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> > ALPHA LIPOIC ACID

> >

> >

> > DESCRIPTION

> >

> > Alpha lipoic acid, (also known as lipoic acid and thioctic acid) is a

> > sulphur-containing vitamin-like antioxidant. Alpha lipoic acid is

produced

> > naturally in the body and found in the food sources of liver, brewer's

> > yeast, and potatoes. Alpha lipoic acid has dual role in human health; it

> is

> > a powerful antioxidant and a key component for producing cellular

energy.

> As

> > an antioxidant, alpha lipoic acid is unique in that it is both water-

and

> > fat-soluble; thus it can be used throughout the body. It also extends

and

> > enhances the effect of other antioxidants, which are used to defend the

> body

> > against free radical damage. In its metabolic role, alpha lipoic acid is

a

> > fundamental coenzyme in two vital reactions that lead to the production

of

> > cellular energy (ATP). Alpha lipoic acid was first isolated in 1957 and

> > originally, seemed to be a member of the vitamin B-complex. Alpha lipoic

> > acid would have been the first fat-soluble B vitamin isolated. Most

human

> > coenzymes are produced from some of the B-complex vitamins or are

> themselves

> > vitamins (Passwater 1995). Alpha lipoic acid is not considered a

vitamin,

> > but is termed a " conditionally essential " nutrient. This is because

> > presumably the body can produce sufficient levels or it is acquired in

> > sufficient quantities from food (Murray 1996). The human body can make

> > enough alpha lipoic acid to prevent a recognizable deficiency disease,

> > though not enough to perform all its functions. The optimal level of

alpha

> > lipoic acid varies with each person depending on biochemical

differences,

> > lifestyle, exercise and how much oxidative stress they experience.

Certain

> > diseases, environmental conditions and age can cause a deficiency in

> lipoic

> > acid, and thus the body often doesn't make enough to meet all its

> metabolic

> > and antioxidant needs.

> >

> > METHOD OF ACTION

> >

> > Alpha lipoic acid is involved in the metabolic process of converting

> > carbohydrates into energy. When sugar is metabolized in the production

of

> > energy, it is converted into pyruvic acid. The pyruvate is broken down

by

> an

> > enzyme complex that contains lipoic acid, niacin and thiamine. Since the

> > human body tends to have only the minimum amount of alpha lipoic acid to

> > prevent recognizable disease, supplementation may help improve energy

> > metabolism. This is particularly applicable in people with lower than

> normal

> > levels, for example, individuals with diabetes, liver cirrhosis, heart

> > disease and HIV.

> >

> > As an antioxidant, since alpha lipoic acid is both water- and

fat-soluble,

> > it is effective against a broader range of free radicals than vitamin C

> > (water soluble) and vitamin E (fat-soluble). Because of it unique size

and

> > chemical structure, lipoic acid has access to virtually the entire body,

> > whereas most antioxidants only protect isolated areas of the body.

Inside

> > the cell, alpha lipoic acid is quickly broken down to dihydrolipoic

acid,

> > and even more potent free-radical scavenger. Supplementation with lipoic

> > acid wards off scurvy (vitamin C deficiency).

> >

> > THERAPEUTIC APPROACHES

> >

> > The principal uses of alpha lipoic acid are in the treatment of diabetes

> and

> > HIV/AIDS. It has also been used in cases of liver cirrhosis, heart

> disease,

> > cataracts, heavy-metal toxicity and detoxification support. Alpha lipoic

> > acid is available in supplemental form of tablets and capsules. For use

as

> a

> > general antioxidant, the recommended dose is 20 to 50 mg daily. In the

> > treatment of diabetes, the recommended dose is 300 to 600 mg daily. In

the

> > treatment of AIDS, the recommended dose is 150 mg three times daily

> (Murray,

> > 1996). Although lipoic acid deficiency states have not been demonstrated

> in

> > human beings, animal studies show that a deficiency of lipoic acid

results

> > in reduced muscle mass, brain atrophy, failure to thrive and increased

> > lactic acid accumulation.

> >

> > DIABETES

> >

> > Alpha lipoic acid has been used in Europe for over three decades to

treat

> > diabetic neuropathy, to help regulate blood sugar, and prevent diabetic

> > retinopathy and cardiopathy. Alpha lipoic acid is an approved drug in

> > Germany for the treatment of diabetic neuropathy. Alpha lipoic acid

> > normalizes blood sugar levels in diabetics and also reduces the

secondary

> > effects of diabetes, including retinopathy, cataract formation, nerve

and

> > heart damage, as well as increasing energy levels. It is used in the

> > treatment of both insulin-dependent and non-insulin dependent diabetes.

