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Lozano-Ros A, Martínez-Ginés ML, García-Domínguez JM, Salvador-Martín S, Goicochea-Briceño H, Cuello JP, Meldaña-Rivera A, Higueras-Hernández Y, Sanjurjo-Sáez M, Álvarez-Sala-Walther LA, López-Fernández LA. Changes in the Expression of TGF-Beta Regulatory Pathway Genes Induced by Vitamin D in Patients with Relapsing-Remitting Multiple Sclerosis. Int J Mol Sci 2023; 24:14447. [PMID: 37833895 PMCID: PMC10572771 DOI: 10.3390/ijms241914447] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/20/2023] [Accepted: 09/20/2023] [Indexed: 10/15/2023] Open
Abstract
Vitamin D is an environmental factor related to multiple sclerosis that plays a significant role in immune regulation. TGF-β is a superfamily of cytokines with an important dual effect on the immune system. TGF-β inhibits the Th1 response while facilitating the preservation of regulatory T cells (FOXP3+) in an immunoregulatory capacity. However, when IL-6 is present, it stimulates the Th17 response. Our aim was to analyze the regulatory effect of vitamin D on the in vivo TGF-β signaling pathway in patients with relapsing-remitting multiple sclerosis (RRMS). A total of 21 patients with vitamin D levels < 30 ng/mL were recruited and supplemented with oral vitamin D. All patients were receiving disease-modifying therapy, with the majority being on natalizumab. Expression of SMAD7, ERK1, ZMIZ1, BMP2, BMPRII, BMP4, and BMP5 was measured in CD4+ lymphocytes isolated from peripheral blood at baseline and one and six months after supplementation. SMAD7 was overexpressed at six months with respect to baseline and month one. ERK1 was overexpressed at six months with respect to month one of treatment. No significant differences in expression were observed for the remaining genes. No direct correlation was found with serum vitamin D levels. BMPRII expression changed differentially in non-natalizumab- versus natalizumab-treated patients. Changes were observed in the expression of ERK1, BMP2, and BMP5 based on disease activity measured using the Rio-Score, BMP2 in patients who had relapses, and BMP5 in those whose EDSS worsened. Our results suggest indirect regulation of vitamin D in TGF-β pathway genes in patients with RRMS.
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Affiliation(s)
- Alberto Lozano-Ros
- Servicio de Neurología, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (M.L.M.-G.); (J.M.G.-D.); (H.G.-B.); (J.P.C.); (A.M.-R.); (Y.H.-H.)
| | - María L. Martínez-Ginés
- Servicio de Neurología, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (M.L.M.-G.); (J.M.G.-D.); (H.G.-B.); (J.P.C.); (A.M.-R.); (Y.H.-H.)
| | - José M. García-Domínguez
- Servicio de Neurología, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (M.L.M.-G.); (J.M.G.-D.); (H.G.-B.); (J.P.C.); (A.M.-R.); (Y.H.-H.)
| | - Sara Salvador-Martín
- Servicio de Farmacia, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (S.S.-M.); (M.S.-S.)
| | - Haydee Goicochea-Briceño
- Servicio de Neurología, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (M.L.M.-G.); (J.M.G.-D.); (H.G.-B.); (J.P.C.); (A.M.-R.); (Y.H.-H.)
| | - Juan P. Cuello
- Servicio de Neurología, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (M.L.M.-G.); (J.M.G.-D.); (H.G.-B.); (J.P.C.); (A.M.-R.); (Y.H.-H.)
| | - Ariana Meldaña-Rivera
- Servicio de Neurología, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (M.L.M.-G.); (J.M.G.-D.); (H.G.-B.); (J.P.C.); (A.M.-R.); (Y.H.-H.)
| | - Yolanda Higueras-Hernández
- Servicio de Neurología, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (M.L.M.-G.); (J.M.G.-D.); (H.G.-B.); (J.P.C.); (A.M.-R.); (Y.H.-H.)
| | - María Sanjurjo-Sáez
- Servicio de Farmacia, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (S.S.-M.); (M.S.-S.)
| | - Luis A. Álvarez-Sala-Walther
- Servicio de Medicina Interna, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain;
| | - Luis A. López-Fernández
- Servicio de Farmacia, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (S.S.-M.); (M.S.-S.)
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Hajeer S, Nasr F, Nabha S, Saab MB, Harati H, Desoutter A, Al Ahmar E, Estephan E. Association between vitamin D deficiency and multiple sclerosis- MRI significance: A scoping review. Heliyon 2023; 9:e15754. [PMID: 37180903 PMCID: PMC10172888 DOI: 10.1016/j.heliyon.2023.e15754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 04/04/2023] [Accepted: 04/20/2023] [Indexed: 05/16/2023] Open
Abstract
Background/Objective Multiple Sclerosis is a common demyelinating disease of the central nervous system. Several studies suggested a link between vitamin D deficiency and multiple sclerosis disease activity, which can be evaluated by magnetic resonance imaging. Thereby, the main objective of the following scoping review is to summarize the magnetic resonance imaging findings assessing the probable effects of vitamin D on MS disease activity. Methodology PRISMA checklist for systematic reviews and meta-analyses was employed to structure this review. Literature was searched for observational and clinical studies tackling the given matter using several search engines including PubMed, CORE, and Embase. Data was extracted in a systematic manner, and the articles meeting the inclusion criteria were quality-assessed by Jadad scale for randomized clinical trials (RCTs) and Newcastle-Ottawa scale for observational studies. Results A total of 35 articles were included. Twenty-one (60%) studies noted a statistically significant association between vitamin D and Multiple Sclerosis MRI-detected disease activity. MRI-detected features involved lower contrast-enhancing T1 lesions, lower hyperintense T2 lesions, and a decrease in lesions volume. On the other hand, 40% (14 articles) of the articles did not detect any significant effect of vitamin D on Multiple Sclerosis disease activity. Due to the heterogeneity of the studies involved, meta-analysis was not employed in the given review. Discussion/conclusion There was an abundance in the number of research studies investigating the relationship between vitamin D and Multiple Sclerosis while highlighting the significant role of MRI in assessing the activity of the disease. Numerous studies found that higher serum vitamin D levels are associated with decreased new active cortical and subcortical lesions and lower lesions volume. These findings highlight the importance of imaging modalities in the various aspects of neurological diseases and encourage further research to focus on the preventive effects of vitamin D on MS patients.
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Affiliation(s)
- Shorouk Hajeer
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Farah Nasr
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Sanaa Nabha
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Marie-belle Saab
- Faculty of Pedagogy, Lebanese University, Furn-El-Chebbak, Lebanon
| | - Hayat Harati
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | | | - Elie Al Ahmar
- Faculty of Arts and Sciences, Holy Spirit University of Kaslik, Jounieh, Lebanon
- School of Engineering, Holy Spirit University of Kaslik, Jounieh, Lebanon
- Corresponding author. Faculty of Arts and Sciences, Holy Spirit University of Kaslik, Jounieh, Lebanon
| | - Elias Estephan
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
- LBN, University Montpellier, Montpellier, France
- Faculty of Arts and Sciences, Holy Spirit University of Kaslik, Jounieh, Lebanon
- Corresponding author. LBN, University Montpellier, Montpellier, France.
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Manu MS, Hohjoh H, Yamamura T. Extracellular Vesicles as Pro- and Anti-inflammatory Mediators, Biomarkers and Potential Therapeutic Agents in Multiple Sclerosis. Aging Dis 2021; 12:1451-1461. [PMID: 34527421 PMCID: PMC8407883 DOI: 10.14336/ad.2021.0513] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 05/11/2021] [Indexed: 12/11/2022] Open
Abstract
Multiple sclerosis (MS) is an autoimmune neurodegenerative disease of the central nervous system (CNS) characterized by multiple demyelinating lesions in the spinal cord and brain. Neuronal disruption caused by myelin loss or demyelination, which may accompany axonal changes, leads to multiple neurological symptoms. They may transiently appear for weeks during periods of disease worsening (relapse) in relapsing-remitting form of MS (RRMS). Although a number of genetic, metabolic and environmental factors influencing the development of MS have been identified, the precise mechanisms involved in the CNS tissue damage in MS are still poorly understood. Recent studies have revealed a significant role of circulating extracellular vesicles (EVs) in many diseases. EVs are known to serve as a cellular communication tool between two cell types either in close proximity or in different parts of the body. During the recent development in understanding of the pathogenesis of MS, studies have revealed the possible role of EVs in MS. Furthermore, circulating EVs can be used as a biomarker for monitoring disease progression and activity of MS, and they can also be therapeutic reagents or targets of therapy. In this review we overview and discuss in detail about generation of EVs and their diversified roles in MS.
