Vitamin E supplements and coronary heart disease

Antioxidant therapy in the elderly with tinnitus

INTRODUCTION

Several approaches have been tried for the treatment of tinnitus, from cognitive-behavioral therapies and sound enrichment to medication. In this context, antioxidants, widely used in numerous areas of medicine, appear to represent a promising approach for the control of this symptom, which often is poorly controlled.

OBJECTIVE

To evaluate the effects of antioxidant therapy for tinnitus in a group of elderly patients.

METHODS

Prospective, randomized, double-blinded, placebo-controlled clinical trial. The sample consisted of 58 subjects aged 60 years or older, with a complaint of tinnitus associated with sensorineural hearing loss. These individuals completed the Tinnitus Handicap Inventory (THI) questionnaire before and after six months of therapy. The treatment regimens were: Ginkgo biloba dry extract (120mg/day), α-lipoic acid (60mg/day)+vitamin C (600mg/day), papaverine hydrochloride (100mg/day)+vitamin E (400mg/day), and placebo.

RESULTS

There was no statistically significant difference between THI by degree (p=0.441) and by score (p=0.848) before and after treatment.

CONCLUSION

There was no benefit from the use of antioxidant agents for tinnitus in this sample.

Evaluation of serum antioxidants in age-related hearing loss

BACKGROUND

Age-related hearing loss (ARHL) has been linked to the shift in the pro-oxidant/antioxidant ratio. Our objectives were to assess serum levels of retinol and zinc among the elderly individuals and to correlate the levels with hearing threshold.

METHODS

Prospective study of apparently healthy individuals aged ≥60 years of age. Participants had complete clinical history, physical examination and pure tone average conducted. Blood samples were collected for determination of serum levels of retinol and zinc. Mann-Whitney U test was used to compare retinol and zinc values. Pearson's correlation test was used to determine the relationship between hearing threshold and serum levels of retinol and zinc.

RESULTS

Among 126 elderly participants with mean age 67 ± 2.7 years; the mean pure tone average for air conduction was 29.3 ± 1.6 dBHL while the mean bone conduction was 36.5 ± 1.8 dBHL. The median values of serum retinol and zinc levels in the elderly participants who had hearing loss in the speech frequencies were 52 and 83.3 μg/L, respectively, while among participants with normal hearing threshold, values were 50 and 89.9 μg/L, respectively (p = 0.59 and 0.99, respectively). For the high frequencies, the median value of serum retinol and zinc levels among the elderly participants with normal hearing threshold was 70.3 and 99.9 μg/L, while among those with hearing loss, it was 46.9 and 83.2 μg/L, respectively (p = 0.000 and 0.005, respectively).

CONCLUSION

Serum retinol and zinc levels were significantly lower among elderly with hearing loss involving the high frequencies. This is added evidence to extant literature on the possible role of antioxidants in the development of ARHL and suggests further study on the effect of antioxidants supplementation in the control of ARHL which is presently controversial and inconclusive.

Evaluation of antioxidant treatment in presbyacusis: prospective, placebo-controlled, double-blind, randomised trial

OBJECTIVE

There are many well-known aetiological mechanisms of presbyacusis, and free radicals have been shown to play an important role. This study aimed to evaluate the effect of antioxidant agents on the hearing threshold of patients with presbyacusis.

METHODS

One hundred and twenty individuals were divided into four groups and received one of the following treatment schemes: ginkgo biloba dry extract, α-lipoic acid plus vitamin C, papaverine chlorhydrate plus vitamin E, or placebo. All participants were evaluated at recruitment and after six months, using pure tone audiometry (at isolated and average frequencies), speech recognition threshold and percentage index of speech recognition.

RESULTS

The various treatments had no effect on any of the evaluated measures of hearing, either between groups or over time.

CONCLUSION

There was no statistically significant change in the hearing threshold after treatment with any of the tested drugs, during the study period.

Biomarkers related to aging in human populations

Biomarkers are increasingly employed in empirical studies of human populations to understand physiological processes that change with age, diseases whose onset appears linked to age, and the aging process itself. In this chapter, we describe some of the most commonly used biomarkers in population aging research, including their collection, associations with other markers, and relationships to health outcomes. We discuss biomarkers of the cardiovascular system, metabolic processes, inflammation, activity in the hypothalamic-pituitary axis (HPA) and sympathetic nervous system (SNS), and organ functioning (including kidney, lung, and heart). In addition, we note that markers of functioning of the central nervous system and genetic markers are now becoming part of population measurement. Where possible, we detail interrelationships between these markers by providing correlations between high risk levels of each marker from three population-based surveys: the National Health and Nutrition Examination Survey (NHANES) III, NHANES 1999-2002, and the MacArthur Study of Successful Aging. NHANES III is used instead of NHANES 1999-2002 when specific markers of interest are available only in NHANES III and when we examine the relationship of biomarkers to mortality which is only known for NHANES III. We also describe summary measures combining biomarkers across systems. Finally, we examine associations between individual markers and mortality and provide information about biomarkers of growing interest for future research in population aging and health.

