Association of ovarian response with picoAMH in women undergoing controlled ovarian hyperstimulation

OBJECTIVE

Our study aims to evaluate the diagnostic performance of a high-sensitivity picoAnti-Müllerian Hormone (picoAMH) for predicting ovarian response in women undergoing controlled ovarian hyperstimulation and occurrence of ovarian hyperstimulation syndrome.

METHODS

Retrospective cohort study at a single academic fertility center including all patients with picoAMH ELISA who underwent controlled ovarian hyperstimulation. The primary outcome was the number of oocytes retrieved, and secondary outcomes included cycle cancellation and ovarian hyperstimulation syndrome. Patients were grouped into poor, normal, and hyper-responders based on number of oocytes retrieved.

RESULTS

The mean AMH and antral follicle count (AFC) were significantly different between normal response vs. hyper response group (p < 0.0001). Only serum AMH and not AFC was significantly increased in patients diagnosed with ovarian hyperstimulation syndrome (OHSS). For prediction of OHSS, receiver operating characteristic (ROC) analysis revealed that AMH (area under the ROC curve [AUC] = 0.85) was significantly better than the AFC (AUC = 0.64). The serum AMH cut-off at sensitivity of 80% for predicting OHSS among hyper responders from ROC curve was 3.67 ng/ml. Serum AMH measured by picoAMH ELISA showed superior correlation to number of oocytes retrieved when compared to AFC in the age group over 40 years old (r² = 0.74 and r² = 0.4, respectively) CONCLUSION: This study shows great utility of picoAMH ELISA for predicting ovarian response to controlled ovarian hyperstimulation (COH). Diagnostic performance of picoAMH for prediction of OHSS is superior to the AFC in our cohort.

Metallization of Porous Polyethylene Using a Wire-Arc Spray Process for Heat Transfer Applications

Metallization of polyethylene (PE) using thermal spray techniques has proved difficult due to its low melting point and softness. In this study, metallic coatings were applied on porous polyethylene substrates using a twin wire-arc spray process. Commercially available polyethylene sheets, 3 mm in thickness, were used as substrates. Copper (Cu), aluminum (Al), and zinc (Zn) were successfully deposited on the porous polymer, without prior surface preparation, to form coatings with thickness of about 400 µm. Coating surface morphology and cross-sections were examined using a scanning electron microscope. Individual metal splats on the porous and non-porous substrates were observed to study the differences in the bonding mechanisms. The adhesion strength and electrical resistivity of the coatings on porous PE were evaluated. It was found that the bond strength of all three metallic coatings was found to be higher than the ultimate fracture strength of the porous. These results suggest that porosity in the polymer helps to overcome the challenges of metallizing polyethylene and provides a significant reduction in the weight of the polymer. Therefore, all these properties aided in fabricating an extremely lightweight, composite material with potential use in thermal management applications.

Few-layered mesoporous graphitic carbon nitride: a graphene analogue with high capacitance properties

Exfoliation of multi-layered MGCN into few-layered MGCN results in 50% enhancement in the specific capacitance value.

Facile Synthesis of Mesoporous MnCO₃ for Supercapacitor Applications

We report a rapid and facile synthesis of MnCO3 with uniform mesopores for supercapacitor applications. Mesoporous MnCO3 was synthesised by a co-precipitation method using MnSO4 and (NH4)HCO3 as manganese and carbonate source, respectively. Powder X-ray diffraction study confirmed the formation of rhodochrosite phase of MnCO3. X-ray photoelectron spectroscopic study ascertained the oxidation state of Mn as 2+ in MnCO3. Scanning and Transmission electron microscopic studies revealed that nanograins of size less than 10 nm agglomerated into submicron sized spherical particles of MnCO3. N2 sorption studies displayed a typical type-IV isotherm with H2 hysteresis, demonstrating mesoporosity of as-prepared MnCO3. Furthermore, the mesoporous MnCO3 particles were evaluated for their capacitance properties by cyclic voltammetry and galvanostatic charge-discharge cycling in aqueous 0.1 M Mg(ClO4)2 electrolyte. The fabricated mesoporous MnCO3 electrodes delivered a specific capacitance of 144 F g-1 at a current density of 0.34 A g-1. It also exhibited good rate capability, high reversibility and cyclic stability over 1000 cycles.