> > Alpha lipoic acid helps control blood sugar by facilitating the

conversion

> > of sugar into energy. Alpha lipoic acid reduces glycation (also known as

> > glycosylation), which is the process in which proteins react with excess

> > glucose. This sugar reaction to protein is just as detrimental as oxygen

> > damage (free radical damage). Alpha lipoic acid helps to keep blood

sugar

> > levels under control and reduced levels of glucose mean less glycation.

> This

> > is important in reducing diabetic side effects and slowing aging. In

> > summary, alpha lipoic acid's effect on diabetes is through its potent

> > antioxidant capabilities, as well improving blood sugar metabolism,

> reducing

> > glycosylation of proteins, improving blood flow to the peripheral

nerves,

> > and actually stimulating regeneration of nerve fibers (see Current

> Abstracts

> > under Diabetes listing).

> >

> > AIDS

> >

> > Individuals infected with the HIV virus tend to have a compromised

> > antioxidant defense system. During HIV infection, key cells of the

immune

> > system called CD lymphocytes lose their ability to make and to transport

> > glutathione. Antioxidants such as glutathione prevent HIV viral

> replication

> > while reactive oxidants tend to stimulate the virus. Glutathione is a

> major

> > cellular antioxidant, and thus, the CD lymphocytes are exposed to excess

> > oxidative stress and this contributes to immune system failure. Alpha

> lipoic

> > acid is a powerful antioxidant and facilitator of glutathione

production.

> A

> > strong antioxidant defense system can help prevent this oxidative damage

> and

> > help keep the immune system strong.

> >

> > A study was conducted by Dr. Fuchs and colleagues, to determine the

> > short-term effect of supplemental lipoic acid. Alpha lipoic acid was

given

> > as a supplement (150 mg three times daily for a two week period) to

> > HIV-infected patients. Lipoic acid supplementation increased total

> > glutathione in seven of seven patients, plasma ascorbate in nine of ten

> > patients, total plasma sulfur groups in eight of nine patients, and T

> helper

> > lymphocytes and T helper/suppressor cell ratio in six of ten patients.

The

> > conclusion of this study is that lipoic acid supplementation led to

> > significant beneficial changes in the blood of HIV-infected patients

> (Fuchs,

> > et al., 1993)

> >

> > Alpha lipoic acid has been beneficial to cancer patients suffering with

> > peripheral neuropathy, a damaging side effect of chemotherapy. Lipoic

acid

> > also protects against cancer as a result of its potent antioxidant

> effects.

> > Lipoic acid protects a complex called Nuclear Factor kappa-B and

prevents

> it

> > from activating oncogenes. Oncogenes are genes that contribute to cancer

> > cell proliferation. When these genes are altered by either NF kappa-B or

a

> > carcinoen, they cause the cell to become malignant. Lipoic acid can

enter

> > the cytosol of cells and protect NF kappa-B from activation by free

> radical,

> > radiation, or even sunlight.

> >

> > Alpha lipoic acid may be helpful in other conditions including Liver

> > cirrhosis, hepatitis, heart disease, cataracts, heavy metal toxicity,

and

> > support during detoxification. Its role in detoxification is as a

chelator

> > (remover) of heavy metals and toxic minerals from the body.

> >

> > Alpha lipoic acid protects the nervous system and may be involved in

> > regenerating the nerves. It is being studied in the treatment of

Parkinson

> 's

> > disease and Alzheimer's disease.

> >

> > Alpha lipoic acid has been shown to improve antibody response in

> > immunosuppressed animals (Quillin 1998).

> >

> > TOXICITY FACTORS

> >

> > Alpha lipoic acid supplementation is very safe. In over 30 years of

> > extensive use and testing in European clinical trials in the treatment

of

> > diabetic neuropathy, there have been no reported side effects (Quillin,

> > 1998, Murray, 1996). As a precaution, until further information is

> > available, alpha lipoic acid is not recommended for pregnant women.

Animal

> > studies show very low toxicity (Murray, 1996).

> >

> > CURRENT ABSTRACTS

> >

> > DIABETES

> >

> > Ziegler D; Gries FA. Alpha-lipoic acid in the treatment of diabetic

> > peripheral and cardiac autonomic neuropathy. Diabetes Research Institute

> at

> > the Heinrich Heine University, Dusseldorf, Germany.: Diabetes 1997

Sep;46

> > Suppl 2:S62

> >

> > Antioxidant treatment has been shown to prevent nerve dysfunction in

> > experimental diabetes, providing a rationale for a potential therapeutic

> > value in diabetic patients. The effects of the antioxidant alpha-lipoic

> acid

> > (thioctic acid) were studied in two multicenter, randomized,

double-blind

> > placebo-controlled trials. In the Alpha-Lipoic Acid in Diabetic

Neuropathy

> > Study, 328 patients with NIDDM and symptomatic peripheral neuropathy

were

> > randomly assigned to treatment with intravenous infusion of alpha-lipoic

> > acid using three doses (ALA 1,200 mg; 600 mg; 100 mg) or placebo (PLAC)

> over

> > 3 weeks. The total symptom score (TSS) (pain, burning, paresthesia, and

> > numbness) in the feet decreased significantly from baseline to day 19 in

> ALA

> > 1,200 and ALA 600 vs. PLAC. Each of the four individual symptom scores

was

> > significantly lower in ALA 600 than in PLAC after 19 days (all P <

0.05).

