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Vitamin E (Tocopherol): Sources, Daily requirements, Functions, Deficiency Symptoms, and Toxicity

Characteristics
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Synonyms: tocopherol, tocotrienols
Active form: tocopherol
Sources: meat, eggs, vegetable oils, leafy vegetables[7]
Transport: alpha-tocopherol transfer protein (α-TTP)
Storage: adipose tissue, parenchymal cells of the liver

Functions
----------------
Antioxidant
Protection from free radicals, especially erythrocytes and cell membranes
Interrupts free radical chains and oxidizes itself as a result

Other functions
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Inhibition of platelet aggregation, cell proliferation, and monocyte adhesion
Enzyme inhibition (e.g., protein kinase C, phospholipase A2)
Inhibition of gene transcription (e.g., for α-TTP, tropomyosin alpha-1 chain)

Vitamin E deficiency
---------------------------------
Deficiency is very rare
Causes
Fat malabsorption disorders (e.g., cystic fibrosis)
Defects in genes that code for α-TTP

Clinical features
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Neurologic dysfunction
Demyelination of the posterior column and spinocerebellar tract → ↓ proprioception and vibration sensation; ataxia → symptoms similar to vitamin B12 deficiency
Differentiation from vitamin B12 deficiency: lack of hypersegmented neutrophils, megaloblastic anemia, and increased methylmalonic acid levels
Hemolytic anemia: deficiency results in increased fragility of erythrocytes and membrane breakdown
Acanthocytosis
Muscle weakness

Vitamin E toxicity
-----------------------------
Toxicity is very rare
Causes: over-supplementation
Clinical features
In infants: increased risk of necrotizing enterocolitis (NEC)
Alteration of warfarin metabolism → increased anticoagulation → increased risk of bleeding
Increased incidence of heart failure, subarachnoid hemorrhage, and increased mortality
Therapeutic uses
Non-alcoholic steatohepatitis: consider vitamin E for antioxidant effect

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