The transport of vitamin C and effects of disease

Scurvy in the Modern World: Extinct or Not?

Scurvy is a nutritional disorder caused by vitamin C deficiency. It was a notorious disease in the ancient world, especially among the sailors, and is of rare occurrence in contemporary, developed countries due to increased access and advancement in nutrition services. Scurvy primarily affects the skin and soft tissue, presenting with a myriad of clinical manifestations ranging from musculoskeletal to bleeding-related complaints and even sudden death in later stages. In this article, we present the case of an elderly female with scurvy-related weakness and gait instability leading to mechanical falls, easy bruising, fatigue, and petechial rash. She had improvement in her constitutional symptoms after the initiation of vitamin C supplements. This case reinforces the need to consider scurvy as one of the differentials for petechial rash and easy bruising apart from bleeding diathesis and vasculitis in the contemporary world, especially in at-risk populations.

Differential status and significance of non-enzymatic antioxidants (reactive oxygen species scavengers) in malaria and dengue patients

An imbalance in oxidants and antioxidants is observed during malaria and dengue infections which is associated with the production of reactive oxygen species (ROS) via haem degradation or immune activation, a contributing factor for disease pathogenesis. The levels of non-enzymatic antioxidants and total antioxidant status (TAS) in malaria and dengue patients were analysed and compared with healthy controls. Particular attention was paid to elevated levels of total bilirubin (TB) and uric acid (UA) during disease progression and haemolysis and noticed a significant increase in dengue patients (dengue>Pf>Pv>control). A highly significant difference was also observed between dengue and Pf patients (p < 0.0001) for these parameters. Glutathione levels were comparable in dengue and falciparum malaria but were significantly higher than that of vivax malaria patients. Ascorbate levels were significantly depleted in all the patient groups (p < 0.0001) and a negative correlation was established for TAS and ascorbate levels in dengue patients (r=-0.32). A good positive correlation was observed between TAS-UA and TAS-TB levels. Thus, these findings suggest that severe haemolysis, renal failure, and liver dysfunction have higher prominence in dengue patients during the simultaneous outbreak of the two arthropod-borne diseases. A differential status of non-enzymatic antioxidants was also observed during the different stages of dengue and malaria.

Genetic Variation in Human Vitamin C Transporter Genes in Common Complex Diseases

Adequate plasma, cellular, and tissue vitamin C concentrations are required for maintaining optimal health through suppression of oxidative stress and optimizing functions of certain enzymes that require vitamin C as a cofactor. Polymorphisms in the vitamin C transporter genes, compromising genes encoding sodium-dependent ascorbate transport proteins, and also genes encoding facilitative transporters of dehydroascorbic acid, are associated with plasma and tissue cellular ascorbate status and hence cellular redox balance. This review summarizes our current knowledge of the links between variations in vitamin C transporter genes and common chronic diseases. We conclude that emerging genetic knowledge has a good likelihood of defining future personalized dietary recommendations and interventions; however, further validations through biological studies as well as controlled dietary trials are required to identify predictive and actionable genetic biomarkers. We further advocate the need to consider genetic variation of vitamin C transporters in future clinical and epidemiologic studies on common complex diseases.

Hemato-biochemical and Cortisol Profile of Holstein Growing-calves Supplemented with Vitamin C during Summer Season

Effect of vitamin C (VC) on biochemical, hematological and cortisol profile of growing Holstein calves during summer was investigated. Eighteen calves between 14 and 16 weeks of age were divided equally into two groups. One group received a diet supplemented with VC (20 g/d) for 60 days, while other non-supplemented diet fed group served as a control (CON). The temperature humidity index (THI) was recorded and computed during the experiment. From days 0 to 60, the THI exceeded 70. Blood samples were collected from the jugular vein of each calf at days 0, 15, 30, 45 and 60. Serum albumin and total protein decreased (p<0.05) in CON and VC calves with age. Serum glutamic-oxaloacetic transaminase concentrations were not affected by treatments. Serum creatinine, albumin and glutamic-pyruvic transaminase concentrations were higher in calves in the VC group than the CON group. While red blood cells, hemoglobin and hematocrit were lower (p<0.05) in VC calves, mean corpuscular volume, mean corpuscular hemoglobin, red blood cell distribution width and mean platelet volume were higher (p<0.05) in these VC supplemented calves. Leukocyte parameters including white blood cells and full term for lymphocytes were not affected by the treatments. Also, serum cortisol was not affected by treatments. At day 15, 30 and 45, the total VC in plasma was higher (p<0.05) in calves fed with VC. In conclusion, serum cortisols were not affected by plasma VC concentration, while some blood parameters were positively influenced in calves fed with VC.

