Topical vitamin D3: A randomized controlled trial (RCT)

Modulatory role of vitamins A, B3, C, D, and E on skin health, immunity, microbiome, and diseases

Disruption of the skin barrier and immunity has been associated with several skin diseases, namely atopic dermatitis (AD), psoriasis, and acne. Resident and non-resident immune cells and the barrier system of the skin are integral to innate immunity. Recent advances in understanding skin microbiota have opened the scope of further understanding the various communications between these microbiota and skin immune cells. Vitamins, being one of the important micronutrients, have been reported to exert antioxidant, anti-inflammatory, and anti-microbial effects. The immunomodulatory action of vitamins can halt the progression of skin diseases, and thus, understanding the immuno-pharmacology of these vitamins, especially for skin diseases can pave the way for their therapeutic potential. At the same time, molecular and cellular markers modulated with these vitamins and their derivatives need to be explored. The present review is focused on significant vitamins (vitamins A, B3, C, D, and E) consumed as nutritional supplements to discuss the outcomes and scope of studies related to skin immunity, health, and diseases.

Evaluation of the safety, tolerability and plasma vitamin D response to long-term use of patented transdermal vitamin D patches in healthy adults: a randomised parallel pilot study

Background

Vitamin D delivered transdermally may suppress hyperactivity in nociceptor pain receptors and alter pain intensity, offering a useful addition to localised pain management in varying clinical settings. Currently, little is known about long-term usage of continuous-release vitamin D patches.

Method

We conducted a randomised parallel pilot trial to evaluate safety and tolerability of daily application of patented (US8821921B2) transdermal vitamin D patches over 8 weeks and assess time-level profile of serum vitamin D. Compliance, tolerance and sun exposure were monitored daily, serum 25(OH)D measured 2-weekly and dietary intake and safety markers 4-weekly.

Results

Thirty healthy adults were randomised to two treatment groups: big patch and small patch. mean age was 36 years (20-68 years) with a 63% female to 37% male split. Patches differed in size but contained identical ingredients including 30 000 IU cholecalciferol. Physical and blood safety markers remained stable, within normal clinical parameters, and with no clinically meaningful changes throughout. Five big patch participants experienced skin irritation, which was mild and occasional for three, but continuous for two leading to patch withdrawal. There were no skin reactions in small patch group. average, serum 25(OH)D levels increased by +14 nmol/L (SD 11.63, range, -4 to 40 nmol/L) between baseline and week 8, with no significant differences between patch sizes. There was a shift in overall vitamin D status between baseline and week 8 (23% deficient (<30 nmol/L) decreasing to 0%, and normal (>50 nmol/L) increasing from 37% to 70% at week 8).

Conclusion

Based on these results, long-term (8 weeks) application of patented transdermal vitamin D patches was found to be safe. There may be minor skin tolerance issues with big patches for some, which appears to relate to patch size. Larger trials are warranted to explore the increase in vitamin D levels beyond 8 weeks.

Trial registration number

NCT04851990.

Efficacy of transdermal delivery of liposomal micronutrients through body oil massage on neurodevelopmental and micronutrient deficiency status in infants: results of a randomized placebo-controlled clinical trial

BACKGROUND

Micronutrient deficiency is a known cause of adverse neurodevelopment and growth. Poor adherence to oral regimes of micronutrient supplements is a known challenge during the implementation of supplementation programs. The present study evaluates the benefits of liposomal encapsulated micronutrient fortified body oils (LMF oil) that can be used for infant body massage in terms of neurodevelopment and prevention of deficiency.

STUDY DESIGN

Double-blind randomized clinical trial.

METHODS

A total of 444 healthy infants aged 4-7 weeks were randomized to receive either LMF oil (containing iron, vitamin D, folate, and vitamin B12) or placebo oil for gentle body massage till 12 months of age. Blood samples were collected at 6 and 12 months for transferrin saturation (TSAT), hemoglobin, and 25-hydroxy vitamin (25-OH-D) levels. Mental and motor development was assessed at 12 months using developmental assessment for Indian Infants (DASII).

