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1.  Correlation of Oxidative Stress with Serum Trace Element Levels and Antioxidant Enzyme Status in Beta Thalassemia Major Patients: A Review of the Literature 
Anemia  2012;2012:270923.
Beta thalassemia major is an inherited disease resulting from reduction or total lack of beta globin chains. Patients with this disease need repeated blood transfusion for survival. This may cause oxidative stress and tissue injury due to iron overload, altered antioxidant enzymes, and other essential trace element levels. The aim of this review is to scrutinize the relationship between oxidative stress and serum trace elements, degree of damage caused by oxidative stress, and the role of antioxidant enzymes in beta thalassemia major patients. The findings indicate that oxidative stress in patients with beta thalassemia major is mainly caused by tissue injury due to over production of free radical by secondary iron overload, alteration in serum trace elements and antioxidant enzymes level. The role of trace elements like selenium, copper, iron, and zinc in beta thalassemia major patients reveals a significant change of these trace elements. Studies published on the status of antioxidant enzymes like catalase, superoxide dismutase, glutathione, and glutathione S-transferase in beta thalassemia patients also showed variable results. The administration of selective antioxidants along with essential trace elements and minerals to reduce the extent of oxidative damage and related complications in beta thalassemia major still need further evaluation.
doi:10.1155/2012/270923
PMCID: PMC3357501  PMID: 22645668
2.  Total Antioxidant Status in Patients with Major β-Thalassemia 
Iranian Journal of Pediatrics  2011;21(2):159-165.
Objective
Beta-thalassemia major is an autosomal recessive disease causing severe and hemolytic anemia, which begins about 2-6 months after birth. Iron overload, which arises from recurrent transfusion and ineffective erythropoiesis, can enhance oxidative stress in thalassemic patients. The aim of this study was to evaluate the serum total antioxidant capacity of patients with ß-Thalassemia major.
Methods
Sixty six Iranian patients with β-thalassemia major and 66 age-gender matched controls were evaluated for serum total antioxidant status (TAS), uric acid (UA), bilirubin and albumin. In addition, serum ferritin and transaminases were recorded in these subjects.
Findings
Significant increases of TAS, UA, and bilirubin were observed in the patient group, compared with the control group (P<0.01). Mean TAS and bilirubin in male patients was higher than in females (P=0.005 and P=0.008, respectively). There was also direct correlation between TAS and albumin (P<0.001), bilirubin (P<0.001) and UA (P=0.002).
Conclusion
Endogenous antioxidants such as ferritin, UA and bilirubin can result in increased level of TAS in the patients with Beta-thalassemia major. Compensatory excess of TAS to oxidative stress could also be the reason for difference between our findings and previous studies.
PMCID: PMC3446157  PMID: 23056782
β-Thalassemia Major; Oxidative Stress; Antioxidants; Ferritin; Uric Acid
3.  Depleted nitrite and enhanced oxidative stress in urolithiasis 
Crystal aggregation and retention are critical events for the formation of kidney stones. There is a close association between crystal development and free radical activity in vivo. In the present study 30 subjects presenting with urolithiasis were included. Serum levels of total lipid peroxides, nitric oxide (as nitrite), α-tocopherol, plasma ascorbic acid (vitamin C) and erythrocyte superoxide dismutase activity were measured. These findings were compared with 30 age matched control subjects irrespective of sex. Student's ‘t’ test was applied for statistical analysis. There was a significant increase in lipid peroxides (p<0.001), where as significant decrease in nitrite (p<0.01) and α-tocopherol (p<0.001) levels were observed. Plasma ascorbate (p>0.05) and erythrocyte superoxide dismutase activity (p>0.05) was also found to be decreased but the difference was not statistically significant which suggests that oxidative stress is evident in urolithiasis with depletion in antioxidant status where as decrease in nitric oxide may be less abetting in disease condition.
doi:10.1007/BF02912938
PMCID: PMC3453986  PMID: 23105640
Urolithiasis; Lipid Peroxidation; Nitric Oxide; Antioxidants
4.  Iron and Ferritin Levels in Saliva of Patients with Thalassemia and Iron Deficiency Anemia 
Most of the techniques for measuring iron stores such as serum iron concentration, iron binding capacity, serum ferritin level, liver biopsy can be troublesome or invasive for patients with thalassemia. The salivary iron measurement could be of potential advantage being an easy and non invasive approach for diagnosis of iron deficiency and iron overload . The aim of this study was to compare the levels of iron and ferritin in saliva and serum of patients affected by thalassemia or iron deficiency anemia. For this purpose, 96 patients with iron overload (71 with thalassemia major, 10 with thalassemia intermedia and 15 with thalassemia trait), 30 patients with iron deficiency anemia, and 35 healthy children as control group were involved in this study. Their saliva and serum iron and ferritin levels were measured. Iron and ferritin levels were higher in iron overload groups than in control group and lower in iron deficiency group (p<0.05). Furthermore serum and saliva iron and ferritin levels paralleled in all groups. In conclusion, iron and ferritin saliva can be routinely used for diagnosis of both iron overload and deficiency; furthermore this procedure may be an important advantage for blood donors being easily available and not invasive.