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Affiliation(s)
- Mallahalli S Manu
- 1Department of Immunology, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Kodaira, Tokyo, 187-8502 Japan
| | - Hirohiko Hohjoh
- 2Department of Molecular Pharmacology, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Kodaira, Tokyo, 187-8502 Japan
| | - Takashi Yamamura
- 1Department of Immunology, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Kodaira, Tokyo, 187-8502 Japan
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McCartney DM, O'Shea PM, Faul JL, Healy MJ, Byrne G, Griffin TP, Walsh JB, Byrne DG, Kenny RA. Vitamin D and SARS-CoV-2 infection-evolution of evidence supporting clinical practice and policy development : A position statement from the Covit-D Consortium. Ir J Med Sci 2021; 190:1253-1265. [PMID: 33219912 PMCID: PMC7679797 DOI: 10.1007/s11845-020-02427-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 10/29/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Daniel M McCartney
- School of Biological and Health Sciences, College of Sciences & Health, Technological University Dublin - City Campus, Dublin 8, Ireland.
| | - Paula M O'Shea
- Department of Clinical Biochemistry, Galway University Hospitals, Galway, Ireland
- School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - John L Faul
- James Connolly Memorial Asthma Research Centre, Royal College of Surgeons in Ireland, Connolly Hospital Blanchardstown, Dublin 15, Ireland
| | - Martin J Healy
- Biochemistry Department, St. James's Hospital, Dublin 8, Ireland
| | - Greg Byrne
- School of Biological and Health Sciences, College of Sciences & Health, Technological University Dublin - City Campus, Dublin 8, Ireland
| | - Tomás P Griffin
- Regenerative Medicine Institute at CÚRAM SFI Research Centre, School of Medicine, National University of Ireland Galway, Galway, Ireland
- Centre for Endocrinology, Diabetes and Metabolism, Galway University Hospitals, Galway, Ireland
| | - James Bernard Walsh
- Mercer's Institute for Successful Ageing, St James's Hospital, Dublin 8, Ireland
- Department of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin 2, Ireland
| | - Declan G Byrne
- Department of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin 2, Ireland
- Medicine Directorate, St. James's Hospital, Dublin 8, Ireland
| | - Rose Anne Kenny
- Mercer's Institute for Successful Ageing, St James's Hospital, Dublin 8, Ireland
- Department of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin 2, Ireland
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Ponsonby AL. Reflection on modern methods: building causal evidence within high-dimensional molecular epidemiological studies of moderate size. Int J Epidemiol 2021; 50:1016-1029. [PMID: 33594409 DOI: 10.1093/ije/dyaa174] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2020] [Indexed: 12/29/2022] Open
Abstract
This commentary provides a practical perspective on epidemiological analysis within a single high-dimensional study of moderate size to consider a causal question. In this setting, non-causal confounding is important. This occurs when a factor is a determinant of outcome and the underlying association between exposure and the factor is non-causal. That is, the association arises due to chance, confounding or other bias rather than reflecting that exposure and the factor are causally related. In particular, the influence of technical processing factors must be accounted for by pre-processing measures to remove artefact or to control for these factors such as batch run. Work steps include the evaluation of alternative non-causal explanations for observed exposure-disease associations and strategies to obtain the highest level of causal inference possible within the study. A systematic approach is required to work through a question set and obtain insights on not only the exposure-disease association but also the multifactorial causal structure of the underlying data where possible. The appropriate inclusion of molecular findings will enhance the quest to better understand multifactorial disease causation in modern observational epidemiological studies.
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Milles P, De Filippo G, Maurey H, Tully T, Deiva K. Obesity in Pediatric-Onset Multiple Sclerosis: A French Cohort Study. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2021; 8:8/5/e1044. [PMID: 34285094 PMCID: PMC8293287 DOI: 10.1212/nxi.0000000000001044] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 05/26/2021] [Indexed: 01/03/2023]
Abstract
Objective To study the link between a high body mass index (BMI) in childhood and the occurrence of pediatric-onset multiple sclerosis (POMS) and to compare, within the MS population, the clinical-radiologic-biological characteristics, according to BMI. Methods A case-control study comparing BMI data of 60 patients with POMS (39 girls and 21 boys) at Bicêtre Hospital with that of 113 non-neurologic controls NNCs (68 girls and 45 boys) and 18,614 healthy controls HCs (9,271 girls and 9,343 boys) was performed. Crude BMI (cBMI), residual BMI (rBMI = measured BMI − expected BMI for age), z-score (rBMI/SD), and adult equivalent categories (International Obesity Task Force ≥25 = overweight, ≥30 = obese) were assessed. Results In boys, cBMI and rBMI were significantly higher in patients with POMS compared with NNCs (cBMI: +2.9; rBMI: +2.95, p < 0.01) and HCs (cBMI: +2.04, p < 0.01). In girls, cBMI or rBMI did not differ between POMS and NNCs patients (cBMI p = 0.4; rBMI p = 0.44) but with HCs (cBMI +0.99, p < 0.01). CSF inflammatory markers increased with BMI in prepubertal patients (p < 0.01), whereas vitamin D level at diagnosis was lower in boys with higher BMI (p = 0.016). Increased BMI was not associated with clinical and radiologic disease characteristics. Conclusions Overweight and obesity are more frequently observed at diagnosis, particularly in boys with POMS compared with non-neurologic controls and French HCs. Moreover, BMI is related to initial inflammation in the CSF in prepubertal patients with POMS suggesting an interaction between excess body fat, sexual hormones, and POMS occurrence.
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Affiliation(s)
- Pauline Milles
- From the Assistance Publique-Hôpitaux de Paris (P.M., H.M., K.D.), Hôpitaux Universitaires Paris Saclay, Hôpital Bicêtre, Pediatric Neurology Department, National Reference Center for Rare Inflammatory Brain and Spinal Diseases, Le Kremlin-Bicêtre; Assistance Publique-Hôpitaux de Paris (G.D.F.), Hôpital Robert Debré, Pediatric Endocrinology Department, French Clinical Research Group in Adolescent Medicine and Health, Paris; and Sorbonne Université (T.T.), CNRS, IRD, INRA, Institute of Ecology and Environmental Sciences, iEES Paris, UMR7618, France.
| | - Gianpaolo De Filippo
- From the Assistance Publique-Hôpitaux de Paris (P.M., H.M., K.D.), Hôpitaux Universitaires Paris Saclay, Hôpital Bicêtre, Pediatric Neurology Department, National Reference Center for Rare Inflammatory Brain and Spinal Diseases, Le Kremlin-Bicêtre; Assistance Publique-Hôpitaux de Paris (G.D.F.), Hôpital Robert Debré, Pediatric Endocrinology Department, French Clinical Research Group in Adolescent Medicine and Health, Paris; and Sorbonne Université (T.T.), CNRS, IRD, INRA, Institute of Ecology and Environmental Sciences, iEES Paris, UMR7618, France
| | - Hélène Maurey
- From the Assistance Publique-Hôpitaux de Paris (P.M., H.M., K.D.), Hôpitaux Universitaires Paris Saclay, Hôpital Bicêtre, Pediatric Neurology Department, National Reference Center for Rare Inflammatory Brain and Spinal Diseases, Le Kremlin-Bicêtre; Assistance Publique-Hôpitaux de Paris (G.D.F.), Hôpital Robert Debré, Pediatric Endocrinology Department, French Clinical Research Group in Adolescent Medicine and Health, Paris; and Sorbonne Université (T.T.), CNRS, IRD, INRA, Institute of Ecology and Environmental Sciences, iEES Paris, UMR7618, France
| | - Thomas Tully
- From the Assistance Publique-Hôpitaux de Paris (P.M., H.M., K.D.), Hôpitaux Universitaires Paris Saclay, Hôpital Bicêtre, Pediatric Neurology Department, National Reference Center for Rare Inflammatory Brain and Spinal Diseases, Le Kremlin-Bicêtre; Assistance Publique-Hôpitaux de Paris (G.D.F.), Hôpital Robert Debré, Pediatric Endocrinology Department, French Clinical Research Group in Adolescent Medicine and Health, Paris; and Sorbonne Université (T.T.), CNRS, IRD, INRA, Institute of Ecology and Environmental Sciences, iEES Paris, UMR7618, France
| | - Kumaran Deiva
- From the Assistance Publique-Hôpitaux de Paris (P.M., H.M., K.D.), Hôpitaux Universitaires Paris Saclay, Hôpital Bicêtre, Pediatric Neurology Department, National Reference Center for Rare Inflammatory Brain and Spinal Diseases, Le Kremlin-Bicêtre; Assistance Publique-Hôpitaux de Paris (G.D.F.), Hôpital Robert Debré, Pediatric Endocrinology Department, French Clinical Research Group in Adolescent Medicine and Health, Paris; and Sorbonne Université (T.T.), CNRS, IRD, INRA, Institute of Ecology and Environmental Sciences, iEES Paris, UMR7618, France
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Multiple sclerosis in Peru: National prevalence study using capture-recapture analysis. Mult Scler Relat Disord 2021; 55:103147. [PMID: 34332455 DOI: 10.1016/j.msard.2021.103147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 07/08/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND There is scarce epidemiological data on Multiple Sclerosis (MS) in Latin America. National epidemiological studies are needed to guide the health policy related to MS. OBJECTIVE To determine MS national prevalence in Peru and describe clinical and epidemiological characteristics of the disease. METHODS We conducted a cross-sectional prevalence study in Peru's four largest regions using two sources. We included adult patients diagnosed with MS by a neurologist using the McDonald criteria. We performed a capture-recapture analysis using the nearly unbiased estimator model, and calculated prevalence as the proportion of the adult Peruvian population in 2016. Additionally, we summarized patients epidemiological and clinical characteristics. RESULTS We identified 417 cases: 135 from the first source and 282 from the one. We found a point prevalence of 9.12 cases per 100 000 inhabitants (95% CI: 5.6 - 12.6). The age range was 35 to 45 years-old, and 51.9% were female. The most common type of MS was relapsing-remitting (79.3%) and the most frequent treatment was subcutaneous IFN-1b (40.7%). CONCLUSION Peru has a medium MS prevalence compared to other Latin American countries. Lima is the region with the highest number of cases, with similar clinical characteristics to other countries in the region.