The relationship between acute changes in the systemic inflammatory response and plasma ascorbic acid, alpha-tocopherol and lipid peroxidation after elective hip arthroplasty

BACKGROUND & AIMS

Vitamin C (ascorbic acid, AA) is a water soluble vitamin with many functions including antioxidative properties, haemostasis, hormone synthesis, collagen synthesis, carnitine synthesis, bile salt production and enhancing iron absorption. There is some evidence that there is a negative inverse relationship between plasma vitamin C concentration and the systemic inflammatory response as measured by C-reactive protein (CRP). The aim of the present study was to examine, in the context of a longitudinal study, the change in plasma concentrations of ascorbic acid (AA) and Vitamin E (α-tocopherol, AT) and their relationship to free radical damage during the evolution of the systemic inflammatory response.

METHODS

Venous blood samples were obtained pre-operatively and at 1, 2, 3 and 90 days post-operatively from 11 patients undergoing elective hip arthroplasty at Glasgow Royal Infirmary. AA, AT, cholesterol, MDA (marker of free radical damage), CRP and albumin were measured in plasma.

RESULTS

Plasma AA fell significantly by 74% (P < 0.01), AT fell by 36% (P < 0.01), cholesterol by 40% (P < 0.01), MDA by 38% (P < 0.01), albumin by 29% (P < 0.01) and CRP increased significantly by 160 fold (P < 0.01) during the systemic inflammatory response. The fall in plasma AA remained significant when adjusted for albumin (P < 0.01). Plasma AT adjusted for cholesterol did not change significantly during the study period. The fall in plasma MDA remained significant when adjusted for albumin (P 0.01). At 3 months post-operatively, all measurements (including AA) except albumin had returned to baseline values.

CONCLUSIONS

Plasma AA levels are unlikely to be a reliable measurement of Vitamin C where there is evidence of a systemic inflammatory response. The decrease in plasma AA concentration is likely to be secondary to increased consumption, increased usage neutralising free radicals, increased utilisation in supporting AT regeneration and increased urinary excretion.

P66Shc-rac1 pathway-mediated ROS production and cell migration is downregulated by ascorbic acid

The oxidative role(s) of p66Shc protein has been increasingly expanded over the last decade. However, its relation with the most potent antioxidant molecule, i.e. ascorbic acid has never been studied. We have previously shown that p66Shc mediates rac1 activation, reactive oxygen species (ROS) production and cell death. Here we studied the effect of ascorbic acid on the pathway involving p66Shc and rac1. Our results indicate a decrease in the expression of p66Shc in a dose- and time-dependent manner. We studied the effect of ascorbic acid on rac1 expression and its activity. Ascorbic acid has no effect on total rac1 expression; however, rac1 activation was inhibited in a dose-dependent manner. Results suggest that the decrease in rac1 activity is mediated through ascorbic acid-modulated p66Shc expression. The decrease in rac1 activity was evident in cells transfected with the p66shc mutant (proline motif mutant, at residues P47 to P50). Our studies indicate that p66Shc-mediated ROS upregulation is significantly decreased in the presence of ascorbic acid. Cell migration experiments point towards the inhibition of p66Shc-rac1-mediated migration in the presence of ascorbic acid. Finally, results are suggestive that ascorbic acid-mediated decrease in Shc expression occurs through an increased Shc ubiquitination. Overall, the study brings out the novel role of ascorbic acid in antioxidant signal transduction.

