Vitamin D metabolism

1(OH) vitamin D3 supplementation improves the sensitivity of the immune-response during Peg-IFN/RBV therapy in chronic hepatitis C patients-case controlled trial

OBJECTIVE

1,25(OH)2 vitamin D3 can affect immune cells. However, the mechanism responsible for the favorable effects of 1(OH) vitamin D3, which becomes 1,25(OH)2 vitamin D3 in the liver, is not clear. The aim of this study is to analyze the immunological response of 1(OH) vitamin D3 supplementation in CH-C patients.

DESIGN

Forty-two CH-C patients were treated with 1(OH) vitamin D3/Peg-IFNα/RBV. Forty-two case-matched controls were treated with Peg-IFNα/RBV. The expression of Interferon-stimulated genes (ISGs)-mRNA in the liver biopsy samples and JFH-1 replicating Huh-7 cells were quantified by real-time PCR. Ten kinds of cytokines in the plasma were quantified during treatment by using a suspension beads array. A trans-well co-culture system with peripheral blood mononuclear cells (PBMCs) and Huh-7 cells was used to analyze the effect of 1(OH) vitamin D3. The activities of the Th1 response were compared between subjects treated with 1(OH) vitamin D3/Peg-IFN/RBV and those treated with Peg-IFN/RBV therapy alone.

RESULTS

1(OH) vitamin D3/Peg-IFN/RBV treatment could induce rapid viral reduction, especially in IL28B T/T polymorphism. Several kinds of cytokines including IP-10 were significantly decreased after 4 weeks of 1(OH) vitamin D3 treatment (p<0.05). Th1 responses in the subjects treated with 1(OH) vitamin D3/Peg-IFN/RBV were significantly higher than those treated with Peg-IFN/RBV at 12 weeks after Peg-IFN/RBV therapy (p<0.05). The expression of ISGs in the patient's liver biopsy samples was significantly lower than in those treated without 1(OH) vitamin D3 (p<0.05).

CONCLUSION

1(OH) vitamin D3 could improve the sensitivity of Peg-IFN/RBV therapy on HCV-infected hepatocytes by reducing the IP-10 production from PBMCs and ISGs expression in the liver.

1(OH) vitamin D3 supplementation improves the sensitivity of the immune-response during Peg-IFN/RBV therapy in chronic hepatitis C patients-case controlled trial

OBJECTIVE

1,25(OH)2 vitamin D3 can affect immune cells. However, the mechanism responsible for the favorable effects of 1(OH) vitamin D3, which becomes 1,25(OH)2 vitamin D3 in the liver, is not clear. The aim of this study is to analyze the immunological response of 1(OH) vitamin D3 supplementation in CH-C patients.

DESIGN

Forty-two CH-C patients were treated with 1(OH) vitamin D3/Peg-IFNα/RBV. Forty-two case-matched controls were treated with Peg-IFNα/RBV. The expression of Interferon-stimulated genes (ISGs)-mRNA in the liver biopsy samples and JFH-1 replicating Huh-7 cells were quantified by real-time PCR. Ten kinds of cytokines in the plasma were quantified during treatment by using a suspension beads array. A trans-well co-culture system with peripheral blood mononuclear cells (PBMCs) and Huh-7 cells was used to analyze the effect of 1(OH) vitamin D3. The activities of the Th1 response were compared between subjects treated with 1(OH) vitamin D3/Peg-IFN/RBV and those treated with Peg-IFN/RBV therapy alone.

RESULTS

1(OH) vitamin D3/Peg-IFN/RBV treatment could induce rapid viral reduction, especially in IL28B T/T polymorphism. Several kinds of cytokines including IP-10 were significantly decreased after 4 weeks of 1(OH) vitamin D3 treatment (p<0.05). Th1 responses in the subjects treated with 1(OH) vitamin D3/Peg-IFN/RBV were significantly higher than those treated with Peg-IFN/RBV at 12 weeks after Peg-IFN/RBV therapy (p<0.05). The expression of ISGs in the patient's liver biopsy samples was significantly lower than in those treated without 1(OH) vitamin D3 (p<0.05).

