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Jaff S, Zeraattalab-Motlagh S, Amiri Khosroshahi R, Gubari M, Mohammadi H, Djafarian K. The effect of selenium therapy in critically ill patients: an umbrella review of systematic reviews and meta-analysis of randomized controlled trials. Eur J Med Res 2023; 28:104. [PMID: 36849891 PMCID: PMC9972714 DOI: 10.1186/s40001-023-01075-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 02/19/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Selenium is an essential nutrient with antioxidant, anti-inflammatory, and immuno-regulatory properties. Studies have displayed that in critically ill patients, selenium supplementation may be a potentially promising adjunctive therapy. OBJECTIVE We aimed to present an overview of the effects of selenium supplementation in adult critically ill patients based on published systematic reviews and meta-analyses (SRMAs) of randomized controlled trials (RCTs). METHODS A literature search in three electronic databases, PubMed, Scopus, and Web of Science, was performed to find eligible SRMAs until July 2022. For each outcome, the risk ratios (RRs) or mean differences (MDs) and 95% confidence intervals (CIs) were recalculated using either random or fixed effect models. The methodological quality and quality of evidence of the SRMAs were assessed by applying "A Measurement Tool to Assess Systematic Reviews" (AMSTAR2) and Grading of Recommendations Assessment, Development, and Evaluation(GRADE) tools, respectively. RESULTS We included 17 meta-analyses containing 24 RCTs based on inclusion criteria. Selenium supplementation can reduce the incidence of mortality (RR: 0.83, 95% CI 0.71, 0.98, P = 0.024) and incidence of acute renal failure (RR: 0.67, 95% CI 0.46, 0.98, P: 0.038) significantly; however, the certainty of evidence was low. Moreover, with moderate to very low certainty of evidence, no significant effects were found for risk of infection (RR: 0.92, 95% CI 0.80, 1.05, P: 0.207), pneumonia (RR: 1.11, 95% CI 0.72, 1.72, P: 0.675), as well as the length of ICU (MD: 0.15, 95% CI - 1.75, 2.05, P: 0.876) and hospital stay (MD: - 0.51, 95% CI - 3.74, 2.72, P: 0.757) and days on ventilation (MD: - 0.98, 95% CI - 2.93, 0.98, P: 0.329). CONCLUSIONS With low quality of evidence, the use of selenium supplementation could improve the risk of mortality and acute renal failure, but not other outcomes in critically ill patients.
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Affiliation(s)
- Salman Jaff
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, P.O. Box 14155-6117, Tehran, Iran
| | - Sheida Zeraattalab-Motlagh
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Reza Amiri Khosroshahi
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, P.O. Box 14155-6117, Tehran, Iran
| | - Mohammed Gubari
- Department of Community and Family Medicine, School of Medicine, University of Sulaimani, Sulaymaniyah, Iraq
| | - Hamed Mohammadi
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, P.O. Box 14155-6117, Tehran, Iran
| | - Kurosh Djafarian
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, P.O. Box 14155-6117, Tehran, Iran.
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Potential Antioxidant Multitherapy against Complications Occurring in Sepsis. Biomedicines 2022; 10:biomedicines10123088. [PMID: 36551843 PMCID: PMC9775396 DOI: 10.3390/biomedicines10123088] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/05/2022] [Accepted: 11/10/2022] [Indexed: 12/03/2022] Open
Abstract
Septic shock currently represents one of the main causes of mortality in critical patient units with an increase in its incidence in recent years, and it is also associated with a high burden of morbidity in surviving patients. Within the pathogenesis of sepsis, oxidative stress plays an important role. The excessive formation of reactive oxygen species (ROS) leads to mitochondrial damage and vasomotor dysfunction that characterizes those patients who fall into septic shock. Currently, despite numerous studies carried out in patients with septic shock of different causes, effective therapies have not yet been developed to reduce the morbidity and mortality associated with this pathology. Despite the contribution of ROS in the pathophysiology of sepsis and septic shock, most studies performed in humans, with antioxidant monotherapies, have not resulted in promising data. Nevertheless, some interventions with compounds such as ascorbate, N-acetylcysteine, and selenium would have a positive effect in reducing the morbidity and mortality associated with this pathology. However, more studies are required to demonstrate the efficacy of these therapies. Taking into account the multifactorial features of the pathophysiology of sepsis, we put forward the hypothesis that a supplementation based on the association of more than one antioxidant compound should result in a synergistic or additive effect, thus improving the beneficial effects of each of them alone, potentially serving as a pharmacological adjunct resource to standard therapy to reduce sepsis complications. Therefore, in this review, it is proposed that the use of combined antioxidant therapies could lead to a better clinical outcome of patients with sepsis or septic shock, given the relevance of oxidative stress in the pathogenesis of this multi-organ dysfunction.
