VITAMINS

Dr. Nguyen Thi

Hoang Yen
Vision, reproduction,
growth, immune function,
maintenance of epithelial tissue

Vision
VITAMIN A

All (- vision, reproduction)

Beta-carotene
(pro-vitamin A)
VITAMIN A DEFICIENCY
11-cis-retinol: component of rhodopsin
Deficiency: night blindness
 RETINOID TOXICITY
Hypervitaminosis: dose > 7.5 mg/day Requirement:
Male: 900 retinol activity equivalent (RAE)
Female: 700 RAE
Symptoms: Pregnancy: 3000 µg preformed vit. A/day
1 RAE = 1µg of retinol
Skin (dry, pruritic) = 12 µg of β-carotene
Liver: enlarged  cirrhotic liver disease = 24 µg carotenoid
CNS: intracranial pressure
Pregnancy: teratogenesis, increases the risk of bone fractures
Contraindication for isotretinoin: pregnancy
Prolong use of isotretinoin: increases TAG, cholesterol
 VITAMIN D
Sterol: hormone-like function
Function: regulate Ca2+, phosphorus (PO43-)

Vit. D2 25-hydroxylase 25-hydroxyl- 1-hydroxylase 1,25-dihydroxyl-

Vit. D3 In liver cholecalciferol In kidneys cholecalciferol *
(Calcitriol)
 VITAMIN D DEFICIENCY
NUTRITIONAL RICKETS RENAL OSTEODYSTROPHY
Chronic kidney disease
RICKETS OSTEOMALACIA
Collagen matrix - Active form vit D
Phosphorus

no mineralization
Hyperphosphatemia
Cause: Hypocalcemia
• in Northern latitude
• Mutation of vit. D receptor
PTH
Treatment:
vit D supplement
Bone?
Ca2+ and PO43- ?
 TOXICITY
Only in supplement
High dose:
100000 IU/week or month  metastatic in calcification
Symptoms:
loss of appetite, nausea, thirst, weakness
 VITAMIN E

Alpha-tocopherol

Function: antioxidant >< non-enzymatic oxidation

Source: vegetable oils, liver, eggs
Requirement: 15 mg/d
 VITAMIN E DEFICIENCY
NEWBORNS ADULTS
Very low birth weight infants Abetalipoproteinemia

Vit E prevents
Def. of chylomicrons,
VLDL
Hemolysis
Retinopathy

Vit E def.

CLINICAL USE TOXICITY

Vit E and C: age-related macular degeneration Less toxic
Dose 30-1000 mg/d
VITAMIN K
Hydroquinone Epoxide form
Note:
carboxylation of proteins

VITAMIN K CYCLE

Glutamic acid
residue

gamma-carboxyl
glutamate residue
 VITAMIN K DEFICIENCY
ADULT NEWBORN
Rare
Sterile intestine
Antibiotics (Ex: cephalosporin (cefamandole))
Malnutrition
Debilitated geriatric patients
Lacking of vit K synthesis

hypoprothrombinemia
Hemorrhagic dis.

Supplement of vit K:
Bleeding • Breast milk (1/5 daily requirement)
Bone health • Recommended: a single
intramuscular dose of vit K
Treatment: vit K
 VITAMIN K TOXICITY

No UL for the natural form and synthetic form

Menadione
prolonged administration
large dose

Infant
Hemolytic anemia
Jaundice
 VITAMIN C (ASCOBIC ACID)
Function: reducing agent
Product: hydroxyproline and hydroxylysine
Enzyme: prolyl hydroxylase and lysyl hydroxylase
Requirement: oxygen, ferrous iron (Fe2+), vitamin C
SCURVY
 VITAMIN B1 (THIAMINE)
ATP AMP
Thiamine Thiamine pyrophosphate (TPP)
pyrophosphokinase (TPK)

