Retinol is one of the animal forms of vitamin A. It is a diterpenoid and an alcohol.

It is
convertible to other forms of vitamin A, and the retinyl ester derivative of the alcohol serves as
the storage form of the vitamin in animals.

When converted to the retinal (retinaldehyde) form, vitamin A is essential for vision, and when
converted to retinoic acid, is essential for skin health, teeth remineralization and bone growth.
These chemical compounds are collectively known as retinoids, and possess the structural motif
of all-trans retinol as a common feature in their structure. Structurally, all retinoids also possess a
-ionone ring and a polyunsaturated side chain, with either an alcohol, aldehyde, a carboxylic
acid group or an ester group. The side chain is composed of four isoprenoid units, with a series
of conjugated double bonds which may exist in trans- or cis-configuration.

Retinol is produced in the body from the hydrolysis of retinyl esters, and from the reduction of
retinal. Retinol in turn is ingested in a precursor form; animal sources (liver and eggs) contain
retinyl esters, whereas plants (carrots, spinach) contain pro-vitamin A carotenoids (these may
also be considered simply vitamin A). Hydrolysis of retinyl esters results in retinol, while pro-
vitamin A carotenoids can be cleaved to produce retinal . Retinal, also known as retinaldehyde,
can be reversibly reduced to produce retinol or it can be irreversibly oxidized to produce
retinoic acid, which then cannot function as the vitamin in the eye.

Commercial production of retinol typically requires retinal synthesis through reduction of a

pentadiene derivative and subsequent acidification/hydrolysis of the resulting isomer to produce
retinol. Pure retinol is extremely sensitive to oxidization and is prepared and transported at low
temperatures and oxygen free atmospheres. When prepared as a dietary supplement, retinol is
stabilized as the ester derivatives retinyl acetate or retinyl palmitate.

Discovery
In 1913, Elmer McCollum, a biochemist at the University of WisconsinMadison, and colleague
Marguerite Davis identified a fat-soluble nutrient in butterfat and cod liver oil. Their work
confirmed that of Thomas Osborne and Lafayette Mendel, at Yale, which suggested a fat-soluble
nutrient in butterfat, also in 1913. Vitamin A was first synthesized in 1947 by two Dutch
chemists, David Adriaan van Dorp and Jozef Ferdinand Arens.

Although the vitamin A was not identified until the 20th century, written observations of
conditions created by deficiency of this nutrient appeared much earlier in history. Sommer
(2008) classified historical accounts related to vitamin A and/or manifestations of deficiency as
follows: "Ancient" accounts; 18th- to 19th-century clinical descriptions (and their purported
etiologic associations); early 20th-century laboratory animal experiments, and clinical and
epidiomologic observations that identified the existence of this unique nutrient and
manifestations of its deficiency.

Chemical structure and function

Many different geometric isomers of retinol, retinal and retinoic acid are possible as a result of
either a trans or cis configuration of four of the five double bonds found in the polyene chain.
The cis isomers are less stable and can readily convert to the all-trans configuration (as seen in
the structure of all-trans-retinol shown here). Nevertheless, some cis isomers are found naturally
and carry out essential functions. For example, the 11-cis-retinal isomer is the chromophore of
rhodopsin, the vertebrate photoreceptor molecule. Rhodopsin is composed of the 11-cis-retinal
covalently linked via a Schiff base to the opsin protein (either rod opsin or blue, red or green
cone opsins). The process of vision relies on the light-induced isomerisation of the chromophore
from 11-cis to all-trans resulting in a change of the conformation and activation of the
photoreceptor molecule. One of the earliest signs of vitamin A deficiency is night-blindness
followed by decreased visual acuity.

George Wald won the 1967 Nobel Prize in Physiology or Medicine for his work with retina
pigments (also called visual pigments), which led to the understanding of the role of vitamin A in
vision.

Many of the non-visual functions of vitamin A are mediated by retinoic acid, which regulates
gene expression by activating nuclear retinoic acid receptors. The non-visual functions of
vitamin A are essential in the immunological function, reproduction and embryonic development
of vertebrates as evidenced by the impaired growth, susceptibility to infection and birth defects
observed in populations receiving suboptimal vitamin A in their diet.

