The effect of sea buckthorn supplement on oral health, inflammation, and DNA damage in hemodialysis patients: a double-blinded, randomized crossover study

Antioxidants for adults with chronic kidney disease

BACKGROUND

Chronic kidney disease (CKD) is a significant risk factor for cardiovascular disease (CVD) and death. Increased oxidative stress in people with CKD has been implicated as a potential causative factor. Antioxidant therapy decreases oxidative stress and may consequently reduce cardiovascular morbidity and death in people with CKD. This is an update of a Cochrane review first published in 2012.

OBJECTIVES

To examine the benefits and harms of antioxidant therapy on death and cardiovascular and kidney endpoints in adults with CKD stages 3 to 5, patients undergoing dialysis, and kidney transplant recipients.

SEARCH METHODS

We searched the Cochrane Kidney and Transplant Register of Studies until 15 November 2022 using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Registry Platform (ICTRP) Search Portal, and ClinicalTrials.gov.

SELECTION CRITERIA

We included all randomised controlled trials investigating the use of antioxidants, compared with placebo, usual or standard care, no treatment, or other antioxidants, for adults with CKD on cardiovascular and kidney endpoints.

DATA COLLECTION AND ANALYSIS

Titles and abstracts were screened independently by two authors who also performed data extraction using standardised forms. Results were pooled using random effects models and expressed as risk ratios (RR) or mean difference (MD) with 95% confidence intervals (CI). Confidence in the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

MAIN RESULTS

We included 95 studies (10,468 randomised patients) that evaluated antioxidant therapy in adults with non-dialysis-dependent CKD (31 studies, 5342 patients), dialysis-dependent CKD (41 studies, 3444 patients) and kidney transplant recipients (21 studies, 1529 patients). Two studies enrolled dialysis and non-dialysis patients (153 patients). Twenty-one studies assessed the effects of vitamin antioxidants, and 74 assessed the effects of non-vitamin antioxidants. Overall, the quality of included studies was moderate to low or very low due to unclear or high risk of bias for randomisation, allocation concealment, blinding, and loss to follow-up. Compared with placebo, usual care, or no treatment, antioxidant therapy may have little or no effect on cardiovascular death (8 studies, 3813 patients: RR 0.94, 95% CI 0.64 to 1.40; I² = 33%; low certainty of evidence) and probably has little to no effect on death (any cause) (45 studies, 7530 patients: RR 0.95, 95% CI 0.82 to 1.11; I² = 0%; moderate certainty of evidence), CVD (16 studies, 4768 patients: RR 0.79, 95% CI 0.63 to 0.99; I² = 23%; moderate certainty of evidence), or loss of kidney transplant (graft loss) (11 studies, 1053 patients: RR 0.88, 95% CI 0.67 to 1.17; I² = 0%; moderate certainty of evidence). Compared with placebo, usual care, or no treatment, antioxidants had little to no effect on the slope of urinary albumin/creatinine ratio (change in UACR) (7 studies, 1286 patients: MD -0.04 mg/mmol, 95% CI -0.55 to 0.47; I² = 37%; very low certainty of evidence) but the evidence is very uncertain. Antioxidants probably reduced the progression to kidney failure (10 studies, 3201 patients: RR 0.65, 95% CI 0.41 to 1.02; I² = 41%; moderate certainty of evidence), may improve the slope of estimated glomerular filtration rate (change in eGFR) (28 studies, 4128 patients: MD 3.65 mL/min/1.73 m², 95% CI 2.81 to 4.50; I² = 99%; low certainty of evidence), but had uncertain effects on the slope of serum creatinine (change in SCr) (16 studies, 3180 patients: MD -13.35 µmol/L, 95% CI -23.49 to -3.23; I² = 98%; very low certainty of evidence). Possible safety concerns are an observed increase in the risk of infection (14 studies, 3697 patients: RR 1.30, 95% CI 1.14 to 1.50; I² = 3%; moderate certainty of evidence) and heart failure (6 studies, 3733 patients: RR 1.40, 95% CI 1.11 to 1.75; I² = 0; moderate certainty of evidence) among antioxidant users. Results of studies with a low risk of bias or longer follow-ups generally were comparable to the main analyses.

