“…The two major limitations of this study, the short time of one-year follow-up and the small number of patients with LVEF <45% in the baseline do not allow any further conclusion and reinforce the need for more studies to clarify those questions. A recent review further highlighted the role of selenium in cell survival and its correlation with protective effects against cardiovascular disease [44] .…”
Section: Discussionmentioning
confidence: 99%
“…Another limitation of STCC was the excessive time required to start the study (2005 to 2014). During this time, many new knowledge and interesting results added concepts that could not be included in the trial design, such as (i) the organic Se as best for cardiovascular effects [ 18 , 35 ], (ii) the better performance of Se in trials when coenzyme Q10 is synergistically administered as the active substance [37] and (iii) genetic and epigenetic polymorphisms that could interfere with Se intake and expression of selenoproteins [44] . Self-reported information of nutritional consumption, including dietary Selenium intake, should also acknowledged as a limitation and we cannot exclude the possibility of other factors that we did not control could influence the results obtained so far.…”
Background
Chagas disease (caused by
Trypanosoma cruzi
infection) evolves to chronic chagasic cardiomyopathy (CCC) affecting 1.8 million people worldwide. This is the first randomized, placebo-controlled, double-blinded, clinical trial designed to estimate efficacy and safety of selenium (Se) treatment in CCC.
Methods
66 patients with CCC stages B1 (left ventricular ejection fraction [LVEF] > 45% and no heart failure;
n
= 54) or B2 (LVEF < 45% and no heart failure;
n
= 12) were randomly assigned to receive 100 mcg/day sodium selenite (
Se, n
= 32) or placebo (
Pla, n
= 34) for one year (study period: May 2014-September 2018). LVEF changes over time and adverse effects were investigated. Trial registration number: NCT00875173 (clinicaltrials.gov).
Findings
No significant differences between the two groups were observed for the primary outcome: mean LVEF after 6 (β
=
+1.1
p
= 0.51 for
Se vs Pla
) and 12 months (β
=
+2.1;
p
= 0.23). In a subgroup analysis, statistically significant longitudinal changes were observed for mean LVEF in the stage B2 subgroup (β= +10.1;
p
= 0.02 for
Se
[
n
= 4]
vs Pla
[
n
= 8]). Se treatment was safe for CCC patients, and the few adverse effects observed were similarly distributed across the two groups.
Interpretation
Se treatment did not improve cardiac function (evaluated from LVEF) in CCC. However, in the subgroup of patients at B2 stage, a potential beneficial influence of Se was observed. Complementary studies are necessary to explore diverse Se dose and/or associations in different CCC stages (B2 and C), as well as in A and B1 stages with longer follow-up.
Funding
Brazilian Ministry of Health, Fiocruz, CNPq, FAPERJ.
“…The two major limitations of this study, the short time of one-year follow-up and the small number of patients with LVEF <45% in the baseline do not allow any further conclusion and reinforce the need for more studies to clarify those questions. A recent review further highlighted the role of selenium in cell survival and its correlation with protective effects against cardiovascular disease [44] .…”
Section: Discussionmentioning
confidence: 99%
“…Another limitation of STCC was the excessive time required to start the study (2005 to 2014). During this time, many new knowledge and interesting results added concepts that could not be included in the trial design, such as (i) the organic Se as best for cardiovascular effects [ 18 , 35 ], (ii) the better performance of Se in trials when coenzyme Q10 is synergistically administered as the active substance [37] and (iii) genetic and epigenetic polymorphisms that could interfere with Se intake and expression of selenoproteins [44] . Self-reported information of nutritional consumption, including dietary Selenium intake, should also acknowledged as a limitation and we cannot exclude the possibility of other factors that we did not control could influence the results obtained so far.…”
Background
Chagas disease (caused by
Trypanosoma cruzi
infection) evolves to chronic chagasic cardiomyopathy (CCC) affecting 1.8 million people worldwide. This is the first randomized, placebo-controlled, double-blinded, clinical trial designed to estimate efficacy and safety of selenium (Se) treatment in CCC.
Methods
66 patients with CCC stages B1 (left ventricular ejection fraction [LVEF] > 45% and no heart failure;
n
= 54) or B2 (LVEF < 45% and no heart failure;
n
= 12) were randomly assigned to receive 100 mcg/day sodium selenite (
Se, n
= 32) or placebo (
Pla, n
= 34) for one year (study period: May 2014-September 2018). LVEF changes over time and adverse effects were investigated. Trial registration number: NCT00875173 (clinicaltrials.gov).