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Sunlight exposure exerts immunomodulatory effects to reduce multiple sclerosis severity. Proc Natl Acad Sci U S A 2021; 118:2018457118. [PMID: 33376202 PMCID: PMC7817192 DOI: 10.1073/pnas.2018457118] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Multiple sclerosis (MS) disease risk is associated with reduced sun-exposure. This study assessed the relationship between measures of sun exposure (vitamin D [vitD], latitude) and MS severity in the setting of two multicenter cohort studies (n NationMS = 946, n BIONAT = 990). Additionally, effect-modification by medication and photosensitivity-associated MC1R variants was assessed. High serum vitD was associated with a reduced MS severity score (MSSS), reduced risk for relapses, and lower disability accumulation over time. Low latitude was associated with higher vitD, lower MSSS, fewer gadolinium-enhancing lesions, and lower disability accumulation. The association of latitude with disability was lacking in IFN-β-treated patients. In carriers of MC1R:rs1805008(T), who reported increased sensitivity toward sunlight, lower latitude was associated with higher MRI activity, whereas for noncarriers there was less MRI activity at lower latitudes. In a further exploratory approach, the effect of ultraviolet (UV)-phototherapy on the transcriptome of immune cells of MS patients was assessed using samples from an earlier study. Phototherapy induced a vitD and type I IFN signature that was most apparent in monocytes but that could also be detected in B and T cells. In summary, our study suggests beneficial effects of sun exposure on established MS, as demonstrated by a correlative network between the three factors: Latitude, vitD, and disease severity. However, sun exposure might be detrimental for photosensitive patients. Furthermore, a direct induction of type I IFNs through sun exposure could be another mechanism of UV-mediated immune-modulation in MS.
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Affiliation(s)
| | - Laura Fantuzzi
- Istituto Superiore di Sanità, National Center for Global Health, Rome, Italy
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Martínez-Lapiscina EH, Mahatanan R, Lee CH, Charoenpong P, Hong JP. Associations of serum 25(OH) vitamin D levels with clinical and radiological outcomes in multiple sclerosis, a systematic review and meta-analysis. J Neurol Sci 2020; 411:116668. [PMID: 32004798 DOI: 10.1016/j.jns.2020.116668] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 12/16/2019] [Accepted: 01/02/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Vitamin D supplementation is recommended for patients with multiple sclerosis (MS). However, a recent meta-analysis based on low-quality trials suggested no evidence of supplementation benefit. A systematic review and meta-analysis of high-quality observational cohort studies should provide us further evidences. METHODS MEDLINE, EMBASE, and WEB-of-SCIENCE databases were systematically searched to identify eligible studies published before October 2018. Prospective cohort studies assessing the associations of serum 25(OH)D levels with MS relapses, radiological inflammatory lesions, or changes in expanded disability status scale in adults (≥18 years) with MS were included. Pooled RRs were calculated using fixed-effect or random-effects model depending on heterogeneity. RESULTS Thirteen studies and 3498 patients were included. Each 25 nmol/L increase in serum 25(OH)D levels was associated with a reduction in (1) clinical relapse rate [RR = 0.90; 95% confidence interval (CI) = 0.83-0.99], (2) gadolinium-enhancing lesions (RR = 0.69; 95% CI = 0.60-0.79), (3) new/enlarging T2 lesions (RR = 0.86; 95% CI = 0.77-0.95), and (4) new active lesions (RR = 0.81; 95% CI = 0.74-0.89) in the magnetic resonance imaging(MRI). CONCLUSIONS Serum 25(OH)D levels are associated with a modest decrease in relapse rate and radiological inflammatory activities in patients with MS. The association with disability worsening remains inconclusive.
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Affiliation(s)
- Elena H Martínez-Lapiscina
- Center of Neuroimmunology and Department of Neurology, Hospital Clinic of Barcelona, Institute d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), University of Barcelona, Spain; Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
| | - Rattanaporn Mahatanan
- Department of Internal Medicine, Redington Fairview General Hospital, Skowhegan, ME, USA; Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
| | - Chih-Hong Lee
- Departments of Neurology, Chang Gung Memorial Hospital Linkao Medical Center and Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Prangthip Charoenpong
- Department of Internal Medicine, Division of Pulmonary and Critical Care, Louisiana State University, Shreveport, Louisiana, USA; Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
| | - Jia-Pei Hong
- Departments of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital Linkao Medical Center and Chang Gung University, College of Medicine, Taoyuan, Taiwan; Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA.
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Abstract
Vitamin D and its main active metabolite 1,25-dihydroxyvitamin D serve a crucial role in maintenance of a healthy calcium metabolism, yet have additional roles in immune and central nervous system cell homeostasis. Serum levels of 25-hydroxyvitamin D are a biomarker of future disease activity in patients with early relapsing-remitting multiple sclerosis (RRMS), and vitamin D supplementation in patients with low circulating 25-dihydroxyvitamin D levels has been anticipated as a potential efficacious treatment strategy. The results of the first large randomized clinical trials (RCTs), the SOLAR and CHOLINE studies, have now been published. The SOLAR study compared 14,000 IU of vitamin D3 (cholecalciferol) per day with placebo for 48 weeks in 232 randomized patients, whereas CHOLINE compared vitamin D3 100,000 IU every other week with placebo for 96 weeks in 129 randomized patients. All patients in both studies also used interferon-β-1a. None of the studies met their primary endpoints, which were no evidence of disease activity (NEDA-3) at 48 weeks in SOLAR and annualized relapse rate at 96 weeks in CHOLINE. Both studies did, however, suggest modest effects on secondary endpoints. Thus, vitamin D reduced the number of new or enlarging lesions and new T2 lesions in SOLAR, and the annualized relapse rate and number of new T1 lesions, volume of hypointense T1 lesions, and disability progression in the 90 patients who completed 96 weeks' follow-up in CHOLINE. We conclude that none of the RCTs on vitamin supplementation in MS have met their primary clinical endpoint in the intention to treat cohorts. This contrasts the observation studies, where each 25 nmol/l increase in 25-hydroxyvitamin D levels were associated with 14-34% reduced relapse risk and 15-50% reduced risk of new lesions on magnetic resonnance imaging. This discrepancy may have several explanations, including confounding and reverse causality in the observational studies. The power calculations of the RCTs have been based on the observational studies, and the RCTs may have been underpowered to detect less prominent yet important effects of vitamin D supplementation. Although the effect of vitamin D supplementation is uncertain and less pronounced than suggested by observational studies, current evidence still support that people with MS should avoid vitamin D insufficiency, and preferentially aim for vitamin D levels around 100 nmol/L or somewhat higher.
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Affiliation(s)
- Joost Smolders
- Department of Neurology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
- Neuroimmunology Research Group, Netherlands Institute for Neuroscience, Amsterdam, The Netherlands
| | - Øivind Torkildsen
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
- Institute for Clinical Medicine, University of Bergen, Bergen, Norway
| | - William Camu
- Centre de Référence SLA, CHU Gui de Chauliac et Univ Montpellier, Montpellier, France
| | - Trygve Holmøy
- Department of Neurology, Akershus University Hospital, Box 1000, 1478, Lørenskog, Norway.
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
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Feng X, Wang Z, Howlett-Prieto Q, Einhorn N, Causevic S, Reder AT. Vitamin D enhances responses to interferon-β in MS. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2019; 6:e622. [PMID: 31582399 PMCID: PMC6807660 DOI: 10.1212/nxi.0000000000000622] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 08/13/2019] [Indexed: 01/18/2023]
Abstract
Objective To determine the effect of vitamin D3 on interferon-β (IFN-β) response and immune regulation in MS mononuclear cells (MNCs). Methods MNCs from 126 subjects, including therapy-naive patients with different forms of MS, plus patients with MS receiving IFN-β or glatiramer treatment, plus healthy controls were incubated in vitro with IFN-β-1b ± vitamin D3 (calcitriol). Activation of the IFN-β–induced transcription factor, p-Y-STAT1, and antiviral myxovirus A (MxA) protein was measured with flow cytometry and Western blots; serum proteins were measured with a customized 31-protein multiplex assay. Results Vitamin D enhanced in vitro IFN responses, as measured by induction of p-Y-STAT1 and MxA in MNCs, T cells, and monocytes. Vitamin D augmentation of IFN responses was seen in untreated and in IFN-β-1b–treated MS. The combination of vitamin D plus IFN-β reduced Th1 and Th17 cytokines, and increased Th2 responses, reversing the effect of IFN-β alone. Exacerbations and progression in untreated patients reduced the vitamin D enhancement of IFN responses. Vitamin D had less effect on IFN response in clinically stable glatiramer-treated than in IFN-β–treated patients. Conclusion Vitamin D enhances IFN-β induction of multiple proteins and also reverses the Th1/Th2 bias in MS seen with IFN-β alone. The combination of vitamin D and IFN-β has potential benefit in ameliorating MS.
