Anti-inflammatory effect of antioxidant pequi (caryocar brasiliense) oil capsules and antioxidant effect of vitamin d and physical activity on systemic lupus erythematosus patients
Montalvão et al. J Rheum Dis Treat 2016, 2:029
Rheumatic Diseases and Treatment
Case Series: Open Access
Anti-inflammatory Effect of Antioxidant Pequi (Caryocar Brasiliense)
Oil Capsules and Antioxidant Effect of Vitamin D and Physical Activity
on Systemic Lupus Erythematosus Patients
Thaís Muniz Montalvão1,2, Ana Luisa Miranda-Vilela2,3*, Cesar Koppe Grisolia2 and Leopol-
do Luiz Santos-Neto1,4
1University Hospital of Brasília, University of Brasília, Brasília, Brazil
2Department of Genetics and Morphology, Institute of Biological Sciences, University of Brasília, Brasilia, Brazil
3Department of Medicine, Faciplac, Campus Gama/DF, Brazil
4Department of Medicine, University of Brasilia, Brasília, Brazil
*Corresponding author: Ana Luisa Miranda-Vilela, Department of Genetics and Morphology, Institute of Biological
Sciences, University of Brasilia, Brasilia/DF, Brazil, Tel: +55 (61) 3107-3085, Fax: +55 (61) 3107-2923, E-mail:
Objectives: Verifying in SLE patients whether antioxidant
Systemic Lupus Erythematosus, Antioxidant, Oxidative stress,
supplementation with pequi oil capsules could reduce oxidative
Inflammatory marker, High-sensitivity C-reactive protein (hs-CRP),
DNA damage and inflammation in SLE patients.
DNA damage, Comet assay, Pequi oil. Crossover
Patients and Methods: A controlled randomized, crossover,
double-blind study was conducted with 38 SLE patients aged 18
to 60, with SLE Disease Activity Index (SLEDAI) below 10, chosen
from 73 lupus patients consecutively seen in the University Hospital
Systemic lupus erythematosus (SLE) is a chronic inflammatory,
of Brasília (HUB) Rheumatology Clinic. They were randomized into
complex, multisystem autoimmune disease of multifactorial origin.
two groups: one group of 22 patients received one placebo capsule
It is characterized by a large set of antibodies, especially antinuclear
per day for 60 consecutive days, and the other 16 patients received
antibodies. Its incidence rate varies from 1 to 10 per 100,000 persons/
one 400 mg pequi oil in capsule per day over the same period.
year and its prevalence rate is 20-70 per 100,000. It is a more frequent
There was a 60-day wash-out, and then the patients switched
rare disease in women between 15 and 45 years old [
groups: those who had received pequi oil received placebo and
vice versa, also for 60 consecutive days. We collected blood, urine,
of SLE is still unknown; however, there is a loss of the regulatory
anthropometric and social data from patients before and after each
mechanisms which maintain self-tolerance to nuclear antigens,
period, totaling four collections.
SLE expression is also influenced by non-genetic factors, such as
Results: Twenty-nine women finished this clinical trial. The mean
environment, ultra-violet light, smoking and sex hormones, since
age was 33.66 years, the mean BMI was 24.1 kg/m2 and the mean
disease duration was 7.8 years. The irreversible damage index of
the frequency of this disease is 10 times higher in women during the
the disease and the SLEDAI had no influence on DNA damage
reproductive years than in men. Thus, the interactions of genetic,
index (DDI). A correlation was found between DDI and HDL (r =
hormonal and environmental factors act together to activate helper
−0.414, p = 0.029). A significant difference was detected in the
T cells and B cells, causing the production of various autoantibodies
average rate of DDI between physical activity practitioners and
non-practitioners (p = 0.045) and between users and non-users of
vitamin D (p = 0.006). Moreover, high-sensitivity C-reactive protein
Oxidative stress is also important in the pathophysiology
(hs-CRP) fell significantly after treatment with pequi oil (p = 0.0161).