Optimization of oestradiol assays to improve utility in an in vitro fertilization setting

Background The measurement of oestradiol is an integral component for the management of ovarian stimulation for in vitro fertilization. Automated immunoassays offer fast assay times and high throughput, with less sensitivity and specificity. The aim of this study is to optimize the oestradiol assay in patients undergoing ovarian stimulation for in vitro fertilization via comparison of oestradiol values obtained using two immunoassays compared with mass spectrometry. Methods Patients undergoing ovarian stimulation were prospectively recruited. Serum samples were analysed with ADVIA Centaur® CP Immunoassay, Abbott Architect i1000® immunoassay and AB Sciex 5500 liquid chromatography-tandem mass spectrometry (LC-MS/MS) systems. Per cent bias was determined for each system to report the average tendency of the values to be larger or smaller than the LC-MS/MS value. Linear regression of total follicular volume and oestradiol was computed. Results The ADVIA Centaur® CP assay had a positive bias of 20% compared with LC-MS/MS, while the Architect i1000® had a non-significant, negative bias of 0.3%. With regression fit, a clear, positive relationship was seen between follicular volume and oestradiol. The Architect i1000® assay had a greater correlation (R²= 0.46) compared with Centaur® CP (R²= 0.36), when oestradiol values were >1000 pg/mL (3670 pmol/L). Conclusions The Abbott Architect i1000® oestradiol assay exhibits greater agreement with LC-MS/MS and exhibited better correlation to follicular volume when oestradiol values are >1000 pg/mL (3670 pmol/L), prompting a change in the clinic's oestradiol platform. Attention to assay quality assurance via LC-MS/MS can improve the oestradiol accuracy and permit more informed clinical decisions for improved patient outcomes.

α-Tocopherol and Atherosclerosis

Cardiovascular disease is the leading cause of morbidity and mortality in the Western world. There is compelling evidence incriminating oxidative stress in the pathogenesis of the atherosclerotic lesion. Several lines of evidence suggest that antioxidants, especially α-tocopherol, have potential beneficial effects with regard to cardiovascular disease. In vitro, α-tocopherol has been shown to inhibit platelet adhesion and aggregation and smooth muscle cell proliferation, exert anti-inflammatory effects on monocytes, and improve endothelial function. Also, supplementation with α-tocopherol has been shown to decrease lipid peroxidation, platelet aggregation, and pro-inflammatory activity of monocytes. However, clinical trials with α-tocopherol supplementation to date have been equivocal. Thus, although mounting in vitro evidence and animal models provide a sound scientific basis for α-tocopherol supplementation, further clinical trials are required before a definitive recommendation can be made with respect to the primary and secondary prevention of heart disease.

Serum adiposity-induced biomarkers in obese and lean children with recently diagnosed autoimmune type 1 diabetes

BACKGROUND/OBJECTIVE

Obesity increases the risk of cardiovascular disease and diabetic complications in type 1 diabetes. Adipokines, which regulate obesity-induced inflammation, may contribute to this association. We compared serum adipokines and inflammatory cytokines in obese and lean children with new-onset autoimmune type 1 diabetes.

SUBJECTS AND METHODS

We prospectively studied 32 lean and 18 obese children (age range: 2-18 yr) with new-onset autoimmune type 1 diabetes and followed them for up to 2 yr. Serum adipokines [leptin, total and high molecular weight (HMW) adiponectin, omentin, resistin, chemerin, visfatin], cytokines [interferon (IFN)-gamma, interleukin (IL)-10, IL-12, IL-6, IL-8, and tumor necrosis factor (TNF)-alpha] and C-reactive protein (CRP) were measured at a median of 7 wk after diagnosis (range: 3-16 wk).

