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Kibel A, Lukinac AM, Dambic V, Juric I, Selthofer-Relatic K. Oxidative Stress in Ischemic Heart Disease. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2020; 2020:6627144. [PMID: 33456670 PMCID: PMC7785350 DOI: 10.1155/2020/6627144] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 11/27/2020] [Accepted: 12/07/2020] [Indexed: 02/06/2023]
Abstract
One of the novel interesting topics in the study of cardiovascular disease is the role of the oxidation system, since inflammation and oxidative stress are known to lead to cardiovascular diseases, their progression and complications. During decades of research, many complex interactions between agents of oxidative stress, oxidation, and antioxidant systems have been elucidated, and numerous important pathophysiological links to na number of disorders and diseases have been established. This review article will present the most relevant knowledge linking oxidative stress to vascular dysfunction and disease. The review will focus on the role of oxidative stress in endotheleial dysfunction, atherosclerosis, and other pathogenetic processes and mechanisms that contribute to the development of ischemic heart disease.
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Affiliation(s)
- Aleksandar Kibel
- Department for Heart and Vascular Diseases, Osijek University Hospital, Osijek, Croatia
- Department of Physiology and Immunology, Faculty of Medicine, University J.J. Strossmayer in Osijek, Osijek, Croatia
| | - Ana Marija Lukinac
- Department of Rheumatology and Clinical Immunology, Osijek University Hospital, Osijek, Croatia
- Faculty of Medicine, University J.J. Strossmayer in Osijek, Osijek, Croatia
| | - Vedran Dambic
- Faculty of Medicine, University J.J. Strossmayer in Osijek, Osijek, Croatia
- Department for Emergency Medical Services of the Osijek-Baranja county, Osijek, Croatia
| | - Iva Juric
- Department for Heart and Vascular Diseases, Osijek University Hospital, Osijek, Croatia
- Department of Internal Medicine, Faculty of Medicine, University J.J. Strossmayer in Osijek, Osijek, Croatia
| | - Kristina Selthofer-Relatic
- Department for Heart and Vascular Diseases, Osijek University Hospital, Osijek, Croatia
- Department of Internal Medicine, Faculty of Medicine, University J.J. Strossmayer in Osijek, Osijek, Croatia
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Varghese T, Pal AK, Sahu NP, Mishal P, Dasgupta S. Effects of hypoxia and dietary vitamin E on growth performance and oxidative status of Cirrhinus mrigala (Ham., 1822). ANIM BIOL 2017. [DOI: 10.1163/15707563-00002526] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Vitamin E is of importance for several physiological processes, some of which also apply to fish. Here, we conducted an experiment to assess the effect of environmental hypoxia and dietary vitamin E on oxidative status and tissue injury in a bottom dwelling carp,Cirrhinus mrigala(Ham., 1822). The four treatments combined oxygen availability (Normoxia/Hypoxua) and Vitamin E presence/absence. Lipid peroxidation parameters such as thiobarbituric acid reactive substances (TBAR), peroxide value (PV), polyunsaturated fatty acids/saturated fatty acid (PUFA/SFA) ratio, catalase (CAT), superoxide dismutase (SOD) and erythrocyte fragility were assessed. The results indicate that exposure to hypoxia elevates these parameters. However, the supplementation of vitamin E via the diet effectively reduced erythrocyte membrane damage (EF) and myeloperoxidase activity (MPO), which were enhanced by the exposure to hypoxia. Dietary vitamin E also improved antioxidant enzyme status in the hypoxia exposed fish, as indicated by the decreased catalase and superoxide dismutase activities. Vitamin E supplementation also compensated for increased levels of peroxide value, thiobarbituric acid reactive substances, and an increased polyunsaturated fatty acids/saturated fatty acid ratio resulting from the exposure to hypoxia. Overall, it can be concluded that fortification of vitamin E in the diet of this carp species, and possibly other fish that live under hypoxic conditions, can restore the antioxidant status and well-being to some extent.
