Vitamin E alleviates the oxidative stress of erythropoietin in uremic children on hemodialysis

Abstract

The efficacy of combined therapy with recombinant human erythropoietin (rhEPO) and vitamin E versus rhEPO alone in the treatment of anemia was examined in children (n = 10, aged 15.2 +/- 3.2 years) on chronic hemodialysis at the restart of rhEPO therapy after a 4-week interval. The results confirmed that rhEPO induced oxidative stress of the red blood cells as observed during the first rhEPO therapy. Vitamin E (15 mg/kg per day per os) was introduced after 2 weeks of rhEPO monotherapy, when the signs of acute oxidative stress appeared. The level of oxidized glutathione (GSSG) increased from 8.9 +/- 3.1 to 26.7 +/- 5.7 nmol/g hemoglobin (Hb) by that time. After 2 weeks of simultaneous vitamin E treatment, there was a significant difference in GSSG values compared with rhEPO monotherapy (10.1 +/- 3.9 vs. 56.7 +/- 15.8 nmol/g Hb, P < 0.001). A considerable decrease was observed in the previously high ratio of GSSG/reduced glutathione (GSH), an indicator of oxidative stress, and the level of carboxyhemoglobin, indicating hemolysis. A significant increase in Hb and hematocrit (P < 0.01) was achieved within 2 weeks of starting the combined therapy, while similar results occurred only at the 8th and 5th weeks without vitamin E. Antioxidant vitamin E supplementation improved the therapeutic effect of rhEPO in patients with chronic renal failure on hemodialysis.

Vitamins A, E and C as Non-Enzymatic Antioxidants and Their Relation to Lipid Peroxidation in Children with Chronic Renal Failure

“…The SPACE trial demonstrated a decreased incidence of cardiovascular events after vitamin E supplementation in patients with CRF and cardiovascular disease [14]. Nemeth et al [15] showed that vitamin E improved the therapeutic effect of erythropoietin in children with CRF on HD. Otting and Hellmann [16] postulated that oral supplementation of vitamin E increases the antioxidant capacity in children with CRF.…”

Status of and #945;-tocopherol concentration and oxidative stress in infertile females of Vijayapur District, northern Karnataka

“…Németh et al [18] demonstrated alleviation of oxidative stress by vitamin E leading to a significant increase in Hb levels. The mechanism by which vitamin E enhances the serum levels of erythropoietin and Hb is not clear.…”

“…[25] Moreover, some evidence reported that oxidative stress is involved in developing female infertility. [5,18,26] Substantial increase in oxidative stress levels has been linked with damage to the DNA of the oocytes and spermatozoa, resulting in defective fertilization. [24] Even if fertilization is achieved, reactive oxygen species induce apoptosis leading to implantation failure, abortion, and embryo fragmentation.…”

Antioxidant vitaminsCandEsupplementation increases markers of haemolysis in sickle cell anaemia patients: a randomized, double‐blind, placebo‐controlled trial

“…Specifically for vitamins C and E, improvement in several physiological abnormalities induced by oxidative stress in SCA has been demonstrated, leading to reduction of dense cells and irreversibly sickled erythrocytes generation (Spielberg et al, 1979;McCall & Frei, 1999;Pryor, 2000;Amer & Fibach, 2004;Das et al, 2004;Krukoski et al, 2009). Other clinical trials with oral or parenteral antioxidant supplementation for several haemolytic conditions, such as thalassaemia (Kahane & Rachmilewitz, 1976;Giardini et al, 1985;Suthutvoravut et al, 1993;Tesoriere et al, 2001;Unchern et al, 2003;Dissayabutra et al, 2005;Kalpravidh et al, 2005;Palasuwan et al, 2006Palasuwan et al, , 2008Pfeifer et al, 2008), G-6-phosphate dehydrogenase deficiency (Eldamhougy et al, 1988;Sultana et al, 2008), anaemia in uraemic patients on haemodialysis (Ono, 1985;Nemeth et al, 2000;Candan & Gultekin, 2002), haemolytic anaemia during hepatitis C treatment (Saeian et al, 2004), snakebite-induced haemolysis Table VII). Only four of these studies evaluated VitC or VitE, alone or in combination with other drugs.…”