retinol-palmitate and Liver-Diseases

Malabsorption of fat-soluble vitamins is a major complication of chronic cholestatic liver disease. The most accurate way to assess vitamin A status in children who have cholestasis is unknown. The goal of this study was to assess the accuracy of noninvasive tests to detect vitamin A deficiency. Children with chronic cholestatic liver disease (n = 23) and noncholestatic liver disease (n = 10) were studied. Ten cholestatic patients were identified as vitamin A-deficient based on the relative dose response (RDR). Compared with the RDR, the sensitivity and specificity to detect vitamin A deficiency for each test was, respectively: serum retinol, 90% and 78%; retinol-binding protein (RBP), 40% and 91%; retinol/RBP molar ratio, 60% and 74%; conjunctival impression cytology, 44% and 48%; slit-lamp examination, 20% and 66%; tear film break-up time, 40% and 69%; and Schirmer's test, 20% and 78%. We developed a modified oral RDR via oral coadministration of d-alpha tocopheryl polyethylene glycol-1000 succinate and retinyl palmitate. This test had a sensitivity of 80% and a specificity of 100% to detect vitamin A deficiency. In conclusion, vitamin A deficiency is relatively common in children who have chronic cholestatic liver disease. Our data suggest that serum retinol level as an initial screen followed by confirmation with a modified oral RDR test is the most effective means of identifying vitamin A deficiency in these subjects.

Topics: Administration, Oral; Adolescent; Adult; Child; Child, Preschool; Cholestasis; Chronic Disease; Diterpenes; Dry Eye Syndromes; Female; Humans; Infant; Liver Diseases; Male; Polyethylene Glycols; Retinol-Binding Proteins; Retinyl Esters; Sensitivity and Specificity; Vitamin A; Vitamin A Deficiency; Vitamin E

Vitamin A deficiency (VAD) is associated with the progression of chronic liver disease (CLD). The aim in this study was to assess levels of serum retinol and retinol-binding protein (RBP) as well as liver vitamin A stores in the presence of liver cirrhosis and hepatocellular carcinoma.. We ascertained the serum retinol and RBP levels of randomly selected CLD patients divided into two groups, one given 1500 UI (n = 89) and the other receiving 2500 UI (n = 89) doses of retinyl palmitate for the relative dose response test. Blood samples were collected in a fasting state and 5 and 7 h after supplementation.. The prevalence of VAD was 62.4%. There was a progressive drop in serum retinol (P < 0.001) and RBP (P = 0.002) according to the severity of the liver disease, and a greater prevalence of severe VAD was noted in cirrhosis Child & Pugh C (52.8%). Fifty percent of the patients presented a low availability of RBP relative to retinol concentration, and there was no peak in RBP levels regardless of the dose of retinyl palmitate administered.. Our findings suggest serum retinol and RBP are relevant as indicators of vitamin A nutritional status in the presence of CLD. Liver vitamin A store cannot be evaluated using the RDR test because CLD causes a reduction in RBP synthesis and interferes with the mobilization of endogenous vitamin A. Considering how the patients already showed a drop in RBP relative to retinol concentrations, it is reasonable to assume vitamin A supplementation may trigger harmful effects in CLD patients.

Topics: Adult; Aged; Diterpenes; Female; Humans; Liver Diseases; Male; Metabolism, Inborn Errors; Middle Aged; Nutritional Status; Retinol-Binding Proteins; Retinyl Esters; Severity of Illness Index; Treatment Outcome; Vitamin A; Vitamin A Deficiency

To investigate the role of vitamin A in liver damage induced by bile duct ligation (BDL) in rats.. Thirty male Wistar rats were randomly divided into three groups: SHAM group, BDL group, and BDL + VitA group . The concentrations of retinol and retinyl palmitate in the liver were analyzed using HPLC, and liver function was evaluated by the level of TBIL, ALT, AST, and ALP in serum. Hepatic oxidative status was estimated by measuring T-SOD, CAT, GSH, MDA, and AOPP. Nrf2 expression was assessed using immunohistochemistry and western blotting, and EMSA was performed to determine Nrf2 DNA-binding activity. The expression of the downstream factors such as Ho1 and Nqo1 was also examined using immunohistochemistry and western blotting assays.. Vitamin A treatment restored levels of retinoids in liver, improved liver function, alleviated oxidative stress, and facilitated the translocation of Nrf2 to the nucleus in the experimental obstructive jaundice. Vitamin A was also found to increase the expression of Nrf2 downstream proteins such as Ho1 and Nqo1.. Vitamin A was here found to ameliorate cholestatic liver injury. This effect may be related to the activation of Nrf2/ARE pathway in bile duct ligation rats.

