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Current and future therapeutic approaches to the common cold.

For decades, investigators have strived to elucidate the pathogenesis, and hence a treatment, for the common cold. Therapy has been tried with a variety of agents, ranging from anecdotal folk remedies, to well-designed medications. Measures primarily directed to relieve the symptoms of the common cold, rather than specific antimicrobial agents, are the current main stay of therapy. Millions of patients would benefit from an easy-to-perform diagnostic test and specific therapy that works quickly, shortening the duration of illness and preventing further spread of infection.

Anti-Bacterial Agents↗

Cure of advanced L1210 leukemia after correction of abnormal red blood cell deformability.

Chemotherapeutic efficacy is inversely related to pretreatment tumor burden. A possible contributory factor in chemotherapy resistance is the occurrence of decreased red blood cell deformability in mice with advanced tumors. Poorly deformable red blood cells may prevent adequate drug delivery to tumor cells. Two methods for improving red cell deformability were found in this study. The first involved treatment of L1210 leukemia-bearing mice with red cell metabolic substrates, including inosine, adenosine, glucose, sodium pyruvate, and ascorbic acid. The combination of inosine plus sodium pyruvate (3 mg of each drug in 0.5 cm3 phosphate-buffered saline) was most effective in restoring deformability to normal. Administration of an active chemotherapeutic agent (BCNU or cyclophosphamide) also improved red cell deformability, with maximal restoration occurring 4--5 days after drug treatment. Standard and 50% of standard drug doses were equally effective in restoring deformability. The optimal therapy program for day 7 L1210 leukemia utilized inosine plus sodium pyruvate given 10--15 min before BCNU 15 mg/kg on day 7 and before BCNU 30 mg/kg on day 12. This treatment yielded 44% cures, whereas BCNU alone, in identical dose and schedule, gave no cures. Median survival was 50 days for the inosine-pyruvate-treated mice, as against 30 days for BCNU alone. Therefore, treatment with non-toxic doses of red blood cell metabolic substrates plus optimal timing of chemotherapy, two maneuvers that significantly increased red blood cell deformability, resulted in significant therapeutic benefit.

Animals↗

Evaluation of nonionic nitroxyl lipids as potential organ-specific contrast agents for magnetic resonance imaging.

Considering their intrinsic properties of accumulation in the hepatic tissue, we have synthesized nitroxyl-containing lipids as potential organ-specific contrast agents for magnetic resonance imaging (MRI). Their resistance to reduction by ascorbate and in liver homogenates, and their relaxivity in different media were investigated and compared to those of free carboxyl-Proxyl (3-carboxy-2,2,5,5-tetramethylpyrrolidine-1-oxyl) and Tempamaine (4-amino-2,2,6,6-tetramethylpiperidine-1-oxyl). With respect to the reduction rates by ascorbate, the lipid derivatives show the same well-known order of reactivity as carboxy-Proxyl and Tempamine, the five-membered nitroxyls being more stable than the six-membered compounds. However the binding of the piperidinoxyl compounds to the fatty acids confers to those lipid derivatives a markedly increased stability. Similarly, in liver homogenates, the nitroxyl lipids remained unchanged more than 20 min, contrarily to carboxy-Proxyl and Tempamine. The measurements of spin-lattice relaxation time (T1) in biological media have demonstrated a higher relaxivity of nitroxyl lipids, which can be related to their interaction with proteins. Tested in vivo, one of the synthesized compounds (0.75 mmol/kg) produced an enhancement of 44 +/- 12% of the hepatic signal 5 min after intraportal injection in T1-weighted images. The potential applicability of the other nitroxyl lipids as contrast agents for MRI was limited in the in vivo studies by an unexpected toxicity. Work is currently in progress to improve the therapeutic index of the present class of nitroxyl lipids.

Animals↗

Prolonged hemolysis and methemoglobinemia following organic copper fungicide ingestion.

