Effects of three months of treatment with vitamin E and N-acetyl cysteine on the oxidative balance in patients with tran
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ORIGINAL ARTICLE
Effects of three months of treatment with vitamin E and N-acetyl cysteine on the oxidative balance in patients with transfusion-dependent β-thalassemia Sezaneh Haghpanah 1 & Nader Cohan 1 & Mohammadreza Bordbar 1 & Asghar Bazrafshan 1 & Mehran Karimi 1 & Soheila Zareifar 1 & Sanaz Safaei 1 & Azam Aramesh 1 & Mohamad Moghadam 1 & Saeid Amiri Zadeh Fard 2 & Omid Reza Zekavat 1 Received: 5 August 2020 / Accepted: 11 November 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Oxidative stress is a major mechanism contributing to the progression of β-thalassemia. To assess the effect of vitamin E and Nacetyl cysteine (NAC) as antioxidant agents on total oxidative stress (TOS) status and total antioxidant capacity (TAC) in patients with transfusion-dependent β-thalassemia (TDT). In this open-label randomized controlled trial, from May to August 2019, 78 eligible patients with TDT over the age of 18 were enrolled. All patients were registered at the Thalassemia Clinic of Shiraz University of Medical Sciences in Southern Iran. Patients were randomly allocated to the NAC group (10 mg/kg/day, orally), vitamin E group (10 U/kg/day, orally), and control group. The duration of the study was 3 months. The mean age of the participants was 28.5 ± 5.1 (range: 18–41) years. At the end of the study, TOS significantly decreased only in the vitamin E group (mean difference (MD), 95% confidence interval (CI): 0.27 (0.03–0.50), P = 0.026). TAC significantly decreased in both supplemented groups at the 3rd month of treatment (NAC group: MD (95% CI): 0.11 (0.04–0.18), P = 0.002 and vitamin E group: 0.09 (0.01–0.16), P = 0.022 respectively). Hemoglobin did not significantly change at the end of the study in each group (P > 0.05). Mild transient adverse events occurred in 4 patients of the NAC group and 5 patients of the vitamin E group with no need to discontinue the treatment. Vitamin E can be a safe and effective supplement in improving oxidative stress in patients with TDT. Moreover, it seems that a longer duration of using antioxidant supplements needs to make clinical hematologic improvement in TDT patients. Keywords Antioxidants . β-thalassemia . N-Acetyl cysteine . Oxidative stress . Vitamin E
Introduction β-thalassemia is one of the most common single-gene disorders worldwide. It is characterized by the absence or decrease in the β-globin chain due to the mutation in the β-globin gene. Depending on the amount of genetic defect, patients present with mild to severe clinical phenotype. In severe form, transfusion-dependent β-thalassemia (TDT), patients need * Omid Reza Zekavat [email protected] 1
Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
2
Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
regular blood transfusion since early infancy due to severe hemolytic anemia and ineffective erythropoiesis [1, 2]. So, TDT patients face iron overload due to lifelong blood transfusion on the one hand as well as hemolysis
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