RESULTS

A total of 391 infants completed the study. There was no significant improvement in the hemoglobin in the intervention group at 12 months of age as compared to the placebo group [- 0.50 vs.-0.54 g%]. There was a marginally significant improvement in 25-OH-D at 12 months in the LMF oil group [+ 1.46vs.-0.18 ng/ml, p = 0.049]. In the subgroup of infants with moderate anemia, the intervention prevented the decline in hemoglobin at 12 months of age [adjusted mean change + 0.11vs.-0.51 g%, p = 0.043]. The mental or motor developmental quotients in the intervention group were not significantly different from those in the placebo group.

CONCLUSION

Use of LMF oil for prevention of nutritional deficiency did not offer significant protection against nutritional anemia but prevented vitamin D deficiency to some extent with improvement in 25-OH-D at 12 months. In the subgroup of infants with moderate anemia, the intervention prevented the decline in hemoglobin at 12 months of age. The intervention did not result in significant improvement in mental or motor development. Further evaluation with increased doses needs to be undertaken.

TRIAL REGISTRATION

CTRI no: CTRI/2017/11/010710 ; dated 30/11/2017.

The efficacy of different vitamin D supplementation delivery methods on serum 25(OH)D: A randomised double-blind placebo trial

BACKGROUND

The use of vitamin D supplementation has increased due to greater recognition of widespread deficiency.

AIMS

There has been little research on the effectiveness of different delivery methods and therefore the aim of was to test the efficacy of different delivery methods on serum 25(OH)D.

METHODS

Using a randomised repeated measures double-blind placebo design (registered under ClinicalTrials.gov Identifier no. NCT03463642), changes in serum 25(OH)D over a 4-week period using a capillary spot method were monitored. 62 female participants blindly chose a number related to a supplementation delivery method: pill placebo, pill, oral liquid, oral liquid placebo, Skin oil application (SOA) placebo, SOA plus vitamin D₃ suspension, or SOA plus vitamin D₃ suspension with essential oil enhancer; active vitamin D supplements contained 100,000IU. Participants took their allocated supplements over a 24-hr period with serum 25(OH)D retested 4 weeks later. Liquid chromatography-tandem mass spectrometry method was applied to dried blood spot samples by an independent laboratory.

RESULTS

ANCOVA reported a significant difference between the groups (F_1,6 = 146.68; p < 0.001, eta² = 0.51). Separate analysis within the delivery methods (pill, SOA, oral liquid) indicated significant differences between the active and placebo supplementation groups (p < 0.01). Post hoc analysis of absolute changes indicated vit D pill and SOA + vit D + essential oil had significant increases (p < 0.05) in serum 25(OH)D compared to all other interventions with no significant difference between them.

CONCLUSIONS

In human participants vitamin D oral pill has the greatest effect on serum 25(OH)D levels. Skin oil application delivery of vitamin D using a penetrator enhancer has also been shown to be an effective method of delivery.

Drug Delivery Systems for Vitamin D Supplementation and Therapy

Vitamin D (VD) is a fat-soluble prohormone well known for its role in regulating calcium and phosphate metabolism. It has been clinically used for many years to prevent rickets in children, osteomalacia, and osteoporosis in adults. VD insufficiency is a common medical condition, and many supplements are available in the market in order to increase serum 25-hydroxy VD levels to recommended amounts. Over the course of the last decades, it has become increasingly clear that calcitriol, an active form of VD, regulates multiple cellular processes with effects on normal and malignant cell growth and differentiation, and on the immune and cardiovascular function. Increasing evidence supports the role of the VD system in cancer prevention and therapy. Due to many pleiotropic and beneficial effects in extra-skeletal disorders, VD has gained potential and become an interesting active for encapsulation into drug delivery systems. The purpose of this review is to present the diversity of drug delivery systems that have been reported for VD or VD derivatives in an orderly manner across the following categories: Oral administration, application on the skin, cancer prevention/therapy, and other diseases or routes of administration.

