Vitamin A as "anti-infective" therapy, 1920-1940

In the last fifteen years, a large series of controlled clinical trials showed that vitamin A supplementation reduces morbidity and mortality of children in developing countries. It is less well known that vitamin A underwent two decades of intense clinical investigation prior to World War II. In the 1920s, a theory emerged that vitamin A could be used in "anti-infective" therapy. This idea, largely championed by Edward Mellanby, led to a series of at least 30 trials to determine whether vitamin A--usually supplied in the form of cod-liver oil--could reduce the morbidity and mortality of respiratory disease, measles, puerperal sepsis, and other infections. The early studies generally lacked such innovations known to the modern controlled clinical trial such as randomization, masking, sample size and power calculations, and placebo controls. Results of the early trials were mixed, but the pharmaceutical industry emphasized the positive results in their advertising to the public. With the advent of the sulfa antibiotics for treatment of infections, scientific interest in vitamin A as "anti-infective" therapy waned. Recent controlled clinical trials of vitamin A from the last 15 y follow a tradition of investigation that began largely in the 1920s.

A history of vitamin A and retinoids

This is a historical account of the recognition of human vitamin A deficiency from ancient Egypt to the present century, as well as history of the discovery of vitamin A and the functions of vitamin A and the retinoids.

New imperatives for an old vitamin (A)

This year marks the 75th anniversary of the discovery of vitamin A by E.V. McCollum. Interest over the past 40 years has focused almost exclusively on the ocular complications of deficiency. Recent data from Indonesia, India, Thailand, Tanzania, Guatemala and elsewhere are reorienting concerns. Observational studies indicate that vitamin A--deficient children grow poorly, are more anemic, have more infections and are more likely to die than their peers, and that the magnitude of many of these consequences is directly related to the severity of the deficiency, even after adjusting for other variables. The few supplementation trials completed to date support these conclusions. Even after excluding children with frank deficiency at baseline, vitamin A-supplemented children have grown faster, developed higher hemoglobin values, and died less frequently (by 30-60%) than their nonsupplemented peers. The great surprise is not the central role vitamin A plays in each of these areas (McCollum and others recognized this long ago), but that this single nutrient can so profoundly affect children who are subject to multiple adverse influences.

From research to global reality: the micronutrient story

The professional life history of E. V. McCollum exemplifies how sound nutrition-related laboratory research was translated into practical realities that influenced individual and national nutrition-related decisions. Public health and educational programs emerging in the first third of this century improved health and nutritional well-being in the United States. Characteristics that surrounded pioneering efforts early in the century are similar to those that have reinvigorated global micronutrient concerns in the last third of the century. Sound community-oriented scientific research revealed the true consequences of iodine, vitamin A and iron micronutrient malnutrition. Repositioning the image of these three micronutrients from that of a clinical problem affecting relatively few to one with consequences for individual, national and global development affecting many more, and disseminating these facts through high-level political forums incited attention, commitment and actions. As in the early days of McCollum and his contemporaries, current nutrition scientists played a significant role, interacting with politically oriented counterparts, in taking micronutrient research to reality for improving health and quality of life globally. Lessons learned from the process, both past and present, should guide future nutrition-oriented endeavours in moving research to reality for betterment of global community health.

Professor Toshio Ito: a clairvoyant in pericyte biology

Ito cells are liver-specific pericytes which were first described as Fett Speicherung Zellen, the fat-storing cells encircling outside sinusoidal endothelial cells, in 1951 by the late professor Toshio Ito. His pioneering approaches for morphological characterization of the cells stimulate investigators to further examine their functional roles in liver homeostasis: a body of evidence has been accumulated in recent years showing that the cells play a crucial role in storage and delivery of vitamin A, regulation of sinusoidal tone and local blood supply, and tissue repair and fibrosis. It is now widely accepted that microvascular pericytes including Ito cells serve as a key player that controls angiogenesis. Furthermore, recent studies support a concept that Ito cells constitutes a bridging apparatus mediating bidirectional metabolic interactions between sinusoids and hepatocytes, utilizing prostanoids and/or gaseous mediators such as nitric oxide and carbon monoxide as signaling molecules. This article reviews researches on this liver-specific pericyte and its leading roles in recent development of pericyte biology.

Vitamin A and Sir Douglas Mawson

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History of the International Vitamin A Consultative Group 1975-2000

The International Vitamin A Consultative Group (IVACG) was established in May 1975. Since then, IVACG has actively led the campaign against vitamin A deficiency disorders (VADD). It operates through a network of policy makers, program administrators, and scientists interested in resolving the problem of VADD. Through its international meetings, IVACG provides a forum to exchange new ideas, to discuss research findings and their policy implications, and share experiences with program interventions. It provides technical guidance through state-of-the-art publications on VADD. More than 30 technical references have been developed. IVACG collaborates with international organizations in developing and establishing policy guidelines for diagnosis, treatment, and prevention of VADD. During its 25 years, IVACG has given careful consideration to the role of vitamin A in infections, morbidity and mortality; assessment methods for use in the field and laboratory; other micronutrients and their interaction with vitamin A; bioavailability of vitamin A in foods; various interventions including supplementation, fortification and dietary diversification; the link between science and action; and sustainable control of VADD. IVACG is recognized as a credible source and galvanizing force in the field. It should continue to identify important research and policy issues and provide policy recommendations upon which others can act. Greater emphasis should be placed on integrated and multisectoral strategies, taking into account a community's overall needs for social, economic, and ecologic development.

Global health in conflict. Understanding opposition to vitamin A supplementation in India

Vitamin A supplementation is a public health intervention that clinical trials have suggested can significantly improve child survival in the developing world. Yet, prominent scientists in India have questioned its scientific validity, opposed its implementation, and accused its advocates of corruption and greed. It is ironic that these opponents were among the pioneers of populationwide vitamin A supplementation for ocular health. Historically, complex interests have shaped vitamin A supplementation resistance in India. Local social and nutritional revolutions and shifting international paradigms of global health have played a role. Other resistance movements in Indian history, such as those in response to campaigns for bacillus Calmette-Guérin and novel vaccines, have been structured around similar themes. Public health resistance is shaped by the cultural and political context in which it develops. Armed with knowledge of the history of a region and patterns of past resistance, public health practitioners can better understand how to negotiate global health conflicts.

Eduard Schwarz, a neglected pioneer in the history of nutrition

An account of the journey around the world by the Austrian ship's doctor Eduard Schwarz on a sailing ship from 1857 to 1859, his successful cure of nightblindness among the sailors, and how he was maligned by some of the Viennese medical press for his view that nightblindness is a nutritional disorder.

Bernard Strehler-inspiration for basic research into the mechanisms of aging

Bernard Strehler, who passed away recently, has provided inspiration and intellectual guidance for a generation of scientists interested in the biology of aging. My own career in this field was launched in large part by the ideas and concepts discussed by Dr Strehler in his book, Time, Cells, and Aging. Much of my scientific career has been devoted to studying one aspect of the aging process-the intracellular accumulation of autofluorescent lysosomal storage bodies (lipofuscin) during senescence. Work in my laboratory has contributed to the elucidation of the molecular mechanisms that underlie formation of lipofuscin in the retinal pigment epithelium of the eye. The challenge for the work on lipofuscin, and for much of the current research on aging, is to determine whether specific age-related changes such as lipofuscin accumulation, are involved in determining maximum life span. Bernard Strehler's eloquent statement of this challenge will hopefully continue to inspire new research to further our understanding of the aging phenomenon.