For scbd something 4ation.

The term retinoids applies to both natural and synthetic

compounds with vitamin A activity and is most often used in the context

of vitamin A acting at the gene level. Numerous synthetic retinoids

have gained clinical acceptance in the treatment of skin disorders and

certain cancers.

During embryonic development, retinoic acid is among the most

important signaling molecules that determine body patterning (mor-

phogenesis). Many physiologic processes are sensitive to a deficiency

or excess of vitamin A or RA, including reproduction, growth, bone

development, and the functions of the respiratory, gastrointestinal,

hematopoietic, and immune systems. Vitamin A, presumably by enhanc-

ing immune function and host defense, is particularly important in

developing countries; studies show that vitamin A supplementation or

therapy reduces morbidity and mortality from various infectious diseases,

including measles (see Chapter 273).

Vitamin A plays a critical role in vision, mediated by 11-cis retinal.

The human retina contains 2 distinct photoreceptor systems: the rods,

in which rhodopsin senses light of low-intensity, and the cones, in which

iodopsins detect different colors; 11-cis-retinal is the prosthetic group

on both these visual proteins. The mechanism of vitamin A action is

similar for rods and cones, based on photoisomerization of 11-cis to

all-trans retinal (change shape when exposed to light), which initiates

signal transduction via the optic nerve to the brain, resulting in visual

sensation. After isomerization (also known as photobleaching), a series

of reactions serves to regenerate the 11-cis retinal for resynthesis of

rhodopsin and iodopsin; accessory cells, including retinal pigment

epithelium and Müller cells, are involved in this recycling process.

VITAMIN A DEFICIENCY

If the growing child has a well-balanced diet and obtains vitamin A

from foods rich in vitamin A or provitamin A (Table 61.1), the risk of

vitamin A deficiency is small. However, even subclinical vitamin A

deficiency can have serious consequences.

Deficiency states in developed countries are rare, except in some

impoverished populations (see Chapter 57), or after mistakes in food

preparation or with fad diets, but are common in many developing

countries and often associated with global malnutrition. In the clinical

setting, vitamin deficiencies can also occur as complications in children

with various chronic disorders or diseases. Information obtained in the

medical history related to dietary habits can be important in identifying

the risk of such nutritional problems. Except for vitamin A, toxicity

from excess intake of vitamins is rare. Table 61.1 summarizes the

food sources, functions, and deficiency and excess symptoms of the

vitamins.