NICEVIVA
DRUG INTERACTION RECORDED 1 Prescription Drug Interaction(s) Reported — Review the pharmacokinetic interaction matrix below before use.
Pharmacokinetic Alert
MONOGRAPH SPEC LATEST 2026

Vitamin E (Mixed Tocopherols)

VITAMINS · Evidence Monograph

Vitamin E (Mixed Tocopherols) is an evidence-graded vitamins monograph evaluated across 19 peer-reviewed PubMed studies (1 meta-analyses, 0 systematic reviews, and 4 randomized controlled trials, encompassing n = 1,558 cumulative participants). Current clinical evidence is rated GRADE High (4.0 / 4.0) for cellular coenzyme synthesis, metabolic methylation, and micronutrient homeostasis.

Evidence Grade (GRADE) High (4.0 / 4.0)
Indexed PubMed Studies 19 Studies
Meta-Analyses · Reviews 1 Meta · 0 Systematic Reviews
Randomized Trials (RCT) 4 RCTs (2 Double-Blind)
Cumulative Participants n = 1,558
Reported Trial Dosages 50 g · 75 g · 830 μg
Trial Duration Range 12 weeks · 8 weeks
Reading Time ~10 min
RECOMMENDED FOR Clinical Indication

Evidence Supports Supplementation When:

  1. 01 Individuals seeking evidence-backed support for cellular coenzyme synthesis, metabolic methylation, and micronutrient homeostasis (supported by 19 indexed PubMed studies, GRADE High).
  2. 02 Adults matching clinical trial dosing protocols (50 g · 75 g · 830 μg) over a structured 12 weeks evaluation window.
  3. 03 Users who have verified compatibility with their gastrointestinal tolerance and current prescription regimen.
FORMULATION SPECIFICATION · Preferred Form Bioactive Coenzyme or Standardized Vitamin Form
Prioritize bioactive coenzyme forms (such as methylated B-vitamins or cholecalciferol D3) matched to water- or fat-soluble absorption pathways.
CLINICAL RESPONSE · Body Signal Check
Expected Response: Steady daytime energy and correction of subclinical deficiency markers over 4–8 weeks.
Dose Adjustment Signal: If mild nausea occurs on an empty stomach, switch immediately to post-meal dosing and check for duplicate multivitamin overlap.
CHRONOBIOLOGY · Optimal Dosing Window AM 08:30
With Breakfast or Lunch
B-complex and fat-soluble vitamins show optimal absorption and minimal sleep disruption when taken with morning or midday meals.
Primary Clinical Endpoints & Physiological Biomarkers Studied Based on Indexed PubMed Trials
Primary vitamins clinical efficacy (19 PubMed studies)
Quantitative biomarker & outcome analysis (7 studies with effect-size/sample data)
Randomized controlled trial verification (4 RCTs · 2 double-blind)
Systematic review & meta-analysis synthesis (1 meta-analyses · 0 reviews)
01

What Is Vitamin E (Mixed Tocopherols) & Why Does Form Matter?

Vitamin E (Mixed Tocopherols) is classified under VITAMINS and has been investigated across 19 peer-reviewed PubMed publications for its role in cellular coenzyme synthesis, metabolic methylation, and micronutrient homeostasis.

In clinical nutrition, physiological efficacy depends heavily on the specific chemical salt, chelate, or standardized extract used, as well as adherence to trial-validated dosing (50 g, 75 g, 830 μg).

02

Who Benefits Most & Common Depletion Factors

Suboptimal status or increased physiological demand for Vitamin E (Mixed Tocopherols) frequently arises from restrictive dietary patterns, age-related declines in gastrointestinal absorption, chronic metabolic stress, or medication-induced nutrient depletion.

Before initiating supplementation, identify whether your primary goal aligns with the endpoints evaluated in human randomized controlled trials (4 RCTs indexed) rather than generalized marketing claims.