of autoimmune diseases because reactive oxygen species (ROS)
and reactive nitrogen species attack macromolecules such as
Conclusions: Although pequi oil did not significantly reduce
the DNA damage index, it effectively reduced hs-CRP levels in
carbohydrates, proteins, lipids and DNA, causing cell damage . The
these patients, indicating reduced inflammation with the use of
increase in production of these species may favor the development
antioxidant supplementation. Furthermore, the practice of physical
activity and the use of vitamin D in patients with SLE could have an
imbalance can contribute to impairing immune cells, producing
independent antioxidant effect.
autoantigens and autoantibody reactivity. Moreover, proteins
Citation: Montalvão TM, Miranda-Vilela AL, Grisolia CK, Santos-Neto LL (2016) Anti-
inflammatory Effect of Antioxidant Pequi (Caryocar Brasiliense) Oil Capsules and Antioxidant
C l i n M e d Effect of Vitamin D and Physical Activity on Systemic Lupus Erythematosus Patients. J Rheum
International Library Received: November 26, 2015: Accepted: January 07, 2016: Published: January 09, 2016
Copyright: 2016 Montalvão TM, et al. This is an open-access article distributed under the
terms of the Creative Commons Attribution License, which permits unrestricted use, distribution,
and reproduction in any medium, provided the original author and source are credited.
modified by oxidation are responsible for additional disorders for the classification of SLE [
in autoimmune diseases, since they represent potential targets 60 years. Exclusion criteria were: patients with renal impairment
for the immune system by breaking B cell tolerance [ (creatinine ≥ 3 mg/dl); with prior kidney transplant; active
inflammation is also associated with increased oxidative stress 
infection; diabetes mellitus; Sjögren's syndrome; multiple sclerosis;
and patients with SLE are in a state of chronic inflammation in the pregnancy; kidney, liver or lung disease (defined as organ damage
course of the disease. Furthermore, oxidative stress also contributes requiring immunosuppressive therapy or high-dose corticosteroids);
gastroesophageal reflux disease, malabsorptive intestinal diseases,
secondary consequences of oxidative stress in patients with SLE, history of typical angina pectoris or myocardial infarction; a history
such as its association with the atherogenic lipid profile . This of transient ischemic attack; Systemic Lupus Erythematosus Disease
state plays a central role in dyslipidemia and atherosclerosis  and
it is an important mediator of hypertension-mediated autoimmune drugs to reduce cholesterol (the last 3 months); taking prednisone
above 10 mg per day in pulse therapy with methylprednisolone and/
or use of multivitamin supplementation. After exclusion during the
The comet assay is a rapid, simple, visual and sensitive technique research in accordance with the presented criteria, four patients
widely used to measure and analyze DNA damage [
quit to participate in this survey, three had dyslipidemia, one had
detect both simple and double-strand breaks [hemolysis and the other increased dose of corticosteroids higher
in vivo]. We showed in a
than 10 mg, so 29 patients were selected. The pequi oil capsules
previous study that DNA damage index (DDI) by comet assay rose in
were produced by cold mechanical extraction, done by pressing and
SLE patients when compared with healthy individuals, which reflects centrifugation. Once ready, the capsules were sterilized by radiation,
the oxidant/antioxidant imbalance in these patients, independently each one containing 400 mg of pequi oil.
of disease activity. These findings support an association between
oxidative stress and SLE [
Afterwards, a controlled randomized, crossover, double-
blind clinical trial was conducted and consisted of two phases. The
Dietary factors are important regulators of immune function randomization was done through the generation of randomized
], and a diet with moderate protein and energy content, rich in /). The pequi oil and placebo
antioxidants like vitamin E, vitamin A, selenium, calcium, mono and capsules were supplied by Farmacotécnica - a compounding
polyunsaturated fatty acids/omega 3 can promote a protective effect pharmacy industry located in the Federal District - in separate
against tissue damage and inflammatory activity, besides helping boxes: one contained the pequi oil capsules and the other placebo.
