Selenium and Behçet's disease

Systemic and local effect of oxidative stress on recurrent aphthous stomatitis: systematic review

Recurrent aphthous stomatitis (RAS) is a chronic and recurrent inflammatory disease of the mouth. It is characterised by the appearance of painful ulcers in the oral mucosa. RAS is believed to be a multifactorial disease with genetic predisposition, environmental factors and alterations in the immune system. Oxidative stress, caused by an imbalance between free radicals and the antioxidant system, also appears to be involved in the pathogenesis of RAS. Several risk factors, such as smoking, iron and vitamin deficiency and anxiety, may contribute to the development of the disease. Understanding the underlying mechanisms may help in the prevention and treatment of RAS. We searched PubMed, Scopus and Web of Science databases for articles on oxidative stress in patients with RAS from 2000 to 2023. Studies analysing oxidant and antioxidant levels in the blood and saliva of RAS patients and healthy controls were selected. Of 170 potentially eligible articles, 24 met the inclusion criteria: 11 studies on blood samples, 6 on salivary samples and 7 on both blood and salivary samples. Multiple oxidative and antioxidant markers were assessed in blood and saliva samples. Overall, statistically significant differences were found between RAS patients and healthy controls for most markers. In addition, increased oxidative DNA damage was observed in patients with RAS. Patients with RAS show elevated levels of oxidative stress compared to healthy controls, with a significant increase in oxidative markers and a significant decrease in antioxidant defences in saliva and blood samples.

Selenium and Autoimmune Diseases: A Review Article

BACKGROUND

Selenium is an essential trace element with fundamental effects on human biology. Trace elements deficiency is not an uncommon finding in autoimmune diseases. This deficiency may be a consequence of autoimmune diseases or may contribute to their etiology. With regard to evidence showing the association between selenium deficiency and generation of reactive oxygen species and subsequent inflammation, reviewing the role of selenium in collagen vascular diseases could help researchers to devise strategies for managing these diseases.

OBJECTIVE

The present study aimed to evaluate the role of selenium and autoimmune rheumatic diseases.

DATA SOURCES

PubMed, Scopus, Science Direct, and Google Scholar.

STUDY ELIGIBILITY CRITERIA

All the studies on the use of selenium without any limitations in terms of the preparation method, administration route, or formulation process were included in the study. The exclusion criteria were: 1) Articles published in languages other than English, 2) Administration of chemical and hormonal drugs rather than selenium, 3) Investigation of the effects of selenium on the autoimmune problems in animal models, and 4) Insufficiency of the presented data or poor description of the applied methods. Furthermore, review articles, meta-analyses, expert opinions, editorial letters, case reports, consensus statements, and qualitative studies were excluded from the study.

DATA EXTRACTION

In this systematic review, articles were evaluated through searching following keywords in combination with selenium: "autoimmune rheumatic diseases "or "scleroderma" or "systemic sclerosis" or "Behcet's disease" or "Sjögren syndrome" or "systemic lupus erythematosus" or "musculoskeletal diseases" or "rheumatoid arthritis" or "vasculitis" or "seronegative arthritis" or "antiphospholipid antibody syndrome".

RESULTS

Of 312 articles, 280 were excluded and 32 articles were entered in this study. Based on the majority of studies assessing selenium level in patients with collagen vascular diseases, lower selenium levels were observed in these patients. Moreover, the majority of articles showed an improvement in clinical symptoms of collagen vascular diseases compared to controls after the treatment of patients with different dosages of L-selenomethionine.

CONCLUSION

A decrease in the serum level of selenium was noted in patients with autoimmune diseases, which may be a risk factor for inflammation and initiation of autoimmunity in these patients. A sufficient quantity of selenium has been shown to contribute to the management of complications of autoimmune diseases and even improved survival in patients with autoimmune diseases, which may be due to the anti-inflammatory effects of selenium. Since this issue is of clinical importance, it can be considered in potential nutrition interventions and have beneficial effects on some autoimmune diseases.