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The effects of selenium supplementation on inflammatory markers in critically ill patients. SN APPLIED SCIENCES 2022; 4:326. [PMID: 36405547 PMCID: PMC9643959 DOI: 10.1007/s42452-022-05208-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 10/19/2022] [Indexed: 11/09/2022] Open
Abstract
Abstract Low serum selenium (Se) levels have been shown in critical illness, which is associated with poor clinical outcomes and a higher mortality rate. Se plays an important role in inflammation and oxidative stress. Since the overproduction of inflammatory cytokines and increased oxidative stress is a major component of critical illnesses, its supplementation has been demonstrated to have promising effects on critically ill patients. This study aims to review the evidence regarding the effects of Se supplementation on inflammatory and oxidative markers in critically ill patients. The literature review highlights alterations of inflammatory markers, including procalcitonin, leukocyte count, albumin, prealbumin, C-reactive protein (CRP), inflammatory cytokines, and cholesterol following Se supplementation in critically ill patients. Besides, the antioxidant properties of Se due to its presence in the structure of several selenoenzymes have been reported. Article highlights Low serum Se level have been shown in critical illness, which is associated with poor clinical outcome and higher mortality rate. Se plays an important role in inflammation and oxidative stress. Se supplementation can have promising effects by alterations of inflammatory markers and its antioxidant properties for critically ill patients.
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Mousavi MA, Saghaleini SH, Mahmoodpoor A, Ghojazadeh M, Mousavi SN. Daily parenteral selenium therapy in critically ill patients: An updated systematic review and meta-analysis of randomized controlled trials. Clin Nutr ESPEN 2021; 41:49-58. [PMID: 33487307 DOI: 10.1016/j.clnesp.2020.11.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 11/05/2020] [Accepted: 11/16/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND AIM Patients hospitalized at the intensive care unit (ICU) are more prone to oxidative stress. Antioxidants such as selenium (Se) may have beneficial effects on outcomes in these patients. Studies and systematic reviews in this field have inconclusive results. METHODS An updated systematic search was done to find clinical trials published in PubMed, Cochrane's library, ISI web of Science, Scopus, and Ovid databases from January 1980 up to April 2020, to assess the effects of daily Se supplementation on patient's survival, hospital and ICU stay, duration of mechanical ventilation, infection, acute renal failure (ARF) occurrence and serum creatinine levels. RESULTS From 1394 papers found in the first step of the search, after deleting duplicate findings, 24 studies were included in this meta-analysis. Results of the pooled random-effect size analysis of 24 trials showed no remarkable effect of daily parenteral Se administration on patient's hospital and ICU stay, duration of mechanical ventilation, infectious complications, ARF, survival and serum creatinine levels (p > 0.05). The subgroup analysis showed that daily parenteral Se administration (in doses higher than 1000 μg/d) increased the length of ICU stay by 4.48-folds (95%CI: -0.5, 9.46, p = 0.07). Parenteral Se supplementation at the first and following dose of ≤1000 μg reduced the number of ARF at the hospitalized patients by 76% and 45%, respectively (p = 0.02, and p = 0.05). CONCLUSIONS High doses of Se increases days of ICU stay, but low doses decreases the number of ARF occurrence in ICU patients. More trials are needed to assess its effect on ARF occurrence.
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Affiliation(s)
- Mir Ali Mousavi
- Students Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Seied Hadi Saghaleini
- Department of Anesthesiology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Ata Mahmoodpoor
- Department of Anesthesiology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Morteza Ghojazadeh
- Research Center for Evidence Based Medicine (RCEBM), Tabriz University of Medical Sciences, Tabriz, Iran
| | - Seyedeh Neda Mousavi
- Department of Nutrition, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran.