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Affiliation(s)
- Xuan Feng
- From the Department of Neurology (X.F., Q.H.-P., N.E., S.C., A.T.R.), University of Chicago Medicine, IL; and Department of Neurology (Z.W.), The First Affiliated Hospital of Dalian Medical University, China
| | - Zhe Wang
- From the Department of Neurology (X.F., Q.H.-P., N.E., S.C., A.T.R.), University of Chicago Medicine, IL; and Department of Neurology (Z.W.), The First Affiliated Hospital of Dalian Medical University, China
| | - Quentin Howlett-Prieto
- From the Department of Neurology (X.F., Q.H.-P., N.E., S.C., A.T.R.), University of Chicago Medicine, IL; and Department of Neurology (Z.W.), The First Affiliated Hospital of Dalian Medical University, China
| | - Nathan Einhorn
- From the Department of Neurology (X.F., Q.H.-P., N.E., S.C., A.T.R.), University of Chicago Medicine, IL; and Department of Neurology (Z.W.), The First Affiliated Hospital of Dalian Medical University, China
| | - Suad Causevic
- From the Department of Neurology (X.F., Q.H.-P., N.E., S.C., A.T.R.), University of Chicago Medicine, IL; and Department of Neurology (Z.W.), The First Affiliated Hospital of Dalian Medical University, China
| | - Anthony T Reder
- From the Department of Neurology (X.F., Q.H.-P., N.E., S.C., A.T.R.), University of Chicago Medicine, IL; and Department of Neurology (Z.W.), The First Affiliated Hospital of Dalian Medical University, China.
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Evaluation of variation in genes of the arylhydrocarbon receptor pathway for an association with multiple sclerosis. J Neuroimmunol 2019; 334:576979. [DOI: 10.1016/j.jneuroim.2019.576979] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 05/14/2019] [Accepted: 05/31/2019] [Indexed: 01/11/2023]
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Camu W, Lehert P, Pierrot-Deseilligny C, Hautecoeur P, Besserve A, Jean Deleglise AS, Payet M, Thouvenot E, Souberbielle JC. Cholecalciferol in relapsing-remitting MS: A randomized clinical trial (CHOLINE). NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2019; 6:6/5/e597. [PMID: 31454777 PMCID: PMC6705622 DOI: 10.1212/nxi.0000000000000597] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 06/13/2019] [Indexed: 11/15/2022]
Abstract
Objective To evaluate the safety and efficacy of cholecalciferol in patients with relapsing-remitting MS (RRMS). Methods In this double-blind, placebo-controlled parallel-group, 2-year study, 181 patients with RRMS were randomized 1:1. Key inclusion criteria were a low serum 25-hydroxy vitamin D (25OHD) concentration (<75 nmol/L), a treatment with interferon beta-1a 44 μg (SC 3 times per week) 4 months ± 2 months before randomization, and at least one documented relapse during the previous 2 years. Patients received high-dose oral cholecalciferol 100,000 IU or placebo every other week for 96 weeks. Primary outcome measure was the change in the annualized relapse rate (ARR) at 96 weeks. Secondary objectives included safety and tolerability of cholecalciferol and efficacy assessments (ARR, MRI parameters, and Expanded Disability Status Scale [EDSS]). Results The primary end point was not met. In patients who completed the 2-year follow-up (45 with cholecalciferol and 45 with placebo), all efficacy parameters favored cholecalciferol with an ARR reduction (p = 0.012), less new hypointense T1-weighted lesions (p = 0.025), a lower volume of hypointense T1-weighted lesions (p = 0.031), and a lower progression of EDSS (p = 0.026). The overall rate of adverse events was well balanced between groups. Conclusions Although the primary end point was not met, these data suggest a potential treatment effect of cholecalciferol in patients with RRMS already treated with interferon beta-1a and low serum 25OHD concentration. Together with the good safety profile, these data support the exploration of cholecalciferol treatment in such patients with RRMS. Clinicaltrials.gov identifier NCT01198132. Classification of evidence This study provides Class II evidence that for patients with RRMS and low serum 25OHD, cholecalciferol did not significantly affect ARRs.
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Affiliation(s)
- William Camu
- From CHU Gui de Chauliac (W.C.) and Institut de Génomique Fonctionnelle (E.T.), Université de Montpellier, France; Faculty of Economics (P.L.), UCL Mons, Louvain, Belgium; Faculty of Medicine (P.L.), the University of Melbourne, Australia; CHU Pitié Salpêtrière (C.P.-D.), Paris; GHICL St Vincent de Paul (P.H.), Lille; Merck (A.B., A.-S.J.-D., M.P.), Lyon; CHU Caremeau (E.T.), Nîmes; and CHU Necker (J.C.S.), Paris, France.
| | - Philippe Lehert
- From CHU Gui de Chauliac (W.C.) and Institut de Génomique Fonctionnelle (E.T.), Université de Montpellier, France; Faculty of Economics (P.L.), UCL Mons, Louvain, Belgium; Faculty of Medicine (P.L.), the University of Melbourne, Australia; CHU Pitié Salpêtrière (C.P.-D.), Paris; GHICL St Vincent de Paul (P.H.), Lille; Merck (A.B., A.-S.J.-D., M.P.), Lyon; CHU Caremeau (E.T.), Nîmes; and CHU Necker (J.C.S.), Paris, France
| | - Charles Pierrot-Deseilligny
- From CHU Gui de Chauliac (W.C.) and Institut de Génomique Fonctionnelle (E.T.), Université de Montpellier, France; Faculty of Economics (P.L.), UCL Mons, Louvain, Belgium; Faculty of Medicine (P.L.), the University of Melbourne, Australia; CHU Pitié Salpêtrière (C.P.-D.), Paris; GHICL St Vincent de Paul (P.H.), Lille; Merck (A.B., A.-S.J.-D., M.P.), Lyon; CHU Caremeau (E.T.), Nîmes; and CHU Necker (J.C.S.), Paris, France
| | - Patrick Hautecoeur
- From CHU Gui de Chauliac (W.C.) and Institut de Génomique Fonctionnelle (E.T.), Université de Montpellier, France; Faculty of Economics (P.L.), UCL Mons, Louvain, Belgium; Faculty of Medicine (P.L.), the University of Melbourne, Australia; CHU Pitié Salpêtrière (C.P.-D.), Paris; GHICL St Vincent de Paul (P.H.), Lille; Merck (A.B., A.-S.J.-D., M.P.), Lyon; CHU Caremeau (E.T.), Nîmes; and CHU Necker (J.C.S.), Paris, France
| | - Anne Besserve
- From CHU Gui de Chauliac (W.C.) and Institut de Génomique Fonctionnelle (E.T.), Université de Montpellier, France; Faculty of Economics (P.L.), UCL Mons, Louvain, Belgium; Faculty of Medicine (P.L.), the University of Melbourne, Australia; CHU Pitié Salpêtrière (C.P.-D.), Paris; GHICL St Vincent de Paul (P.H.), Lille; Merck (A.B., A.-S.J.-D., M.P.), Lyon; CHU Caremeau (E.T.), Nîmes; and CHU Necker (J.C.S.), Paris, France
| | - Anne-Sophie Jean Deleglise
- From CHU Gui de Chauliac (W.C.) and Institut de Génomique Fonctionnelle (E.T.), Université de Montpellier, France; Faculty of Economics (P.L.), UCL Mons, Louvain, Belgium; Faculty of Medicine (P.L.), the University of Melbourne, Australia; CHU Pitié Salpêtrière (C.P.-D.), Paris; GHICL St Vincent de Paul (P.H.), Lille; Merck (A.B., A.-S.J.-D., M.P.), Lyon; CHU Caremeau (E.T.), Nîmes; and CHU Necker (J.C.S.), Paris, France
| | - Marianne Payet
- From CHU Gui de Chauliac (W.C.) and Institut de Génomique Fonctionnelle (E.T.), Université de Montpellier, France; Faculty of Economics (P.L.), UCL Mons, Louvain, Belgium; Faculty of Medicine (P.L.), the University of Melbourne, Australia; CHU Pitié Salpêtrière (C.P.-D.), Paris; GHICL St Vincent de Paul (P.H.), Lille; Merck (A.B., A.-S.J.-D., M.P.), Lyon; CHU Caremeau (E.T.), Nîmes; and CHU Necker (J.C.S.), Paris, France
| | - Eric Thouvenot
- From CHU Gui de Chauliac (W.C.) and Institut de Génomique Fonctionnelle (E.T.), Université de Montpellier, France; Faculty of Economics (P.L.), UCL Mons, Louvain, Belgium; Faculty of Medicine (P.L.), the University of Melbourne, Australia; CHU Pitié Salpêtrière (C.P.-D.), Paris; GHICL St Vincent de Paul (P.H.), Lille; Merck (A.B., A.-S.J.-D., M.P.), Lyon; CHU Caremeau (E.T.), Nîmes; and CHU Necker (J.C.S.), Paris, France
| | - Jean Claude Souberbielle
- From CHU Gui de Chauliac (W.C.) and Institut de Génomique Fonctionnelle (E.T.), Université de Montpellier, France; Faculty of Economics (P.L.), UCL Mons, Louvain, Belgium; Faculty of Medicine (P.L.), the University of Melbourne, Australia; CHU Pitié Salpêtrière (C.P.-D.), Paris; GHICL St Vincent de Paul (P.H.), Lille; Merck (A.B., A.-S.J.-D., M.P.), Lyon; CHU Caremeau (E.T.), Nîmes; and CHU Necker (J.C.S.), Paris, France
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Abstract
Multiple sclerosis (MS) is an inflammatory demyelinating disease of the central nervous system (CNS) and a major contributor to disability of young adults in western countries. MS prevalence is highest in areas with low vitamin D. Vitamin D is a fat-soluble compound with numerous physiologic responses, including immune regulation. An increasing volume of work suggests that lower levels of serum vitamin D are associated with an increased risk of MS and a more severe disease course. With the suggestion of a role in MS disease activity, increasing attention is being paid to the potential of using vitamin D as an add-on therapy to established MS disease-modifying therapies. Several preliminary studies have reported results which have shown some promise, but none has yet provided significant evidence of a clinically meaningful improvement. We review our recommendations for off-label supplementation in the context of these findings.