Protective effects of novel derivatives of vitamin D3 and lumisterol against UVB-induced damage in human keratinocytes involve activation of Nrf2 and p53 defense mechanisms

We tested whether novel CYP11A1-derived vitamin D₃- and lumisterol-hydroxyderivatives, including 1,25(OH)₂D₃, 20(OH)D₃, 1,20(OH)₂D₃, 20,23(OH)₂D₃, 1,20,23(OH)₃D₃, lumisterol, 20(OH)L₃, 22(OH)L₃, 20,22(OH)₂L₃, and 24(OH)L₃, can protect against UVB-induced damage in human epidermal keratinocytes. Cells were treated with above compounds for 24 h, then subjected to UVB irradiation at UVB doses of 25, 50, 75, or 200 mJ/cm², and then examined for oxidant formation, proliferation, DNA damage, and the expression of genes at the mRNA and protein levels. Oxidant formation and proliferation were determined by the DCFA-DA and MTS assays, respectively. DNA damage was assessed using the comet assay. Expression of antioxidative genes was evaluated by real-time RT-PCR analysis. Nuclear expression of CPD, phospho-p53, and Nrf2 as well as its target proteins including HO-1, CAT, and MnSOD, were assayed by immunofluorescence and western blotting. Treatment of cells with the above compounds at concentrations of 1 or 100 nM showed a dose-dependent reduction in oxidant formation. At 100 nM they inhibited the proliferation of cultured keratinocytes. When keratinocytes were irradiated with 50–200 mJ/cm² of UVB they also protected against DNA damage, and/or induced DNA repair by enhancing the repair of 6-4PP and attenuating CPD levels and the tail moment of comets. Treatment with test compounds increased expression of Nrf2-target genes involved in the antioxidant response including GR, HO-1, CAT, SOD1, and SOD2, with increased protein expression for HO-1, CAT, and MnSOD. The treatment also stimulated the phosphorylation of p53 at Ser-15, increased its concentration in the nucleus and enhanced Nrf2 translocation into the nucleus. In conclusion, pretreatment of keratinocytes with 1,25(OH)₂D₃ or CYP11A1-derived vitamin D₃- or lumisterol hydroxy-derivatives, protected them against UVB-induced damage via activation of the Nrf2-dependent antioxidant response and p53-phosphorylation, as well as by the induction of the DNA repair system. Thus, the new vitamin D₃ and lumisterol hydroxy-derivatives represent promising anti-photodamaging agents.

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Vitamin D₃ and lumisterol derivatives stimulate antioxidative responses in skin.

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Vitamin D₃ and lumisterol derivatives protect against UVB-induced DNA damage.

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Vitamin D₃ and lumisterol derivatives target p53 and Nrf2-antioxidant pathways.

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Vitamin D₃ and lumisterol derivatives promise to be skin photoprotectors

Vitamin D testing and treatment: a narrative review of current evidence

Vitamin D testing and treatment is a subject of controversial scientific discussions, and it is challenging to navigate through the expanding vitamin D literature with heterogeneous and partially opposed opinions and recommendations. In this narrative review, we aim to provide an update on vitamin D guidelines and the current evidence on the role of vitamin D for human health with its subsequent implications for patient care and public health issues. Vitamin D is critical for bone and mineral metabolism, and it is established that vitamin D deficiency can cause rickets and osteomalacia. While many guidelines recommend target serum 25-hydroxyvitamin D (25[OH]D) concentrations of ≥50 nmol/L (20 ng/mL), the minimum consensus in the scientific community is that serum 25(OH)D concentrations below 25-30 nmol/L (10-12 ng/mL) must be prevented and treated. Using this latter threshold of serum 25(OH)D concentrations, it has been documented that there is a high worldwide prevalence of vitamin D deficiency that may require public health actions such as vitamin D food fortification. On the other hand, there is also reason for concern that an exploding rate of vitamin D testing and supplementation increases costs and might potentially be harmful. In the scientific debate on vitamin D, we should consider that nutrient trials differ from drug trials and that apart from the opposed positions regarding indications for vitamin D treatment we still have to better characterize the precise role of vitamin D for human health.