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Affiliation(s)
- Tincy Varghese
- Division of Fish Nutrition, Biochemistry and Physiology, ICAR-Central Institute of Fisheries Education, Mumbai-400061, India
| | - Asim Kumar Pal
- Division of Fish Nutrition, Biochemistry and Physiology, ICAR-Central Institute of Fisheries Education, Mumbai-400061, India
| | - Narottam Prasad Sahu
- Division of Fish Nutrition, Biochemistry and Physiology, ICAR-Central Institute of Fisheries Education, Mumbai-400061, India
| | - Puthiyottil Mishal
- Feed Research Laboratory, ICAR-Central Inland Fisheries Research Institute, Barrackpore, Kolkata-700120, India
| | - Subrata Dasgupta
- Division of Fish Nutrition, Biochemistry and Physiology, ICAR-Central Institute of Fisheries Education, Mumbai-400061, India
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Penumathsa SV, Kode A, Rajagopalan R, Menon VP. Changes in Activities of MMP in Alcohol and Thermally Oxidized Sunflower Oil-Induced Liver Damage: NAC Antioxidant Therapy. Toxicol Mech Methods 2012; 16:267-74. [PMID: 20021024 DOI: 10.1080/15376520500194734] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Liver fibrosis is the result of imbalance between extracellular matrix (ECM) synthesis and breakdown. Ethanol-induced increase in redox state is a sign of major change in hepatic metabolism and this inhibits tricarboxylic acid cycle activity and, fatty acid oxidation and increases fatty acid uptake, thus predisposing fatty liver. Fibrotic changes induced by alcohol are provoked by diets rich in PUFA. Heating of oils rich in PUFA produces toxic volatile and nonvolatile compounds, which aggravate liver damage. Hepatotoxicity was induced in male Wistar rats by administering alcohol (20%) and thermally oxidized sunflower oil (Delta PUFA) (15%). When N-acetyl cyteine (NAC) (150 mg/kg body weight), an ROS scavenger, was administered, there was a reversal of liver damage, which was demonstrated biochemically. Matrix metalloproteinases (MMPs), being potential biochemical indicators of fibroproliferation, were estimated in the present study, which were found to be altered in alcohol, Delta PUFA, and alcohol + Delta PUFA. The altered activities of MMPs in these groups were effectively modulated by treatment with NAC. Thus, in this study, NAC was found to modulate the effect of alcohol and Delta PUFA-induced liver damage.
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Affiliation(s)
- Suresh Varma Penumathsa
- Department of Biochemistry, Faculty of Science, Annamalai University, Annamalainagar608 002, India
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Vishal RP, Rakesh KP. In vivo anti-oxidant activity of Dhatrinisha churna and Manjisthadi churna in high fat diet induced oxidative stress. ACTA ACUST UNITED AC 2012. [DOI: 10.5530/ax.2012.2.2.4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Abstract
Edible oils form an essential part of the modern diet. These oils play a role as an energy source, and provide the diet with many beneficial micronutrients. Although a popular conception may be that fat should be avoided, certain edible oils as a dietary supplement may play an important role in the improvement of cardiovascular health. CVD has become one of the leading causes of death worldwide. Dietary supplementation with different oils may have beneficial effects on cardiovascular health. While olive oil and sunflower-seed oil are known to reduce serum cholesterol, fish oil has become well known for reducing potentially fatal cardiac arrhythmias. Recently, red palm oil research has shown beneficial effects on cardiac recovery from ischaemia-reperfusion injury. It is clear that dietary supplementation with edible oils may play a vital role in reducing the mortality rate due to heart disease. The specific benefits and disadvantages of these oils should, however, be explored in greater depth. The present review will attempt to identify the benefits and shortcomings of four popular edible oils, namely olive oil, sunflower-seed oil, fish oil and palm oil. Additionally the present review will aim to reveal potential areas of research which could further enhance our understanding of the effects of edible oils on cardiovascular health.
