Molecular Biology‐Based Assessment of Vitamin E‐Coated Dialyzer Effects on Oxidative Stress, Inflammation, and Vascular Remodeling

Abstract

Cardiovascular disease represents the most common cause for the excess of morbidity and mortality found in end-stage renal disease (ESRD) and has prompted the exploration of multiple approaches to improve outcomes in these patients. Cardiovascular risk factors such as increased oxidative stress (OxSt) and inflammation are found in ESRD patients. A vitamin E-coated dialyzer using polysulfone membranes has been suggested to have positive effects on these factors. This 1-year study evaluated in 25 ESRD patients under chronic dialysis, the effects of a vitamin E-coated membrane (VitabranE ViE) "ex vivo" on mononuclear cells, OxSt, and inflammation-related biochemical and molecular biology markers using a molecular biology approach. p22(phox), heme oxygenase (HO)-1, plasminogen activator inhibitor (PAI)-1 protein level, and phosphorylated extracellular signal-regulated kinase (pERK)1/2 status were evaluated at the beginning of the study, after 6 months and after 12 months by Western blot analysis and oxidized low-density lipoprotein (OxLDL) plasma level by enzyme-linked immunosorbent assay, alongside vascular remodeling assessment as measured by carotid intima-media thickness (IMT) in a subgroup of nine randomly selected patients. p22(phox), PAI-1, OxLDL, and pERK all decreased with VitabranE use, while HO-1 increased. Carotid IMT did not increase. Treatment with VitabranE significantly decreases the expression of proteins and markers relevant to OxSt and inflammation tightly associated with cardiovascular disease, and it appears highly likely that VitabranE use will provide a benefit in terms of cardiovascular protection.

Effects of Vitamin E-Coated versus Conventional Membranes in Chronic Hemodialysis Patients: A Systematic Review and Meta-Analysis

“…This absence of effect was in line with isolated findings from 7 studies [11,17,23,35,62,64,65] in which outcome data were not suitable to be included in meta-analysis.…”

“…Fifteen studies [11,15,19,21,23,30,32,34,35,61,64,65,[68][69][70] investigated the effect of ViE-m on inflammation. Inflammation was evaluated by changes in C-reactive protein (CRP) and interleukin-6 (IL-6) in 14 [11, 19, [18,20,59,64,70] respectively.…”

“…Six studies [11,16,26,30,49,63] focused on blood vitamin C levels. Variation in plasma oxidized low density lipoprotein (Ox-LDL), nitric oxide (NOx) and thiobarbituric acid reactive substances (TBARS) were given in 11 [18,19,24,25,46,48,51,56,65,67,70] , 4 [16,22,57,62] and 8 studies [20,26,29,33,39,44,47,70] , respectively. Thirteen studies [10,20,23,26,30,33,44,48,49,51,58,64,70] reported information on total anti-oxidant status (TAS) and anti-oxidant capacity (AOC).…”

“…Five studies [32,42,51,55,69] reported information on total serum iron, 11 [17,23,27,32,34,42,51,54,55,64,69] on ferritin levels and 6 [23,32,34,42,54,55] on transferrin saturation (TSAT). Erythropoietin (EPO) dosage was specified in 16 studies [11,16,19,21,23,27,45,50,51,54,55,60,61,64,65,69] .…”

Review of the Effectiveness of Cellulose- and Polysulfone-Based Vitamin E-Bonded Dialysis Membranes

“…In these studies, a lower inflammatory response was associated with improved ERI, which is consistent with the role of chronic inflammation and oxidative stress as pathogenic factors of uremic anemia (Del Vecchio et al, 2011). Calò et al, 2011, conducted a 1-year study on 25 HD patients to evaluate the effects of VitabranE on the biochemical markers of inflammation. The authors employed a molecular approach by using immunoblot (western blot) analysis to assess the expression of p22 phox , plasminogen activator inhibitor (PAI)-1, phosphorylated extracellular signal-regulated kinase (pERK)1/2 and heme oxygenase (HO)-1 in circulating mononuclear leukocytes at the beginning of the study and after 6 and 12 months of treatment with VitabranE.…”