Antioxidants and Cardiovascular Disease: 258 (Developments in Cardiovascular Medicine)

J C Tardif/Martial G Bourassa: Antioxidants and Cardiovascular Disease (kartoniertes Buch)
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Exogenous ROS derive by exposure to cigarette smoke, environmental pollutants, consumption of alcohol in excess, exposure to ionizing radiations, viral and bacterial infections, and others [8]. Individual, hereditary factors, and lifestyle are the main determinants of OS.

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Useful methods to evaluate OS include [9,10]. These ROS can attack some molecules in biological membranes and tissues, thus inducing various diseases [7,11]. Afterwards, we refer on some pathologies favored by detrimental effects of ROS, responsible for morbidity and death of total population []. We also refer on healthy ageing connected to OS in different ways [20,21] Figure 1. Atherosclerosis is the result of the oxidation of the low density lipoproteins LDL present in the arterial wall and produced by ROS.

The LDL-oxidation induces, in turn, the expression of adhesion-molecules, the proliferation and migration of smooth muscle cells, the oxidation of lipids, the endothelial dysfunction apoptosis and the alteration of vasomotor activity []. In confirmation of the role of ROS in the progressive endothelium dysfunction we underline the increased Nitrosodine a cellular marker of OS concentration in aged subjects in comparison with young healthy individuals [25]. Another mechanism through which OS participates to atherogenesis consists in the production of trascription factors, as nuclear factor xB NF-xB and activator protein 1, which participate in the expression of adhesion molecules as vascular cellular adhesion molecules VCAM-1 , intracellular adhesion molecules ICAM-1 and other cytokines acting in smooth muscle cells of atherosclerotic vessels [26,27].

Adult Stem Cells in Vascular Remodeling

In addition, ROS are able to modulate matrix metalloproteinases MMPs degradation and could contribute to the instability of atherosclerotic plaques [28,29]. The role plays by OS in the atherosclerotic process was confirmed by the use of statins in atherosclerosis. As well as the cholesterol levels' reduction, these drugs also lead to an increase of NO production and inhibit LDL oxidation [30]. The cancer-induction is a multifactorial process that involves several factors, as genetic, physical, chemical and environmental factors. Recent knowledge's in ROS biology and tumor genesis suggest that free radicals control various aspects of tumor development including inflammation, transformation, survival, proliferation of cancers' cells, invasion, angiogenesis, and metastasis [].

Specifically, free radicals directly or indirectly act, via DNA damage, on gene expression and signaling at the cellular levels [9]. In succession, the main effects of ROS on tumor genesis and some clinical their complications are reported:.

OS effects on several biochemical pathways, such as epidermal growth factor receptor EGFR or mTOR, that involve key signaling proteins favoring cells' reproduction [34]. ROS contributes to increased cell's motility, migration and invasion of cancer-cells, resulting in tumor expansion and metastases [35]. Of these, VEGF has emerged as the crucial role in the regulation of neo-angiogenesis. MMPs are a family of enzymes that proteolytically degrade some components of the extracellular matrix, favoring neo-angiogenesis.

That happens by degradation of the vascular basement membrane of the extracellular matrix in order to allow endothelial cells to migrate and invade into the surrouding tissue. Effects on mRNA. Concerning this topic, Favaro et al.


The majority of agents used to kill cancer cells ionizing radiations, most chemotherapeutical agents and some targeted therapies work through either directly or indirectly generating ROS that block key steps in the cell cycle [42]. In this connection, current evidences support that antioxidants protect normal cells against the insults of chemotherapy and radiotherapy [42]. On the other hand, these same prevent tumorigenesis and increase lifespan [43].

Previous investigations provide convincing evidence about the relationship between mitochondrial pro-oxidant agents production and insulin resistance [44].

The link between OS and insulin resistant conditions seems to be the inflammatory state [45]. In confirmation of the role of OS in metabolic disorders, Meigs et al. Initially, the condition of insulin resistance is compensated by hyperinsulinemia with normal glucose tolerance. Impaired glucose tolerance occurs when either insulin resistance increases or compensatory insulin secretory response decreases or both occur, accelerating the progression to overt type 2 diabetes mellitus T2DM. A recent editorial of Youn et al. On the other hand, the expansion of visceral adipose tissue caused by over-consumption of nutrients, generate an increase of visceral adipose tissue.


As visceral fat stores expand, adipocytes generate increased ROS levels and metabolic syndrome [51]. Therefore, two conditions OS and obesity can be considered reciprocally as cause and effect one of another [52,53]. Neurodegenerative diseases indicates a loss of nerve structure and function, leading to a progressive brain damage and neurodegeneration. Apart from environmental or genetic factors, OS largely contributes to neurodegeneration.