Quantitative data on the magnitude of the systemic inflammatory response and its effect on micronutrient status based on plasma measurements

BACKGROUND

Plasma concentrations of several trace elements and vitamins decrease because of the systemic inflammatory response. Thus, low values do not necessarily indicate deficiency.

OBJECTIVE

The magnitude of this effect on plasma micronutrient concentrations was investigated to provide guidance on the interpretation of routine clinical results.

DESIGN

Between 2001 and 2011, the results (2217 blood samples from 1303 patients) of routine micronutrient screens (plasma zinc, copper, selenium, and vitamins A, B-6, C, and E) and all vitamin D results (4327 blood samples from 3677 patients) were extracted from the laboratory database. C-reactive protein concentrations were measured as a marker of the severity of inflammation and categorized into 6 groups; for each group, plasma micronutrient concentrations and percentage changes were calculated.

RESULTS

Except for copper and vitamin E, all plasma micronutrient concentrations decreased with increasing severities of the acute inflammatory response. For selenium and vitamins B-6 and C, this occurred with only slightly increased C-reactive protein concentrations of 5 to 10 mg/L. For each micronutrient, the change in plasma concentrations varied markedly from patient to patient. The magnitude of the effect was greatest for selenium and vitamins A, B-6, C, and D, for which the median plasma concentrations decreased by >40%.

CONCLUSIONS

The clinical interpretation of plasma micronutrients can be made only with knowledge of the degree of inflammatory response. A reliable clinical interpretation can be made only if the C-reactive protein is <20 mg/L (plasma zinc), <10 mg/L (plasma selenium and vitamins A and D), or <5 mg/L (vitamins B-6 and C).

Evidence for oxidative stress and defective antioxidant response in guinea pigs with tuberculosis

The development of granulomatous inflammation with caseous necrosis is an important but poorly understood manifestation of tuberculosis in humans and some animal models. In this study we measured the byproducts of oxidative stress in granulomatous lesions as well as the systemic antioxidant capacity of BCG vaccinated and non-vaccinated guinea pigs experimentally infected with Mycobacterium tuberculosis. In non-vaccinated guinea pigs, oxidative stress was evident within 2 weeks of infection as measured by a decrease in the serum total antioxidant capacity and blood glutathione levels accompanied by an increase in malondialdehyde, a byproduct of lipid peroxidation, within lesions. Despite a decrease in total and reduced blood glutathione concentrations, there was an increase in lesion glutathione by immunohistochemistry in response to localized oxidative stress. In addition there was an increase in the expression of the host transcription factor nuclear erythroid 2 p45-related factor 2 (Nrf2), which regulates several protein and non-proteins antioxidants, including glutathione. Despite the increase in cytoplasmic expression of Nrf2, immunohistochemical staining revealed a defect in Nrf2 nuclear translocation within granulomatous lesions as well as a decrease in the expression of the Nrf2-regulated antioxidant protein NQO1. Treating M. tuberculosis-infected guinea pigs with the antioxidant drug N-acetyl cysteine (NAC) partially restored blood glutathione concentrations and the serum total antioxidant capacity. Treatment with NAC also decreased spleen bacterial counts, as well as decreased the lung and spleen lesion burden and the severity of lesion necrosis. These data suggest that the progressive oxidative stress during experimental tuberculosis in guinea pigs is due in part to a defect in host antioxidant defenses, which, we show here, can be partially restored with antioxidant treatment. These data suggest that the therapeutic strategies that reduce oxidant-mediated tissue damage may be beneficial as an adjunct therapy in the treatment and prevention of tuberculosis in humans.

