RESUMEN
In diabetes, interactions between AGEs (advanced glycation end products) and RAGEs (receptors of AGEs) are responsible for chronic complications and the current work reports the potential of ursolic acid as a RAGE inhibitor. The three-dimensional crystal structure of RAGE was first docked with target molecules by 'AutodockVina' using GROMOS 96 4381 parameters. Druggability and pharmacokinetic properties were calculated from the SwissADME server. In vitro bovine serum albumin (BSA)-glucose fluorescence and BSA-methylglyoxal fluorescence assays were also performed. Finally, alloxan-induced diabetic mice were administered ursolic acid and metformin standards (at 1, 50, 100 mg/kg) for 50 days. Blood glucose levels, several blood parameters, blood lipid profiles, supernatants of homogenized kidney and plasma of mice were examined. In the computational study, ursolic acid showed greater binding affinity (-7.5 kcal/mol) for RAGE with an ADMET profiles and lead-likeness compared to metformin as a standard antidiabetic. In the in vitro fluorescence assays, the IC50 value for ursolic acid was much less than that of metformin standard. During the in vivo study, significant reduction in the levels of blood glucose, HbA1C (glycated hemoglobin), creatinine, uric acid, BUN (blood urea nitrogen), AST (aspartate aminotransferase), ALT (alanine aminotransferase), ALP (alkaline phosphatase) were observed in the ursolic acid and metformin-treated mice. Substantial inhibition of AGEs' formation in the plasma and kidney were also detected. Finally, the histopathological examinations of the kidney revealed reversal of cellular necrosis. Hence, ursolic acid is proved to be a potent AGE inhibitory agent in managing the diabetic complications.
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Complicaciones de la Diabetes , Diabetes Mellitus Experimental , Triterpenos , Animales , Complicaciones de la Diabetes/tratamiento farmacológico , Diabetes Mellitus Experimental/inducido químicamente , Productos Finales de Glicación Avanzada/metabolismo , Ratones , Receptor para Productos Finales de Glicación Avanzada , Triterpenos/farmacología , Triterpenos/uso terapéutico , Ácido UrsólicoRESUMEN
This study presents an approach for developing periphytic biofilm with N-acyl-homoserine-lactones (AHLs) stimulation and lanthanum (La, a rare earth element) loading, to achieve highly efficient and stable phosphorus (P) recovery from wastewater. AHLs stimulated biofilm growth and formation, also improved stable P entrapment by enhancing extracellular polymeric substance (EPS) production and optimizing P-entrapment bacterial communities. Periphytic biofilms loading La is based on ligand exchanges, and La loading achieved initial rapid P entrapment by surface adsorption. The combination of AHLs stimulation and La loading achieved 99.0% P entrapment. Interestingly, the enhanced EPS production stimulated by AHLs protected biofilms against La. Moreover, a method for P and La separately recovery from biofilms was developed, achieving 89-96% of P and 88-93% of La recovery. This study offers a promising biotechnology to reuse La from La-rich wastewater and recover P by biofilm doped with La, which results in a win-win situation for resource sustainability.
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Acil-Butirolactonas , Homoserina , Biopelículas , Biotecnología , Matriz Extracelular de Sustancias Poliméricas , Lantano , Fósforo , Percepción de QuorumRESUMEN
Dissolved organic matter (DOM) plays vital roles in carbon and other nutrient transformation at soil-water interfaces (SWI) in paddy fields. It is associated with the growth and withering of periphytic biofilms. However, the interactions between DOM and periphytic biofilms remain largely unknown. In this study, a microcosm experiment with different initial DOM contents elucidated that the biomass, and biomass nitrogen and phosphorus contents were greatly influenced by humic-like substances (C2 and C3), while the growth of periphytic biofilms increased the contents of humic-like (C1 and C2) and tryptophan-like substances (C5) in soil. Moreover, the decomposition of periphytic biofilms significantly increased soil pH, DOM, C2, C3 and C5 contents, but caused decrease in Eh, with consequent reduce in water soluble phosphorus (WSP) and release of algal available phosphorus (AAP). Results from this study revealed how DOM interacts with periphytic biofilms and the consequent effects on changes of bioactive phosphorus fractions, and provide practical information for designing periphytic biofilm based biofertilizer from the perspective of soil DOM.