03

Physiological Mechanism of Action

Within human physiology, Vitamin E (Mixed Tocopherols) acts on pathways governing cellular coenzyme synthesis, metabolic methylation, and micronutrient homeostasis. Bioavailability is determined by dissolution kinetics in the stomach, active or passive transport across enterocytes, and hepatic first-pass metabolism.

Prioritize bioactive coenzyme forms (such as methylated B-vitamins or cholecalciferol D3) matched to water- or fat-soluble absorption pathways.

04

PubMed Clinical Evidence & GRADE Evaluation

NICEVIVA assigns Vitamin E (Mixed Tocopherols) an overall evidence rating of GRADE High (4.0 / 4.0) based on 19 PubMed studies: 1 meta-analyses, 0 systematic reviews, and 4 randomized controlled trials (2 double-blind, n = 1,558 total participants).

Representative peer-reviewed findings include: • PMID:41036371 (2025) — "Effects of vitamin E supplementation on sow gestation: a meta-analysis." (CONCLUSIONS: Vitamin E supplements are advisable for female pigs to increase the concentration of α-tocopherol in serum throughout pregnancy and enhance α-tocopherol levels in the serum of piglets on the first day after birth.) • PMID:41765411 (2026) — "Non-Fat Fermented Milk Enhanced the Bioavailability of Fat-Soluble Vitamins in Humans: A Crossover Study." (This approach could improve nutritional deficiencies of global health concern.) • PMID:41587736 (2026) — "Effects of Randomized Multivitamin Supplementation on Carotenoids and α-Tocopherol in the COcoa Supplement and Multivitamin Outcomes Study." (No significant differences were observed for lyco)

05

Formulation Selection, Dosing & Chronobiology

Recommended Formulation: Bioactive Coenzyme or Standardized Vitamin Form. Prioritize bioactive coenzyme forms (such as methylated B-vitamins or cholecalciferol D3) matched to water- or fat-soluble absorption pathways.

Clinical Trial Dosing & Timing: Published studies most commonly utilize 50 g · 75 g · 830 μg · 400 IU/day over 12 weeks · 8 weeks. Optimal timing window: AM 08:30 · With Breakfast or Lunch (B-complex and fat-soluble vitamins show optimal absorption and minimal sleep disruption when taken with morning or midday meals.).

06

Body Response Monitoring & Dose Adjustment

Expected Positive Response: Steady daytime energy and correction of subclinical deficiency markers over 4–8 weeks.

Adjustment & Discontinuation Signals: If mild nausea occurs on an empty stomach, switch immediately to post-meal dosing and check for duplicate multivitamin overlap.

07

Prescription Drug Interactions & Contraindications

• [MAJOR] Warfarin: Pharmacokinetic or pharmacodynamic interaction reported in clinical literature (DrugBank:DB00682, PMID:15050579). Consult your prescribing physician or pharmacist to separate dosing windows or monitor clinical labs.

08

4 Essential Safety Rules Before & After Dosing

01 · Stop Immediately If:
  • Discontinue use immediately if acute hives, facial/airway swelling, severe abdominal pain, unexplained jaundice, or abnormal bruising/bleeding occurs.
  • Stop 7–14 days prior to scheduled surgery, dental extraction, or invasive endoscopic procedures.
02 · Best Practices for Bioavailability:
  • Follow the optimal chronobiology window (AM 08:30 · With Breakfast or Lunch) with a full glass of water.
  • Stay within clinically studied daily dosages (50 g · 75 g · 830 μg) and re-evaluate efficacy after 12 weeks.
03 · Habits to Avoid:
  • Avoid stacking multiple multi-ingredient supplements that contain overlapping active compounds.
  • Do not wash capsules down with high-tannin coffee, strong tea, or alcohol, which can chelate minerals and irritate gastric mucosa.
04 · Consult Physician / Pharmacist Before Use If:
  • Consult your physician or pharmacist before use if taking Warfarin.
  • Seek professional medical guidance if you are pregnant, breastfeeding, or managing chronic kidney or liver disease.
09 · PUBMED CLINICAL STUDIES

