Retinol is a hydrolytic metabolite of retinyl esters belonging to the group of vitamin A1 as an alcohol form. Retinol or other forms of vitamin A are fat-soluble vitamins that are found in food and used as a dietary supplement. Either of them is needed for vision, cellular development, maintenance of skin and mucous membranes, immune function and reproductive development. Dietary sources include fish, dairy products, and meat.
The term vitamin A may refer to several related fat-soluble retinoids. Retinol is the alcohol form of vitamin A; retinal and retinoic acid are metabolites of retinol; and retinyl esters, such as retinyl palmitate and retinyl acetate, are forms used in storage and in some dietary supplements. In European Union cosmetics regulation, the INCI names Retinol, Retinyl Acetate, and Retinyl Palmitate are described as substances collectively known as vitamin A.
As a supplement it is used to treat and prevent vitamin A deficiency, especially that which results in xerophthalmia. It is taken by mouth or by injection into a muscle. As an ingredient in skin-care products, it is used topically (externally) to reduce wrinkles and other effects of skin aging.
Retinol at normal doses is well tolerated. High doses may cause enlargement of the liver, dry skin, and hypervitaminosis A. High doses during pregnancy may harm the fetus. The body converts retinol to retinal and retinoic acid, through which it acts.
Retinol was discovered in 1909, isolated in 1931, and first made in 1947. It is on the World Health Organization's List of Essential Medicines. Retinol is available as a generic medication and is also used in over-the-counter cosmetic products. In 2021, vitamin A was the 298th most commonly prescribed medication in the United States, with more than 500,000 prescriptions.
Medical uses Retinol is used to treat vitamin A deficiency.
Three approaches may be used when populations have low vitamin A levels:
Through dietary modification involving the adjustment of menu choices of affected persons from available food sources to optimize vitamin A content. Enriching commonly eaten and affordable foods with vitamin A, a process called fortification. It involves the addition of synthetic vitamin A to staple foods like margarine, bread, flour, cereals, and infant formula during processing. By giving high doses of vitamin A to the targeted deficient population, a method known as supplementation. In regions where deficiency is common, a single large dose is recommended to those at high risk twice a year.
Retinol is also used to reduce the risk of complications in measles patients.
Side effects
The Recommended Daily Intake (RDA) for preformed supplemental vitamin A for adult men and women is 900 and 700 Retinol Activity Units(RAE)/day, respectively, or about 3,000 IU and 2,300 IU. In pregnancy, the vitamin A RDA is 750–770 RAE/day (about 2,500–2,550 IU). During lactation, the RDA increases to 1,200–1,300 RAE/day (about 4,000–4,300 IU, with differences depending on age).
Retinol Activity Units can only be converted to IU (International Units) when the source of the vitamin A is known. The IU values listed above do not apply to food sources of vitamin A.
Too much vitamin A in retinoid form can be harmful. The body converts the dimerized form, carotene, into vitamin A as it is needed, so high levels of carotene are not toxic, whereas the ester (animal) forms are. The livers of certain animals, especially those adapted to polar environments, such as polar bears and seals, 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 possibly caused by vitamin A poisoning was that of 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 may have consumed lethal amounts of vitamin A by eating the dogs' livers.
Vitamin A acute toxicity occurs when a person ingests vitamin A in large amounts more than the daily recommended value in the threshold of 25,000 IU/kg or more. Often, the patient consumes about 3–4 times the RDA's specification. Toxicity of vitamin A is believed to be associated with the methods of increasing vitamin A in the body, such as food modification, fortification, and supplementation, all of which are used to combat vitamin A deficiency. Toxicity is classified into two categories: acute and chronic. The former occurs a few hours or days after ingestion of a large amount of vitamin A. Chronic toxicity takes place when about 4,000 IU/kg or more of vitamin A is consumed for a long time. Symptoms of both include nausea, blurred vision, fatigue, weight loss, and menstrual abnormalities.
Excess vitamin A is 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 or retinyl esters into vitamin A is downregulated when physiological requirements are met; but excessive uptake of carotenoids can cause carotenosis.
Excess preformed vitamin A during early pregnancy is 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 recommends that pregnant women get their vitamin A from foods containing beta carotene and that they 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 sufficient stores of vitamin A in their liver cells, so over-supplementation 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 A increased mortality by 5% and 16%, respectively. This effect has been attributed to the role of retinol and retinoic acid in increasing circulating cholesterol and triglycerides as well as promoting cancer incidence.
Studies emerging from developing countries India, Bangladesh, and Indonesia strongly suggest that, in populations in which vitamin A deficiency is common and maternal mortality is high, dosing expectant mothers with retinol can greatly reduce maternal mortality. Similarly, dosing newborn infants with 50,000 IU (15 mg) of vitamin A within two days of birth can significantly reduce neonatal mortality.
Biological roles Retinol or other forms of vitamin A are needed for eyesight, maintenance of the skin, and human development. Other than for vision, which requires 11-cis retinal, the active compound is retinoic acid, synthesized from retinal, in turn synthesized from retinol. The differing biological roles of retinoic acid depend on its stereochemistry and whether it is present in the all-trans, 9-cis, or 13-cis forms.
Embryology Retinoic acid via the retinoic acid receptor influences the process of cell differentiation and, 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 to retinoic acid differently depending on the amount present. For example, in vertebrates, the hindbrain transiently forms eight rhombomeres 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 Homeobox (Hox) genes that encode different homeodomain transcription factors which in turn can turn on cell type-specific genes. Deletion of the Homeobox (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 the 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 Synthetic retinoic acid is 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 several different cell lineages through activation of the Retinoic acid receptor. It has numerous applications in the experimental induction of stem cell differentiation; amongst these is the differentiation of human embryonic stem cells to posterior foregut lineages.
Vision
Retinol is an essential compound in the cycle of light-activated chemical reactions called the "visual cycle" that underlies vertebrate vision. Retinol is converted by the protein RPE65 within the pigment epithelium of the retina into 11-cis-retinal. This molecule is then transported into the retina's photoreceptor cells (the rod or cone cells in mammals) where it binds to an opsin protein and acts as a light-activated molecular switch. When 11-cis-retinal absorbs light it isomerizes into all-trans-retinal. The change in the shape of the molecule in turn changes the configuration of the opsin in a cascade that leads to the neuronal firing, which signals the detection of light. The opsin then splits into the protein component (such metarhodopsin) and the cofactor all-trans-retinal. The regeneration of active opsin requires conversion of all-trans-retinal back to 11-cis-retinal via retinol. The regeneration of 11-cis-retinal occurs in vertebrates via the conversion of all-trans-retinol to 11-cis-retinol in a sequence of chemical transformations that occurs primarily in the pigment epithelial cells.
Without adequate amounts of retinol, regeneration of rhodopsin is incomplete and night blindness occurs. Night blindness, the inability to see well in dim light, is associated with a deficiency of vitamin A, a class of compounds that includes retinol and retinal. In the early stages of vitamin A deficiency, the more light-sensitive and abundant rods, which have rhodopsin, have impaired sensitivity, and the cone cells are less affected. The cones are less abundant than rods and come in three types, each contains its own type of iodopsin, the opsins of the cones. The cones mediate color vision, and vision in bright light (day vision).
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 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). Vitamin A maintains immune barriers in the gut through its activity as retinoic acid.
Skin