Retinoic acid

Retinoic acid is a derivative of vitamin A. Two treatment forms of retinoic acid have been developed - all-trans retinoic acid and 9-cis retinoic acid.

All-trans retinoic acid influences the development of skin cells in laboratory studies. It is being examined as a potential treatment for Kaposi’s sarcoma, with encouraging results. Furthermore, there is preliminary evidence that all-trans retinoic acid may slow down cell death associated with HIV disease.1

9-cis retinoic acid comes as either a topical gel or an oral formulation. The gel has been found to be moderately effective in treating Kaposi’s sarcoma lesions independently of CD4 cell count and antiretroviral therapy, producing a positive response in around a third of patients.2 3 In the United States, it was approved as a treatment for Kaposi’s sarcoma lesions in November 1998. The gel, known by the brand name Panretin, was developed by Ligand Pharmaceuticals.

Mild side-effects to the gel, primarily skin irritation, are common. Other common side-effects associated with the oral formulation are headache, dry or peeling skin, hair loss and high blood lipids. Rare cases of pancreatitis have been reported among people on high doses.

A capsule formulation of 9-cis retinoic acid has been tested for Kaposi’s sarcoma, but the side-effects, particularly headache, made it intolerable for most patients.4 5

References

  1. Szondy Z et al. All-trans retinoic acid inhibition of anti-CD3-induced T cell apoptosis in HIV infection mostly concerns CD4 T lymphocytes and is mediated via regulation of CD95 ligand expression. J Infect Dis 178: 1288-1298, 1998
  2. Walmsley S et al. Treatment of AIDS-related cutaneous Kaposi's sarcoma with topical alitretinoin (9-cis-retinoic acid) gel. Panretin Gel North American Study Group. J Acquir Immune Defic Syndr 22: 235-246, 1999
  3. Duvic M et al. Topical treatment of cutaneous lesions of acquired immunodeficiency syndrome-related Kaposi sarcoma using alitretinoin gel: results of phase 1 and 2 trials. Arch Dermatol 136: 1461-1469, 2000
  4. Miles SA et al. Antitumor activity of oral 9-cis-retinoic acid in HIV-associated Kaposi’s sarcoma. AIDS 16: 421-429, 2002
  5. Aboulafia DM et al. 9-cis-retinoic acid capsules in the treatment of AIDS-related Kaposi’s sarcoma: results of a phase 2 multicenter clinical trial. Arch Dermatol 139: 178-186, 2003

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