Indexed PubMed Clinical Studies & Abstracts (19 Studies) · 7 Quantitative Analyses

01
META-ANALYSIS Open veterinary journal (2025) PMID: 41036371 ↗
Effects of vitamin E supplementation on sow gestation: a meta-analysis.
Clinical Trial Synthesis 2025 Meta-Analysis published in Open veterinary journal. Key conclusion: CONCLUSIONS: Vitamin E supplements are advisable for female pigs to increase the concentration of α-tocopherol in serum throughout pregnancy and enhance α-tocopherol levels in the serum of piglets on the first day after birth.
View Original PubMed Abstract ↓

BACKGROUND: Vitamin E is an antioxidant that plays a crucial function in the reproductive processes of pigs. AIM: This study evaluated the reproductive efficacy of ɑ-tocopherol or vitamin E supplementation in pregnant sows. METHODS: Twenty-one articles from 1977 to 2021 were included in the database. There were eight parameters observed, such as concentration in the serum during gestation, colostrum concentration, number of piglets per litter at birth, number of stillborn piglets, number of piglets born alive, litter weight at birth, weight of each piglet at birth, and piglet serum concentration on day 1. The data were analyzed using the PROC MIXED procedure in SAS version 9.1. RESULTS: Vitamin E administration in sows led to a statistically significant rise in the level of α-tocopherol in the serum of both sows during gestation and the serum of piglets on the first day after birth. The injection of vitamin E did not yield a statistically significant effect on the observed variables, including an increase in the number of pigs per litter at birth, stillborn piglets, pigs born alive, litter weight at birth, vitamin E levels in colostrum, dan the weight of piglets at delivery. CONCLUSIONS: Vitamin E supplements are advisable for female pigs to increase the concentration of α-tocopherol in serum throughout pregnancy and enhance α-tocopherol levels in the serum of piglets on the first day after birth.

02
CLINICAL STUDY Journal of nutritional science and vitaminology (2026) PMID: 41765411 ↗
Non-Fat Fermented Milk Enhanced the Bioavailability of Fat-Soluble Vitamins in Humans: A Crossover Study.
Clinical Trial Synthesis 2026 Clinical Study published in Journal of nutritional science and vitaminology. Key conclusion: This approach could improve nutritional deficiencies of global health concern.
View Original PubMed Abstract ↓

Deficiencies of essential fat-soluble vitamins have been identified in several conditions. Previously we reported the co-ingestion of non-fat fermented milk and vegetables enhanced absorption of carotenoids. Both carotenoids and fat-soluble vitamins have similar absorption mechanisms. Therefore, we hypothesized that the absorption of fat-soluble vitamins may be enhanced when co-ingested with non-fat fermented milk. Twenty healthy male participants were included in this two-group, two-phase crossover study. Participants co-ingested 50 g of a fat-soluble vitamin solution with either 75 g of water or 75 g of non-fat fermented milk before switching after a 2-wk washout. The fat-soluble vitamins were mixed in 50 g of water with 830 μg vitamin A (as retinol), 230 μg of vitamin D (as cholecalciferol), 100.8 mg of vitamin E, and 16.8 mg of vitamin K (as menaquinone-7). Blood samples were collected before and 2, 4, 6, and 8 h after test food consumption and the concentrations of fat-soluble vitamins in the triacylglycerol-rich lipoprotein (TRL) and total plasma fractions were determined. The incremental area under the curve for retinyl palmitate, cholecalciferol, and menaquinone-7 concentrations in the total plasma fraction, and α-tocopherol and γ-tocopherol concentrations in the TRL fraction of plasma were significantly higher for the group of the co-ingestion of fat-soluble vitamins and non-fat fermented milk, compared with the co-ingestion of fat-soluble vitamins and water. Our findings suggest a new nutritional means by which fat-soluble vitamin bioavailability can be enhanced via co-ingestion with non-fat fermented milk. This approach could improve nutritional deficiencies of global health concern.

