A Study to Improve the Vitamin A and Iodine Status of Pregnant Women through a Multiple Micronutrient Fortified Salt

Background. To study the efficacy of a multiple micronutrient fortified salt enriched with iron, iodine, vitamin A, vitamin B1, vitamin B2, vitamin B6, vitamin B12, niacin, and folic acid in improving serum retinol and iodine status of pregnant women. Methods. It was a randomized control trial in the antenatal clinic of a hospital. 151 women in the experimental group received a multiple micronutrient fortified salt to cook all their meals, and 150 women in the control group did not receive the fortified salt. Blood was collected in the three trimesters. Urine was collected in their first and third trimesters. Serum retinol, CRP (C-reactive protein), and AGP (Alpha glycoprotein) in blood were assessed, and iodine was assessed in urine. All the women were dewormed once. Results. The inflammation adjusted mean serum retinol in three trimesters in the experimental group was 24.51, 27.29, and 25.68 µg/dL, and it was 28.97, 27.63, and 22.72 µg/dL in the control group. Over the study period of 6 months, the increase in serum retinol in the experimental group was 1.17 µg/dL whereas in the control group serum retinol decreased by 6.25 µg/dL. The experimental group increase in serum retinol is significantly more ( $p=0.0001$ ) than the changes in retinol in the control group. The prevalence of serum retinol deficiency in the three trimesters was 39.1%,25.8%, and 37.7% in the experimental group and 14%, 22.7%, and 39.3% in the control group, and the change in the experimental group was significant ( $p=0.001$ ) compared to the control group by binary logistic regression. Over the study period of 6 months there is a significant increase in urinary iodine concentration in the experimental group ( $p=0.030$ ), showing absorption of iodine from the fortified salt whereas there is a significant decline in the iodine values in the control group ( $p=0.008$ ). At the end of the study, the urinary iodine concentration of the experimental group was significantly more ( $p=0.0001$ ) than that of the control group. Conclusion. The fortified salt was able to improve serum retinol levels and urinary iodine levels in pregnant women. Trial Registration. This trial was registered retrospectively on 19/02/2022 in the ISRCTN registry with trial ID ISRCTN17782574.

Insight Into Biological Targets and Molecular Mechanisms in the Treatment of Arsenic-Related Dermatitis With Vitamin A via Integrated in silico Approach

Exposure to arsenic (As), an inorganic poison, may lead to skin lesions, including dermatitis. Vitamin A (VA), a fat-soluble vitamin essential for mucous membrane integrity, plays a key role in skin protection. Although the beneficial actions of VA are known, the anti-As-related dermatitis effects of VA action remain unclear. Hence, in this study, we aimed to interpret and identify the core target genes and therapeutic mechanisms of VA action in the treatment of As-related dermatitis through integrated in silico approaches of network pharmacology and molecular docking. We integrated the key VA-biological target-signaling pathway-As-related dermatitis networks for identifying core drug targets and interaction pathways associated with VA action. The network pharmacology data indicated that VA may possess potential activity for treating As-related dermatitis through the effective regulation of core target genes. An enrichment analysis in biological processes further revealed multiple immunoregulation-associated functions, including interferon-gamma production and negative regulation of T-cell activation and production of molecular mediator of immune response. An enrichment analysis in molecular pathways mainly uncovered multiple biological signaling, including natural killer cell mediated cytotoxicity, autophagy, apoptosis, necroptosis, platelet activation involved in cell fate, and immunity regulations. Molecular docking study was used to identify docked well core target proteins with VA, including Jun, tumor protein p53 (TP53), mitogen-activated protein kinase-3 (MAPK3), MAPK1, and MAPK14. In conclusion, the potential use of VA may suppress the inflammatory stress and enhance the immunity against As-related dermatitis. In the future, VA might be useful in the treatment of dermatitis associated with As through multi-targets and multi-pathways in clinical practice.

An Updated Comprehensive Review on Vitamin A and Carotenoids in Breast Cancer: Mechanisms, Genetics, Assessment, Current Evidence, and Future Clinical Implications

Vitamin A and carotenoids are fat-soluble micronutrients that play important role as powerful antioxidants modulating oxidative stress and cancer development. Breast cancer is the most common malignancy in women. As the risk of breast cancer is dependent on various lifestyle factors such as dietary modifications, there is increasing interest surrounding the anti-cancerous properties of vitamin A and carotenoids. Despite the suggested protective roles of vitamin A and carotenoids in breast cancer development, their clinical application for the prevention and treatment of breast cancer is limited. In this narrative review, we discuss the roles of vitamin A and carotenoids along with the evaluation method of vitamin A status. We also exhibit the association of genetic variations involved in metabolism of vitamin A and carotenoids with cancers and other diseases. We demonstrate the epidemiological evidence for the relationship of vitamin A and carotenoids with breast cancer risk, their effects on cancer mechanism, and the recent updates in clinical practice of vitamin A or carotenoids as a potential therapeutic agent against breast cancer. This review provides insight into the preventive and therapeutic roles of vitamin A and carotenoids in breast cancer development and progression.