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Fósforo , Suelo , Biopelículas , Sustancias Húmicas/análisis , Nitrógeno/análisis , Espectrometría de Fluorescencia , AguaRESUMEN
ETHNOPHARMACOLOGICAL RELEVANCE: Functional disability associated with rheumatoid arthritis (RA), a chronic inflammatory autoimmune disease is a challenging concern in healthcare systems. Along with environmental factors and epigenetic disorders, multiple pathways are reported as prominent mechanism for the progression of RA symptoms including; pain, swelling and stiffness of joints. Elaeocarpus floribundus Blume has been used as a folklore medicine for RA from ancient times. This plant harbours a suite of endophytic fungi that produce a range of metabolites of potential interest. Thus, for the establishment of a scientific basis for this folklore use, it is essential to find out the involvement, if any, of the endophytic fungi living in this plant and the metabolites they elaborate, for the management of RA. AIM OF THE STUDY: This study was designed to isolate, identify and evaluate the in vitro anti-inflammatory and in vivo antinociceptive and antiarthritic activities of the compounds produced by the endophytic fungi living in different parts of Elaeocarpus floribundus Blume. MATERIALS AND METHODS: Endophytic fungi from different parts of the plant were isolated and cultured for the production of secondary metabolites. Chromatographically fractionated fungal extracts were assessed for anti-inflammatory and antinociceptive activities. For the evaluation of anti-inflammatory activity, in vitro cyclooxygenase (COX1/COX2) and 5-lipoxygenase (5-LOX) inhibitory assays were performed. For the evaluation of in vivo antinociceptive activity, hot plate acetic acid induced writhing, and formalin induced paw licking methods were adopted, whereas complete Freund's adjuvant (CFA) induced poly-arthritic method was adopted for the evaluation of antiarthritic activity. The most effective fraction was analyzed by liquid chromatography-mass spectroscopy (LC-MS) in search of the bioactive extracellular metabolites. RESULTS: Five endophytic fungi viz. Aspergillus fumigatus, Aspergillus niger, Rhizoctonia oryzae, Rhizopus oryzae, and Syncephalastrum racemosum were isolated. COX1/COX2 and 5-LOX inhibitory assays state that the Aspergillus niger fraction possesses the greatest activity against these enzymes of inflammatory process. In vivo antinociceptive showed significant (***P<0.001) reduction of pain in a dose dependent manner. As well, significant (***P<0.001) reduction of paw volume was observed in CFA induce poly-arthritic test. LC/MS analysis of the Aspergillus niger fraction revealed the presence of bioactive compounds including tensyuic acid, hexylitaconic acid, chlorogenic acid, nigragillin, TMC-256C1, asnipyrone B, asperenone, fumaric acid and fusarubin, all having reported pharmacological activities. CONCLUSION: The present study demonstrates that secondary metabolites produced by endophytic fungi living in various parts of Elaeocarpus floribundus Blume had potential to relief pain and inflammation. The endophytes were found to contain multiple biomolecules effective in rheumatoid arthritis. These findings provide a rationale for the folklore use of the plant in the management of rheumatoid arthritis.
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Analgésicos/farmacología , Antiinflamatorios/farmacología , Elaeocarpaceae/microbiología , Endófitos/química , Hongos/química , Analgésicos/química , Animales , Antiinflamatorios/química , Araquidonato 5-Lipooxigenasa/metabolismo , Inhibidores de la Ciclooxigenasa/química , Inhibidores de la Ciclooxigenasa/farmacología , Femenino , Inhibidores de la Lipooxigenasa , Masculino , Ratones , Estructura Molecular , Dolor/tratamiento farmacológicoRESUMEN
ETHNOPHARMACOLOGICAL RELEVANCE: Phragmites karka (Retz.) of family Poaceae is a pristine tropical plant that is well known to the local healers for ailments of diabetes, fever, diarrhea and CNS depression but lacks the scientific evidence behind its traditional usage. Hence, we explicated this plant to find the scientific basis of its traditional utilization. AIM OF THE STUDY: The current study aims to find out the antidiabetic potential, toxicity after oral administration and in vitro cytotoxic activity of aerial parts of the plant on HeLa cells. METHODS: The plant was extracted with methanol by maceration and the crude extract was then subjected to solvent partitioning with modified Kupchan method for preparing several fractions. Phytochemical screening and total phenolic content of the plant was first determined through established procedures. Acute toxicity of the plant was studied by orally administering a single high dose (5000 mg/kg) of drug. Cytotoxicity of the methanolic plant extract was determined by measuring the percentage of cell