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Affiliation(s)
- Thomas Jack Shoemaker
- Department of Neurology, School of Medicine, The Johns Hopkins University, Baltimore, MD, USA
| | - Ellen M Mowry
- Department of Neurology, School of Medicine, The Johns Hopkins University, Baltimore, MD, USA
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Vitamin D supplementation has no effects on progression of motor dysfunction in amyotrophic lateral sclerosis (ALS). Eur J Clin Nutr 2019; 74:167-175. [PMID: 31197218 DOI: 10.1038/s41430-019-0448-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 05/05/2019] [Accepted: 05/26/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To investigate the effects of cholecalciferol supplementation on the progression of motor disability in a cohort of amyotrophic lateral sclerosis (ALS) patients with low blood 25-hydroxyvitamin D3 [25(OH)D] levels, on the basis of the hypothesis of potential neuroprotective effects of vitamin D supplementation. METHODS Forty-eight ALS patients, 34 with deficient (<20 ng/mL) and 14 with insufficient (20-29 ng/mL) serum levels of 25(OH)D, were randomized and treated by 3 different doses of cholecalciferol [50.000, 75.000 and 100.000 international units (IU) /month] and evaluated after 6-months. Assessment of motor dysfunction at baseline and after 6 months included ALS Functional Rating Scale-Revised (ALFRS-R) and upper motor neuron (UMN) scores and blood samples for 25(OH)D levels. RESULTS Clinical data of 33 patients were available after 6 months. Analysis of Covariance (ANCOVA), with pre-treatment measurements included as covariate, did not show statistically significant differences in the ALSFRS-R (p > 0.05) and UMN (p > 0.05) among the patient groups who underwent 3 different doses of cholecalciferol. Conversely, the treatment with 75.000 IU/month or 100.000 IU/month induced a significant increase in serum levels of 25(OH)D in comparison with the supplementation with 50.000 IU/month; no significant differences were found between 75.000 IU/month and 100.000 IU/month. CONCLUSIONS Our findings highlighted that 6-month supplementation of vitamin D in ALS patients had no significant effects on motor dysfunction. However, it is recommended to prevent medical complications of vitamin D deficiency in ALS patients as well as in other populations of neurodegenerative patients, characterized by low mobility and decreased sun exposure.
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Lifestyle and Environmental Factors in Multiple Sclerosis. Cold Spring Harb Perspect Med 2019; 9:cshperspect.a028944. [PMID: 29735578 DOI: 10.1101/cshperspect.a028944] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Lifestyle and environmental factors potently influence the risk of multiple sclerosis (MS), because genetic predisposition only explains a fraction of the risk increase. There is strong evidence for associations of Epstein-Barr virus (EBV) infection, smoking, sun exposure/vitamin D, and adolescent obesity to risk of MS. There is also circumstantial evidence on organic solvents and shift work, all associate with greater risk, although certain factors like nicotine, alcohol, and a high coffee consumption associate with a reduced risk. Certain factors, smoking, EBV infection, and obesity interact with human leukocyte antigen (HLA) risk genes, arguing for a pathogenic pathway involving adaptive immunity. There is a potential for prevention, in particular for people at greater risk such as relatives of individuals with MS. All of the described factors for MS may influence adaptive and/or innate immunity, as has been argued for MS risk gene variants.
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Hongell K, Silva DG, Ritter S, Meier DP, Soilu-Hänninen M. Efficacy and safety outcomes in vitamin D supplement users in the fingolimod phase 3 trials. J Neurol 2017; 265:348-355. [PMID: 29243005 DOI: 10.1007/s00415-017-8697-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 11/28/2017] [Accepted: 11/30/2017] [Indexed: 01/17/2023]
Abstract
BACKGROUND Low serum levels of 25-hydroxyvitamin D have been associated with worse outcomes in multiple sclerosis (MS) patients treated with interferon-beta. Association of vitamin D nutrition on the outcomes of other MS therapies has been studied less. OBJECTIVE Whether patients in the phase 3 fingolimod trials using vitamin D supplements have better clinical, MRI and safety outcomes than non-users. MATERIALS AND METHODS Pooled data from phase 3 FREEDOMS trials was analyzed post hoc. Vitamin D use was defined as 'non-users' (n = 562), 'casual users' (n = 157) and 'daily users' (usage 100% time in the study, n = 110). RESULTS Expanded Disability Status Scale change from baseline to month 24, and annual relapse rate and proportion of patients with relapses were similar across the vitamin D user groups. Proportion of patients free of new/enlarging T2 lesions significantly favored vitamin D 'daily users' versus 'non-users'. Mean number of lesions were lower and proportion of patients free of gadolinium-enhanced T1-lesions were higher in the 'daily users'. At month 12, percent brain volume change was significantly lower in the 'daily users' versus 'non-users' and remained low at month 24 (non-significant). Incidence of depression was lower for vitamin D 'daily users' (non-significant). CONCLUSIONS We observed improved MRI outcomes on percent brain volume change and proportion of patients free of new/enlarging T2 lesions, and a trend of less depression in the 'daily users' of vitamin D supplement in patients in the FREEDOMS trials.
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Affiliation(s)
- Kira Hongell
- Division of Clinical Neurosciences, Turku University Hospital and University of Turku, PB 52, 20521, Turku, Finland.
| | - Diego G Silva
- Novartis Pharma AG, Fabrikstrasse 12, 4056, Basel, Switzerland
| | - Shannon Ritter
- Novartis Pharmaceuticals Corporation, One Health Plaza, Bldg. 200, Office 238, East Hanover, NJ, 07936-1080, USA
| | | | - Merja Soilu-Hänninen
- Division of Clinical Neurosciences, Turku University Hospital and University of Turku, PB 52, 20521, Turku, Finland
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Abstract
Numerous observational studies have suggested that there is a correlation between the level of serum vitamin D and MS risk and disease activity. To explore this hypothesis, a literature search of large, prospective, observation studies, epidemiological studies, and studies using new approaches such as Mendelian randomization was conducted. Available data and ongoing research included in this review suggest that the level of serum vitamin D affects the risk of developing MS and also modifies disease activity in MS patients. Newer Mendelian randomization analyses suggest there is a causal relationship between low vitamin D level and the risk of MS. Post-hoc evaluations from two phase 3 studies, BENEFIT and BEYOND, support the findings of observational trials. Study limitations identified in this review recognize the need for larger controlled clinical trials to establish vitamin D supplementation as the standard of care for MS patients. Though there is increasing evidence indicating that lower vitamin D levels are associated with increased risk of MS and with greater clinical and brain MRI activity in established MS, the impact of vitamin D supplementation on MS activity remains inadequately investigated.
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Sadeghi H, Taheri M, Sajadi E, Movafagh A, Arsang Jang S, Sayad A. VDR and CYP24A1 Expression Analysis in Iranian Relapsing-Remitting Multiple Sclerosis Patients. CELL JOURNAL 2017; 19:352-360. [PMID: 28836398 PMCID: PMC5570401 DOI: 10.22074/cellj.2017.4192] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 08/27/2016] [Indexed: 02/01/2023]
Abstract
OBJECTIVES Multiple sclerosis (MS) is a common disease of the central nervous system.This disease may be initiated by either vitamin deficiency or triggered by abnormality in CYP24A1 and vitamin D receptor. MATERIALS AND METHODS In this case-control study, the expression of genes encoding vitamin D receptor (VDR) and CYP24A1 in relapsing-remitting MS (RR-MS) patients was compared with normal individuals in the Iranian population. RNA from whole blood of 50 RR-MS patients (HLA-DRB1*15-negative and responders to interferonbeta with a normal vitamin D level) and 50 normal controls was extracted. The levels of CYP24A1 and VDR expression were measured using real-time quantitative polymerase chain reaction. RESULTS The RR-MS group had a significantly more than 2 times higher expression level of VDR than the normal group (P=0.04). On the other hand, there was a 0.89 times decrease in the expression level of CYP24A1 in RR-MS patients which was not statistically significant. There was no linear correlation between the risk of expanded disability status scale of Kurtzke (EDSS) and the expression level of either CYP24A1 or VDR. In addition, the expression level of CYP24A1 or VDR was not correlated with the duration of the disease. CONCLUSIONS Up-regulation of VDR is likely to happen in RR-MS patients in the Iranian population. We did not observe a gene expression-phenotype correlation for CYP24A1 which may be due to limited statistical power as a result of the small sample size. Although the individuals taking part in this study had normal levels of vitamin D, the increase in VDR expression levels may perhaps be a response to a defect in vitamin D processing. Another possibility is that despite an increase in VDR expression level, factors such as micro-RNAs may result in their deactivation while an increase in VDR expression level can be seen as a compensatory response. Of course, further studies are required to identify the mechanism of action of vitamin D by analyzing genes involved in its signaling pathway, particularly VDR and CYP24A1.
