Accelerated accumulation of lipofuscin pigments in the RPE of a mouse model for ABCA4-mediated retinal dystrophies following Vitamin A supplementation.
OBJECTIVE
Dietary supplementation with vitamin A is sometimes prescribed as a treatment for retinitis pigmentosa, a group of inherited retinal degenerations that cause progressive blindness. Loss-of-function mutations in the ABCA4 gene are responsible for a subset of recessive retinitis pigmentosa. Other mutant alleles of ABCA4 cause the related diseases, recessive cone-rod dystrophy, and recessive Stargardt macular degeneration. Mice with a knockout mutation in the abca4 gene massively accumulate toxic lipofuscin pigments in the retinal pigment epithelium. Treatment of these mice with fenretinide, an inhibitor of vitamin A delivery to the eye, blocks formation of these toxic pigments. Here the authors tested the hypothesis that dietary supplementation with vitamin A may accelerate lipofuscin pigment formation in abca4(-/-) mice.


METHODS
Wild-type and abca4(-/-) mice were fed normal or vitamin A-supplemented diets. Tissues from these mice were analyzed biochemically for retinoids and lipofuscin pigments. Eyes from these mice were analyzed morphologically for lipofuscin in the retinal pigment epithelium and for degeneration of photoreceptors. Visual function in these mice was analyzed by electroretinography.


RESULTS
Mice that received vitamin A supplementation had dramatically higher levels of retinyl esters in the liver and retinal pigment epithelium. Lipofuscin pigments were significantly increased by biochemical and morphologic analysis in wild-type and abca4(-/-) mice fed the vitamin A-supplemented diet. Photoreceptor degeneration was observed in 11-month-old albino, but not pigmented, abca4(-/-) mice on both diets.


CONCLUSIONS
Vitamin A supplementation should be avoided in patients with ABCA4 mutations or other retinal or macular dystrophies associated with lipofuscin accumulation in the retinal pigment epithelium.
Department of Ophthalmology, University of California at Los Angeles School of Medicine, Los Angeles, California, USA.
Roxana A
RA
Radu
Quan
Q
Yuan
Jane
J
Hu
Jennifer H
JH
Peng
Marcia
M
Lloyd
Steven
S
Nusinowitz
Dean
D
Bok
Gabriel H
GH
Travis
D018528:ATP-Binding Cassette Transporters / Q000235:genetics*; D000818:Animals; D019587:Dietary Supplements; D004195:Disease Models, Animal; D004596:Electroretinography; D008062:Lipofuscin / Q000378:metabolism*; D008099:Liver / Q000378:metabolism; D051379:Mice; D008807:Mice, Inbred BALB C; D008815:Mice, Inbred Strains; D018345:Mice, Knockout; D010857:Pigment Epithelium of Eye / Q000378:metabolism*; D012160:Retina / Q000473:pathology; D012162:Retinal Degeneration / Q000188:drug therapy / Q000235:genetics*; D021241:Spectrometry, Mass, Electrospray Ionization; D014801:Vitamin A / Q000008:administration & dosage / Q000627:therapeutic use*
D018528:ATP-Binding Cassette Transporters; C512841:Abca4 protein, mouse; D008062:Lipofuscin; D014801:Vitamin A