> > The total scale of the Hamburg Pain Adjective List (HPAL) was

> significantly

> > reduced in ALA 1,200 and ALA 600 compared with PLAC after 19 days (both

P

> <

> > 0.05). In the Deutsche Kardiale Autonome Neuropathie Studie, patients

with

> > NIDDM and cardiac autonomic neuropathy diagnosed by reduced heart rate

> > variability were randomly assigned to treatment with a daily oral dose

of

> > 800 mg alpha-lipoic acid (ALA) (n = 39) or placebo (n = 34) for 4

months.

> > Two out of four parameters of heart rate variability at rest were

> > significantly improved in ALA compared with placebo. A trend toward a

> > favorable effect of ALA was noted for the remaining two indexes. In both

> > studies, no significant adverse events were observed. In conclusion,

> > intravenous treatment with alpha-lipoic acid (600 mg/day) over 3 weeks

is

> > safe and effective in reducing symptoms of diabetic peripheral

neuropathy,

> > and oral treatment with 800 mg/day for 4 months may improve cardiac

> > autonomic dysfunction in NIDDM.

> >

> > Roy S; Sen CK; Tritschler HJ; Packer L Modulation of cellular reducing

> > equivalent homeostasis by alpha-lipoic acid. Mechanisms and implications

> for

> > diabetes and ischemic injury. Department of Molecular and Cell Biology,

> > University of California, Berkeley 94720-3200, U.S.A.

> > sashwati@... Biochem Pharmacol 1997 Feb 7;53(3):393-9

> >

> > The therapeutic potential of alpha-lipoic acid (thioctic acid) was

> evaluated

> > with respect to its influence on cellular reducing equivalent

homeostasis.

> > The requirement of NADH and NADPH as cofactors in the cellular reduction

> of

> > alpha-lipoic acid to dihydrolipoate has been reported in various cells

and

> > tissues. However, there is no direct evidence describing the influence

of

> > such reduction of alpha-lipoate on the levels of cellular reducing

> > equivalents and homeostasis of the NAD(P)H/NAD(P) ratio. Treatment of

the

> > human Wurzburg T-cell line with 0.5 mM alpha-lipoate for 24 hr resulted

in

> a

> > 30% decrease in cellular NADH levels. alpha-Lipoate treatment also

> decreased

> > cellular NADPH, but this effect was relatively less and slower compared

> with

> > that of NADH. A concentration-dependent increase in glucose uptake was

> > observed in Wurzburg cells treated with alpha-lipoate. Parallel

decreases

> > (30%) in cellular NADH/NAD+ and in lactate/pyruvate ratios were observed

> in

> > alpha-lipoate-treated cells. Such a decrease in the NADH/NAD+ ratio

> > following treatment with alpha-lipoate may have direct implications in

> > diabetes, ischemia-reperfusion injury, and other pathologies where

> reductive

> > (high NADH/NAD+ ratio) and oxidant (excess reactive oxygen species)

> > imbalances are considered as major factors contributing to metabolic

> > disorders. Under conditions of reductive stress, alpha- lipoate

decreases

> > high NADH levels in the cell by utilizing it as a co- factor for its own

> > reduction process, whereas in oxidative stress both alpha-lipoate and

its

> > reduced form, dihydrolipoate, may protect by direct scavenging of free

> > radicals and recycling other antioxidants from their oxidized forms.

> >

> > S; Henriksen EJ; Schiemann AL; Simon I; Clancy DE; Tritschler HJ;

> Jung

> > WI; Augustin HJ; Dietze GJ Enhancement of glucose disposal in patients

> with

> > type 2 diabetes by alpha-lipoic acid. Department of Internal Medicine,

> City

> > Hospital, Baden-Baden, Germany. Arzneimittelforschung 1995

Aug;45(8):872-4

> >

> > Insulin resistance of skeletal muscle glucose uptake is a prominent

> feature

> > of Type II diabetes (NIDDM); therefore pharmacological interventions

> should

> > aim to improve insulin sensitivity. Alpha-lipoic acid (CAS 62-46-4,

> thioctic

> > acid, ALA), a natural occurring compound frequently used for treatment

of

> > diabetic polyneuropathy, enhances glucose utilization in various

> > experimental models. To see whether this compound also augments insulin

> > mediated glucose disposal in NIDDM, 13 patients received either ALA

(1000

> > mg/Thioctacid/500 ml NaCl, n = 7) or vehicle only (500 ml NaCl, n = 6)

> > during a glucose-clamp study. Both groups were comparable in age,

> body-mass

> > index and duration of diabetes and had a similar degree of insulin

> > resistance at baseline. Acute parenteral administration of ALA resulted

in

> a

> > significant increase of insulin-stimulated glucose disposal; metabolic

> > clearance rate (MCR) for glucose rose by about 50% (3.76 ml/kg/min = pre

> vs.

