Measures of cellular oxidative damage following vitamin E supplementation in young patients with transfusion-dependent thalassemia: a double-blind randomized controlled trial
Abstract Background Patients with thalassemia acquire cellular oxidative damage mainly from the degradation of excessive uncoupled hemoglobin (Hb) chains and iron overload. The oxidative damage of red blood cells (RBCs) and platelets potentially results in the worsening of ineffective erythropoiesis...
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2025-05-01
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| Online Access: | https://doi.org/10.1186/s12887-025-05741-2 |
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| author | Nutthida Hemprachitchai Rattanaporn Praneetponkang Pakawan Wongwerawattanakoon Chokdee Wongborisuth Pawarit Innachai Praguywan Kadegasem Tanyanee Khlangtan Thanaporn Sriwantana Phanphen Phoonlapdacha Oraporn Dumrongwongsiri Ampaiwan Chuansumrit Kovit Pattanapanyasat Nongnuch Sirachainan Nathawut Sibmooh Pornthip Chaichompoo Duantida Songdej |
| author_facet | Nutthida Hemprachitchai Rattanaporn Praneetponkang Pakawan Wongwerawattanakoon Chokdee Wongborisuth Pawarit Innachai Praguywan Kadegasem Tanyanee Khlangtan Thanaporn Sriwantana Phanphen Phoonlapdacha Oraporn Dumrongwongsiri Ampaiwan Chuansumrit Kovit Pattanapanyasat Nongnuch Sirachainan Nathawut Sibmooh Pornthip Chaichompoo Duantida Songdej |
| author_sort | Nutthida Hemprachitchai |
| collection | DOAJ |
| description | Abstract Background Patients with thalassemia acquire cellular oxidative damage mainly from the degradation of excessive uncoupled hemoglobin (Hb) chains and iron overload. The oxidative damage of red blood cells (RBCs) and platelets potentially results in the worsening of ineffective erythropoiesis, hemolysis, and the occurrence of thromboembolic events. Vitamin E (VitE) is an antioxidant that inhibits membrane lipid peroxidation. It is widely used as a supplement in thalassemia; however, its benefits in improving cellular oxidative damage remain unclear. Methods We conducted a double-blind, randomized, controlled trial registered in the Thai Clinical Trials Registry (TCTR20220801001) on 01/08/2022. We randomized transfusion-dependent (TD) β- and α-thalassemia (aged 10–25 years) to receive oral VitE 400 IU/day or placebo at a 1:1 ratio for 6 months. Cellular oxidative damage markers, including phosphatidyl serine (PS)-bearing RBCs, PS-bearing RBC vesicles, PS-bearing platelets, PS-bearing microparticles (MPs), PS-bearing RBC-MPs, PS-bearing platelet MPs (PMPs) and platelet activation, were measured before and after the intervention as the primary outcomes. Results Seventy-four TD thalassemia patients were categorized into 63 β-thalassemia (10 splenectomy, β-Thal-S; and 53 non-splenectomy, β-Thal-NS) and 11 α-thalassemia (non-splenectomy, α-Thal-NS). Randomized from all patient groups, 36 received VitE and 38 received a placebo. A significant reduction in PS-bearing RBCs and PS-bearing RBC vesicles was observed in the β-Thal-NS receiving VitE. This occurred parallel with a substantial decrease in malondialdehyde levels, as a marker of lipid peroxidation, found only in the β-Thal-NS but not in β-Thal-S and α-Thal-NS groups. In the β-Thal-NS group, VitE had improved RBC pathology as demonstrated by the inverse correlation between post-treatment VitE levels and PS-bearing RBCs (p = 0.001) as well as reticulocyte count (p = 0.006), although Hb levels remained unchanged. The VitE treatment did not result in improving platelet pathology or reducing MPs. No adverse event was reported in both VitE and placebo groups. Conclusions VitE 400 IU/day was well-tolerated and associated with improved oxidative damage of the RBCs in TD β-Thal-NS patients. Accordingly, advice for VitE supplementation in young TD β-Thal-NS patients can be beneficial. |
| format | Article |
| id | doaj-art-31ae99b6cd7547dda5b4387d3dfe1f59 |
| institution | OA Journals |
| issn | 1471-2431 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | BMC |
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| series | BMC Pediatrics |
| spelling | doaj-art-31ae99b6cd7547dda5b4387d3dfe1f592025-08-20T01:53:25ZengBMCBMC Pediatrics1471-24312025-05-0125111110.1186/s12887-025-05741-2Measures of cellular oxidative damage following vitamin E supplementation in young patients with transfusion-dependent thalassemia: a double-blind randomized controlled trialNutthida Hemprachitchai0Rattanaporn Praneetponkang1Pakawan Wongwerawattanakoon2Chokdee Wongborisuth3Pawarit Innachai4Praguywan Kadegasem5Tanyanee Khlangtan6Thanaporn Sriwantana7Phanphen Phoonlapdacha8Oraporn Dumrongwongsiri9Ampaiwan Chuansumrit10Kovit Pattanapanyasat11Nongnuch Sirachainan12Nathawut Sibmooh13Pornthip Chaichompoo14Duantida Songdej15Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol UniversityGraduate Program in Molecular Medicine, Faculty of Science, Mahidol UniversityDepartment of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol UniversityResearch Center, Faculty of Medicine Ramathibodi Hospital, Mahidol UniversityResearch Center, Faculty of Medicine Ramathibodi Hospital, Mahidol UniversityDepartment of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol UniversityDepartment