Inability to walk due to scurvy: A forgotten disease

Scurvy has become rare in modern societies, but should be considered in malnourished persons, alcoholics, and in infants on unsupplemented milk diets who present with musculoskeletal pain or a bleeding tendency. The diagnosis of scurvy can be challenging because of the rare incidence and vague and nonspecific early symptoms. We report here a case of scurvy in a young boy who presented with an inability to walk and severe musculoskeletal pain. The diagnosis was established based on his clinical picture, radiological appearance, and low serum level of vitamin C. The patient responded well to vitamin C supplementation with full resolution of his symptoms. He regained his ability to walk and his family was happy and satisfied with the outcome of treatment. Although the incidence of scurvy has become low in Saudi Arabia, it can still occur and early recognition is important because of the excellent prognosis.

The ‘anomalous’ absorption of labelled and unlabelled vitamin C in man

Previous studies of vitamin C absorption in man using stable isotope probes have given results which cannot easily be reconciled with those obtained using non-isotope measurement. In order to investigate some of the apparent paradoxes we have conducted a study using two consecutive doses of vitamin C, one labelled and one unlabelled, given 90 min apart. Compatibility of the experimental results with two feasible models was investigated. In Model 1, ingested vitamin C enters a pre-existing pool before absorption, which occurs only when a threshold is exceeded; in Model 2, ingested vitamin C is exchanged with a pre-existing flux before absorption. The key difference between these two models lies in the predicted profile of labelled material in plasma. Model 1 predicts that the second unlabelled dose will produce a secondary release of labelled vitamin C which will not be observed on the basis of Model 2. In all subjects Model 1 failed to predict the observed plasma concentration profiles for labelled and unlabelled vitamin C, but Model 2 fitted the experimental observations. We speculate on possible physiological explanations for this behaviour, but from the limited information available cannot unequivocally confirm the model structure by identifying the source of the supposed flux.

Regulation of vitamin C transport

Ascorbic acid and dehydroascorbic acid (DHAA, oxidized vitamin C) are dietary sources of vitamin C in humans. Both nutrients are absorbed from the lumen of the intestine and renal tubules by, respectively, enterocytes and renal epithelial cells. Subsequently vitamin C circulates in the blood and enters all of the other cells of the body. Concerning flux across the plasma membrane, simple diffusion of ascorbic acid plays only a small or negligible role. More important are specific mechanisms of transport and metabolism that concentrate vitamin C intracellularly to enhance its function as an enzyme cofactor and antioxidant. The known transport mechanisms are facilitated diffusion of DHAA through glucose-sensitive and -insensitive transporters, facilitated diffusion of ascorbate through channels, exocytosis of ascorbate in secretory vesicles, and secondary active transport of ascorbate through the sodium-dependent vitamin C transporters SVCT1 and SVCT2 proteins that are encoded by the genes Slc23a1 and Slc23a2, respectively. Evidence is reviewed indicating that these transport pathways are regulated under physiological conditions and altered by aging and disease.

Proton pump inhibitors reduce the bioavailability of dietary vitamin C

BACKGROUND

The gastric juice concentration of vitamin C is reduced in subjects with elevated intragastric pH. This is probably because of the fact that the vitamin is unstable at non-acidic pH and undergoes irreversible denaturation.

AIM

To determine whether elevation of intragastric pH reduces the bioavailability of dietary vitamin C.

METHODS

Plasma vitamin C was measured before and after a course of omeprazole 40 mg/day for 4 weeks in 14 Helicobacter pylori positive and 15 H. pylori negative subjects. Dietary intake of vitamin C was measured and intragastric pH monitored.

RESULTS

Compared with the H. pylori negative subjects, H. pylori positive subjects had a lower mean daily vitamin C intake (141.7 mg vs. 41.5 mg, P < 0.01) and also lower plasma vitamin C concentration (25.1 microg/mL vs. 17.4 microg/mL, P < 0.0001). After 28 days of 40 mg/day of omeprazole the mean plasma vitamin C level had fallen by 12.3% (P = 0.04). This fall affected both the H. pylori positive and negative subjects.

CONCLUSIONS

We have shown that a short course of omeprazole will cause a reduction in the plasma vitamin C level of healthy volunteers. This decrease in plasma vitamin C is independent of dietary intake of the vitamin and indicates reduced bioavailability. The clinical significance of this is unclear but any adverse effects will be most apparent in H. pylori infected subjects who have a low pre-treatment vitamin C status.