Acute ingestion of copper sulfate has been reported to cause gastrointestinal injury, hemolysis, methemoglobinemia, hepatorenal failure, shock; or even death. The toxicity of organocopper compounds, however, remains largely unknown. A 40-y-old man attempted suicide by ingesting some 50 ml of Sesamine fungicide. He immediately developed headache, vomiting and abdominal pain, followed by progressive dyspnea, cyanosis, dark urine and diarrhea. Severe methemoglobinemia and hemolysis were documented, and treatment with ascorbic acid and hydration was commenced. He was referred to our service 3 d later for methylene blue treatment. Despite the above treatment, his symptomatology persisted and it was not until 5 d post-ingestion that the implicated fungicide was identified as copper-8-hydroxyquinolate. BAL therapy and plasma exchange were instituted, which decreased his plasma hemoglobin from 1,300 mg/dL to 29.1 mg/dL, and lowered his methemoglobin level from 20.9% to 1.1%. His serum and urine copper concentration dropped from 238 microg/dL to 96 microg/dL and from 112 microg/dL to 16 microg/dL, respectively. He was discharged uneventfully 18 d post-ingestion. Pre-existing glucose-6-phosphate dehydrogenase (G6PD) deficiency as well as copper-induced inhibition of G6PD activity was documented during hospitalization. Organocopper compounds may cause prolonged hemolysis and methemoglobinemia through oxidative stress, especially among patients with G6PD deficiency. Antidotal therapy with methylene blue is not likely to be effective in this setting: treatment with intensive supportive measures and other therapeutic options, such as plasma exchange, should be sought.

Adult↗

Use of antioxidant supplements in the treatment of human oral leukoplakia.

An increasing public awareness of antioxidants may prompt a patient's request to be treated without surgery if a leukoplakic lesion is discovered. However, surgical excision remains the treatment of choice for oral leukoplakia. The use of antioxidant supplements has shown some promise, but the predictability of success remains uncertain and long-term results are unavailable. Before the decision to use any antioxidant is made, it is critical to obtain a histopathologic diagnosis of the lesion. When dealing with a lesion diagnosed as hyperkeratosis, it may be appropriate to choose an antioxidant that may take some time for clinical improvement to occur. However, as the grade of epithelial dysplasia becomes more severe, consideration must be given to the possibility of malignant transformation during antioxidant treatment. We do not recommend the use of antioxidant supplements in the treatment of any carcinoma. The therapeutic use of antioxidant supplements outside of clinical trials conducted at academic medical centers should be done with considerable caution by practitioners in private practice. It should be emphasized that in these clinical trial patients were seen at frequent intervals to monitor their progress and to intervene if there was a noticeable deterioration in the clinical appearance of the lesion. In spite of the uncertainty with respect to antioxidant treatment, there are circumstances in which it should be considered. Recurrence after surgical excision when there is little reason to believe that a second surgical excision would be any more successful is an ideal candidate. Also, patients with widespread leukoplakia that involves a large area of the oral mucosa might be suitable for treatment with antioxidants, as well as patients who have extensive medical problems that make them surgical risks. The choice of which antioxidant(s) to use is complex because thus far there is no combination that is superior to the others. Beta-carotene with ascorbic acid or alpha-tocopherol is attractive because of a lack of side effects, but the range in reported values for lesion improvement has been broad and the clinical improvement typically takes several months. Clinical response with 13-cRA is faster but requires baseline and periodic serologic testing, as well as close monitoring for side effects. In those circumstances in which time is an important consideration, 13-cRA might be useful because clinical improvement can be evaluated within a matter of weeks as compared with beta-carotene. The group from M.D. Anderson Hospital has shown the value of an induction dose of 13-cRA that is followed by a lower maintenance dose. Unfortunately, the problem of recurrence after discontinuation of 13-cRA is quite common. One aspect that has not been evaluated is the combination of conventional surgical excision and the administration of postoperative antioxidants. This would have the obvious advantage of conventional treatment of surgery together with the possible protective effect of the antioxidants. Although this is an attractive hypothesis, we do not know of any studies that have proven this to be beneficial.

Animals↗

Benoxaprofen: a pro-oxidant anti-inflammatory drug?