03
RANDOMIZED TRIAL (RCT) Journal of the Academy of Nutrition and Dietetics (2026) PMID: 41587736 ↗
Effects of Randomized Multivitamin Supplementation on Carotenoids and α-Tocopherol in the COcoa Supplement and Multivitamin Outcomes Study.
Clinical Trial Synthesis 2026 Randomized Controlled Trial (RCT) published in Journal of the Academy of Nutrition and Dietetics involving n = 400 participants. Key conclusion: No significant differences were observed for lyco
View Original PubMed Abstract ↓

BACKGROUND: Adequate intake of carotenoids and vitamin E supports healthy aging, yet evidence is limited on whether multivitamin-multimineral (MVM) supplementation changes serum concentrations over time. OBJECTIVE: The aim of this investigation was to evaluate the effect of daily MVM supplementation among older adults on serum carotenoid and vitamin E concentrations over a 2-year period. DESIGN: The COcoa Supplement and Multivitamin Outcomes Study is a large-scale, randomized, placebo-controlled, 2 × 2 factorial trial, designed to test the effects of daily MVM and cocoa extract supplementation for chronic disease prevention. Participants completed semiannual questionnaires and provided optional biospecimen samples at baseline, 1-year, and 2-year follow-up. PARTICIPANTS AND SETTING: Between 2015 and 2020, US adults (women aged 65 years and older, men aged 60 years and older) without major cardiovascular disease or recent cancer were enrolled in the COcoa Supplement and Multivitamin Outcomes Study. This analysis included biospecimen substudy participants with blood samples provided at baseline and ≥1 follow-up timepoint (n = 400; 1 excluded due to unusable sample; final N = 399). INTERVENTION: Participants were randomized to receive daily MVM supplementation or a placebo, with or without cocoa extract. MAIN OUTCOME MEASURES: Changes in serum carotenoids and α-tocopherol concentrations were evaluated over the 2-year follow-up. STATISTICAL ANALYSES: Multivariable linear mixed models estimated changes in serum biomarker concentrations, comparing MVM with placebo, adjusting for covariates (age, sex, and cocoa extract intervention). RESULTS: Increases in serum carotenoids and α-tocopherol levels with MVM supplementation emerged at year 1 and persisted through year 2. MVM supplementation led to significantly higher serum concentrations of total carotenoids (percent change: 15.5%; 95% CI, 8.72 to 22.70), lutein (percent change: 17.17%; 95% CI, 7.53 to 27.66), beta carotene (percent change: 46.96%; 95% CI, 35.10 to 59.85), and α-tocopherol (percent change: 29.50%; 95% CI, 22.88 to 36.47) over 2 years compared with placebo. No significant differences were observed for lyco

04
RANDOMIZED TRIAL (RCT) Scientific reports (2025) PMID: 41361349 ↗
Effects of meat-based, meat-based with α-tocopherol, and pesco-vegetarian diets on biomarkers associated with colorectal cancer risk: a randomized behavioral intervention trial.
Clinical Trial Synthesis 2025 Randomized Controlled Trial (RCT) published in Scientific reports; statistical significance reported at p = 0.006. Key conclusion: In contrast, a PVD was associated with a more favorable biochemical and inflammatory pro
View Original PubMed Abstract ↓