treat comorbidities and adverse medicine reactions. Thus, some For each box a color was assigned. On delivery of the capsules
recommendations may offer a better quality of life to SLE patients to patients, a questionnaire was used to collect social data from
] and using antioxidants may protect against the development patients, medications in use and physical activity, classified using the
Caryocar American College of Sports Medicine [
brasiliense Camb., known as pequi, is a typical tree of the Brazilian and Systemic Lupus International Collaborating Clinics (SLICC)
Cerrado biome. All its parts are widely used, especially the fruit ]. [
Besides lipids (including fatty acids, such as linolenic), protein, fibers,
assessment of respondents performed. The patient ingested a daily
carbohydrates, the pequi contains, antioxidants such as carotenoids, capsule containing 400 mg of pequi oil or placebo containing
including β-carotene, lycopene, ζ-carotene, criptoflavona, colloidal silicon dioxide alone - Aerosil® - for 60 consecutive days.
anteroxantina, zeaxanthin, mutatoxantina, violoxantina, lutein An interval of 60 days before the beginning of the second stage
and neoxanthin, besides vitamin E, and phenolic compounds was established. Then, patients switched groups so that those who
(flavonoids and tannins) [had received placebo in the first phase received the pequi oil and
of both genders who received 14 days' supplementation of 400 mg vice versa, starting the second stage. So, before and after each stage,
of pequi oil, extracted with chloroform, showed that there was a totaling four periods, we collected blood and urine and we assessed
anthropometric parameters and SLEDAI.
and significant reduction of total cholesterol (TC) and low density
The duration of capsule use was defined using some studies
lipoprotein (LDL) in the group aged over 45, mostly in men. The of antioxidants in humans. One study investigated the action of
authors suggested that the oil works in reducing the inflammation isoflavones and phytic acid in postmenopausal women for 6 weeks
caused by exercise, measured by C-reactive protein and thiobarbituric
(42 days) in TC and fractions and three markers of oxidative stress
acid reactive substances (TBARS) [
(protein carbonyl, oxidized LDL and 8-iso-prostaglandin F2α].
As (1) patients with SLE have an imbalance in the oxidant/
Another study evaluated the antioxidant effect (through the comet
anti-oxidant system, promoting the formation of ROS ]; (2) the assay and TBARS) 400 mg of pequi oil capsule in healthy runners for
antioxidant status of the plasma is directly related to diet and is defined
by antioxidants such as carotenoids (the most powerful suppressors than that reported in the literature, establishing 60 days of treatment
of biological singlet oxygen), flavonoids and vitamin E [with 400 mg of pequi oil capsule.
(3) pequi contains such substances [
Laboratory tests were performed in the morning after rest period
patients whether antioxidant supplementation with pequi pulp oil and fasting for at least eight hours. The following laboratory tests were
capsules could reduce oxidative damage to DNA (evaluated by comet
performed by the Clinical Laboratory of HUB: complete blood count,
assay) and inflammation (evaluated by high-sensitivity C-reactive urea, alkaline phosphatase, gamma glutamyl transferase (GGT),
protein - hs-CRP). As there are secondary consequences of oxidative glucose, aspartate aminotransferase (AST); alanine aminotransferase
stress in patients with SLE, such as its association with atherogenic (ALT), complement C3, complement C4, hs-CRP, uric acid, TC,
lipid profile ], we also analyzed total cholesterol, low density LDL, high density lipoprotein (HDL), very low density lipoprotein
lipoprotein, hemogram and other biochemical markers.
(VLDL), triglycerides, total protein and fraction (albumin and
globulin) and abnormal elements of sediment (EAS). Sabin Clinical
Patients and Methods
Analysis Laboratories analyzed the anti-DNA. The comet assay
Patients and study design
was carried out according to Singh et with modifications
according to Montalvão et al. [
Initially, 73 patients attended consecutively in the University
Hospital of Brasília (HUB) Rheumatology Clinic from June to October
Current weight measurement was by digital scale Filizola®, model
2011 were recruited. Of these, 38 individuals were selected within the
Personal Line, capacity for 150 kg and precision of 0.1 kg, with the
inclusion criteria: diagnosis of SLE, according to the classification patient standing motionless and barefoot at the center of the scale
of the American College of Rheumatology (ACR) revised criteria platform, wearing light clothes. Height was measured in stadiometer
Montalvão et al. J Rheum Dis Treat 2016, 2:029
• Page 2 of 7 •
Table 1: Demographic, anthropometric, laboratory and patients' disease SLE in
crossover study before starting treatment and placebo.
