present, study was conducted to determine the level of malondialdehyde (MDA) as an index of free radial induced lipid peroxidation and antioxidant vitamins-vitamins A, vitamin C and vitamin E in 75 confirmed cases of urolithiasis. Significantly high level of MDA (p<0.001) with significantly low levels of vitamin E (p<0.001) and vitamin A (p<0.001) with no significant decrease in vitamin C (p>0.05) were observed in the plasma of urolithiasis cases as compared to normal controls. In conclusion, it appears that a role of lipid peroxidation and oxidative function exists in the pathogenesis of urolithiasis. But, the exact mechanism how this occurs remains to be elucidated.     

The Appraisement of Antioxidant and Oxidant Status in Women Undergoing Surgical Menopause

The present study was undertaken to study the impact of surgical menopause on oxidant and antioxidant status in relation to estrogen levels after 3 months of surgery. Total 130 women who had undergone total hysterectomy (TH) with or without bilateral salpingo-oophorectomy (BSO) were included in this study. The oxidant status was assessed by measuring plasma levels of malondialdehyde and antioxidant status was assessed by measuring superoxide dismutase, catalase, glutathione, glutathione peroxidase, estrogen, and Vitamin A, E and C levels. The malondialdehyde level was significantly increased (p < 0.05) in all women who underwent TH with or without BSO. Significant increased levels of superoxide dismutase were observed in women who underwent TH with BSO. The blood glutathione levels were significantly decreased in women after TH only but significantly increased in women who had undergone TH with BSO. The levels of estrogen, vitamin E and vitamin C were significantly decreased in women who underwent TH with BSO. The catalase, GPx and vitamin A did not differ significantly in all groups. The result suggests that surgical menopause is associated with oxidative stress which reiterates the fact that ovaries retain some function even after menopause.     

Antioxidant status in neonatal jaundice before and after phototherapy

Phototherapy has been related to increased oxidative stress and lipid peroxidation. In the present study, thirty full term jaundiced neonates with appropriate weight were analyzed before and after completion of phototherapy for malondialdehyde (MDA), reduced glutathione (GSH), total thiols, vitamin C and superoxide dismutase (SOD) levels in hemolysate and albumin levels in plasma. These parameters were analyzed in cord blood samples of 20 healthy neonates as control. It was observed that levels of MDA were elevated significantly (p<0.001) in patients as compared to controls and that the levels increased significantly after phototherapy (p<0.001). Levels of SOD were also found to be increased significantly as compared to controls and the levels rose after phototherapy (p<0.001). On the other hand, the levels of non-enzymatic antioxidants such as GSH, total thiols and vitamin C were significantly low (p<0.001) as compared to controls and the levels decreased significantly after phototherapy (p<0.001). The plasma albumin levels also were found to be decreased significantly after phototherapy (p<0.01). Therefore, phototherapy increases oxidative stress and should be used with care.     

Evaluation of oxidative stress in pregnancy induced hypertension

This work was undertaken to investigate correlation between oxidative stress and initiation of pathogenesis of pregnancy induced hypertension (PIH). Fifty primigravidae in age group of 20–35 years and gestational age 28–42 weeks with PIH were taken as cases. Twenty healthy primigravidae with no medical and surgical complications of pregnancy and with blood pressure ≤140/90 mm Hg served as controls. The cases were again subgrouped as severe preeclampsia (12 in number) and mild pre-eclampsia (38 in number). All of them were evaluated for serum malondialdehyde (MDA), Serum vitamin E and plasma vitamin C levels. The serum MDA levels were raised significantly in women with mild preeclampsia (P<0.01) and in women with severe preeclampsia (P<0.01) in comparison to normal primi gravida. The serum vitamin E levels were decreased in primi gravida with mild preeclampsia (p<0.1) and in primi with severe pre eclampsia (P<0.1) in comparison to normal primi gravida but the fall was not statistically significant. There was a significant fall (P<0.05) in the vitamin C levels in primi with mild preeclampsia than in the normal primi. The vitamin C levels in severe preeclamptic patients were lower than the normal primi but the fall was not statistically significant (P=0.10). The serum MDA and vitamin E showed a negative correlation in all the cases. The serum MDA and plasma vitamin C also showed a negative correlation in the control and study group. This observation suggests that in hypertensive disorders of pregnancy there is an imbalance between lipid peroxidation and antioxidant vitamin status because of oxidative stress. The decreased serum concentrations of the antioxidant vitamins supports the hypothesis that lipid peroxidation is an important causative factor in the pathogenesis of preeclampsia. The rise in antioxidants is probably to compensate the increased peroxide load in severe preeclampsia.     

Role of Homocysteine in Cognitive Impairement and Alzheimer’s Disease

A high circulating concentration of the non proteinogenic amino acid homocysteine has been implicated as a risk factor for Alzheimer’s Disease and its prodromal stage, mild cognitive impairement. Furthermore, hyperhomocysteinaemia has been directly attributed to a deficiency in vitamins B12, folate, and B6. Several studies have demonstrated decrease in progression of mild cognitive impairement to Alzheimer’s Disease, and some have even shown an improvement in cognition after vitamin supplements with B12 and folate. Plausible mechanisms linking hyperhomocysteinaemia to Alzheimer’s and cognitive impairement have been hypothesized and demonstrated in hyperhomocysteinemic mice models. However, some studies have not elucidated any benefit of vitamin supplements in subjects with cognitive impairment. Hence, multicentric clinical studies need to be conducted to substantiate the mechanisms of neuronal degeneration due to hyperhomocysteinaemia and to demonstrate the beneficial effect of folate, B6 and B12 supplements on cognition.