Changes in Vitamin C Concentrations in Plasma and Milk from Dairy Cows After an Intramammary Infusion of Escherichia coli

Plasma and milk concentrations of ascorbic acid and dehydro-L-ascorbic acid (DHAA) were measured before and after 21 Holstein cows (approximately 26 DIM) were given an intramammary infusion of Escherichia coli. Blood, milk from the unchallenged quarters, and milk from the challenged gland were sampled immediately before challenge (d 0) and 24 h and 7 d postchallenge. Plasma vitamin C (ascorbic acid + DHAA) concentrations decreased 39%, and concentrations of vitamin C and ascorbic acid in milk from the challenged quarter decreased 52 and 62%, respectively, in samples taken 24 h postchallenge. No change was observed in vitamin C concentrations in milk from unchallenged quarters. The concentration of DHAA in milk from challenged quarters increased 67% 24 h postchallenge. The duration of clinical mastitis, peak body temperature, number of colony-forming units of E. coli isolated from the infected gland, and loss in milk yield were associated with a change in concentration of vitamin C in milk from the challenged quarter. Increased severity of clinical signs was associated with large decreases in concentration of vitamin C in milk from the challenged quarter. Similar, but statistically weaker, relationships were observed for changes in plasma vitamin C concentrations.

Anti-oxidant therapy for the treatment of coronary artery disease

Coronary artery disease is the most common cause of death in developed countries. It may present in many different ways, but most frequently as a myocardial infarction, sudden death, angina or heart failure. Preventive measures in relation to coronary artery disease are particularly important because of its high incidence, high mortality and because most patients die outside hospital. Since the oxidation of low density lipoprotein cholesterol (LDL-C) is a critical early step in the process of atheroma formation, taking anti-oxidants to prevent LDL-C oxidation may prove a very effective means of reducing coronary artery disease mortality. However, the role of anti-oxidants in coronary artery disease prevention needs to be evaluated as part of an overall strategy that includes pharmacological and non-pharmacological measures, which are described in this review. In addition, a more structured and scientific approach to anti-oxidant therapy needs to be adopted. This requires that evidence for oxidative stress in a particular condition is obtained, the nature and severity determined and an appropriate anti-oxidant is administered, in an effective dose, which can be shown to correct the oxidative stress. When this is achieved, meaningful clinical trials should be possible, which will determine the place of anti-oxidant therapy for the specified condition.

Micronutrients, vitamins, and cancer risk

There is now considerable evidence that a high intake of fruit and vegetables can decrease the risk of developing cancer. While it is by no means clear how this particular diet alters cancer risk, there is substantial metabolic and experimental evidence to implicate antioxidant micronutrients, The dietary components include some vitamins, such as C and E, the carotenoids, and the flavinoids. In chemical systems, cell culture, and experimental animals, these components have the ability to quench the carcinogenic potential of reactive oxygen species and other carcinogens, such as N-nitrosocompounds. Some of these micronutrients can act synergistically, and high concentrations are often found in tissues, such as the leucocytes and mucosal cells, that are particularly prone to reactive species attack. Experimental systems containing these micronutrients also appear to be able to reduce DNA damage and mutagenesis. However, assessment of individual vitamin intake, as opposed to fruit and vegetable consumption, does not increase the protective association of these components, and the results of intervention studies in man, especially with carotenoids, have been disappointing. We await the results of other clinical trials, but as yet, there is insufficient evidence to recommend supplements of these particular micronutrients for the prevention of cancer. However, it would be prudent to suggest changes in diet that would increase consumption of fruit and vegetables, such as a diet is clearly associated with protection.

