Evaluation of Oxidative Stress in Chronic ITP and the role of an Adjuvant Antioxidant

Abstract

mmune thrombocytopenia (ITP) is an immune-mediated hematologic disorder with increased platelet destruction and decreased platelet production leading to thrombocytopenia and, thus, mucocutaneous bleeding. Oxidative stress occurs as a result of increased activity of free radical–producing enzymes, decreased activity of free radical–removing enzymes, and insufficient levels of antioxidants. Free oxygen radicals may have an effect on the structural and functional damage of platelets and plays a role in pathogenesis of thrombocytopenia in both, acute and chronic ITP. Thus the aim of the study was to assess oxidant and antioxidant systems initially in patients with chronic immune thrombocytopenia (ITP) and to evaluate effect of antioxidant therapy on, platelet count and antioxidant status during 6 months follow-up. The study was an interventional 6 months prospective randomized open-labeled study conducted at Hematology Clinic, Children Hospital Ain Shams University in patients aged less than 18 years with chronic ITP. Patients were randomly allocated to one of two groups. Those in group 1(interventional arm) included twenty-four patients with chronic ITP and all received antioxidant therapy (1 tablet (Antox®) (Mepaco). contains: Vit. A 2000 IU, Vit C 90 mg, Vit E 15 mg and selenium yeast 55 ug), while those in Group 2, (non-interventional arm), included twelve patients with chronic ITP, did not receive the antioxidant therapy. Both groups were comparable and compared with age and sex matched healthy controls. The primary efficacy endpoints were the difference between both groups in the change from baseline to 6 months in mean platelet count, bleeding score, total antioxidant capacity (TAC), catalase (CAT), reduced glutathione (reduced-GSH) and serum malondialdehyde (MDA)levels. Total antioxidant capacity (TAC), catalase (CAT), reduced glutathione (reduced-GSH) and serum malondialdehyde (MDA) levels were measured baseline and 6 months later at end of study. The end of study samples were assessed when patients were 2 weeks off antioxidant therapy. In addition, patients had complete blood count every month, and monthly detailed clinical examination with assessment of bleeding score. Results from this study showed a significantly higher level of MDA, markers of oxidative stress, as well as lower levels of TAC,GSH and CAT in patients with chronic ITP