Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

Users Online : 135343

AbstractMaterial and MethodsDiscussionConclusionReferencesDOI and Others
Article in PDF How to Cite Citation Manager Readers' Comments (0) Audio Visual Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2011 | Month : November | Volume : 5 | Issue : 7 | Page : 1339 - 1342 Full Version

The Effect of Antioxidant Supplementation on the Oxidant and Antioxidant Status in Sickle Cell Anaemia


Published: November 1, 2011 | DOI: https://doi.org/10.7860/JCDR/2011/.1681
Prakash S. Hundekar, Aadinath N. Suryakar, Aarti C. Karnik, Rajesh Valvi, Rahul A. Ghone, Sonali S. Bhagat

1. MSc (medical) Biochemistry, PhD Assistant Professor, Dept. of Biochemistry, ACPM Medical College, Dhule (M.S.), India. 2. MSc (medical)Biochemistry, PhD Registrar, Maharashtra University of Health Sciences, Nasik (M.S.), India. 3. MSc (medical)Biochemistry, PhD Prof. and Head, Dept. of Biochemistry, ACPM Medical College, Dhule (M.S.), India. 4. MD Medicine, Medical Superintendent, Civil Hospital and Medicare Hospital, Nandurbar, (M.S.), India. 5. MSc (medical) Biochemistry, Assistant Professor, Dept. of Biochemistry, ACPM Medical College, Dhule (M.S.), India. 6. MSc (medical) Biochemistry, Assistant Professor, Dept. of Biochemistry, PDVVPF’s Medical College, Ahamadnagar, (M.S.), India.

Correspondence Address :
Prakash S. Hundekar, Associate Professor,
Department of Biochemistry, ACPM Medical College,
Dhule-424001.
Phone: 09422457913
E-mail: pshundekar@gmail.com

Abstract

Background: Sickle cell anaemia is a hereditary disorder, associated with severe haemolytic anaemia, periodical vasoocclusive pain and premature death. Oxidative stress is one of the factors that may enhance the rate of haemolysis by damaging the erythrocyte membrane by lipid peroxidation.

Aim: The present study was carried out to investigate the oxidant and antioxidant status in sickle cell individuals and the effect of antioxidant supplementation on oxidative stress.

Material and Method: A total of 90 subjects participated in the study, including 30 heterozygous (HbAS) and 30 homozygous (HbSS) sickle cell patients and 30 age and sex matched healthy controls. Oxidative stress was evaluated by measuring the levels of serum malondialdehyde (MDA), plasma protein carbonyl , serum nitric oxide (NO), the erythrocytic activity of superoxide dismutase (SOD) and catalase and the total antioxidant capacity (TAC) of plasma before and one month after of antioxidant supplementation.

Results: The baseline levels of MDA, protein carbonyl, NO and the activity of SOD were significantly (p<0.001) elevated in the HbSS and HbAS groups as compared to those of the controls. The baseline level of the activity of catalase and the TAC of plasma were significantly (p<0.001) decreased in the HbSS and HbAS groups as compared to those in the controls. After the supplementation of the antioxidants, we found a significant (p<0.001) decrease in the levels of MDA, protein carbonyl, NO and in the activity of SOD, while there was a significant (p<0.001) increase in the level of activity of catalase and in the TAC of plasma in both the groups of sickle cell patients.

Conclusion: The values of both the oxidants and the antioxidants did not meet that of the controls, thus suggesting a spontaneous generation of free radicals that consumed the antioxidants. Therefore, antioxidant supplementation is essential in sickle cell individuals in the steady state as well as in illness, to prevent the oxidative damage to the erythrocytes.