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Nakazawa Y, Aoki M, Ishiwa S, Morishita N, Endo S, Nagai N, Yamamoto N, Funakoshi-Tago M, Tamura H. Oral intake of α‑glucosyl‑hesperidin ameliorates selenite‑induced cataract formation. Mol Med Rep 2020; 21:1258-1266. [PMID: 32016451 PMCID: PMC7003023 DOI: 10.3892/mmr.2020.10941] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 11/27/2019] [Indexed: 01/09/2023] Open
Abstract
Hesperetin is a natural flavonoid with robust antioxidant properties. Our previous study reported that hesperetin can prevent cataract formation. However, an important consideration regarding hesperetin consumption is the limited bioavailability due to its poor solubility. The present study investigated the anti‑cataract effects of α‑glucosyl hesperidin in vivo and in vitro using a selenite‑induced cataract model. SD rats (age, 13 days) were orally administered PBS (0.2 ml) or α‑glucosyl hesperidin (200 mg/kg) on days 0, 1 and 2. Sodium selenite was subcutaneously administered to the rats 4 h after the first oral administration on day 0. Antioxidant levels in the lens and blood were measured on day 6. In vitro, human lens epithelial cells were treated with sodium selenite (10 µM) and/or hesperetin (50 or 100 mM) for 24 h and analyzed for apoptosis markers using sub‑G1 population and Annexin V‑FITC/propidium iodide staining and DNA ladder formation. α‑glucosyl hesperidin treatment significantly reduced the severity of selenite‑induced cataract. The level of antioxidants was significantly reduced in the selenite‑treated rats compared with in the controls; however, they were normalized with α‑glucosyl hesperidin treatment. In vitro, hesperetin could significantly reduce the number of cells undergoing apoptosis induced by sodium selenite in human lens epithelial cell lines. Overall, oral consumption of α‑glucosyl hesperidin could delay the onset of selenite‑induced cataract, at least in part by modulating the selenite‑induced cell death in lens epithelial cells.
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Affiliation(s)
- Yosuke Nakazawa
- Department of Hygienic Chemistry, Faculty of Pharmacy, Keio University, Tokyo 105‑8512, Japan
| | - Miki Aoki
- Department of Hygienic Chemistry, Faculty of Pharmacy, Keio University, Tokyo 105‑8512, Japan
| | - Sho Ishiwa
- Department of Hygienic Chemistry, Faculty of Pharmacy, Keio University, Tokyo 105‑8512, Japan
| | | | - Shin Endo
- R&D Division, Hayashibara Co., Ltd, Okayama 702‑8006, Japan
| | - Noriaki Nagai
- Department of Advanced Design for Pharmaceuticals, Faculty of Pharmacy, Kindai University, Osaka 577‑8502, Japan
| | - Naoki Yamamoto
- Regenerative Medicine Support Promotion Facility, Center for Research Promotion and Support, Fujita Health University, Toyoake, Aichi 470‑1192, Japan
| | - Megumi Funakoshi-Tago
- Department of Hygienic Chemistry, Faculty of Pharmacy, Keio University, Tokyo 105‑8512, Japan
| | - Hiroomi Tamura
- Department of Hygienic Chemistry, Faculty of Pharmacy, Keio University, Tokyo 105‑8512, Japan
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Kuganesan M, Samra K, Evans E, Singer M, Dyson A. Selenium and hydrogen selenide: essential micronutrient and the fourth gasotransmitter? Intensive Care Med Exp 2019; 7:71. [PMID: 31845001 PMCID: PMC6915170 DOI: 10.1186/s40635-019-0281-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 11/13/2019] [Indexed: 01/10/2023] Open
Abstract
Selenium (Se) is an essential micronutrient required by organisms of diverse lineage. Dietary Se is converted to hydrogen selenide either enzymatically or by endogenous antioxidant proteins. This convergent biochemical step crucially underlies the subsequent biological activity of Se and argues for inclusion of hydrogen selenide as the fourth endogenous gasotransmitter alongside nitric oxide, carbon monoxide and hydrogen sulfide.Endogenously generated hydrogen selenide is incorporated into numerous 'selenoprotein' oxidoreductase enzymes, essential for maintaining redox-status homeostasis in health and disease. Direct effects of endogenous hydrogen selenide on cellular and molecular targets are currently unknown. Given exogenously, hydrogen selenide acts as a modulator of metabolism via transient inhibition of mitochondrial cytochrome C oxidase. Here we provide an overview of Se biology, its impact on several physiological systems (immune, endocrine, cardiovascular and metabolic) and its utility as a supplement in acute and critical illness states. We further explore the evidence base supporting its role as the fourth gasotransmitter and propose a strategic case towards generation of novel selenomimetic therapeutics.
