The pathophysiology of systemic inflammatory response syndrome (SIRS) had been described to involve various strong oxidative reactions affecting the status and progress of the patients. Antioxidant therapy had been suggested in many studies involving SIRS management. The objective of this study was to compare the role of vitamin E Tocotrienol and vitamin E Tocopherol combined with vitamin C as antioxidant therapy in the management of critically ill patients diagnosed with SIRS, admitted to the intensive care unit and high dependency wards of Universiti Kebangsaan Malaysia Medical Centre (UKMMC). It was a single blind randomized clinical trial with a total of 72 patients in which 44.4% Malays, 34.7% Chinese, 19.4% Indians and 1.4% others with 59.7% males and 40.3% females were recruited. Patients in TRI E group received Tocotrienol with Vitamin C while TOCO group received Tocopherol with Vitamin C and a control group did not receive any antioxidant. The clinical parameters (heart rate, respiratory rate, systolic blood pressure) showed improvements with significant difference at the end of study (post-intervention) as compared to admission (pre-intervention).Whereas, the sepsis (temperature, PCT, CRP and WBC) and oxidative stress (8-OHdG/Creatinine) parameters showed improvements with significant difference at the end of study (post-intervention) as compared to admission (pre-intervention). The TRI E group showed obvious improvement in clinical, sepsis and oxidative stress parameters, as compared to TOCO and control groups. This study showed that Vitamin E Tocotrienol and Vitamin E Tocopherol in combination with Vitamin C demonstrated significant improvement in the clinical and laboratory parameters during the management of SIRS. Therefore, Vitamin E in combination with Vitamin C had therapeutic benefits in the treatment of critically ill patients with SIRS.
Tocotrienols

Vitamin E has been a generic term for all tocopherol and tocotrienol derivatives. The most active form of vitamin E isoforms in vivo is regarded to be alpha-tocopherol which is the only form defined as vitamin E in the US Food and Nutrition Board, causing controversy over setting dietary reference intake (DRI) of vitamin E. However, most of the countries other than the US maintain the original concept that all isoforms are accepted as vitamin E but with different biopotency. The roles of the isoforms of vitamin E other than alpha-tocopherol have received continuous attention. Among them those of gamma-tocopherol and alpha-tocotrienol have been most studied in comparison with alpha-tocopherol, since gamma-tocopherol comprises major form of vitamin E in many plant seeds and those of the both vitamin E have been implicated in unique physiological functions. This review summarizes findings that have led a better understanding of vitamin E absorption, transport, tissue storage and various functions common and specific to vitamin E isoforms focusing alpha- and gamma-tocopherol as well as tocotrienols. It is expected to help redefining vitamin E and setting its DRI for Koreans.
Absorption ; alpha-Tocopherol ; gamma-Tocopherol ; Plants ; Protein Isoforms ; Seeds ; Tocopherols ; Tocotrienols ; Vitamin E ; Vitamins