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Collaborators 
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University of California, Berkeley
Gladys Block, Principle Investigator
Chris Jenson, Study Director
Marion Dietrich, Laboratory Advisor
Jo Ann Johnson, Study Manager
University of California, Berkeley: SPH Biorepository
Nina Holland, Primary Investigator
Nishat Shaikh
Karen Huen
Children’s Hospital Oakland, Pediatric Clinical Research Center
Laurie Schumacher, Administration
Lisa Lavrisha, Research Coordinator
Paul Harmatz, MD
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Purpose of the Study
The purpose of the UCB Vitamin research study
is to examine the effect of supplemental antioxidants, vitamin C and E,
on measures of inflammation and oxidative stress. Recent research has
found that compounds found in the blood that are associated with
inflammation and oxidative stress, may increase the rise of heart
disease. Antioxidants nutrients such as vitamin C and E may reduce the
levels of these compounds in the blood, which in turn may reduce the
rise of heart disease.
Study Hypotheses
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Antioxidant supplementation will decrease C-reactive protein (CRP), a
marker of inflammation, and biomarkers of oxidative damage to lipids
and membranes, in nonsmokers. The effect on CRP will be stronger for
treatment with vitamin C than with vitamin E.
- Women will have higher baseline CRP and lipid peroxidation biomarkers than men of similar age.
- Body fat will be significantly positively associated with baseline CRP and lipid peroxidation
- Some but not all of the gender difference will be explained by differences in body fat.
Specific Aims
- To
determine whether antioxidant supplementation can lower the
inflammation marker C-reactive protein (CRP) and lipid peroxidation
biomarkers, in a randomized controlled intervention study of
nonsmokers. Secondary aim.
1a. To determine whether one
treatment is significantly more effective than the other.
1b. To determine whether treatment effects differ by gender or body fat
- To
determine whether there are gender or body fat differences in baseline
CRP or in baseline lipid peroxidation, in nonsmokers, independent of
other covariates. Secondary aim.
2a. In women, to determine whether
menopause status is associated with higher baseline CRP or lipid
peroxidation, independent of covariates
Study Design Overview
Nonsmokers (n=400 to achieve a final sample of 360) will be
recruited from the San Francisco Bay Area. Prior to randomization,
blood will be drawn and assayed for C-reactive protein (CRP),
biomarkers of oxidative damage, serum antioxidants and other serum
factors (see details: “Laboratory Processing Procedures”). Subjects
will then be randomized to one of three intervention groups. After two
months of supplementation with either placebo or one of two different
antioxidants, blood will again be drawn and assayed for the same
factors as at baseline. The primary outcome of the intervention study
will be change in CRP and change in oxidation biomarkers. Baseline
blood values of CRP and lipid peroxidation prior to intervention will
be analyzed to confirm differences by gender and BMI.
Rationale
In a previous randomized trial we observed treatment effects of
antioxidant supplementation on C-reactive protein, in addition to
treatment effects on lipid peroxidation. Oxidative damage has been
associated with numerous disease conditions and C-reactive protein has
been shown to be “remarkably consistent” in its association with
cardiovascular disease. Thus, this is potentially a very important
observation. However, our previous randomized trial did not intervene
on subjects who were not actively or passively exposed to cigarette
smoke. We and others have shown that persons not actively or passively
exposed to cigarette smoke do have elevated C-reactive protein and
oxidative damage. Thus, it is important to now conduct a randomized
trial on this group, who represent the majority of Americans. If such a
randomized trial of antioxidants is shown to reduce C-reactive protein
and oxidative damage, it would provide an inexpensive and nontoxic
approach to reducing these well-established risk factors for disease.
In addition, our previous study observed higher C-reactive protein
and lipid peroxidation in women compared to men. If this is true, it is
of great importance for understanding women’s greater susceptibility
than men to agents such as tobacco and alcohol, as well as for
understanding those diseases more common in women, such as
osteoarthritis. However, two-thirds of subjects in our previous
baseline study were either actively or passively exposed to cigarette
smoke. It is critical to confirm the higher CRP and oxidation in women
compared to men in a sample not exposed to cigarette smoke at all. Such
an observation, if confirmed in non-cigarette smoke-exposed subjects,
would open new avenues of research on women’s health. It is also
critical to determine whether that observation is independent of
women’s higher percentage of body fat, and independent of menopausal
status. This could not be done in our previous study because we did not
have appropriate measures of either of those factors.
Our previous study also observed higher CRP and oxidation in obese
persons compared to those of normal weight. A higher CRP among the
obese is well established, but the link with oxidation is new. As
noted, oxidative damage has been associated with numerous disease
conditions. If confirmed it would be very important, as it could lead
to new approaches to both understanding and managing the health
problems associated with obesity. But again, two-thirds of subjects in
our previous baseline study were either actively or passively exposed
to cigarette smoke. It is critical to confirm the oxidative effects of
overweight and obesity in a non-cigarette smoke exposed sample.
In summary, our previous intervention study included smokers as well
as passive smokers. In addition, that study did not measure body fat
(except as BMI), assess menopause status, or intervene on persons who
neither smoked nor were passively exposed. We now propose a study in
nonsmokers not passively exposed, to test the effects of antioxidant
supplementation on C-reactive protein and oxidative damage. In the
baseline data prior to intervention, we will attempt to confirm our
previous finding of higher oxidation and C-reactive protein in women,
in a much larger sample, and determine the independent effects of
obesity and menopause on those factors.
Laboratory Processing Images
A scheme of sample processing is shown below.
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Publications
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Holland NT, Pfleger LP, Berger E, Ho A, Bastaki M. Molecular Epidemiology Biomarkers - Sample Collection and Banking Considerations. Toxicology and Applied Pharmacology, 206:261-68, 2005.
R Aamodt, A.Anouna, P.Baird, J.Beck, m.Bledsoe, Y De Souza, W.Grizzle, J.Gosh, N.Holland, J.Vaught. ISBER (International Society for Biological and Environmental Repositories), Best practices for repositories I: Collection, storage, and retrieval of human biological materials for research. Cell Preservation and Technology, 3(1):5-48, 2005.
N. T. Holland, M. T. Smith, B. Eskenazi, M. Bastaki. Biological Sample Collection and Processing for Molecular Epidemiological Studies, Mutation Research Reviews, 7702:1-18, 2003.
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