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Congenital Vitamin E Deficiency

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Handbook of Famine, Starvation, and Nutrient Deprivation

Abstract

A growing body of literature has begun to delineate the unique and potent biological properties of vitamin E involved in cardiovascular disease, cancer, chronic inflammation, and neurodegeneration. Vitamin E was initally proposed as a dietary factor essential in preventing embryonic mortality and soon after considered as lipid-soluble antioxidant that inhibits lipid peroxidation by scavenging reactive oxygen species. Recent mechanistic studies indicate that vitamin E possesses functions that are independent of its antioxidant ability and mainly modulate cell signal transduction and gene expression. Despite overt vitamin E deficiency is rare, most commonly it can be found in children with inherited abnormalities that prevent the absorption or maintenance of normal blood concentration of vitamin E. This review summarizes the genetic disorders associated with congenital vitamin E deficiency. In parallel, it provides a brief overview on the historical, metabolic, and functional aspects of vitamin E.

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Abbreviations

ABL:

Abetalipoproteinemia

AD:

Autosomal dominant

apo:

Apolipoprotein

AR:

Autosomal recessive

AVED:

Ataxia with vitamin E deficiency

CEHC:

Carboxyethyl hydroxychromanol

CFTR:

Cystic fibrosis transmembrane conductance regulator

CMRD:

Chylomicron retention disease

COX:

Cyclooxygenase

FFA:

Free fatty acids

FHBL:

Familial hypobetalipoproteinemia

HBL:

Hypobetalipoproteinemia

HDL:

High-density lipoprotein

LDL:

Low-density lipoprotein

LDL-C:

Low-density lipoprotein-cholesterol

MIM:

Mendelian Inheritance in Man

MMPs:

Matrix metalloproteinases

MTP:

Microsomal triglyceride transfer protein

NADPH:

Nicotinamide adenine dinucleotide phosphate

PKC:

Protein kinase C

ROS:

Reactive oxygen species

TTPA:

α-tocopherol transfer protein gene

VLDL:

Very low-density lipoprotein

α-TTP:

α-Tocopherol-transfer protein

References

  • Abdala-Valencia H, Berdnikovs S, Cook-Mills JM (2012) Vitamin E isoforms differentially regulate intercellular adhesion molecule-1 activation of PKCα in human microvascular endothelial cells. PLoS One 7:e41054

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Anheim M, Fleury M, Monga B, Laugel V, Chaigne D, Rodier G, Ginglinger E, Boulay C, Courtois S, Drouot N et al (2010) Epidemiological, clinical, paraclinical and molecular study of a cohort of 102 patients affected with autosomal recessive progressive cerebellar ataxia from Alsace, Eastern France: implications for clinical management. Neurogenetics 11:1–12

    Article  CAS  PubMed  Google Scholar 

  • Azzi A, Boscoboinik D, Hensey C (1992) The protein kinase C family. Eur J Biochem 208:547–557

    Article  CAS  PubMed  Google Scholar 

  • Azzi A, Gysin R, Kempná P, Munteanu A, Negis Y, Villacorta L, Visarius T, Zingg JM (2004) Vitamin E mediates cell signaling and regulation of gene expression. Ann N Y Acad Sci 1031:86–95

    Article  CAS  PubMed  Google Scholar 

  • Benomar A, Yahyaoui M, Meggouh F, Bouhouche A, Boutchich M, Bouslam N, Zaim A, Schmitt M, Belaidi H, Ouazzani R et al (2002) Clinical comparison between AVED patients with 744 del A mutation and Friedreich ataxia with GAA expansion in 15 Moroccan families. J Neurol Sci 198:25–29

    Article  CAS  PubMed  Google Scholar 

  • Berriot-Varoqueaux N, Aggerbeck LP, Samson-Bouma M, Wetterau JR (2000) The role of the microsomal triglygeride transfer protein in abetalipoproteinemia. Annu Rev Nutr 20:663–697

    Article  CAS  PubMed  Google Scholar 

  • Birringer M, Pfluger P, Kluth D, Landes N, Brigelius-Flohé R (2002) Identities and differences in the metabolism of tocotrienols and tocopherols in HepG2 cells. J Nutr 132:3113–3118