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Affiliation(s)
- Hashem Sadeghi
- Department of Medical Genetics, School of Medicine, Shahid Beheshti University of Medical Sciences,Tehran, Iran
| | - Mohammad Taheri
- Department of Medical Genetics, School of Medicine, Shahid Beheshti University of Medical Sciences,Tehran, Iran
| | - Elham Sajadi
- Department of Hematology, School of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abolfazl Movafagh
- Department of Medical Genetics, School of Medicine, Cancer Research Centre, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shahram Arsang Jang
- Department of Epidemiology and Biostatistics, Faculty of Health, Qom University of Medical Sciences, Qom, Iran
| | - Arezou Sayad
- Department of Medical Genetics, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Paganoni S, Macklin EA, Karam C, Yu H, Gonterman F, Fetterman KA, Cudkowicz M, Berry J, Wills A. Vitamin D levels are associated with gross motor function in amyotrophic lateral sclerosis. Muscle Nerve 2017; 56:726-731. [DOI: 10.1002/mus.25555] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 12/27/2016] [Accepted: 12/30/2016] [Indexed: 12/12/2022]
Affiliation(s)
- Sabrina Paganoni
- Neurological Clinical Research Institute, Harvard Medical School, Massachusetts General Hospital165 Cambridge Street, Suite 600, Boston Massachusetts02114 USA
- Department of NeurologyNeurological Clinical Research Institute, Massachusetts General HospitalBoston Massachusetts USA
- Department of Physical Medicine and RehabilitationSpaulding Rehabilitation HospitalCambridge Massachusetts USA
| | - Eric A. Macklin
- Neurological Clinical Research Institute, Harvard Medical School, Massachusetts General Hospital165 Cambridge Street, Suite 600, Boston Massachusetts02114 USA
- Biostatistics Center, Massachusetts General HospitalBoston Massachusetts USA
| | - Chafic Karam
- Department of NeurologyOregon Health and Science UniversityPortland Oregon USA
| | - Hong Yu
- Department of NeurologyNeurological Clinical Research Institute, Massachusetts General HospitalBoston Massachusetts USA
| | - Fernando Gonterman
- Department of NeurologyNeurological Clinical Research Institute, Massachusetts General HospitalBoston Massachusetts USA
| | - K. Ashley Fetterman
- Department of NeurologyNeurological Clinical Research Institute, Massachusetts General HospitalBoston Massachusetts USA
| | - Merit Cudkowicz
- Neurological Clinical Research Institute, Harvard Medical School, Massachusetts General Hospital165 Cambridge Street, Suite 600, Boston Massachusetts02114 USA
- Department of NeurologyNeurological Clinical Research Institute, Massachusetts General HospitalBoston Massachusetts USA
| | - James Berry
- Neurological Clinical Research Institute, Harvard Medical School, Massachusetts General Hospital165 Cambridge Street, Suite 600, Boston Massachusetts02114 USA
- Department of NeurologyNeurological Clinical Research Institute, Massachusetts General HospitalBoston Massachusetts USA
| | - Anne‐Marie Wills
- Neurological Clinical Research Institute, Harvard Medical School, Massachusetts General Hospital165 Cambridge Street, Suite 600, Boston Massachusetts02114 USA
- Department of NeurologyNeurological Clinical Research Institute, Massachusetts General HospitalBoston Massachusetts USA
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Wawrzyniak S, Mikołajewska E, Kuczko-Piekarska E, Niezgodzińska-Maciejek A, Goch A. Association of vitamin D status and clinical and radiological outcomes in a treated MS population in Poland. Brain Behav 2017; 7:e00609. [PMID: 28239520 PMCID: PMC5318363 DOI: 10.1002/brb3.609] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 10/05/2016] [Accepted: 10/17/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Vitamin D influences the immune system significantly. Previous studies have found that vitamin D deficiency in adolescence can play a significant role in increasing the risk of developing autoimmune diseases including multiple sclerosis. The aim of this study was to investigate the relationship between the vitamin D status in serum and clinical and radiological outcomes in a treated population in Poland. METHODS Inclusion criteria met 83 adult patients aged 20-61 years with diagnosis of relapsing-remitting multiple sclerosis, who underwent immunomodulatory treatment which lasted at least 12 months. Levels of serum 25-hydroxyvitamin D were determined using radio-immuno assay. Magnetic resonance imaging of the brain and cervical part of a spinal cord was performed each time after 12 months of the treatment. Patients were assessed neurologically after 12 months of treatment, the level of disability was also assessed using Extended Disability Status Scale. RESULTS The largest group (63.8%) showed significant vitamin D deficiency (<20 ng/ml), 21.7% showed the suboptimal level of vitamin D (20-30 ng/ml). The normal level of 25(OH)D (>30 ng/ml) was observed in 14.5% of the patients. Statistically significant correlation was observed between the vitamin D status and frequency of relapses. CONCLUSIONS Our findings confirm that deficiency of vitamin D in patients with MS is correlated with clinical and radiological course of the disease.
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Affiliation(s)
- Sławomir Wawrzyniak
- Neurology Clinic Military Clinical Hospital No. 10 with Policlinic in Bydgoszcz Bydgoszcz Poland
| | - Emilia Mikołajewska
- Department of Physiotherapy Ludwik Rydygier Collegium Medicum in Bydgoszcz Nicolaus Copernicus University in Toruń Toruń Poland; Neurocognitive Laboratory Centre for Modern Interdisciplinary Technologies Nicolaus Copernicus University in Toruń Toruń Poland
| | - Ewelina Kuczko-Piekarska
- Neurology Clinic Military Clinical Hospital No. 10 with Policlinic in Bydgoszcz Bydgoszcz Poland
| | | | - Aleksander Goch
- Department of Physiotherapy Ludwik Rydygier Collegium Medicum in Bydgoszcz Nicolaus Copernicus University in Toruń Toruń Poland; Cardiology and Cardiosurgery Clinic Military Clinical Hospital No. 10 with Policlinic in Bydgoszcz Bydgoszcz Poland
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Interactions between genetic, lifestyle and environmental risk factors for multiple sclerosis. Nat Rev Neurol 2016; 13:25-36. [PMID: 27934854 DOI: 10.1038/nrneurol.2016.187] [Citation(s) in RCA: 642] [Impact Index Per Article: 80.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Genetic predisposition to multiple sclerosis (MS) only explains a fraction of the disease risk; lifestyle and environmental factors are key contributors to the risk of MS. Importantly, these nongenetic factors can influence pathogenetic pathways, and some of them can be modified. Besides established MS-associated risk factors - high latitude, female sex, smoking, low vitamin D levels caused by insufficient sun exposure and/or dietary intake, and Epstein-Barr virus (EBV) infection - strong evidence now supports obesity during adolescence as a factor increasing MS risk. Organic solvents and shift work have also been reported to confer increased risk of the disease, whereas factors such as use of nicotine or alcohol, cytomegalovirus infection and a high coffee consumption are associated with a reduced risk. Certain factors - smoking, EBV infection and obesity - interact with HLA risk genes, pointing at a pathogenetic pathway involving adaptive immunity. All of the described risk factors for MS can influence adaptive and/or innate immunity, which is thought to be the main pathway modulated by MS risk alleles. Unlike genetic risk factors, many environmental and lifestyle factors can be modified, with potential for prevention, particularly for people at the greatest risk, such as relatives of individuals with MS. Here, we review recent data on environmental and lifestyle factors, with a focus on gene-environment interactions.
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Immune regulatory effects of high dose vitamin D 3 supplementation in a randomized controlled trial in relapsing remitting multiple sclerosis patients receiving IFNβ; the SOLARIUM study. J Neuroimmunol 2016; 300:47-56. [PMID: 27806875 DOI: 10.1016/j.jneuroim.2016.09.018] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 09/26/2016] [Accepted: 09/30/2016] [Indexed: 11/20/2022]
Abstract
Multiple sclerosis (MS) is characterized by a disturbed immune homeostasis and low serum vitamin D levels are associated with an increased disease activity. While vitamin D has been hypothesized to promote the maintenance of immune homeostasis, vitamin D supplementation could be of benefit to patients with MS. The SOLAR study investigated the effects of high dose vitamin D3 supplementation on clinical outcomes in a randomized controlled trial. Here we present the immune regulatory effects, investigated in the SOLARIUM sub-study. Thirty Dutch relapsing remitting (RR) MS patients treated with IFNβ-1a received high dose vitamin D3 supplementation and 23 patients received placebo during a period of 48weeks. Lymphocytes were phenotypically characterized by flow cytometry and in vitro cytokine secretion was assessed in the presence or absence of 1,25(OH)2D3 using Luminex technology. Changes in immune regulatory parameters were determined within subjects as well as between treatment groups. The proportion of cells in the immune regulatory cell compartment (nTreg, iTreg and Breg) was not altered upon high dose vitamin D3 supplementation. Proportions of T helper subsets were not affected by vitamin D3, except for the proportion of IL4+ Th cells, which decreased in the placebo but not in the vitamin D3 group. T cell cytokine secretion increased, most pronounced for IL5 and latency activated protein of TGFβ, in the placebo group but not in the vitamin D3 group. Lymphocytes remained equally reactive to in vitro 1,25(OH)2D3. In conclusion, high dose vitamin D3 supplementation did not result in a relative increase in lymphocytes with a regulatory phenotype. However, this study supports the hypothesis that vitamin D contributes to the maintenance of immune homeostasis by preventing further disturbance of the T cell compartment early in the disease course of MS.