doi:10.4084/MJHID.2012.051
PMCID: PMC3435124  PMID: 22973495
5.  Oxidative stress and antioxidant status in beta-thalassemia heterozygotes 
Background
Several studies have evaluated the oxidant and antioxidant status of thalassemia patients but most focused mainly on the severe and intermediate states of the disease. Moreover, the oxidative status has not been evaluated for the different beta-thalassemia mutations.
Objective
To evaluate lipid peroxidation and Trolox equivalent antioxidant capacity in relation to serum iron and ferritin in beta thalassemia resulting from two different mutations (CD39 and IVS-I-110) compared to individuals without beta-thalassemia.
Methods
One hundred and thirty subjects were studied, including 49 who were heterozygous for beta-thalassemia and 81 controls. Blood samples were subjected to screening tests for hemoglobin. Allele-specific polymerase chain reaction was used to confirm mutations for beta-thalassemia, an analysis of thiobarbituric acid reactive species was used to determine lipid peroxidation, and Trolox equivalent antioxidant capacity evaluations were performed. The heterozygous beta-thalassemia group was also evaluated for serum iron and ferritin status.
Results
Thiobarbituric acid reactive species (486.24 ± 119.64 ng/mL) and Trolox equivalent antioxidant capacity values (2.23 ± 0.11 mM/L) were higher in beta-thalassemia heterozygotes compared to controls (260.86 ± 92.40 ng/mL and 2.12 ± 0.10 mM/L, respectively; p-value < 0.01). Increased thiobarbituric acid reactive species values were observed in subjects with the CD39 mutation compared with those with the IVS-I-110 mutation (529.94 ± 115.60 ng/mL and 453.39 ± 121.10 ng/mL, respectively; p-value = 0.04). However, average Trolox equivalent antioxidant capacity values were similar for both mutations (2.20 ± 0.08 mM/L and 2.23 ± 0.12 mM/L, respectively; p-value = 0.39). There was no influence of serum iron and ferritin levels on thiobarbituric acid reactive species and Trolox equivalent antioxidant capacity values.
Conclusion
This study shows an increase of oxidative stress and antioxidant capacity in beta-thalassemia heterozygotes, mainly in carriers of the CD39 mutation.
doi:10.5581/1516-8484.20130122
PMCID: PMC3905823  PMID: 24478607
Oxidative stress; Beta-thalassemia; Lipid peroxidation; Beta-globins; Thiobarbituric acid reactive substances; Mutation
6.  Oxidants and antioxidants in hypoxic ischaemic encephalopathy 
In the present study, the role of serum lipid peroxide and serum nitric oxide as oxidants and erythrocytic superoxide dismutase & serum vitamin E as antioxidants were determined in the 50 neonates with hypoxic ischaemic encephalopathy. (HIE) as against 25 healthy neonates as controls 50 patients of HIE were further divided into two groups i. e. mild and moderate HIE patients. All subjects were in the age group of 37–41 weeks of gestation. The levels of serum lipid peroxide, serum nitric oxide and erythrocytic superoxide dismutase were significantly elevated in both groups of neonates with HIE than those of controls (P<0.001), whereas serum vitamin E levels were significantly decreased in both groups of HIE patients than those of controls (P<0.001). A positive correlation was obtained between serum lipid peroxide and erythrocytic superoxide dismutase (r=+0.86). Alterations in the status of oxidants and antioxidants indicate role of free radicals in the development of HIE.
doi:10.1007/BF02894254
PMCID: PMC3454200  PMID: 23105453
Lipid peroxide; nitric oxide; superoxide dismutase; vitamin E; hypoxic ischaemic encephalopathy
7.  Iron-Mediated Inhibition of Mitochondrial Manganese Uptake Mediates Mitochondrial Dysfunction in a Mouse Model of Hemochromatosis 
Molecular Medicine  2007;14(3-4):98-108.