RESULTS

Lean children were 71.9% non-Hispanic White, 21.9% Hispanic, and 6.3% African-American, compared with 27.8, 55.6, and 16.7%, respectively, for obese children (p = 0.01). Compared with lean children, obese children had significantly higher serum leptin, visfatin, chemerin, TNF-alpha and CRP, and lower total adiponectin and omentin after adjustment for race/ethnicity and Tanner stage. African-American race was independently associated with higher leptin among youth ≥10 yr (p = 0.007). Leptin levels at onset positively correlated with hemoglobin A1c after 1-2 yr (p = 0.0001) independently of body mass index, race/ethnicity, and diabetes duration. Higher TNF-alpha was associated with obesity and female gender, after adjustment for race/ethnicity (p = 0.0003).

CONCLUSION

Obese children with new-onset autoimmune type 1 diabetes have a proinflammatory profile of circulating adipokines and cytokines that may contribute to the development of cardiovascular disease and diabetic complications.

A novel peptide inhibitor attenuates C-reactive protein's pro-inflammatory effects in-vivo

BACKGROUND

Higher levels of C-reactive protein (CRP) predict cardiovascular events and also portend a poorer prognosis in patients with acute coronary syndromes. Much in-vitro and in-vivo data support a role for CRP in atherogenesis.

METHODS

Using the one-bead-one-compound (OBOC) combinatorial library method we have successfully identified peptides against human CRP that inhibit its biological effects in-vitro. Hence we tested the effect of the best characterized inhibitor (CRP-i2) on the effects of CRP in an appropriate animal model, Wistar rats.

RESULTS

Treatment with CRP resulted in significant increase in superoxide anion, nuclear factor kappaB (NFκb) activity and the release of biomarkers of inflammation from macrophages compared to Wistar rats treated with human albumin (HuSA). Pre-treatment with the inhibitor, CRP-i2, resulted in a significant reduction in CRP induced superoxide anion, NFκb activity and biomarkers of inflammation. Also, there were no observed clinical or laboratory related adverse effects.

CONCLUSIONS

We demonstrate that our novel peptide inhibitor attenuates the proinflammatory effects of CRP in-vivo. Future studies will examine the long-term effects of this inhibitor on vascular pathobiology.

Native valve Escherichia coli endocarditis following urosepsis

Gram-negative organisms are a rare cause of infective endocarditis. Escherichia coli, the most common cause of urinary tract infection and gram-negative septicemia involves endocardium rarely. In this case report, we describe infection of native mitral valve by E. coli following septicemia of urinary tract origin in a diabetic male; subsequently, he required prosthetic tissue valve replacement indicated by persistent sepsis and congestive cardiac failure.

Small interfering-RNA to protein kinase C-delta reduces the proinflammatory effects of human C-reactive protein in biobreeding diabetic rats

Type 1 diabetes (T1DM) is a proinflammatory state characterized by increased C-reactive protein (CRP) levels. Previously we reported that human CRP accentuated macrophage activity in spontaneously diabetic biobreeding (BB) rats and also increased protein kinase C (PKC) delta. Hence we tested the effect of molecular inhibition of PKC delta on plasma and macrophage proinflammatory biomarkers using small interfering (si)RNA to PKC delta. Prior to administration of human CRP, daily for 3 days to diabetic rats, scrambled siRNA or siRNA to PKC delta was also delivered for the 3 days, and the animals were sacrificed on day 4. Peritoneal macrophages and plasma were obtained. Compared to scrambled siRNA, siRNA to PKC delta resulted in a significant decrease in biomediators of inflammation in plasma and from macrophages (IL-1, TNF-alpha, IL-6, MCP-1, KC/IL-8, and PAI -1). However, siRNA to PKC delta has no effect on superoxide release from macrophages. In conclusion, our novel data suggests that siRNA to PKC delta attenuates the proinflammatory effect of human CRP in spontaneously diabetic BB rats and could have implications with regard to attenuating inflammation and vascular complications in T1DM.

Retroperitoneal lymph node dissection for metastatic germ cell tumours

INTRODUCTION

In the North Trent Cancer network (NTCN) patients requiring retroperitoneal lymphadenectomy for metastatic testicular cancer have been treated by vascular service since 1990. This paper reviews our experience and considers the case for involvement of vascular surgeons in the management of these tumours.