AUTHORS' CONCLUSIONS

We found no evidence that antioxidants reduced death or improved kidney transplant outcomes or proteinuria in patients with CKD. Antioxidants likely reduce cardiovascular events and progression to kidney failure and may improve kidney function. Possible concerns are an increased risk of infections and heart failure among antioxidant users. However, most studies were of suboptimal quality and had limited follow-up, and few included people undergoing dialysis or kidney transplant recipients. Furthermore, the large heterogeneity in interventions hampers drawing conclusions on the efficacy and safety of individual agents.

Periodontal disease in chronic kidney disease patients: salivomics by Fourier-transform infrared spectroscopy

It has been reported that 58% of individuals with chronic kidney disease (CKD) have moderate to advanced periodontitis due to alterations of pH and biochemical composition in the saliva. In fact, the composition of this important biofluid may be modulated by systemic disorders. Here we investigate the micro-reflectance Fourier-transform infrared spectroscopy (FTIR) spectra of saliva that CKD patients submitted to periodontal treatment, aiming to identify spectral biomarkers of kidney disease evolution and the effectiveness of periodontal treatment, proposing possible biomarkers of disease evolution. Saliva from 24 CKD patients-stage-5 men, 29 to 64 years old-was evaluated in (i) patients starting periodontal treatment; (ii) patients 30 days after periodontal treatment; and (iii) patients 90 days after periodontal treatment. Our findings indicated that there are statistically relevant changes among the groups after 30 and 90 days of periodontal treatment, when considering the overall spectra in the fingerprint region (800-1800cm^-1). The key bands presenting good prediction power (area under the receiver operating characteristic curve >0.70) were related to poly (ADP-ribose) polymerase (PARP) conjugated to DNA at 883, 1031, and 1060cm^-1 (carbohydrates at 1043 and 1049cm^-1) and triglycerides (1461cm^-1). Interestingly when analyzing the derivative spectra in the secondary structure region (1590-1700cm^-1), we detected over-expression of the β-sheet class of secondary structures in 90 days of periodontal treatment, possibly related to over-expression of human B-defensins. Conformational changes in ribose sugar in this region corroborate the interpretation concerning PARP detection. To our knowledge, PARP was detected for the first time in saliva samples of stage-5 CKD patients by FTIR. All observed changes were correctly interpreted in terms of intensive apoptosis and dyslipidemia due to kidney disease progression. Biomarkers due to CKD predominate in saliva, and the relative improvement in the periodontal state did not cause remarkable changes in the spectra of saliva.

Effects of sea buckthorn (Hippophae rhamnoides L.) on factors related to metabolic syndrome: A systematic review and meta-analysis of randomized controlled trial

The purpose of this meta-analysis is to explore whether the supplement of sea buckthorn affects the factors related to metabolic syndrome. The related RCTs from five databases were systematically searched and comprehensively random effects model was used to calculate SMD and 95% CI. The Cochrane deviation risk tool was used to evaluate the deviation risk. Fifteen studies were involved in the meta-analysis. First, sea buckthorn supplementation reduced triglycerides [-0.722 (-1.129, -0.316); p < .001], total cholesterol [-0.345 (-0.639, -0.051); p = .021], low density lipoprotein cholesterol [-0.396 (-0.755, -0.037); p = .031], and increased high density lipoprotein cholesterol [0.370 (0.056, 0.684); p = .021] in overall subjects. Second, subgroup analysis showed that sea buckthorn supplementation reduced lipids only in people with abnormal lipid metabolism. Third, sea buckthorn had no effect on blood sugar, blood pressure, and BMI of the overall subjects. Sea buckthorn may affect the lipid metabolism in circulation, but it cannot affect blood glucose, blood pressure, and BMI. These indicators are closely associated with metabolic syndrome. This study may contribute to the development and utilization of sea buckthorn, and may provide a new and safer way for the prevention and treatment of metabolic syndrome. The limitation of this study is high heterogeneity, even if subgroup analysis is used. However, more clinical studies are needed to determine the real effect of sea buckthorn on metabolic syndrome.