CONCLUSION

1(OH) vitamin D3 could improve the sensitivity of Peg-IFN/RBV therapy on HCV-infected hepatocytes by reducing the IP-10 production from PBMCs and ISGs expression in the liver.

Longitudinal assessment of bone mineral density in children and adolescents with inflammatory bowel disease

OBJECTIVES

Low bone mineral density (BMD) is recognized as a potential problem in children with inflammatory bowel disease (IBD). We aimed to describe the longitudinal development of BMD in a population of Swedish pediatric patients with IBD.

METHODS

A total of 144 patients with IBD (93 males; 83 with ulcerative colitis [UC], 45 with Crohn disease [CD]) were examined with dual-energy x-ray absorptiometry at baseline. At follow-up 2 years later, 126 of the initial 144 patients were reexamined. BMD values are expressed as z scores.

RESULTS

Children with UC and CD had significantly lower mean BMD z scores for the lumbar spine (LS) at baseline and after 2 years. The reduction in BMD was equally pronounced in patients with UC and CD, and neither group improved their z score during the follow-up period. Furthermore, significantly lower mean BMD z scores for the LS were found at baseline in boys (-1.1 SD, ±2.7 SD, P < 0.001), but not in girls (-0.0 SD, ±3.0 SD). This finding remained unchanged at follow-up. Subanalyses of the different age groups at baseline showed the lowest BMD values in the group of patients ages 17 to 19 years in boys (mean z score for the LS 1.59 SD, ±3.1 SD) and in girls (mean z score for the LS -3.40 SD, ±3.1 SD); however, at follow-up, these patients had improved their BMD significantly (mean change z score for the LS 1.00 SD, 95% CI 0.40-1.60; 1.90 SD, 95% CI 0.60-3.20).

CONCLUSIONS

In this longitudinal study, the entire group of pediatric patients with IBD showed permanent decreases in their BMD z scores for the LS; however, our data indicate that afflicted children have the potential to improve their BMD by the time they reach early adulthood.

Osteoporosis and physical activity

Bone involution poses serious health risks for aging women. Bone mass is subject to both local (mechanical) and systemic (hormonal) homeostatic control mechanisms. The local forces acting on bone are due to gravity and muscular contraction. There are several theories concerning the mechanisms of local control. When bent, bone functions as a piezoelectric crystal with calcium accumulation on the negatively charged concave surface. Microfractures that occur in response to stress greater than normal levels stimulate osteoclastic activity to remove the damaged structure. Studies of astronauts and immobilized subjects have consistently found bone atrophy. The degree of bone loss is related to the difference in levels of stress normally applied and those at bedrest in the site studied. Correspondingly, athletes have greater bone mass than the sedentary population, with the greatest hypertrophy found in the areas most stressed. Exercise intervention also promotes bone hypertrophy. Both middle-aged and elderly women increase bone mass or reduce the rate of loss in response to physical activity intervention programs.

Monocyte-derived cells express CYP27A1 and convert vitamin D3 into its active metabolite

CYP27A1 catalyses hydroxylations in the biosynthesis of bile acids and the bioactivation of vitamin D3. We investigated the expression of CYP27A1 in human monocytes, monocyte-derived macrophages, and dendritic cells on mRNA and protein levels as well as its enzymatic activity in comparison with the expression of CYP27B1 and CYP24A1. Macrophages showed a strong expression of CYP27A1, whereas monocytes and dendritic cells expressed low levels of CYP27A1 mRNA. Immunohistochemistry revealed CYP27A1 and CYP27B1 protein expression in macrophages. Accordingly, macrophages converted vitamin D3 into the active metabolite 1,25(OH)2D3. Dendritic cells also metabolized vitamin D3 although to a lesser extent. This could be due to the high expression of CYP24A1, the enzyme that degrades 25(OH)D3 and 1,25(OH)2D3. Our results show that macrophages and dendritic cells are capable to perform both hydroxylation steps of the vitamin D3 metabolism suggesting a possible role of local 1,25(OH)2D3 synthesis by myeloid cells in the skin and gut.