Previous phenotyping of glucose homeostasis and insulin secretion in a mouse model of hereditary hemochromatosis (Hfe−/−) and iron overload suggested mitochondrial dysfunction. Mitochondria from Hfe−/− mouse liver exhibited decreased respiratory capacity and increased lipid peroxidation. Although the cytosol contained excess iron, Hfe−/− mitochondria contained normal iron but decreased copper, manganese, and zinc, associated with reduced activities of copper-dependent cytochrome c oxidase and manganese-dependent superoxide dismutase (MnSOD). The attenuation in MnSOD activity was due to substantial levels of unmetallated apoprotein. The oxidative damage in Hfe−/− mitochondria is due to diminished MnSOD activity, as manganese supplementation of Hfe−/− mice led to enhancement of MnSOD activity and suppressed lipid peroxidation. Manganese supplementation also resulted in improved insulin secretion and glucose tolerance associated with increased MnSOD activity and decreased lipid peroxidation in islets. These data suggest a novel mechanism of iron-induced cellular dysfunction, namely altered mitochondrial uptake of other metal ions.
doi:10.2119/2007-00114.Jouihan
PMCID: PMC2258172  PMID: 18317567
8.  Total antioxidant capacity and lipid peroxidation in liver transplantation 
Liver transplantation is an accepted therapy for chronic liver disease patients. These patients generally have low levels of fat soluble vitamins, which have important antioxidant roles. Therefore, this study was undertaken to investigate whether such patients had evidence of antioxidant depletion and increased lipid peroxidation before transplant and whether the subsequent ischemia and reperfusion encountered during liver transplantation have any effect on antioxidant levels and lipid peroxidation. We assessed plasma total antioxidant capacity and serum lipid peroxide in 12 patients undergoing liver transplantation and equal numbers of healthy subjects. We found that before reperfusion, antioxidant levels were significantly decreased along with significantly elevated lipid peroxidation levels as compared with healthy controls (P<0.001). On reperfusion of the liver graft, further declined values of total antioxidant accompanied with highly elevated lipid peroxidation were seen than those of pre-reperfusion samples (P<0.001). This data shows that patients undergoing liver transplant have lowered antioxidant defenses and evidence of free radical damage, which compound the additional insult of reperfusion injury. Therefore antioxidant therapy in these patients before transplantation may ameliorate the effects of reperfusion.
doi:10.1007/s12291-009-0018-x
PMCID: PMC3453468  PMID: 23105816
Ischemia/reperfusion injury; Total antioxidant; Lipid peroxidation
9.  Antioxidant Enzymes and Oxidative Stress in the Erythrocytes of Iron Deficiency Anemic Patients Supplemented with Vitamins 
Iranian Biomedical Journal  2014;18(2):82-87.
Background: Iron deficiency anemia is one of the major causes of morbidity and mortality worldwide. Evidences from epidemiological and clinical studies suggest a possible correlation between antioxidant levels and the anemic disease risk. The present work is to investigate antioxidant levels and lipid peroxidation in anemic patients. Methods: A number of 30 patients (15 males and 15 females) were selected for the study. Likewise, 30 age- and gender-matched healthy volunteers (15 males and 15 females) were selected with their informed consent. Patients and healthy subjects were supplemented with vitamins C and E for 15 days. The lipid peroxidation both in plasma and erythrocyte lysates was determined by thiobarbituric acid reactive substances and lipid peroxides. The antioxidant vitamins A, C, and E and total antioxidant activity were also analyzed. The antioxidant enzyme superoxide dismutase, catalase, and glutathione peroxidase were also determined. Results: Based on analysis, we found that the increase in lipid peroxidation was higher in the anemic subjects before vitamin supplementation, which was statistically significant at P<0.05. The antioxidant enzymes were higher in the patients before antioxidant supplementation when compared with patients after vitamin supplementation. Conclusion: Our data revealed higher oxidative stress before vitamin supplementation in iron deficiency anemic patients and after supplementation, lower lipid peroxidation and increased antioxidant vitamins were achieved.
PMCID: PMC3933916  PMID: 24518548
Iron deficiency anemia; Lipid hydroperoxides (LOOH); Vitamin C; Vitamin E; Thiobarbituric acid reactive substances (TBARS)
10.  Serum iron, copper and zinc status in maternal and cord blood 
Pregnancy is associated with increased demand of all the nutrients like Iron, Copper, Zinc etc. and deficiency of any of these could affect pregnancy, delivery and out come of pregnancy. With this consideration, the study was conducted on 80 mothers and newborns and 20 age matched control women. Out of 80 mothers, 34 had Iron deficiency anemia and their Hb levels were below 9.0 gm/d1. Pregnant women had significantly lower Iron and Zinc levels while Copper and Total Iron Binding Capacity (TIBC) were significantly higher (P<0.001). Newborns had significantly elevated Iron and Zinc levels and low levels of Copper and TIBC as compared to their mothers irrespective of Iron deficiency anemia. Micronutrient status of newborn was found to be dependent on their mother's micronutrient status. Besides, results also suggest micronutrient interactions, which are reflected in Iron/Zinc, Iron/Copper and Zinc/Copper ratios. In view of this, there is need for proper, adequate and balanced micronutrient supplementation during pregnancy to affect a healthy outcome.
doi:10.1007/BF02894257
PMCID: PMC3454214  PMID: 23105456
Iron; Copper; Zinc; Pregnancy; Newborn; Iron Deficiency Anemia
11.  Effects of Vitamin E and Zinc Supplementation on Antioxidants in Beta thalassemia major Patients 
Iranian Journal of Pediatrics  2011;21(1):8-14.
