Journal article
Role of vitamin A metabolism in IIH: Results from the idiopathic intracranial hypertension treatment trial
Journal of the Neurological Sciences, Vol.372, pp.78-84
01/15/2017
DOI: 10.1016/j.jns.2016.11.014
PMCID: PMC5290478
PMID: 28017254
Abstract
Vitamin A and its metabolites (called retinoids) have been thought to play a role in the development of idiopathic intracranial hypertension (IIH). The IIH Treatment Trial (IIHTT) showed the efficacy of acetazolamide (ACZ) in improving visual field function, papilledema grade, quality of life and cerebrospinal fluid (CSF) pressure. We postulated that IIH patients would demonstrate elevated measures of vitamin A metabolites in the serum and CSF. Comprehensive measures of serum vitamin A and its metabolites were obtained from 96 IIHTT subjects, randomly assigned to treatment with ACZ or placebo, and 25 controls with similar gender, age and body mass index (BMI). These included retinol, retinol binding protein, all-trans retinoic acid (ATRA), alpha- and beta-carotenes, and beta-cryptoxanthin. The IIHTT subjects also had CSF and serum vitamin A and metabolite measurements obtained at study entry and at six months. At study entry, of the vitamin A metabolites only serum ATRA was significantly different in IIHTT subjects (median 4.33nM) and controls (median 5.04nM, p=0.02). The BMI of IIHTT subjects showed mild significant negative correlations with serum ATRA, alpha- and beta-carotene, and beta-cryptoxanthin. In contrast, the control subject BMI correlated only with serum ATRA. At six months, the serum retinol, alpha-carotene, beta-carotene, and CSF retinol were increased from baseline in the ACZ treated group, but only increases in alpha-carotene (p=0.02) and CSF ATRA (p=0.04) were significantly greater in the ACZ group compared with the placebo group. No other vitamin A measures were significantly altered over the six months in either treatment group. Weight loss correlated with only with the change in serum beta-carotene (r=−0.44, p=0.006) and the change in CSF retinol (r=−0.61, p=0.02). Vitamin A toxicity is unlikely a contributory factor in the causation of IIH. Our findings differ from those of prior reports in part because of our use of more accurate quantitative methods and measuring vitamin A metabolites in both serum and CSF. ACZ may alter retinoid metabolism in IIH patients. •Idiopathic intracranial hypertension (IIH) is not due to vitamin A metabolism toxicity.•Some vitamin A metabolite levels in IIH patients differ from obese normal subjects.•Acetazolamide treatment, a proven therapy of IIH, appears to also alter vitamin A metabolism.
Details
- Title: Subtitle
- Role of vitamin A metabolism in IIH: Results from the idiopathic intracranial hypertension treatment trial
- Creators
- J Libien - Pathology, State University of New York, Downstate School of Medicine, Brooklyn, NY, United StatesM J Kupersmith - Neurology and Ophthalmology, Mount Sinai West, Icahn School of Medicine at Mount Sinai, New York, NY, United StatesW Blaner - Medicine, College of Physicians and Surgeons, Columbia University School of Medicine, New York, NY, United StatesM P McDermott - Biostatistics, University of Rochester, Rochester, NY, United StatesS Gao - Biostatistics, University of Rochester, Rochester, NY, United StatesY Liu - State University of New YorkJ Corbett - Neurology, University of Mississippi School of Medicine, Jackson, MS, United StatesM Wall - Neurology, University of Iowa School of Medicine, Iowa City, IA, United StatesThe NORDIC Idiopathic Intracranial Hypertension Study Group
- Resource Type
- Journal article
- Publication Details
- Journal of the Neurological Sciences, Vol.372, pp.78-84
- DOI
- 10.1016/j.jns.2016.11.014
- PMID
- 28017254
- PMCID
- PMC5290478
- NLM abbreviation
- J Neurol Sci
- ISSN
- 0022-510X
- eISSN
- 1878-5883
- Publisher
- Elsevier B.V
- Language
- English
- Date published
- 01/15/2017
- Academic Unit
- Neurology; Ophthalmology and Visual Sciences
- Record Identifier
- 9983979969302771
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