Response of plasma 1,25-dihydroxyvitamin D in the human PTH(1-34) infusion test: an improved index for the diagnosis of idiopathic hypoparathyroidism and pseudohypoparathyroidism

Synthetic human parathyroid hormone (1-34) (hPTH(1-34] infusion test has been utilized in the differential diagnosis of hypoparathyroidism by examining the incremental response of urinary phosphate and cyclic adenosine monophosphate (AMP). The response of plasma levels of 1,25-dihydroxyvitamin D (1,25(OH)2D) in parathyroid hormone (PTH) infusion test was studied as a new criterion for the differential diagnosis of idiopathic hypoparathyroidism (IHP) and pseudohypoparathyroidism (PHP). Fourteen patients with IHP, 4 patients with PHP, and five control subjects were studied. All subjects received an intravenous infusion of 30 micrograms hPTH(1-34) over 5 minutes. The basal levels of plasma 1,25(OH)2D in patients with IHP and PHP were significantly lower than those in control subjects, but there was no significant difference between the levels in patients with IHP and in patients with PHP. The plasma levels of 1,25(OH)2D increased after the infusion of hPTH(1-34) and reached a peak 6 to 24 hours afterward. The 1,25(OH)2D increase at 24 hours afterward the infusion (delta 1,25(OH)2D) in control subjects and in patients with IHP were 18.1 +/- 3.91 (mean +/- SEM) and 24.1 +/- 2.80 pg/ml, respectively. There was no significant increase in patients with PHP (delta 1,25(OH)2D = 4.9 +/- 1.97 pg/ml). From these results, the measurement of delta 1,25(OH)2D in hPTH(1-34) infusion test is useful as a criterion for the differential diagnosis of hypoparathyroidism.

26,27-Hexafluoro-1,25-dihydroxyvitamin D3 (F6-1,25(OH)2D3) prevents osteoporosis induced by immobilization combined with ovariectomy in the rat

The effect of 26,27-hexafluoro-1,25-dihydroxyvitamin D3 (F6-1,25(OH)2D3) on experimental osteoporosis in the rat induced by a combination of immobilization and ovariectomy was evaluated. F6-1,25(OH)2D3 increased the femur score and the photo-density. The administration of F6-1,25(OH)2D3 also significantly increased the dry weight, the ash weight and the ash content of the bone. Both F6-1,25(OH)2D3 and 1 alpha(OH)D3 showed a nearly dose-dependent effect and significant inhibition of the decrease of bone mass. Histomorphometry revealed a significant decrease of resorption by the administration of F6-1,25(OH)2D3. Bone formation rate in the F6-1,25(OH)2D3 treated group significantly decreased compared with the vehicle group. In conclusion, the pharmacological effective dose of F6-1,25(OH)2D3 was considered to prevent the osteoporotic decrease of bone mass by suppressing the elevated bone turnover.

A permissive role for extracellular Ca2+ in regulation of prolactin production by 1,25-dihydroxyvitamin D3 in GH3 pituitary cells