Phytochemistry and pharmacology of sea buckthorn (Elaeagnus rhamnoides; syn. Hippophae rhamnoides): progress from 2010 to 2021

Sea buckthorn (Elaeagnus rhamnoides; syn. Hippophae rhamnoides) is a thorny shrub or a small tree belonging to the Elaeagnaceae family, native to Eurasia. Sea buckthorn fruit is rich in vitamins and minerals, oils from the seeds and fruit flesh find use in medicine and the cosmetic industry or as nutraceutical supplements. Fruit, leaves and other parts of buckthorn have been used in traditional medicine, especially in China, Tibet, Mongolia, and Central Asia countries, and are a rich source of many bioactive substances. Due to its health-promoting and medicinal properties, the plant has been extensively investigated for several decades, and its phytochemical composition and pharmacological properties are well characterized. The years 2010-2021 brought significant progress in phytochemical research on sea buckthorn. Dozens of new compounds, mainly phenolics, were isolated from this plant. Numerous pharmacological studies were also performed, investigating diverse aspects of the biological activity of different extracts and natural products from sea buckthorn. This review focuses on the progress in research on sea buckthorn specialized metabolites made in this period. Pharmacological studies on sea buckthorn are also discussed. In addition, biosynthetic pathways of the main groups of these compounds have been shortly described.

The Relationship Between Salivary Redox, Diet, and Food Flavor Perception

The mouth is the gateway for entrance of food and microorganisms into the organism. The oral cavity is bathed by saliva, which is thus the first fluid that food and microorganisms will face after their entrance. As a result, saliva plays different functions, including lubrication, predigestion, protection, detoxification, and even transport of taste compounds to chemoreceptors located in the taste buds. To ensure its function of protection, saliva contains reactive harmful compounds such as reactive oxygen species that are controlled and neutralized by the antioxidant activity of saliva. Several antioxidant molecules control the production of molecules such as reactive oxygen compounds, neutralize them and/or repair the damage they have caused. Therefore, a balance between reactive oxidant species and antioxidant compounds exists. At the same time, food can also contain antioxidant compounds, which can participate in the equilibrium of this balance. Numerous studies have investigated the effects of different food components on the antioxidant capacity of saliva that correspond to the ability of saliva to neutralize reactive oxygen species. Contradictory results have sometimes been obtained. Moreover, some antioxidant compounds are also cofactors of enzymatic reactions that affect flavor compounds. Recent studies have considered the salivary antioxidant capacity to explain the release of flavor compounds ex vivo or in vivo. This article aims to review the effect of food on the antioxidant capacity of saliva and the impact of salivary antioxidant capacity on flavor perception after a brief presentation of the different molecules involved.

Effect of microwave-drying on the quality and antioxidant properties of Ganoderma lucidum fermented sea-buckthorn tea

Effects of microwave power on the sensory properties (taste and aroma), chemical composition (catechins, caffeine, crude protein, and amino acid), active composition (flavones, triterpene, polysaccharide, and ergosterol) and antioxidant properties (superoxide free radical and hydroxyl radical scavenging abilities, reducing power) of Ganoderma lucidum fermented sea-buckthorn tea were investigated. G. lucidum fermented sea-buckthorn tea was dehydrated using microwaves at three power settings: 125, 250, and 500. After microwave treatment, a statistically significant difference in the chemical composition, active composition and antioxidant capacity (p < 0.05) of teas dried at different power settings was found. These results indicate that 250 W microwave treatments could effectively release and activate active components, improving the antioxidant activity of fermented tea.