Cristobalite and Hematite Particles in Human Brain

Foreign substances get into the internal environment of living bodies and accumulate in various organs. Cristobalite and hematite particles in the glial cells of pons cerebri of human brain with diagnosis of Behhet disease with scanning electron microscopy (SEM), energy-dispersive microanalysis (EDX), and transmission electron microscopy (TEM) with diffraction were identified. SEM with EDX revealed the matter of irregular micrometer-sized particles sometimes forming polyhedrons with fibrilar or stratified structure. It was found in some particles Ti, Fe, and Zn. Some particles contained Cu. TEM and electron diffraction showed particles of cristobalite and hematite. The presence of the particles can be a result of environmental effect, disruption of normal metabolism, and transformation of physiologically iron-ferrihydrite into more stable form-hematite. From the size of particles can be drawn the long-term accumulation of elements in glial cells.

[Epidemiology of Behçet's disease]

With more than 30 published prevalence estimates for Behçet's disease (BD), covering many different regions worldwide, the prevalence of BD is quite well described. Even though the interpretation of these data is complicated by between-study differences in methodology, which may substantially influence the results, these data suggest large geographic variations in frequency of BD, with prevalence rates of 20-420/100,000 inhabitants for Turkey, 2.1-19.5 for other Asian countries, 1.5-15.9 for southern Europe and 0.3-4.9 for northern Europe. Additional epidemiological studies or case series from North and South America, the Caribbean Islands, and individuals of sub-Saharan ancestry further suggest that the geographic distribution of BD is much wider than the boundaries of the ancient Silk Road. The few available incidence rates prevent from making strong inferences as to whether the frequency of BD has changed over time. Recent population-based studies of immigrants or migrant populations consistently indicate that migrants from areas of high BD prevalence remain at high risk for BD, which may even be close to the prevalence observed in their countries of origin. Genetic factors, which are not detailed in this review, seem to play a preponderant role in BD development, although they cannot explain the wide between-country disparities in BD prevalence. However, environmental risk factors, including infectious and non-infectious causes, remain poorly investigated and have not yet produced solid hints.

Study of the correlation of serum selenium level with Behcet's disease

BACKGROUND

Selenium, like other trace elements and antioxidant enzymes, is known as an antioxidant and immunomodulator trace element. Due to recent evidence for selenium deficiency in Behcet's syndrome, this study is to evaluate the correlation of serum selenium level with Behcet's disease (BD).

MATERIALS

This case-control study was conducted on 46 BD patients and 46 healthy controls in a rheumatology research centre. The case and control groups were both age- and race-matched. Serum selenium level was then measured by atomic absorption spectrometry Shimadzu AA-680. Average serum levels of both groups were then compared and analyzed using t-test.

RESULTS

Mean serum selenium levels of patients appeared to be 66.4 ± 15.38 μg/L which was significantly lower than that in the healthy controls (86.87 ± 17.18 μg/L) (P < 0.005). Taking physician global assessment of disease activity into account, significant difference was detected between the patients with active disease (66.57 ± 15.21 μg/L) and those in the inactive state (65.83 ± .75 μg/L). Regardless of the findings mentioned above, serum selenium level was meaningfully elevated among the patients with ocular involvement (P < 0.001).

CONCLUSIONS

These findings demonstrated that selenium serum level among BD patients was lower than that in healthy controls, whereas among the patients with ocular involvement it was higher than those not involved.