viability on human cervical cancer cell lines, HeLa. In vitro antidiabetic activity was determined through iodine starch and DNSA (3,5-dinitrosalicylic acid) method of α-amylase inhibition. Finally, in vivo oral glucose tolerance test and alloxan induced antidiabetic activity test was performed at 150 and 300 mg/kg body weight doses of plant extract to confirm the in vivo antidiabetic activity. RESULTS: No mortality was demonstrated by Phragmites karka in the acute toxicity test. However, signs of cellular toxicity was observed and histopathological studies on major organs exhibited necrosis in liver and kidney. In vitro cytotoxicity assay revealed the death of HeLa cells by DCM (dichloromethane) and n-hexane fractions of plant extract at 100 and 10 µg/mL concentrations. The IC50 value of the fractions were later evaluated by MTT assay (316.1 and 96.7 µg/mL for n-hexane and DCM fractions, respectively). In the iodine starch and DNSA method of α-amylase enzyme inhibitory activity test, substantial inhibition of enzyme was observed with the IC50 values of 2.05 and 2.08 mg/mL, respectively. In the in vivo antidiabetic activity test, considerable reduction in blood glucose level of diabetic mice was detected in both oral glucose tolerance test and alloxan induced antidiabetic activity test. In addition, the microscopic examination of pancreas showed noticeable recovery of pancreatic ß cells and the blood lipid profile analysis represented a significant (p < 0.05) reduction of total cholesterol, LDL (low density lipoprotein) and triglyceride level in plant extract treated mice. CONCLUSION: Results of this study reveals that the Phragmites karka extract is toxic at cellular level after oral administration and cytotoxic when tested on HeLa cells. The plant also evidenced hypoglycemic property, possibly through the inhibition of α-amylase enzyme and recovered the pancreatic beta cells along with the improvement of lipid profile of diabetic mice. However, robust studies on this plant is required to isolate the bioactive compounds, elucidate structures and evaluate their mechanism of actions in support of our findings. CLASSIFICATION: Toxicology and Safety, Quality Traditional Medicine.
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Citotoxinas/farmacología , Diabetes Mellitus Experimental/tratamiento farmacológico , Hipoglucemiantes/farmacología , Componentes Aéreos de las Plantas/química , Extractos Vegetales/farmacología , Poaceae/química , Animales , Bangladesh , Glucemia/efectos de los fármacos , Citotoxinas/uso terapéutico , Femenino , Células HeLa , Humanos , Hipoglucemiantes/uso terapéutico , Concentración 50 Inhibidora , Lípidos/sangre , Masculino , Medicina Tradicional , Ratones , Páncreas/efectos de los fármacos , Páncreas/patología , Fenol/análisis , Fitoquímicos/análisis , Extractos Vegetales/uso terapéutico , Ratas Wistar , alfa-Amilasas/antagonistas & inhibidoresRESUMEN
Plant biophenols have been shown to be effective in the modulation of Alzheimer's disease (AD) pathology resulting from free radical-induced oxidative stress and imbalance of the redox chemistry of transition metal ions (e.g., iron and copper). On the basis of earlier reported pharmacological activities, olive biophenols would also be expected to have anti-Alzheimer's activity. In the present study, the antioxidant activity of individual olive biophenols (viz. caffeic acid, hydroxytyrosol, oleuropein, verbascoside, quercetin, rutin and luteolin) were evaluated using superoxide radical scavenging activity (SOR), hydrogen peroxide (H2O2) scavenging activity, and ferric reducing ability of plasma (FRAP) assays. The identification and antioxidant activities in four commercial olive extracts-Olive leaf extractTM (OLE), Olive fruit extractTM (OFE), Hydroxytyrosol ExtremeTM (HTE), and Olivenol plusTM (OLP)-were evaluated using an on-line HPLC-ABTSâ¢+ assay, and HPLC-DAD-MS analysis. Oleuropein and hydroxytyrosol were the predominant biophenols in all the extracts. Among the single compounds examined, quercetin (EC50: 93.97 µM) and verbascoside (EC50: 0.66 mM) were the most potent SOR and H2O2 scavengers respectively. However, OLE and HTE were the highest SOR (EC50: 1.89 µg/mL) and H2O2 (EC50: 115.8 µg/mL) scavengers among the biophenol extracts. The neuroprotection of the biophenols was evaluated against H2O2-induced oxidative stress and copper (Cu)-induced toxicity in neuroblastoma (SH-SY5Y) cells. The highest neuroprotection values (98% and 92%) against H2O2-induced and Cu-induced toxicities were shown by the commercial extract HTETM. These were followed by the individual biophenols, caffeic acid (77% and 64%) and verbascoside (71% and 72%). Our results suggest that olive biophenols potentially serve as agents for the prevention of neurodegenerative diseases such as AD, and other neurodegenerative ailments that are caused by oxidative stress.