    CAS  PubMed  Google Scholar 

  • Birringer M, Lington D, Vertuani S, Manfredini S, Scharlau D, Glei M, Ristow M (2010) Proapoptotic effects of long-chain vitamin E metabolites in HepG2 cells are mediated by oxidative stress. Free Radic Biol Med 49:1315–1322

    Article  CAS  PubMed  Google Scholar 

  • Boldrini R, Biselli R, Bosman C (2001) Chylomicron retention disease – the role of ultrastructural examination in differential diagnosis. Pathol Res Pract 197:753–757

    CAS  PubMed  Google Scholar 

  • Borel P, Pasquier B, Armand M, Tyssandier V, Grolier P, Alexandre-Gouabau MC, Andre M, Senft M, Peyrot J, Jaussan V et al (2001) Processing of vitamin A and E in the human gastrointestinal tract. Am J Physiol Gastrointest Liver Physiol 280:G95–G103

    CAS  PubMed  Google Scholar 

  • Boscoboinik D, Szewczyk A, Hensey C, Azzi A (1991) Inhibition of cell proliferation by alpha-tocopherol. Role of protein kinase C. J Biol Chem 266:6188–6194

    CAS  PubMed  Google Scholar 

  • Bradley JL, Blake JC, Chamberlain S, Thomas PK, Cooper JM, Schapira AH (2000) Clinical, biochemical and molecular genetic correlations in Friedreich's ataxia. Hum Mol Genet 9:275–282

    Article  CAS  PubMed  Google Scholar 

  • Brigelius-Flohé R (2009) Vitamin E: the shrew waiting to be tamed. Free Radic Biol Med 46:543–554

    Article  PubMed  Google Scholar 

  • Burck U, Goebel HH, Kuhlendahl HD, Meier C, Goebel KM (1981) Neuromyopathy and vitamin E deficiency in man. Neuropediatrics 12:267–278

    Article  CAS  PubMed  Google Scholar 

  • Burnett JR, Shan J, Miskie BA, Whitfield AJ, Yuan J, Tran K, McKnight CJ, Hegele R, Yao Z (2003) A novel nontruncating APOB gene mutation, R463W, causes familial hypobetalipoproteinemia. J Biol Chem 278:13442–13452

    Article  CAS  PubMed  Google Scholar 

  • Burnett JR, Bell DA, Hooper AJ, Hegele RA (2012) Clinical utility gene card for: Familial hypobetalipoproteinaemia (APOB). Eur J Hum Genet 20(8). doi:10.1038/ejhg.2012.85

    Google Scholar 

  • Butterfield DA, Castegna A, Drake J, Scapagnini G, Calabrese V (2002) Vitamin E and neurodegenerative disorders associated with oxidative stress. Nutr Neurosci 5:229–239

    Article  CAS  PubMed  Google Scholar 

  • Cachia O, Benna JE, Pedruzzi E, Descomps B, Gougerot-Pocidalo MA, Leger CL (1998) alpha-tocopherol inhibits the respiratory burst in human monocytes. Attenuation of p47(phox) membrane translocation and phosphorylation. J Biol Chem 273:32801–32805

    Article  CAS  PubMed  Google Scholar 

  • Cavalier L, Ouahchi K, Kayden HJ, Di Donato S, Reutenauer L, Mandel JL, Koenig M (1998) Ataxia with isolated vitamin E deficiency: heterogeneity of mutations and phenotypic variability in a large number of families. Am J Hum Genet 62:301–310

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Copp RP, Wisniewski T, Hentati F, Larnaout A, Ben Hamida M, Kayden HJ (1999) Localization of alpha-tocopherol transfer protein in the brains of patients with ataxia with vitamin E deficiency and other oxidative stress related neurodegenerative disorders. Brain Res 822:80–87

    Article  CAS  PubMed  Google Scholar 

  • Doerflinger N, Linder C, Ouahchi K, Gyapay G, Weissenbach J, Le Paslier D, Rigault P, Belal S, Ben Hamida C, Hentati F et al (1995) Ataxia with vitamin E deficiency: refinement of genetic localization and analysis of linkage disequilibrium by using new markers in 14 families. Am J Hum Genet 56:1116–1124