Role in embryology

Retinoic acid via the retinoic acid receptor influences the process of cell differentiation, hence,
the growth and development of embryos. During development there is a concentration gradient
of retinoic acid along the anterior-posterior (head-tail) axis. Cells in the embryo respond
differently to retinoic acid depending on the amount present. For example, in vertebrates the
hindbrain transiently forms eight rhombomers and each rhombomere has a specific pattern of
genes being expressed. If retinoic acid is not present the last four rhombomeres do not develop.
Instead rhombomeres 1-4 grow to cover the same amount of space as all eight would normally
occupy. Retinoic acid has its effects by turning on a differential pattern of Hox genes which
encode different homeodomain transcription factors which in turn can turn on cell type specific
genes. Deletion of the Hox-1 gene from rhombomere 4 makes the neurons growing in that region
behave like neurons from rhombomere 2. Retinoic acid is not required for patterning of the retina
as originally proposed, but retinoic acid synthesized in the retina is secreted into surrounding
mesenchyme where it is required to prevent overgrowth of perioptic mesenchyme which can
cause microphthalmia, defects in the cornea and eyelid, and rotation of the optic cup.

Stem cell biology

Retinoic acid is an influential factor used in differentiation of stem cells to more committed fates,
echoing retinoic acid's importance in natural embryonic developmental pathways. It is thought to
initiate differentiation into a number of different cell lineages by unsequestering certain
sequences in the genome.
It has numerous applications in the experimental induction of stem cell differentiation; amongst
these are the differentiation of human embryonic stem cells to posterior foregut lineages and also
to functional motor neurons.

Vision

visual cycle

Vitamin A is required in the production of rhodopsin, the visual pigment used in low light levels.
This is why eating foods rich in vitamin A is often said to allow an individual to see in the dark.

Epithelial cells

Vitamin A is essential for the correct functioning of epithelial cells. In vitamin A deficiency,
mucus-secreting cells are replaced by keratin producing cells, leading to xerosis.

Glycoprotein synthesis

Glycoprotein synthesis requires adequate vitamin A status. In severe vitamin A deficiency, lack
of glycoproteins may lead to corneal ulcers or liquefaction.

Immune system

Vitamin A is essential to maintain intact epithelial tissues as a physical barrier to infection; it is

also involved in maintaining a number of immune cell types from both the innate and acquired
immune systems. These include the lymphocytes (B-cells, T-cells, and natural killer cells), as
well as many myelocytes (neutrophils, macrophages, and myeloid dendritic cells).

Formation of red blood cells (Haematopoiesis)

Vitamin A may be needed for normal haematopoiesis; deficiency causes abnormalities in iron
metabolism.

Growth

Vitamin A affects the production of human growth hormone.

Clinical use
Further information: Tretinoin

All retinoid forms of vitamin A are used in cosmetic and medical applications applied to the skin.
Retinoic acid, termed Tretinoin in clinical usage, is used in the treatment of acne and keratosis
pilaris in a topical cream. An isomer of tretinoin, isotretinoin is also used orally (under the trade
names Accutane and Roaccutane), generally for severe or recalcitrant acne.
 Vitamin properties
Solubility Fat
RDA (adult male) 900 g/day
Tretinoin, under the alternative name of all-
RDA (adult female) 700 g/day
trans retinoic acid (ATRA), is used as
chemotherapy for acute promyelocytic RDA upper limit (adult male) 3,000 g/day
leukemia, a subtype of acute myelogenous
RDA upper limit (adult female) 3,000 g/day
leukemia. This is because cells of this subtype
of leukemia are sensitive to agonists of the Deficiency symptoms
retinoic acid receptors (RARs).
Night blindness
Units of measurement
Keratomalacia
When referring to dietary allowances or
nutritional science, retinol is usually measured Pale, dry skin
in international units (IU). IU refers to
biological activity and therefore is unique to
each individual compound, however 1 IU of Excess symptoms
retinol is equivalent to approximately 0.3
micrograms (300 nanograms). Liver toxicity

Nutrition Dry skin

This vitamin plays an essential role in vision, Hair loss

particularly night vision, normal bone and tooth
development, reproduction, and the health of Teratological effects
skin and mucous membranes (the mucus-
secreting layer that lines body regions such as Osteoporosis (suspected, long-term)
the respiratory tract). Vitamin A also acts in the
body as an antioxidant, a protective chemical
Common sources
that may reduce the risk of certain cancers.

There are two sources of dietary vitamin A. Liver and other organs
Active forms, which are immediately available
to the body are obtained from animal products. fortified Dairy products
These are known as retinoids and include
retinaldehyde and retinol. Precursors, also Darkly colored fruits
known as provitamins, which must be converted
to active forms by the body, are obtained from Leafy vegetables
fruits and vegetables containing yellow, orange
and dark green pigments, known as carotenoids,
the most well-known being beta-carotene. For this reason, amounts of vitamin A are measured in
Retinal Equivalents (RE). One RE is equivalent to 0.001 mg of retinal, or 0.006 mg of beta-
carotene, or 3.3 International Units of vitamin A.

