Abstract | INTRODUCTION:
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. METHODS: RESULTS: 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). CONCLUSION:
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.
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Authors | J Libien, M J Kupersmith, W Blaner, M P McDermott, S Gao, Y Liu, J Corbett, M Wall, NORDIC Idiopathic Intracranial Hypertension Study Group |
Journal | Journal of the neurological sciences
(J Neurol Sci)
Vol. 372
Pg. 78-84
(Jan 15 2017)
ISSN: 1878-5883 [Electronic] Netherlands |
PMID | 28017254
(Publication Type: Journal Article, Randomized Controlled Trial)
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Copyright | Copyright © 2016 Elsevier B.V. All rights reserved. |
Chemical References |
- Anticonvulsants
- Retinol-Binding Proteins
- Vitamin A
- Carotenoids
- Tretinoin
- Acetazolamide
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Topics |
- Acetazolamide
(therapeutic use)
- Adult
- Anticonvulsants
(therapeutic use)
- Carotenoids
(metabolism)
- Chromatography, High Pressure Liquid
- Chromatography, Liquid
- Female
- Follow-Up Studies
- Humans
- Male
- Mass Spectrometry
- Obesity
(metabolism)
- Pseudotumor Cerebri
(blood, cerebrospinal fluid, complications, drug therapy)
- Retinol-Binding Proteins
(metabolism)
- Tretinoin
(blood)
- Visual Fields
(drug effects)
- Vitamin A
(blood, cerebrospinal fluid)
- Young Adult
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