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Affiliation(s)
- Mathun Kuganesan
- Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, Gower Street, London, WC1E 6BT, UK
| | - Kavitej Samra
- Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, Gower Street, London, WC1E 6BT, UK
| | - Eloise Evans
- Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, Gower Street, London, WC1E 6BT, UK
| | - Mervyn Singer
- Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, Gower Street, London, WC1E 6BT, UK
| | - Alex Dyson
- Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, Gower Street, London, WC1E 6BT, UK.
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Zhao Y, Yang M, Mao Z, Yuan R, Wang L, Hu X, Zhou F, Kang H. The clinical outcomes of selenium supplementation on critically ill patients: A meta-analysis of randomized controlled trials. Medicine (Baltimore) 2019; 98:e15473. [PMID: 31096444 PMCID: PMC6531101 DOI: 10.1097/md.0000000000015473] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Selenium supplementation is a potentially promising adjunctive therapy for critically ill patients, but the results are controversy among studies. Accordingly, we performed this meta-analysis to more clearly detect the efficacy and safety of selenium supplementation on critically ill patients. METHODS Systematic literature retrieval was carried out to obtain RCTs on selenium supplementation for critically ill patients up to August 2017. Data extraction and quality evaluation of these studies were performed by 2 investigators. Statistical analyses was performed by RevMan 5.3. Trial sequential analysis (TSA) was conducted to control the risks of type I and type II errors and calculate required information size (RIS). RESULTS Totally 19 RCTs involving 3341 critically ill patients were carried out in which 1694 participates were in the selenium supplementation group, and 1647 in the control. The aggregated results suggested that compared with the control, intravenous selenium supplement as a single therapy could decrease the total mortality (RR = 0.86, 95% CI: 0.78-0.95, P = .002, TSA-adjusted 95% CI = 0.77-0.96, RIS = 4108, n = 3297) and may shorten the length of stay in hospital (MD -2.30, 95% CI -4.03 to -0.57, P = .009), but had no significant treatment effect on 28-days mortality (RR = 0.96, 95% CI: 0.85-1.09, P = .54) and could not shorten the length of ICU stay (MD -0.15, 95% CI -1.68 to 1.38, P = .84) in critically ill patients. Our results also showed that selenium supplementation did not increase incidence of drug-induced side effect compared with the control (RR 1.04, 95% CI 0.83 to 1.30, P = .73). CONCLUSIONS The current evidence suggests that the use of selenium could reduce the total mortality, and TSA results showed that our outcome is reliable and no more randomized controlled trials are needed. But selenium supplementation might have no effect on reducing 28-days mortality as well as the incidence of new infections, or on length of stay in ICU or mechanical ventilation. However, the results should be used carefully because of potential limitations.
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Kyriazopoulou E, Giamarellos-Bourboulis EJ. Pharmacological management of sepsis in adults with a focus on the current gold standard treatments and promising adjunctive strategies: evidence from the last five years. Expert Opin Pharmacother 2019; 20:991-1007. [DOI: 10.1080/14656566.2019.1589451] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Evdoxia Kyriazopoulou
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
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Li S, Tang T, Guo P, Zou Q, Ao X, Hu L, Tan L. A meta-analysis of randomized controlled trials: Efficacy of selenium treatment for sepsis. Medicine (Baltimore) 2019; 98:e14733. [PMID: 30817625 PMCID: PMC6831114 DOI: 10.1097/md.0000000000014733] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND To understand the clinical outcomes of selenium therapy in patients with sepsis syndrome, we conducted a meta-analysis of randomized controlled trials (RCT). METHODS A total of 13 RCTs comparing selenium and placebo for patients with sepsis were reviewed systematically. RESULTS However, we could not detect the association of selenium treatment with a decreased mortality at different time course (relative risk [RR] [95% confidence interval, CI]: 0.94 [0.82-1.06] at day 28; 0.73 [0.36-1.47] at day 90; 1.16 [0.78-1.71] at 6 months; respectively). Selenium supplementation did not show favorable efficacy in the incidence of renal failure, secondary infection or duration of mechanical ventilation (RR [95% CI]: 0.65 [0.41-1.03]; 0.96 [0.87-1.06]; standard mean difference [SMD] [95% CI]: 0.17 [-0.30-0.63]; respectively). Interestingly, we found that selenium therapy was benefit for sepsis patients with reduced duration of vasopressor therapy, staying time in intensive care unit and hospital, and incidence of ventilator-associated pneumonia (SMD [95% CI]: -0.75 [-1.37 to -0.13]; -0.15 [CI: -0.25 to -0.04]; -1.22 [-2.44 to -0.01]; RR [95% CI]: 0.61 [0.42-0.89]; respectively). CONCLUSION Based on our findings, intravenous selenium supplementation could not be suggested for routine use.