Objective
In beta thalassemic patients, tissue damage occurs due to oxidative stress and it happens because of the accumulation of iron in the body. This study was conducted to determine the effect of zinc and vitamin E supplementation on antioxidant status in beta-thalassemic major patients.
Methods
This double blind randomized clinical trial was carried out on 120 beta thalassemic patients older than 18 years. Patients were randomly categorized in four groups. Zinc (50mg/day) and vitamin E (400mg/day) supplements were administered for former and latter group, respectively. In the third group both supplements were administered in similar doses. The fourth (control) group received no supplement. The effect of supplementations on serum zinc and vitamin E, superoxide dismutase (SOD), glutathione peroxidase (GPX), total antioxidant capacity (TAC) and body mass index (BMI) were measured at the beginning and the end of the study.
Findings
Serum zinc levels in group 1 and 3 were significantly increased (P<0.007 and P<0.005, respectively). Serum vitamin E levels in group 2 and 3 were also increased significantly (P<0.001). Mean GPX activity in group1, 2 and 3 decreased significantly (P<0.015, P<0.032 and P<0.029, respectively). Mean SOD activity and TAC did not show significant change after supplementation. BMI had significant increase in all treated groups (P<0.001).
Conclusion
Our results suggest that beta thalassemic patients have enhanced oxidative stress and administration of selective antioxidants may preclude oxidative damage.
PMCID: PMC3446117  PMID: 23056757
Vitamin E; Zinc; Glutathione Peroxidase; Superoxide Dismutase; Body Mass Index; Antioxidants
12.  Studies on biochemical changes with special reference to oxidant and antioxidants in malaria patients 
Oxidative stress plays an important role in the development of malarial anemia. The present study was undertaken to study the role of oxidant and antioxidants in the patients ofPlasmodium falciparum malaria (n=25),Plasmodium vivax malaria (n=25) as against the normal control subjects (n=25). The parameters included are the hematological [hemoglobin, erythrocyte adenosine deaminase (ADA) activity, ADP-induced platelet aggregation] and serum total lipid peroxide as an index of oxidative stress and antioxidants [erythrocytic superoxide dismutase (SOD) activity, serum vitamin E] & serum iron.
Significant alterations in all above parameters were noted in both groups of malaria patients as compared to control subjects. Maximum significant alterations in hematological parameters were noticed inP. falciparum infection as compared toP. vivax malaria (p<0.001). Substantial rise in serum total lipid peroxides and a significant reduction in antioxidants such as serum vitamin E and serum iron were noted inP. falciparum malaria as compared toP. vivax malaria (p<0.001), whereas maximum decline in erythrocytic SOD activity was observed inP. vivax infection as compared toP. falciparum malaria (p<0.05). Follow-up examination revealed the restoration of the levels of all biochemical parameters to the normal level after 20 days of antimalarial therapy.
The study specified severity ofP. falciparum malaria and also functional duality of oxidant.
doi:10.1007/BF02867380
PMCID: PMC3453864  PMID: 23105405
Hematological Parameters; Lipid Peroxidation; Antioxidants; Malaria
13.  Antioxidant-Mediated Effects in a Gerbil Model of Iron Overload 
Acta haematologica  2007;118(4):193-199.
Introduction
Iron cardiomyopathy is a lethal complication of transfusion therapy in thalassemia major. Nutritional supplements decreasing cardiac iron uptake or toxicity would have clinical significance. Murine studies suggest taurine may prevent oxidative damage and inhibit Ca2+-channel-mediated iron transport. We hypothesized that taurine supplementation would decrease cardiac iron-overloaded toxicity by decreasing cardiac iron. Vitamin E and selenium served as antioxidant control.
Methods
Animals were divided into control, iron, taurine, and vitamin E/selenium groups. Following sacrifice, iron and selenium measurements, histology, and biochemical analyses were performed.
Results
No significant differences were found in heart and liver iron content between treatment groups, except for higher hepatic dry-weight iron concentrations in taurine-treated animals (p < 0.03). Serum iron increased with iron loading (751 ± 66 vs. 251 ± 54 μg/dl, p < 0.001) and with taurine (903 ± 136 μg/dl, p = 0.03).