Benoxaprofen inhibited the random motility and migration to the leucoattractants endotoxin-activated serum (EAS) and f-met-leu-phe of human polymorphonuclear leucocytes (PMNL) in vitro. Inhibition of random and leucoattractant-induced migration was observed at drug concentrations of greater than 1 X 10(-6) M and 1 X 10(-5) M respectively. Benoxaprofen per se was not leucotactic but was pro-oxidative in that it stimulated PMNL hexose-monophosphate shunt activity, chemiluminescence, myeloperoxidase-mediated iodination reactions and degranulation. The drug also mediated auto-oxidation of PMNL as measured by cellular auto-iodination. The relationship between benoxaprofen-mediated inhibition of PMNL migration and activation of oxidative metabolism was investigated using the anti-oxidants ascorbate and levamisole at concentrations of 10(-2) M and 10(-3) M respectively. These agents prevented the decreased motility and auto-oxidation of PMNL induced by 10(-4) M benoxaprofen. Benoxaprofen (10(-4) M) did not inhibit the migration of PMNL from 3 children with chronic granulomatous disease thus showing that intact PMNL oxidative metabolism is required for the induction of drug-mediated inhibition of cell motility. Ingestion of therapeutic doses of benoxaprofen for 7 days by normal adults gave serum drug concentrations greater than those required for detectable effects on PMNL functions in vitro (mean serum value 126 micrograms/ml). Co-incubation of normal PMNL with serum from individuals who had ingested the drug caused decreased cell migration and increased chemiluminescence. These results show that benoxaprofen inhibits PMNL migration as a consequence of pro-oxidant properties and despite its withdrawal may be the prototype of the pro-oxidative anti-inflammatory drug.

Anti-Inflammatory Agents↗

Suppression of tumor growth and metastasis by dietary fish oil combined with vitamins E and C and cisplatin.

PURPOSE: The anticancer activity of omega-3 polyunsaturated fatty acids (omega-3 PUFA) has been shown in a large number of studies. This study was undertaken to analyze the combined effect of omega-3 PUFA and antioxidative vitamins on the level of spontaneous metastatic dissemination. The supportive effect of this dietary combination on chemotherapy with cisplatin (CP) was determined in parallel. METHODS: C57BL/6J mice bearing the Lewis lung carcinoma 3LL were fed ad libitum one of three isocaloric diets containing 5% soybean oil supplemented with 40 mg/kg alpha-tocopherol acetate (SO diet), or 4% fish oil plus 1% corn oil, and basal amounts of vitamin E (FO diet) or FO diet supplemented with vitamins E and C (FO+E+C diet). These diets were tested in combination with the conventional cytotoxic agent CP in a series of regimens. Tumor growth, feed consumption, body weight, lung metastasis and lung histology were followed. RESULTS: Both the FO dietary groups showed significantly lower tumor development than the SO group in all examined parameters, indicating that omega-3 PUFA have anticancer activity. However, the FO diet, in comparison with the FO+E+C diet induced a significantly slower rate of tumor growth, and lower metastatic load, as reflected in lung weight. The decrease in the anticancer activity of FO by the addition of vitamins E and C suggests that in situ oxidation of omega-3 PUFA underlies their anticancer action. It is thus proposed that oxidized omega-3 PUFA accumulates in the membranes and the cytosol of tumor cells, reducing their vitality and eventually leading to their death. No signs of anorexia or cachexia were observed in either FO group, in contrast to the SO group. CP treatment with the SO diet had no apparent therapeutic effect, while with the FO diets it reduced the metastatic load. The best regimen of this combined treatment was FO diet followed by CP treatment with FO diet supplemented with vitamins E and C after resection of the primary growth. This regimen could be translated to a combined therapy for human cancer. CONCLUSIONS: Diets enriched with omega-3 PUFA may have beneficial anticancer effects in particular when containing only basal amounts of antioxidants such as vitamin E or C. Furthermore, the addition of drugs which promote oxidation of omega-3 PUFA, such as ferrous salts (e.g. as prescribed for the treatment of anemia), may further increase these effects. However, the supportive effect of omega-3 PUFA in chemotherapy (e.g. with CP) increases when vitamins E and C are also included.