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Affiliation(s)
- Shaojun Li
- Department of Emergency, Children's Hospital of Chongqing Medical University
- Ministry of Education Key Laboratory of Child Development and Disorders
| | - Tian Tang
- Department of Emergency, Children's Hospital of Chongqing Medical University
- Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing, China
| | - Pengfei Guo
- Department of Emergency, Children's Hospital of Chongqing Medical University
| | - Qing Zou
- Department of Emergency, Children's Hospital of Chongqing Medical University
| | - Xiaoxiao Ao
- Ministry of Education Key Laboratory of Child Development and Disorders
| | - Lan Hu
- Department of Emergency, Children's Hospital of Chongqing Medical University
| | - Liping Tan
- Department of Emergency, Children's Hospital of Chongqing Medical University
- Key Laboratory of Pediatrics in Chongqing
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Broman LM, Malfertheiner MV, Montisci A, Pappalardo F. Weaning from veno-venous extracorporeal membrane oxygenation: how I do it. J Thorac Dis 2018; 10:S692-S697. [PMID: 29732188 PMCID: PMC5911556 DOI: 10.21037/jtd.2017.09.95] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 09/06/2017] [Indexed: 11/06/2022]
Abstract
Veno-venous extracorporeal membrane oxygenation (VV ECMO) is a rescue treatment for acute respiratory distress syndrome (ARDS) failing protective mechanical ventilation. It temporarily provides proper gas exchange: hypoxia is treated by adjusting the blood flow rate and fraction in spired oxygen over the ventilator (FiO2) on the extracorporeal membrane oxygenation (ECMO) circuit while CO2 removal is regulated by the ECMO fresh gas flow. Therefore, ventilator settings can be gradually reduced allowing the lungs to rest and recover. Nowadays, indications for ECMO referral and implantation are clearly formulated; on the contrary, little evidence currently exists to guide the process of weaning from ECMO support, especially concerning the timing during the course of lung healing. Therefore, indications to stop ECMO are less well standardized so that in clinical trials extracorporeal assistance is generally continued until lung recovery, with neither specific nor homogenous criteria for withdrawal. Notably, in almost all papers dealing with data on VV ECMO support, the management of weaning and the weaning procedure itself are not described. The aim of this paper is to make a picture of VV ECMO weaning, as it is performed in three European large volume intensive care units (ICUs) which represent referral centers for VV ECMO treatment. We focused on data concerning the timing of VV ECMO weaning and parameters at the time of weaning, in order to assess adequacy and safety of VV ECMO removal.
