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CHEMICAL PATHOLOGY
LIPID SOLUBLE VITAMINS
By: Dr. J. K. Sesay (MD)
Senior Resident Surgeon; TDMU
LIPID SOLUBLE VITAMINS
Vitamin А
Retinol. Antixerophthalmic
Active forms
•Retinol
•Retinal
•Retinoic acid
Precursors -
carotenoids
•Most
important –
beta-
carotene
• Are
cleaved to
retinol in
liver
Dark green and
yellow
vegetables are
good sources for
carotenoids:
tomatoes,
carrots,
apricots,
parsley, corn,
radish
Organism gets ¼
of vit. A from
carotenoids
Biological functions of
carotenes
•Antioxidants
•Anticancer properties
Biological functions of vitamin A
•Modulator of biomembranes
-changes the permeability
-synthesis of membranes components
•Growth vitamin
-stimulates the synthesis of proteins
(especially in cartilages)
-stimulates the synthesis of purine and
pyrimidine nucleotides
•Participates in oxidation-reduction
reactions
Biological functions of vitamin A
•Regulates the synthesis of keratin
(prevents the conversion of
cylindrical epithelium into horny
•Promotes the spermatogenesis and
placenta development
•Stimulates the synthesis of
antibodies and phagocytosis
(antiinfectious)
Biological functions of vitamin A
Regulates the hormonal status
-prevents the oxidation of vitamin C
-inhibits the synthesis of thyroxin
•Maintains the antioxidant potential
of different tissues
Biological functions of vitamin A
Is responsible for the vision cycle
Night blindness
– early symptom
of vitamin A
deficiency
Later symptoms of vitamin A deficiency
Anemia (vit. A is required for the synthesis of
transferrin)
Increased susceptibility to infection and cancer
Follicular hyperkeratosis (“goosebumps” skin)
“goosebumps” skin
horny skin
The most
cosmetic
creams contain
retinol
Xerophthalmia (progressive
keratinization of cornea)
Keratomalacia (corneal ulcerations)
Bronchitis, pneumonia (metaplasia of endothelium)
Cysts in salivary glands
Cystitis, pyelonephritis (change of endothelium in
nephrones)
Daily requirement: 2-3 mg
Hypervitaminosis
•Accumulates in liver
•In overdosing in treatment,
consumption a large amount of fish oil,
liver of polar animals
•Symptoms:
obone pain
ovomiting, diarrhea
oliver and spleen
enlargement
odermatitis
oloss of hair
Vitamin D
(cholecalciferol,
аntirickets)
Two forms of vitamin D
•Vitamin D2 – ergocalciferol
•Vitamin D3 - cholecalciferol
ergocalciferol
cholecalciferol
1,25-dihydroxycholecalciferol
Both ergo-
calciferol and
cholecalciferol
are metabo-
lized in liver
Vit.D acts in
concert with
parathyroid
hormone
(PTH)
PTH
stimulates
the
production of
1,25-(OH)2D
Functions of
vitamin D
regulates the Ca and
P levels in the blood
•promotes absorption of
Ca and P in the
intestine
•promotes reabsorption
of Ca in the kidneys
•high levels of serum Ca
and P increase the rate
of bone mineralization
•promote bone
resorption (at low Ca in
blood)
•promotes
phagocytosis
•immunomodu-
latory activity
•induces
differentiation
of immune cells
Functions of vitamin D
affects immune system
Functions of vitamin D
prevents tumorgenesis
•inhibits
proliferation
•inhibits
angiogenesis
•induces
differentiation
Functions of vitamin D
•Activates reabsorption of amino
acids, especially prolin
•Activates the monosaccharides
phosphorylation (glycogen synthesis)
•Promotes ATP formation
Rickets
softening of bones in children potentially
leading to fractures and deformity
Causes:
•vitamin D deficiency
•lack of calcium in the diet (famine)
•severe diarrhea and vomiting
•fat malabsorption
•alcoholism
•severe liver and kidney diseases
Signs and symptoms of rickets
•Bone pain or tenderness
•Dental problems
•Muscle weakness
•Fractures (easily broken bones)
•Skeletal deformity
•Bowed legs (genu varum)
•Knock-knees (genu valgum) or "windswept knees"
•Cranial, spinal, and pelvic deformities
•Hypocalcemia
•Tetany (uncontrolled muscle spasms)
•Craniotabes (soft skull)
•Widening of wrist (due to metaphysial cartilage
hyperplasia)
Knock knee
deformity
(genu
valgum)
Windswept
deformity
Bowing of
long bones
in legs
Bowleg
deformity
(genu
varum)
Frontal bossing
Tibial bowing
Wrist enlargement
Ankle
enlargement
Rib beading
(rachitic rosary) Pot belly
Chest deformity
Scoliosis
Family of children with rickets
Rickets in Bangladesh
Dietary sourses
Daily requirement:
12-25 micrograms
Hypervitaminosis
•Increase of Ca and P in blood
•Demineralization of bones
•Calcification
of inner
organs
•Renal stones
Vitamin E
Tocopherols and
tocotrienols.