In the intestine, vitamin A is protected from being chemically changed by vitamin E. Vitamin A
is fat-soluble and can be stored in the body. Most of the vitamin A consumed is stored in the
liver. When required by a particular part of the body, the liver releases some vitamin A, which is
carried by the blood and delivered to the target cells and tissues.

Dietary intake

The Dietary Reference Intake (DRI) Recommended Daily Amount (RDA) for vitamin A for a 25-
year-old male is 900 micrograms/day, or 3000 IU.

Estimates have changed over time of the rate at which -carotene is converted to vitamin A in the
human body. An early estimate of 6:1 was revised to 12:1 and from recent studies and
experimental trials carried out in developing nations it was revised again to 21:1. The implication
of the reduced estimate is that larger quantities of -carotene are needed to yield the necessary
dietary requirement of vitamin A. This means that more continents are affected by the deficiency
of vitamin A than was previously thought. Changing dietary choices in Africa, Asia, and South
America will not be sufficient, and agricultural practices on those continents will need to change.

The Food Standards Agency states that an average adult should not consume more than 1500
micrograms (5000 IU) per day, because this increases the chance of osteoporosis.

During the absorption process in the intestines, retinol is incorporated into chylomicrons as the
ester form, and it is these particles that mediate transport to the liver. Liver cells (hepatocytes)
store vitamin A as the ester, and when retinol is needed in other tissues, it is de-esterifed and
released into the blood as the alcohol. Retinol then attaches to a serum carrier, retinol binding
protein, for transport to target tissues. A binding protein inside cells, cellular retinoic acid binding
protein, serves to store and move retinoic acid intracellularly. Carotenoid bioavailability ranges
between 1/5 to 1/10 of retinol's. Carotenoids are better absorbed when ingested as part of a fatty
meal. Also, the carotenoids in vegetables, especially those with tough cell walls (e.g. carrots), are
better absorbed when these cell walls are broken up by cooking or mincing.

Deficiency

Vitamin A deficiency

Vitamin A deficiency is common in developing countries but rarely seen in developed countries.
Approximately 250,000 to 500,000 malnourished children in the developing world go blind each
year from a deficiency of vitamin A. Night blindness is one of the first signs of vitamin A
deficiency. Vitamin A deficiency contributes to blindness by making the cornea very dry and
damaging the retina and cornea.

Interventions/remedies

Interventions or remedies in vitamin A deficiency in a deficient population may be enforced

using three approaches:(A) through dietary modification involving the adjustment of menu
choices of affected persons from available food sources to optimize vitamin A content, (B)
enriching commonly eaten and affordable foods with vitamin A, a process called fortification. It
involves addition of synthetic vitamin A to staple foods like margarine, bread, flours, cereals and
other infant formulae during processing and (C) giving high-doses of vitamin A to the targeted
deficient population, a method known as supplementation. Caution should however be exercised
when using supplementation as a method of replenishing vitamin A in the body so that upper
harmful limits are not attained.

Retinoid overdose (toxicity)

see Hypervitaminosis A for details

The Tolerable Upper Intake Level (UL) for vitamin A, for a 25-year-old male, is 3,000
micrograms/day, or about 10,000 IU.

Too much vitamin A in retinoid form can be harmful or fatal, resulting in what is known as
hypervitaminosis A. The body converts the dimerized form, carotene, into vitamin A as it is
needed, therefore high levels of carotene are not toxic compared to the ester (animal) forms. The
livers of certain animals, especially those adapted to polar environments, often contain amounts
of vitamin A that would be toxic to humans. Thus, vitamin A toxicity is typically reported in
Arctic explorers and people taking large doses of synthetic vitamin A. The first documented
death due to vitamin A poisoning was Xavier Mertz, a Swiss scientist who died in January 1913
on an Antarctic expedition that had lost its food supplies and fell to eating its sled dogs. Mertz
consumed lethal amounts of vitamin A by eating the dogs' livers.

