Effect of coffee drinking on platelets: inhibition of aggregation and phenols incorporation.

Epidemiological studies indicate a J-shaped relationship linking coffee consumption and cardiovascular risk, suggesting that moderate coffee consumption can be beneficial. Platelet aggregation is of critical importance in thrombotic events, and platelets play a major role in the aetiology of several CVD. The aim of this study was to evaluate the effect of coffee drinking on platelet aggregation ex vivo, using caffeine as control. A crossover study was performed on ten healthy subjects. In two different sessions, subjects drank 200 ml coffee, containing 180 mg caffeine, or a capsule of caffeine (180 mg) with 200 ml water. Platelets were separated from plasma at baseline and 30 and 60 min after coffee drinking. Platelet aggregation was induced with three different agonists: collagen, arachidonic acid and ADP. Coffee drinking inhibited collagen (P < 0.05 from baseline at time 30 min) and arachidonic acid (P < 0.05 from baseline at time 60 min) induced platelet aggregation. Caffeine intake did not affect platelet aggregation induced by the three agonists. Coffee consumption induced a significant increase of platelet phenolic acids (likely present as glucuronate and sulphate derivatives), caffeic acid, the principal phenolic acid in coffee, raising from 0.3 (SEM 0.1) to 2.4 (SEM 0.6) ng/mg (P < 0.01). Caffeine was not detectable in platelets. Coffee drinking decreases platelet aggregation, and induces a significant increase in phenolic acid platelet concentration. The antiplatelet effect of coffee is independent from caffeine and could be a result of the interaction of coffee phenolic acids with the intracellular signalling network leading to platelet aggregation.

Polyphenols synergistically inhibit oxidative stress in subjects given red and white wine.

Aim of this study was to analyse the relationship between the plasma levels of polyphenols and the antioxidant activity of red and white wine. Twenty healthy subjects (HS) were randomly allocated to drink 300 ml of red (n = 10) or white n = 10 wine for 15 days. Ten HS who refrained from any alcohol beverage for 15 days were used as control. Urinary PGF-2alpha-III, a marker of oxidative stress and plasma levels of polyphenols were measured. Urinary PGF-2alpha-III significantly fell in subjects taking wine with a higher percentage decrease in subjects given red wine (-38.5 +/- 6%, p < 0.001) than in those given white wine (-23.1 +/- 6%). Subjects taking red wine had higher plasma polyphenols than those taking white wine (1.9 +/- 0.6 microM versus 1.5 +/- 0.33 microM, p < 0.001). Plasma polyphenols were inversely correlated with urinary PGF2alpha (r = 0.77, p < 0.001). No changes of urinary isoprostanes were observed in subjects who refrained from wine intake. In vitro study demonstrated that only a mixture of polyphenols, all in a range corresponding to that found in human circulation, inhibited LDL oxidation and PKC-mediated NADPH oxidase activation. Such inhibitory effects were more marked using the concentrations of polyphenols detected in human circulation after red wine intake. This study shows that red wine is more antioxidant than white wine in virtue of its higher content of polyphenols, an effect that may be dependent upon a synergism among polyphenols.

Gliclazide improves anti-oxidant status and nitric oxide-mediated vasodilation in Type 2 diabetes.

AIMS: To evaluate the effects of gliclazide on oxidative status and vascular response to systemic administration of L-arginine, the natural precursor of nitric oxide (NO), in Type 2 diabetic patients. METHODS: Thirty Type 2 diabetic patients received glibenclamide (n = 15) or gliclazide (n = 15) in a 12-week, randomized, observer-blinded, parallel study. Plasma lipid peroxides, total radical-trapping anti-oxidant parameter (TRAP), and blood pressure responses to an intravenous bolus of L-arginine were measured pre- and post-treatment. RESULTS: At 12 weeks, gliclazide patients had lower plasma lipid peroxides (13.3 +/- 3.8 micro mol/l vs. 19.2 +/- 4.3 micro mol/l; P = 0.0001) and higher plasma TRAP (1155.6 +/- 143.0 micro mol/l vs. 957.7 +/- 104.3 micro mol/l; P = 0.0001) than the glibenclamide patients. Gliclazide but not glibenclamide significantly reduced systolic and diastolic blood pressure (P = 0.0199 and P = 0.00199, respectively, two-way repeated measures analysis of variance) in response to intravenous L-arginine. CONCLUSIONS: Gliclazide reduces oxidative stress in Type 2 diabetic patients by improving plasma anti-oxidant status. This effect is associated with enhanced NO-mediated vasodilation.