A clonal strain of rat pituitary tumor cells (GH3) that spontaneously synthesizes and secretes prolactin (PRL) and growth hormone (GH) was used as model system to study the mechanism of action of 1,25-(OH)2D3. We have previously demonstrated that these cells possess specific cytosol binding proteins for 1,25-(OH)2D3 (Haug and Gautvik, 1985). When the GH3 cells were incubated in a serum-free, chemically defined medium of low extracellular Ca2+ concentration, 1,25-(OH)2D3 stimulated PRL production in a dose-dependent manner. The stimulation was detectable at 10(-11) M, and the maximum effect (2-fold increase) was observed at 10(-9) M (ED50 = 2 x 10(-11) M). The dose-response curve was bell-shaped, and at 10(-6) M 1,25-(OH)2D3 even suppressed PRL production to about 75% of controls. The stimulatory effect was first seen after 2 days and was maximal after 4 days. On a molar basis 25-OHD3 and 1-OHD3 were at least 100 times less potent than 1,25-(OH)2D3, while 24,25-(OH)2D3 had no effect on PRL production. At an extracellular concentration of Ca2+ as low as 4 x 10(-5) M the stimulatory effect of 1,25-(OH)2D3 was small (1.3-fold). Increasing extracellular Ca2+ to 1.5 x 10(-4) M increased the 1,25-(OH)2D3-induced PRL response to 2.1-fold. In contrast to the biphasic effect of 1,25-(OH)2D3 on PRL production, GH production was decreased to about 60% of controls at 10(-8) M and above. These findings indicate that in serum-free medium the stimulatory effect of 1,25-(OH)2D3 on PRL production is critically dependent on the concentration of extracellular Ca2+.

Effect of 1 alpha-hydroxyvitamin D3 on osteoporosis induced by immobilization combined with ovariectomy in rats

The effect of low-dose 1 alpha-hydroxyvitamin D3 [1 alpha(OH)D3] on experimental osteoporosis in rats induced by a combination of hemicordotomy and ovariectomy was evaluated. 1 alpha(OH)D3 (0.1 microgram/kg 1 alpha(OH)D3 three times a week) increased the femur score and photo-density. The administration of 1 alpha(OH)D3 also significantly increased the dry weight and ash weight of the bone. Histomorphometry revealed a significant decrease of bone resorption by the administration of 1 alpha(OH)D3. Significant decreases in 45Ca accretion rate and 14C-proline uptake were also observed. Bone formation in the 1 alpha(OH)D3 treated group was thought to decrease following the decrease of bone resorption.

Demonstration and characterization of a 1 alpha,25-(OH)2D3 receptor-like macromolecule in cultured rat pituitary cells

Recent studies have demonstrated the importance of prolactin (PRL) and growth hormone (GH) in the regulation of 25-hydroxycholecalciferol-1 alpha-hydroxylase activity. We have previously shown that 1 alpha,25-dihydroxycholecalciferol (1 alpha,25-(OH)2D3) reduces PRL and GH production by a clonal strain of rat pituitary tumour cells (GH3). The biologically active form of vitamin D3, 1 alpha,25-(OH)2D3, acts via an initial binding to cytoplasmic receptor proteins in target cells, and we demonstrate in this study the presence of specific receptors for 1 alpha,25-(OH)2D3 in the GH3 cells. GH3 cell cytosol was incubated with [3H]1 alpha,25-(OH)2D3 at 0-4 degrees C. Maximal binding was obtained between 2 and 6 h, and Scatchard analysis showed one single class of binding sites with Kd of 0.33 +/- 0.05 nM (mean + SD) and a Bmax of 103 +/- 26 fmol/mg cytosol protein. Competitive binding experiments revealed the following potency order: 1 alpha,25-(OH)2D3 greater than 25-OHD3 greater than 1 alpha-OHD3, 24,25-(OH)2D3. In contrast, corticosterone, testosterone, progesterone and oestradiol showed negligible ability to displace [3H]1 alpha,25-(OH)2D3 from its receptor. Sucrose gradient ultracentrifugation in high salt concentration revealed that GH3 cell cytosol possessed at 3.7S [3H]1 alpha,25-(OH)2D3 receptor protein which was inactivated by heating and protease treatment, but not after incubation with DNase or RNase. The receptor protein aggregated in salt-free sucrose gradients since the 3.7S complex was shifted reversibly to a approximately 6S form. Isoelectric focussing localized most of the [3H]1 alpha,25-(OH)2D3 to a protein peak with an isoelectric point of approximately 6 (pI 5.8-6.2). Since this 1 alpha,25-(OH)2D3 receptor protein has similar properties as the corresponding 1 alpha,25-(OH)2D3 receptors found in normal rat tissues, we suggest that lactotropes and somatotropes represent true target cells for 1 alpha,25-(OH)2D3.

