Vitamin A
Vitamin A is a fat-soluble vitamin that is an essential nutrient. The term "vitamin A" encompasses a group of chemically related organic compounds that includes retinol, retinyl esters, and several provitamin carotenoids, most notably β-carotene. Vitamin A has multiple functions: growth during embryo development, maintaining the immune system, and healthy vision. For aiding vision specifically, it combines with the protein opsin to form rhodopsin, the light-absorbing molecule necessary for both low-light and color vision.
Vitamin A occurs as two principal forms in foods: A) retinoids, found in animal-sourced foods, either as retinol or bound to a fatty acid to become a retinyl ester, and B) the carotenoids α-carotene, β-carotene, γ-carotene, and the xanthophyll beta-cryptoxanthin that function as provitamin A in herbivore and omnivore animals which possess the enzymes that cleave and convert provitamin carotenoids to retinol. Some carnivore species lack this enzyme. The other carotenoids do not have retinoid activity.
Dietary retinol is absorbed from the digestive tract via passive diffusion. Unlike retinol, β-carotene is taken up by enterocytes by the membrane transporter protein scavenger receptor B1, which is upregulated in times of vitamin A deficiency. Retinol is stored in lipid droplets in the liver. A high capacity for long-term storage of retinol means that well-nourished humans can go months on a vitamin A-deficient diet, while maintaining blood levels in the normal range. Only when the liver stores are nearly depleted will signs and symptoms of deficiency show. Retinol is reversibly converted to retinal, then irreversibly to retinoic acid, which activates hundreds of genes.
Vitamin A deficiency is common in developing countries, especially in Sub-Saharan Africa and Southeast Asia. Deficiency can occur at any age but is most common in pre-school age children and pregnant women, the latter due to a need to transfer retinol to the fetus. Vitamin A deficiency is estimated to affect approximately one-third of children under the age of five around the world, resulting in hundreds of thousands of cases of blindness and deaths from childhood diseases because of immune system failure. Reversible night blindness is an early indicator of low vitamin A status. Plasma retinol is used as a biomarker to confirm vitamin A deficiency. Breast milk retinol can indicate a deficiency in nursing mothers. Neither of these measures indicates the status of liver reserves.
The European Union and various countries have set recommendations for dietary intake, and upper limits for safe intake. Vitamin A toxicity also referred to as hypervitaminosis A, occurs when there is too much vitamin A accumulating in the body. Symptoms may include nervous system effects, liver abnormalities, fatigue, muscle weakness, bone and skin changes, and others. The adverse effects of both acute and chronic toxicity are reversed after consumption of high dose supplements is stopped.
Definition
Vitamin A is a fat-soluble vitamin, a category that also includes vitamins D, E and K. The vitamin encompasses several chemically related naturally occurring compounds or metabolites, i.e., vitamers, that all contain a β-ionone ring. The primary dietary form is retinol, which may have a fatty acid molecule attached, creating a retinyl ester, when stored in the liver. Retinol the transport and storage form of vitamin A is interconvertible with retinal, catalyzed to retinal by retinol dehydrogenases and back to retinol by retinaldehyde reductases.Retinal can be irreversibly converted to all-trans-retinoic acid by the action of retinal dehydrogenase
Retinoic acid is actively transported into the cell nucleus by CRABp2 where it regulates thousands of genes by binding directly to gene targets via retinoic acid receptors.
In addition to retinol, retinal and retinoic acid, there are plant-, fungi- or bacteria-sourced carotenoids which can be metabolized to retinol, and are thus vitamin A vitamers.
There are also what are referred to as 2nd, 3rd and 4th generation retinoids which are not considered vitamin A vitamers because they cannot be converted to retinol, retinal or all-trans-retinoic acid. Some are prescription drugs, oral or topical, for various indications. Examples are etretinate, acitretin, adapalene, bexarotene, tazarotene and trifarotene.
Absorption, metabolism and excretion
Retinyl esters from animal-sourced foods are acted upon by retinyl ester hydrolases in the lumen of the small intestine to release free retinol. Retinol enters enterocytes by passive diffusion. Absorption efficiency is in the range of 70 to 90%. Humans are at risk for acute or chronic vitamin A toxicity because there are no mechanisms to suppress absorption or excrete the excess in urine. Within the cell, retinol is there bound to retinol binding protein 2. It is then enzymatically re-esterified by the action of lecithin retinol acyltransferase and incorporated into chylomicrons that are secreted into the lymphatic system.Unlike retinol, β-carotene is taken up by enterocytes by the membrane transporter protein scavenger receptor B1. The protein is upregulated in times of vitamin A deficiency. If vitamin A status is in the normal range, SCARB1 is downregulated, reducing absorption. Also downregulated is the enzyme beta-carotene 15,15'-dioxygenase coded for by the BCMO1 gene, responsible for symmetrically cleaving β-carotene into retinal. Absorbed β-carotene is either incorporated as such into chylomicrons or first converted to retinal and then retinol, bound to RBP2. After a meal, roughly two-thirds of the chylomicrons are taken up by the liver with the remainder delivered to peripheral tissues. Peripheral tissues also can convert chylomicron β-carotene to retinol.
The capacity to store retinol in the liver means that well-nourished humans can go months on a vitamin A deficient diet without manifesting signs and symptoms of deficiency. Two liver cell types are responsible for storage and release: hepatocytes and hepatic stellate cells. Hepatocytes take up the lipid-rich chylomicrons, bind retinol to retinol-binding protein 4, and transfer the retinol-RBP4 to HSCs for storage in lipid droplets as retinyl esters. Mobilization reverses the process: retinyl ester hydrolase releases free retinol which is transferred to hepatocytes, bound to RBP4, and put into blood circulation. Other than either after a meal or when consumption of large amounts exceeds liver storage capacity, more than 95% of retinol in circulation is bound to RBP4.