[Determination of the blood ascorbic acid level after administration of slow-release vitamin C]. / Determinazione del livello di acido ascorbico nel plasma dopo somministrazione di vitamina C a lento rilascio.

PURPOSE: The aim of the present study was to test the effects of a slow releasing form of vitamin C in smokers, because the single high dose previously proposed for smokers gave a transient increase of plasma ascorbate, being rapidly absorbed in the gastrointestinal tract and is rapidly excreted with urine. MATERIALS AND METHODS: In a double-blind placebo-controlled study 18 subjects received both Vitamin C (C-test) and placebo (P-test) in two different periods. During the test-day the subject followed a controlled diet and food Intake was assessed by semiquantitative questionnaire. Peripheral blood sample were collected in fasting conditions, in the morning, before and after 4, 8, 12 and 24 hours from the treatment. Blood sample was collected into EDTA-containing tubes, immediately centrifuged and treated for ascorbate determination, and stored at -70 degrees C until chromatographic analysis. RESULTS: Smokers and nonsmokers were similar for age, height, weight, BMI and for vegetable and fruit consumption. Ascorbic acid level was significantly (p < 0.05) lower than the references level in all subjects, however there were no differences between smokers and non smokers plasma ascorbate concentration increased significantly at T1, T2 and T3 respect to T0 during C test (p < 0.005), whenever remaining higher than T0 was not still significant in T4. CONCLUSION: Our results demonstrate that a slow releasing form of Vitamin C could be useful in clinical pharmacology to increase and to maintain to a constant rate ascorbate level, both in smokers and non smokers with a single daily administration.

Red wine mitigates the postprandial increase of LDL susceptibility to oxidation.

The aim of the present study was to verify the extent of oxidative stress induced by a meal at plasma and LDL level, and to investigate the capacity of red wine to counteract this action. In two different sessions, six healthy men ate the same test meal consisting of "Milanese" meat and fried potatoes. The meal was taken either with 400 ml red wine or with an isocaloric hydroalcoholic solution. Oxidative stress at plasma level was estimated through the measure of ascorbic acid, alpha-tocopherol, protein SH groups, uric acid, and antioxidant capacity, measured before and 1 and 3 h after the meal. The change in the resistance of LDL to oxidative modification was taken as an index of exposure to pro-oxidants. The susceptibility to Cu(II)-catalyzed oxidation of baseline and postprandial LDL was measured as conjugated dienes formation, tryptophan residues, and relative electrophoretic mobility. The experimental meal taken with wine provoked a significant increase in the total plasma antioxidant capacity and in the plasma concentration of alpha-tocopherol and SH groups. Postprandial LDL was more susceptible to metal-catalyzed oxidation than the homologous baseline LDL after the ethanol meal. On the contrary, postprandial LDL obtained after the wine meal was as resistant or more resistant to lipid peroxidation than fasting LDL.

Total antioxidant capacity as a tool to assess redox status: critical view and experimental data.

The measure of antioxidant capacity (AC) considers the cumulative action of all the antioxidants present in plasma and body fluids, thus providing an integrated parameter rather than the simple sum of measurable antioxidants. The capacity of known and unknown antioxidants and their synergistic interaction is therefore assessed, thus giving an insight into the delicate balance in vivo between oxidants and antioxidants. Measuring plasma AC may help in the evaluation of physiological, environmental, and nutritional factors of the redox status in humans. Determining plasma AC may help to identify conditions affecting oxidative status in vivo (e.g., exposure to reactive oxygen species and antioxidant supplementation). Moreover, changes in the plasma AC after supplementation with galenic antioxidants or with antioxidant-rich foods may provide information on the absorption and bioavailability of nutritional compounds. Consequently, this review discusses the rationale, interpretation, confounding factors, measurement limits, and human applications of the measure of plasma AC.

The flavonoids quercetin and catechin synergistically inhibit platelet function by antagonizing the intracellular production of hydrogen peroxide.