26,26,26,27,27,27-hexafluoro-1,25-dihydroxyvitamin D3: a highly potent, long-lasting analog of 1,25-dihydroxyvitamin D3

A new fluoro analog of 1,25-dihydroxyvitamin D3, i.e., 26,26,26,27,27,27-hexafluoro-1,25-dihydroxyvitamin D3, has been compared with the native hormone, 1,25-dihydroxyvitamin D3, in its biological potency, duration of action, and binding to the vitamin D transport protein and intestinal receptor protein. The fluoro analog is about 5 times more active than the native hormone in healing rickets and elevating serum inorganic phosphorus levels of rachitic rats. It is about 10 times more active than 1,25-dihydroxyvitamin D3 in increasing intestinal calcium transport and bone calcium mobilization of vitamin D-deficient rats fed a low-calcium diet. Furthermore, the higher biopotency is manifested in animals after oral dosing. Of great importance is that the action of the fluoro analog is longer lasting than that of 1,25-dihydroxyvitamin D3. This is especially apparent in the elevation of serum phosphorus and bone mineralization responses. The fluoro analog is only slightly less competent than 1,25-dihydroxyvitamin D3 in binding to the vitamin D transport protein in rat blood, and is one-third as competent as 1,25-dihydroxyvitamin D3 in binding to the chick intestinal cytosol receptor for 1,25-dihydroxyvitamin D3. These results suggest that the basis for increased potency of this analog is likely the result of less rapid metabolism.

Chronic renal failure and vitamin D metabolites: a status report

Seventeen undialysed adult patients with chronic renal failure took part in a controlled study of the effects of 1,25(OH)2D3 and D3. After a 6-month observation period the patients were allocated at random to 2 groups for 6 months of treatment with either 1,25(OH)2D3 (mean dose 0.5 micrograms daily) or D3 (dose 100 micrograms daily). Treatment was then discontinued and the patients were studied for a further 3 months. The patients as a group initially had a moderate renal osteodystrophy. During treatment serum iPTH decreased in both groups but most markedly in the 1,25(OH)2D3 group in which the iPTH values became normal. Serum creatinine increased during treatment in both groups, in the group receiving 1,25(OH)2D3 this was coupled with an increase in serum calcium to within the normal range. Our data demonstrate that 1,25(OH)2D3 treatment in patients with chronic renal failure leads to a further reduction in renal function, which may be partially reversible. Physicians should therefore be reluctant to give vitamin D analogues to patients with chronic renal failure unless they have severe symptomatic renal osteodystrophy.

"Nutritional insurance" supplementation and corticosteroid toxicity

Specialized "nutritional insurance" supplementation may reduce the risk of many important complications of long-term corticosteroid treatment. Supplementation with calcium, fluoride, activated vitamin D metabolites, and GTF, should help prevent osteoporosis. GTF, vitamin C, zinc and fluoride might help offset the inhibitory effect of corticosteroids on fibroblast and osteoblast function. Diabetic, hyperlipidemic and protein-losing effects might be compensated with supplementary GTF. Antioxidant nutrients could support humoral immunity and neutrophil function, while complementing the anti-inflammatory actions of corticosteroids. Supplementary magnesium could reduce the risk of nephrocalcinosis and nephrolithiasis.

No effect of low-dose 1 alpha-hydroxycholecalciferol treatment on the renal function deterioration rate in long-term uraemic rabbits

The development of renal function during 18 weeks of oral treatment with 1 alpha-hydroxycholecalciferol was investigated in rabbits with surgically induced chronic renal failure. Renal function was evaluated by the serum creatinine concentration and the 51Cr-EDTA clearance measured by the single injection technique. Three groups of uraemic rabbits on three different diets with high, medium and low content of calcium and phosphate were studied. The treatment with 0.02 microgram/kg/day of 1 alpha-hydroxycholecalciferol did not induce statistically significant changes in the serum concentrations of calcium or phosphate. Compared to placebo 1 alpha-hydroxycholecalciferol did not increase the deterioration rate of renal function in any of the three groups.