Vitamin C: prospective functional markers for defining optimal nutritional status

Most species of plants and animals synthesize ascorbic acid, but human subjects cannot, making vitamin C an essential component of our diet. Relationships between vitamin C intake and status, and between status and health are not yet clear. There is evidence, however, that higher intake of vitamin C is associated with lower risk of disease, supporting the concept that optimal intake is needed for optimal vitamin C status, and that both factors are required for optimal health. Vitamin C has low toxicity in healthy subjects, but a clear definition of optimal status and the dietary intake required to meet and maintain this status is needed before a change in the current recommended intake can be considered. Available evidence suggests that intake of 200 mg vitamin C/d saturates tissues and maintains fasting plasma levels above the proposed threshold (50 mumol/l) for minimum risk of CHD. However, the issue of whether or not these levels produce 'optimal vitamin C status' awaits the clear and accepted definition of the term. This definition in turn awaits the development of reliable functional markers capable of assessing the effects of varying levels of vitamin C nutriture. In the present paper the relationship between intake and body stores of vitamin C and the role of vitamin C in human health are reviewed briefly. The requirements of a reliable functional marker of human vitamin C status are defined, three classes of functional markers (molecular, biochemical and physiological) are described, and possible candidate markers are examined.

Transport of ascorbic acid in gastric epithelial cells in vitro

The normal human stomach contains high concentrations of ascorbic acid in both the mucosa and gastric juice, but the mechanism of ascorbic acid transport in the stomach is unknown. To understand more, ascorbic acid accumulation in gastric epithelial cell lines was investigated. Ascorbic acid was transported into gastric epithelial cells (Kato III and AGS cell lines) and accumulated up to eight-fold against a concentration gradient, as measured by high-performance liquid chromatography with electrochemical detection. Kinetic analysis using both non-radioactive and radioactive sources of ascorbic acid showed that ascorbic acid accumulation was mediated by one saturable concentration-dependent transport system with a Km of 3-11 micromol/l and Vmax of 0.8-0.9 nmol/10(8) cells/min. These data suggest that ascorbic acid uptake in gastric mucosal cells may be facilitated by a high-affinity saturable transport activity. Loss of intracellular ascorbic acid from Kato III and AGS cells was slower than seen in vivo which may limit the usefulness of these cell lines as a physiological model for the secretion of mucosal ascorbic acid into gastric juice.

Does diabetes mellitus increase the requirement for vitamin C?

This paper reviews the scientific evidence regarding the vitamin C status of people with diabetes mellitus and whether they might have increased dietary vitamin C requirements. English language articles published from 1935 to the present that either compare ascorbic acid concentrations of persons with and without diabetes mellitus or assess the impact of vitamin C supplementation on various health outcomes among persons with diabetes mellitus were examined. Most studies have found people with diabetes mellitus to have at least 30% lower circulating ascorbic acid concentrations than people without diabetes mellitus. Vitamin C supplementation had little impact on blood glucose concentrations, but was found to lower cellular sorbitol concentrations and to reduce capillary fragility. Much of the past research in this area has been methodologically weak. To further understand the relation of ascorbic acid and diabetes mellitus, randomized clinical trials of ascorbic acid supplementation should be a high priority for research.

Lipid peroxidation: a review of causes, consequences, measurement and dietary influences

In this review the process of lipid peroxidation and the atherogenicity of peroxidied lipids are discussed. Recent findings with regard to the effect of selected dietary factors on susceptibility of lipids to oxidative stress and on antioxidant defences are analysed with particular reference to their potential use in the prevention and treatment of atherogenesis and, by extension, coronary heart disease. Laboratory methods of assessing antioxidant defences, lipid peroxidation and the effects of lipid peroxidation are also reviewed and discussed with particular reference to their ability to assess in vivo oxidative stress and lipid peroxidation status. A range of oxidative stress indices are presented and their limitations discussed, but the main focus is on the most commonly used laboratory test for lipid peroxidation, the thiobarbituric acid reacting substances (TBARS) test. Finally, the influence of selected dietary factors on measured peroxidation status is discussed, with particular reference to the antioxidant vitamins C (ascorbic acid) and E (alpha tocopherol) and the type of fatty acids (mono- and poly-unsaturated) in the diet.