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Updated: Aug 15, 2026
Real-time Analyses of Retinol Transport by the Membrane Receptor of Plasma Retinol Binding Protein
Published on: January 28, 2013
Retinol-binding protein, transthyretin, and C-reactive protein in extremely low birth weight (ELBW) infants
Namasivayam Ambalavanan1, A Catharine Ross, Waldemar A Carlo
1Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL 35246, USA.
Insights
In extremely low birth weight (ELBW) infants, high C-reactive protein (CRP) and retinol-binding protein/transthyretin (RBP/TTR) ratios at 28 days predict death or bronchopulmonary dysplasia by 36 weeks. Inflammation, not vitamin A deficiency, is indicated.
Area of Science:
- Neonatal medicine
- Biochemistry
- Clinical research
Background:
- Vitamin A deficiency affects retinol-binding protein (RBP) but not transthyretin (TTR).
- Inflammation reduces both RBP and TTR, increasing C-reactive protein (CRP).
Purpose of the Study:
- To assess RBP, TTR, and CRP in extremely low birth weight (ELBW) infants.
- To test if TTR is a negative acute phase reactant.
- To determine if RBP/TTR ratio or CRP predicts death/bronchopulmonary dysplasia (BPD).
Main Methods:
- Serum RBP, TTR, and CRP measured in 79 ELBW infants at 28 days.
- Receiver operating characteristic (ROC) curve analysis used to evaluate predictive values.
Main Results:
- TTR inversely correlated with CRP (r=-0.45, p<0.0001), supporting TTR as a negative acute phase reactant.
- RBP/TTR ratio predicted death/BPD (AUC 0.68).
- CRP strongly predicted death/BPD (AUC 0.85), even excluding sepsis.
Conclusions:
- Higher CRP and RBP/TTR molar ratio at 28 days are associated with death/BPD at 36 weeks in ELBW infants.
- Lower TTR and maintained RBP/TTR ratios suggest inflammation, not vitamin A deficiency, causes low vitamin A levels in ELBW infants.
Background:
Vitamin A deficiency reduces retinol binding protein (RBP) but not transthyretin (TTR), while inflammation reduces both RBP and TTR and increases C-reactive protein (CRP), an acute phase reactant.
Objective:
To estimate serum RBP, TTR, and CRP in ELBW infants to test the hypotheses that (a) TTR is a negative acute phase reactant and (b) a higher RBP/TTR ratio or CRP is associated with death/BPD by 36 weeks corrected age.
Design/Methods:
Serum RBP, TTR, and CRP were measured in 79 ELBW infants at 28 days. Area under the curve (AUC) of receiver operating characteristic curve analysis evaluated the predictive value of TTR, the RBP/TTR ratio, and CRP for death/BPD at 36 weeks.
Results:
(1) TTR inversely correlated with CRP (r=-0.45, p<0.0001) consistent with TTR being a negative acute phase reactant. (2) The RBP/TTR ratio predicted death/BPD (AUC 0.68 (CI 0.57 to 0.78)). (3) CRP strongly predicted death/BPD (AUC 0.85 (CI 0.76 to 0.92)), even after exclusion of sepsis.
Conclusions:
A higher CRP and RBP/TTR molar ratio on day 28 are associated with death/BPD at 36 weeks in ELBW infants. Lower TTR and maintained RBP/TTR ratios suggest inflammation rather than vitamin A deficiency as the cause for lower serum vitamin A levels in ELBW infants..
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