Vascular Health and Risk Management Open Access Full Text Article On the antiatherogenic effects of vitamin E: the search for the Holy Grail Dovepress open access to scientific and medical research L E T T E R s Francesco Galli Department of Internal Medicine, Laboratory of Clinical Biochemistry and Nutrition, University of Perugia, Italy Correspondence: Francesco Galli Department of Internal Medicine, Laboratory of Clinical Biochemistry and Nutrition, University of Perugia, Italy Tel +39 075 585 7445 Fax +39 075 585 7445 Email f.galli@unipg.it submit your manuscript | www.dovepress.com Dovepress In a recent edition of Vascular Health and Risk Management, Kirmizis and Chatzidimitriou have published a review article, “Antiatherogenic effects of vitamin E: the search for the Holy Grail”. Beside a general evaluation of the literature on vitamin E and CVD prevention, the authors pointed out the possibility that vitamin E therapy may have particular efficacy in kidney patients. In this sense, they may represent an elective population with high susceptibility to such a secondary prevention effect, that was not identified in other cardiovascular (CVD) patient populations studied in the largest randomized controlled trials. The SPACE study,1 indeed, provided one of the most striking findings in support of this assumption. The reason for this could be inherent to a defect in the levels and metabolism of vitamin E in kidney patients documented in previous studies,2,3 but also in the higher demand of vitamin E that these patients may have as a consequence of the exposure to chronic inflammation and uremic toxicity. This higher than normal demand of vitamin E may translate into a higher need for antioxidant protection, but also of other biological functions of this vitamin that include homeostatic effects on genes involved in immuno-inflammatory and vascular protection pathways.4 The authors have highlighted the unconventional vitamin E therapy that some of these patients follow while treated with extracorporeal hemodialysis therapy (HD). This consists of the use of a special biomaterial developed to produce hollow-fiber hemodialysesrs that are coated on the blood surface with a layer of all-rac-α-tocopherol, ie, the synthetic form of vitamin E that predominates in our tissues and body fluids.4,5 These hemodialyser membranes, also known as vitamin E-modified membranes, were developed in the 1980s in Japan as cellulosic membranes that were introduced in the clinical practice in the early 1990s in Japan and then in Europe. The first clinical observation on these innovative membranes was published in a peer-reviewed journal on 1997.6 In recent years, this cellulosic prototype has been substituted with a new generation of vitamin E-modified (or -interactive) membranes that possess the highest depurative and biocompatibility standards in HD being produced using a polysulfone-like fiber backbone with an advanced filtration geometry. Other than biocompatible, these synthetic membranes have now a well characterized antioxidant activity profile that was recent described and quantitated in vitro.7 However, this should not lead to consider the antioxidant activity of these dialysers as fully available for an antioxidant effect in vivo, during the extracorporeal circulation. Vascular Health and Risk Management 2010:6 69–71 © 2010 Galli, publisher and licensee Dove Medical Press Ltd.This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited. 69