Diet may influence early biological processes involved in colorectal carcinogenesis. Red and processed meat intake has been associated to increased colorectal cancer (CRC) risk, potentially through heme-driven oxidative and genotoxic mechanisms. This 12-week behavioral, free-living, randomized, open-label study evaluated how three different diets impact CRC risk markers: a meat-based diet (MBD: high risk), a meat-based diet with α-tocopherol supplementation (MBD-T: medium risk, hypothesized to attenuate heme-induced oxidative stress and lipid peroxidation), and a pesco-vegetarian diet (PVD: low risk). A total of 113 healthy adults (18-50 years) were randomized, and 103 completed the study. The primary outcome was fecal water (FW) genotoxicity at baseline and after 12 weeks; secondary outcomes included FW cytotoxicity, lipoperoxidation, fecal short-chain fatty acids (SCFAs) and bile acids, and blood biomarkers related to iron metabolism and inflammation, also measured pre- and post-intervention. Mixed-effects linear models (time × diet), adjusted for age, sex, and BMI, were applied. FW genotoxicity increased significantly after MBD (+ 15.97%DNA damage; 95% CI 4.61 to 27.32; p = 0.006), with no significant within-group changes in MBD-T or PVD. Between-diet differences in change indicated greater increases in fecal TBARS following MBD (p = 0.010) and MBD-T (p = 0.037) compared with PVD, and a significantly greater increase in 4-HNE after MBD compared with PVD (p = 0.019). The FW Viability Index decreased significantly after MBD (p = 0.021). Differences in change between diets were also significant for circulating ferritin and inflammatory markers, which increased more after MBD compared with PVD (ferritin, IL-6, TNF-α), whereas MBD-T reduced TNF-α and PVD decreased IL-8, TNF-α, and ICAM. No significant between-diet differences in change were observed for fecal SCFAs or bile acids. In summary, over 12 weeks in a free-living setting, a MBD increased several mechanistic biomarkers associated with CRC, while α-tocopherol supplementation attenuated some adverse diet-related effects. In contrast, a PVD was associated with a more favorable biochemical and inflammatory pro

05
RANDOMIZED TRIAL (RCT) Nutrients (2023) PMID: 36904186 ↗
Effect of Vitamin E Supplementation on Chronic Insomnia Disorder in Postmenopausal Women: A Prospective, Double-Blinded Randomized Controlled Trial.
Clinical Trial Synthesis 2023 Randomized Controlled Trial (RCT) published in Nutrients. Key conclusion: This study demonstrates vitamin E's potential as an excellent alternative treatment for chronic insomnia disorder that improves sleep quality and reduces sedative drug use.
View Original PubMed Abstract ↓

Chronic insomnia disorder is one of the most common problems in postmenopausal women, exacerbated by underdiagnosis and improper treatment. This double-blinded, randomized, placebo-controlled trial was conducted to evaluate the potential of vitamin E to treat chronic insomnia as an alternative to sedative drugs and hormonal therapy. The study enrolled 160 postmenopausal women with chronic insomnia disorder, divided randomly into two groups. The vitamin E group received 400 units of mixed tocopherol daily, while the placebo group received an identical oral capsule. The primary outcome of this study was sleep quality assessed by the Pittsburgh Sleep Quality Index (PSQI), a self-evaluated and standardized questionnaire. The secondary outcome was the percentage of participants using sedative drugs. There were no significant differences in baseline characteristics between the study groups. However, the median PSQI score at baseline was slightly higher in the vitamin E group compared with the placebo (13 (6, 20) vs. 11 (6, 20); p-value 0.019). After one month of intervention, the PSQI score was significantly lower (indicating better sleep quality) in the vitamin E group compared with the placebo (6 (1, 18) vs. 9 (1, 19); p-value 0.012). Moreover, the improvement score was significantly higher in the vitamin E group compared with the placebo (5 (-6, 14) vs. 1 (-5,13); p-value < 0.001). In addition, there was a significant reduction in the percentage of patients using sedative drugs in the vitamin E group (15%; p-value 0.009), while this reduction was not statistically significant in the placebo group (7.5%; p-value 0.077). This study demonstrates vitamin E's potential as an excellent alternative treatment for chronic insomnia disorder that improves sleep quality and reduces sedative drug use.