Oxidative phosphorylation
The pentose phosphate pathway
Cofactor for α-ketoacid dehydrogenases:
• pyruvate dehydrogenase (PDH)
• α-ketoglutarate dehydrogenase (KGDH)
• branched-chain α-ketoacid dehydrogenase
• transketolase
 CATABOLISM OF BRANCHED-CHAIN AMINO ACIDS (BCAAS)
OXIDATIVE DECARBOXYLATION OF BCKAs
In: liver, adipose and muscle

TPP

Product: branched-chain α-ketoacids (BCKAs)
Enzyme: branched-chain aminotransferases
(BCATs)
Enzyme:
BCKDH: branched-chain α-ketoacid
dehydrogenase
BCKDK: branched-chain α-keto acid
dehydrogenase kinase
PP2Cm: Protein phosphatase 2Cm
PENTOSE PHOSPHATE PATHWAY
Enzyme: trans-ketolase
Coenzyme: TPP

TPP
 BERI-BERI
DRY - WET -
THIAMINE DEFICIENCY

Diagnosis: transketolase activity in RBC

Treatment: vit. B1
 VITAMIN B2 (RIBOFLAVIN)

Flavin mononucleotide (FMN)

Flavin adenine dinucleotide (FAD)

Flavoenzymes:
NADH dehydrogenase [FMN] (complex I)
Succinate dehydrogenase [FAD] (complex II)
 DEFICIENCY OF RIBOFLAVIN
- rare
- Treatment of hyperbilirubinemia: phototherapy
Requirement: vit. B2 supplementation
- Symptoms: dermatitis, cheilosis, glossitis
VITAMIN B3 (NIACIN)
OXIDATION – REDUCTION REACTION
SOURCE OF VITAMIN B3
 DEFICIENCY OF VITAMIN B3

PELLAGRA
• Dermatitis
CORN BASED DIET
• Diarrhea
• Dementia

HYPERLIPIDEMIA TREATMENT
Action: Inhibits TAG synthesis in the liver
Adverse effect: flushing and itching
VITAMIN B5 (PANTOTHENIC ACID)

Function: acyl carrier in FA synthase

Coenzyme A
4’-phosphopantetheinyl
transferase
 VITAMIN B6 (PYRIDOXINE)
Reaction: amino acids

(PLP)

TOXICITY
Neurologic symptoms: sensory neuropathy
> 500mg/day = x 400 daily dose
 Purine
Pyrimidine

SHMT: serin transhydroxy methylase

 VITAMIN B6 DEFICIENCY

Risk: Symptoms:
• Isoniazid • Skin inflammation
• Newborn • Neuropathy in hands and feet
• Oral contraceptive • Neurological problem
• Alcoholism (seizure, depression, dementia)
• Anemia
 VITAMIN B7 (BIOTIN)
Coenzyme: carrier of activated CO2  carboxylation reaction

DEFICIENCY
• Rare
• Cause: raw egg white
• Symptoms: dermatitis, hair loss, loss of appetite, nausea
 VITAMIN B9 (FOLIC ACID)

Tetrahydrofolic acid
Folic acid
VITAMIN B9 (FOLIC ACID)
SAM: S-adenosyl-methionine
SAH: S-adenosyl-homocysteine
 VITAMIN B9 (FOLIC ACID)

(fL = femtoliter)
 DEFICIENCY OF VITAMIN B9

Cause: diet lack of folate

Risk:
• alcoholism
• drugs (methotrexate)
• pregnant women

Neural tube defects (NTD)

Spina bifida anencephaly
Treatment: folic acid (0.4 mg/d)
during the first trimester
 VITAMIN B12 (COBALAMIN)

Corrin ring
SOURCE OF VITAMIN B12
DEFICIENCY OF VITAMIN B12

Causes:
Diet lack of vitamin B12
Absorption  Pernicious anemia

Symptoms: neuropsychiatric –

Treatment for anemia:

vitamin B12 (long-term)