Ascorbic acid status in man: measurements of salivary, plasma and white blood cell concentration

Chemical analysis in saliva and the search for salivary biomarkers – a tutorial review

A review of the uses of saliva biomarkers, detection methods and requirements for new biomarkers.

Use of Saliva Biomarkers to Monitor Efficacy of Vitamin C in Exercise-Induced Oxidative Stress

Saliva is easily obtainable for medical research and requires little effort or training for collection. Because saliva contains a variety of biological compounds, including vitamin C, malondialdehyde, amylase, and proteomes, it has been successfully used as a biospecimen for the reflection of health status. A popular topic of discussion in medical research is the potential association between oxidative stress and negative outcomes. Systemic biomarkers that represent oxidative stress can be found in saliva. It is unclear, however, if saliva is an accurate biospecimen as is blood and/or plasma. Exercise can induce oxidative stress, resulting in a trend of antioxidant supplementation to combat its assumed detriments. Vitamin C is a popular antioxidant supplement in the realm of sports and exercise. One potential avenue for evaluating exercise induced oxidative stress is through assessment of biomarkers like vitamin C and malondialdehyde in saliva. At present, limited research has been done in this area. The current state of research involving exercise-induced oxidative stress, salivary biomarkers, and vitamin C supplementation is reviewed in this article.

Vitamin C: the known and the unknown and Goldilocks

Vitamin C (Ascorbic Acid), the antiscorbutic vitamin, cannot be synthesized by humans and other primates, and has to be obtained from diet. Ascorbic acid is an electron donor and acts as a cofactor for fifteen mammalian enzymes. Two sodium-dependent transporters are specific for ascorbic acid, and its oxidation product dehydroascorbic acid is transported by glucose transporters. Ascorbic acid is differentially accumulated by most tissues and body fluids. Plasma and tissue vitamin C concentrations are dependent on amount consumed, bioavailability, renal excretion, and utilization. To be biologically meaningful or to be clinically relevant, in vitro and in vivo studies of vitamin C actions have to take into account physiologic concentrations of the vitamin. In this paper, we review vitamin C physiology; the many phenomena involving vitamin C where new knowledge has accrued or where understanding remains limited; raise questions about the vitamin that remain to be answered; and explore lines of investigations that are likely to be fruitful.

Oxalic Acid as a uremic toxin

OBJECTIVE

Oxalic acid (OA) is thought to be a uremic toxin that participates in the pathogenesis of uremic syndrome. The objectives of this study were to: (1) evaluate the plasma levels of OA in patients with chronic renal disease with various levels of glomerular filtration rate and after renal transplantation; (2) investigate the salivary secretion of OA and ascorbic acid in healthy subjects and in patients with chronic renal failure (CRF); (3) examine the influence of water and sodium diuresis and furosemide administration on the urinary excretion of OA and ascorbic acid in healthy subjects and in CRF patients without dialysis treatment; and (4) evaluate the influence of renal replacement therapy (RRT) on secondary hyperoxalemia in hemodialysis patients.

DESIGN AND SETTING

This study was conducted at the Nephrological Department of P.J. Safárik University. Sixty-one patients with chronic renal disease, 64 CRF patients, 32 continuous ambulatory peritoneal dialysis (CAPD) patients, 15 hemodialysis patients, 21 patients after renal transplantation, and 15 healthy subjects were examined. Maximal water diuresis, diets with low (2 g/day) and high (15 g/day) sodium intake, administration of intravenous furosemide (20 mg), and renal replacement therapy (CAPD, hemodialysis, hemofiltration, and postdilution hemodiafiltration) were utilized in the study.

RESULTS

In patients with chronic renal disease and those after renal transplantation, direct relationships between plasma OA and serum creatinine were found (r = 0.904 and 0.9431, respectively, P < .01). Despite a high level of plasma OA in uremic patients (23.1 +/- 10 micromol/L), there was no significant difference in salivary OA between control subjects (128 +/- 19 micromol/L) and CRF patients (135 +/- 24 micromol/L). The urinary excretion of OA during maximal water diuresis (from 37.5 to 110.3 micromol/4 hours) and after intravenous furosemide (from 34.5 to 66.7 micromol/3 hours) increased significantly, but was not affected by high intake of NaCl. The most significant decrease of plasma OA was observed during postdilution hemodiafiltration (63.3%).