> > 5.82 ml/kg/min = post, p < 0.05), whereas the control group did not show

> any

> > significant change (3.57 ml/kg/min = pre vs. 3.91 ml/kg/min = post).

This

> is

> > the first clinical study to show that alpha-lipoic acid increases

insulin

> > stimulated glucose disposal in NIDDM. The mode of action of ALA and its

> > potential use as an antihyperglycemic agent require further

investigation.

> >

> > HIV & AIDS

> >

> > Suzuki YJ; Aggarwal BB; Packer L Alpha-lipoic acid is a potent inhibitor

> of

> > NF-kappa B activation in human T cells. Department of Molecular & Cell

> > Biology, University of California, Berkeley.

> >

> > Biochem Biophys Res Commun 1992 Dec 30;189(3):1709-15

> >

> > Acquired immunodeficiency syndrome (AIDS) results from infection with a

> > human immunodeficiency virus (HIV). The long terminal repeat (LTR)

region

> of

> > HIV proviral DNA contains binding sites for nuclear factor kappa B

> (NF-kappa

> > B), and this transcriptional activator appears to regulate HIV

activation.

> > Recent findings suggest an involvement of reactive oxygen species (ROS)

in

> > signal transduction pathways leading to NF-kappa B activation. The

present

> > study was based on reports that antioxidants which eliminate ROS should

> > block the activation of NF- kappa B and subsequently HIV transcription,

> and

> > thus antioxidants can be used as therapeutic agents for AIDS. Incubation

> of

> > Jurkat T cells (1 x 10(6) cells/ml) with a natural thiol antioxidant,

> > alpha-lipoic acid, prior to the stimulation of cells was found to

inhibit

> > NF-kappa B activation induced by tumor necrosis factor-alpha (25 ng/ml)

or

> > by phorbol 12-myristate 13-acetate (50 ng/ml). The inhibitory action of

> > alpha-lipoic acid was found to be very potent as only 4 mM was needed

for

> a

> > complete inhibition, whereas 20 mM was required for N- acetylcysteine.

> These

> > results indicate that alpha-lipoic acid may be effective in AIDS

> > therapeutics.

> >

> > Merin JP; Matsuyama M; Kira T; Baba M; Okamoto T Alpha-lipoic acid

blocks

> > HIV-1 LTR-dependent expression of hygromycin resistance in THP-1 stable

> > transformants. Department of Molecular Genetics, Nagoya City University

> > Medical School, Japan.FEBS Lett 1996 Sep 23;394(1):9-13

> >

> > Gene expression of human immunodeficiency virus (HIV) depends on a host

> > cellular transcription factors including nuclear factor-kappaB (NF-

> kappaB).

> > The involvement of reactive oxygen intermediates (ROI) has been

implicated

> > as intracellular messengers in the inducible activation of NF-kappaB. In

> > this study, we compared the efficacy of two antioxidants, alpha-lipoic

> acid

> > (LA) and N-acetylcysteine (NAC), which are widely recognized NF-kappaB

> > inhibitors. Here, we demonstrate that LA has a more potent activity in

> > inhibiting NF-KappaB-mediated gene expression in THP-1 cells that have

> been

> > stably transfected with a plasmid bearing a hygromycin B resistance gene

> > under the control of HIV- 1 long terminal repeat (LTR) promoter. The

> > spontaneous activation of NF- kappaB in this cell culture system leads

to

> > expression of the hygromycin phosphotransferase gene hence rendering the

> > cells resistance to hygromycin B. In this study, the effect of the test

> > compounds against transcriptional activity of HIV-1 LTR was evaluated

> based

> > on the degree of cellular toxicity due to the inhibitory activity on the

> > expression of hygromycin B resistance gene in the presence of hygromycin

> B.

> > We also found that 0.2 mM LA could cause 40% reduction in the HIV-1

> > expression from the TNF-alpha-stimulated OM 10.1, a cell line latently

> > infected with HIV-1. On the other hand, 10 mM NAC was required to elicit

> the

> > same effect. Furthermore, the initiation of HIV-1 induction by TNF-alpha

> was

> > completely abolished by 1 mM LA. These findings confirm the involvement

of

> > ROI in NF-kappaB-mediated HIV gene expression as well as the efficacy of

> LA

> > as a therapeutic regimen for HIV infection and acquired immunodeficiency

> > syndrome (AIDS). Moreover, this study validates the applicability of our

> > present assay system which we primarily designed for the screening of

> > candidate drugs against HIV-1 gene expression.

