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Update on Vitamin E and Its Potential Role in Preventing or Treating Bronchopulmonary Dysplasia
Cosby A Stone1, Cindy T McEvoy2, Judy L Aschner3
1Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Insights
Vitamin E, an antioxidant, was studied for preventing bronchopulmonary dysplasia (BPD) in premature infants with mixed results. New research explores vitamin E isoforms for improved prevention strategies against BPD.
Area of Science:
- Neonatology
- Nutritional Science
- Pulmonology
Background:
- Vitamin E, an essential dietary antioxidant, plays a role in mitigating oxidative stress.
- Previous trials using high-dose vitamin E (α-tocopherol) to prevent bronchopulmonary dysplasia (BPD) in premature infants yielded inconsistent outcomes.
- Concerns exist regarding supraphysiologic doses and potentially harmful excipients used in earlier vitamin E formulations for BPD prevention.
Purpose of the Study:
- To review and update current knowledge on vitamin E isoforms (α-tocopherol and γ-tocopherol) and their impact on respiratory health and BPD.
- To evaluate the potential of optimizing physiologic concentrations of vitamin E isoforms during pregnancy or post-preterm birth for BPD prevention.
- To identify knowledge gaps and suggest future research directions for vitamin E-based BPD prevention strategies.
Main Methods:
- Literature review and synthesis of studies on vitamin E isoforms and BPD.
- Analysis of advancements in neonatal management and understanding of vitamin E's role since 1991.
- Identification of subgroups at increased risk for vitamin E deficiency, such as smokers.
Main Results:
- Significant differences exist in the effects of α-tocopherol and γ-tocopherol on respiratory morbidity and inflammation.
- Previous BPD prevention trials used supraphysiologic doses and sometimes included harmful excipients.
- Current understanding of vitamin E isoforms in respiratory health has advanced considerably.
Conclusions:
- Further adequately powered studies are needed to investigate the efficacy of individual or combined vitamin E isoforms in preventing BPD.
- Target populations for future research include pregnant women at risk of preterm birth and their premature infants, especially those with vitamin E deficiency risk factors.
- Optimizing vitamin E isoform concentrations may offer a promising avenue for reducing BPD development.
Abstract:
Vitamin E is obtained only through the diet and has a number of important biological activities, including functioning as an antioxidant. Evidence that free radicals may contribute to pathological processes such as bronchopulmonary dysplasia (BPD), a disease of prematurity associated with increased lung injury, inflammation and oxidative stress, led to trials of the antioxidant vitamin E (α-tocopherol) to prevent BPD with variable results. These trials were all conducted at supraphysiologic doses and 2 of these trials utilized a formulation containing a potentially harmful excipient. Since 1991, when the last of these trials was conducted, both neonatal management strategies for minimizing oxygen and ventilator-related lung injury and our understanding of vitamin E isoforms in respiratory health have advanced substantially. It is now known that there are differences between the effects of vitamin E isoforms α-tocopherol and γ-tocopherol on the development of respiratory morbidity and inflammation. What is not known is whether improvements in physiologic concentrations of individual or combinations of vitamin E isoforms during pregnancy or following preterm birth might prevent or reduce BPD development. The answers to these questions require adequately powered studies targeting pregnant women at risk of preterm birth or their premature infants immediately following birth, especially in certain subgroups that are at increased risk of vitamin E deficiency (e.g., smokers). The objective of this review is to compile, update, and interpret what is known about vitamin E isoforms and BPD since these first studies were conducted, and suggest future research directions.
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