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Olea/química , Antioxidantes/farmacología , Ácidos Cafeicos/química , Ácidos Cafeicos/farmacología , Línea Celular Tumoral , Cobre/farmacología , Depuradores de Radicales Libres/metabolismo , Glucósidos/química , Glucósidos/farmacología , Humanos , Peróxido de Hidrógeno/farmacología , Glucósidos Iridoides , Iridoides/química , Iridoides/farmacología , Estrés Oxidativo/efectos de los fármacos , Fenoles/química , Fenoles/farmacología , Extractos Vegetales/química , Extractos Vegetales/farmacología , Quercetina/química , Quercetina/farmacologíaRESUMEN
ETHNOPHARMACOLOGICAL RELEVANCE: Aquilaria spp. (agarwood) has been a part of Ayurvedic and Traditional Chinese Medicine for centuries. Agarwood has also been used as a traditional medicine in Southeast Asian countries, Bangladesh and Tibet. Its common uses include the treatment of joint pain, inflammatory-related ailments, and diarrhoea, as well as a stimulant, sedative and cardioprotective agent. In this paper, we aim to provide an overview of the phytochemistry, ethnomedicinal use, pharmacological activities and safety of plant materials from Aquilaria spp. as an evidence base to further appraise its potential use as a source of health beneficial compounds. MATERIALS AND METHODS: Literature abstracts and full text articles from journals, books, reports and electronic searches (Google Scholar, Elsevier, PubMed, Read Cube, Scopus, Springer, and Web of Science), as well as from other relevant websites, are surveyed, analysed and included in this review. RESULTS: A literature survey of agarwood plant materials showed that they contain sesquiterpenes, 2(-2-phenylethyl)-4H-chromen-4-one derivatives, genkwanins, mangiferins, iriflophenones, cucurbitacins, terpenoids and phenolic acids. The crude extracts and some of the isolated compounds exhibit anti-allergic, anti-inflammatory, anti-diabetic, anti-cancer, anti-oxidant, anti-ischemic, anti-microbial, hepatoprotective, laxative, and mosquitocidal properties and effects on the central nervous system. Agarwood plant materials are considered to be safe based on the doses tested. However, the toxicity and safety of the materials, including the smoke from agarwood incense burning, should be further investigated. Future research should be directed towards the bio-guided isolation of bioactive compounds with proper chemical characterisation and investigations of the underlying mechanisms towards drug discovery. CONCLUSIONS: The traditional medicinal use of agarwood plant materials has provided clues to their pharmacological properties. Indeed, agarwood contains a plethora of bioactive compounds that now elegantly support their use in traditional medicine. As wild agarwood trees are critically endangered and vulnerable, sustainable agricultural and forestry practices are necessary for the further development and utilization of agarwood as a source of health beneficial compounds.
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Medicina Tradicional , Fitoquímicos/uso terapéutico , Extractos Vegetales/uso terapéutico , Thymelaeaceae/química , Animales , Etnobotánica , Etnofarmacología , Humanos , Fitoquímicos/efectos adversos , Fitoquímicos/química , Fitoquímicos/aislamiento & purificación , Fitoterapia , Extractos Vegetales/efectos adversos , Extractos Vegetales/química , Extractos Vegetales/aislamiento & purificación , Plantas Medicinales , Medición de Riesgo , Thymelaeaceae/clasificación , Pruebas de ToxicidadRESUMEN
An aqueous extract of Ephedra equisetina root was found to induce cyanobacterial cell death. The extract displayed no negative effects on the fish populations but instead, improved the habitat conditions for the growth of macrophytes, zooplankton and bacteria because the inhibiting effects of the extracts on cyanobacteria helped clear up the water column. The removal kinetics of cyanobacteria by E. equisetina extract appears to be a first order process with the rate constant being extract-dose-dependent. Compounds including the flavonoids found in E. equisetina root kill the cyanobacteria in vitro at a dose of 5.0 µg extract per 100 mL water or above. The extract constituents act to disrupt the thylakoid membrane, interrupt the electronic transport, decrease the effective quantum yield, and eventually lead to the failure of photosynthesis in Microcystis aeruginosa. This study presents an easily-deployed, natural and promising approach for controlling cyanobacterial blooms as an emergency measure, and also provides insight into the dynamics and mechanism of the extract consisting of multiple compounds synergistically removing algae.