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Affiliation(s)
- Lars M. Broman
- European ECMO Advisory Board
- ECMO Centre Karolinska, Karolinska University Hospital, and Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Maximilian V. Malfertheiner
- European ECMO Advisory Board
- Department of Internal Medicine II, Cardiology and Pneumology, University Medical Center Regensburg, Regensburg, Germany
| | - Andrea Montisci
- Cardiothoracic Centre, Instituto Clinico Sant’Ambrogio, Gruppo Ospedaliero San Donato, Milan, Italy
| | - Federico Pappalardo
- European ECMO Advisory Board
- Department of Anesthesia and Intensive Care, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
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Mahmoodpoor A, Hamishehkar H, Sanaie S, Behruzizad N, Iranpour A, Koleini E, Nader ND. Antioxidant reserve of the lungs and ventilator-associated pneumonia: A clinical trial of high dose selenium in critically ill patients. J Crit Care 2017; 44:357-362. [PMID: 29288963 DOI: 10.1016/j.jcrc.2017.12.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 12/09/2017] [Accepted: 12/22/2017] [Indexed: 02/06/2023]
Abstract
PURPOSE To evaluate the effect of supplemental selenium administration on the incidence of ventilator-associated pneumonia (VAP) in critically ill patients. METHODS Ninety-nine mechanically ventilated patients were randomized to receive either selenium or isotonic saline infusion for 10days. The primary endpoint was serum glutathione peroxidase-3 (GPX-3) activity and secondary endpoints were development of VAP or death, ICU stay and vasopressor requirement. Serum concentrations of selenium and GPX-3 were measured on Day-1, Day-4 and Day-10. Chi Square and log-rank analyses were used for statistical analyses and odds ratios were calculated. RESULTS Serum selenium and GPX-3 activity levels increased steadily in the treatment group within 10days (P<0.025), while they remained unchanged in the placebo group. The incidence of VAP was 19.4/1000days of mechanical ventilation in the placebo group while it was 15.8/1000 ventilated days in the treatment group (P=0.250). The risk of VAP or death was similar between the treatments and placebo groups. CONCLUSION Despite increasing the antioxidant activity, selenium supplementation did not affect the incidence of VAP in critically ill patients. The risk of developing VAP or death within 30days of ICU admission remained the same in the treatment and the controls.
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Affiliation(s)
- Ata Mahmoodpoor
- Department of Anesthesiology, Tabriz University of Medical Sciences, Iran
| | - Hadi Hamishehkar
- Department of Clinical Pharmacy, Tabriz University of Medical Sciences, Iran
| | - Sarvin Sanaie
- Tuberculosis and lung Disease Research Center, Tabriz University of Medical Sciences, Iran
| | - Nazila Behruzizad
- Department of Anesthesiology, Tabriz University of Medical Sciences, Iran
| | - Afshin Iranpour
- Department of Anesthesiology, Al-Garhoud Hospital, Dubai, United Arab Emirates
| | - Evin Koleini
- Department of Anesthesiology, VA Western NY Healthcare System, Buffalo, NY, United States
| | - Nader D Nader
- Department of Anesthesiology, SUNY-Buffalo, Buffalo, NY, United States.
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Lee WJ, Chen YL, Chu YW, Chien DS. Comparison of glutathione peroxidase-3 protein expression and enzyme bioactivity in normal subjects and patients with sepsis. Clin Chim Acta 2017; 489:177-182. [PMID: 29100971 DOI: 10.1016/j.cca.2017.10.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 09/25/2017] [Accepted: 10/30/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Serum glutathione peroxidase-3 (GPx-3) is known as a key selenoprotein with antioxidant properties. GPx-3 deficiency has been associated with sepsis. The objectives of this study are (1) to compare the GPx-3 protein concentrations and GPx-3 bioactivity in normal healthy subjects and septic patients, and (2) to evaluate the relationship between GPx-3 bioactivity and its protein concentration. METHODS Serum samples were collected from 50 normal healthy subjects and 70 septic patients. The reliable bioanalytical methods for GPx-3 protein concentration and bioactivity in human serum were developed and validated. Analyses of GPx-3 bioactivity and GPx-3 protein concentration were then performed. RESULTS Geometric mean GPx-3 bioactivity was 78.13U/l for patients with sepsis, significantly lower than normal subjects with 108.21U/l (p<0.0001). Similarly, the GPx-3 protein concentration was significantly lower in patients with sepsis than in normal subjects, with the mean GPx-3 value of 0.78 vs 3.10μg/ml, respectively (p<0.0001). A positive correlation was observed between the GPx-3 bioactivity and its corresponding protein concentration in septic serum samples (R=0.74, p<0.0001), regardless of gender or age difference. CONCLUSION These findings suggest that the decrease in GPx-3 bioactivity observed in the septic patients was resulted from the significant sepsis-related decline of GPx-3 protein concentrations.