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Latha P, Chaitanya D, Rukkumani R. Protective effect ofPhyllanthus nirurion alcohol and heated sunflower oil induced hyperlipidemia in Wistar rats. Toxicol Mech Methods 2010; 20:498-503. [DOI: 10.3109/15376516.2010.511301] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Tian Q, Grzemski FA, Panagiotopoulos S, Ahokas JT. Peroxisome proliferator-activated receptor alpha agonist, clofibrate, has profound influence on myocardial fatty acid composition. Chem Biol Interact 2006; 160:241-51. [PMID: 16540100 DOI: 10.1016/j.cbi.2006.02.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2005] [Revised: 02/03/2006] [Accepted: 02/03/2006] [Indexed: 11/23/2022]
Abstract
The hypolipidemic fibrates have been identified as agonists of the peroxisome proliferator-activated receptor alpha (PPARalpha), which plays a critical role in the regulation of cardiac fatty acid metabolism. Despite the widespread clinical use of fibrates, their role in myocardial oxidative stress and fatty acid composition is less known. In this study, male Sprague-Dawley rats were treated with either vehicle (olive oil, 1 ml/kg) or clofibrate (300 mg/kgday i.p.) for 1-14 days. Lipid peroxidation in heart homogenate was determined by thiobarbituric acid reactive substance (TBARS) assay. Results show that hearts from clofibrate-treated rats are more susceptible to FeSO(4)-induced TBARS production. The antioxidants including catalase and glutathione-related enzymes were marginally affected. We demonstrated that myocardial fatty acid composition was dramatically altered by clofibrate treatment. In hearts from clofibrate-treated rats, the principal n-6 polyunsaturated fatty acids (PUFAs), linoleic acid (C18:2 n-6) and arachidonic acid (C20:4 n-6), was significantly reduced, while the content of the principal n-3 PUFA, docosahexaenoic acid (C22:6 n-3), was markedly increased. The overall effect was to reduce n-6/n-3 ratio and increase the unsaturation extent of myocardial fatty acids. Functional study showed that hearts from clofibrate-treated rats had an improved recovery of post-ischemic contractile function and reduced ischemia/reperfusion (I/R)-induced infarct size. The data shows that clofibrate has a profound impact on cardiac fatty acid composition, which may contribute to its cardioprotective effect.
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Affiliation(s)
- Qi Tian
- Key Centre for Applied and Nutritional Toxicology, RMIT University, Melbourne, Vic., Australia
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Pinotti MF, Silva MDP, Sugizaki MM, Diniz YS, Sant'Ana LS, Aragon FF, Padovani CR, Novelli ELB, Cicogna AC. Effect of unsaturated fatty acids on myocardial performance, metabolism and morphology. Braz J Med Biol Res 2006; 39:305-12. [PMID: 16470320 DOI: 10.1590/s0100-879x2006000200019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Diets rich in saturated fatty acids are one of the most important causes of atherosclerosis in men, and have been replaced with diets rich in unsaturated fatty acids (UFA) for the prevention of this disorder. However, the effect of UFA on myocardial performance, metabolism and morphology has not been completely characterized. The objective of the present investigation was to evaluate the effects of a UFA-rich diet on cardiac muscle function, oxidative stress, and morphology. Sixty-day-old male Wistar rats were fed a control (N = 8) or a UFA-rich diet (N = 8) for 60 days. Myocardial performance was studied in isolated papillary muscle by isometric and isotonic contractions under basal conditions after calcium chloride (5.2 mM) and ss-adrenergic stimulation with 1.0 microM isoproterenol. Fragments of the left ventricle free wall were used to study oxidative stress and were analyzed by light microscopy, and the myocardial ultrastructure was examined in left ventricle papillary muscle. After 60 days the UFA-rich diet did not change myocardial function. However, it caused high lipid hydroperoxide (176 +/- 5 vs 158 +/- 5, P < 0.0005) and low catalase (7 +/- 1 vs 9 +/- 1, P < 0.005) and superoxide-dismutase (18 +/- 2 vs 27 +/- 5, P < 0.005) levels, and discrete morphological changes in UFA-rich diet hearts such as lipid deposits and mitochondrial membrane alterations compared to control rats. These data show that a UFA-rich diet caused myocardial oxidative stress and mild structural alterations, but did not change mechanical function.
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Affiliation(s)
- M F Pinotti
- Departamento de Clínica Médica, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista Júlio de Mesquita Filho, Botucatu, SP, Brazil
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Rukkumani R, Aruna K, Suresh Varma P, Padmanabhan Menon V. Hepatoprotective role of ferulic acid: a dose-dependent study. J Med Food 2005; 7:456-61. [PMID: 15671689 DOI: 10.1089/jmf.2004.7.456] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Alcohol use is contributing to an unprecedented decline in life expectancy. Damage to the liver after ethanol administration is a well-known phenomenon. Free radical mechanisms have been proposed to play a part in ethanol-induced liver toxicity. Ingestion of diets rich in polyunsaturated fatty acids (PUFAs) along with alcohol is known to result in enhanced liver damage. The present work is aimed at evaluating the protective role of ferulic acid, a naturally occurring plant component, on alcohol- and PUFA-induced liver toxicity. Three different doses of ferulic acid (10, 20, and 40 mg/kg of body weight) were administered to rats given alcohol, heated PUFA (DeltaPUFA), and alcohol + DeltaPUFA. Influence of ferulic acid on alcohol-and PUFA-induced liver damage was evaluated by analyzing the activities of the liver marker enzymes alkaline phosphatase, gamma-glutamyl transferase, alanine transaminase, and aspartate transaminase. The activities of these liver marker enzymes were increased in the alcohol, DeltaPUFA, and alcohol + DeltaPUFA groups but were decreased significantly on treatment with ferulic acid. The low dose (10 mg/kg of body weight) was not effective, but both 20 mg and 40 mg/kg of body weight were found to be effective. The 20 mg/kg of body weight dose was found to be more effective than 40 mg/kg of body weight (the high dose). The administration of ferulic acid to normal rats did not produce any harmful effects. Thus our results show that ferulic acid is an effective anti-hepatotoxic agent without side effects and may be a good candidate in the current search for a natural hepatoprotective agent.