Analysis of Variance↗

Vitamin therapy in the absence of obvious deficiency. What is the evidence?

Vitamins are a group of organic compounds occurring naturally in food and are necessary for good health. Lack of a vitamin may lead to a specific deficiency syndrome, which may be primary (due to inadequate diet) or secondary (due to malabsorption or to increased metabolic need), and it is rational to use high-dose vitamin supplementation in situations where these clinical conditions exist. However, pharmacological doses of vitamins are claimed to be of value in a wide variety of conditions which have no, or only a superficial, resemblance to the classic vitamin deficiency syndromes. The enormous literature on which these claims are based consists mainly of uncontrolled clinical trials or anecdotal reports. Only a few studies have made use of the techniques of randomisation and double-blinding. Evidence from such studies reveals a beneficial therapeutic effect of vitamin E in intermittent claudication and fibrocystic breast disease and of vitamin C in pressure sores, but the use of vitamin A in acne vulgaris, vitamin E in angina pectoris, hyperlipidaemia and enhancement of athletic capacity, of vitamin C in advanced cancer, and niacin in schizophrenia has been rejected. Evidence is conflicting or inconclusive as to the use of vitamin C in the common cold, asthma and enhancement of athletic capacity, of pantothenic acid in osteoarthritis, and folic acid (folacin) in neural tube defects. Most of the vitamins have been reported to cause adverse effects when ingested in excessive doses. It is therefore worthwhile to consider the risk-benefit ratio before embarking upon the use of high-dose vitamin supplementation for disorders were proof of efficacy is lacking.

Acne Vulgaris↗

Disease, nutrition--interaction.

Practical implications of interactions between disease and vitamins in poultry were sought in the readily available literature. The evidence, almost exclusively in chickens, is in accord with that reported in other animals and man,namely 1) dietary vitamin deficiencies can impair body defense mechanisms against disease and 2) occurrence of disease can increase vitamin requirements. Information on viral infections is inadequate and conflicting. Slight indications exist for positive interactions with ascorbic acid and for antagonistic ones with vitamin A. Studies on bacterial diseases involved 7 organisms, 11 vitamins, and 29 observations of which 25 (86%) indicated positive interactions. Those on parasitic infestations involved 9 organisms, 9 vitamins, and 55 observations of which 34 (82%) indicated interactions. The major evidence for interaction between individual vitamins and disease categories was for vitamin A and ascorbic acid in bacterial infections and for vitamins A and K in parasitic infestations. The numbers of confirming studies on individual diseases and vitamins deemed to be reasonably adequate to demonstrate specific interactions were limited to vitamin A in coccidiosis, in ascariasis, and probably in infectious coryza and of vitamin K in coccidiosis. Despite the paucity of specific and quantitative evidence, it appears likely that vitamin levels in chick rations containing generous margins of safety, as referred, should be adequate to meet the increased requirement caused by most diseases. However, when liver reserves of vitamin A are depleted, notably by severe coccidiosis, the effects may be ameliorated and recovery may be aided by additional vitamin A and possibly other fat-soluble vitamins. Decision for such augmentation, selection of formulation, and mode and duration of administration require collaboration of the pathologist and nutritionist familiar with the particular circumstances. It has not been proven that vitamins exert a pharmacodynamic effect or that they will replace the use of appropriate prophylactic or therapeutic drugs. Multidisciplinary research on specific nutrient requirements as affected by specific disease entities is sorely needed.

Animal Nutritional Physiological Phenomena↗

Mechanism of copper-mediated inactivation of herpes simplex virus.