CONCLUSION

Our study indicates that renal replacement therapy is not effective for a permanent reduction of elevated plasma levels of OA.

Oxalic acid in saliva, teeth and tooth tartar

Oxalic acid was determined in human saliva, teeth, tartar, and in animal teeth. Saliva from dentally healthy male subjects contained 0.10 +/- 0.09 mmol/l (n = 41) and those of dentally healthy female subjects 0.18 +/- 0.17 mmol/l (n = 40). Oxalic acid in tartar from 16 patients was 3.3 +/- 1.2 mmol/kg tartar. In human teeth, oxalic acid was 1.0 +/- 0.3 mmol/kg in milk teeth (n = 12) and 0.9 +/- 0.6 mmol/kg in permanent teeth (n = 60). Human teeth were sorted into age groups and into molars, incisors and premolars. In animal teeth, oxalic acid content varied widely. The formed calcium oxalate is proposed to be a 'physiological' protective mechanism for teeth.

Dental caries and mutans streptococci in relation to plasma ascorbic acid

Ascorbic acid (AA) affects in vitro growth of bacteria and may also act in vivo to decrease caries activity. The aim of this study was to evaluate the possible association of AA level in plasma with number of caries lesions, relative numbers of some species of oral cariogenic flora, and rate of salivary secretion. The caries status and some bacteriologic variables of dentulous adult subjects with a low level of AA in the plasma (< or = 25 mumol/l; n = 75) were compared with those of controls (plasma level > or = 50 mumol/l; n = 75) matched for age, sex, and number of teeth. For each subject, site-specific recordings of the presence or absence of plaque, dental caries, fillings, and erosions were recorded clinically by the same dentist in a double-blind system. The amounts of visible plaque and numbers of decayed tooth surfaces were significantly higher in the low AA group than in the controls. No between-group differences were found in the number of fillings and the amount of oral bacterial growth. The frequencies of consumption of vegetables, berries, and other fruit were significantly lower in the low AA group than in the controls.

Response of lingual ascorbic acid test and salivary ascorbate levels to changes in ascorbic acid intake

This study sought to determine whether the lingual ascorbic acid test (LAAT) and measurement of salivary ascorbate reflect plasma and leukocyte ascorbate levels during controlled periods of ascorbic acid depletion and supplementation. Eleven healthy non-smoking men, aged 19-28 years, ate a diet that was repeated every seven days and was adequate in all nutrients except ascorbic acid (AA). This basal diet, which provided less than 5 mg of AA per day, was supplemented with 60 mg of AA per day for two weeks, 0 mg (placebo) per day for four weeks, 600 mg per day for three weeks, and 0 mg per day for four weeks. Oral examinations, the lingual ascorbic acid test, and measurement of salivary, plasma, and leukocyte ascorbate concentrations were conducted throughout the study. Ascorbic acid concentrations in plasma and leukocytes responded rapidly to changes in vitamin C intake. LAAT-derived ascorbate values were unrelated to ascorbic acid intake and plasma and leukocyte ascorbate concentrations. Salivary ascorbate levels approached the lower limits of detection of the assay and remained constant throughout the investigation. Oral hygiene was consistently excellent, and no severe mucosal or periodontal changes were observed. It was concluded that lingual ascorbic acid test values and salivary ascorbate levels are not related to changes in ascorbic acid intake and are not consistent with plasma or leukocyte ascorbate concentrations.

Clinical effects of vitamin C in elderly inpatients with low blood-vitamin-C levels

The effect of oral vitamin C has been examined in elderly long-stay inpatients known to have low levels of vitamin C in their plasma and leucocytes. 1 g of vitamin C given daily for 28 days was shown to be associated with slight, but significant, clinical improvement and weight-gain when compared with placebo therapy.