Conclusion
Consistent with oxidative stress, iron overload increased cardiac malondialdehyde levels, decreased heart glutathione peroxidase (GPx) activity, and increased serum aspartate aminotransferase. Taurine ameliorated these changes, but only significantly for liver GPx activity. Selenium and vitamin E supplementation did not improve oxidative markers and worsened cardiac GPx activity. These results suggest that taurine acts primarily as an antioxidant rather than inhibiting iron uptake. Future studies should illuminate the complexity of these results.
doi:10.1159/000109879
PMCID: PMC2892915  PMID: 17940334
Iron overload; Taurine; Heart; Liver; Antioxidants
14.  Therapeutic Value of Combined Therapy with Deferasirox and Silymarin on Iron Overload in Children with Beta Thalassemia 
Background
Beta thalassemia is an inherited hemoglobin disorder resulting in a severe, chronic anemia requiring life-long blood transfusion that induces iron overload. Silymarin is a flavonoid complex isolated from Silybin marianum with a strong antioxidant activity, inducing an hepatoprotective action, and probably, a protective effect on iron overload. The aim of this work was to determine the silymarin value in improving iron chelation in thalassemic patients with iron overload treated with Deferasirox.
Patients and Methods
This study was conducted on 40 children with beta thalassemia major under follow-up at Hematology Unit, Pediatric Department, Tanta University Hospital with serum ferritin level more than 1000 ng/ml and was divided into two groups. Group IA: Received oral Deferasirox (Exjade) and silymarin for 6 months. Group IB: Received oral Deferasirox (Exjade) and placebo for 6 months and 20 healthy children serving as a control group in the period between April 2011 and August 2012 and was performed after approval from research ethical committee center in Tanta University Hospital and obtaining an informed written parental consent from all participants in this study.
Results
Serum ferritin levels were markedly decreased in group IA cases compared with group IB (P= 0.001).
Conclusion
From this study we concluded that, silymarin in combination with Exjade can be safely used in the treatment of iron-loaded thalassemic patients as it showed good iron chelation with no sign of toxicity.
Recommendations
We recommend extensive multicenter studies in a large number of patients with longer duration of follow-up and more advanced techniques of assessment of iron status in order to clarify the exact role of silymarin in reducing iron overload in children with beta thalassemia.
doi:10.4084/MJHID.2013.065
PMCID: PMC3867224  PMID: 24363880
15.  Prevalence of Hypoparathyroidism (HPT) in Beta Thalassemia Major 
Introduction: The aim of this study was to assess the parathyroid functions and bone mineral density (BMD) in patients with beta thalassemia and to correlate them with serum ferritin, calcium, phosphorus and alkaline phosphatase levels.
Materials and Methods: This is a case control study which was done on 55 subjects (40 cases and 15 controls) in the age group of 2-18 years. The cases included were with confirmed diagnosis of beta thalassemia major, more than ten blood transfusions and serum ferritin levels >2000 μg/L irrespective of chelation therapy.
Results: Significant Hypoparathyroidism (HPT) observed along with low BMD levels in beta thalassemia patients (p < 0.01).
A significant decrease in serum calcium level was seen in cases when compared to controls, where as the levels of both serum phosphorus and alkaline phosphatase levels increased in cases when compared to controls.
Conclusion: BMD and PTH levels are very useful tools for diagnosing HPT. As a routine, in beta thalassemia major, screening for vitamin D deficiency and hypocalcemia should be done in second decade of life and as a preventive measure they should be supplemented with calcium and vitamin D to prevent hypocalcemic tetany, to facilitate bone growth and to prevent fractures.
doi:10.7860/JCDR/2014/6672.3997
PMCID: PMC3972574
Bone mineral density (BMD); Parathyroid hormone (PTH); Dual energy X-ray absorptiometry (DEXA)
16.  Vascular Endothelial Growth Factor in Children with Thalassemia Major 
Background
The β-Thalassemia syndromes are the most common hereditary chronic hemolytic anemia due to impaired globin chain synthesis. Vascular endothelial growth factor (VEGF) plays several roles in angiogenesis which is a crucial process in the pathogenesis of several inflammatory, autoimmune and malignant diseases. Endothelial damage and inflammation make a significant contribution to the pathophysiology of β-thalassemia.
Purpose
: The aim of the study was to assess serum VEGF level in children with beta-thalassemia major as a marker of angiogenesis.
Methods
A total of 50 children entered the study, 40 patients with thalassemia major and 10 healthy controls. We used enzyme-linked immunosorbent assay for quantitative evaluation of VEGF.