The inactivation of herpes simplex virus (HSV) by copper was enhanced by the following reducing agents at the indicated relative level: ascorbic acid >> hydrogen peroxide > cysteine. Treatment of HSV-infected cells with combinations of Cu(II) and ascorbate completely inhibited virus plaque formation to below 0.006% of the infectious virus input, while it maintained 30% viability for the host mammalian cells. The logarithm of the surviving fraction of HSV mediated by 1 mg of Cu(II) per liter and 100 mg of reducing agent per liter followed a linear relationship with the reaction time, in which the kinetic rate constant for each reducing agent was -0.87 min(-1) (r = 0.93) for ascorbate, -0.10 min(-1) (r = 0.97) for hydrogen peroxide, and -0.04 min(-1) (r = 0.97) for cysteine. The protective effects of metal chelators and catalase, the lack of effect of superoxide dismutase, and the partial protection conferred by free-radical scavengers suggest that the mechanism of copper-mediated HSV inactivation is similar to that previously reported for copper-mediated DNA damage. The sensitivity exhibited by HSV to Cu(II) and reducing agents, particularly ascorbate, might be useful in the development of therapeutic antiviral agents.

Animals↗

Vitamin C and the genesis of autoimmune disease and allergy (review).

The purpose of this review paper is to present relevant information for assessing the validity of our clinical investigation on the clinical usefulness of vitamin C infusion treatment tested in the control of autoimmune disease and allergy. Firstly, we describe the historical background of this study and then present the results of both experimental and clinical investigations as regards the therapeutic effect of vitamin C infusion treatment for the control of immune disorders including diabetes mellitus. Secondly, we discuss the interdisciplinary nature of our studies in the light of recent progress in clinical vitaminology, endocrinology and immunology. Thirdly, we suggest the possibility that the use of our vitamin C infusion treatment may be beneficial in the clinical management of AIDS, of which the immunological background data are in favor of the participation of an autoimmune mechanism in the genesis of this disease. Finally, we stress the importance of paradigm change in the achievement of a breakthrough in natural science.

Ascorbic Acid↗

[Antioxidant effect of drugs used in cardiovascular therapy].

Oxidative stress is implicated in the pathogenesis of various cardiovascular disorders. The knowledge, characterisation and comparison of the different antioxidant properties of some cardiovascular drugs might lead to new therapeutic approaches. Blood constituents are biological products easier to obtain. Their oxidative damage is accepted to be involved in several pathogenic pathways such as atherogenesis. Blood products can be utilised as in vitro models of macromolecular and cellular oxidative damage. It is well known that transition metals catalyse the generation of more damaging reactive oxygen species. We studied the antioxidant effect of four beta-adrenergic blocking agents (pindolol, propranolol, atenolol and metoprolol) and of one calcium channel antagonist (nifedipine), on the plasma oxidative damage induced by copper. Lipid peroxidation was evaluated by measuring fluorescent substances. We added the drugs to the assay system, before and after the induction of peroxidation by copper, to elucidate their ability to prevent and/or block lipid peroxidation. We observed that pindolol, propranolol and nifedipine have antioxidant properties, in the assay system, when added 15 min before the addition of copper. This effect is demonstrated by the delay in initiation and decrease in formation of lipid peroxidation products. Nifedipine also has a remarkable chain breaking effect. We compared the drugs with ascorbic acid in their relative antioxidant effect: nifedipine > ascorbate > pindolol > propranolol.

Adrenergic beta-Antagonists↗

The role of free radicals in the pathogenesis of rheumatoid arthritis.