Pro-oxidative versus antioxidative reactions between Trolox and Cr(VI): The role of H(2)O(2)

The effect of the Vitamin E model compound Trolox in reactions with Cr(VI) in the presence or absence of hydrogen peroxide was investigated. The aim of this study was to establish and discuss potential Trolox-mediated pro-oxidative reactions. The importance of the Trolox:Cr(VI) ratio in the Cr(VI) reduction process was determined from the EPR spectra and DNA cleavage reactions. In the absence of hydrogen peroxide, reduction of Cr(VI) occurred with concomitant oxidation of Trolox to the phenoxyl radical. In the presence of hydrogen peroxide, Cr(V), produced by the reduction of Cr(VI), reduced hydrogen peroxide to the hydroxyl radical. The latter was detected by spin-trapping the methyl radical following reaction with N-methyl sulfoxide. During Cr(VI) reduction with Trolox, DNA single- or double-strand breaks due to Trolox radical formation were not observed. Relaxed DNA appeared only when H(2)O(2) was added to Trolox/Cr(VI) mixtures most probably due to hydroxyl radical formation during the redox cycling of Cr(V/IV)-species. Fenton-like reactions do not play a significant role in the Trolox/Cr(VI) system in the absence of added H(2)O(2).

Antioxidant activities of Physalis peruviana

Physalis peruviana (PP) is a widely used medicinal herb for treating cancer, malaria, asthma, hepatitis, dermatitis and rheumatism. In this study, the hot water extract (HWEPP) and extracts prepared from different concentrations of ethanol (20, 40, 60, 80 and 95% EtOH) from the whole plant were evaluated for antioxidant activities. Results displayed that at 100 mug/ml, the extract prepared from 95% EtOH exhibited the most potent inhibition rate (82.3%) on FeCl2-ascorbic acid induced lipid peroxidation in rat liver homogenate. At concentrations 10-100 microg/ml, this extract also demonstrated the strongest superoxide anion scavenging and inhibitory effect on xanthine oxidase activities. In general, the ethanol extracts revealed a stronger antioxidant activity than alpha-tocopherol and HWEPP. Compared to alpha-tocopherol, the IC50 value of 95% EtOH PP extract was lower in thiobarbituric acid test (IC50=23.74 microg/ml vs. 26.71 microg/ml), in cytochrome c test (IC50=10.40 microg/ml vs. 13.39 microg/ml) and in xanthine oxidase inhibition test (IC50=8.97 microg/ml vs. 20.68 microg/ml). The present study concludes that ethanol extracts of PP possess good antioxidant activities, and the highest antioxidant properties were obtained from the 95% EtOH PP.

Antioxidant activity of Cinnamomum cassia

The antioxidant activities of hot water extracts (HWECC) and ethanol extracts (EECC) from the dry bark of Cinnamomum cassia Presl were evaluated in this study. Results showed that at 1.0 mg/mL, the ethanol extracts of C. cassia (96.30%) exhibited a greater inhibition than the alpha-tocopherol (93.74%) on FeCl(2)-ascorbic acid induced lipid peroxidation of rat liver homogenate in vitro. From 0.05 to 1.0 mg/mL, the EECC demonstrated the highest superoxide anions scavenging activity and the strongest anti-superoxide formation activity (p < 0.05). The same extract also showed an excellent antioxidant activity in enzymatic and nonenzymatic liver tissue oxidative systems. EECC revealed the strongest antioxidant activity followed by alpha-tocopherol and HWECC. Compared to alpha-tocopherol, the IC(50) values of EECC were found to be lower in thiobarbituric acid test (IC(50) = 0.24 mg/mL vs 0.37 mg/mL), in cytochrome c test (IC(50) = 0.16 mg/mL vs 0.27 mg/mL) and in xanthine oxidase inhibition test (IC(50) = 0.09 mg/mL vs 0.19 mg/mL). The present study concludes that EECC could be used as a good source of antioxidant in the dietary supplement.