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Freitas RGBDON, Nogueira RJN, Cozzolino SMF, Vasques ACJ, Hessel G. Influence of selenium supplementation on patients with inflammation: A pilot double blind randomized study. Nutrition 2017; 41:32-36. [PMID: 28760425 DOI: 10.1016/j.nut.2017.03.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 03/08/2017] [Accepted: 03/10/2017] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The aim of the study was to analyze the effect of selenium supplementation on patients with inflammation receiving PN. METHODS This double-blind randomized study included 20 hospitalized patients experiencing an inflammatory process while being fed by PN, who were monitored in three stages: first 72 h (0), day 7 (1), and day 14 (2) of PN. The supplemented patients group (G+S) received 60 μg/d (0.75 μmol) of selenium as selenious acid which was added to the PN bag. The nonsupplemented group (G-S) did not receive selenium. The concentration range of 84 to 100 μg/L (1.07-1.27 μmol/L) was used as a reference of plasma selenium. RESULTS The study included 20 patients (8 G+S and 12 G-S) mainly diagnosed with cancer and/or sepsis. Most of them were hospitalized in the intensive care unit and were receiving PN for clinical reasons. Plasma selenium was greater in the G+S than in the G-S (P = 0.05) in two stages (0 and 1). Since the start of assessment, C-reactive protein (CRP) levels were elevated; however, there was no statistical difference in CRP values between groups (P > 0.05). There was no significant change of glutathione peroxidase over time or between groups (P > 0.05). CONCLUSION The selenium concentration was greater in the G+S than in the G-S, acting independently from CRP behavior. However, supplementation was not enough to reach the reference values.
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Affiliation(s)
| | | | | | | | - Gabriel Hessel
- College of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil
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14
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Weiss G, Carver PL. Role of divalent metals in infectious disease susceptibility and outcome. Clin Microbiol Infect 2017; 24:16-23. [PMID: 28143784 DOI: 10.1016/j.cmi.2017.01.018] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 01/21/2017] [Accepted: 01/22/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Divalent metals play important roles in maintaining metabolism and cellular growth of both eukaryotic hosts and invading microbes. Both metal deficiency and overload can result in abnormal cellular function or damage. Given its central role in host-pathogen interactions, subtle alterations of divalent metal homeostasis can occur in the course of infectious diseases which aim, from the host perspective, either to reduce the availability of respective metals to microbes or to use toxic metal accumulation to eliminate pathogens. AIMS To provide the reader with background information and clinical data on divalent metal homeostasis in host-pathogen interactions, how this affects the course of infectious disease and whether correction of metal disturbances has shown benefit in infections. SOURCES An in-depth analysis of PubMed articles related to the topic of this review published in English between 1970 and 2016 was performed. CONTENT From the microbial perspective, divalent metals are essential for growth and pathogenicity and to mount effective protection against antimicrobial host responses, including toxic radical formation. Microbes have evolved multiple strategies to control their access to divalent metals. From the clinical perspective, alterations of divalent metal levels may result in increased or decreased susceptibility to infection and often occur in response to infections. However, keeping in mind the strategies underlying such alterations, for which the term 'nutritional immunity' was coined, the uncritical correction of such divalent metal imbalances may cause harm to patients. This review addresses the role of the divalent metals iron, selenium, zinc, manganese and copper in infectious diseases from a mechanistic and clinical perspective. IMPLICATIONS We point out areas of research needed to expand our limited knowledge, hoping to improve the clinical management of patients with infections and to identify promising new targets for treatment by modulation of host or microbe divalent metal metabolism.
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Affiliation(s)
- G Weiss
- Department of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria.
| | - P L Carver
- College of Pharmacy, University of Michigan, Ann Arbor, MI, USA.