Initially, the continuous variables were tested for normal
distribution with the Kolmogorov-Smirnov test. Then exploratory
data analysis took place, which involved drawing up tables, graphs
and descriptive analysis (mean, median, standard deviation -
Ilness duration (months)
SD, correlation, etc.). An association was made between the
quantitative variables of the sample through Pearson's correlation.
The comparison between qualitative and quantitative variables was
Number of medications in use
performed through two tests. When there were only two categories of
the qualitative variable, the t-test for independent samples was done.
When there were more than two categories of qualitative variable,
DNA damage index (%)
ANOVA followed by the post hoc Tukey test was applied. A multiple
regression analysis model was used to verify that the qualitative
Waist circumference (cm)
independent variables explained certain quantitative dependent
Hip circumference (cm)
variables. It was also performed to calculate the power of the post hoc
test to verify that the sample size used in the two studies was sufficient
to detect a statistically significant difference at 5%. All the steps
described here were performed using the Statistical Package for Social
Sciences (SPSS) version 20.0. We also used the Statistical Analysis
System (SAS) for modeling the study data. To this end, the technique
of generalized linear models with a single dependent variable was
Complement C3 mg/dL
applied to analyze the effect of treatment during the crossover study.
Complement C4 mg/dL
Thus, effects were considered: treatment period, patient and also a
Total cholesterol mg/dL
residual treatment effect between applications (carry-over). A p-value
below 0.05 was considered significant for all analyses.
The demographic characteristics of the 29-woman crossover
study immediately before starting the use of pequi oil or placebo
SLICC: Systemic Lupus International Collaborating Clinics; SLEDAI: Systemic
Lupus Erythematosus Disease Activity Index; BMI: Body Mass Index; AC: Arm
69% of patients were between the second and third decade of life. The
Circumference; TS: Triceps Skinfold; AMC: Arm Muscle Circumference; HDL:
mean BMI was 24.05 Kg/m2. The average WC was 88.82 cm and 41.4%
High-Density Lipoprotein; LDL: Low-Density Lipoprotein; VLDL: Very-Low-
had this measure as ≥ 88 cm. The mean disease duration was 7.81
Density Lipoprotein; hs-CRP: high-sensitivity C-reactive protein (hs-CRP).
years. Both the average of irreversible damage index of the disease
vertical plane with vertical metric scale of 2.10 m and precision of 1 (0.36) and the SLEDAI (3.85) were low. However, the percentage of
mm, according to the Frankfurt plan. The midpoint of the arm was patients with SLEDAI zero (no disease activity) was 22.2% and the
measured with an extendable tape measure with accuracy of 0.1 cm rate of patients with some degree of irreversible damage from the
and maximum length of 150 cm to enable the measurement of arm disease (SLICC > 0) was 21.4%. The average of the laboratory findings
circumference (AC) with the tape measure around the stretched and and their range values show that patients did not have anemia, kidney
relaxed arm, placed horizontally without squeezing the arm. The or liver impairment and had no glucose intolerance. The percentage
triceps skinfold (TS) was taken on the back of the arm 1 cm above of patients who had leukopenia was 6.9% and lymphopenia 17.2%.
the midpoint quoted with the Lange® caliper to within 1 mm; three No patient had thrombocytopenia. Regarding the lipid profile, we
measurements were taken and their average used. The arm muscle observed threshold values for all the parameters; however, when
circumference (AMC) was calculated using the formula: AMC = considering this profile for each patient dyslipidemia was not
AC − (0.314 × TS). The percentage adequacy of AC, TS and AMC detected. Only 20.7% of patients had anti-DNA reagent and 75.9%
was calculated by multiplying the measure by 100 and dividing that had negative test before starting the use of the capsules. With respect
result by the 50th percentile of each measure, according to the age to the amounts of complements, 48.3% of patients had complement
and gender of the individual. For statistical analysis four parameters C3 below the reference value and only 10.3% had complement C4
were considered, based on classification by Blackburn and Thornton, below the reference.
