Vitamin E status of the newborn in relation to gestational age, birth weight and maternal vitamin E status

Expanding role of vitamin E in protection against metabolic dysregulation: Insights gained from model systems, especially the developing nervous system of zebrafish embryos

This review discusses why the embryo requires vitamin E (VitE) and shows that its lack causes metabolic dysregulation and impacts morphological changes at very early stages in development, which occur prior to when a woman knows she is pregnant. VitE halts the chain reactions of lipid peroxidation (LPO). Metabolomic analyses indicate that thiols become depleted in E- embryos because LPO generates products that require compensation using limited amino acids and methyl donors that are also developmentally relevant. Thus, VitE protects metabolic networks and the integrated gene expression networks that control development. VitE is critical especially for neurodevelopment, which is dependent on trafficking by the α-tocopherol transfer protein (TTPa). VitE-deficient (E-) zebrafish embryos initially appear normal, but by 12 and 24 h post-fertilization (hpf) E- embryos are developmentally abnormal with expression of pax2a and sox10 mis-localized in the midbrain-hindbrain boundary, neural crest cells and throughout the spinal neurons. These patterning defects indicate cells that are especially in need of VitE-protection. They precede obvious morphological abnormalities (cranial-facial malformation, pericardial edema, yolksac edema, skewed body-axis) and impaired behavioral responses to locomotor activity tests. The TTPA gene (ttpa) is expressed at the leading edges of the brain ventricle border. Ttpa knockdown using morpholinos is 100% lethal by 24 hpf, while E- embryo brains are often over- or under-inflated at 24 hpf. Further, E- embryos prior to 24 hpf have increased expression of genes involved in glycolysis and the pentose phosphate pathway, and decreased expression of genes involved in anabolic pathways and transcription. Combined data from both gene expression and the metabolome in E- embryos at 24 hpf suggest that the activity of the mechanistic Target of Rapamycin (mTOR) signaling pathway is decreased, which may impact both metabolism and neurodevelopment. Further evaluation of VitE deficiency in neurogenesis and its subsequent impact on learning and behavior is needed.

RedEfish: Generation of the Polycistronic mScarlet: GSG-T2A: Ttpa Zebrafish Line

The vitamin E regulatory protein, the alpha-tocopherol transfer protein (Ttpa), is necessary for zebrafish embryo development. To evaluate zebrafish embryo Ttpa function, we generated a fluorescent-tagged zebrafish transgenic line using CRISPR-Cas9 technology. One-cell stage embryos (from Casper (colorless) zebrafish adults) were injected the mScarlet coding sequence in combination with cas9 protein complexed to single guide RNA molecule targeting 5′ of the ttpa genomic region. Embryos were genotyped for proper insertion of the mScarlet coding sequence, raised to adulthood and successively in-crossed to produce the homozygote RedEfish (mScarlet: GSG-T2A: Ttpa). RedEfish were characterized by in vivo fluorescence detection at 1, 7 and 14 days post-fertilization (dpf). Fluorescent color was detectable in RedEfish embryos at 1 dpf; it was distributed throughout the developing brain, posterior tailbud and yolk sac. At 7 dpf, the RedEfish was identifiable by fluorescence in olfactory pits, gill arches, pectoral fins, posterior tail region and residual yolk sac. Subsequently (14 dpf), the mScarlet protein was found in olfactory pits, distributed throughout the digestive tract, along the lateral line and especially in caudal vertebrae. No adverse morphological outcomes or developmental delays were observed. The RedEfish will be a powerful model to study Ttpa function during embryo development.

Anti-oxidant profiles and markers of oxidative stress in preterm neonates

BACKGROUND

Preterm birth is associated with an increased oxidant burden which places these infants at a higher risk of injury.

AIMS

This prospective study aimed to assess levels of antioxidants and a marker of oxidative stress in preterm neonates.