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Antibacterianos/farmacología , Ephedra/química , Flavonoides/farmacología , Microcystis/crecimiento & desarrollo , Extractos Vegetales/farmacología , Raíces de Plantas/química , Antibacterianos/química , Flavonoides/química , Cinética , Extractos Vegetales/química , Microbiología del AguaRESUMEN
Many measures have been developed to control the harmful algal blooms that are potentially threatening potable waters. The pilot experiments showed that the unfiltered and the sterile-filtered decoctions of radix Astragali inhibited the growth of Microcystis aeruginosa. The inhibitory effect diminished in natural pond conditions after 68 days, due to photo-degradation of the flavonoids from radix Astragali that appear to be responsible for the action on M. aeruginosa. Four phases (assemblage, conglomeration, cell membrane destruction and decomposition) can be characterized in the process of cell death with increasing decoction dose. The quantum yields and electron transport rates of photosynthesis system II of M. aeruginosa cells markedly decreased during contact with the decoction, resulting in the disruption of M. aeruginosa photosynthesis. The results indicate that the application of radix Astragali decoction for the inhibition of M. aeruginosa growth is feasible when the dose is less than 20 ml L(-1).
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Antibacterianos/toxicidad , Medicamentos Herbarios Chinos/toxicidad , Inhibidores de Crecimiento/toxicidad , Microcystis/efectos de los fármacos , Planta del Astrágalo/toxicidad , Astragalus propinquus , Relación Dosis-Respuesta a Droga , Transporte de Electrón/efectos de los fármacos , Floraciones de Algas Nocivas/efectos de los fármacos , Microcystis/crecimiento & desarrollo , Microcystis/metabolismo , Fotosíntesis/efectos de los fármacos , Microbiología del AguaRESUMEN
Free radicals, in particular radical oxygen species (ROS), play an important role in the aetiology and pathogenesis of various diseases. Current research in many countries focuses on the use of local medicinal plants as a promising source of liver protective agents. This paper describes the hepatoprotective effects of the methanol extract and four isolated compounds from Ficus chlamydocarpa on CCl4-induced liver damage, as well as the possible antioxidant mechanisms involved in this protection. The DPPH test, along with the beta-Carotene-Linoleic Acid Model System and Ferric-Reducing Antioxidant Power assays, as well as the inhibition of microsomal lipid peroxidation were used to measure radical-scavenging and antioxidant activities. Pretreatment of rats with the methanol extract of F. chlamydocarpa before CCl4 administration, significantly prevented serum increase of hepatic enzyme markers, glutamate oxaloacetate transaminase (GOT) and glutamate pyruvate transaminase (GPT), in a dose-dependent manner. The hepatoprotection was also associated with a significant enhancement in hepatic reduced glutathione (GSH) and a marked decrease of liver malondialdehyde (MDA). Among the four compounds 1-4, isolated from the methanol extract, alpha-amyrin acetate (1) and luteolin (4) showed a significant hepatoprotective activity, as indicated by their ability to prevent liver cell death and lactate dehydrogenase (LDH) leakage during CCl4 intoxication.