> >

> > Han D; Tritschler HJ; Packer L. Alpha-lipoic acid increases

intracellular

> > glutathione in a human T- lymphocyte Jurkat cell line. Department of

> > Molecular and Cell Biology, University of California at Berkeley

> 94720-3200.

> > Biochem Biophys Res Commun 1995 Feb 6;207(1):258-64.

> >

> > The addition of exogenous alpha-lipoic acid to cellular medium causes a

> > rapid increase of intracellular unbound thiols in Jurkat cells, a human

> > T-lymphocyte cell line. The rise of cellular thiols is a result of the

> > cellular uptake and reduction of lipoic acid to dihydrolipoic acid and a

> > rise in intracellular glutathione. Although the level of dihydrolipoic

> acid

> > is 100-fold lower than glutathione, the cellular concentration of

> > dihydrolipoic acid might be responsible for the modulation of total

> cellular

> > thiol levels. Rises in glutathione correlate with the levels of

> > intracellular dihydrolipoic acid (p < .01). This increase in glutathione

> is

> > not the result of expression of new proteins like gamma-glutamylcysteine

> > synthetase, since the rise in glutathione was not inhibited by

> > cycloheximide, a protein synthesis inhibitor. Lipoic acid administration

> is

> > therefore a potential therapeutic agent in an array of diseases with

> > glutathione anomalies including HIV infection.

> >

> > Sen CK; Roy S; Han D; Packer L. Regulation of cellular thiols in human

> > lymphocytes by alpha-lipoic acid: a flow cytometric analysis. Department

> of

> > Molecular and Cell Biology, University of California, Berkeley

94720-3200,

> > USA. Free Radic Biol Med 1997;22(7):1241-57

> >

> > Modulation of cellular thiols is an effective therapeutic strategy,

> > particularly in the treatment of AIDS. Lipoic acid, a metabolic

> antioxidant,

> > functions as a redox modulator and has proven clinically beneficial

> effects.

> > It is also used as a dietary supplement. We utilized the specific

> > capabilities of N-ethylmaleimide to block total cellular thiols,

> > phenylarsine oxide to block vicinal dithiols, and buthionine sulfoximine

> to

> > deplete cellular GSH to flow cytometrically investigate how these thiol

> > pools are influenced by exogenous lipoate treatment. Low concentrations

of

> > lipoate and its analogue lipoamide increased Jurkat cell GSH in a

> > dose-dependent manner between 10 (25 microM for lipoamide) to 100

microM.

> > This was also observed in mitogenically stimulated peripheral blood

> > lymphocytes (PBL). Studies with Jurkat cells and its Wurzburg subclone

> > showed that lipoate dependent increase in cellular GSH was similar in

CD4+

> > and - cells. Chronic (16 week) exposure of cells to lipoate resulted in

> > further increase of total cellular thiols, vicinal dithiols, and GSH.

High

> > concentration (2 and 5 mM) of lipoate exhibited cell shrinkage, thiol

> > depletion, and DNA fragmentation effects. Based on similar effects of

> > octanoic acid, the cytotoxic effects of lipoate at high concentration

> could

> > be attributed to its fatty acid structure. In certain diseases such as

> AIDS

> > and cancer, elevated plasma glutamate lowers cellular GSH by inhibiting

> > cystine uptake. Low concentrations of lipoate and lipoamide were able to

> > bypass the adverse effect of elevated extracellular glutamate. A

> > heterogeneity in the thiol status of PBL was observed. Lipoate,

lipoamide,

> > or N-acetylcysteine corrected the deficient thiol status of cell

> > subpopulations. Hence, the favorable effects of low concentrations of

> > lipoate treatment appears clinically relevant.

> >

> > ANTIOXIDANT

> >

> > Packer L. alpha-Lipoic acid: a metabolic antioxidant which regulates

> > NF-kappa B signal

> >

> > transduction and protects against oxidative injury. Department of

> Molecular

> > and Cell Biology, University of California, Berkeley, Drug Metab Rev

1998

> > May;30(2):245-75.

> >

> > Although the metabolic role of alpha-lipoic acid has been known for over

> 40

> > years, it is only recently that its effects when supplied exogenously

have

> > become known. Exogenous alpha-lipoic acid is reduced intracellularly by

at

> > least two and possibly three enzymes, and through the actions of its

> reduced

> > form, it influences a number of cell process. These include direct

radical

> > scavenging, recycling of other antioxidants, accelerating GSH synthesis,

> and

> > modulating transcription factor activity, especially that of NF-kappa B.