Altered vitamin D metabolism and bone remodelling in patients with medullary thyroid carcinoma and hypercalcitoninemia

Fourteen patients with medullary carcinoma of the thyroid (MCT) and hypercalcitoninemia were studied. Serum concentrations of calcium, phosphorus and iPTH (C-terminal) were normal. Serum 1,25-dihydroxyvitamin D (1,25-(OH)2D) levels were increased (p less than 0.001) in spite of reduced serum 25-hydroxyvitamin D (25-OHD) levels (p less than 0.02) indicating an enhanced activity of the renal 1 alpha-hydroxylase. Serum 24,25-dihydroxyvitamin D levels were normal and correlated positively with serum 25-OHD. Histomorphometric analyses of iliac crest bone biopsies after in vivo tetracycline double-labelling were performed in patients and controls. The patients showed a normal trabecular bone volume. The mean size of the cortical osteocytic lacunae was increased (p less than 0.001). Significant increases were found in fractional formation surfaces (p less than 0.05), fractional labelled surfaces (p less than 0.01) and fractional resorption surfaces (p less than 0.005) in trabecular bone. The appositional rate of newly mineralized bone was reduced (p less than 0.025). The mean osteoid seam width was normal due to an unchanged mineralization lag time and a normal osteoid appositional rate. The bone formation rate at tissue level was high normal. The altered vitamin D metabolism may be caused by a direct effect of hypercalcitoninemia on the renal l alpha-hydroxylase or may represent an adaptive change in calcium-phosphorus homeostasis. The dynamic bone changes are similar to those found in primary hyperparathyroidism and may be caused by an enhanced sensitivity to circulating PTH induced by the increased 1,25-(OH)2D.

Changes in plasma 1,25 and 24,25-dihydroxyvitamin D after renal transplantation in children

The purpose of this investigation is to analyze changes in plasma 1,25-(OH)2D and 24,25-(OH)2D after successful renal transplantation in 20 children and young adults. Studies were performed on 8 subjects between the 1st and 10th month and on 12 others between the 20th and 30th to 36th month. Samples were assayed for plasma and urinary calcium, inorganic phosphate, creatinine, plasma bicarbonate, immunoreactive parathyroid hormone, 25-(OH)D, 24,25-(OH)2D, and 1,25-(OH)2D concentrations. Results showed the following: (1) All subjects had normal or high plasma levels of dihydroxyvitamin D metabolites. (2) In subjects with normal GFR's there was a significant inverse correlation between plasma 1,25-(OH)2D concentrations and tubular reabsorption of phosphorus. (3) These correlations were not found in subjects with subnormal creatinine clearances (50 to 100 ml/min/1.73 m2) even though plasma 1,25-(OH)2D concentrations in these subjects were similar to those with normal creatinine clearances. (4) In subjects with subnormal creatinine clearances, an increase in plasma 1,25-(OH)2D concentrations to very high levels was observed during the first months following renal transplantation.

Adequate bone mineralization in breast-fed infants

To determine if human milk provides sufficient nutrients for adequate bone mineralization in healthy term infants, 76 term Caucasian infants were evaluated at 2 and 16 weeks of age. The infants and their mothers were divided according to the infant's diet into three groups: human milk alone, human milk with supplemental vitamin D, and Similac. At 2 and 16 weeks of age, bone mineral content was measured by photon absorptiometry and blood was drawn for measurement of serum calcium, phosphate, alkaline phosphatase, and 25-OH vitamin D. At both 2 and 16 weeks of age, BMC was similar among all three feeding groups. At 16 weeks of age there was no difference in serum total Ca, ionized Ca, P, or alkaline phosphatase values. At 16 weeks of age the serum 25-OH D concentration was lower in the infants fed human milk alone (P less than 0.05), but was within the normal adult range. Maternal BMC and serum 25-OH D values are similar among the three groups. No seasonal effect on BMC was observed. Our data suggest that during the first 16 weeks of life, routine vitamin D supplementation for breast-fed term Caucasian infants may not be necessary.