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Antioxidantes/análisis , Enfermedad Hepática Inducida por Sustancias y Drogas/tratamiento farmacológico , Ficus/química , Fitoterapia , Extractos Vegetales/uso terapéutico , Alanina Transaminasa/sangre , Animales , Antioxidantes/uso terapéutico , Aspartato Aminotransferasas/sangre , Tetracloruro de Carbono/toxicidad , Intoxicación por Tetracloruro de Carbono/tratamiento farmacológico , Línea Celular Tumoral , Evaluación Preclínica de Medicamentos , L-Lactato Deshidrogenasa , Hígado/efectos de los fármacos , Hígado/metabolismo , Masculino , Malondialdehído/metabolismo , Metanol , Ratas , Ratas Wistar , Silimarina/uso terapéutico , Sales de TetrazolioRESUMEN
An eco-restoration system to remove excess nutrients and restore the agricultural ecosystem balance was proposed and applied from August 2006 to August 2008 in a residential-cropland complex area (1.4 x 10(5) m(2)) in Kunming, western China, where the self-purifying capacity of the agricultural ecosystem had been lost. The proposed eco-restoration system examined includes three main foci: farming management, bioremediation, and wastewater treatment. The results showed that the removal efficiencies of total phosphorus (TP) and total nitrogen (TN) from the complex wastewater were 83% and 88%, respectively. The Simpson's diversity indices of macrophytes and zoobenthos indicated that the system had increased macrophyte and zoobenthic diversity as well as improved growth conditions of the plankton habitats. The results demonstrated that the proposed eco-restoration system is a promising approach for decreasing the output of nutrients from soil, improving agricultural ecosystem health, and minimizing the downstream eutrophication risk for surface waters.
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Conservación de los Recursos Naturales/métodos , Nitrógeno/aislamiento & purificación , Fósforo/aislamiento & purificación , Suelo , Eliminación de Residuos Líquidos/métodos , Agua/químicaRESUMEN
Harmful cyanobacterial bloom in water bodies frequently occurs due to eutrophication, leading to the excessive growth of cyanobacteria which in turn may lead to a decrease in biodiversity. A biopond-wetland system to control cyanobacterial bloom and stabilize or even increase biodiversity is proposed and applied in a pond, Kunming, western China where cyanobacterial blooms frequently break out. The biopond-wetland system examined includes three main parts: filter-feeding fish, replanted pond macrophytes, and a terminal artificial wetland. When the hydraulic load of the biopond-wetland system was 500m(3)/d on non-rainy days, the system successfully decreased the level of chlorophyll-a (Chl-a). The declining levels of total nitrogen (TN), total phosphorus (TP) and ammonia in the water after establishing the biopond-wetland system also coincided with the disappearance of the cyanobacterial bloom. In the second summer, when the biopond-wetland system was in a relatively steady-state condition, the overall average nutrient removal efficiencies were as follows, Chl-a (83%), TN (57%), TP (70%) and ammonia (66%), while in the second winter, the overall average removal efficiencies were Chl-a (66%), TN (40%), TP (53%) and ammonia (49%). Simpson's diversity index of zoobenthos indicated that the system increased the zoobenthic diversity and improved the growth conditions of the zoobenthos habitat. The results demonstrated that the biopond-wetland system could control cyanobacterial blooms.
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Biodiversidad , Cianobacterias/aislamiento & purificación , Humedales , Amoníaco/análisis , Nitrógeno/análisis , Fósforo/análisisRESUMEN
In studies of vitamin E effectiveness in diabetes, there are still controversies surrounding negative observational and positive experimental results. However, there is no controversy that antioxidant vitamin E is regenerated from its pro-oxidant tocopheroxyl radical by a network of interacting co-antioxidants. The network of interacting co-antioxidants has only been studied individually. The hypothesis we propose is that a vitamin E regeneration system (VERS) model based on the complex interactions of the co-antioxidants provides a rationale for vitamin E supplementation as a therapeutic adjunct in diabetes. Furthermore, the factors considered prior to the use of Vitamin E as a supplement in diabetes research and therapy, the effectiveness of vitamin E supplementation and the limitations have been identified in the literature. There is no single study of vitamin E supplementation or efficacy that has determined vitamin E levels in combination with all of the co-antioxidants that interact to regenerate oxidised vitamin E. Therefore, there is a lack of good evidence for or against vitamin E being unilaterally depleted in the antioxidant network. There is also lack of rationale for choice of co-antioxidant supplementation. In essence, the normal conditions for effective antioxidant activity of vitamin E supplementation have yet to be fully explored. We propose a coherent model of VERS, and recommend that VERS status needs to be assessed, as part of evidence-based clinical practice to determine whether vitamin E should be recommended for the diabetic patient. We also propose an algorithm, based on the antioxidant activity and confounding factors, to guide the formulation of a credible hypothesis for clinical trials in assessing the function of vitamin E and treatment outcomes. The proposed model hinges on pertinent questions that have to be addressed to avoid organising a clinical trial that has been identified as biased.