> > These mechanisms may account for the sometimes dramatic effects of

> > alpha-lipoic acid in oxidative stress conditions (e.g., brain ischemia-

> > reperfusion), and point the way toward its therapeutic use.

> >

> > Packer L; Witt EH; Tritschler HJ alpha-Lipoic acid as a biological

> > antioxidant. Department of Molecular & Cell Biology, University of

> > California, Berkeley 94720, USA. Free Radic Biol Med 1995

Aug;19(2):227-50

> >

> > Alpha-Lipoic acid, which plays an essential role in mitochondrial

> > dehydrogenase reactions, has recently gained considerable attention as

an

> > antioxidant. Lipoate, or its reduced form, dihydrolipoate, reacts with

> > reactive oxygen species such as superoxide radicals, hydroxyl radicals,

> > hypochlorous acid, peroxyl radicals, and singlet oxygen. It also

protects

> > membranes by interacting with vitamin C and glutathione, which may in

turn

> > recycle vitamin E. In addition to its antioxidant activities,

> dihydrolipoate

> > may exert prooxidant actions through reduction of iron. alpha-Lipoic

acid

> > administration has been shown to be beneficial in a number of oxidative

> > stress models such as ischemia- reperfusion injury, diabetes (both

> > alpha-lipoic acid and dihydrolipoic acid exhibit hydrophobic binding to

> > proteins such as albumin, which can prevent glycation reactions),

cataract

> > formation, HIV activation, neurodegeneration, and radiation injury.

> > Furthermore, lipoate can function as a redox regulator of proteins such

as

> > myoglobin, prolactin, thioredoxin and NF-kappa B transcription factor.

We

> > review the properties of lipoate in terms of (1) reactions with reactive

> > oxygen species; (2) interactions with other antioxidants; (3) beneficial

> > effects in oxidative stress models or clinical conditions.

> >

> > Biewenga GP; Haenen GR; Bast A; The pharmacology of the antioxidant

lipoic

> > acid Leiden/Amsterdam Center for Drug Research, Vrije Universiteit,

> > Department of Pharmacochemistry, The Netherlands. Gen Pharmacol 1997

> > Sep;29(3):315-31

> >

> > 1. Lipoic acid is an example of an existing drug whose therapeutic

effect

> > has been related to its antioxidant activity. 2. Antioxidant activity is

a

> > relative concept: it depends on the kind of oxidative stress and the

kind

> of

> > oxidizable substrate (e.g., DNA, lipid, protein). 3. In vitro, the final

> > antioxidant activity of lipoic acid is determined by its concentration

and

> > by its antioxidant properties. Four antioxidant properties of lipoic

acid

> > have been studied: its metal chelating capacity, its ability to scavenge

> > reactive oxygen species (ROS), its ability to regenerate endogenous

> > antioxidants and its ability to repair oxidative damage. 4.

Dihydrolipoic

> > acid (DHLA), formed by reduction of lipoic acid, has more antioxidant

> > properties than does lipoic acid. Both DHLA and lipoic acid have

> > metal-chelating capacity and scavenge ROS, whereas only DHLA is able to

> > regenerate endogenous antioxidants and to repair oxidative damage. 5. As

a

> > metal chelator, lipoic acid was shown to provide antioxidant activity by

> > chelating Fe2+ and Cu2+; DHLA can do so by chelating Cd2+. 6. As

> scavengers

> > of ROS, lipoic acid and DHLA display antioxidant activity in most

> > experiments, whereas, in particular cases, pro-oxidant activity has been

> > observed. However, lipoic acid can act as an antioxidant against the

> > pro-oxidant activity produced by DHLA. 7. DHLA has the capacity to

> > regenerate the endogenous antioxidants vitamin E, vitamin C and

> glutathione.

> > 8. DHLA can provide peptide methionine sulfoxide reductase with reducing

> > equivalents. This enhances the repair of oxidatively damaged proteins

such

> > as alpha-1 antiprotease. 9. Through the lipoamide

dehydrogenase-dependent

> > reduction of lipoic acid, the cell can draw on its NADH pool for

> antioxidant

> > activity additionally to its NADPH pool, which is usually consumed

during

> > oxidative stress. 10. Within drug-related antioxidant pharmacology,

lipoic

> > acid is a model compound that enhances understanding of the mode of

action

> > of antioxidants in drug therapy.

> >

> > GLYCATION

> >

> > Bierhaus A; Chevion S; Chevion M; Hofmann M; Quehenberger P; Illmer T;

> > Luther T; Berentshtein E; Tritschler H; Muller M; Wahl P; Ziegler R;

> Nawroth

> > PP Advanced glycation end product-induced activation of NF-kappaB is

> > suppressed by alpha-lipoic acid in cultured endothelial cells.