OBJECTIVES

(i) To compare levels of anti-oxidants [vitamin A, vitamin E, catalase, total anti-oxidant status (TAS)] as well as malondialdehyde level (MDA) (a marker of lipid peroxidation) between preterm and full-term neonates; (ii) to determine changes in the values of measured vitamins at birth and at discharge among preterm neonates; and (iii) to compare levels of anti-oxidants with MDA levels in relation to complications of prematurity and outcome.

METHODS

The study was undertaken in 100 preterm neonates and 100 full-term neonates as a control group. MDA was estimated by a thiobarbituric acid-reactive technique; TAS was determined using a Randox assay kit; catalase activity was measured spectrophotometrically and vitamin A and E levels were estimated by high performance liquid chromatography.

RESULTS

The plasma levels of vitamin A, vitamin E, TAS and catalase were significantly lower in the preterm than in the full-term group (P < 0.01), and the plasma level of MDA was significantly higher in preterm than full-term neonates (P < 0.01). Vitamin A and E levels in preterm neonates were significantly higher at discharge than at birth (P < 0.01). Vitamin A, vitamin E and catalase levels at birth were significantly lower in patients who developed necrotizing enterocolitis or bronchopulmonary dysplasia than in those who did not.

CONCLUSION

Preterm neonates are exposed to increased oxidant stress at birth and are susceptible to anti-oxidant deficiencies. A higher dose of enteral vitamin A supplementation in preterm neonates might reduce morbidity and improve outcome. Further studies are warranted to evaluate the appropriate dose of oral vitamin E supplementation for preterm neonates.

Oxygen toxicity in premature infants

Oxygen causes tissue injury through the formation of reactive oxygen intermediates and peroxidation of membrane lipids. Premature infants, who have severely reduced antioxidant defenses, are particularly sensitive to the toxic effects of oxygen. Supplemental oxygen in premature infants contributes to the development of chronic lung disease (bronchopulmonary dysplasia), characterized by dysregulated inflammation and altered expression of proteases and growth factors. This can result in fibrosis, asymmetric aeration, and respiratory insufficiency. Oxygen also induces aberrant physiologic responses that can be damaging in premature infants. For example, vasoconstriction in the retina is an early response to oxygen that can lead to vasoobliteration, neovascularization, and retinal traction (retinopathy of prematurity). Increasing knowledge of the mechanisms underlying oxygen toxicity in premature infants has suggested strategies to minimize tissue injury and to optimize long-term medical outcomes. These include limiting oxygen supplementation and light exposure, the use of antiinflammatory agents or antioxidants, and the use of room air in neonatal resuscitation.

Antioxidant vitamin levels in term and preterm infants and their relation to maternal vitamin status

BACKGROUND

Lipid peroxidation plays a vital role in the pathogenesis of many neonatal complications. Preterm babies are especially predisposed to lung diseases and retinopathy, probably due to a deficiency in their antioxidant systems. Vitamins E, A, and C are part of the natural antioxidant defense systems. We aimed to determine the levels of vitamins E, A, and C in maternal and cord blood plasma of term and preterm infants and to investigate the relationships between these levels.

METHODS

In the present study we determined vitamin E, A, and C levels in the umbilical cord blood of term (n = 30) and preterm (n = 22) infants and their mothers by HPLC. Blood samples were taken during delivery.

RESULTS

Levels of lipid soluble antioxidant vitamin E and A in cord blood were lower than maternal values (p <0.01, p <0.05, respectively). Conversely, the level of water-soluble vitamin C was higher in cord blood than in maternal level (p <0.05). Significantly higher levels of vitamins E, A, and C were found in term babies as compared with those born preterm (p <0.05).

CONCLUSIONS

There was a positive correlation between maternal and cord blood levels of vitamins E and A (r = 0.775, r = 0.725, respectively). In conclusion, preterm babies have fewer lipid-soluble antioxidant vitamins in their serum compared to term infants. Therefore, it is possible to postulate that preterm infants are more susceptible to oxidative stress.