The ultrastructure of nephrocalcinosis induced in chicks by Cestrum diurnum leaves

Powdered Cestrum diurnum leaves, mixed with two diets differing in calcium and phosphorus contents, produced nephrocalcinosis in young chicks regardless of serum calcium elevation. The calcific deposits, found in both proximal and distal portions of cortical tubules, began either in the cytoplasm or in lysosomal bodies as a unilaminar spheroid structure containing apatite crystals. The ultrastructural characteristics of intraluminal concretions suggested that they were formed intracellularly but later were extruded into the lumen. The extent of calcific deposits increased with duration and with hypercalcemia. Although Cestrum contains an analog of 1,25-dihydroxycholecalciferol, neither mitochondria nor basal lamina contained calcific deposits described in nephrocalcinosis secondary to hypervitaminosis D.

1,25(OH)2D3 is not the only D metabolite involved in the pathogenesis of osteomalacia

Three patients are described in whom there was no simple correlation between plasma 1,25(OH)2D3 concentration and the occurrence of osteomalacia. One patient had severe osteomalacia with high plasma 1,25(OH)2D3 and normal mineral ion product; the second had a normal mineral ion product and no evidence of osteomalacia even though plasma 1,25(OH)2D3 was undetectable; and the third had osteomalacia, low plasma 1,25(OH)2D3 and a reduced mineral ion product. In considering these data in the light of presently available information, it is concluded that osteomalacia can occur as a consequence of a lack of a vitamin D metabolite other than 1,25(OH)2D3, or a consequence of a reduced mineral ion product, but not as a consequence of 1,25(OH)2D3 lack if the mineral ion product is normally maintained and other D metabolites are present. However, a deficiency of 1,25(OH)2D3 normally leads to a reduction in the mineral ion product hence 1,25(OH)2D3 deficiency may play a role in the development of certain forms of osteomalacia.

Thyrotropes in the pituitary are target cells for 1,25 dihydroxy vitamin D3

In the anterior pituitary of the rat, target cells of 1,25 (OH)2 vitamin D3 are identified as those that secrete thyroid stimulating hormone by means of a combined technique of thaw-mount autoradiography and immunohistochemistry. The results for the first time provide evidence that suggests a central effect of 1,25 (OH)2 vitamin D3 on the modulation of thyrotropin secretion in a manner similar to that of other steroid hormones at the level of the pituitary.

The vitamin d hormonal system: implications for bone diseases

A half century ago, vitamin D was recognized as a vitamin. Now it has become clear that it is also a hormone--indeed the biochemical cornerstone of a major hormonal system involved in regulating the body's calcium economy. The active metabolite, calcitriol, produced in the kidney, acts on bone and intestine and has been found effective in therapy of osteodystrophy and perhaps other metabolic bone diseases.

Effects of 1 alpha-hydroxyvitamin D3 and 24R,25-dihydroxyvitamin D3 on bone remodeling

The present study was undertaken to evaluate the effects of 1 alpha-hydroxyvitamin D3 and 24R,25-dihydroxyvitamin D3 on bone remodeling in dogs with osteomalacia induced by vitamin D depletion. To assess the rates of skeletal remodeling, intravital tetracycline labeling and morphometry of surface pattern were employed. Either vitamin D3 derivative accelerated the appositional growth rate, increased the percentage of osteoid seams labeled, and decreased the number, width, and perimeter of new osteoid seams. But the derivatives differed in bone resorbing activity: 1 alpha-hydroxyvitamin D3 increased the number and perimeter of resorption sites whereas 24R,25-dihydroxyvitamin D3 decreased them. Thus the results show that the former is a better bone remodeler while the latter may be useful in treating osteoporosis.