Results
VEGF level was significantly higher in patients with β-thalassemia major than healthy controls (p=0.001). VEGF level was also higher in splenectomised thalassemic patients than non splenectomised ones (p=0.001). There were a positive correlation between VEGF and chelation starting age (p=0.008), and a negative correlation between VEGF and frequency of blood transfusion (p=0.002).
Conclusion
Thalassemia patients, especially splenectomized, have elevated serum levels of VEGF. Early chelation and regular blood transfusion help to decrease serum VEGF and the risk of angiogenesis.
doi:10.4084/MJHID.2013.044
PMCID: PMC3684348  PMID: 23795282
17.  Total antioxidant capacity – a novel early bio-chemical marker of oxidative stress in HIV infected individuals 
Background
Oxidative stress induced by the production of reactive oxygen species may play a critical role in the stimulation of HIV replication and the development of immunodeficiency. This study was conducted as there are limited and inconclusive studies on the significance of a novel early marker of oxidative stress which can reflect the total antioxidant capacity in HIV patients,
Methods
Total antioxidant capacity (TAC) and lipid peroxidation were evaluated in 50 HIV-1 seropositive patients (including HIV-1 symptomatics and asymptomatics). Controls included 50 age and sex matched and apparently healthy HIV-1 seronegative subjects. Serum malondialdehyde (MDA), Total antioxidant capacity [TAC] (by ferric reducing antioxidant power assay), vitamin E, vitamin C and superoxide dismutase (SOD) enzyme activity were estimated among controls and cases. Statistical comparisons and correlations at 5% level of significance were determined.
Results and Discussion
The mean MDA concentrations were significantly elevated in both HIV-1 asymptomatic (CD4+ count > 500 cells/microliter) and HIV-1 symptomatic (CD4+ count <500 cells/microliter) groups (Mean ± S.D values were 2.2 +/- 0.7 nmol/ml and 2.8 +/- 0.8 nmol/ml respectively) when compared with the control group (Mean ± S.D value was 0.9 +/- 0.2 nmol/ml) (p < 0.01). The mean TAC of HIV- 1 asymptomatic and HIV-1 symptomatic (Mean ± S.D values were 754.6 ± 135.6 μmol/L and 676.6 ± 154.1 μmol/L respectively) patients were significantly reduced compared with the control group (Mean ± S.D value was 1018.7 ± 125.6 μmol/L) (p < 0.01). Also, there were significantly decreased levels of vitamin E, vitamin C and SOD among HIV-1 seropositive patients(controls > asymptomatic > symptomatic) compared to controls (p < 0.01). TAC showed significant negative correlation with MDA among HIV-1 infected patients (p < 0.01).
Conclusion
Our results clearly show that severe oxidative stress occurs in the HIV-1 seropositive patients in comparison with controls, and increases significantly with the progression of disease, i.e. HIV-1 symptomatics > asymptomatics > controls. TAC can be used as a novel early bio-chemical marker of oxidative stress in HIV-1 infected patients which may result in reduced tissue damage by free radicals and help to monitor and optimize antioxidant therapy in such patients.
doi:10.1186/1423-0127-16-61
PMCID: PMC2714592  PMID: 19583866
18.  Role of free radicals and antioxidant status in childhood nephrotic syndrome 
Indian Journal of Nephrology  2011;21(1):37-40.
Nephrotic syndrome (NS) is characterized by heavy proteinuria and hypoalbuminuria. Reactive oxygen species (ROS) seem to play an important role in the etiopathogenesis of proteinuria in NS. This study aims to evaluate the potential role of reactive oxygen species in pathogenesis of NS by estimating the levels of oxidants and antioxidants in children with NS. Thirty patients of NS and thirty age, sex-matched healthy subjects, were selected for the study. As compared to healthy controls, the levels of serum lipid peroxide were significantly elevated while levels of nitric oxide, erythrocyte-superoxide dismutase activity, levels of vitamin C, albumin and total antioxidant capacity were significantly reduced in nephrotic patients. The levels of uric acid and bilirubin were significantly increased in children with NS as compared to controls. There was no significant difference in vitamin E level between patients and controls. It can be concluded that increased ROS generation and decreased antioxidant defense may be related to the pathogenesis of proteinuria in NS.
