section 38.1 
Fat-Soluble Vitamins
905
(trimethyl-
cyclohexenyl)
ring
FIG U RE 38-1
Chemical structure of all
-tra n s
retinol (vitamin Ai), the most active form 
of vitamin A. Oxidation of C
15
to an aldehyde or an acid produces, 
respectively, retinaldehyde (retinal) and retinoic acid. The cis-trans 
isomerization of the double bond between Ci 
1
and C
12
occurs during 
functioning of retinaldehyde in vision.
naturally occurring retinoid is all
-trans
retinol, also called 
vitamin A (Figure 38-1). The /f-ionone ring is required 
for biological activity. Vitamin Ai exists free or as retinyl 
esters of fatty acids (primarily palmitic acid) in foods of 
animal origin, including eggs, butter, cod liver oil, and the 
livers of other vertebrates. In most of the dietary retinol, 
the four double bonds of the side chain are in the trans 
configuration. They are readily oxidized by atmospheric 
oxygen, inactivating the vitamin. They can be protected 
by antioxidants such as vitamin E.
Several provitamins are present in yellow and dark 
green leafy vegetables and fruits, such as carrots, man-
goes, apricots, collard greens, and broccoli. They are col-
lectively known as the carotenoid pigments or 
carotenes.
The most widely occurring and biologically active is 
/1-carotene (Figure 38-2). Other nutritionally important 
carotenoid pigments are cryptoxanthine, a yellow pigment 
found in corn, and 
a-
and /-carotenes. Other carotenoids, 
such as lycopene the red pigment of tomatoes, and xan- 
thophyll, lack the /3-ionone ring essential for vitamin A 
activity.
Absorption, Transport, and Metabolism
Retinyl esters
are hydrolyzed in the intestinal lumen 
by pancreatic carboxylic ester hydrolase, which also 
hydrolyzes cholesteryl esters. In mucosal cells, 
retinol
is reesterified, mostly with long-chain fatty acids, by
acyl-CoA: retinol acyltransferase. The retinyl esters are 
incorporated into chylomicron particles and secreted into 
the lacteals. In humans and rats, 50% of the retinol is 
esterified with palmitic acid, 25% with stearic acid, and 
smaller amounts with linoleic and oleic acids. These es-
ters are eventually taken up by the liver in chylomicron 
remnants. /
6
-Carotene is cleaved in the intestinal mucosa 
to two molecules of retinaldehyde by /f-carotene-15,15'- 
dioxygenase, a soluble enzyme. Other provitamins are also 
activated upon cleavage by this enzyme. Retinaldehyde is 
then reduced to retinol by retinaldehyde reductase, using 
either NADH or NADPH.
In the liver, retinyl esters are hydrolyzed and reesteri-
fied. More than 95% of hepatic retinol is present as esters 
of long-chain fatty acids, primarily palmitate. In an adult 
receiving the RDA of vitamin A, a year’s supply or more 
may be stored in the liver.
More than 90% of the body’s supply of vitamin A is 
stored in the liver. The hepatic parenchymal cells are in-
volved in its uptake, storage, and metabolism. Retinyl es-
ters are transferred to hepatic fat-storing cells (also called 
Ito cells or lipocytes) from the parenchymal cells. The 
capacity of these fat-storing cells may determine when 
vitamin A toxicosis becomes symptomatic. During the de-
velopment of hepatic fibrosis (e.g., in alcoholic liver dis-
ease), vitamin A stores in Ito cells disappear and the cells 
differentiate to myofibroblasts. These cells appear to be 
the ones responsible for the increased collagen synthesis 
seen in fibrotic and cirrhotic livers.
Retinol is released from the liver and transported in 
plasma bound to 
retinol-binding protein
(RBP), which 
is synthesized by hepatic parenchymal cells. Less than 
5% circulates as retinyl esters. Retinol-binding pro-
tein from human plasma is a monomeric polypeptide 
(M.W. 21,000), which has a single binding site. Transfer 
of retinol into cells may be mediated by cell surface re-
ceptors that specifically recognize RBP. After binding and 
releasing its vitamin A, RBP appears to have decreased 
affinity for prealbumin (see below) and is rapidly filtered 
by the kidney and degraded or excreted.
The retinol-RBP complex circulates as a 1:1 complex 
with prealbumin (
transthyretin;
M.W. 55,000), which
FIG U RE 38-2
Structure of all
-tra n s
/3-carotene.