Application of single-cell gel electrophoresis (comet) assay for assessing levels of DNA damage in canine and feline leukocytes

Increasing evidence suggests involvement of free-radical species in the development of oxidative DNA damage, the consequences of which have been implicated in a number of degenerative disorders associated with the aging process. Here we report the application of a single-cell gel electrophoresis (comet) assay for assessing levels of DNA damage in canine and feline leukocytes. Leukocytes were collected from 24 healthy adult cats and dogs and subjected to DNA damage ex vivo by exposure to a range of hydrogen peroxide (H(2)O(2)) concentrations (0-250 micromol/L). The optimal concentration of H(2)O(2) to induce a significant increase in DNA damage was 100 micromol/L for both canine and feline leukocyte samples. Levels of DNA damage were assessed and quantified by visual and computer image analysis. The results obtained showed high correlations between visual scoring and computer image analysis for feline samples (percentage DNA in tail, R(2) > 0.99; tail moment, R(2) > 0.95; tail length, R(2) > 0.90) and canine samples (percentage DNA in tail, R(2) > 0.97; tail moment, R(2) > 0.95; tail length, R(2) > 0.91). In conclusion, this method provides a way of assessing levels of DNA damage utilizing visual and/or computer image analysis in the feline and canine systems. With the capacity of the comet assay to be able to measure end products of free-radical reactions, it is a useful tool for determining the optimal effects of dietary antioxidants on a reliable biomarker of oxidative stress such as cellular DNA status in cats and dogs.

Role of dietary antioxidants to protect against DNA damage in adult dogs

We studied the effects of feeding an antioxidant blend of vitamins, minerals and carotenoids to a mixed adult dog population (n = 40, mean 4.4 +/- 1.85 y) for a 16-wk period. Compared to the control group of dogs (n = 20), the antioxidant (AOX)-supplemented group of dogs (n = 20) demonstrated significant increases in plasma levels of vitamin E and taurine by 4 wk of supplementation (P < 0.01) and total antioxidant activity (as measured by ferric-reducing antioxidant power assay) by 8 wk of supplementation (P < 0.05). Following 8 wk of supplementation, the AOX-supplemented dogs also showed significant reductions in both endogenous and exogenous DNA damage (P < 0.005) compared to that of the control dogs, as measured by the comet assay. Over an 8-wk rabies vaccination course that started at 8 wk supplementation, the AOX-supplemented dogs also demonstrated significantly higher vaccine-specific virus-neutralizing antibody levels at 2, 4 and 6 wk postvaccination (P < 0.05) and a tendency toward establishing a vaccine-specific antibody response quicker than did the control group of dogs. These findings in dogs suggest that antioxidant supplementation can achieve sustained increases in circulating levels of antioxidants that exert a protective effect by a decrease in DNA damage, leading to improved immunological performance. These findings also have implications in a wider context where free-radical damage has been associated with a variety of degenerative disorders and the aging process in general.

Antioxidant vitamins in the prevention of cardiovascular disease: a systematic review

Do antioxidant vitamins, in regular food or as food supplements, protect against myocardial infarction and stroke? In this systematic literature review on the effects of antioxidant vitamins in the primary prevention of cardiovascular disorders, studies with ischaemic heart disease, stroke or combined cardiovascular events as end-points have been included. Studies on the effects of antioxidant vitamins on intermediary end-points (such as blood lipids and blood pressure) and as secondary prevention in patients with manifest cardiovascular disease are reviewed in a conventional manner. In observational studies (case-control or cohort design), people with high intake of antioxidant vitamins by regular diet or as food supplements generally have a lower risk of myocardial infarction and stroke than people who are low-consumers of antioxidant vitamins. The associations in observation studies have been shown for carotene, ascorbic acid as well as tocopherol. In randomized controlled trials, however, antioxidant vitamins as food supplements have no beneficial effects in the primary prevention of myocardial infarction and stroke. Serious adverse events have been reported. After an initial enthusiasm for antioxidants in the secondary prevention of cardiovascular disease, recent reports from of several large randomized trials have failed to show any beneficial effects. Thus, the apparent beneficial results of high intake of antioxidant vitamins reported in observational studies have not been confirmed in large randomized trials. The discrepancy between different types of studies is probably explained by the fact that supplement use is a component in a cluster of healthy behaviour. Antioxidant vitamins as food supplements cannot be recommended in the primary or secondary prevention against cardiovascular disease.