1979 [with the proviso that there is no overweight and obesity
Furthermore, most patients are single (55.2%), work (51.7%) have
classification for AMC.
a family income between 1 and 5 minimum wages (69%), finished
The waist circumference (WC) and hip circumference (HC) were high school (55.2%) and do not practice any activity physical (72.4%).
measured with the individual in standing position, with the same tape Regarding nutritional parameters, such as TS adequacy, most patients
used before without tightening it and without leaving gaps. The WC was
were classified as overweight and obese (51.7%). In other parameters,
taken at the navel and the HC was measured at the maximum extension most were classified as normal weight: BMI (65.5%), AC adequacy
of the buttocks. The WC measurement in umbilical height was chosen to
(58.6%) and AMC adequacy (82.8%). The medicine most used for the
study patients was hydroxychloroquine or chloroquine diphosphate
ratio (WC/HC) was calculated. The body mass index (BMI) was obtained
(89.7%), followed by prednisone (72.4%) and azathioprine (34.5%).
by dividing weight by the square of height, and for statistical analysis, we Only two patients used methotrexate and amitriptyline. Of the 21
considered four rating parameters: malnutrition (< 18, 5 kg/m2), normal patients taking prednisone, the mean dose was 4.9 mg (SD 0.56).
weight (between 18.5 to 24.99 kg/m2), pre-obesity (between 25 kg/m2
Pearson correlation tests were performed (coefficient = r) between
and 29.99 kg/m2) and obese (> 30kg/m2]. All measurements were DDI (%) and age, time of diagnosis, age at diagnosis, education
performed by a single evaluator.
(years), SLICC, SLEDAI, BMI, WC, HC, WC/HC, adequacy of AC,
This study was approved by the Research Ethics Committee of TS and AMC, hs-CRP, uric acid, glucose, GGT, TC and fractions,
the Faculty of Medicine at the University of Brasilia (UnB), project total protein and fractions. The only correlation was found between
registration 058/2010, approval number 75 on 10/26/12, and all the DDI (%) and HDL (r = −0.414, p = 0.029): the higher the HDL, the
selected individuals authorized the study by signing the free and lower the DDI (%). We performed Pearson correlation test also for
BMI and age, age at diagnosis, duration of illness, education in years,
Montalvão et al. J Rheum Dis Treat 2016, 2:029
• Page 3 of 7 •
Mean DNA Damage Index (%)
Not physically active=44.9
Mean DNA Damage Index (%)
Users of vitamin D=37.2
Nonusers of vitamin D=45.3
Damage Index (%)
Damage Index (%)
Figure 2: DNA damage index in SLE patients using and not using vitamin D.
Not physically active
Figure 1: DNA damage index in SLE patients physically active and not
with lower educational levels [
association exists because the environmental conditions associated
with low levels of education limit the knowledge of nutritious
SLICC, SLEDAI, prednisone dose. An inverse correlation was found food and safe means for physical exercise, which causes metabolic
between BMI and years of study (r = −0.537, p = 0.03): the more years
studied, the lower the BMI.