Keywords

Oxidative stress, Sickle cell anaemia, Superoxide Dismutase, TAC of plasma, Nitric Oxide

Introduction
Sickle cell anaemia (SCA) results from a point mutation in the genetic code, GAG→GTG, which causes the substitution of valine for glutamic acid at the 6th position in the β-globin chain of haemoglobin (Hb), resulting in an abnormal globin: βS. This results in the transformation of normal haemoglobin HbAA (α2β2) to ‘sickle haemoglobin’ HbS (α2βS 2). Upon deoxygenation, HbS undergoes aggregation and polymerisation, thus changing the discoidal erythrocyte into a crescent or sickle shape (1).

The prevalence of sickle cell anaemia is alarmingly high in the districts of Nandurbar and Dhule in Maharashtra. The sickling disorder is seen predominantly in the Pawra and Bhil communities of the tribal population (1). A variable degree of haemolysis and intermittent vaso-occlusion leads to chronic organ damage involving the spleen, brain, bone and the penis. The consequences of the haemolysis include chronic anaemia, jaundice, predisposition to an aplastic crisis, and cholelithiasis. Delayed growth, dactilytis, acute chest syndrome, stroke, priapism and leg ulceration are common in sickle cell anaemia.

Oxidative stress is an imbalanced redox status which is caused due to the over-production of oxidants and the depletion of antioxidants. Oxidative stress may play a major role in the pathogenesis of sickle cell anaemia by enhancing the sickling phenomena. Various studies have shown an enhanced production of the reactive oxygen species (ROS) and a decreased antioxidant status in SCA.

The sickle erythrocytes generate approximately two times more amounts than usual of superoxide, peroxide and hydroxyl radicals (2). The erythrocytes become more vulnerable during the sickling,the iron released and the denatured haemoglobin releases iron, which may produce free radicals through Fenton’s reaction. These free radicals target the erythrocyte membrane by initiating lipid peroxidation, which may be involved in the progression of sickling, thereby converting the reversible sickle cells (RSC) into irreversible sickle cells (ISC), thus leading to occlusion and haemolytic consequences (3).

With the above view, the present study was aimed to measure the levels of MDA, protein carbonyl, NO, the activity of SOD and catalase and TAC of plasma before and after one month of the supplementation of antioxidant to evaluate its effect on oxidative stress in the sickle cell anaemia individuals.

Material and Methods

The present study was carried out in the Department of Biochemistry, ACPM Medical College, Dhule and the Medicare Hospital, Nandurbar, Maharashtra. Prior to the start of the study, local ethical clearance was obtained. A total population of 90 subjects were enrolled in the study, including 30 (15 males and 15 females) heterozygous (HbAS) and 30 (15 males and 15 females) homozygous (HbSS) sickle cell patients and 30 age and sex matched (15 males and 15 females) healthy controls (HbAA) on the basiso(f2 t)he solubility test and the HPLC (a3n) alysis of blood. The subjects were excluded from the study by using a criteria of age <15 years, other than the HbAS and the HbSS pattern, the past three month’s history of crisis, blood transfusion, treatment with hydroxyurea and pregnancy.

After obtaining a written consent from all the subjects who were included in the study, 5 ml of blood was withdrawn aseptically from the antecubital vein from each subject. From this, approximately 2 ml of blood in an EDTA (0.47 mol/L K3-EDTA) container and 3 ml blood in a plain container were drawn. The samples were centrifuged at 3000 rpm for 10 min to separate RBCs, plasma and serum respectively. The serum lipid peroxide product, malondialdehyde (MDA) was measured by a thiobarbituric reaction described by K Satoh (4). Plasma protein carbonyl was measured by using a (dinitrophenyl hydrazine) DNPH–guanidine complex according to the method of Levine et al5. Serum nitric oxide (NO) was evaluated by the cadmium granule reaction which was described by Cortas and Wakid (6). The activity of erythrocytic SOD was determined by the inhibition of the reduction of riboflavin according to Winterbourne’s method (7). The activity of erythrocytic catalase was measured by the method which was described by L Goth (8). The total antioxidant capacity of plasma was determined by the ferric reducing ability of plasma (FRAP) assay9. The assessment of the above parameters was conducted before the antioxidant supplementation and on the 30th day of the antioxidant supplementation in the form of an antioxidant tablet which was composed of predominantly antioxidant vitamins and trace elements. The statistical analysis was carried out by using the SPSS (Statistical Package for Social Sciences) statistical software, version 16.0 for Windows. The paired and unpaired Student’s t tests were applied for the significance and the results were expressed in mean values with SD. P values which were <0.05 were considered as a significant difference.