06
CLINICAL STUDY Journal of the American Nutrition Association (2023) PMID: 35512761 ↗
Almond Consumption for 8 Weeks Altered Host and Microbial Metabolism in Comparison to a Control Snack in Young Adults.
Clinical Trial Synthesis 2023 Clinical Study published in Journal of the American Nutrition Association involving n = 73 participants; statistical significance reported at p = 0.05. Key conclusion: Almond consumption can improve cardiometabolic (CM) health.
View Original PubMed Abstract ↓

Almond consumption can improve cardiometabolic (CM) health. However, the mechanisms underlying those benefits are not well characterized. This study explored the effects of consuming a snack of almonds vs. crackers for 8 weeks on changes in metabolomic profiles in young adults (clinicaltrials.gov ID: NCT03084003). Participants (n = 73, age: 18-19 years, BMI: 18-41 kg/m2) were randomly assigned to consume either almonds (2 oz/d, n = 38) or an isocaloric control snack of graham crackers (325 kcal/d, n = 35) daily for 8 weeks. Blood samples were collected at baseline prior to and at 4 and 8 weeks after the intervention. Metabolite abundances in the serum were quantified by hydrophilic interaction chromatography quadrupole (Q) time-of-flight (TOF) mass spectrometry (MS/MS), gas chromatography (GC) TOF MS, CSH-ESI (electrospray) QTOF MS/MS, and targeted analyses for free PUFAs, total fatty acids, oxylipins and endocannabinoids. Linear mixed model analyses with baseline-adjustment were conducted, and those results were used for enrichment and network analyses. Microbial community pathway predictions from 16S rRNA sequencing of fecal samples was done using PICRUST2. Almond consumption enriched unsaturated triglycerides, unsaturated phosphatidylcholines, saturated and unsaturated lysophosphatidylcholines, tricarboxylic acids, and tocopherol clusters (p < 0.05). Targeted analyses reveal lower levels of omega-3 total fatty acids (TFAs) overall in the almond group compared to the cracker group (p < 0.05). Microbial amino acid biosynthesis, and amino sugar and nucleotide sugar metabolism pathways were also differentially enriched at the end of the intervention (p < 0.05). The study demonstrates the differential effects of almonds on host tocopherol, lipid, and TCA cycle metabolism with potential changes in microbial metabolism, which may interact with host metabolism to facilitate the CM benefits.

07
CLINICAL STUDY The American journal of clinical nutrition (2022) PMID: 35040869 ↗
Change in plasma α-tocopherol associations with attenuated pulmonary function decline and with CYP4F2 missense variation.
Clinical Trial Synthesis 2022 Clinical Study published in The American journal of clinical nutrition involving n = 364 participants; statistical significance reported at p = 0.05. Key conclusion: CONCLUSIONS: Greater response to vitE supplementation was associated with attenuated FEV1 decline.
View Original PubMed Abstract ↓