BACKGROUND: Epidemiologic studies have shown an inverse relation between moderate consumption of red wine and cardiovascular disease. Studies have shown that red wine and its component flavonoids inhibit in vivo platelet activation, but the underlying mechanism has not yet been identified. OBJECTIVE: Because we showed previously that collagen-induced platelet aggregation is associated with a burst of hydrogen peroxide, which in turn contributes to stimulating the phospholipase C pathway, the aim of this study was to investigate whether flavonoids synergize in inhibiting platelet function and interfere with platelet function by virtue of their antioxidant effect. DESIGN: We tested the effect of 2 flavonoids, quercetin and catechin, on collagen-induced platelet aggregation and hydrogen peroxide and on platelet adhesion to collagen. RESULTS: Catechin (50-100 micromol/L) and quercetin (10-20 micromol/L) inhibited collagen-induced platelet aggregation and platelet adhesion to collagen. The combination of 25 micromol catechin/L and 5 micromol quercetin/L, neither of which had any effect on platelet function when used alone, significantly inhibited collagen-induced platelet aggregation and platelet adhesion to collagen. Such a combination strongly inhibited collagen-induced hydrogen peroxide production, calcium mobilization, and 1,3,4-inositol triphosphate formation. CONCLUSIONS: These data indicate that flavonoids inhibit platelet function by blunting hydrogen peroxide production and, in turn, phospholipase C activation and suggest that the synergism among flavonoids could contribute to an understanding of the relation between the moderate consumption of red wine and the decreased risk of cardiovascular disease.

Superoxide anion and hydroxyl radical release by collagen-induced platelet aggregation--role of arachidonic acid metabolism.

Previous study demonstrated that platelets undergoing anoxia-reoxygenation generate superoxide anion (O2-) and hydroxyl radical (OH ) which in turn contribute to activate arachidonic acid (AA) metabolism. However it has not been clarified if oxygen free radicals (OFRs) are also generated when platelets are aggregated by common agonists. We used two probes, i.e. lucigenin and salicylic acid (SA), to measure platelet release of O2- and OH(0), respectively. Among the agonists used, such as ADP, thrombin and collagen, the release of O2- and OH was observed mainly when platelets were stimulated with collagen. Such release was inhibited in platelets pre-treated by aspirin suggesting that AA metabolism was the main source of O2- and OH(0) formation. To further analyze this relationship, O2- and OH(0) formation was measured during AA-stimulated platelet aggregation (PA); we observed that O2- and OH(0) release were dependent upon AA concentration. Furthermore, we found that the incubation of platelets with AACOCF3, a potent inhibitor of cytosolic phospholipase A2, inhibited collagen-induced platelet O2- and OH(0) release. The incubation of platelets with salicylic acid or ascorbic acid, which blunt OH and O2- respectively, inhibited both collagen-induced platelet aggregation and AA-release. This study demonstrated that collagen-induced platelet aggregation is associated with O2- and OH formation, which is dependent upon AA release and metabolism.

Beer increases plasma antioxidant capacity in humans.

The positive association of a moderate intake of alcoholic beverages with a low risk for cardiovascular disease, in addition to ethanol itself, may be linked to their polyphenol content. This article describes the effect of acute ingestion of beer, dealcoholized beer, and ethanol (4.5% v/v) on the total plasma antioxidant status of subjects, and the change in the high performance liquid chromatography profile of some selected phenolic acids (caffeic, sinapic, syringic, and vanillic acids) in 14 healthy humans. Plasma was collected at various times: before (T0), 1 hour after (T1), and 2 hours after (T2) drinking. The study is part of a larger research planned to identify both the impact of brewing on minor components potentially present in beer and their metabolic fate in humans. Beer was able to induce a significant (P < 0.05) increase in plasma antioxidant capacity at T1 (mean +/- SD: T0 1,353 +/- 320 microM; T1 1,578 +/- 282 microM), returning close to basal values at T2. All phenolic acids measured in plasma tended to increase after beer intake (20% at T1, 40% at T2). Syringic and sinapic acid reached statistical significance (P < 0.05 by one-way analysis of variance-Fisher's test) at T1 and T2, respectively. Plasma metabolic parameters (glucose, total cholesterol, triglycerides, and uric acid) and plasma antioxidants (alpha-tocopherol and glutathione) remained unchanged. Ethanol removal impaired the absorption of phenolic acids, which did not change over the time of the experiment, accounting for the low (and not statistically significant) increase in plasma antioxidant capacity after dealcoholized beer drinking. Ethanol alone did not affect plasma antioxidant capacity or any of the antioxidant and metabolic parameters measured.

Iron-dependent human platelet activation and hydroxyl radical formation: involvement of protein kinase C.