PATIENTS AND METHODS

Patients referred by the NTCN to the vascular service for retroperitoneal lymphadenectomy between 1990 and 2009 were identified through a germ cell database. Data were supplemented by a review of case notes to record histology, intraoperative and postoperative details.

RESULTS

A total of 64 patients were referred to the vascular service for retroperitoneal lymph node dissection, with a median age of 29 years (16-63 years) and a median follow-up of 4.9 years. Ten patients died: eight from tumour recurrence, one from septicaemia during chemotherapy and one by suicide. Of the 54 who survived, 7 were alive with residual masses and 47 patients were disease-free at the last follow-up. Sixteen patients required vascular procedures: four had aortic repair (fascia), three had aortic replacement (spiral graft), four had inferior vena cava resection, two had iliac artery replacement and two had iliac vein resection.

CONCLUSIONS

Retroperitoneal lymph node dissection often involves mobilisation and/or the resection/replacement of major vessels. We recommend that a vascular surgeon should be a part of testicular germ cell multidisciplinary team.

Role of mammography in the triple assessment of single-quadrant breast symptoms

Background

Most women over the age of 35 years referred to a breast clinic have single-quadrant symptoms and undergo mammography (MMG) as part of the triple assessment of these. A proportion of these women has no abnormality clinically or on ultrasonography (P1 U1). The aim of this study was to assess the additional contribution of MMG in diagnosing cancer in patients with P1 U1 findings and to consider whether it is safe to be more selective when requesting MMG.

Methods

Over a 2-year interval the clinical and radiological details of women whose single-quadrant breast symptoms were assessed as P1 U1, and who were then sent for MMG, were entered into a database. The results of further investigations initiated by a non-benign MMG report were recorded, and the patients reviewed to establish how many cancers were diagnosed purely by MMG and whether these were located at the site of symptoms.

Results

There were 454 women in the study group, representing 17·5 per cent of all new referrals. Twenty-one patients (4·6 per cent) were recalled following a non-benign MMG result, ten of whom required image-guided biopsy. Cancer was diagnosed in three patients (0·7 per cent of the study group), located in the contralateral breast in two women and a different ipsilateral quadrant in one.

Conclusion

MMG in this subset of patients did not increase the cancer detection rate at the site of symptoms and therefore constituted screening. The rationale for requesting MMG in these patients, and indeed for applying the triple assessment rule, should be reconsidered.

Low vitamin D levels in Northern American adults with the metabolic syndrome

Metabolic syndrome (MetS), is a constellation of cardiometabolic disease risk factors, that affects 1 in 3 US adults and predisposes to increased risks for both diabetes and cardiovascular disease. While epidemiological studies show low vitamin D [(25(OH)D] levels in MetS, there is sparse data on vitamin D status in MetS patients in North America. Thus, the aim of our study was to examine plasma vitamin D concentration among adults with MetS in Northern California (sunny climate), but without diabetes or cardiovascular disease. 25(OH)D levels were significantly decreased in MetS compared to controls. 8 % of controls and 30% of MetS North American adult subjects were deficient in 25(OH)D (<20 ng/ml; p=0.0236, Controls vs. MetS). There were no significant differences between the groups with respect to blood sampling in winter and summer months, total calcium and phosphate, and creatinine levels. Vitamin D levels were significantly inversely correlated with fasting glucose (r=-0.29, p=0.04) and HOMA (r=-0.34, p=0.04). Future studies of vitamin D supplementation in these subjects on subsequent risk of diabetes will prove instructive with respect to potential health claims in these high risk patients with MetS.

Decreased number and impaired functionality of endothelial progenitor cells in subjects with metabolic syndrome: implications for increased cardiovascular risk

OBJECTIVE

Metabolic syndrome (MetS) is characterized by low-grade inflammation and confers an increased risk for cardiovascular disease. Endothelial progenitor cells (EPCs) are a measure of vascular health and are decreased in patients with various risk factors for cardiovascular disease (CVD). There is a paucity of data examining the EPC status especially in terms of their functionality in MetS subjects without diabetes or cardiovascular disease. We aimed to enumerate and functionally characterize EPCs in subjects with MetS in comparison to healthy controls.