    CAS  PubMed  PubMed Central  Google Scholar 

  • Dolara P, Bigagli E, Collins A (2013) Antioxidant vitamins and mineral supplementation, life span expansion and cancer incidence: a critical commentary. Eur J Nutr 51:769–781

    Article  Google Scholar 

  • Dutta A, Dutta SK (2003) Vitamin E and its role in the prevention of atherosclerosis and carcinogenesis: a review. J Am Coll Nutr 22:258–268

    Article  CAS  PubMed  Google Scholar 

  • Eggermont E (2006) Recent advances in vitamin E metabolism and deficiency. Eur J Pediatr 165:429–434

    Article  CAS  PubMed  Google Scholar 

  • El Euch-Fayache G, Bouhlal Y, Amouri R, Feki M, Hentati F (2014) Molecular, clinical and peripheral neuropathy study of Tunisian patient with ataxia with vitamin E deficiency. Brain 137:402–410

    Article  PubMed  Google Scholar 

  • Evans HM, Bishop KS (1922) On the existence of a hitherto unrecognized dietary factor essential for reproduction. Science 56:650–651

    Article  CAS  PubMed  Google Scholar 

  • Evans HM, Emerson OH, Emerson GA (1936) The isolation from wheat germ oil of an alcohol, α-tocopherol, having the properties of vitamin E. J Biol Chem 113:319–332

    CAS  Google Scholar 

  • Evans JL, Goldfine ID, Maddux BA, Grodsky GM (2002) Oxidative stress and stress-activated signaling pathways: a unifying hypothesis of type 2 diabetes. Endocr Rev 23:599–622

    Article  CAS  PubMed  Google Scholar 

  • Frank J, Chin XW, Schrader C, Eckert GP, Rimbach G (2012) Do tocotrienols have potential as neuroprotective dietary factors? Ageing Res Rev 11:163–180

    Article  CAS  PubMed  Google Scholar 

  • Fusco C, Frattini D, Pisani F, Gellera C, Della Giustina E (2008) Isolated vitamin E deficiency mimicking distal hereditary motor neuropathy in a 13-year-old boy. J Child Neurol 23:1328–1330

    Article  PubMed  Google Scholar 

  • Gabsi S, Gouider-Khouja N, Belal S, Fki M, Kefi M, Turki I, Ben Hamida M, Kayden H, Mebazaa R, Hentati F (2001) Effect of vitamin E supplementation in patients with ataxia with vitamin E deficiency. Eur J Neurol 8:477–481

    Article  CAS  PubMed  Google Scholar 

  • Gibson RL, Burns JL, Ramsey BW (2003) Pathophysiology and management of pulmonary infections in cystic fibrosis. Am J Respir Crit Care Med 168:918–951

    Article  PubMed  Google Scholar 

  • Hacquebard M, Carpentier YA (2005) Vitamin E: absorption, plasma transport and cell uptake. Curr Opin Clin Nutr Metab Care 8:133–138

    Article  CAS  PubMed  Google Scholar 

  • Hakim F, Kerem E, Rivlin J, Bentur L, Stankiewicz H, Bdolach-Abram T, Wilschanski M (2007) Vitamins A and E and pulmonary exacerbations in patients with cystic fibrosis. J Pediatr Gastroenterol Nutr 45:347–353

    Article  CAS  PubMed  Google Scholar 

  • Harding AE, Muller DP, Thomas PK, Willison HJ (1982) Spinocerebellar degeneration secondary to chronic intestinal malabsorption: a vitamin E deficiency syndrome. Ann Neurol 12:419–424

    Article  CAS  PubMed  Google Scholar 

  • Himmelfarb J, Kane J, McMonagle E, Zaltas E, Bobzin S, Boddupalli S, Phinney S, Miller G (2003) Alpha and gamma tocopherol metabolism in healthy subjects and patients with end-stage renal disease. Kidney Int 64:978–991

    Article  CAS  PubMed  Google Scholar 

  • Institute of Medicine (2000) Dietary Reference Intakes for Vitamin C, Vitamin E, Selenium, and Carotenoids. The National Academies Press, Washington, DC