Free radicals are reactive chemical species that differ from other compounds in that they have unpaired electrons in their outer orbitals. They are capable of damaging cellular components, and accumulating evidence suggests that they may contribute to various disease entities including inflammatory joint disease. Reactive oxygen species (ROS) as well as reactive nitrogen species (RNS) can directly or indirectly damage basic articular constituents and lead to the clinical expression of the inflammatory arthritis. Hydroxyl radicals degrade isolated proteoglycans, and HOCl fragments collagen. Hydrogen peroxide, which is very diffusible, readily inhibits cartilage proteoglycan synthesis, e.g. by interfering with ATP synthesis, in part by inhibiting the glycolytic enzyme glyceraldehyde-3-phosphate dehydrogenase in chondrocytes, aggravating the effects of proteolytic and free-radical-mediated cartilage degradation. Peroxynitrite and HOCl may facilitate cartilage damages by inactivating TIMPs. TIMP-1 inhibits stromelysins, collagenases and gelatinases and this ability is lost after ONOO(-) or HOCl treatment. HOCl can also activate latent forms of neutrophil collagenases and gelatinase with obvious consequences. Hypochlorous acid, ONOO(-) and O(2)(*-) react with ascorbate, which is essential for cartilage function, leading to low levels of ascorbate in synovial fluid. Low concentrations of H2O(2), O(2)(*-) or both, accelerate bone resorption by osteoclasts, whereas NO. inhibits it. NO. promotes chondrocyte apoptosis, inhibits proteoglycan synthesis and activates latent metalloproteinases and cyclooxygenase. ROS, produced by activated phagocytes, could alter the antigenic behaviour of immunoglobulin G, producing fluorescent protein aggregates that can further activate phagocytic cells. Radical-exposed IgG is able to bind rheumatoid factor and results in the generation of C3alpha. This reaction may be self-perpetuating within the rheumatoid joint, suggesting that free radicals play a role in the chronicity of the inflammatory reaction which is a key question regarding to which extent free radicals contribute to the consequences of inflammation, such as the cartilage and bone destruction. Reactive oxygen intermediates can also function as signaling messengers to activate transcription factors, like NFkB and AP-1, and induce gene expression. All this knowledge might serve to apply a rational selection of antioxidants for possible therapeutic purposes, enforcing combination therapy of the inflammatory joint disease.

Animals↗

[Therapeutic measures in osteogenesis imperfecta (author's transl)].

The treatment of osteogenesis imperfecta with magnesium is theoreticaly sound, but usually works in a few individuals. There are greater expectations with calcitonin, which reduces the overall osteolysis. The treatment of fractures should, whenever possible, be concervative. Internal fixation by plates is not indicated, because the plate should span from metaphysis to metyphysis, which leads to a softeming of the underlying cortex. Because of the weak bone, srews do not hold well. For operative treatment of the lower limb, the Küntscher nail is the fixation of choice, as well as for treatment of deformity by multiple fragmentation. Rapidly progressive scoliosis should be treated operatively from 9 years of age on.

Age Factors↗

Chronic idiopathic thrombocytopenic purpura in the elderly.

From a group of 118 patients with chronic idiopathic thrombocytopenic purpura (ITP), 43 were older than 60 years at diagnosis. In this report, we describe the clinical evolution and therapeutic response in young and old patients. The overal rate of hemorrhagic manifestations was similar in the two age groups, but a greater risk for severe bleeding was observed in elderly patients. There were no significant differences between old and young patients in response to steroids. In none of our patients was mortality associated with bleeding or side effects of the treatment. In conclusion, we have observed a more benign clinical course in elderly patients with chronic ITP as compared to previous reports.

Adolescent↗

Cyclosporin A attenuates the decrease in tyrosine hydroxylase immunoreactivity in nigrostriatal dopaminergic neurons and in striatal dopamine content in rats with intrastriatal injection of 6-hydroxydopamine.

To explore new therapeutic strategies for Parkinson's disease, we studied the possible protective effect of an immunosuppressant, cyclosporin A (CsA), treatment on changes in dopaminergic function in rats with intrastriatal injections of 6-hydroxydopamine (6-OHDA). Four weeks after injection of 6-OHDA, dopamine (DA) and dihydroxyphenylacetic acid in the striatum were depleted by 70-80%, and repeated high-dose CsA (20 mg/kg) treatment for 1 week significantly protected against these depletions. Tyrosine hydroxylase immunoreactivity (TH-IR) of the cell bodies in the substantia nigra pars compacta (SNc) ipsilateral to the injection were lower than on the contralateral side at 4 weeks but not at 1 week after 6-OHDA injection. The number of TH-positive cell bodies in the SNc decreased to 64% but CsA treatment increased this to 87%. The staining of microglia in the SN with OX42 and Griffonia simplicifolia B4 isolectin was intense at 3 days and gradually decreased by 28 days after injection. At 3 and 7 days after injection, the microglial staining in the SN was prominent and equal both in the 6-OHDA group and in ascorbic acid (SA)-injected controls. By 28 days postinjection, the staining had decreased to control levels in the SA group but was still above the control in the 6-OHDA group. CsA treatment did not affect this staining in either group. These results suggest that CsA protects against 6-OHDA-induced injury of nigrostriatal DA neurons by a mechanism not involving microglia.