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Affiliation(s)
- Rajagopalan Rukkumani
- Department of Biochemistry, Faculty of Science, Annamalai University, Annamalainagar, Tamilnadu, India
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Sánchez-Moreno C, Dorfman SE, Lichtenstein AH, Martín A. Dietary fat type affects vitamins C and E and biomarkers of oxidative status in peripheral and brain tissues of golden Syrian hamsters. J Nutr 2004; 134:655-60. [PMID: 14988463 DOI: 10.1093/jn/134.3.655] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Oxidative stress is an important trigger in the complex chain of events leading to neurodegenerative diseases. On the other hand, dietary fatty acids play an essential role in brain function. The objectives of this study were to assess the effect of dietary fat type on vitamin C and vitamin E (alpha-and gamma-tocopherol) concentrations in peripheral and brain tissues and its effect on 8-epiPGF(2)alpha (F(2)-isoprostanes). Male Golden Syrian hamsters (n = 120, 8 wk old) were fed diets enriched in butter, hydrogenated fat (margarine), and canola and soybean oils. After 12 wk, hamsters were deprived of food, anesthetized with isoflurane, and killed via terminal exsanguination. Analyses of vitamins C, E, and 8-epiPGF(2)alpha were performed in peripheral tissues and brain. Hamsters consuming the margarine-enriched diet had lower (P < 0.05) vitamin C and alpha-tocopherol concentrations in liver, plasma, and brain, and higher (P < 0.02) plasma 8-epiPGF(2)alpha than groups fed the butter, and the canola and soybean oil diets. Liver and plasma gamma-tocopherol concentration was higher (P < 0.001) among the groups fed the soybean- and margarine-enriched diets compared with the other groups. alpha-Tocopherol was higher (P < 0.05) and 8-epiPGF(2)alpha lower (P < 0.01) among the groups fed the canola and soybean oil diets compared with the other groups. Across the groups, an inverse correlation between plasma levels of vitamin C and 8-epiPGF(2)alpha (r = -0.37, P = 0.03) and a positive correlation between plasma levels of vitamin C and alpha-tocopherol were observed (r = 0.341, P = 0.003). Hamsters fed the butter-enriched diet had a higher (P < 0.03) plasma uric acid concentration than the other groups. The results of this study provide new evidence concerning the effect of dietary fat on antioxidant status, which is important for the maintenance of good health.
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Affiliation(s)
- Concepción Sánchez-Moreno
- Nutrition and Neurocognition Laboratory, Cardiovascular Nutrition Research Laboratory, Jean Mayer U.S. Department of Agriculture-Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
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Yuan YV, Kitts DD. Dietary (n-3) fat and cholesterol alter tissue antioxidant enzymes and susceptibility to oxidation in SHR and WKY rats. J Nutr 2003; 133:679-88. [PMID: 12612137 DOI: 10.1093/jn/133.3.679] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Previously, 8% fish oil blend diets, compared to butter and soybean oil blend diets, reduced specific antioxidant enzyme activities and tissue susceptibility to in vitro oxidative stress in spontaneously hypertensive (SHR) and Wistar Kyoto (WKY) rats. Moreover, high cholesterol (5.0 g/kg diet) diets protected against in vitro tissue lipid oxidation. In this study, we hypothesized that 160 g fat/kg diet as blends of (n-6) or (n-3) oils and cholesterol would alter antioxidant enzyme activities and thus increase tissue susceptibility to oxidation. The effects of diet blends of saturated (butter, B), (n-6) (soybean oil, SBO) or (n-3) (menhaden oil, MO) oils with cholesterol (0.5 or 5.0 g/kg) on systolic blood pressure (SBP), plasma lipids, antioxidant enzymes and susceptibility to oxidation were examined in SHR and WKY rats. SBP at 13 wk of age was greater (P < 0.001) in SHR than in WKY rats, but was not affected by diets. Plasma cholesterol and triacylglycerols were decreased (P < 0.001) by MO diets. Hepatic glutathione reductase activities were reduced (P < 0.001) in SBO-fed SHR and enhanced in SBO- and MO-fed WKY rats. Glutathione levels were reduced (P < 0.001) in RBC and enhanced (P < 0.001) in livers of MO-fed rats. Lipid oxidation was enhanced (P < 0.001) in red blood cells (RBC) from SBO groups, and hearts and livers of MO groups. High cholesterol diets reduced (P < or = 0.001) susceptibility to lipid peroxidation in RBC and liver of SHR and WKY rats. Greater amounts of dietary (n-3) fat enhance tissue susceptibility to oxidation, which can be modulated by increased dietary cholesterol in SHR and WKY rats.