Efficacy of Polyunsaturated Fatty Acids on Inflammatory Markers in Patients Undergoing Dialysis: A Systematic Review with Network Meta-Analysis of Randomized Clinical Trials

The effects of polyunsaturated fatty acids (PUFAs) on inflammatory markers among patients receiving dialysis have been discussed for a long time, but previous syntheses made controversial conclusion because of highly conceptual heterogeneity in their synthesis. Thus, to further understanding of this topic, we comprehensively gathered relevant randomized clinical trials (RCTs) before April 2019, and two authors independently extracted data of C-reactive protein (CRP), high-sensitivity C-reactive protein (hs-CRP), and interleukin-6 (IL-6) for conducting network meta-analysis. Eighteen eligible RCTs with 962 patients undergoing dialysis were included in our study. The result showed that with placebo as the reference, PUFAs was the only treatment showing significantly lower CRP (weighted mean difference (WMD): −0.37, 95% confidence interval (CI): −0.07 to −0.68), but the CRP in PUFAs group was not significantly lower than vitamin E, PUFAs plus vitamin E, or medium-chain triglyceride. Although no significant changes were noted for hs-CRP and IL-6 levels, PUFAs showed the best ranking among treatments according to surface under the cumulative ranking. Therefore, PUFAs could be a protective option for patients receiving dialysis in clinical practice.

Flavonoids from sea buckthorn inhibit the lipopolysaccharide-induced inflammatory response in RAW264.7 macrophages through the MAPK and NF-κB pathways

Sea buckthorn has long been used as a functional food to regulate cholesterol, relieve angina, and diminish inflammation. Flavonoids are one of the main active components in sea buckthorn. We investigated the effects of sea buckthorn flavonoid (SF) treatment on two pathways that mediate inflammation, the mitogen-activated protein kinase (MAPK) and nuclear factor-kappa B (NF-κB) pathways, to explore the anti-inflammatory activity of SFs in lipopolysaccharide (LPS)-stimulated RAW264.7 macrophages. The LPS-induced over-production of nitric oxide (NO) and prostaglandin E2 (PGE₂) was inhibited by SFs through a mechanism related to the modulatory effects of the inducible nitric oxide synthase (iNOS) and cyclooxygenase-2 (COX-2) genes. Additionally, SFs downregulated the production and mRNA expression of pro-inflammatory cytokines including tumor necrosis factor (TNF)-α, interleukin (IL)-6 and IL-1β. Moreover, SFs inhibited the phosphorylation of the p38 and stress-activated protein kinase/jun amino-terminal kinase (SAPK/JNK) MAPK pathways, and they reduced the nuclear translocation of NF-κB to prevent its activation by blocking the phosphorylation and degradation of inhibitor protein of NF-κB α (IκB-α). Based on these findings, SFs may exert their inhibitory effects on inflammation by regulating the release of inflammatory mediators through the MAPK and NF-κB pathways. SFs highlight the potential benefits of using functional foods with anti-inflammatory actions to combat inflammatory diseases.

Abundance of active ingredients in sea-buckthorn oil

Vegetable oils are obtained by mechanical extraction or cold pressing of various parts of plants, most often: seeds, fruits, and drupels. Chemically, these oils are compounds of the ester-linked glycerol and higher fatty acids with long aliphatic chain hydrocarbons (min. C14:0). Vegetable oils have a variety of properties, depending on their percentage of saturation. This article describes sea-buckthorn oil, which is extracted from the well characterized fruit and seeds of sea buckthorn. The plant has a large number of active ingredients the properties of which are successfully used in the cosmetic industry and in medicine. Valuable substances contained in sea-buckthorn oil play an important role in the proper functioning of the human body and give skin a beautiful and healthy appearance. A balanced composition of fatty acids give the number of vitamins or their range in this oil and explains its frequent use in cosmetic products for the care of dry, flaky or rapidly aging skin. Moreover, its unique unsaturated fatty acids, such as palmitooleic acid (omega-7) and gamma-linolenic acid (omega-6), give sea-buckthorn oil skin regeneration and repair properties. Sea-buckthorn oil also improves blood circulation, facilitates oxygenation of the skin, removes excess toxins from the body and easily penetrates through the epidermis. Because inside the skin the gamma-linolenic acid is converted to prostaglandins, sea-buckthorn oil protects against infections, prevents allergies, eliminates inflammation and inhibits the aging process. With close to 200 properties, sea-buckthorn oil is a valuable addition to health and beauty products.