BACKGROUND: Iron is an important modulator of lipid peroxidation, and its levels have been associated with the progression of atherosclerosis. Little is known about the possibility that this metal, when released from tissue stores, may modulate the reactivity of blood cell components, in particular platelets. Therefore, we investigated a possible link between iron, oxygen free radical formation, and platelet function. METHODS AND RESULTS: Human whole blood was stimulated with collagen 2 micrograms/mL, and an irreversible aggregation with thromboxane (Tx)B2 formation was observed (15+/-4 versus 130+/-10 ng/mL). Deferoxamine (DSF), a specific iron chelator, and catalase, an H2O2 scavenger, inhibited collagen-induced whole-blood aggregation. The aggregation was accompanied by an increase in hydroxyl radical (OH.) levels (30+/-8 versus 205+/-20 nmol/L dihydroxybenzoates), which were reduced by DSF and by 2 specific OH. scavengers, mannitol and deoxyribose. Iron (Fe2+) dose-dependently induced platelet aggregation, TxB2 formation (6+/-2 versus 135+/-8 ng/mL), and protein kinase C (PKC) translocation from the cytosol to the cell membrane when added to platelets that have been primed with a low concentration of collagen (0.2 micrograms/mL). In the same system, an increase in OH. levels was observed (37+/-12 versus 230+/-20 nmol/L dihydroxybenzoates). Mannitol and deoxyribose, but not urea, were able to reduce OH. formation, PKC activation, and platelet aggregation. Selective inhibition of PKC activity by GF 109203X prevented iron-dependent platelet aggregation without influencing OH. production. CONCLUSIONS: The present study shows that iron can directly interact with human platelets, resulting in their activation. Its action is mediated by OH. formation and involves PKC activity. Our findings provide an additional contribution to the understanding of the mechanism(s) by which iron overload might promote atherosclerosis and coronary artery disease.

Beer affects oxidative stress due to ethanol in rats.

The relationship between chronic moderate beer consumption and oxidative stress was studied in rats. Animals were fed three different isocaloric diets for six weeks: a beer-containing diet (30% w/w), an ethanol-supplemented diet (1.1 g/100 g, the same as in the beer diet) and an alcohol-free basal diet. At the end of the feeding period, rats were analyzed for plasma and liver oxidative status. Some livers were isolated and exposed to ischemia-reperfusion to assess the additional oxidative stress determined by reperfusion. No significant differences in plasma antioxidant status were found among the three dietary groups. Lipoproteins from the beer group, however, showed a greater propensity to resist lipid peroxidation. Ischemia caused a decrease in liver energy and antioxidant status in all groups. Nevertheless, ATP was lower in the livers of rats exposed to the ethanol diet. During reperfusion, lipoperoxidation increased significantly in all groups. However, livers obtained from ethanol-treated rats showed the higher formation of lipoperoxides. In conclusion, a moderate consumption of beer in a well-balanced diet did not appear to cause oxidative stress in rats; moreover, probably through its minor components, beer could attenuate the oxidative action of ethanol by itself.

Analysis of plasma antioxidant capacity by competition kinetics.

A competition kinetics procedure for measuring plasma antioxidant capacity is described. This procedure is based on the "crocin bleaching test" (Bors, W., et al. Biochim. Biophys. Acta 796:312-319; 1984) modified for analyzing the antioxidant capacity of complex mixtures (Tubaro, F., et al. J. Am. Oil Chem. Soc. 73:173-179; 1996). The information produced by this test is similar to that of the popular "total radical trapping antioxidant potential" (TRAP) analysis. However, the adopted kinetic approach is, in principle, more precise, taking into account both the concentration of antioxidants and their rate constant for the reaction with peroxy radical, which is overlooked in TRAP tests, as implied by the theory of the approach and confirmed by dynamic modeling. The kinetic analysis has also the advantage of accounting for the average between antioxidant effect (reduction of peroxy radicals) and possible prooxidant effect (oxidation by the radical of the antioxidant of the target supposed to be protected) if any. Thus, the result of this analysis provides a more precise evaluation of the efficiency of antioxidant defense. The intraassay variation resulted in less than 8% and, in young healthy subjects, the plasma antioxidant capacity, expressed as mM equivalents of a reference antioxidant (Trolox C), gave 1.59 +/- 0.28. The validated procedure has been used to show that plasma antioxidant capacity is deeply influenced by the consumption of wine.

Antioxidant Activity of Different Phenolic Fractions Separated from an Italian Red Wine.