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Affiliation(s)
- Yvonne V Yuan
- School of Nutrition, Faculty of Community Services, Ryerson University, Toronto, Ontario, Canada M5B 2K3
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Diniz YS, Faine LA, Almeida JA, Silva MDP, Ribas BO, Novelli ELB. Toxicity of dietary restriction of fat enriched diets on cardiac tissue. Food Chem Toxicol 2002; 40:1893-9. [PMID: 12419704 DOI: 10.1016/s0278-6915(02)00172-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The present study examines the effects of caloric restriction in cardiac tissue evaluation markers of oxidative stress. High-fat dietary restrictions can have a long-term impact on cardiac health. Dietary restriction of control diet increased myocardial superoxide dismutase (SOD) and catalase activities. Dietary restriction of fatty acid-enriched diets increased myocardial lipoperoxide concentrations, while SOD activity was decreased in cardiac tissue of rats with dietary restriction of fatty acid-enriched diets. Dietary restriction of unsaturated fatty acid-enriched diet induced the highest lipoperoxide concentration and the lowest myocardial SOD activity. Dietary restriction of unsaturated fatty acid decreased myocardial glycogen, and increased the lactate dehydrogenase/citrate synthase ratio. Dietary restriction of fatty acid-enriched diets were more deleterious to cardiac tissue than normal ad lib.-fed diet. In conclusion, the effects of caloric restriction on myocardial oxidative stress is dependent on which nutrient is restricted. Dietary restriction of fatty acid-enriched diets is deleterious relative to ad lib.-fed chow diet.
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Affiliation(s)
- Y S Diniz
- Post Graduation Course Fisiopatologia em Clínica Médica, Faculty of Medicine, UNESP, Botucatu, São Paulo, Brazil
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α-tocopherol concentrations, lipid peroxidation and superoxide dismutase and glutathione peroxidase activities in rat heart and liver after feeding stabilized and unstabilized fish oil. Nutr Res 2001. [DOI: 10.1016/s0271-5317(01)00387-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Youdim KA, Martin A, Joseph JA. Essential fatty acids and the brain: possible health implications. Int J Dev Neurosci 2000; 18:383-99. [PMID: 10817922 DOI: 10.1016/s0736-5748(00)00013-7] [Citation(s) in RCA: 306] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Linoleic and alpha-linolenic acid are essential for normal cellular function, and act as precursors for the synthesis of longer chained polyunsaturated fatty acids (PUFAs) such as arachidonic (AA), eicosapentaenoic (EPA) and docosahexaenoic acids (DHA), which have been shown to partake in numerous cellular functions affecting membrane fluidity, membrane enzyme activities and eicosanoid synthesis. The brain is particularly rich in PUFAs such as DHA, and changes in tissue membrane composition of these PUFAs reflect that of the dietary source. The decline in structural and functional integrity of this tissue appears to correlate with loss in membrane DHA concentrations. Arachidonic acid, also predominant in this tissue, is a major precursor for the synthesis of eicosanoids, that serve as intracellular or extracellular signals. With aging comes a likely increase in reactive oxygen species and hence a concomitant decline in membrane PUFA concentrations, and with it, cognitive impairment. Neurodegenerative disorders such as Parkinson's and Alzheimer's disease also appear to exhibit membrane loss of PUFAs. Thus it may be that an optimal diet with a balance of n-6 and n-3 fatty acids may help to delay their onset or reduce the insult to brain functions which these diseases elicit.
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Affiliation(s)
- K A Youdim
- Laboratory of Neuroscience, United States Department of Agriculture, Jean Mayer Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA.
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