Several studies showed that OS plays a central role in the neuropathological lesions of AD. There are: beta-amyloid peptide deposits also called as senile plaques , happening at early stage of AD and neurofibrillary tangles, typical of the late stage [54]. Recent evidences suggest that OS may also favour AD pathogenesis by disruption of homeostasis of some metals such as iron, zinc and copper and ROS accumulation in the mitochondria mitochondrial dysfunction [55,56].

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Therapeutically, it is evidenced that some compounds, as Mitoquinone mesylate reduces beta-amyloid accumulation decreasing OS [57,58]. Most of cases of PD are idiopathic. Exposure to some substances as pesticides, organic solvents, toxins viral and bacteric infections play also a role.

Obviously, aging di per se is an important factor favoring the onset of PD. But, in all PD variants, OS is the underlying mechanism that leads to cellular dysfunctions [61]. The major sources of ROS, in PD are: dopaminergic cells' metabolism, mitochondrial dysfunction and neuroinflammation [62]. Specifically, OS happening in dopaminergic neurotransmitters, results in modification of intracellular macromolecules whose functions are important for cell survival. In addition, Dopamine metabolites have been shown to induce proteosomal inhibition, which can lead the cells to undergo apoptosis [65].

Adult Stem Cells in Vascular Remodeling

Finally in the disease's progression, Neuromelanin the last product of Dopamine oxidation can be accumulated in the nigral region pars compacta as expression of death's neurons in this region, favouring PD [66]. Another source of OS associated with the pathogenesis of PD is the mitochondrial dysfunction [62]. Neuronal loss happening in PD is also associated with chronic neuroinflammation controlled by microglia [67]. For these complicated connections between PD and ROS, it is difficult to determine whether OS leads to or is a consequence of neurodegeneration [68].

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Amyotrophic Lateral Sclerosis ALS is characterized by progressive injury and death of lower motor neurons in the spinal cord on brainstem, and upper motor neurons in the motor cortex. The causes of ALS are unknown but, among the mechanisms inducing this, OS is certainly involved [69,70]. An increased Nitrosodine a marker for oxidative damage levels, was found to demonstrate the primary role of OS in the ALS beginning [71].

DNA damage induced by elevated levels of hydroxyl-deoxyguanosine was described too [72]. In addition, the hypothesis that OS is a cause of ALS was indirectly confirmed by the discovery that mutation of anti-oxidant enzyme superoxide dismutase-1 SOD-1 was found in a significant ALS cases [73]. The mechanism by which mutant enzyme leads to motor neuron degeneration was recently identified in the neuronal mitochondrial damage induced by the SOD-1 mutation [74]. Excitotoxicity, mitochondrial dysfunction, protein aggregation, cytoskeletal dysfunction and others are other mechanisms implicated in motor neuron injury.

Although the mechanisms inducing ageing are poorly understood, a growing body of evidence points ROS as one of the main determinants of this condition. The effect is attained by the OS acting on some macromolecules, such as DNA, proteins, carbohydrates, and lipids.

The age-dependent accumulation of ROS induces a loss of human organs' function, with chronic changes of physiological conditions and acceleration of cells death. Particularly, oxidative damage in aged organisms happens in specific intracellular organelles, as the mitochondria [75].

But, several evidences does not support this statement [76]. In contrast with Hartman theory of ageing, recent evidences shown that increasing ROS generation can increase longevity even rather than reducing [77,78]. In accordance with these controversial effects of free radicals on healthy ageing, it must be also relate on the conflicting results obtained by the antioxidant supplementation. A recent meta-analysis show no evidence to support the use of vitamin and antioxidant supplements for prevention of age-related diseases [80].

But, a meta-analysis on the risk of Alzheimer's disease shown that dietary intakes of vitamin E, vitamin C, and beta carotene can lower the risk of this disease [81]. Therefore, the effectiveness of anti-oxidants' treatment to contrast age-related diseases is still uncertain and further studies are requested [82]. OS also intervenes in other pathologic conditions frequently occurring among human diseases, such as chronic fatigue syndrome, chronic obstructive pulmonary disease, and skin disease.

Chronic fatigue syndrome CFS is an emerging disorder, particularly frequent in women. The syndrome is characterized by incapacitating fatigue of at least 6 months duration. It can affect every major system in the body, with neurological, immunological, hormonal, gastro-intestinal, musculoskeletal and pshycological problems [83]. The pathophysiology of the syndrome remains elusive. Initially, Holmes et al. Smith et al.

In this area, Kennedy et al. In fact, the sarcolemmal and sarcoplasmic membranes of CFS patients clearly present signs of OS [87]. The mitochondrial respiratory chain is the major site of ROS production in muscle cells [88]. It is known that the pathogenesis of chronic obstructive pulmonary disease COPD depends on the interaction between environmental and genetic factors.

Among the firsts , the most important factor of COPD acting in the western world is the cigarette smoking and the inhalation of combustion products [89]. Concerning this, OS plays an important role through injury to the respiratory apparatus [90]. That results in the degradation of polyunsaturated fatty acids, and leads to the alterations in the structure and permeability of the membrane.