Oxidant/antioxidant status in patients with recurrent aphthous stomatitis

Recurrent aphthous stomatitis (RAS) is recognized as one of the most common oral mucosal diseases worldwide. The aim of this study was to determine the oxidant/antioxidant status in erythrocyte and plasma samples from patients with RAS in comparison with healthy controls. Twenty-two patients with RAS and 23 healthy controls were recruited. Superoxide dismutase, glutathione peroxidase (GSHPx) and catalase (CAT) activities, and malondialdehyde (MDA) and antioxidant potential (AOP) levels were measured in plasma and erythrocytes from patient with RAS and controls. We found decreased CAT and GSHPx activities and AOP levels in the erythrocytes, and decreased AOP and increased MDA plasma levels in patients with RAS in comparison with control subjects. In summary, this study demonstrated that enzymatic and nonenzymatic antioxidant defence systems are impaired in patients with RAS.

Management strategies for HIV-associated aphthous stomatitis

Recurrent aphthous stomatitis (RAS) is the most common oral mucosal disorder found in men and women of all ages, races, and geographic regions. There are three forms of the lesions (minor, major, and herpetiform), with major aphthous ulcers causing significant pain and potential for scarring. In HIV-infected individuals, these ulcers occur more frequently, last longer, and produce more painful symptoms than in immunocompetent persons. In addition, they may be associated with similar ulcerations involving the esophagus, rectum, anus, and genitals. The diagnosis of HIV-induced RAS requires a careful history of the condition, and a thorough extra- and intra-oral examination. Oral mucosal biopsies are required for non-healing ulcers in order to exclude the possibility of deep fungal infections, viral infections, and neoplasms. The cause of the ulcers in HIV-positive persons has not been elucidated--local diseases, genetic, immunologic, and infectious factors all probably play a role. The goals of current treatments are to promote ulcer healing, to reduce ulcer duration and pain while maintaining nutritional intake, and to prevent or diminish the frequency of recurrence. Initial therapy for infrequent RAS recurrences includes over-the-counter topical protective and analgesic products. Initial therapy for frequent RAS outbreaks requires topical anesthetics, binding agents, and corticosteroids. Major RAS and non-healing minor or herpetiform RAS may require intralesional corticosteroids and systemic prednisone. Second-line immunomodulators for frequent and non-healing ulcers includes thalidomide and other immunomodulators.

Effects of vitamin E supplementation on blood antioxidants levels in patients with Behçet's disease

Behçet's disease (BD) is known for many years, yet its etiology remains unknown. In BD, the increased production of reactive oxygen species from activated neutrophils may reduce concentrations of antioxidant vitamins and enzymes in plasma and red blood cells (RBC). Vitamin E is an important fat soluble antioxidant and its role on antioxidant parameters of BD is unclear. The study was undertaken to evaluate the role of vitamin E on lipid peroxidation (MDA) levels, antioxidant vitamin and enzyme concentrations in plasma and RBC in patients with BD. There were three groups i.e., control, patient and treatment groups with twenty-five subjects in each. Nonsmoking patients with BD, patient group, was compared with an equal number of healthy control subjects (control group). Blood samples were taken from both control and patient groups and then oral vitamin E was daily supplemented to the patients with BD for six weeks (treated group). At the end of six weeks, blood was taken from the treated group once more. RBC and plasma MDA levels, serum neopterin, complement system (C(3) and C(4)), ASO, CRP, rheumatoid factor, plasma lipoprotein (a), total cholesterol concentrations and erythrocyte sedimentation rate were higher in the patient group than in the control group, but they were lower in the treatment group than in the patient group. While vitamins A, E and beta-carotene concentrations in plasma, catalase, glutathione peroxidase activities and reduced glutathione levels in RBC and plasma were lower in patient group than in the controls, they were found to be higher in the treatment group than in the patient group. These results provide some evidence for a potential role of increased lipid peroxidation and decreased enzymatic and non enzymatic antioxidants in BD by its inflammatory character and vitamin E which may strengthen the antioxidant defense system, and may contribute to the treatment of BD.