    Google Scholar 

  • Jiang Q, Christen S, Shigenaga MK, Ames BN (2001) gamma-tocopherol, the major form of vitamin E in the US diet, deserves more attention. Am J Clin Nutr 74:714–722

    CAS  PubMed  Google Scholar 

  • Jiang Q, Yin X, Lill MA, Danielson ML, Freiser H, Huang J (2008) Long-chain carboxychromanols, metabolites of vitamin E, are potent inhibitors of cyclooxygenases. Proc Natl Acad Sci USA 105:20464–20469

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Jones B, Jones EL, Bonney SA, Patel HN, Mensenkamp AR, Eichenbaum-Voline S, Rudling M, Myrdal U, Annesi G, Naik S et al (2003) Mutations in a Sar1 GTPase of COPII vesicles are associated with lipid absorption disorders. Nat Genet 34:29–31

    Article  CAS  PubMed  Google Scholar 

  • Kamal-Eldin A, Appelqvist LA (1996) The chemistry and antioxidant properties of tocopherols and tocotrienols. Lipids 31:671–701

    Article  CAS  PubMed  Google Scholar 

  • Kane JP, Havel RJ (2001) Disorders of the biogenesis and secretion of lipoproteins containing the B apolipoproteins. In: Scriver CR, Beaudet AL, Sly WS (eds) The Metabolic and Molecular Bases of Inherited Disease. McGraw-Hill, New York, pp 2717–2752

    Google Scholar 

  • Kayden HJ, Silber R, Kossmann CE (1965) The role of vitamin E deficiency in the abnormal autohemolysis of acanthocytosis. Trans Assoc Am Phys 78:334–342

    CAS  PubMed  Google Scholar 

  • Koscik RL, Lai HJ, Laxova A, Zaremba KM, Kosorok MR, Douglas JA, Rock MJ, Splaingard ML, Farrell PM (2005) Preventing early, prolonged vitamin E deficiency: an opportunity for better cognitive outcomes via early diagnosis through neonatal screening. J Pediatr 147:S51–S56

    Article  PubMed  Google Scholar 

  • Lee J, Hegele RA (2014) Abetalipoproteinemia and homozygous hypobetalipoproteinemia: a framework for diagnosis and management. J Inherit Metab Dis 37:333–339

    Article  CAS  PubMed  Google Scholar 

  • London SJ, Stein EA, Henderson IC, Stampfer MJ, Wood WC, Remine S, Dmochowski JR, Robert NJ, Willett WC (1992) Carotenoids, retinol, and vitamin E and risk of proliferative benign breast disease and breast cancer. Cancer Causes Control 3:503–512

    Article  CAS  PubMed  Google Scholar 

  • Mariotti C, Gellera C, Rimoldi M, Mineri R, Uziel G, Zorzi G, Pareyson D, Piccolo G, Gambi D, Piacentini S et al (2004) Ataxia with isolated vitamin E deficiency: neurological phenotype, clinical follow-up and novel mutations in TTPA gene in Italian families. Neurol Sci 25:130–137

    Article  CAS  PubMed  Google Scholar 

  • Marzouki N, Benomar A, Yahyaoui M, Birouk N, Elouazzani M, Chkili T, Benlemlih M (2005) Vitamin E deficiency ataxia with (744 del A) mutation on alpha-TTP gene: genetic and clinical peculiarities in Moroccan patients. Eur J Med Genet 48:21–28

    Article  PubMed  Google Scholar 

  • Moya-Camarena SY, Jiang Q (2012) The role of vitamin E forms in cancer prevention and therapy-Studies in human intervention trials and animal models. In: Sarkar FH (ed) Nutraceuticals and Cancer. Springer, New York, pp 323–354. ISBN:978-94-007-2629-1

    Chapter  Google Scholar 

  • Myung SK, Ju W, Cho B, Oh SW, Park SM, Koo BK, Park BJ (2013) Efficacy of vitamin and antioxidant supplements in prevention of cardiovascular disease: systematic review and meta-analysis of randomised controlled trials. BMJ 346:f10