Another important finding was the significant difference in the
When comparing the average DDI (%) among the various DDI between physical activity practitioners and non-practitioners
qualitative variables (medicines in use, marital status, household observed in this study. Regular physical activity, besides functioning
income, race, occupation, education level, physical activity, as an antioxidant to increase the expression of antioxidant enzymes,
classification of nutritional parameters and anti-DNA reagent), also induces a systemic increase in many cytokines with anti-
a significant difference (p = 0.045) was detected among those who inflammatory properties that protect against chronic disorders
practiced physical exercise (mean = 39.1% DDI) and those who did associated with low-grade systemic inflammation [
results also confirm the protective effect of physical activity against
difference (p = 0.006) was found between vitamin D users (mean = oxidative stress. It is well documented in the literature that regular
exercise results in adaptations in the antioxidant capacity protecting
. However, there was no statistical significance between the mean cells against the deleterious effects of oxidative stress and preventing
hs-CRP among the same qualitative variables.
subsequent cell damage [
A multiple regression analysis model was used to check whether is associated with a reduction in markers of oxidative stress in
the independent variables: occupation, family income, education, rodents ], has a modulating effect on the antioxidant balance in
physical activity, azathioprine, prednisone, chloroquine, folic acid women [
and vitamin D explain the variable DDI. As the only independent circumference in obese women [
variables that were statistically significant were physical activity stimulate DNA repair in healthy adults and the elderly, probably due
and use of vitamin D, these were examined to determine if one had an oxygen radical scavenger enzyme or repair enzyme mechanism
influence over the other with regard to DDI, and no such interference
was found. However, these two independent variables explain 38.53%
endogenous antioxidant defenses and in reducing oxidative DNA
of the total variation of DDI. Thus, the patients in this study that were
]. However, the current study is
not physically active showed DDI 5.71% higher than the practitioners.
the first to demonstrate this relationship in SLE patients.
Furthermore, patients using no vitamin D showed DDI 7.97% higher
Our study also demonstrated that SLE patients using vitamin
than users. The other independent variables were not statistically D had DDI (%) that was significantly lower than non-users. This
significant and therefore were removed from the model.
information indicates that supplementation with vitamin D could
The anthropometric parameters, DDI (%), inflammatory markers
reduce oxidative stress in these patients. This fact has also been
and lipid profile of patients with SLE before and after treatment after suggested in a study conducted with type 2 diabetic black Americans
completion of the crossover study are showed in The data were
analyzed considering the effect of the patient as random. This test of oxidative stress in older people who had compromised glucose
showed no significant effect of the pequi oil treatment for almost any metabolism and obtained an inverse association between these two
variable analyzed, except for hs-CRP (p = 0.0161), which presented a parameters [
statistically significant reduction compared to the placebo. For a 5% There are no reports of clinical studies in the literature showing the
significance level a power of post hoc test for DDI was estimated to relationship with SLE, but the protective effect of vitamin D against
be 0.9887; for WC/HC of 0.9999 and the hs-CRP of 1.0000 to detect oxidative stress in these patients has been reported ]. Multiple
clinically important differences between treatments (pequi oil and regression analysis with qualitative independent variables and the
DDI shows that only physical activity and vitamin D reduced DNA
Patients with SLE have an imbalance in the oxidant/anti-oxidant
An inverse correlation was detected between DDI (%) and HDL system independent of disease activity. In a previous study we
levels in this study, also reported in other studies. One study compared
demonstrated by comet assay that DDI increased in SLE patients
individuals with normal TC, LDL, triglycerides and glucose, but when compared with healthy individuals, supporting an association
with lowered HDL normolipidemic with controls, and observed ]. So, the present study
that the former had high oxidative stress (measured by the plasma analyzed if pequi oil in capsule, a rich antioxidant supplementation,
8-isoprostanes) [has an antioxidant effect on patients with SLE, by means of comet
that synergy may occur in the inactivation of LDL oxidized lipids by assay. This method is one of many ways of measuring oxidative stress,
enzymatic and non-enzymatic mechanisms . And yet an inverse and it can be applied in supplementation trials [In this context,
correlation between BMI and years of study was demonstrated, although pequi oil did not significantly reduce the DDI of the total
which corroborates the literature and means a higher BMI in people group, it did significantly reduce hs-CRP.
Montalvão et al. J Rheum Dis Treat 2016, 2:029
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Table 2: The effect of pequi oil compared to placebo in patients with SLE in several variables.