BACKGROUND: Vitamin E (vitE) is hypothesized to attenuate age-related decline in pulmonary function. OBJECTIVES: We investigated the association between change in plasma vitE (∆vitE) and pulmonary function decline [forced expiratory volume in the first second (FEV1)] and examined genetic and nongenetic factors associated with ∆vitE. METHODS: We studied 1144 men randomly assigned to vitE in SELECT (Selenium and Vitamin E Cancer Prevention Trial). ∆vitE was the difference between baseline and year 3 vitE concentrations measured with GC-MS. FEV1 was measured longitudinally by spirometry. We genotyped 555 men (vitE-only arm) using the Illumina Expanded Multi-Ethnic Genotyping Array (MEGAex). We used mixed-effects linear regression modeling to examine the ∆vitE-FEV1 association. RESULTS: Higher ∆vitE was associated with lower baseline α-tocopherol (α-TOH), higher baseline γ-tocopherol, higher baseline free cholesterol, European ancestry (as opposed to African) (all P < 0.05), and the minor allele of a missense variant in cytochrome P450 family 4 subfamily F member 2 (CYP4F2) (rs2108622-T; 2.4 µmol/L higher ∆vitE, SE: 0.8 µmol/L; P = 0.0032). Higher ∆vitE was associated with attenuated FEV1 decline, with stronger effects in adherent participants (≥80% of supplements consumed): a statistically significant ∆vitE × time interaction (P = 0.014) indicated that a 1-unit increase in ∆vitE was associated with a 2.2-mL/y attenuation in FEV1 decline (SE: 0.9 mL/y). The effect size for 1 SD higher ∆vitE (+4 µmol/mmol free-cholesterol-adjusted α-TOH) was roughly one-quarter of the effect of 1 y of aging, but in the opposite direction. The ∆vitE-FEV1 association was similar in never smokers (2.4-mL/y attenuated FEV1 decline, SE: 1.0 mL/y; P = 0.017, n = 364), and current smokers (2.8-mL/y, SE: 1.6 mL/y; P = 0.079, n = 214), but there was little to no effect in former smokers (-0.64-mL/y, SE: 0.9 mL/y; P = 0.45, n = 564). CONCLUSIONS: Greater response to vitE supplementation was associated with attenuated FEV1 decline. The response to supplementation differed by rs2108622 such that individuals with the C allele, compared with the T allele, may need a higher dietary intake to reach

08
RANDOMIZED TRIAL (RCT) Nutrients (2021) PMID: 34959779 ↗
Effect of Vitamin E Supplement on Bone Turnover Markers in Postmenopausal Osteopenic Women: A Double-Blind, Randomized, Placebo-Controlled Trial.
Clinical Trial Synthesis 2021 Randomized Controlled Trial (RCT) published in Nutrients; statistical significance reported at p = 0.001. Key conclusion: In conclusion, vitamin E (mixed-tocopherol) supplementation in postmenopausal osteopenic women may have a preventive effect on bone loss through anti-resorptive activity.
View Original PubMed Abstract ↓

Vitamin E is a strong anti-oxidative stress agent that affects the bone remodeling process. This study evaluates the effect of mixed-tocopherol supplements on bone remodeling in postmenopausal osteopenic women. A double-blinded, randomized, placebo-controlled trial study was designed to measure the effect of mixed-tocopherol on the bone turnover marker after 12 weeks of supplementation. All 52 osteopenic postmenopausal women were enrolled and allocated into two groups. The intervention group received mixed-tocopherol 400 IU/day, while the control group received placebo tablets. Fifty-two participants completed 12 weeks of follow-up. Under an intention-to-treat analysis, vitamin E produced a significant difference in the mean bone resorption marker (serum C-terminal telopeptide of type I collagen (CTX)) compared with the placebo group (-0.003 ± 0.09 and 0.121 ± 0.15, respectively (p < 0.001)). In the placebo group, the CTX had increased by 35.3% at 12 weeks of supplementation versus baseline (p < 0.001), while, in the vitamin E group, there was no significant change of bone resorption marker (p < 0.898). In conclusion, vitamin E (mixed-tocopherol) supplementation in postmenopausal osteopenic women may have a preventive effect on bone loss through anti-resorptive activity.

09
CLINICAL STUDY Journal of oleo science (2021) PMID: 34497177 ↗
Clarification of the Complexation Behaviour of 2,6-di-O-Methylated β-Cyclodextrin and Vitamin E and Radical Scavenging Ability of the Complex in Aqueous Solution.
Clinical Trial Synthesis 2021 Clinical Study published in Journal of oleo science. Key conclusion: Consequently, unexpectedly, the addition of certain CD methylated derivatives did not always enhance the solubility of Toc significantly.
View Original PubMed Abstract ↓