Topics: Alanine Transaminase; Alkaline Phosphatase; Animals; Aspartate Aminotransferases; Bile Ducts; Bilirubin; Catalase; Cholestasis, Extrahepatic; Dietary Supplements; Diterpenes; Glutathione; Liver; Liver Diseases; Male; Malondialdehyde; NF-E2-Related Factor 2; Rats; Rats, Wistar; Retinyl Esters; Superoxide Dismutase; Vitamin A

Although vitamin A deficiency is common in chronic liver disease, limited data exist on impairment of dark adaptation and response to therapy. The aims were (1) to assess dark adaptation in patients, (2) to assess the relationship between dark adaptation and vitamin A status, zinc and Child-Pugh score, (3) to compare perceived and measured dark adaptation and (4) to assess the dark adaptation response to intramuscular vitamin A.. This was a prospective study of 20 patients (alcoholic liver disease 10, other parenchymal diseases six, cholestatic diseases four) awaiting liver transplantation. Selection was based on low serum retinol. There were 15 age-matched controls. Dark adaptation was measured with a SST-1 dark adaptometer and perception by questionnaire. Eight patients received 50, 000 IU of retinyl palmitate, and dark adaptation was repeated at 1 month.. Forty per cent of patients had impaired dark adaptation. Patients with alcoholic liver disease were more impaired than those with other parenchymal diseases (p=0.015). No relationship was found between dark adaptation and the biochemical indicators or Child-Pugh score. Seventy-five per cent of patients with impairment did not perceive a problem. After intervention, light of half the previous intensity could be seen (p=0.05).. Dark-adaptation impairment was common, was worse in alcoholic liver disease, was largely not appreciated by the patients and improved with vitamin A treatment.

Topics: Adult; Case-Control Studies; Dark Adaptation; Diterpenes; Female; Humans; Injections, Intramuscular; Liver Cirrhosis, Alcoholic; Liver Diseases; Liver Transplantation; Male; Middle Aged; Prospective Studies; Retinyl Esters; Treatment Outcome; Vitamin A; Vitamin A Deficiency; Vitamins; Zinc

Pretreatment of rats with large doses of vitamin A (VA, retinol) has been shown to potentiate carbon tetrachloride hepatotoxicity. The relationship between VA dose or pretreatment duration with VA and the extent of potentiation of CCl4 hepatotoxicity is unknown. Therefore, VA was administered to male SD rats (180-200 g) by oral gavage in daily doses of 100,000, 150,000, 200,000, or 250,000 IU/kg for 3 weeks. In another experiment, rats were given VA in a daily dose of 250,000 IU/kg for 1 day, 1, 2, 3, or 5 weeks. At 24 hr after the last VA dose, CCl4 (0.15 ml/kg, ip) was administered. Hepatotoxicity was assessed by increases in plasma alanine aminotransferase activity and by histological evaluation of the liver. Additionally, the correlation between the hepatic concentration of retinol and retinyl palmitate after VA treatment and the extent of potentiation of CCl4-induced liver injury was studied. In the initial 3-week dose-response study, as the daily dose of VA increased so did the degree of potentiation of CCl4 hepatotoxicity. All treatment durations with VA (250,000 IU/kg per day), except 1 day, resulted in equivalent potentiation of CCl4 hepatotoxicity. VA treatment did not result in elevated hepatic concentration of retinol. However, VA treatment did increase the concentration of retinyl palmitate in the liver (except for the 1-day treatment). No linear correlation could be seen between the hepatic concentration of retinyl palmitate and the extent of VA potentiation of CCl4 hepatotoxicity. VA treatment also potentiated to hepatotoxicity of minimally hepatotoxic doses of acetaminophen, allyl alcohol, and endotoxin. Because these chemicals produce hepatic injury by diverse mechanisms it is concluded that VA potentiates hepatic injury by altering a process involved in the progression of cell injury.

Topics: 1-Propanol; Acetaminophen; Alanine Transaminase; Animals; Carbon Tetrachloride; Chemical and Drug Induced Liver Injury; Chromatography, High Pressure Liquid; Diterpenes; Dose-Response Relationship, Drug; Drug Synergism; Endotoxins; Liver Diseases; Male; Propanols; Rats; Rats, Sprague-Dawley; Retinyl Esters; Vitamin A

Liver retinoid levels and the retinyl esters were examined in liver biopsy specimens from 70 patients with alcoholic and nonalcoholic liver diseases. There was a wide variation in the liver retinoid levels. The liver retinoid level was statistically significantly lower in 15 patients with alcoholic liver disease and a depressed Normotest (NT) value of less than 65% compared with patients with alcoholic liver disease and a normal NT value of greater than 65% (P less than 0.01). The mean serum retinol level in patients with alcoholic cirrhosis was 0.68 +/- 0.38 mumol/l compared with 1.99 +/- 1.14 mumol/l in patients with alcoholic fatty liver (P less than 0.03). The relative amount of retinyl oleate was increased in the alcoholic fatty liver compared with the nonalcoholic fatty liver (P less than 0.001).

Topics: Adult; Aged; Diterpenes; Ethanol; Fatty Liver; Fatty Liver, Alcoholic; Female; Humans; Liver; Liver Diseases; Liver Diseases, Alcoholic; Male; Middle Aged; Retinoids; Retinol-Binding Proteins; Retinyl Esters; Vitamin A

The relative dose response (RDR) test has been proposed as a tool for estimation of total body stores of vitamin A. In this study we have validated a variation of this test in children with or without liver disease. Administration of vitamin A was done by intravenous injection of 1000 micrograms of retinyl palmitate. We conclude that the RDR test by intravenous injection performed after 5 h is a reliable and sensitive indicator of vitamin A status. Values found were greater than 20% when liver vitamin A concentration is less than 20 micrograms/g liver and less than 10% when liver vitamin A concentration is greater than 20 micrograms/g liver. We also conclude that the RDR test can be applied to evaluate the efficiency of vitamin A therapy and we confirm that plasma retinol levels should not be used to screen vitamin A status.

Topics: Biliary Atresia; Biopsy; Child, Preschool; Diterpenes; Dose-Response Relationship, Drug; Humans; Infant; Liver; Liver Diseases; Retinyl Esters; Time Factors; Vitamin A; Vitamin A Deficiency