At the border between personalized nutrition and medicine (which should be kind of a continuum in a self enriching balance), to me the following looks important and worth attention when considering the evidence, the diabetes (DM) and cardiovascular disease (CVD) costs and the simplicity of treatment using Vitamin E in haptoglobulin (Hp) 2-2 genotypes. I do not know an easy way to genotype for Hp though (comments?).
Please allow me to use the wording of the study (bold mine):
“People suffering from diabetes mellitus (DM) are prone to an array of complications in target organs. Accelerated atherosclerosis is prevalent in this population, and is a leading cause of morbidity and mortality. Interventions to tightly control plasma glucose levels have been proven vital in the control of microvascular complications[1, 2]. However, the importance of strict glycemic control on macrovascular clinical outcomes is a matter of considerable debate[3]. Additionally, interventions to control cardiovascular (CV) risk such as life-style interventions and pharmacotherapy with statins and angiotensin converting enzyme inhibitors are not always applicable, due to patient preferences or related costs[4], as well as questionable effectiveness[5, 6]. In this respect, it is of paramount importance to assess new and novel approaches to control atherosclerosis in DM, outside the scope of traditional health-care.”
“Dr Levy is the author of a series of patents which claim that the Hp genotype is predictive of CVD in individuals with DM and that vitamin E may be used in combination with the Hp genotype”
“Haptoglobin (Hp) is an abundant plasma glycoprotein synthesized by hepatocytes. Two classes of functional alleles (1 and 2) have been identified at the Hp locus on chromosome 16q22, with homozygous (1-1 or 2-2) and heterozygous (2-1) genotypes possible”
“The best known function of Hp is to bind free hemoglobin (Hb) released from red blood cells[21], which is released into the blood during the natural turn-over of red cells. Free Hb is capable of causing considerable oxidative tissue damage as a result of its heme iron. However, whenever Hb is released into the circulation it immediately binds to Hp with extremely high affinity (Kd ~10-15) to form an Hp-Hb complex. The binding of Hp to Hb serves to inhibit the oxidative potential of Hb by preventing the release of heme iron from Hb[25-27].”
“Studies have shown that Hp 2-2-Hb complexes are cleared less efficiently than non Hp 2-2-Hb complexes [25, 27]. In DM individuals this phenomenon is more pronounced due to the down regulation of CD163, particularly in Hp 2-2 individuals[30]”
“Meta-analysis of the HOPE and ICARE data showed that vitamin E significantly reduces a composite of CV mortality, MI and stroke in Hp 2-2 diabetes patients (OR 0.58, confidence interval (CI) 0.4-0.86), while having no influence in Hp 1-1 or Hp 1-2 diabetes patients[42].”
“The requirements for Hp typing, although not readily available for commercial use, are expected to be simple and inexpensive. In the broader context of public, policy-makers’, and professionals’ attention moving towards personalized medicine[47]..”
Is it time to screen for the haptoglobin genotype to assess the cardiovascular risk profile and vitamin E therapy responsiveness in patients with diabetes?
http://www.ncbi.nlm....pubmed/22427005