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15
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High-dose intravenous selenium does not improve clinical outcomes in the critically ill: a systematic review and meta-analysis. Crit Care 2016; 20:356. [PMID: 27788688 PMCID: PMC5084353 DOI: 10.1186/s13054-016-1529-5] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 10/14/2016] [Indexed: 11/24/2022] Open
Abstract
Background Selenium (Se) is an essential trace element with antioxidant, anti-inflammatory, and immunomodulatory effects. So far, several randomized clinical trials (RCTs) have demonstrated that parenteral Se may improve clinical outcomes in intensive care unit (ICU) patients. Since publication of our previous systematic review and meta-analysis on antioxidants in the ICU, reports of several trials have been published, including the largest RCT on Se therapy. The purpose of the present systematic review was to update our previous data on intravenous (IV) Se in the critically ill. Methods We searched MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials. We included RCTs with parallel groups comparing parenteral Se as single or combined therapy with placebo. Potential trials were evaluated according to specific eligibility criteria, and two reviewers abstracted data from original trials in duplicate independently. Overall mortality was the primary outcome; secondary outcomes were infections, ICU length of stay (LOS), hospital LOS, ventilator days, and new renal dysfunction. Results A total of 21 RCTs met our inclusion criteria. When the data from these trials were aggregated, IV Se had no effect on mortality (risk ratio [RR] 0.98, 95 % CI 0.90–1.08, P = 0.72, heterogeneity I2 = 0 %). In addition, when the results of ten trials in which researchers reported on infections were statistically aggregated, there was no significant treatment effect of parenteral Se (RR 0.95, 95 % CI 0.88–1.02, P = 0.15, I2 = 0 %). There was no positive or negative effect of Se therapy on ICU and hospital LOS, renal function, or ventilator days. Conclusions In critically ill patients, IV Se as monotherapy does not improve clinical outcomes. Electronic supplementary material The online version of this article (doi:10.1186/s13054-016-1529-5) contains supplementary material, which is available to authorized users.
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Yui K, Tanuma N, Yamada H, Kawasaki Y. Reduced endogenous urinary total antioxidant power and its relation of plasma antioxidant activity of superoxide dismutase in individuals with autism spectrum disorder. Int J Dev Neurosci 2016; 60:70-77. [PMID: 27554135 DOI: 10.1016/j.ijdevneu.2016.08.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 07/12/2016] [Accepted: 08/11/2016] [Indexed: 12/30/2022] Open
Abstract
Individuals with autism spectrum disorders (ASD) have impaired detoxification capacity. Investigating the neurobiological bases of impaired antioxidant capacity is thus a research priority in the pathophysiology of ASD. We measured the urinary levels of hexanoyl-lysine (HEL) which is a new oxidative stress biomarker, total antioxidant power (TAP) and DNA methylation biomarker 8-hydroxy-2'-deoxyguanosine (8-OHdG), and the plasma levels of superoxide dismutase (SOD), which is a major antioxidant enzyme. We examined whether the urinary levels of these enzymes and biomarkers may be related to symptoms of social impairment in 20 individuals with ASD (meanage,11.1±5.2years) and 12 age- and gender-matched healthy controls (meanage,14.3±6.2years). Symptoms of social impairment were assessed using the Social Responsiveness Scale (SRS). The dietary TAP of the fruit juice, chocolate, cookies, biscuits, jam and marmalade were significantly higher in the ASD group than in the control group, although the intake of nutrients was not significantly different between the groups. The urinary TAP levels were significantly lower in the ASD group than in the control group. There were no significantly differences in urinary HEL and 8-OHdG levels between the ASD and control groups. The SRS scores were significantly higher in the ASD group than in the control group. Stepwise regression analysis revealed that urinary TAP levels and plasma SOD levels can differences in the biomarkers and the SRS scores between the ASD group and the control group. The endogenous antioxidant capacity may be deficient without altered urinary HEL and 8-OHdG levels in individuals with ASD. The plasma SOD levels may be related to reduced endogenous antioxidant capacity.
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Affiliation(s)
- Kunio Yui
- Department of Pediatrics, Dokkyo Medical University, 880 Kitakobayashi, Mibu 321-0293, Tochigi, Japan; Department of Drug Evaluation and Informatics, School of Pharmaceutical Science, University of Shizuoka, Shizuoka 422-8526, Japan.
| | - Nasoyuki Tanuma
- Department of Pediatrics, Tokyo Metropolitan Fuchu Medical Center for the Disabled, Tokyo 183-8553, Japan
| | - Hiroshi Yamada
- Department of Drug Evaluation and Informatics, School of Pharmaceutical Science, University of Shizuoka, Shizuoka 422-8526, Japan
| | - Yohei Kawasaki
- Department of Drug Evaluation and Informatics, School of Pharmaceutical Science, University of Shizuoka, Shizuoka 422-8526, Japan
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