    Article  PubMed  PubMed Central  Google Scholar 

  • Özer NK, Şirikçi Ö, Taha S, Engin KN, Boscobionik D, Clement S, Stocker A, Azzi A (1998) Prevention of atherosclerosis by α-tocopherol in smooth muscle cells by a mechanism involving signal transduction modulation. In: Özben T (ed) Free radicals, oxidative stress and antioxidants. Springer, New York, pp 333–342. ISBN:978-1-4419-3292-1

    Chapter  Google Scholar 

  • Papaioannou D, Cooper KL, Carroll C, Hind D, Squires H, Tappenden P, Logan RF (2011) Antioxidants in the chemoprevention of colorectal cancer and colorectal adenomas in the general population: a systematic review and meta analysis. Color Dis 13:1085–1099

    Article  CAS  Google Scholar 

  • Peretti N, Marcil V, Drouin E, Levy E (2005) Mechanisms of lipid malabsorption in Cystic Fibrosis: the impact of essential fatty acids deficiency. Nutr Metab (Lond) 2:11

    Article  CAS  Google Scholar 

  • Peretti N, Sassolas A, Roy CC, Deslandres C, Charcosset M, Castagnetti J, Pugnet-Chardon L, Moulin P, Labarge S, Bouthillier L et al (2010) Guidelines for the diagnosis and management of chylomicron retention disease based on a review of the literature and the experience of two centers. Orphanet J Rare Dis 5:24

    Article  PubMed  PubMed Central  Google Scholar 

  • Rimbach G, Minihane AM, Majewicz J, Fischer A, Pallauf J, Virgli F, Weinberg PD (2002) Regulation of cell signalling by vitamin E. Proc Nutr Soc 61:415–425

    Article  CAS  PubMed  Google Scholar 

  • Rimm EB, Stampfer MJ, Ascherio A, Giovannucci E, Colditz GA, Willett WC (1993) Vitamin E consumption and the risk of coronary heart disease in men. N Engl J Med 328:1450–1456

    Article  CAS  PubMed  Google Scholar 

  • Rossato M, Mariotti C (2014) Normal spermatogenesis and sperm function in a subject affected by cerebellar ataxia due to congenital vitamin E deficiency. Andrologia 46:322–324

    Article  CAS  PubMed  Google Scholar 

  • Schonfeld G (2003) Familial hypobetalipoproteinemia: a review. J Lipid Res 44:878–883

    Article  CAS  PubMed  Google Scholar 

  • Sinaasappel M, Stern M, Littlewood J, Wolfe S, Steinkamp G, Heijerman HG, Robberecht E, Döring G (2002) Nutrition in patients with cystic fibrosis: a European Consensus. J Cyst Fibros 1:51–75

    Article  CAS  PubMed  Google Scholar 

  • Sontag TJ, Parker RS (2007) Influence of major structural features of tocopherols and tocotrienols on their omega-oxidation by tocopherol-omega-hydroxylase. J Lipid Res 48:1090–1098

    Article  CAS  PubMed  Google Scholar 

  • Sure B (1924) Dietary requirements for reproduction. II. The existence of a specific vitamin for reproduction. J Biol Chem 58:693–709

    CAS  Google Scholar 

  • Tarugi P, Averna M, Di Leo E, Cefalù AB, Noto D, Magnolo L, Cattin L, Bertolini S, Calandra S (2007) Molecular diagnosis of hypobetalipoproteinemia: an ENID review. Atherosclerosis 195:e19–e27

    Article  CAS  PubMed  Google Scholar 

  • Tasinato A, Boscoboinik D, Bartoli GM, Maroni P, Azzi A (1995) d-alpha-tocopherol inhibition of vascular smooth muscle cell proliferation occurs at physiological concentrations, correlates with protein kinase C inhibition, and is independent of its antioxidant properties. Proc Natl Acad Sci USA 92:12190–12194

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Traber MG, Sokol RJ, Kohlschütter A, Yokota T, Muller DP, Dufour R, Kayden HJ (1993) Impaired discrimination between stereoisomers of alpha-tocopherol in patients with familial isolated vitamin E deficiency. J Lipid Res 34:201–210