Vitamin A deficiency - experience from a tertiary referral UK hospital; not just a low- and middle-income country issue

OBJECTIVE

Vitamin A (VA) deficiency, more common in low- and middle-income countries (LMIC) secondary to malnutrition, is associated with increased morbidity and mortality. The prevalence and impact of VA deficiency in high-income countries (HIC) where chronic conditions may predispose is less well understood.

SETTING

We examined the scale of low and deficient VA status in our tertiary University Teaching Hospital (HIC).

PARTICIPANTS

Patients undergoing serum retinol concentrations 2012-2016 were identified from laboratory records, and records examined.

DESIGN

Interpretation of serum retinol may be affected by inflammation, so C-reactive protein (CRP) levels were sought. Binary logistic regression and generalised estimating equations were performed to review the relationship between CRP and VA.

RESULTS

628 assays were requested, with 82 patients VA low (0.7-0.99umol/L) or deficient (<0.7umol/L). 16 patients were symptomatic (15 deficient), predominantly visual. Only one symptomatic patient's VA deficiency was secondary to poor intake. Other symptomatic patients had chronic illnesses resulting in malabsorption. The incidence of a low VA level increases significantly with a raised CRP.

CONCLUSION

The majority of patients tested either were replete or likely to have abnormal VA levels due to concomitant inflammation. A minority of patients had signs and symptoms of VA deficiency and was a cause of significant morbidity, but aetiology differs from LMIC, overwhelmingly malabsorption, most commonly secondary to surgery or hepatobiliary disease. A correlation between inflammation and low VA levels exists, which raises the possibility that requesting a VA level in an asymptomatic patient with active inflammation may be of questionable benefit.

Relationship between nutritional status and the systemic inflammatory response: micronutrients

Micronutrients such as trace elements and vitamins are important as enzyme cofactors in the metabolism of all cells in the body and therefore key to determining nutritional status. The present systematic review examined the evidence of the impact of the systemic inflammatory response on plasma micronutrient status in acute (surgical) and chronic tissue injury. A literature review using targeted subject headings was carried out. Plasma C-reactive protein was used to classify minor (<10 mg/l), moderate (11–80 mg/l) and major (>80 mg/l) inflammation. The literature search produced 2344 publications and plasma vitamin D, zinc and carotenoids were most commonly studied and plasma vitamins K, B2and B6were least studied. In acute injury thirteen studies (all prospective) and in chronic injury twenty-four studies (largely retrospective) were included in the review. There was consistent evidence that most common measured micronutrients in the plasma (zinc, selenium, vitamins A, D, E, K, B2, B6, B12, C, lutein, lycopene, α- and β-carotene) were significantly lowered from minor to moderate to major inflammation. The results of the present systematic review indicate that most plasma micronutrients fall as part of the systemic inflammatory response irrespective of acute or chronic injury. Therefore, in the presence of a systemic inflammation, plasma micronutrient concentrations should be interpreted with caution. There are a number of methods applied to adjust plasma micronutrient concentrations to avoid misdiagnosis of deficiency. Alternatively, intracellular measurements appear to obviate the need for such plasma adjustment to assess micronutrient status.

Comparative Proteomic Analysis of Bleomycin-induced Pulmonary Fibrosis Based on Isobaric Tag for Quantitation

BACKGROUND

Pulmonary fibrosis (PF) is a destructive pulmonary disease and the molecular mechanisms underlying PF are unclear. This study investigated differentially expressed proteins associated with the occurrence and development of PF in rat lung tissue with bleomycin-induced PF.

METHODS

Sixteen Sprague-Dawley rats were randomly divided into 2 groups: the PF model group (n = 8) and the control group (n = 8). After successfully establishing the rat PF model induced by bleomycin, the differentially expressed proteins in the 2 groups were identified through isobaric tag for relative and absolute quantitation coupled with liquid chromatography-mass spectrometry and bioinformatics analysis.

RESULTS

A total of 146 differentially expressed proteins were identified; 88 of which displayed increased abundance and 58 were downregulated in the PF rat model group. Most functional proteins were associated with extracellular matrix, inflammation, damage response, vitamin A synthesis and metabolism. Critical proteins related to PF development and progression was identified, such as type V collagen-3, arachidonic acid 12-lipoxygenase, arachidonic acid 15-lipoxygenase and cytochrome P4501A1. Kyoto Encyclopedia of Genes and Genomes pathway analysis showed that these differentially expressed proteins were enriched in extracellular matrix receptor interaction pathway, renin-angiotensin system and metabolic pathway of retinol.

CONCLUSIONS

The proteins expressed in bleomycin-induced PF rat model provide important data for further functional analysis of proteins involved in PF.