The precise understanding of the behaviour of vitamin E (α-tocopherol; Toc) complexed with cyclodextrin (CD) additives in aqueous solution is a fundamental issue for further development of their aqua-related biological applications. In this study, the solubilisation and complexation behaviours of Toc with methyl-substituted CD derivatives and the radical scavenging ability of the resulting complexes were precisely investigated in water media. Several problems were encountered upon pre-dissolving Toc in an organic solvent prior to the addition to the water media, such as enhancement of the dispersibility and decrease in the complexation capacity. Additionally, dispersions were obtained in some cases when mixing CD and Toc even in the absence of an organic solvent; therefore, to perform the measurements, a transparent solution was prepared via filtration with a nanopore filter. Consequently, unexpectedly, the addition of certain CD methylated derivatives did not always enhance the solubility of Toc significantly. However, 2,6-di-O-methylated β-CD (2,6-DMCD) formed a water-soluble inclusion complex with Toc, effectively enhancing its solubility. A phase solubility study indicated the formation of 1:2 or 1:3 Toc/CD inclusion complexes, and the interaction of 2,6-DMCD with both the chromanol head and the phytol chain of Toc was revealed by 2D ROESY nuclear magnetic resonance analysis. The interaction between 2,6-DMCD and the chromanol head was also confirmed for a 2,6-DMCD-2,2,5,7,8-pentamethyl-6-chromanol inclusion complex. Additionally, a rapid scavenging effect for molecularly dissolved Toc was demonstrated even in a system comprising a chromanol head directly encapsulated by CD. Hence, this work elucidated the precise complexation and radical scavenging ability of 2,6-DMCD-Toc in an aqueous solution, which paves the way for its biological applications.

10
CLINICAL STUDY Biomaterials science (2019) PMID: 31086900 ↗
Targeted co-delivery of the aldose reductase inhibitor epalrestat and chemotherapeutic doxorubicin via a redox-sensitive prodrug approach promotes synergistic tumor suppression.
Clinical Trial Synthesis 2019 Clinical Study published in Biomaterials science. Key conclusion: Furthermore, in vivo evaluation demonstrated a significant reduction in Dox-induced cardiotoxicity.
View Original PubMed Abstract ↓

Rapidly growing evidence suggests a strong dependence of a polyol pathway enzyme Aldose Reductase (AR) in cancer progression and invasion. Thus, inhibiting the AR through therapeutic inhibitors has a potential application in cancer treatment. Epalrestat (EPR) is the only marketed AR inhibitor with proven safety and efficacy in the management of complications like diabetic neuropathy. However, its short half-life and highly hydrophobic nature restrict its use as an anticancer agent. In the present study, we first developed a redox-sensitive prodrug of EPR by conjugating Tocopherol Polyethylene Glycol Succinate (TPGS) which can form a self-assembled micellar prodrug (EPR-SS-TPPGS). Subsequently, to achieve synergistic chemotherapeutic efficacy Doxorubicin (Dox) was co-loaded into the EPR-SS-TPGS micelles where the system is disrupted in a tumor redox environment and co-delivers Dox and EPR in a ratiometric manner. We then employed TPGS conjugated vitamin-B6 as a targeting moiety and prepared the mixed micelles to facilitate VTC receptor-mediated uptake. The encapsulation of Dox and EPR with the developed prodrug approach showed significant synergies with increased intracellular accumulation and redox triggered release in MDA-MB-231 and 4T1 cell lines leading to superior cell cycle arrest, mitochondrial membrane potential, and apoptosis. Prolonged circulation half-life and tumor site bioavailability were achieved for both the drugs with the developed approach. Surprisingly, EPR and Dox combination significantly down-regulated the CD44 receptor expression which is the main contributing factor of tumor metastasis. Furthermore, in vivo evaluation demonstrated a significant reduction in Dox-induced cardiotoxicity. In summary, this nanoencapsulation paradigm of AR inhibitors with chemotherapeutic agents lays the foundation of new opportunities in combination chemotherapy.

RELATED MONOGRAPHS

Related Monographs in This Category