Influence of caesarean delivery and maternal factors on fat-soluble vitamins in blood from cord and neonates

We measured plasma and erythrocyte vitamin E (VE) and plasma vitamin A (VA) profiles in 48 full-term and 8 preterm pairs of neonates and their mothers at birth and we determined whether there is any relationship between maternal and umbilical cord for the nutrients measured. At the same time, we assessed the influence of the delivery type and neonate anthropometric measurements on maternal and cord blood VA and VE levels. We measured vitamin levels in vein and arterial blood in order to establish differences due to fetal metabolism. To determine the influence of pregnancy on vitamin levels, we compared the maternal results with data from a group of 13 non-pregnant women. Cord blood had lower plasma VE (arterial 275.8+/-71.7 microg/dl and vein 282.89+/-64.4 microg/dl values), erythrocyte VE (arterial 256.96+/-50.41 microg/dl packet cells and vein 257.41+/-44.35 microg/dl values), and VA levels (arterial 26.72+/-11.83 microg/dl and 27.15+/-10.05 microg/dl values) and a lower vitamin E/total lipids ratio (VE/LT) (arterial 1.60+/-0.4 and vein 1.62+/-0.3 values) than maternal blood (1474.62+/-424.51 microg/dl, 305.94+/-54.75 microg/dl packet cells, 41.03+/-18.83 microg/dl, 2.34+/-0.5, respectively). VA levels were higher in preterm than full-term neonates (P<0.05). Plasma and erythrocyte VE levels were not correlated in maternal blood but were correlated in neonates and infants (r>0.40; P<0.01). We found a good correlation between erythrocyte tocopherol of maternal and cord blood (r>0.40; P<0.01), although there was no correlation with plasma VE values. Cord vein plasma VE levels were higher than cord arterial blood measurements (P<0.01). The plasma VE and VE/LT of the mother and cord following vaginal delivery were higher than measurements from caesarean delivery (P<0.05), although erythrocyte levels were similar. The plasma VE level was higher in mothers at delivery than non-pregnant women.

Maternal and neonatal plasma antioxidant levels in normal pregnancy, and the relationship with fatty acid unsaturation

During pregnancy, maternal plasma concentrations of the peroxidation-susceptible polyunsaturated fatty acids (polyenes) increase. In addition, the proportion of polyenes is higher in neonatal plasma than in maternal plasma. To study whether these increased amounts of polyenes affect antioxidant levels, we measured lipid-soluble antioxidants in maternal and neonatal plasmas obtained during thirty-five normal pregnancies. These values were then related to the degree of phospholipid-fatty acid unsaturation. Maternal plasma levels of tocopherols and lutein increased during pregnancy, as assessed at 14, 22, and 32 weeks of gestation. However beta-carotene levels decreased, and levels of other carotenoids remained unchanged. Retinol levels were only decreased at 32 weeks of gestation. The value for alpha-tocopherol: phospholipid-polyene unsaturation index (UI) also increased during pregnancy, despite the observed increase in UI. Corresponding ratios for several carotenoids and retinol, however, decreased during pregnancy. After delivery, maternal plasma levels of delta-tocopherol and beta + gamma-tocopherol, as well as beta + gamma-tocopherol: UI values, were lower than values at 32 weeks of gestation. Umbilical-cord plasma antioxidant levels and antioxidant: UI values, except retinol: UI, were significantly lower than maternal values. Significant and consistent cord v. maternal correlations were observed for plasma levels of beta + gamma-tocopherol, lutein and beta-carotene, but not for delta-tocopherol, alpha-tocopherol, lycopene, alpha-carotene, and retinol. In conclusion, although during pregnancy maternal plasma tocopherol levels increased concurrently with, or more than, fatty acid unsaturation in plasma phospholipids, the decrease in carotenoid: UI values during gestation, the decrease in maternal plasma levels of delta-tocopherol and beta + gamma-tocopherol after delivery, and the low neonatal antioxidant levels merit further investigation.