doi:10.4103/0971-4065.78062
PMCID: PMC3109781  PMID: 21655168
Nephrotic syndrome; reactive oxygen species; lipid peroxide; total antioxidant capacity
19.  Oxidative stress and calcium-phosphorus levels in Rheumatoid arthritis 
Generation of reactive oxygen species is an important factor in the development and maintenance of rheumatoid arthritis (RA) in humans. This study was undertaken to investigate interplay among oxidants, antioxidants and pathogenesis of Rheumatoid arthritis. Serum levels of lipid peroxides, nitric oxide, vitamin E and ratio of calcium/phosphorus in RA patients were determined and compared with normal healthy controls. Significant increases in lipid peroxides (p<0.001) and nitric oxide (p<0.001) levels were found in patients presenting with RA as compared to controls. Whereas significant decrease in vitamin E (P<0.001) and calcium/phosphorus ratio (p<0.001) were found in Rheumatoid arthritis patients as compared to controls. Positive correlation was found between lipid peroxides and nitric oxide as well as between vitamin E and calcium. While lipid peroxides and nitric oxide were correlated negatively with vitamin E. whereas negative correlation was observed between MDA and Calcium/Phosphorus ratio in patients with rheumatoid arthritis. Our findings suggest that there is a close association between bone loss and oxidative threat in patients presenting with Rheumatoid arthritis.
doi:10.1007/BF02912928
PMCID: PMC3453991  PMID: 23105630
Rheumatoid arthritis; oxidative stress; lipid peroxidation; vitamin E; Calcium/Phosphorus
20.  Oxidative stress and antioxidant status in cervical cancer patients 
Cervical cancer (CaCx) is a global public health problem as it is the second most common cancer leading to the death of women worldwide. Many references revealed that the low levels of antioxidants induce the generation of free radicals leading to DNA damage and further mutations. In the present study attempt have been made to evaluate the levels of serum Lipid peroxide, Nitric Oxide (NO.) Erythrocytic—Superoxide Dismutase (RBC-SOD), Vitamin-C, serum Copper (Cu) and serum Zinc (Zn). 120 patients were divided in 4 groups according to the increasing CaCx stages i.e. stage I, II, III & IV respectively. All the patients were around the age group of 25–65 years. 30 healthy women between the same age group were treated as controls. Highly significant increased values of MDA, NO. and Cu were observed (p<0.001) whereas the activity of RBC-SOD, levels of Vitamin-C and Zn were significantly decreased in CaCx patients as compared with healthy controls (p<0.001). Cu/Zn ratio was found to be altered in CaCx patients. From our findings it can be concluded that the oxidative stress is induced among CaCx patients, which inturn increases the risk of CaCx.
doi:10.1007/BF02913333
PMCID: PMC3453822  PMID: 23105702
Lipid peroxide; Cervical cancer; RBC-SOD; Nitric Oxide; Vitamin-C; Copper; Zinc
21.  Iron status in HIV-1 infection: implications in disease pathology 
Background
There had been conflicting reports with levels of markers of iron metabolism in HIV infection. This study was therefore aimed at investigating iron status and its possible mediation of severity of HIV- 1 infection and pathogenesis.
Method
Eighty (80) anti-retroviral naive HIV-1 positive and 50 sero-negative controls were recruited for the study. Concentrations of serum total iron, transferrin, total iron binding capacity (TIBC), CD4+ T -lymphocytes, vitamin C, zinc, selenium and transferrin saturation were estimated.
Results
The mean CD4+ T-lymphocyte cell counts, serum iron, TIBC, transferrin saturation for the tests and controls were 319 ± 22, 952 ± 57 cells/μl (P < 0.001), 35 ± 0.8, 11.8 ± 0.9 μmol/l (P < 0.001), 58.5 ± 2.2, 45.2 ± 2.4 μmol/l (P < 0.005) and 68.8 ± 3.3, 27.7 ± 2.2%, (P <0.001), respectively, while mean concentrations of vitamin C, zinc and selenium were 0.03 ± 0.01, 0.3 ± 0.04 (P < 0.001), 0.6 ± 0.05, 11.9 ± 0.26 μmol/l (P < 0.001) and 0.1 ± 0.01, 1.2 ± 0.12 μmol/l (P < 0.001) respectively. Furthermore, CD4+ T-lymphocyte cell count had a positive correlation with levels of vitamin C (r = 0.497, P < 0.001), zinc (r = 0.737, P < 0.001), selenium (r = 0.639, P < 0.001) and a negative correlation with serum iron levels (r = −0.572, P < 0.001).
Conclusion
It could be inferred that derangement in iron metabolism, in addition to oxidative stress, might have contributed to the depletion of CD4+ T cell population in our subjects and this may result in poor prognosis of the disease.
doi:10.1186/1472-6890-12-26
PMCID: PMC3551638  PMID: 23245266
Iron metabolism; HIV-1 infection; Pathogenesis; Prognosis; Antioxidant; Free radicals
22.  Antihyperglycemic and antioxidant activity of Clitorea ternatea Linn. on streptozotocin-induced diabetic rats 
Ayu  2013;34(4):433-439.