of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol UniversityChakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol UniversityDepartment of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol UniversityDepartment of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol UniversityDepartment of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol UniversityCenter of Excellence for Microparticle and Exosome in Diseases, Department of Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol UniversityDepartment of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol UniversityChakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol UniversityDepartment of Pathobiology, Faculty of Science, Mahidol UniversityDepartment of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol UniversityAbstract Background Patients with thalassemia acquire cellular oxidative damage mainly from the degradation of excessive uncoupled hemoglobin (Hb) chains and iron overload. The oxidative damage of red blood cells (RBCs) and platelets potentially results in the worsening of ineffective erythropoiesis, hemolysis, and the occurrence of thromboembolic events. Vitamin E (VitE) is an antioxidant that inhibits membrane lipid peroxidation. It is widely used as a supplement in thalassemia; however, its benefits in improving cellular oxidative damage remain unclear. Methods We conducted a double-blind, randomized, controlled trial registered in the Thai Clinical Trials Registry (TCTR20220801001) on 01/08/2022. We randomized transfusion-dependent (TD) β- and α-thalassemia (aged 10–25 years) to receive oral VitE 400 IU/day or placebo at a 1:1 ratio for 6 months. Cellular oxidative damage markers, including phosphatidyl serine (PS)-bearing RBCs, PS-bearing RBC vesicles, PS-bearing platelets, PS-bearing microparticles (MPs), PS-bearing RBC-MPs, PS-bearing platelet MPs (PMPs) and platelet activation, were measured before and after the intervention as the primary outcomes. Results Seventy-four TD thalassemia patients were categorized into 63 β-thalassemia (10 splenectomy, β-Thal-S; and 53 non-splenectomy, β-Thal-NS) and 11 α-thalassemia (non-splenectomy, α-Thal-NS). Randomized from all patient groups, 36 received VitE and 38 received a placebo. A significant reduction in PS-bearing RBCs and PS-bearing RBC vesicles was observed in the β-Thal-NS receiving VitE. This occurred parallel with a substantial decrease in malondialdehyde levels, as a marker of lipid peroxidation, found only in the β-Thal-NS but not in β-Thal-S and α-Thal-NS groups. In the β-Thal-NS group, VitE had improved RBC pathology as demonstrated by the inverse correlation between post-treatment VitE levels and PS-bearing RBCs (p = 0.001) as well as reticulocyte count (p = 0.006), although Hb levels remained unchanged. The VitE treatment did not result in improving platelet pathology or reducing MPs. No adverse event was reported in both VitE and placebo groups. Conclusions VitE 400 IU/day was well-tolerated and associated with improved oxidative damage of the RBCs in TD β-Thal-NS patients. Accordingly, advice for VitE supplementation in young TD β-Thal-NS patients can be beneficial.https://doi.org/10.1186/s12887-025-05741-2Vitamin EOxidative stressRed cell pathologyThalassemiaPS-bearing RBCFood supplements |
| spellingShingle | Nutthida Hemprachitchai Rattanaporn Praneetponkang Pakawan Wongwerawattanakoon Chokdee Wongborisuth Pawarit Innachai Praguywan Kadegasem Tanyanee Khlangtan Thanaporn Sriwantana Phanphen Phoonlapdacha Oraporn Dumrongwongsiri Ampaiwan Chuansumrit Kovit Pattanapanyasat Nongnuch Sirachainan Nathawut Sibmooh Pornthip Chaichompoo Duantida Songdej Measures of cellular oxidative damage following vitamin E supplementation in young patients with transfusion-dependent thalassemia: a double-blind randomized controlled trial BMC Pediatrics Vitamin E Oxidative stress Red cell pathology Thalassemia PS-bearing RBC Food supplements |
| title | Measures of cellular oxidative damage following vitamin E supplementation in young patients with transfusion-dependent thalassemia: a double-blind randomized controlled trial |
| title_full | Measures of cellular oxidative damage following vitamin E supplementation in young patients with transfusion-dependent thalassemia: a double-blind randomized controlled trial |
| title_fullStr | Measures of cellular oxidative damage following vitamin E supplementation in young patients with transfusion-dependent thalassemia: a double-blind randomized controlled trial |
| title_full_unstemmed | Measures of cellular oxidative damage following vitamin E supplementation in young patients with transfusion-dependent thalassemia: a double-blind randomized controlled trial |
| title_short | Measures of cellular oxidative damage following vitamin E supplementation in young patients with transfusion-dependent thalassemia: a double-blind randomized controlled trial |
| title_sort | measures of cellular oxidative damage following vitamin e supplementation in young patients with transfusion dependent thalassemia a double blind randomized controlled trial |
| topic | Vitamin E Oxidative stress Red cell pathology Thalassemia PS-bearing RBC Food supplements |
| url | https://doi.org/10.1186/s12887-025-05741-2 |
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