Findings
No significant differences between the two groups were observed for the primary outcome: mean LVEF after 6 (β
=
+1.1
p
= 0.51 for
Se vs Pla
) and 12 months (β
=
+2.1;
p
= 0.23). In a subgroup analysis, statistically significant longitudinal changes were observed for mean LVEF in the stage B2 subgroup (β= +10.1;
p
= 0.02 for
Se
[
n
= 4]
vs Pla
[
n
= 8]). Se treatment was safe for CCC patients, and the few adverse effects observed were similarly distributed across the two groups.
Interpretation
Se treatment did not improve cardiac function (evaluated from LVEF) in CCC. However, in the subgroup of patients at B2 stage, a potential beneficial influence of Se was observed. Complementary studies are necessary to explore diverse Se dose and/or associations in different CCC stages (B2 and C), as well as in A and B1 stages with longer follow-up.
Funding
Brazilian Ministry of Health, Fiocruz, CNPq, FAPERJ.
“…With the likely linkage between Se and cardiovascular health, studies have been conducted to examine the mechanism behind this association. Se has been suggested to participate in cell survival [ 32 , 33 , 34 ], a role reviewed recently [ 35 ]. The key findings in the studies connecting Se to cardiomyocyte survival is that, predominantly, Se deficiency increased apoptosis while inhibiting autophagy in the heart.…”
Section: The Relationship Between Se Deficiency and Cardiovascular Healthmentioning
confidence: 99%
“…The key findings in the studies connecting Se to cardiomyocyte survival is that, predominantly, Se deficiency increased apoptosis while inhibiting autophagy in the heart. Pro-apoptotic proteins, such as cleaved caspases-3, -8, and -9 and Bax, were upregulated, while anti-apoptotic ones, such as BCL-2, were reduced [ 32 , 33 , 34 ]. Combined, these findings suggest that Se regulates cardiomyocyte apoptosis.…”
Section: The Relationship Between Se Deficiency and Cardiovascular Healthmentioning
Selenium (Se) is an essential trace element that is necessary for various metabolic processes, including protection against oxidative stress, and proper cardiovascular function. The role of Se in cardiovascular health is generally agreed upon to be essential yet not much has been defined in terms of specific functions. Se deficiency was first associated with Keshan’s Disease, an endemic disease characterized by cardiomyopathy and heart failure. Since then, Se deficiency has been associated with multiple cardiovascular diseases, including myocardial infarction, heart failure, coronary heart disease, and atherosclerosis. Se, through its incorporation into selenoproteins, is vital to maintain optimal cardiovascular health, as selenoproteins are involved in numerous crucial processes, including oxidative stress, redox regulation, thyroid hormone metabolism, and calcium flux, and inadequate Se may disrupt these processes. The present review aims to highlight the importance of Se in cardiovascular health, provide updated information on specific selenoproteins that are prominent for proper cardiovascular function, including how these proteins interact with microRNAs, and discuss the possibility of Se as a potential complemental therapy for prevention or treatment of cardiovascular disease.
“…Recent studies have shown that selenium significance as a protective agent in heart failure is associated not only with its antioxidant properties, but also with its ability to prevent inflammation, autophagy, as well as the intrinsic and extrinsic apoptosis pathways (Mirdamadi et al 2019;Al-Mubarak et al 2020;Belenichev et al 2020). Signaling pathways, such as p-AMPK, PARP, Nrf2, STAT, are involved in the protective effects of selenium (Zhang et al 2019;Rayman 2020;Shalihat et al 2021).…”
Selenium is an essential component of more than two dozen enzymes and other selenoproteins that play critical roles in reproduction, DNA synthesis, thyroid hormone metabolism, and protection from oxidative damage and infection. Selenium has a protective action against some forms of cancer and cardiovascular diseases, modulates levels of inflammatory mediators, promotes to maintain bone homeostasis and protects against bone loss. Selenium significance as a cardioprotective agent may be associated not only with its antioxidant properties, but also with its ability to prevent inflammation, autophagy, as well as the intrinsic and extrinsic apoptosis pathways. Signaling pathways, such as p-AMPK, PARP, Nrf2, STAT, are involved in the protective effects of selenium. Selenium protects against cardiovascular damage by increasing the survival rate of cardiomyocytes, including a mitochondria-dependent pathway and autophagy through peroxisome proliferator-activated receptors. Research demonstrating neuroprotective and cardioprotective effects of selenium preparations – selenoline, selenocysteine and selenomethionine – is growing at a rapid rate. It has been established that these compounds are able to normalize the levels of heat shock proteins (HSP70), which limit the cytotoxic effects of free radicals, produce energotropic action, prevent a decrease in the membrane mitochondria charge, and the opening of the mitochondrial pore. Also regulate the expression of transmembrane factors NF-kB, c-fos, which is associated with their main biological function of chaperone proteins, providing protection of neurons from damage. In this review, we want to emphasize pharmacological role of Selenium and its derivatives on human health is very complex and has yet to be fully understood.
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