Discussion

Results and discussion
[Tables/Fig 1] and [Tables/Fig 2] show significantly (<0.001) elevated baseline levels of serum MDA, plasma protein carbonyl and serum NO, elevated baseline levels of the erythrocytic activity of SOD and significantly (p<0.001) decreased baseline levels of the TAC of plasma and the activity of catalase in the heterozygous and homozygous sickle cell subjects as compared to those in the controls. After one month of antioxidant supplementation, we noted a significant decrease in the levels of MDA, NO and protein carbonyl and in the activity of SOD as compared to the baseline levels. On the other hand, the levels of the TAC of plasma and the activity of catalase were significantly increased on the 30th day of the antioxidant supplementation.

Earlier studies have reported increased levels of the lipid peroxidation product, MDA in the sickle cell subjects as compared to the controls, which was in accordance with our finding [2,10,11]. The HbS RBC membranes were exposed to increased amounts of the endogenous oxidant. Haemoglobin-free iron acts as Fenton’s reagent and produces superoxide, peroxide and hydroxyl radicals, which may further initiate membrane lipid peroxidation (12). Superoxide/peroxide driven hydroxyl radical (OH•) generation is facilitated by membrane-bound hemichrome (HC), a denatured ferric haemoglobin (Hb) which is found in excessive amounts and is bound to the HbS RBC membranes (13). This enhanced oxidative stress may be a contributing factor in the pathogenesis of sickle cell anaemia.

There are conflicting reports regarding the activity of SOD. Schacter et al (1988) reported the decreased activity of SOD in the homozygous subjects as compared to the heterozygous subjects and the controls [14,15], Das and Nair (1980) and Titus et al (2004) have shown an elevated activity of SOD in the homozygous as well as the heterozygous subjects [10,11], which may be due tothe variation in the genetic expression. The elevated activity of SOD may imbalance the cellular antioxidant defence, resulting in the accelerated generation of H2O2, which is a product of the dismutation of O• 2. This effect is significantly exacerbated under conditions in which the H2O2 catabolism is altered. An enhanced activity does not decrease the intensity of the oxidative damage, but rather, it increases the concentration of H2O2. Further, it may inhibit the activity of erythrocytic catalase, leading to the denaturation of Hb and the formation of Heinz bodies, thus contributing to sickling and haemolytic effects (16).

In the present study, the TAC level was assessed by the FRAP assay, based on the antioxidant power of low molecular weight antioxidants such as vitamins (A,E,C) and trace elements (Zinc, Selenium, Copper). The lower levels of TAC suggested the depletion of these low molecular weight antioxidants. Previous studies have reported significantly decreased levels of tocopherol, retinol, carotenes, ascorbic acid and zinc [17,18,19]. The deficiency of these antioxidants may account for some of the observed manifestations of sickle cell disease, such as an increased susceptibility to infection and haemolysis (19). The regular supplementation of these antioxidants may ameliorate some of the sickle cell manifestations such as vaso-occlusive crises, acute chest syndrome, recurrent infection and growth retardation (20). The haemolysis which was observed in the sickle cell anemia subjects correlated with the percentage of the circulating ISCs. The supplementation of the sickle cell patients with vitamin E led to a greater than 50% reduction of the ISCs (from 25% to 11%) (21). However, it was stated that vitamin E was ineffective as a terminating factor in disorders which were characterized by iron decompartmentalization (2).