Ethanol extract of Clitorea ternatea Linn. (EECT) was evaluated for its antihyperglycemic and antioxidative activity in normal and streptozotocin-induced diabetic rats. Antihyperglycemic activity of EECT was studied in normal fasted and glucose fed hyperglycemic and epinephrine induced hyperglycemic rats by estimating fasting serum glucose (FSG) by glucose oxidisae or peroxidase enzymatic method. Antioxidant activity of EECT was studied by assaying lipid peroxide/Thiobarbituric acid reactive substances (TBARS), superoxide dismutase (SOD), total nitric oxide, catalase (CAT) and glutathione levels in diabetic rats. The EECT (200 and 400 mg/kg) showed significant antihyperglycemic activity by decreasing FSG in all hyperglycemic models except epinephrine induced hyperglycemic rats; in which improvement in FSG was observed only with EECT in 400 mg/kg dose, whereas significant decrease in TBARS (P < 0.001), nitric oxide (P < 0.001) and significant increase in SOD (P < 0.001), CAT (P < 0.01) and reduced glutathione levels (P < 0.001) was observed in animals treated with EECT (200 and 400 mg/kg) compared to diabetic control group. The results indicated that EECT has remedial effects on hyperglycemia and oxidative stress in diabetic rats.
doi:10.4103/0974-8520.127730
PMCID: PMC3968710
Antioxidant; Clitorea ternatea; epinephrine; streptozotocin models
23.  Hepcidin in β-thalassemia 
Iron overload is the principal cause of morbidity and mortality in β-thalassemia with or without transfusion dependence. Iron homeostasis is regulated by the hepatic peptide hormone hepcidin. Hepcidin controls dietary iron absorption, plasma iron concentrations, and tissue iron distribution. Hepcidin deficiency is the main or contributing factor of iron overload in iron-loading anemias such as β-thalassemia. Hepcidin deficiency results from a strong suppressive effect of the high erythropoietic activity on hepcidin expression. Although in thalassemia major patients iron absorption contributes less to the total iron load than transfusions, in non-transfused thalassemia, low hepcidin and the consequent hyperabsorption of dietary iron is the major cause of systemic iron overload. Hepcidin diagnostics and future therapeutic agonists may help in management of patients with β-thalassemia.
doi:10.1111/j.1749-6632.2010.05585.x
PMCID: PMC2924878  PMID: 20712769
hepcidin; β-thalassemia; iron overload
24.  Lipid peroxidation and the levels of antioxidant enzymes in coronary artery disease 
Coronary Artery Disease is the major cause of mortality and morbidity worldwide. Traditional risk factors account for only half of the morbidity and mortality from coronary artery disease. There is substantial evidence that oxidative stress plays the major role in the atherosclerotic process. The present study was undertaken to evaluate the level of lipid peroxidation (by measuring malondialdehyde) and antioxidant enzymes (ceruloplasmin, glutathione, superoxide dismutase) in coronary artery disease. Serum malondialdehyde levels and serum ceruloplasmin levels were significantly raised in all the subgroups of study group as compared to control group (p<0.001). Whole blood glutathione levels and hemolysate superoxide dismutase activity was significantly decreased in all the subgroups of study group as compared to control group (p<0.001). Above results suggests that the patients of coronary artery disease show increased oxidative stress and decreased levels of antioxidant enzymes. So it is recommended that the management protocol for coronary artery disease patients should include antioxidant supplementation along with simultaneous lowering of lipid peroxidation.
doi:10.1007/s12291-008-0008-4
PMCID: PMC3453659  PMID: 23105716
Coronary artery disease; Lipid peroxidation; Antioxidants; Ceruloplasmin
25.  Antioxidant status in neonatal jaundice before and after phototherapy 
Phototherapy has been related to increased oxidative stress and lipid peroxidation. In the present study, thirty full term jaundiced neonates with appropriate weight were analyzed before and after completion of phototherapy for malondialdehyde (MDA), reduced glutathione (GSH), total thiols, vitamin C and superoxide dismutase (SOD) levels in hemolysate and albumin levels in plasma. These parameters were analyzed in cord blood samples of 20 healthy neonates as control. It was observed that levels of MDA were elevated significantly (p<0.001) in patients as compared to controls and that the levels increased significantly after phototherapy (p<0.001). Levels of SOD were also found to be increased significantly as compared to controls and the levels rose after phototherapy (p<0.001). On the other hand, the levels of non-enzymatic antioxidants such as GSH, total thiols and vitamin C were significantly low (p<0.001) as compared to controls and the levels decreased significantly after phototherapy (p<0.001). The plasma albumin levels also were found to be decreased significantly after phototherapy (p<0.01). Therefore, phototherapy increases oxidative stress and should be used with care.
doi:10.1007/BF02913086
PMCID: PMC3453759  PMID: 23105589
Neonatal Jaundice; Oxidative stress; Phototherapy

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