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Bhise V, Dhib-Jalbut S. Further understanding of the immunopathology of multiple sclerosis: impact on future treatments. Expert Rev Clin Immunol 2016; 12:1069-89. [PMID: 27191526 DOI: 10.1080/1744666x.2016.1191351] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION The understanding of the immunopathogenesis of multiple sclerosis (MS) has expanded with more research into T-cell subtypes, cytokine contributors, B-cell participation, mitochondrial dysfunction, and more. Treatment options have rapidly expanded with three relatively recent oral therapy alternatives entering the arena. AREAS COVERED In the following review, we discuss current mechanisms of immune dysregulation in MS, how they relate to current treatments, and the impact these findings will have on the future of therapy. Expert commentary: The efficacy of these medications and understanding their mechanisms of actions validates the immunopathogenic mechanisms thought to underlie MS. Further research has exposed new targets, while new promising therapies have shed light on new aspects into the pathophysiology of MS.
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Affiliation(s)
- Vikram Bhise
- a Rutgers Biomedical and Health Sciences - Departments of Pediatrics , Robert Wood Johnson Medical School , New Brunswick , NJ , USA
| | - Suhayl Dhib-Jalbut
- b Rutgers Biomedical and Health Sciences - Departments of Neurology , Robert Wood Johnson Medical School , New Brunswick , NJ , USA
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Zimmerman RK, Lin CJ, Raviotta JM, Nowalk MP. Do vitamin D levels affect antibody titers produced in response to HPV vaccine? Hum Vaccin Immunother 2016; 11:2345-9. [PMID: 26176493 DOI: 10.1080/21645515.2015.1062955] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
In addition to its well-known effects on bone metabolism, vitamin D is an immunomodulating hormone. Serum vitamin D levels in males 18-25 years were measured at baseline, and HPV antibody titers were measured one month following the third quadrivalent HPV vaccine dose. Vitamin D levels were ≥ 30 ng/ml (normal) in 60 males and <30 ng/ml (low) in 113 males. Reverse cumulative distribution curves and scatter plots showed higher antibody titers with low vitamin D for all vaccine strains (P < 0.05). In linear regression analyses, antibody titers for all HPV strains were significantly higher among those with lower vitamin D levels and among younger participants (P < 0.05). These relationships add to the body of knowledge of the complex role of vitamin D in immunoregulation.
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Affiliation(s)
- Richard K Zimmerman
- a Department of Family Medicine ; University of Pittsburgh School of Medicine ; Pittsburgh PA USA
| | - Chyongchiou Jeng Lin
- a Department of Family Medicine ; University of Pittsburgh School of Medicine ; Pittsburgh PA USA
| | - Jonathan M Raviotta
- a Department of Family Medicine ; University of Pittsburgh School of Medicine ; Pittsburgh PA USA
| | - Mary Patricia Nowalk
- a Department of Family Medicine ; University of Pittsburgh School of Medicine ; Pittsburgh PA USA
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Muris AH, Smolders J, Rolf L, Klinkenberg LJJ, van der Linden N, Meex S, Damoiseaux J, Hupperts R. Vitamin D Status Does Not Affect Disability Progression of Patients with Multiple Sclerosis over Three Year Follow-Up. PLoS One 2016; 11:e0156122. [PMID: 27276080 PMCID: PMC4898831 DOI: 10.1371/journal.pone.0156122] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Accepted: 05/10/2016] [Indexed: 01/12/2023] Open
Abstract
Background and Objective The risk of developing multiple sclerosis (MS) as well as MS disease activity is associated with vitamin D (25(OH)D) status. The relationship between the main functional disability hallmark of MS, disability progression, and 25(OH)D status is less well established though, especially not in MS patients with progressive disease. Methods This retrospective follow-up study included 554 MS patients with a serum baseline 25(OH)D level and Expanded Disability Status Scale (EDSS) with a minimum follow-up of three years. Logistic regressions were performed to assess the effect of baseline 25(OH)D status on relapse rate. Repeated measures linear regression analyses were performed to assess the effect on disability and disability progression. Results Baseline deseasonalized 25(OH)D status was associated with subsequent relapse risk (yes/no), but only in the younger MS patients (≤ 37.5 years; OR = 0.872, per 10 nmol/L 25(OH)D, p = 0.041). Baseline 25(OH)D status was not significantly associated with either disability or disability progression, irrespective of MS phenotype. Conclusion Within the physiological range, 25(OH)D status is just significantly associated with the occurrence of relapses in younger MS patients, but is not associated with disability or disability progression over three years follow-up. Whether high dose supplementation to supra physiological 25(OH)D levels prevents disability progression in MS should become clear from long term follow-up of supplementation studies.
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Affiliation(s)
- Anne-Hilde Muris
- School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands
- Academic MS Center Limburg, Zuyderland Medical Center, Sittard, the Netherlands
- * E-mail:
| | - Joost Smolders
- Academic MS Center Limburg, Zuyderland Medical Center, Sittard, the Netherlands
| | - Linda Rolf
- School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands
- Academic MS Center Limburg, Zuyderland Medical Center, Sittard, the Netherlands
| | - Lieke J. J. Klinkenberg
- Central Diagnostic Laboratory, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Noreen van der Linden
- Central Diagnostic Laboratory, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Steven Meex
- Central Diagnostic Laboratory, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Jan Damoiseaux
- Central Diagnostic Laboratory, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Raymond Hupperts
- School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands
- Academic MS Center Limburg, Zuyderland Medical Center, Sittard, the Netherlands
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Hypovitaminosis D upscales B-cell immunoreactivity in multiple sclerosis. J Neuroimmunol 2016; 294:18-26. [DOI: 10.1016/j.jneuroim.2016.03.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 03/15/2016] [Accepted: 03/16/2016] [Indexed: 11/19/2022]
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Yamout B, Karaky NM, Mahfouz RAR, Jaber F, Estaitieh N, Shamaa D, Abbas F, Hoteit R, Daher RT. Vitamin D receptor biochemical and genetic profiling and HLA-class II genotyping among Lebanese with multiple sclerosis - A pilot study. J Neuroimmunol 2016; 293:59-64. [PMID: 27049563 DOI: 10.1016/j.jneuroim.2016.02.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Accepted: 02/09/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) is an autoimmune demyelinating disease affecting mostly young adult females with multifactorial etiology. Recent studies suggested that adequate vitamin D levels may lower the risk of developing MS. OBJECTIVES Our aim was to explore the relationship between vitamin D receptor (VDR) polymorphism, HLA-DR locus genotype, and serum vitamins D and A levels in the Lebanese population. METHODS Fifty MS patients were recruited for this study. The control group consisted of 48 healthy and 51 patients with other neurological disorders (non-MS). Biochemical analysis included serum 25 hydroxyvitamin D (25OHD) and vitamin A. Molecular analysis targeted VDR genotypes (ApaI, TaqI and BsmI) and low resolution HLA typing for DRB1 locus. RESULTS Healthy and non-MS groups had comparable parameters and were combined into one control group. No significant differences were found between MS and control groups for VDR genotypes. The frequency of HLA-DRB1*15 was significantly higher in MS patients (22%) compared to controls (8%) (p=0.018). Odds ratio for MS in the presence of DRB1*15 allele was 3.21 (p=0.018). Cosegregation with A (ApaI) and b (BsmI) alleles did not influence the risk for MS. 25OHD levels were significantly higher in MS patients compared to controls (p=0.002), due to more frequent oral supplementation (p=0.005). Vitamin A levels were comparable between the two groups. When all parameters were included in a logistic regression model adjusted for supplementation, only HLA-DRB1*15 (OR=3.42; p=0.027) contributed significantly to MS risk. CONCLUSION There was no association between serum vitamin D or A or VDR genotypes and MS. HLA-DRB1*15 was the major factor imposing more than 3 folds greater risk for developing MS among Lebanese.
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Affiliation(s)
- Bassem Yamout
- Multiple Sclerosis Center, Department of Neurology, American University of Beirut Medical Center, Lebanon
| | - Nathalie M Karaky
- Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Lebanon
| | - Rami A R Mahfouz
- Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Lebanon
| | - Fadel Jaber
- Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Lebanon
| | - Nour Estaitieh
- Department of Neurology, American University of Beirut Medical Center, Lebanon
| | - Dina Shamaa
- Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Lebanon
| | - Fatmeh Abbas
- Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Lebanon
| | - Rouba Hoteit
- Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Lebanon
| | - Rose T Daher
- Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Lebanon.