Antisterile
•Group of tocopherols and
tocotrienols
•Most active – alpha-tocopherol
Biological role
•Most potent antioxidant
•Active scavenger of free oxygen
and nitrogen radicals
•Protects vit.
A from
oxidation
•Prevents
oxidation of
Se
•Stabilizes the cell membranes
•Increases the resistance of membranes to
oxidation and toxic effects
•Improves cellular respiration stabilizing
ubiquinone
•Prevents oxidation of LDL
•Reduces risk of atherosclerosis
•Regulates transcription
•Maintains normal immune function
•Inhibits cholesterol biosynthesis
Hypovitaminosis
•Causes: malabsorption, famine
•Symptoms:
oActivation of FRO
oIncrease of membrane permeability
oHemolysis of erythrocytes
oDeficit of ATP
oMuscle dystrophy (creatinuria)
oDemyelization of nerves (CNS changes)
oDisorders of reproductive function
(atrophy of testis, azoospermia, inability
to implantation)
Daily requirement: 20-50 mg
Using:
•Cardiovascular
diseases
•Stimulation of
immunity
•Tumors
•Miscarriages
Vitamin K
Quinone
derivatives
Antihemorrhagic
K1, phyloquinone (in green vegetables)
K2, menaquinone (is synthesized by
intestinal bacteria)
Biological functions
•Stimulates the synthesis of
coagulation factors in liver
•Increases the resistance of
capillaries
•Stimulates the synthesis of
albumins, pepsin, trypsis, lipase,
amilase
•Increases the peristalsis of
intestine
•Inhibits free radical oxidation
Hypovitaminosis
Causes:
•Lipids malabsorption (lack of bile
acids)
•Disbacteriosis (vit. K is synthesized
by intestinal microflora)
•Taking of antivitamins (dicumarol)
dicumarol
Hypovitaminosis
Symptoms:
•Hemorrhages (subcutaneous,
intramuscular, into inner organs)
•Increased coagulation time
Hemorrhages in the retina
Hemorrhages in heart.
Daily requirement: 0.2-0.3 mg
Vikasol
•Water soluble
analog of vit. K
•Is used to
stop bleeding
•Can be
administered
parenterally
Vitamin F
Polyunsaturated
fatty acids
Antisclerotic
Linoleic acid
Linolenic acid
Arachidonic acid
Biological functions
•Participate in the organism growth
and development
•Components of phospholipids (cell
membranes)
•Regeneration of skin epithelium
•Synthesis of prostaglandins
•Decrease cholesterol level
•Increase the organism resistance
Hypovitaminosis
Causes:
•Growth retardation
•Dermatitis
•Dry skin
•Exema
•Atherosclerosis
Atherosclerosis
Dermatitis
Exema Dry skin
Daily
requirement:
10-15 g

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