Huang et al (2003) carried out a short trial on the supplementation of vitamin E and C in SCA. Specifically, the supplementation with 500 mg of vitamin C per day or 400 IU of vitamin E per day for 2 months, resulted in a reduction in the lipid peroxidation of equal to 10% on the basis of the measured urinary excretion of the 8-iso- PGF2α, However, the supplementation with a combination of both vitamin C and vitamin E conferred no additional benefits (22). Natta et al (1979) investigated the vitamin E levels in sickle cell patients before and after the supplementation of vitamin E. He found a significantly low level of vitamin E in the SCA patients. After the supplementation of 150 IU of vitamin E (dl-α tocopheryl acetate), three times a day for 2 months, the plasma tocopherol levels were found to be similar to the controls (23).

Muskiet et al (1991), have seen the effect of the supplementation of α-tocopherol, vitamin C, zinc, soybean oil and fish oil in thirteen patients with homozygous sickle cell disease. They found a reduction in the urinary zinc and an increase in the plasma vitamin C, plasma cholesterol ester and erythrocyte (RBC) ω-3 fatty acids. The plasma and RBC α-tocopherol levels were found to be increased. They also observed a decrease in the irreversibly sickled cells by 37.5%, decreased RBC protoporphyrin and urinary porphyrins, and an increase in the RBC total fatty acid cholesterol ratio. However, they also observed that the supplements did not change the haemoglobin concentrations, the RBC age (reticulocytes, polyamines), or the number of aplastic and vaso-occlusive crises24. Lanchant and Tanaka (1986) observed that Vitamin C corrected their hydrogen peroxide-induced sensitivity for lipid peroxidation and haemolysis in the sickle cell individuals (25).

In the present study, one month of antioxidant supplementation showed a significant elevation in the antioxidant status, with a decrease in the oxidant level, thus suggesting the necessity ofantioxidant supplementation in SCA. Elevated oxidative stress may certainly have a role in the pathogenesis of sickle cell anaemia. The antioxidant supplementation may intervene to the chain reaction process of the oxidants and probably delay the sickling effect. However, further studies are needed to see the effect of the increased duration of antioxidant supplementation on oxidative stress and on the health status of the SCA patients. The antioxidant supplementation may be of additional benefit in crises conditions along with the crises treatment that ameliorates the vaso-occlusive and the haemolytic consequences.

Conclusion

In the present study, we observed increased oxidative stress in terms of elevated serum MDA, serum NO, plasma Protein carbonyl and erythrocytic SOD activity. However, a decrease in the antioxidant capacity of plasma may be due to the overburden of the ROS. The supplementation of antioxidants shows the improved antioxidant capacity of the plasma as well as a decrease in the oxidant levels. The present study may be helpful for the further treatment policy for sickle cell anaemia in the steady state as well as in the crisis state.