Department

> of

> > Internal Medicine, University of Heidelberg, Germany. Diabetes 1997

> > Sep;46(9):1481-90.

> >

> > Depletion of cellular antioxidant defense mechanisms and the generation

of

> > oxygen free radicals by advanced glycation end products (AGEs) have been

> > proposed to play a major role in the pathogenesis of diabetic vascular

> > complications. Here we demonstrate that incubation of cultured bovine

> aortic

> > endothelial cells (BAECs) with AGE albumin (500 nmol/l) resulted in the

> > impairment of reduced glutathione (GSH) and ascorbic acid levels. As a

> > consequence, increased cellular oxidative stress led to the activation

of

> > the transcription factor NF-kappaB and thus promoted the upregulation of

> > various NF-kappaB-controlled genes, including endothelial tissue factor.

> > Supplementation of the cellular antioxidative defense with the natural

> > occurring antioxidant alpha- lipoic acid before AGE albumin induction

> > completely prevented the AGE albumin-dependent depletion of reduced

> > glutathione and ascorbic acid. Electrophoretic mobility shift assays

> (EMSAs)

> > revealed that AGE albumin- mediated NF-kappaB activation was also

reduced

> in

> > a time- and dose- dependent manner as long as alpha-lipoic acid was

added

> at

> > least 30 min before AGE albumin stimulation. Inhibition was not due to

> > physical interactions with protein DNA binding, since alpha-lipoic acid,

> > directly included into the binding reaction, did not prevent binding

> > activity of recombinant NF-kappaB. Western blots further demonstrated

that

> > alpha-lipoic acid inhibited the release and translocation of NF- kappaB

> from

> > the cytoplasm into the nucleus. As a consequence, alpha- lipoic acid

> reduced

> > AGE albumin-induced NF-kappaB mediated transcription and expression of

> > endothelial genes relevant in diabetes, such as tissue factor and

> > endothelin-1. Thus, supplementation of cellular antioxidative defense

> > mechanisms by extracellularly administered alpha-lipoic acid reduces AGE

> > albumin-induced endothelial dysfunction in vitro.

> >

> > LIVER DISEASE

> >

> > Bustamante J; Lodge JK; Marcocci L; Tritschler HJ; Packer L; Rihn BH.

> > Alpha-lipoic acid in liver metabolism and disease. Department of

Molecular

> > and Cell Biology, University of California, Berkeley. Free Radic Biol

Med

> > 1998 Apr;24(6):1023-39

> >

> > R-alpha-Lipoic acid is found naturally occurring as a prosthetic group

in

> > alpha-keto acid dehydrogenase complexes of the mitochondria, and as such

> > plays a fundamental role in metabolism. Although this has been known for

> > decades, only recently has free

> >

> > supplemented alpha-lipoic acid been found to affect cellular metabolic

> > processes in vitro, as it has the ability to alter the redox status of

> cells

> > and interact with thiols and other antioxidants. Therefore, it appears

> that

> > this compound has important therapeutic potential in conditions where

> > oxidative stress is involved. Early case studies with alpha-lipoic acid

> were

> > performed with little knowledge of the action of alpha-lipoic acid at a

> > cellular level, but with the rationale that because the naturally

> occurring

> > protein bound form of alpha-lipoic acid has a pivotal role in

metabolism,

> > that supplementation may have some beneficial effect. Such studies

sought

> > evaluate the effect of supplemented alpha-lipoic acid, using low doses,

on

> > lipid or carbohydrate metabolism, but little or no effect was observed.

A

> > common response in these trials was an increase in glucose uptake, but

> > increased plasma levels of pyruvate and lactate were also observed,

> > suggesting that a inhibitory effect on the pyruvate dehydrogenase

complex

> > was occurring. During the same period, alpha-lipoic acid was also used

as

> a

> > therapeutic agent in a number of conditions relating to liver disease,

> > including alcohol-induced damage, mushroom poisoning, metal

> intoxification,

> > and CCl4 poisoning. Alpha-Lipoic acid supplementation was successful in

> the

> > treatment for these conditions in many cases. Experimental studies and

> > clinical trials in the last 5 years using high doses of alpha-lipoic

acid

> > (600 mg in humans) have provided new and consistent evidence for the

> > therapeutic role of antioxidant alpha-lipoic acid in the treatment of

> > insulin resistance and diabetic polyneuropathy. This new insight should

> > encourage clinicians to use alpha-lipoic acid in diseases affecting

liver

> in

> > which oxidative stress is involved.

> >

> > NEURODEGENERATIVE DISEASES

> >

> > Packer L; Tritschler HJ; Wessel K Neuroprotection by the metabolic

> > antioxidant alpha-lipoic acid.