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Vitamin D deficiency and its role in neurological conditions: A review. Rev Neurol (Paris) 2016; 172:109-22. [DOI: 10.1016/j.neurol.2015.11.005] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 10/25/2015] [Accepted: 11/02/2015] [Indexed: 12/14/2022]
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Abstract
PURPOSE OF REVIEW Recent studies indicate a role for immune dysregulation in the pathogenesis of multiple sclerosis, an inflammatory demyelinating and degenerative disease of the central nervous system. This review addresses the current mechanisms of immune dysregulation in the development of multiple sclerosis, including the impact of environmental risk factors on immunity in both multiple sclerosis and its animal models. RECENT FINDINGS CD4 T-helper (Th) cells have long been implicated as the main drivers of pathogenesis of multiple sclerosis. However, current studies indicate that multiple sclerosis is largely a heterogeneous disease process, which involves both innate and adaptive immune-mediated inflammatory mechanisms that ultimately contribute to demyelination and neurodegeneration. Therefore, B cells, CD8 T cells, and microglia/macrophages can also play an important role in the immunopathogenesis of multiple sclerosis apart from proinflammatory CD4 Th1/Th17 cell subsets. Furthermore, increasing evidence indicates that environmental risk factors, such as Vitamin D deficiency, Epstein-Barr virus, smoking, Western diet, and the commensal microbiota, influence the development of multiple sclerosis through interactions with genetic variants of multiple sclerosis, thus leading to the dysregulation of immune responses. SUMMARY A better understanding of immune-mediated mechanisms in the pathogenesis of multiple sclerosis and the contribution of environmental risk factors toward the development of multiple sclerosis will help further improve therapeutic approaches to prevent disease progression.
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Sundström P, Salzer J. Vitamin D and multiple sclerosis—from epidemiology to prevention. Acta Neurol Scand 2016; 132:56-61. [PMID: 26046560 DOI: 10.1111/ane.12432] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2015] [Indexed: 02/06/2023]
Abstract
In the present review, we discuss observational and experimental data suggesting a protective effect from sun exposure and/or vitamin D in multiple sclerosis (MS). These data include geographic variations in MS occurrence, temporal trends, genetics, biobank, and questionnaire data. We look more closely at the differentiation between general effects from UV exposure, and those of vitamin D per se, including plausible mechanisms of action. Finally, primary prevention is touched upon, and we suggest actions to be taken while awaiting the results from ongoing randomized controlled trials with vitamin D in MS.
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Affiliation(s)
- P. Sundström
- Department of Pharmacology and Clinical Neuroscience; Section of Neurology; Umeå University; Umeå Sweden
| | - J. Salzer
- Department of Pharmacology and Clinical Neuroscience; Section of Neurology; Umeå University; Umeå Sweden
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The Association of Vitamin D Receptor Polymorphisms with Multiple Sclerosis in a Case-Control Study from Kuwait. PLoS One 2015; 10:e0142265. [PMID: 26540116 PMCID: PMC4634763 DOI: 10.1371/journal.pone.0142265] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 10/20/2015] [Indexed: 11/25/2022] Open
Abstract
Vitamin D deficiency is associated with several diseases including multiple sclerosis (MS). Several factors influence vitamin D levels and its optimal multi-function maintenance. Our objective was to assess quantifiable variables influencing vitamin D level and metabolism in MS patients from Kuwait. In a case-control study involving 50 MS patients, and 50 healthy control individuals for which plasma vitamin D levels, supplement use, vitamin D receptor (VDR) variants, and skin pigmentation indices were ascertained; we found overall vitamin D levels to be deficient in both groups, and supplement use to be common practice. VDR variants TaqI and BsmI associated with MS risk, and ApaI associated with low disease progression. VDR variant FokI associated with higher vitamin D levels in both groups. We conclude that several quantifiable variables related to vitamin D associate with MS suggesting a possible clinical immuno-modulatory application of vitamin D for MS patients in Kuwait.
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Karaky M, Alcina A, Fedetz M, Barrionuevo C, Potenciano V, Delgado C, Izquierdo G, Matesanz F. The multiple sclerosis-associated regulatory variant rs10877013 affects expression of CYP27B1 and VDR under inflammatory or vitamin D stimuli. Mult Scler 2015; 22:999-1006. [DOI: 10.1177/1352458515610208] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 09/10/2015] [Indexed: 12/19/2022]
Abstract
Background: Vitamin D deficit is considered an important risk factor for many inflammatory and autoimmune diseases. Objective: To investigate the influence of the multiple sclerosis (MS)-associated regulatory variant rs10877013 on the expression of genes involved in vitamin D activation ( CYP27B1), vitamin D receptor ( VDR), and vitamin D degradation ( CYP24A1) under inflammatory environment or vitamin D. Methods: We used lipopolysaccharide and interferon-gamma (LPS+IFNγ) activated monocytes from 119 individuals and vitamin D-stimulated lymphoblastoid cell lines (LCLs, n = 109) of 1000 genomes to quantify the mRNA expression of vitamin D genes by quantitative reverse transcription polymerase chain reaction (RT-qPCR). Results: We found that CYP27B1 mRNA expression level was associated with the rs10877013 genotypes ( p = 5.0E-6) in LPS+IFNγ treated monocytes, but not in vitamin D-stimulated LCLs. Inversely, rs10877013 genotypes were associated with VDR expression in LCLs ( p = 6.0E-4) but not in monocytes. Finally, CYP24A1 was highly induced by the active form of vitamin D and its expression correlated with the expression of VDR in LCLs but neither the MS-associated variant in the region (rs2248359) nor any other variant located in 1 Mb around CYP24A1 was associated with its expression. Conclusions: The MS-associated variant rs10877013 is a genetic determinant that affects the functioning of the vitamin D system linking environmental and genetic factors.
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Affiliation(s)
- Mohamad Karaky
- Department of Cell Biology and Immunology, Instituto de Parasitología y Biomedicina “López Neyra” (IPBLN-CSIC), Granada, Spain
| | - Antonio Alcina
- Department of Cell Biology and Immunology, Instituto de Parasitología y Biomedicina “López Neyra” (IPBLN-CSIC), Granada, Spain
| | - María Fedetz
- Department of Cell Biology and Immunology, Instituto de Parasitología y Biomedicina “López Neyra” (IPBLN-CSIC), Granada, Spain
| | - Cristina Barrionuevo
- Department of Cell Biology and Immunology, Instituto de Parasitología y Biomedicina “López Neyra” (IPBLN-CSIC), Granada, Spain
| | - Victor Potenciano
- Department of Cell Biology and Immunology, Instituto de Parasitología y Biomedicina “López Neyra” (IPBLN-CSIC), Granada, Spain
| | - Concepción Delgado
- Centro Regional de Transfusión Sanguínea Granada-Almería (CRTS), Granada, Spain
| | - Guillermo Izquierdo
- Unidad de Esclerosis Múltiple, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Fuencisla Matesanz
- Department of Cell Biology and Immunology, Instituto de Parasitología y Biomedicina “López Neyra” (IPBLN-CSIC), Granada, Spain
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Mouhieddine TH, Darwish H, Fawaz L, Yamout B, Tamim H, Khoury SJ. Risk factors for multiple sclerosis and associations with anti-EBV antibody titers. Clin Immunol 2015; 158:59-66. [DOI: 10.1016/j.clim.2015.03.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 03/14/2015] [Indexed: 12/18/2022]
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Røsjø E, Myhr KM, Løken-Amsrud KI, Bakke SJ, Beiske AG, Bjerve KS, Hovdal H, Lilleås F, Midgard R, Pedersen T, Šaltytė Benth J, Torkildsen Ø, Wergeland S, Michelsen AE, Aukrust P, Ueland T, Holmøy T. Vitamin D status and effect of interferon-β1a treatment on MRI activity and serum inflammation markers in relapsing-remitting multiple sclerosis. J Neuroimmunol 2015; 280:21-8. [PMID: 25773151 DOI: 10.1016/j.jneuroim.2015.02.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 01/10/2015] [Accepted: 02/09/2015] [Indexed: 10/24/2022]
Abstract
To explore if vitamin D modulates interferon-β1a treatment effects in relapsing-remitting multiple sclerosis, we examined relationships between serum vitamin D and magnetic resonance imaging (MRI) activity and ten systemic inflammation markers in 88 patients, before and during treatment. Odds ratios for all MRI parameters were negatively associated with vitamin D levels before therapy, but converged to equally low values irrespective of vitamin D status during treatment. During therapy, similar alterations of MRI activity and inflammation markers were found across patients categorized by mean vitamin D values. This suggests that vitamin D status has no major influence on interferon-β1a treatment effects.
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Affiliation(s)
- Egil Røsjø
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Kjell-Morten Myhr
- Norwegian Multiple Sclerosis Registry and Biobank, Department of Neurology, Haukeland University Hospital, Bergen, Norway; KG Jebsen MS Research Centre, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | | | - Søren J Bakke
- Department of Neuroradiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | | | - Kristian S Bjerve
- Clinic of Laboratory Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Harald Hovdal
- Department of Neurology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | | | - Rune Midgard
- Department of Neurology, Molde Hospital, Molde, Norway; Unit for Applied Clinical Research, Norwegian University of Science and Technology, Trondheim, Norway
| | | | - Jūratė Šaltytė Benth
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Helse Sør-Øst Health Services Research Centre, Akershus University Hospital, Lørenskog, Norway
| | - Øivind Torkildsen
- KG Jebsen MS Research Centre, Department of Clinical Medicine, University of Bergen, Bergen, Norway; Norwegian Multiple Sclerosis Competence Centre, Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Stig Wergeland
- Norwegian Multiple Sclerosis Registry and Biobank, Department of Neurology, Haukeland University Hospital, Bergen, Norway; Norwegian Multiple Sclerosis Competence Centre, Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Annika E Michelsen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Pål Aukrust
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway; Section for Clinical Immunology and Infectious Diseases, Oslo University Hospital Rikshospitalet, Oslo, Norway; KG Jebsen Inflammatory Research Center, University of Oslo, Oslo, Norway
| | - Thor Ueland
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Trygve Holmøy
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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