    CAS  PubMed  Google Scholar 

  • Wang J, Hegele RA (2000) Microsomal triglyceride transfer protein (MTP) gene mutations in Canadian subjects with abetalipoproteinemia. Hum Mutat 15:294–295

    Article  CAS  PubMed  Google Scholar 

  • Wechter WJ, Kantoci D, Murray ED Jr, D'Amico DC, Jung ME, Wang WH (1996) A new endogenous natriuretic factor: LLU-alpha. Proc Natl Acad Sci USA 93:6002–6007

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Wilfond BS, Farrell PM, Laxova A, Mischler E (1994) Severe hemolytic anemia associated with vitamin E deficiency in infants with cystic fibrosis. Implications for neonatal screening. Clin Pediatr (Phila) 33:2–7

    Article  CAS  Google Scholar 

  • Wolf G (1997) gamma-Tocopherol: an efficient protector of lipids against nitric oxide-initiated peroxidative damage. Nutr Rev 55:376–378

    Article  CAS  PubMed  Google Scholar 

  • Wu D, Liu L, Meydani M, Meydani SN (2005) Vitamin E increases production of vasodilator prostanoids in human aortic endothelial cells through opposing effects on cyclooxygenase-2 and phospholipase A2. J Nutr 135:1847–1853

    CAS  PubMed  Google Scholar 

  • Yokota T, Shiojiri T, Gotoda T, Arita M, Arai H, Ohga T, Kanda T, Suzuki J, Imai T, Matsumoto H et al (1997) Friedreich-like ataxia with retinitis pigmentosa caused by the His101Gln mutation of the alpha-tocopherol transfer protein gene. Ann Neurol 41:826–832

    Article  CAS  PubMed  Google Scholar 

  • Yokota T, Uchihara T, Kumagai J, Shiojiri T, Pang JJ, Arita M, Arai H, Hayashi M, Kiyosawa M, Okeda R et al (2000) Postmortem study of ataxia with retinitis pigmentosa by mutation of the alpha-tocopherol transfer protein gene. J Neurol Neurosurg Psychiatry 68:521–525

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Yokota T, Igarashi K, Uchihara T, Jishage K, Tomita H, Inaba A, Li Y, Arita M, Suzuki H, Mizusawa H et al (2001) Delayed-onset ataxia in mice lacking alpha -tocopherol transfer protein: model for neuronal degeneration caused by chronic oxidative stress. Proc Natl Acad Sci USA 98:15185–15190

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Yoshida Y, Saito Y, Jones LS, Shigeri Y (2007) Chemical reactivities and physical effects in comparison between tocopherols and tocotrienols: physiological significance and prospects as antioxidants. J Biosci Bioeng 104:439–445

    Article  CAS  PubMed  Google Scholar 

  • Zamel R, Khan R, Pollex RL, Hegele RA (2008) Abetalipoproteinemia: two case reports and literature review. Orphanet J Rare Dis 3:19

    Article  PubMed  PubMed Central  Google Scholar 

  • Zingg JM, Azzi A (2004) Non-antioxidant activities of vitamin E. Curr Med Chem 11:1113–1133

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Internal Medicine 3, Department of Medicine – DIMED, University of Padova, Via Giustiniani 2, 35128, Padova, Italy

    Hamza El Hadi, Roberto Vettor & Marco Rossato

Authors
  1. Hamza El Hadi
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  2. Roberto Vettor
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  3. Marco Rossato
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Corresponding author

Correspondence to Marco Rossato .

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Editors and Affiliations

  1. Diabetes & Nutritional Sci Div Sch, King's College London, London, United Kingdom

    Victor Preedy

  2. Clinical Biochemistry, University of Westminster, Westminster, United Kingdom

    Vinood B. Patel

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El Hadi, H., Vettor, R., Rossato, M. (2018). Congenital Vitamin E Deficiency. In: Preedy, V., Patel, V. (eds) Handbook of Famine, Starvation, and Nutrient Deprivation. Springer, Cham. https://doi.org/10.1007/978-3-319-40007-5_86-1

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  • DOI: https://doi.org/10.1007/978-3-319-40007-5_86-1

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