> >

> > Department of Molecular and Cell Biology, University of California,

> Berkeley

> > 94720-3200, USA. Free Radic Biol Med 1997;22(1-2):359-78

> >

> > Reactive oxygen species are thought to be involved in a number of types

of

> > acute and chronic pathologic conditions in the brain and neural tissue.

> The

> > metabolic antioxidant alpha-lipoate (thioctic acid, 1, 2-

> > dithiolane-3-pentanoic acid; 1, 2-dithiolane-3 valeric acid; and 6, 8-

> > dithiooctanoic acid) is a low molecular weight substance that is

absorbed

> > from the diet and crosses the blood-brain barrier. alpha- Lipoate is

taken

> > up and reduced in cells and tissues to dihydrolipoate, which is also

> > exported to the extracellular medium; hence, protection is afforded to

> both

> > intracellular and extracellular environments. Both alpha-lipoate and

> > especially dihydrolipoate have been shown to be potent antioxidants, to

> > regenerate through redox cycling other antioxidants like vitamin C and

> > vitamin E, and to raise intracellular glutathione levels. Thus, it would

> > seem an ideal substance in the treatment of oxidative brain and neural

> > disorders involving free radical processes. Examination of current

> research

> > reveals protective effects of these compounds in cerebral

> > ischemia-reperfusion, excitotoxic amino acid brain injury, mitochondrial

> > dysfunction, diabetes and diabetic neuropathy, inborn errors of

> metabolism,

> > and other causes of acute or chronic damage to brain or neural tissue.

> Very

> > few neuropharmacological intervention strategies are currently available

> for

> > the treatment of stroke and numerous other brain disorders involving

free

> > radical injury. We propose that the various metabolic antioxidant

> properties

> > of alpha-lipoate relate to its possible therapeutic roles in a variety

of

> > brain and neuronal tissue pathologies: thiols are central to antioxidant

> > defense in brain and other tissues. The most important thiol

antioxidant,

> > glutathione, cannot be directly administered, whereas alpha-lipoic acid

> can.

> > In vitro, animal, and preliminary human studies indicate that alpha-

> lipoate

> > may be effective in numerous neurodegenerative disorders.

> >

> > REFERENCES

> >

> > REFERENCES

> >

> > Berkson, B. 1998, The Alpha Lipoic Acid Breakthrough. Rockilin, CA:

Prima

> > Publishing.

> >

> > Fuchs, J. et al., Studies on lipoate effects on blood redox state in

human

> > immunodeficiency virus (HIV 1) replication. Arzeim Forsch 43,

> > 1359-1362,1993.

> >

> > Golan, R.1995. Optimal Wellness. New York: Ballentine books.

> >

> > , S. et al., Enhancement of Glucose Disposal in Patients with Type

2

> > diabetes by Alpha Lipoic Acid. Arzeim Forsch 45,872-874,1995.

> >

> > Klip, A. et al.,Glucose Transporters of Muscle Cells in Culture.

Molecular

> > Biology of Diabetes. N.J.: Humana Press, 1994.

> >

> > Murray, M. 1996. Encyclopedia of Nutritional Supplements. Rocklin, Ca:

> Prima

> > Publishing.

> >

> > Murray, M. & Pizzorno, J. 1998, Encyclopedia of Natural Medicine.

Rocklin,

> > CA: Prima Publishing.

> >

> > Packer, L. Antioxidant Properties of Lipoic Acid and its Therapeutic

> Effects

> > in Prevention of Diabetes Complications and Cataracts. ls NY Acad

Sci

> > 738, 257-264, 1994.

> >

> > Packer, L. & Tritschler, H. Alpha Lipoic as a Biological Antioxidant.

Free

> > Rad Biol Med 19, 227-250, 1995.

> >

> > Passwater, R. 1995. Lipoic Acid: The Metabolic Antioxidant.New Canaan,

> > Conneticut: Keats Publishing.

> >

> > Quillin, P. & N. 1998. Beating Cancer with Nutrition. Tulsa, OK.:

Nutrtion

> > Times Press.

> >

> > Quillin, P. & Reynolds, A. 1988. The La Costa Book of Nutrition. New

york:

> > Pharos Books.

> >

> > Quillin, P. 1989. Healing Nutrients. New York: Random House.

> >

> > , B. et al., Lipoic and Dihydrolipoic Acids as Antioxidants: A

> Critical

> > Review. Free Rad Res 20, 119-133, 1994.

> >

> > Somer, E.1995. The Essential Guide to Vitamins and Minerals.New York:

> > Harper.

> >

> > Wagh, S. et al., Mode of Action of Lipoic Acid in Diabetes. Journal of

> > Bioscience. 11:59-75 (1987).

> >

> >

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