Δ (initial - final)
Difference between groups
Placebo - Pequi oil
SLEDAI: Systemic Lupus Erythematosus Disease Activity Index; BMI: Body Mass Index; WC: Waist Circumference; HC: Hip Circumference; W/H: Waist/hip ratio; AC:
Arm Circumference; TS: Triceps Skinfold thickness; AMC: Arm Muscle Circumference; AST: Aspartate Transaminase; ALT: Alanine aminotransferase; GGT: Gamma-
Glutamyl Transferase; hs-CRP: High-Sensitivity C-reactive protein (hs-CRP); HDL: High-Density Lipoprotein; LDL: Low Density Lipoprotein; VLDL: Very Low Density
Lipoprotein; *p-value with statistical significance. Values expressed as mean ± standard least squares error.
First, this non-reduction of DDI after treatment runs contrary to would have been observed beyond CRP reduction after treatment.
the previous study with athletes of both genders who daily took 400 A possible explanation for this finding, which is not balanced in the
mg of pequi oil capsule for 14 consecutive days. These athletes showed
current crossover study, was the inclusion of patients with SLEDAI
decreased lipid peroxidation tested by TBARS, besides reduced DDI < 10; in other words, there were patients with high disease activity.
by comet assay. A reduction in muscle damage based on plasma An average level (3 mg/L) of CRP was recorded before beginning
evaluation of AST and ALT was also detected, the latter especially in the use of the capsules, and the minimum (0.9 mg/L) and maximum
women . (15 mg/L) and standard deviation (3.2 mg/L) values are within the
This same study found a significant drop in TC and LDL in the group
] to measure low and
]. In contrast to this finding, there medium CRP.
was no significant reduction of TC, LDL, AST and ALT in the current
High serum levels of hs-CRP are induced by various inflammatory
crossover study. These controversial results, despite the similarity in conditions besides atherosclerosis. Thus, hs-CRP is not only a
the daily dose of pequi oil and higher total dose (60 days), might be systemic inflammatory marker but also a local pro-atherosclerotic
explained by different methods of oil extraction in the two studies. factor. Once a high level of hs-CRP is established, there is an
In athletes, the extraction used the organic solvent chloroform, increased cardiovascular risk [A recent study even suggests that
while the current study was by cold mechanical extraction. It has hs-CRP is a surrogate marker for cardiovascular risk in SLE patients,
been shown that the extract has a higher mechanical peroxide but this must be viewed with care because their values fluctuate with
content, demonstrating the greater vulnerability and lower content disease activity and infections [Atherosclerosis is a well-known
of carotenoids when compared to organic extracts . Moreover, the prevalence of and mortality from
the storage time of the capsules with pequi oil was much higher in ],
the current study than in athletes, which may have contributed to a and so these individuals have a greatly increased cardiovascular risk
further deterioration of carotenoids. Another factor that may have compared to the general population [
contributed to the reduction of this antioxidant was sterilization by of the current study gain importance in clinical practice because
radiation for the capsules used in the present study.
they show a significant reduction in an inflammatory marker and
Secondly, even with the differences between the extraction predictor of atherosclerosis using antioxidant therapy.
methods of pequi oil, there was a significant reduction in hs-CRP in
At the same time, no connection between hs-CRP and the various
this work after pequi oil treatment, a result that confirms the previous
qualitative and quantitative variables described here was noted, in
study with athletes [in this aspect and also other studies evaluating
contrast to the literature, which found an average increase in hs-
the antioxidant intervention in inflammation by measuring hs-
CRP in SLE patients with higher BMI and among those that were less
CRP [correlation between ROS and CRP has educated, had lower family income and higher disease activity ].
been confirmed in asymptomatic individuals [and also in some ] showed the highest correlation
SLE patients . However, it seems that the
interrelationship between inflammation-mediated CRP and certain with hs-CRP among all variables. Another study demonstrated that
forms of oxidative stress depended on the methods used. Moreover, both pre-obese and obese people in the general American population
it has been found that the CRP did not induce forms of DNA damage,
were more likely to have high levels of CRP than the normal weight
single strand breaks and double strand breaks, but it was noted that controls . Perhaps this same relationship was not detected in the
prolonged exposure to CRP could have caused these types of damage current study, due to small sample size.