Superoxide dismutase activity and glutathione system in erythrocytes of men with Behchet's disease

In order to clarify whether erythrocyte superoxide dismutase (SOD) activity and glutathione system including reduced glutathione (GSH), glutathione peroxidase (G-Px), glutathione reductase (G-Red), glutathione S-transferase (GST) are impaired in men with Behchet's disease (BD) at the first diagnosed time, erythrocyte SOD activity, GSH level, activities of G-Px, G-Red and GST were determined in men with new diagnosed BD. Erythrocyte GSH level, G-Px and G-Red activities were found to be lower, SOD activity was found to be higher in the patients as compared the controls. There was no significant difference between patients and controls for GST activity. Significant positive correlations between GSH and G-Px, GSH and G-Red; significant negative correlations between GSH and SOD, G-Px and SOD, G-Red and SOD were determined. It was concluded that erythrocyte SOD activity and glutathione system are altered in men with new diagnosed BD. It was concluded that these alterations may be a contributory factor for tissue damage associated with BD.

Lipid peroxidation and erythrocyte antioxidant enzymes in patients with Behçet's disease

In spite of unknown etiology, it is now accepted that reactive oxygen species (ROS) produced by neutrophils may be related to the pathogenesis of Behçet's Disease (BD). The objective was to investigate whether increased production of ROS may affect erythrocyte oxidant/antioxidant system in patients with BD. The levels of malondialdehyde (MDA), one of the end products of lipid peroxidation, in plasma and erythrocyte, and the activities of superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px), antioxidant enzymes, in erythrocyte, also C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were measured in 22 patients in active stage of the disease and also in 30 healthy controls. Increased CRP, ESR, and MDA levels in plasma and erythrocyte and increased SOD but decreased GSH-Px activities in erythrocytes were observed in the patients, when compared to the controls. In addition, significantly positive correlations between plasma and erythrocyte MDA levels, and erythrocyte MDA-CRP, MDA-ESR, MDA-SOD, SOD-ESR and SOD-CRP levels, but negative correlation between plasma MDA and erythrocyte GSH-Px, were found in BD patients. It may be suggested that increased production of ROS in BD, as reflected by higher plasma and erythrocyte MDA levels, may impair erythrocyte membrane integrity and also may lead to the alterations in the erythrocyte antioxidant defense system, as reflected by higher SOD and lower GSH-Px activities in erythrocytes.

Erythrocyte antioxidant activity and trace element levels in Behçet's disease

Selenium (Se), zinc (Zn), copper (Cu), and antioxidant enzyme (superoxide dismutase [SOD] and glutathione peroxidase [GSH-Px]) levels in sera were detected in Behçet patients. Age and sex matched controls were used to find out if oxidative stress takes place in the etiopathogenesis of Behçet's disease. Superoxide dismutase levels were found to be lower in the whole patients group when compared to controls. In whole patients and inactive patients' group Zn and Se levels were found to be higher, but not different in the active patients group when compared to controls. No significant difference was found between the groups as Cu and glutathione peroxidase levels were taken into consideration. According to the results of the present study, SOD level is low in Behçet's disease patients' sera independent from the phase of the disease, and as a result of decreased SOD activity, increased production of free oxygen radicals may play a role in the etiopathogenesis of the disease.

Plasma glutathione peroxidase activity and selenium levels of newborns with jaundice

The plasma glutathione peroxidase (GSH-Px) and selenium (Se) levels were determined in 31 newborns affected by jaundice (NWJ). The GSH-Px levels of both full-term and premature newborns exhibiting jaundice and having a birthweight lower than 2000 g were significantly low (p < 0.05) when compared to controls. No significant differences were found in the corresponding Se levels, which were similar in all groups and independent of the pregnancy period and birthweight.