Effects of dietary restriction and antioxidants on presbyacusis

OBJECTIVES/HYPOTHESIS

The premise of this study is that the membrane hypothesis of aging, also known as the mitochondrial clock theory of aging, is the basis for presbyacusis. Furthermore, it is proposed that treatment with antioxidants or dietary restriction can attenuate age-related hearing loss. Many studies have demonstrated a reduction in blood flow to specific tissues, including the cochlea, with aging. Hypoperfusion leads to the formation of reactive oxygen metabolites (ROM). ROM are highly toxic molecules that directly affect tissues including inner ear structures. In addition, ROM can damage mitochondrial DNA (mtDNA), resulting in the production of specific mtDNA deletions (mtDNA del4977 [human] or mtDNA del4834 [rat]; also known as the common aging deletion]. Previous corroborating data suggest that the common aging deletion mtDNA4834 may be associated not only with aging but also with presbyacusis, thus further strengthening the basis of the current studies. In this study, experiments provide compelling evidence that long-term treatment with compounds that block or scavenge reactive oxygen metabolites attenuate age-related hearing loss and reduce the impact of associated deleterious changes at the molecular level.

STUDY DESIGN

Prospective randomized study.

METHODS

One hundred thirty rats were randomly assigned to one of six groups with appropriate controls. Animals were divided into the following treatment arms: group 1, 30% caloric restriction; group 2, vitamin E oversupplementation; group 3, vitamin C over-supplementation; group 4, melatonin treatment; group 5, lazaroid treatment; and group 6, placebo. In addition, 10 animals were used to determine the appropriate caloric restriction. All subjects underwent baseline and every-3-month testing until their health failed (range, 18-28 mo; average, 25 mo). This testing included auditory sensitivity studies using auditory brainstem response (ABR) testing, as well as tissue analysis for mtDNA deletions using molecular biological techniques. At the conclusion of the study, animals underwent a final ABR test and were tested for mtDNA deletions in brain and inner ear tissues, and the opposite ear was used for histological analysis.

RESULTS

Results indicated that the 30%-caloric-restricted group maintained the most acute auditory sensitivities, the lowest quantity of mtDNA deletions, and the least amount of outer hair cell loss. The antioxidant-treated subjects had improved auditory sensitivities, and a trend for fewer mtDNA deletions was observed compared with the placebo subjects. The placebo subjects had the poorest auditory sensitivity, the most mtDNA deletions, and the greatest degree of outer hair cell loss.

CONCLUSIONS

Intervention designed to reduce reactive oxygen metabolite damage appears to protect against age-related hearing loss specifically and aging in general. This is reflected by an overall reduction in mtDNA deletions. These data also suggest that the common aging deletion appears to be associated with presbyacusis, as demonstrated by an increased frequency of the mtDNA del4834 in the cochleae with the most significant hearing loss. Nutritional and pharmacological strategies may very well provide rational treatment options that would limit the age-associated increase in ROM generation, reduce mtDNA damage, and reduce the degree of hearing loss as the organism advances in age.

Lactic acidosis and other mitochondrial disorders

The ability of mitochondria to oxidize substrates and generate energy is integral to normal homeostasis and to the ability of cells to survive in the face of impending energy failure. Lactic acidosis is a common and readily apparent biochemical marker for mitochondrial dysfunction. However, lactic acidosis represents only the most obvious example in which acquired or congenital abnormalities of mitochondrial oxidative phosphorylating capacity contribute to the pathobiology and phenotypic expression of a broad spectrum of clinical disorders. Consequently, interventions that improve mitochondrial function or prevent mitochondrial energy failure may have widespread therapeutic implications.

Resveratrol: a molecule whose time has come? And gone?

OBJECTIVES

Resveratrol (3,5,4'-trihydroxystilbene) is the parent compound of a family of molecules, including glucosides and polymers, existing in cis and trans configurations in a narrow range of spermatophytes of which vines, peanuts and pines are the prime representatives. Its synthesis from p-coumaroyl CoA and malonyl CoA is induced by stress, injury, infection or UV-irradiation, and it is classified as a phytoalexin anti-fungicide conferring disease resistance in the plant kingdom.

RESULTS

In vitro, ex vivo and animal experiments have shown that it possesses many biological attributes that favour protection against atherosclerosis, including antioxidant activity, modulation of hepatic apolipoprotein and lipid synthesis, inhibition of platelet aggregation as well as the production of pro-atherogenic eicosanoids by human platelets and neutrophils. Red wine represents its main source in the human diet, and it has been proposed as a major constituent of the polyphenol fraction to which the health benefits of red wine consumption have been attributed.

CONCLUSIONS

The past several years have witnessed intense research devoted to its measurement in wine and the factors likely to promote its enrichment in this beverage. Up to the present, conclusive evidence for its absorption by human subjectsin biologically significant amounts is lacking, and it is questionable (but not yetexcluded) that its powerful and beneficial in vitro activities are reproduced as a consequence of sustained moderate red wine consumption.

