Plasma antioxidant status after high-dose chemotherapy: a randomized trial of parenteral nutrition in bone marrow transplantation patients

Abstract

Background: Chemotherapy and radiation therapy result in increased free radical formation and depletion of tissue antioxidants. It is not known whether parenteral nutrition (PN) administered during bone marrow transplantation (BMT) supports systemic antioxidant status. Objective: The aims of the study were to determine 1) whether high-dose chemotherapy decreases concentrations of major circulating antioxidants in patients undergoing BMT and 2) whether administration of standard PN maintains systemic antioxidant concentrations compared with PN containing micronutrients and minimal lipids alone. Design: Twenty-four BMT patients were randomly assigned to receive either standard PN containing conventional amounts of dextrose, amino acids, micronutrients, and lipid (120 kJ/d) or a solution containing only micronutrients (identical to those in standard PN) and a small amount of lipid (12 kJ/d). Plasma antioxidant status was measured before conditioning therapy and serially at days 1, 3, 7, 10, and 14 after BMT. Results: Plasma glutathione (GSH) and ␣-and ␥-tocopherol concentrations decreased and the GSH redox state became more oxidized after conditioning chemotherapy. Plasma cysteine concentrations were unchanged, whereas cystine concentrations increased. Plasma vitamin C and zinc concentrations and GSH peroxidase activity increased over time. Plasma ␣-tocopherol concentrations were lower in patients given standard PN. There were no differences in other plasma antioxidants between groups. Conclusions: A significant decline in GSH-glutathione disulfide, cysteine-cystine, and vitamin E status occurs after chemotherapy and BMT. Standard PN does not improve antioxidant status compared with administration of micronutrients alone. Further evaluation of PN formulations to support patients undergoing high-dose chemotherapy and BMT are needed.Am J Clin Nutr 2000;72:181-9.

Evaluation of oxidative and antioxidative parameters in pediatric hematopoietic SCT patients

“…In erythrocytes, SOD, glutathione peroxidase and CAT activities were reported to be decreased or increased (1,3,4,7,9). Furthermore, plasma antioxidants such as atocopherol, b-carotene and vitamin C were shown to be depleted (3,(8)(9)(10).…”

“…They have severe acute and delayed toxic effects on several tissues, such as mucous membranes, gastrointestinal tract, liver, lung, bladder, central nervous system, and, rarely, other tissues possibly related to peroxidation processes and exhaustion of antioxidants. [3][4][5][6][7] It is well known that chemotherapy and radiation therapy are associated with the formation of reactive oxygen species and depletion of antioxidants, such as glutathione (GSH), antioxidant enzymes, and antioxidant vitamins such as a-tocopherol, b-carotene and vitamin C. 4,[8][9][10][11] A limited number of studies demonstrated that the conditioning therapy given to HSCT patients creates a high oxidative stress, resulting in a measured reduction in antioxidants. In summary, these studies revealed a disturbance of the pro-oxidative/antioxidative balance in the plasma of patients undergoing HSCT.…”

“…Therefore, it has been suggested that high-dose chemotherapy increased the oxidative stress and decreased the antioxidant defence system. [3][4][5][6][7][8][9][10][11] The objective of this study was to evaluate the oxidative and antioxidative status in pediatric allo-HSCT patients.…”

Metabolic effects of enteral versus parenteral alanyl-glutamine dipeptide administration in critically ill patients receiving enteral feeding: A pilot study

“…Catabolic illnesses are commonly associated with oxidative stress and decreased antioxidant capacity [15,21,[36][37][38]. Gln supplementation has been shown to improve tissue and blood GSH concentration in animal models of critical illness, possibly by serving as a precursor to glutamate, a constituent of the tripeptide GSH [35].…”

“…Plasma α-and γ-tocopherol concentrations were measured via reversed-phase HPLC [20]. Plasma zinc concentrations were determined by atomic absorption spectroscopy [21]. The former antioxidant measures were performed in the Antioxidants Research Laboratory of the Jen Meyer USDA Human Nutrition Research Center on Aging (by JBB).…”