METHODS

The study was performed at the University of California Davis Medical Center. Healthy controls (n=31) and MetS (n=46) subjects were included in the study. EPCs were enumerated in fasting blood by KDR/CD34 dual positivity. Functionality was assessed by the colony forming units (CFU) assay, migration and tubule formation.

RESULTS

Subjects with MetS had significantly decreased number of EPCs compared to control subjects. Furthermore, EPCs from MetS subjects depicted significantly impaired clonogenic capacity, i.e., decreased colony forming units, and impaired capacity to incorporate into tubular structures suggesting functional impairment of EPCs from MetS subjects.

CONCLUSIONS

We make the novel observation that MetS subjects without diabetes or CVD have decreased EPC number and impaired functionality as compared to control subjects. These findings could contribute to the increased CV risk in this population.

1-[2-(2,4-Dinitro-benzyl-ideneamino)phen-yl]-3-phenyl-thio-urea

In the title compound, C₂₀H₁₅N₅O₄S, the central benzene ring makes dihedral angles of 59.5 (1) and 51.7 (1)°, respectively, with the terminal phenyl and benzene rings. The mol­ecular structure exhibits weak intra­molecular N—H⋯N and C—H⋯S inter­actions. In the crystal structure, mol­ecules are linked by weak inter­molecular N—H⋯S and C—H⋯O inter­actions, forming a chain along [11].

Increased levels of ligands of Toll-like receptors 2 and 4 in type 1 diabetes

AIMS/HYPOTHESIS

Type 1 diabetes is a proinflammatory state characterised by increased levels of circulating biomarkers of inflammation and monocyte activity. We have shown increased Toll-like receptor 2 (TLR2) and TLR4 expression and signalling in monocytes from type 1 diabetic patients. Several endogenous ligands of TLR2 and TLR4 have been identified; however, there is a paucity of data on levels of these endogenous ligands in diabetes. Thus, the aim of this study was to examine circulating levels of exogenous/endogenous ligands of TLR2 and TLR4 in type 1 diabetic patients and to compare these with the levels in matched healthy controls.

METHODS

Healthy controls (n = 37) and type 1 diabetic patients (n = 34) were recruited, and a fasting blood sample was obtained. Circulating levels of endotoxin, heat-shock protein 60 (Hsp60), high-mobility group box 1 (HMGB1) and growth arrest-specific 6 (GAS6) proteins were assessed by ELISA, and TLR2 and TLR4 expression was determined by flow cytometry.

RESULTS

Levels of the classical TLR4 ligand, endotoxin, were significantly elevated in type 1 diabetic patients compared with those in matched controls. Hsp60 and HMGB1 concentrations were also significantly increased in the patients (p < 0.01 and p < 0.001, respectively). No significant differences were observed in GAS6.

CONCLUSIONS/INTERPRETATION

We report the novel observation that levels of ligands of TLR2 and TLR4 are significantly elevated in type 1 diabetes, and this, in concert with hyperglycaemia, accounts for the increase in TLR2 and TLR4 activity, underscoring the proinflammatory state of type 1 diabetes.

Ultrasound surveillance of ectatic abdominal aortas

INTRODUCTION

Some studies have considered abdominal aortas of 2.6-2.9 cm diameter (ectatic aortas) at age 65 years as being abnormal and have recommended surveillance, whereas others have considered these normal and surveillance unnecessary. It is, therefore, not clear how to manage patients with an initial aortic diameter between 2.6-2.9 cm detected at screening. The aim of this study was to evaluate growth rates of ectatic aortas detected on initial ultrasound screening to determine if any developed into clinically significant abdominal aortic aneurysms (AAAs; > 5.0 cm) and clarify the appropriate surveillance intervals for these patients.

PATIENTS AND METHODS

Data were obtained from a prospective AAA screening programme which commenced in 1992. The group of patients with initial aortic diameters of 2.6-2.9 cm with a minimum of 1-year follow-up were included in this study (Group 2). This was further divided into two subgroups (Groups 3a and 3b) based on a minimum follow-up interval obtained from outcome analysis. Mean growth rate was calculated as change in aortic diameter with time. The comparison of growth rates in Groups 3a and 3b was performed using the t-test. The number and proportion of AAAs that expanded to >or= 3.0 cm and >or= 5.0 cm in diameter were also calculated.