Using liquid/liquid extraction, three fractions were obtained from an Italian red wine containing single polyphenolic subfractions: (1) phenolic acids and quercetin-3-glucuronide, (2) catechins and quercetin-3-glucoside, and (3) anthocyanins. Beside the scavenging capacity of the different fractions against hydroxyl and peroxyl radicals, the in vitro inhibition of low density lipoprotein oxidation and platelet aggregation (two main events in the pathogenesis of atherosclerosis) were tested. The antioxidant activity of the fractions has been compared with that of the original red wine before and after dealcoholization. The anthocyanin fraction was the most effective both in scavenging reactive oxygen species and in inhibiting lipoprotein oxidation and platelet aggregation. This higher activity can be explained by both its high concentration in red wine and its antioxidant efficiency, which, at least for peroxyl radical scavenging, was three times as high as that of the other two fractions. Our results suggest that anthocyanins could be the key component in red wine in light of the protection against cardiovascular diseases, although this hypothesis needs in vivo evidence.

The antioxidant potential of the Mediterranean diet.

The Mediterranean diet not only produces favourable effects on blood lipids but also protects against oxidative stress. Oxidative damage is thought to represent one of the mechanisms leading to chronic diseases such as atherosclerosis and cancer. Many studies suggest that a link exists between fruit and vegetables in the diet or the amounts of plasma antioxidant vitamins (ascorbic acid, tocopherol and carotenoids) and risk of death from cancer or coronary heart diseases. Although a large emphasis has been given to different components of the diet, attention has recently shifted to the diet as a whole. The Mediterranean diet is able to modulate oxidative stress through complex mechanisms and not just the high antioxidant compound content. The preference for fresh fruit and vegetables in the Mediterranean diet will result in a higher consumption of raw foods, a lower production of cooking-related oxidants and a consequent decreased waste of nutritional and endogenous antioxidants. The high intake of antioxidant and fibre helps to scavenge even the small amount of oxidants or oxidized compounds.

Platelet activation by superoxide anion and hydroxyl radicals intrinsically generated by platelets that had undergone anoxia and then reoxygenated.

BACKGROUND: Platelet activation has been demonstrated in experimental and clinical models of ischemia-reperfusion, but the underlying mechanism is still unclear. We mimicked the ischemia-reperfusion model in vitro by exposing platelets to anoxia-reoxygenation (A-R) and evaluated the role of oxygen free radicals (OFRs), which are usually produced during the reperfusion phase, in inducing platelet activation. METHODS AND RESULTS: Human platelets were exposed to 15 and 30 minutes of anoxia and then reoxygenated. Compared with control platelets kept in atmospheric conditions, platelets exposed to A-R showed spontaneous platelet aggregation (SPA), which was maximal after 30 minutes of anoxia. Superoxide dismutase (SOD) (-74%, P < .005), catalase (-67%. P < .005). SOD plus catalase (-82%, P < .005), and the hydroxyl radical (OH0) scavengers mannitol (-66%, P < .005) and deoxyribose (-55%, P < .005) inhibited SPA. Platelets that had undergone A-R released superoxide anion (0-2), as detected by lucigenin chemiluminescence. Also, platelets exposed to A-R and incubated with salicylic acid generated 2.3- and 2,5-dihydroxybenzoates, which derive from salicylic acid reaction with OH0. SPA was significantly inhibited by the cyclooxygenase enzyme inhibitors aspirin and indomethacin: by SQ29548, a thromboxane (Tx) A2 receptor antagonist; by diphenyliodonium an inhibitor of flavoprotein-dependent enzymes: and by arachidonyl trifluoromethyl ketone, a selective inhibitor of cytosolic phospholipase A2. Platelets exposed to A-R markedly generated inositol 1,3,4-trisphosphate and TxA2, which were inhibited by incubation of platelets with SOD plus catalase. CONCLUSIONS: This study shows that platelets exposed to A-R intrinsically generated 0-2 and OH0, which in turn activate arachidonic acid metabolism via phospholipases A2 and C, and provides further support for the use of antioxidant agents as inhibitors of platelet function in ischemia-reperfusion models.

In vivo antioxidant effect of green and black tea in man.