Sea Buckthorn (Hippophae Rhamnoides) Lipids and their Functionality on Health Aspects

Hippophae rhamnoides, also named as Sea Buckthorn(SB) is a spiny bush with long and narrow leaves, and orange yellow berries. It is native to Europe and mainly to Asia. The leaves, fruits and the seeds of sea bucHippophae rhamnoides, also named as Sea Buckthorn(SB) is a spiny bush with long and narrow leaves, and orange yellow berries. It is native to Europe and mainly to Asia. The leaves, fruits and the seeds of sea buckthorn contain many bioactive compounds. These compounds are various natural antioxidants such as ascorbic acid, tocopherols, carotenoids, flavonoids, whereas besides them all we can find macronutrients such as proteins, lipids (mainly unsaturated fatty acids and phytosterols), vitamins (especially vitamin C), minerals, small amounts of sugars and organic acids . The present review focuses on the functionality of SB lipids and refers to those studies that suggest the sea buckthorn could have various beneficial effects on cardiovascular health, insulin and glucose response, renal health, hepatic health, Gastric health, epidermis health, cancer, ophthalmologic health and oxidative stress and toxicity.kthorn contain many bioactive compounds. These compounds are various natural antioxidants such as ascorbic acid, tocopherols, carotenoids, flavonoids, whereas besides them all we can find macronutrients such as proteins, lipids (mainly unsaturated fatty acids and phytosterols), vitamins (especially vitamin C), minerals, small amounts of sugars and organic acids . The present review focuses on the functionality of SB lipids and refers to those studies that suggest the sea buckthorn could have various beneficial effects on cardiovascular health, insulin and glucose response, renal health, hepatic health, Gastric health, epidermis health, cancer, ophthalmologic health and oxidative stress and toxicity.

A pilot randomized crossover trial assessing the safety and short-term effects of pomegranate supplementation in hemodialysis patients

OBJECTIVE

Oxidative stress and systemic inflammation are highly prevalent in patients undergoing maintenance hemodialysis (MHD) and are linked to excess cardiovascular risk. This study examined whether short-term supplementation with pomegranate juice and extract is safe and well tolerated by MHD patients. The secondary aim was to assess the effect of pomegranate supplementation on oxidative stress, systemic inflammation, monocyte function, and blood pressure.

DESIGN

Prospective, randomized, crossover, pilot clinical trial (NCT01562340).

SETTING

The study was conducted from March to October 2012 in outpatient dialysis facilities in the Seattle metropolitan area.

SUBJECTS

Twenty-four patients undergoing MHD (men, 64%; mean age, 61 ± 14 years) were randomly assigned to receive pomegranate juice or extract during a 4-week intervention period. After a washout period, all patients received the alternative treatment during a second 4-week intervention period.

INTERVENTION

Patients assigned to receive pomegranate juice received 100 mL of juice before each dialysis session. Patients assigned to receive pomegranate extract were given 1,050 mg of extract daily.

MAIN OUTCOME MEASURES

The main outcome measures were safety and tolerability of pomegranate juice and extract. Additional secondary outcomes assessed included serum lipids, laboratory biomarkers of inflammation (C-reactive protein and interleukin 6) and oxidative stress (plasma F2 isoprostanes and isofurans), monocyte cytokine production, and predialysis blood pressure.

RESULTS

Both pomegranate juice and extract were safe and well tolerated by study participants. Over the study period, neither treatment had a significant effect on lipid profiles, plasma C-reactive protein, interleukin 6, F2-isoprostane or isofuran concentrations, predialysis systolic or diastolic blood pressure nor changed the levels of monocyte cytokine production.

CONCLUSIONS

Both pomegranate juice and extract are safe and well tolerated by patients undergoing MHD but do not influence markers of inflammation or oxidative stress nor affect predialysis blood pressure.