RESULTS

Out of 999 patients with AAA >or= 2.6 cm with minimum 1-year follow-up, 358 (36%) were classified as ectatic aortas (2.6-2.9 cm) at initial ultrasound screening with the mean growth rate of 1.69 mm/year (95% CI, 1.56-1.82 mm/year) with a mean follow-up of 5.4 years. Of these 358 ectatic aortas, 314 (88%) expanded into >or= 3.0 cm, 45 (13%) expanded to >or= 5.0 cm and only 8 (2%) expanded to >or= 5.5 cm over a mean follow-up of 5.4 years (range, 1-14 years). No ectatic aortas expanded to >or= 5.0 cm within the first 4 years of surveillance. Therefore, the minimum follow-up interval was set at 4 years and this threshold was then used for further analysis. The mean growth rate in Group 3a (< 5.0 cm at last scan) was 1.33 mm/year (95% CI, 1.23-1.44 mm/year) with a mean follow-up of 7 years compared to Group 3b (>or= 5.0 cm at last scan) with the mean growth rate of 3.33 mm/year (95% CI 3.05-3.61 mm/year) and a mean follow-up of 8 years. The comparison of mean growth rates between Groups 3a and 3b is statistically significant (t-test; T = 13.00; P < 0.001).

CONCLUSIONS

One-third of patients undergoing AAA screening will have ectatic aortas (2.6-2.9 cm) and at least 13% of these will expand to a size of >or= 5.0 cm over a follow-up of 4-14 years. A threshold diameter of 2.6 cm for defining AAAs in a screening programme is recommended and ectatic aortas detected at age 65 years can be re-screened at 4 years after the initial scan. A statistically significant difference was found in the growth rates of ectatic aortas with minimum 4 years follow-up, expanding to >or= 5.0 cm compared to those less than 5.0 cm at last surveillance scan. Further studies are required to test the hypothesis of whether growth rate over the first 4 years of surveillance will identify those who are most likely to expand to a clinically significant size (> 5.0 cm).

Human C-reactive protein promotes oxidized low density lipoprotein uptake and matrix metalloproteinase-9 release in Wistar rats

C-reactive protein (CRP) is present in the atherosclerotic plaques and appears to promote atherogenesis. Intraplaque CRP colocalizes with oxidized low density lipoprotein (OxLDL) and macrophages in human atherosclerotic lesions. Matrix metalloproteinase-9 (MMP-9) has been implicated in plaque rupture. CRP promotes OxLDL uptake and MMP induction in vitro; however, these have not been investigated in vivo. We examined the effect of CRP on OxLDL uptake and MMP-9 production in vivo in Wistar rats. CRP significantly increased OxLDL uptake in the peritoneal and sterile pouch macrophages compared with human serum albumin (huSA). CRP also significantly increased intracellular cholesteryl ester accumulation compared with huSA. The increased uptake of OxLDL by CRP was inhibited by pretreatment with antibodies to CD32, CD64, CD36, and fucoidin, suggesting uptake by both scavenger receptors and Fc-gamma receptors. Furthermore, CRP treatment increased MMP-9 activity in macrophages compared with huSA, which was abrogated by inhibitors to p38 mitogen-activated protein kinase, extracellular signal-regulated kinase (ERK), and nuclear factor (NF)-kappaB but not Jun N-terminal kinase (JNK) before human CRP treatment. Because OxLDL uptake by macrophages contributes to foam cell formation and MMP release contributes to plaque instability, this study provides novel in vivo evidence for the role of CRP in atherosclerosis.

1-{2-[(Anthracen-10-yl)methyl-ene-amino]phen-yl}-3-phenyl-thio-urea

The title compound, C(28)H(21)N(3)S, crystallizes with two mol-ecules in the asymmetric unit. There are only very slight differences in the torsion angles between the two molecules. The two mol-ecules are stabilized by intra-molecular N-H⋯N inter-actions and the crystal packing is stabilized by inter-molecular N-H⋯S inter-actions.