3,4-Dihydroxyphenylacetic Acid↗

Vitamin C: an aldose reductase inhibitor that normalizes erythrocyte sorbitol in insulin-dependent diabetes mellitus.

OBJECTIVE: Diabetic hyperglycemia promotes sorbitol production from glucose via aldose reductase. Since the intracellular accumulation of sorbitol, or its sequelae, are postulated to contribute to the progression of chronic diabetic complications, aldose reductase inhibitors (ARI) offer therapeutic promise. Others have shown that vitamin C at pharmacologic doses decreases erythrocyte (RBC) sorbitol. We examined whether smaller, physiologic doses of vitamin C were also effective in individuals with insulin-dependent diabetes mellitus (IDDM) and whether vitamin C was an ARI in vitro. METHODS: Vitamin C supplements (100 or 600 mg) were taken daily for 58 days by young adults with IDDM and nondiabetic adults in an otherwise free-living design. Diabetic control was monitored by fasting plasma glucose, glycosylated hemoglobin, and glycosuria and was moderate to poor throughout the study. RBC sorbitol was measured at baseline and again at 30 and 58 days. Three-day dietary records and 24-hour urine collections were performed for each sampling day. RESULTS: RBC sorbitol levels were significantly elevated in IDDMs, on average doubled, despite their more than adequate dietary intakes of vitamin C and normal plasma concentrations. Vitamin C supplementation at either dose normalized the RBC sorbitol in IDDMs within 30 days. This correction of sorbitol accumulation was independent of changes in diabetic control. Furthermore, our in vitro studies show that ascorbic acid inhibited aldose reductase activity. CONCLUSIONS: Vitamin C supplementation is effective in reducing sorbitol accumulation in the erythrocytes of diabetics. Given its tissue distribution and low toxicity, we suggest a superiority for vitamin C over pharmaceutic ARIs.

Adult↗

Physiologic concentrations of magnesium and placental apoptosis: prevention by antioxidants.

OBJECTIVE: To identify the role of physiologic magnesium concentrations on the induction of placental apoptosis in vitro and test the anti-apoptotic action of antioxidants. METHODS: Placental tissue was obtained from normal pregnancies after cesarean delivery. Placental explants were incubated with increasing concentrations of extracellular magnesium (range 0-2.0 mM). Placental apoptosis was evaluated by tissue morphology, DNA fragmentation, cytokeratin-18 neoepitope formation, and cleavage of plasminogen activator inhibitor type 2. RESULTS: Physiologic concentrations of extracellular magnesium stimulated placental apoptosis. Magnesium stimulated apoptosis within the physiologic range (0.8-1.2 mM) (n = 6, P <.001) and was associated with cleavage of plasminogen activator inhibitor type 2 and cytokeratin-18 neoepitope formation. These data implicate caspase activation in the transduction of the magnesium-induced apoptotic signal. Therapeutic concentrations of vitamin C, vitamin E, and acetylcysteine (all at 25 microg/mL) inhibited DNA fragmentation and attenuated cleavage of plasminogen activator inhibitor type 2 and cytokeratin-18 neoepitope formation. CONCLUSION: Magnesium-induced placental apoptosis is a potent mechanism of placental degeneration in vitro and may represent an important regulator of placental tissue dynamics in vivo. The ability of antioxidants to prevent magnesium-induced placental apoptosis implicates oxidation-reduction-dependent signaling events in this process. Furthermore, these findings provide a basis for further studies of antioxidants in mitigating the adverse effects of preeclampsia.

Acetylcysteine↗