Vitamin A toxicity and hepatic pathology: A comprehensive review

Vitamin A is essential for vision, immunity, and cellular function, but excessive intake, known as hypervitaminosis A, leads to liver toxicity. Toxicity can be acute (from high single doses) or chronic (from prolonged overconsumption), causing symptoms like nausea, bone pain, and liver damage. The normal values of vitamin A in adults, measured as serum retinol, can range from 0.3 mg/L to 1.2 mg/L. The liver, which stores vitamin A in hepatic stellate cells, becomes overwhelmed, leading to retinoid accumulation, oxidative stress, and inflammation. Pathologically, vitamin A toxicity progresses from hepatic steatosis (fatty liver) to fibrosis and cirrhosis. Histological changes include hepatocellular ballooning, stellate cell activation, and perisinusoidal fibrosis. Molecular mechanisms involve oxidative stress from reactive oxygen species, apoptosis, and dysregulated pathways (tumor growth factor-beta, nuclear factor-kappa B), which drive fibrogenesis. Chronic toxicity also disrupts lipid metabolism, worsening liver injury. Clinically, management includes limiting vitamin A intake and exploring antioxidants (e.g., N-acetylcysteine) or anti-fibrotic therapies. Research gaps include the need for better biomarkers, personalized risk assessment, and refined dietary guidelines. Future studies should focus on therapeutic interventions and experimental models to improve outcomes. In conclusion, while vitamin A is vital, its toxicity poses serious hepatic risks. Understanding its mechanisms and developing targeted treatments are crucial for preventing liver damage and ensuring safe consumption.