OBJECTIVE: Evaluation of the vitro antioxidant activity of green and black tea, their in vivo effect on plasma antioxidant potential in man and the effect of milk addition. DESIGN: The antioxidant activity of the tea, with and without milk, was tested in vitro by measuring the length of the peroxyl radical induced lag-phase. The in vivo activity was tested on two groups of five healthy adults. Each group ingested 300 ml of either black or green tea, after overnight fast. The experiment was repeated on a separate day, adding 100 ml whole milk to the tea (ratio 1:4 ). Five subjects acted as controls. The human plasma antioxidant capacity (TRAP) was measured before and 30, 50 and 80 min from the ingestion of tea. RESULTS: Both teas inhibited the in vitro peroxidation in a dose-dependent manner. Green tea was sixfold more potent than black tea. The addition of milk to either tea did not appreciably modify their in vitro antioxidant potential. In vivo, the ingestion of tea produced a significant increase of TRAP (P <0.05), similar in both teas, which peaked at 30-50 min. When tea was consumed with milk, their in vivo activity was totally inhibited. CONCLUSIONS: The paper shows that tea possesses a strong antioxidant activity in vitro which is believed to be exerted by its polyphenols moiety. It also provides compelling evidence that tea has also a potent in vivo activity in man. The promptness of the in vivo response suggests that the absorption of the bioactive components of tea takes place in the upper part of the gastrointestinal system. The inhibition of this effect by milk is thought to be due to the complexation of tea polyphenols by milk proteins. These findings might help to clarify the putative role of dietary poly- phenols in modulating oxidative stress in vivo.

A fluorescence-based method for measuring total plasma antioxidant capability.

The Total Radical-Trapping Antioxidant Parameter (TRAP) of 10 freshly prepared human plasmas was measured by a new fluorometric assay. In this method, the rate of peroxidation induced by 2,2'-diazobis (2-amidinopropane) dihydrochloride (ABAP) was monitored through the loss of fluorescence of the protein R-Phycoerythrin (R-PE). The lag-phase induced by plasma was compared to that induced by 6-hydroxy-2,5,7,8-tetramethylchroman-2- carboxylic acid (Trolox, a water-soluble analogue of vitamin E). Proteins (but not their sulphydryl groups) interfere with the analysis, partially protecting R-PE when all plasma antioxidants are exhausted. A Trolox-induced lag-phase must therefore be measured on each plasma sample. We found that ascorbate (2.5-5.3%), alpha-tocopherol (2.9-8.5%), urate (19.6-61.0), and thiol groups (17.3-42.3%) jointly explain up to 70% of TRAP. Thus, either other compounds present in plasma are likely to exert antioxidant action, or a marked synergistic action between antioxidants should be postulated to exist. This latter hypothesis is supported by the finding that the simultaneous inactivation of ascorbate and thiol groups produces a loss in antioxidant capacity of plasma greater (26%) than the sum of the decreases produced by the separate inactivation of each of the two compounds. The proposed method appears simple, reliable, and allows the rapid handling of a reasonable number of freshly prepared plasma samples. Given the rapid loss of TRAP upon storage, the latter characteristic is crucial in studies on humans, involving a large number of subjects.

Effect of aldose reductase inhibition on glutathione redox status in erythrocytes of diabetic patients.

Diabetic patients undergo a chronic oxidative stress. This phenomenon is demonstrated by low levels of reduced glutathione (GSH) levels. The NADPH used by glutathione reductase for the reduction of oxidized glutathione (GSSG) to GSH is also used by aldose reductase for the reduction of glucose to sorbitol through the polyol pathway. The competition for NADPH could be responsible for the decreased glutathione levels found in non-insulin-dependent diabetic patients. For this purpose, we investigated the effect of polyol pathway inhibition on the glutathione redox status in these patients. We measured GSH and GSSG levels in erythrocytes of non-insulin-dependent diabetic patients (n = 15) before and after 1 week of treatment with placebo, followed by 1 week of treatment with an aldose reductase inhibitor (tolrestat 200 mg/dl). We found lower GSH levels (7.7 +/- 1.4 mumol/g hemoglobin [Hb]), higher GSSG levels (0.35 +/- 0.09 mumol/g Hb), and lower GSH/GSSG ratios (23.9 +/- 7.7) in diabetics compared with controls (n = 15; 9.8 +/- 0.8 mumol/g Hb, P < .001; 0.17 +/- 0.02, P < .001; and 58.3 +/- 9.1, P < .001, respectively). We did not demonstrate any statistical difference after 1 week of treatment with placebo. In contrast, the treatment with tolrestat induced a significant increase in GSH (8.9 +/- 0.7 mumol/g Hb, P < .01), a decrease in GSSG (0.25 +/- 0.06 mumol/g Hb, P < .02), and an increase in the GSH/GSSG ratio (37.3 +/- 8.4, P < .01). These data strongly support the hypothesis that the polyol pathway plays an important role in the impairment of the glutathione redox status in diabetic patients.