title: Lack of effect of high dose vitamin E on xanthoma regression in homozygous familial hypercholesterolaemia.
abstract: There is increasing evidence that oxidative modification of low-density lipoprotein (LDL) plays an important role in the pathogenesis of atherosclerosis. Homozygous familial hypercholesterolaemia (HFH) is characterized by premature, severe atherosclerosis. Drugs available at present are ineffective in lowering the markedly elevated LDL levels in this condition; antioxidant therapy to protect the LDL against oxidation may be of benefit. Probucol, the only drug shown to induce xanthoma regression in HFH, is a potent antioxidant, but it also lowers high-density lipoprotein cholesterol (HDL-C) levels, causing some concern. Vitamin E is a naturally occurring antioxidant that does not affect HDL-C levels. We have therefore evaluated the effect of long-term high dose vitamin E on xanthoma regression in HFH. Ten subjects with HFH, mean age 17 years (range 4-34), received vitamin E (400-1000 mg/dl alpha-tocopherol acetate/day) for a period of 23 months (range 12-27). There was a 4.2-fold increase in the mean serum vitamin E level (mean (S.D.) 49.7 (19.9) to 177.9 (45.6) mumol/l; P < 0.005), but no change in serum lipid or lipoprotein concentrations. Although there was an increase in the in vitro resistance of LDL to oxidation as determined by the duration of the lag phase during copper-mediated oxidation (116 (8.34) vs. 141.5 (9.23) min; P < 0.005) there was no xanthoma regression; in fact they progressed in 4 subjects. Unlike probucol, high dose long-term vitamin E has no demonstrable effect on xanthoma regression in HFH.
authors.affiliation: Carbohydrate and Lipid Metabolism Research Group, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: F J
authors.initials: FJ
authors.lastname: Raal
authors.forename: A J
authors.initials: AJ
authors.lastname: Areias
authors.forename: G J
authors.initials: GJ
authors.lastname: Pilcher
authors.forename: B I
authors.initials: BI
authors.lastname: Joffe
authors.forename: H C
authors.initials: HC
authors.lastname: Seftel
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000975:Antioxidants / Q000008:administration & dosage* / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D002784:Cholesterol / Q000097:blood; D005260:Female; D006720:Homozygote; D006801:Humans; D006938:Hyperlipoproteinemia Type II / Q000097:blood / Q000150:complications* / Q000235:genetics; D066298:In Vitro Techniques; D008054:Lipid Peroxides / Q000378:metabolism; D008297:Male; D010084:Oxidation-Reduction; D014280:Triglycerides / Q000097:blood; D014810:Vitamin E / Q000008:administration & dosage* / Q000097:blood / Q000627:therapeutic use; D014973:Xanthomatosis / Q000188:drug therapy* / Q000209:etiology
chemical_list: D000975:Antioxidants; D008054:Lipid Peroxides; D014280:Triglycerides; D014810:Vitamin E; D002784:Cholesterol