Community Pharmacists' Knowledge of Antioxidant Vitamins

Objective:

The current interest in antioxidant vitamins has led consumers to seek advice from community pharmacists. The primary objective of this study was to evaluate community pharmacists' knowledge of antioxidant vitamins.

Design:

An interviewer-based questionnaire was developed to represent the questions most frequently asked by consumers in community pharmacies about antioxidant vitamins.

Setting:

Pharmacies in the Tri-cities area (Albany, Schenectady, and Troy, NY) were identified from the Yellow Pages of the Albany, NY telephone directory, and each was visited by the interviewer (DMO).

Main Outcome Measures:

Questions were divided into the demographic data and practice setting of the participant; the antioxidant vitamins, knowledge of supplements and foods containing antioxidants, dosage recommendations, and toxicities; and therapeutic claims attributed to their use.

Results:

Of 75 pharmacists approached, 70 agreed to participate in the study. The number of questions per week received from customers regarding antioxidant vitamins was estimated to be between 0 and 25. All pharmacists had heard of the terms “free radical” and “antioxidant,” but few were able to provide an adequate definition of either term. The majority of pharmacists knew which vitamins are considered to be antioxidants, but were unfamiliar with appropriate dosage recommendations. In keeping with current literature recommendations, the use of antioxidant supplements was generally not advocated.

Conclusions:

In this study, pharmacists provided inadequate information regarding antioxidant vitamins. Because antioxidants are rarely indicated according to the current literature, pharmacists have a responsibility to base their recommendations to customers on substantiated data.

Serum levels of vitamin E in relation to cardiovascular diseases

Serum vitamin E levels in healthy people (n = 71) and patients with cardiovascular diseases (n = 62) were determined. The cases of cardiovascular disease comprised patients with acute myocardial infarction (AMI) (n = 31), atherosclerosis (AT) (n = 23) and myocardial ischaemia (MI) (n = 8). The mean (+/- SD) serum vitamin E levels of the control group and the group with cardiovascular disease were 1.12 +/- 0.27 mg% and 0.98 +/- 0.41 mg%, respectively. Patients with AMI, AT and MI had corresponding levels of 0.97 +/- 0.48 mg%, 1.00 +/- 0.39 mg% and 1.01 +/- 0.44 mg%, respectively. Overall serum vitamin E levels were lower in the group with cardiovascular disease than in the control group. Patients and the control group are also discussed with respect to a number of potentially confounding parameters such as age, sex, smoking status, quetelet index (kg/m2), alcohol consumption, dietary intake and serum lipids.

NADPH oxidase activity of cytochrome P-450 BM3 and its constituent reductase domain

Cytochrome P-450 BM3 from Bacillus megaterium catalyses NADPH oxidation in the absence of added substrate. This activity is also associated with the independently expressed flavin-containing reductase domain of the protein. The rates of these activities are more than two orders of magnitude lower than those in the presence of fatty acid P-450 substrates or artificial electron acceptors. Electrons derived from NADPH in this fashion are transferred onto oxygen, generating superoxide (O2-) anions. The formation of these active oxygen species is detectable by luminometry and the chemiluminescence can be inhibited through the addition of superoxide dismutase (but not catalase). This activity is reminiscent of the microbicidal NADPH oxidase activity associated with neutrophils and other leukocyte blood cell types. Diphenyliodonium, a potent inhibitor of the neutrophil NADPH oxidase, effectively inhibits fatty acid hydroxylase and electron transferase activities catalysed by P-450 BM3 and its reductase domain. CD studies on the native and NADPH-reduced P-450 BM3 and BM3 reductase indicate that no secondary structural alteration is caused by pre-incubation with the reductant. Therefore, the previously recognised reversible time-dependent inactivation of P-450 BM3 by NADPH may be attributed to the NADPH oxidase activity associated with the reductase domain of the enzyme.

Free radicals and antioxidants: a personal view

Free radicals and other oxygen-derived species are constantly generated in vivo, both by "accidents of chemistry" and for specific metabolic purposes. The reactivity of different free radicals varies, but some can cause severe damage to biological molecules, especially to DNA, lipids, and proteins. Antioxidant defense systems scavenge and minimize the formation of oxygen-derived species, but they are not 100% effective. Hence, diet-derived antioxidants may be particularly important in diminishing cumulative oxidative damage and helping us to stay healthier for longer. Repair systems exist to deal with molecules that have been oxidatively damaged. Damage to DNA by hydroxyl radicals appears to occur in all aerobic cells, and might be a significant contributor to the age-dependent development of cancer. Lipid peroxidation probably contributes significantly to the development of atherosclerosis.