Study: Vitamin D effectively to suppress immune reactions
Study: Vitamin D effectively to suppress immune reactions
This is part of October 2016 Special Issue on Immunology. Read the Volle edition or .
Reference
Konijeti GG, Arora P, Boylan Mr, et al. Vitamin D supplementation modulates T-cell-mediated immunity in humans: results of a randomized control study. j clin endocrinol metab . 2016; 101 (2): 533-538.
Study goal
to determine whether oral supplementation with vitamin D3 influences the T cell activation in patients with existing vitamin D deficiency
Design
This was an individual additional study within a study that examined vitamin D therapy for people with a high risk of high blood pressure. It was a double -blind, multicenter, randomized, controlled study.
participant
The participants (n = 38) came from vitamin D therapy for people with a high risk of hypertension. The original study comprised 534 men and women between the ages of 18 and 50 with 25 (OH) D below 25 ng/ml and untreated preaching hypertension or hypertension in the stage I. The participants were randomized and received low -dosed vitamin D (400 IE) or high -dose vitamin D (4,000 IE) for 6 months.
The current publication included a sub-group of 38 randomly selected men and women in whom the T cell function was measured in whole blood.
The cohort of 38 patients in whom the T cell function was examined, 20 participants were randomized to a low vitamin D dose and 18 participants of a high vitamin D dose years); 9 were women (24%); 8 (21 %) were white, 29 (76 %) blacks and 1 (3 %) was from other or unknown breed. The patients were treated with vitamin D an average of 117 days (SD: 52 days). According to the protocol, both groups had a vitamin D deficiency with similar low output values of 25 (OH) D (mean 16.2 ng/ml; standard deviation 6.8 ng/ml).
The exclusion criteria was the use of a blood pressure -lowering drug within the past 3 months; Vitamin D supplement (defined as vitamin D in a multivitamin preparation or nutritional supplement) of a total of 400 IE / day within the 3 months before registration; and well-known cardiovascular disease (defined as an earlier myocardial infarction, percutaneous transluminal coronary artery, angioplasty, coronary artery bypass or stroke).
This study confirms that significant changes in the serum vitamin D level were made in just 2 months of therapy.
Other exclusion criteria were ulcerative colitis, Crohn's disease, celiac disease, colostomy, pancreatic male deficiency, short intestine syndrome, stomach bypass, cystic fibrosis or dumping syndrome in history.
study parameters evaluated
The activation of T cells was measured by estimating the release of intracellular ATP in vitro using plant steeplect phytohemagglutinin of thoroughbred samples from the participants. The measurements were carried out with vitamin D at the start of the course and after 2 months of treatment.
primary result measurements
whether the changes in the ATP level between the treatment groups differ significantly
important knowledge
After 2 months of treatment, the 25 (OH) D levels rose significantly by 5.77 ng/ml for which vitamin D3 was administered in a low dose, and 9.77 ng/ml for which vitamin D3 was administered in high dose.
Treatment with high -dose vitamin D significantly reduced the intracellular release of CD4+ATP (difference = 95.5 ng/ml; interquartile area [iQR], –219.5 to –105.8; p <0.026). In contrast, treatment with low -dosed vitamin D3 had no significant influence on the intracellular release of CD4+ ATP (difference = 0.5 ng/ml; iQR, –69.2 to –148.5; p = 0.538). The difference in the follow-up atp mirror after 2 months was significantly different between the groups with low and high vitamin D3 dose.
In a proportional ODDS model, it was more likely that treatment with high-dose vitamin D3 would reduce the ATP after antigen stimulation, compared to low-dosed vitamin D3 (ODDS Ratio [OR]: 3.43; 95% confident interval [CI]: 1.06-1.11).
eleven of the 20 patients (45 %) treated with high-dose vitamin D3 were considered the "responder" with significant decreases of the ATP levels. Among those who were treated with high -dose vitamin D3 were 63.5 % (7/16) of the men, 25 % (1/4) of women, 52.9 % (9/17) of the White and 48.1 % (8/17) of the black participants were response.
This study observed no significant difference in the results depending on the race. However, there was a significant difference by gender ( p , interaction <0.02). Compared to women, men were more likely to have a reduced ATP anti-stimulation.
practice implications
This study examined the function of CD4+T cells. To quick memory of immunology: The CD4+T cells have several immune functions and include TH1, Th2, Th17- and T regulator (TREG) cells. The diverse functions of T cells include the activation of the congenital immune system, B-lymphocytes, cytotoxic T cells and non-immune cells. 1 In addition, Tregs can inhibit the effect of other T cells and, as a balance, act as an inflammatory immune response. Unfortunately, this study did not differentiate Sub species of CD4+T cells. It is therefore impossible to know which subgroups of CD4+T cells have been influenced by a vitamin D3 supplementation.
In clinical practice we are often asked: "How long does it take for my vitamin D levels to rise?". This study confirms that significant changes in the serum vitamin D level were made in just 2 months of therapy.
In this study, vitamin D was associated with changes in cell -mediated immunity by reducing activation (less produced ATP). This reduction in activation was significantly different in the low-dose and high dose groups, whereby the activation in the high dose group was more strongly suppressed. This indicates that high doses can cause stronger immune modulation than low doses.
This study is in accordance with animal studies that have shown the modulation of autoimmunity through vitamin D. 2 The suppression of overactive immune -mediated conditions can have far -reaching clinical effects. However, the story is complicated. Vitamin D receptors (VDRS) are located on a variety of immune cells. These VDRs have high variability even, with many genotypes possible. There are also vitamin D binding proteins (VDBPS) that influence the availability of vitamin D. In short, the interaction of vitamin D to immune function is complex, and the data is being made by the influence of VDRS, VDBPS, other nutrients (z) and hormonal influences.
There is indications that vitamin D represents an effective therapy for cell-mediated immunity-based diseases such as inflammatory bowel diseases, but the ideal dosage is still being examined.
vitamin D can also be used as a supplement to medicinal products that are established for overactive immune diseases. A study in which high-dosed vitamin D was combined with interferon β-1b in patients with multiple sclerosis showed an improvement in the function and reduction in relapses compared to patients who were only treated with the medication.
The role of vitamin D3 supplementation on immune function requires the results of clinical studies to finally determine whether and how many oral vitamin D3 affects disease states. In the meantime, it cannot be considered harmful to bring our patients into the normal range of 25 hydroxycholicalciferol to optimize their health while clinical studies continue to inform us.
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