Plasma Lipoprotein(a) and its relationship with disease activity in patients with Behçet's disease

Behçet's disease is characterized by orogenital ulcerations and ocular lesions. Other features include arthritis, thrombophlebitis, neurological abnormalities and skin lesions. The disease is characterized by a relapsing inflammatory process of unknown aetiology. Lipoprotein(a) is an LDL-like particle with a large glycoprotein called apolipoprotein(a) attached to its apolipoprotein B moiety through one or more disulphide bonds. Apolipoprotein(a) is related to plasminogen from which the enzyme plasmin, that hydrolyses fibrin blood clots, is released by tissue plasminogen activators. The unique structural features of Lp(A) give it the potential for atherogenic and thrombogenic activities. In the present study 35% of patients with Behçet's disease were shown to have higher Lp(a) concentrations than the cut-off point (0.30 g/l) for atherosclerosis. Plasma Lp(a) concentrations in the remission period were also found to be lower than during the active period in the same patients (23% decreased). Lp(a) showed significant correlations with acute phase reactants such as erythrocyte sedimentation rate, polymorphonuclear leukocytes and polymorphonuclear leukocyte elastase activity. Therefore, it was concluded that the fluctuations of plasma Lp(a) levels with the activity of disease may be a contributing risk factor in the development of thrombogenic complications in patients with Behçet's disease.

Polymorphonuclear leukocyte elastase levels in patients with Behçet's disease

Behçet's disease is a chronic multisystem disorder characterized by a relapsing inflammatory process of unknown aetiology. The increased activity of polymorphonuclear leukocytes (PMN) in Behçet's disease has been intensively studied. PMN elastase, an acute phase reactant, was investigated to determine whether it may serve as a biochemical marker in Behçet's disease. Erythrocyte sedimentation rate, protein electrophoresis, immunoglobulins (IgA, IgG, IgM), complement components (C3, C4) as well as PMN elastase were evaluated in 42 patients with Behçet's disease and 40 healthy subjects. The mean PMN elastase levels were found to be 244.2 micrograms/l (median 210 micrograms/l, S.D. 126.8) in patients with Behçet's disease and 44.3 micrograms/l (median 45, S.D. 19.2) in healthy subjects (P < 0.001). In addition, the mean PMN elastase levels were found to be 321.5 micrograms/l (median 300, S.D. 117.9) in the acute phase and 159 micrograms/l (median 162, S.D. 59.3) in remission (P < 0.001). It was concluded that PMN elastase may be a good biochemical marker for diagnosis and therapy control in patients with Behçet's disease.

Mineral status in selenium-deficient rats compared to selenium-sufficient rats fed vitamin-free casein-based or torula yeast-based diet

To clarify the mineral status in selenium (Se)-deficient rats fed a vitamin-free casein (VFC)-based or torula yeast (TY)-based diet, 24 weanling male Wistar rats were divided into 4 groups fed diets using VFC or TY as the protein source and containing Se at sufficient (0.5 microgram/g, +Se) or deficient (0.019 microgram/g for VFC-based and < 0.005 microgram/g for TY-based diets, -Se) level for 8 wk. TY supplied a larger amount of extra minerals (Na, K, Ca, Mg, Fe, Mn, Zn, and Cu) except Se than VFC. Se concentration and glutathione peroxidase activity were significantly lower in TY-fed rats than in VFC-fed rats, as well as in -Se rats compared to +Se rats. Compared to +Se rats, Fe concentration was higher in liver and muscle of -Se rats fed the VFC-based diet and in plasma, heart, liver, and tibia of -Se rats fed the TY-based diet. Compared to +Se rats, decreases of Mn concentration appeared in plasma, heart, and tibia of VFC-fed -Se rats and in brain, heart, liver and tibia of TY-fed -Se rats. There was also a little imbalance in Ca, Mg, Na, K, and Cu caused by Se deficiency. The results indicated that Se deficiency induced the mineral imbalance in rats, especially an increase in Fe and decrease in Mn, which was more severe in TY-fed rats than VFC-fed rats. However, TY cannot be used as a model for both Se and other mineral deficiency because of the extra minerals except Se found in TY. Instead, VFC can be employed, which contains fewer minerals except Se than TY and also can produce a severe degree of Se deficiency.