Table

Manifestations of Scurvy

Constitutional

Fatigue, listlessness; decreased exercise tolerance; depression, uncooperative

Oral

Gingivitis, halitosis, easy bleeding of gums

Ophthalmologic

Conjunctival varicosities, retinal hemorrhages, retrobulbar hemorrhages, optic atrophy, dryness, photophobia

Gastrointestinal

Anorexia, submucosal hemorrhage

Cutaneous

Dry, rough skin; pale skin; follicular hyperkeratosis; hemorrhagic lesions; capillary fragility, petechiae; edema, especially legs; subungual hemorrhages; alopecia; poor wound healing or breakdown of old wounds; acne

Musculoskeletal

Polymyalgia, polyarthralgias, hemarthroses, back pain, osteoporosis

Cardiorespiratory

Dyspnea, congestive heart failure, syncope, chest pain, sudden death

Hematologic

Anemia, leukopenia

Source: Levine, M., Katz, A., and Padayatty, S. Chapter 31, in Modern Nutrition in Health and Disease, Shils, Shike, Ross, Caballero, and Cousins, Eds., Lippincott Williams & Wilkens, Philadelphia, 2006, p. 520. Reprinted by permission.

many years were forced open again . . ."38 As discussed in detail below and in Chapter 1, deficiency of ascorbic acid has profound effects on wound healing, primarily through its effect on collagen synthesis. However, independent effects on the immune system — presumably through its effects on the function of phagocytes, T-lymphocyte proliferation, production of interferon, its antioxidant activity, and gene expression of monocyte adhesion molecules — also play a role.14911 Due to the crucial importance of the immune response in the inflammatory phase of wound healing, it is not surprising that deficiency of ascorbate would have devastating effects on wound healing. The multitude of findings of vitamin C deficiency are described in Table 8.1. The diversity of findings with ascorbate deficiency indicates the diverse functions of this vitamin for many chemical processes and organs of the body.

biochemical functions of ascorbic acid

Vitamin c as an Enzymatic Cofactor

One of the major functions of ascorbic acid, like most vitamins, is as a cofactor in enzymatic reaction, where it serves as an electron donor. As will be seen below, this ability to function as a reducing agent also allows it to have a powerful effect on the metabolism of oxygen free radicals in a nonenzymatic fashion. At least eight different mammalian enzyme systems use ascorbic acid as a cofactor (Table 8.2).11213 While it is the function as a cofactor in collagen metabolism that is most relevant to scurvy and the process of wound healing, it is likely that the effects on carnitine biosynthesis and

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