References

1.
Kate SL, Lingojwar DP. The epidemiology of sickle cell disorder in the state of Maharashtra. Int J Hum Genet 2002; 2: 161-67.
2.
Hebbel RP, Eaton JW, Balasingam M, Steinberg MH. Spontaneous oxygen radical generation by sickle erythrocytes. J Clin Invest 1982; 70: 1253-59.
3.
Rice-Evans C, Omorphos SC, Baysal E. Sickle cell membranes and oxidative damage. Biochem J 1986; 237: 265-69.
4.
Satoh K. Serum lipid peroxide in cerebrovascular disorders which was determined by a new colorimetric method. Clinica Chemica Acta 1978; 90: 37-43.
5.
Levine RL, Willium JA, Stadtman ER. Carbonyl assays for the determination of oxidatively modified proteins. Methods Enzymol 1994; 233:346-57.
6.
Cortas NK, Wakid NW. The determination of inorganic nitrate in serum and urine by the kinetic cadmium reduction method. Clinical Chemistry 1990; 36:1440-43.
7.
Winterbourn CC, Hawkins RE, Brian M, Carrell RW. The estimation of red cell superoxide dismutase activity. Lab Gun Med 1975; 85: 337-41.
8.
Goth L. A simple method for the determination of the serum catalase activity and the revision of the reference range. Clinica Chimica Acta 1991; 196:143-45.
9.
Benzie IFF, Strain JJ. The ferric reducing ability of plasma (FRAP) as a measure of “antioxidant power”: the FRAP assay. Anal Biochem 1996; 239:70-76.
10.
Titus J, Chari S, Gupta M, Parekh N. Pro-oxidant and anti-oxidant status in patients of sickle cell anaemia. Indian Journal Clinical Biochemistry 2004; 19: 168-72.
11.
Das SK, Nair RC. Superoxide dismutase, glutathione peroxidase, catalase, and the lipid peroxidation of normal and sickled erythrocytes. Br J Haematol 1980; 44: 87-92.
12.
Kuross SA, Hebbel RP. Nonheme iron in sickle erythrocyte membranes: association with phospholipids and potential role in lipid peroxidation. Blood 1988; 72:1278-85.
13.
Asakura T, Minakata K, Adachi K, Russell MO, Schwartz E. Denatured hemoglobin in sickled erythrocytes. J Clin Invest 1977; 59: 633-40.
14.
Hongmei R, Ghebremeskel K, Okpala. Patients with sickle cell anaemia have reduced antioxidant production. Int J Vitam Nutr Res 2008; 78:139-47.
15.
Schacter L, Warth JA, Gordon EM, Prasad AS, Klein BL. Altered amount and activity of superoxide dismutase in sickle cell anemia. FASEB 1988; 2: 237-43.
16.
Scott MD, Eaton JW, Chiu DT-Y, Kuypers FA, Lubin B. Enhancement of the erythrocyte superoxide dismutase activity: effect on cellular oxidant defense. Blood 1989; 74:2542-49.
17.
Adelekan DA, Thurnham DI, Adekile AD. Reduced antioxidant capacity in pediatric patients with homozygous sickle cell disease. Eur J of Clin Nutr 1989; 43:609-14.
18.
Hasanato RMW. Zinc and antioxidant vitamin deficiency in patients with severe sickle cell anemia. Ann Saudi Med 2006; 26: 17-22.
19.
Essien EU. Plasma levels of retinol, ascorbic acid and alpha-tocopherol in sickle cell anemia. Cent Afr J Med 1995; 41:48-50.
20.
Gupta VL, Chaubey BS. Efficacy of zinc therapy in the prevention of a crisis in sickle cell anemia a double – blind randomized controlled clinical trial. J Assoc Physicians India 1995; 43: 467-69.
21.
Serjeant OR, Serjeant BE, Milner PF. The irreversibly sickled cell; a determinant of haemolysis in sickle cell anemia. Brit J Haematol 1969; 17: 527-33.
22.
Huang HY, Appel LJ, Croft KD, Miller ER III, Mori TA, Puddey IB. Effects of vitamin C and vitamin E on in vivo lipid peroxidation: results of a randomized controlled trial. Am J Clin Nutr 2002; 76:549-55.
23.
Natta, Lawrence. Plasma levels of tocopherol in sickle cell anemia subjects. Am J Clin Nutr 1979; 32: 1359-62.
24.
Muskiet FA, Muskiet FD, Meiborg G, Schermer JG. Supplementation of patients with homozygous sickle cell disease with zinc, a-tocopherol, vitamin c, soybean oil, and fish oil. Am J Clin Nutr 1991; 54:736-44.
25.
Lachant NA, Tanaka KR. Antioxidants in sickle cell disease: the in vitro effects of ascorbic acid. Am J Med Sci 1986; 292:3-l0.

DOI and Others

JCDR/2011/1681

JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • Embase
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)
  • www.omnimedicalsearch.com