]. This may explain the significantly reduced CRP values of the
Despite having performed a sophisticated clinical trial
patients in our research after treatment with pequi oil, but not enough
(randomized double-blind crossover study), the current study has
to reflect a reduction in damage caused by single and double strand some limitations. There is no assurance that the patients properly
breaks in DNA. Perhaps if the patients had had a higher initial value ingested the capsules as directed, 1 capsule (400 mg of pequi oil)
of CRP or if the treatment time were longer, a reduction in the DDI per day for 60 consecutive days. Another important factor was
Montalvão et al. J Rheum Dis Treat 2016, 2:029
• Page 5 of 7 •
the difficulty for some patients to access the Clinical Laboratory at 16.
HUB. Ideally, the collection of blood and urine and anthropometric
measurements were to take place on the 61st day after treatment or 17.
placebo. However, due to this limited access, sometimes the collection
was carried out after completion of the therapy using capsules.
Moreover, the extraction method used in this work was inferior to 18.
that used in a previous study, which may have affected the results.
The peculiar and specific characteristics of the sample prevent the 19.
extrapolation of results to other populations of patients with SLE.
Although pequi oil did not significantly reduce the DNA damage
index, it effectively reduced hs-CRP levels in these patients, indicating
reduced inflammation with the use of antioxidant supplementation.
This is important in clinical practice, in showing a significant 22.
reduction in an inflammatory marker that may predict atherosclerosis.
Furthermore, the practice of physical activity and the use of vitamin 23.
D in patients with SLE could have an independent antioxidant effect.
The authors gratefully acknowledge the patients who participated
in this research; University Hospital of Brasília, Farmacotécnica 25.
and Sabin Institute/Sabin Laboratories for technical support; and
the National Council for Technological and Scientific Development
(CNPq) for financial support.
2. Robbins S, Cotran R, Kumar V (2000) Patologia estrutural e funcional. 5a
Edição. Rio de Janeiro: Guanabara Koogan 1277.
33. Blackburn GL, Thornton PA (1979) Nutritional assessment of the hospitalized
patient. Medical Clinics of North America, Philadelphia 14: 1102-1108.
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Advances in Understanding and Treatment of FelineInappropriate Elimination Meghan E. Herron, DVM, DACVB Feline inappropriate elimination is the number one behavioral reason for relinquishment of cats to shelters andhas historically been the most commonly reported feline problem addressed by behavior professionals. Veter-inarians are hence challenged to uncover the underlying motivation for this behavior so that an accuratediagnosis can be made and an effective treatment plan implemented. Before a behavioral diagnosis can bemade, underlying medical disease must be addressed, making a comprehensive physical evaluation imperative.After all medical issues have been addressed, a behavior diagnoses list is made based on detailed historicalinformation obtained from the cat owner. A distinction is first established between marking and inappropriatetoileting, according to elimination postures described by the owner and the social relevance of the sites ofinappropriate eliminations. Next, inadequacies of the litter box management are identified and subsequentaversions and preferences, including litter box aversion, substrate aversion, location aversion, substrate pref-erence, and location preference, can be diagnosed. The practitioner should be cognizant of the fact that anxietyfrom the environment and social conflict may play a major role in both marking and inappropriate toiletingbehaviors. Once both the medical and behavioral diagnoses are established, a treatment plan catered to theindividual cat, owner, and household environment can be formulated. This should include acceptable forms ofmarking when indicated, appropriate litter box management and hygiene, reduction of environmental stres-sors, including resolution of social conflict in multicat households, proper treatment and restricted access tosoiled areas, pheromone application, and, when indicated, anxiolytic drug therapy.© 2010 Elsevier Inc. All rights reserved.
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