Vitamin E: inflammation and atherosclerosis

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in the western world with its incidence increasing lately in developing countries. Several lines of evidence support a role for inflammation in atherogenesis. Hence, dietary micronutrients having antiinflammatory properties may have a potential beneficial effect with regard to CVD. Vitamin E is a potent antioxidant with antiinflammatory properties. It comprises eight different isoforms: four tocopherols (T) (alpha, beta, gamma, and delta) and four tocotrienols (T3) (alpha, beta, gamma, and delta). A wealth of data is available for the preventive efficacy of alpha-T. alpha-T supplementation in human subjects and animal models has been shown to be antioxidant and antiinflammatory in terms of decreasing C-reactive protein (CRP) and release of proinflammatory cytokines, the chemokine IL-8 and PAI-1 levels especially at high doses. gamma-T is effective in decreasing reactive nitrogen species and also appears to have antiinflammatory properties; however, there are scanty data examining pure gamma-T preparations. Furthermore, tocotrienols (alpha and gamma) also have implications for prevention of CVD; however, there are conflicting and insufficient data in the literature with regards to their potency. In this chapter, we have gathered recent emerging data on alpha-T specifically and also have given a composite view of gamma-T and tocotrienols especially with regards to their effect on inflammation as it relates to CVD.

O—H...O-bridged dimers linkedviaC—H...O and C—H...π interactions in 4,6-di-O-benzyl-myo-inositol 1,3,5-orthoformate

The centrosymmetric O-H...O-bonded head-to-head dimers of the title compound, C(21)H(22)O(6), are linked together via bifurcated C-H...O interactions along the a axis and via favourable C-H...pi interactions along the b axis in the crystal structure.

Vitamin E, oxidative stress, and inflammation

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in the Western world. Its incidence has also been increasing lately in developing countries. Several lines of evidence support a role for oxidative stress and inflammation in atherogenesis. Oxidation of lipoproteins is a hallmark in atherosclerosis. Oxidized low-density lipoprotein induces inflammation as it induces adhesion and influx of monocytes and influences cytokine release by monocytes. A number of proinflammatory cytokines such as interleukin-1beta (IL-1beta), IL-6, and tumor necrosis factor-alpha (TNF-alpha) modulate monocyte adhesion to endothelium. C-reactive protein (CRP), a prototypic marker of inflammation, is a risk marker for CVD and it could contribute to atherosclerosis. Hence, dietary micronutrients having anti-inflammatory and antioxidant properties may have a potential beneficial effect with regard to cardiovascular disease. Vitamin E is a potent antioxidant with anti-inflammatory properties. Several lines of evidence suggest that among different forms of vitamin E, alpha-tocopherol (AT) has potential beneficial effects with regard to cardiovascular disease. AT supplementation in human subjects and animal models has been shown to decrease lipid peroxidation, superoxide (O2-) production by impairing the assembly of nicotinamide adenine dinucleotide phosphate (reduced form) oxidase as well as by decreasing the expression of scavenger receptors (SR-A and CD36), particularly important in the formation of foam cells. AT therapy, especially at high doses, has been shown to decrease the release of proinflammatory cytokines, the chemokine IL-8 and plasminogen activator inhibitor-1 (PAI-1) levels as well as decrease adhesion of monocytes to endothelium. In addition, AT has been shown to decrease CRP levels, in patients with CVD and in those with risk factors for CVD. The mechanisms that account for nonantioxidant effects of AT include the inhibition of protein kinase C, 5-lipoxygenase, tyrosine-kinase as well as cyclooxygenase-2. Based on its antioxidant and anti-inflammatory activities, AT (at the appropriate dose and form) could have beneficial effects on cardiovascular disease in a high-risk population.

Scientific evidence to support a vitamin E and heart disease health claim: research needs

In addition to epidemiologic studies suggesting a benefit for high intakes of alpha-tocopherol, studies following supplementation in humans have clearly shown that alpha-tocopherol decreases lipid peroxidation, platelet aggregation, and functions as a potent anti-inflammatory agent. However, prospective human clinical trials with alpha-tocopherol alone and in combination with other antioxidants have been largely negative. In this review, we critically appraise the various clinical trials and provide recommendations for future research.