Normal plasma-1,25-(OH)2-vitamin-D concentrations in nutritional osteomalacia

Three patients with advanced untreated nutritional osteomalacia had low plasma concentrations of 25-OHD and 24, 25-(OH)2D, and a raised concentration of immuno-assayable parathyroid hormone. The plasma concentration of 1, 25-(OH)2D was normal in all 3 patients.

Evidence for extra-renal 1 alpha-hydroxylation of 25-hydroxyvitamin D3 in pregnancy

The kidneys are thought to be the only organs capable of 1 alpha-hydroxylation of vitamin D and its metabolites. We have examined the in vivo conversion of 3H-(25,26)-25-hydroxyvitamin D3(25OHD3) to 3H-(25,26)-1 alpha,25-dihydroxyvitamin D3 [1 alpha,25(OH)2D3] in vitamin D-deficient, pregnant and nonpregnant rats. As expected, nephrectomy of nonpregnant, vitamin D-deficient rats prevented the conversion of 25OHD3 to 1 alpha,25(OH)2D3. In contrast, nephrectomy of pregnant, vitamin D-deficient rats reduced but did not abolish the formation of 1 alpha,25(OH)2D3 from its precursor. The identity of the radioactive metabolite formed from 3H-25OHD3 which circulated in nephrectomized, pregnant rats was established as 1 alpha,25(OH)2D3 by comigration with synthetic 1 alpha,25(OH)2D3 on high-pressure liquid chromatography. The simultaneous absence of 1 alpha,25(OH)2D3 in the fetal kidneys indicated that the site of 1 alpha-hydroxylation after nephrectomy of the pregnant rat was probably extra-renal in origin. Two sites of 1 alpha-hydroxylation of 25OHD3, one renal and the other extra-renal, either fetoplacental or maternal, may exist in the pregnant, vitamin D-deficient rat.

Effect of 1-alpha-hydroxyvitamin D3 on osteoporosis in rats induced by oophorectomy

Fifty adult female rats were used to study the effect of 1-alpha-hydroxyvitamin D3 (1alpha-OH-D3) on bone after oophorectomy. The experimental period was 6 months. At the end of the experiment the femurs and the tibias were investigated for bone mass and composition. Significant signs of osteopenia occurred as a result of oophorectomy. The treatment with 1alpha-OH-D3 induced only minor changes in blood chemistry but increased bone mass significantly. The findings support the view that 1alpha-OH-D3 may be a valuable tool in the treatment of osteoporosis resulting from ovarian insufficiency.

Deterioration of renal function during treatment of chronic renal failure with 1,25-dihydroxycholecalciferol

A controlled study of the effects of the potent vitamin-D metabolite, 1, 25-dihydroxycholecalciferol (1,25[OH]2D3), and vitamin D3 was done in 18 non-dialysed patients with chronic renal failure (C.R.F.). Patients with a creatinine clearance below 35 ml/min and mild renal osteodystrophy were selected. After 6 months' observation of the spontaneous course the patients were randomly allocated to 6 months' oral treatment with either 1, 25 (OH)2D3 or vitamin D3 in initial daily doses of 1microgram and 4000 I.U., respectively, combined with 0.5 g calcium. 1,25(OH)2D3 quickly corrected hypocalcaemia, reduced serum-alkaline-phosphatases and serum-immunoreactive-parathyroid-hormone, and more than doubled the urinary excretion rate of calcium. D3 had similar, but less pronounced effects. 7 out of 8 patients on 1,25(OH)2D3, developed hypercalcaemia which necessitated a reduction in dosage. None of the patients on D3 treatment developed hypercalcaemia. The percentage fall in creatinine clearance was greater during treatment than before treatment in all patients on 1, 25 (OH)2D3 (P less than 0.01) and in 7 of 9 patients on vitamin D3 treatment (though the group change here was not significant). Deterioration of renal function is a major limitation of the clinical use of 1, 25(OH)2D3 and D3 in non-dialysed patients with C.R.F. In fact, the decrased formation of 1, 25(OH)2D3 seen in C.R.F. might protect renal function at the expense of abnormalities in mineral metabolism.