Vitamin A toxicity occurs when an individual ingests vitamin A in large amounts more than the
daily recommended value in the threshold of 25,000 IU/Kg or more. Often, the individual
consumes about 3-4 times the RDA's specification Toxicity of vitamin A is believed to be
associated with the intervention methods used to upgrade vitamin A levels in the body such as
food modification, fortification and supplementation, all of which are employed to combat
vitamin A deficiency Toxicity is classified into two categories: acute and chronic toxicities. The
former occurs few hours or days after ingestion of large amounts of vitamin A accidentally or via
inappropriate therapy. The later toxicity (Chronic) takes place when about 25,000 IU/Kg or more
of vitamin A is consumed for a prolonged period of time. Symptoms associated with both
toxicities include, but not limited to nausea, blurred vision, fatigue, weight-loss, menstrual
abnormalities etc.

If eaten in one meal, 30 to 90 grams of polar bear liver is enough to kill a human being, or to
make even sled dogs very ill.

Excess vitamin A has also been suspected to be a contributor to osteoporosis. This seems to
happen at much lower doses than those required to induce acute intoxication. Only preformed
vitamin A can cause these problems, because the conversion of carotenoids into vitamin A is
downregulated when physiological requirements are met. An excessive uptake of carotenoids
can, however, cause carotenosis.

The carotenoid synthetic form of beta-carotene was interestingly associated with an increase in
lung cancer when it was studied in a lung cancer prevention trial in male smokers. In non-
smokers, the opposite effect has been noted.
Excess preformed vitamin A during early pregnancy has also been associated with a significant
increase in birth defects. These defects may be severe, even life-threatening. Even twice the daily
recommended amount can cause severe birth defects. The FDA currently recommends that
pregnant women get their vitamin A from foods containing beta carotene and that they should
ensure that they consume no more than 5,000 IU of preformed vitamin A (if any) per day.
Although vitamin A is necessary for fetal development, most women carry stores of vitamin A in
their fat cells, so oversupplementation should be strictly avoided.

A review of all randomized controlled trials in the scientific literature by the Cochrane
Collaboration published in JAMA in 2007 found that supplementation with beta-carotene or
vitamin increased mortality by 5% and 16%, respectively.

Contrary to earlier observations, recent studies emerging from some developing countries (India,
Bangladesh and Indonesia) have strongly suggested that dosing expectant mothers in the
population in which vitamin A deficiency is common and maternal mortality is high can greatly
reduce maternal mortality ratio Similarly, dosing newborn infants with 50,000 IU (15 mg) of
vitamin A within 2 days of birth, can significantly reduce neonatal mortality

Sources

All sources of vitamin A can provide retinol, but retinoids are found naturally in some foods of
animal origin. Each of the following contains at least 0.15 mg of retinoids per 1.757 oz (50200
g):

Cod liver oil

Butter, Margarine

Liver (beef, pork, chicken, turkey, fish)

Eggs

Cheese, Milk

Synthetic sources

Synthetic retinol is marketed under the following trade names: Acon, Afaxin, Agiolan, Alphalin,
Anatola, Aoral, Apexol, Apostavit, Atav, Avibon, Avita, Avitol, Axerol, Dohyfral A, Epiteliol,
Nio-A-Let, Prepalin, Testavol, Vaflol, Vi-Alpha, Vitpex, Vogan, and Vogan-Neu.

There are three known routes to retinol that are used industrially, all of which start with beta-
ionone.

Night vision
Night blindnessthe inability to see well in dim lightis associated with a deficiency of
vitamin A. At first, the most light sensitive (containing more retinal) protein rhodopsin is
influenced. Less pigmented by retinal iodopsins (three forms/colors in humans), responsible for
color vision and sensing relatively high light intensities (day vision), are less impaired at early
stages of the vitamin A deficiency. All these protein-pigment complexes are located in the light-
sensing cells in eye's retina.

When stimulated by light, rhodopsin splits into a protein and a cofactor: opsin and all-trans-
retinal (a form of vitamin A). The regeneration of active rhodopsin requires opsin and 11-cis-
retinal. The regeneration of 11-cis-retinal occurs in vertebrates via a sequence of chemical
transformations that constitute "the visual cycle" and which occurs primarily in the retinal
pigmented epithelial cells.

Without adequate amounts of retinal, regeneration of rhodopsin is incomplete and night

blindness occurs.

Closely related chemicals

Tretinoin (Tradename: Retin-A)

Isotretinoin (Tradename: Accutane(US), Roaccutane)

Retinyl palmitate ("vitamin A palmitate")

Genetically engineered vitamin A enriched rice

Due to the high prevalence of vitamin A deficiency in developing countries, there are efforts to
produce genetically modified rice rich in beta carotene. The idea is that this would help poor
people, who can not afford a varied diet containing sufficient natural sources of vitamin A, meet
their dietary needs. The golden rice project is one such effort, and is already undergoing trials.