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Lin SH, Wang CC, Huang KT, Chen KD, Hsu LW, Eng HL, Chiu KW. Liver Graft Pathology and Low Serum 25-Hydroxyvitamin D after Living Donor Liver Transplantation. Metabolites 2022; 12:388. [PMID: 35629892 PMCID: PMC9147938 DOI: 10.3390/metabo12050388] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 04/22/2022] [Accepted: 04/22/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Most cases of advanced liver diseases are associated with low serum 25-hydroxyvitamin D and vitamin D deficiency. This phenomenon may occur in living donor liver transplantation (LDLT). AIMS We conducted this study to explore the interplay between VDR and CYP2R1 in liver graft and compared our findings with the pathological interpretation of serum 25(OH)D concentration. METHODS In total, 60 patients received liver graft biopsy after LDLT and were separated (1:1) into two groups: graft rejection group and graft non-rejection group. We extracted both of the recipients' and donors' serum DNA to investigate the vitamin D receptor (VDR) rs2228530 and CYP2R1 rs10741657 single nucleotide polymorphisms (SNPs) using real-time polymerase chain reaction. We also extracted DNA from liver graft tissues to explore the genetic alleles of VDR rs2228530 and CYP2R1 rs10741657 after LDLT. Serum biochemistry profile and 25(OH)D concentrations were measured before and after LDLT. RESULTS There were no significant differences in serum VDR rs2228530 and CYP2R1 rs10741657 genetic alleles between recipients and donors. The percentage of genetic modification was 33.4% (10/30) for the rejection and non-rejection groups in VDR rs2228530, and 66.7% (20/30) for both groups in CYP2R1 rs10741657. Serum 25(OH)D concentrations were significantly lower after LDLT D30 than that before LDLT in the rejection (p = 0.0001) and non-rejection graft pathology (p = 0.0017) groups. CONCLUSIONS The presence of low serum 25(OH)D concentrations after LDLT suggested that post-transplant low serum 25(OH)D concentrations may develop with the homogenous phenomenon of VDR rs2228530 and CYP2R1 rs10741657 genetic modifications in recipients regardless of graft pathology.
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Affiliation(s)
- Shu-Hsien Lin
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan;
- Liver Transplantation Program, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan; (K.-T.H.); (K.-D.C.); (L.-W.H.)
| | - Chih-Chi Wang
- Liver Transplantation Program, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan; (K.-T.H.); (K.-D.C.); (L.-W.H.)
- Division of General Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan;
| | - Kuang-Tzu Huang
- Liver Transplantation Program, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan; (K.-T.H.); (K.-D.C.); (L.-W.H.)
- Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan
| | - Kuang-Den Chen
- Liver Transplantation Program, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan; (K.-T.H.); (K.-D.C.); (L.-W.H.)
- Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan
| | - Li-Wen Hsu
- Liver Transplantation Program, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan; (K.-T.H.); (K.-D.C.); (L.-W.H.)
- Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan
| | - Hock-Liew Eng
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan;
- Department of Pathology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan
| | - King-Wah Chiu
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan;
- Liver Transplantation Program, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan; (K.-T.H.); (K.-D.C.); (L.-W.H.)
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan;
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Bolat H, Erdoğan A. Benign nodules of the thyroid gland and 25-hydroxy-vitamin D levels in euthyroid patients. Ann Saudi Med 2022; 42:83-88. [PMID: 35380060 PMCID: PMC8982002 DOI: 10.5144/0256-4947.2022.83] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 11/26/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The presence of nodules in the thyroid gland is common in iodine-deficient areas of the world. Recently, vitamin D levels were found to be lower than normal and sometimes deficient in malignant nodules of the thyroid. OBJECTIVE Evaluate the relationship between the serum vitamin D levels and benign thyroid nodules in euthyroid patients. DESIGN Cross-sectional. SETTING Tertiary care center in Turkey. PATIENTS AND METHODS Patients referred to the general surgery outpatient clinic and diagnosed with thyroid nodules were the study group. The control group consisted of healthy individuals without thyroid nodules. Age, BMI, thyroid ultrasonography, serum 25-hydroxyvitamin D, free T3, free T4, thyroid stimulating hormone, calcium, magnesium, phosphorous, total protein, albumin, glucose, creatinine levels and glomerular filtration rate (GFR) were compared between groups. MAIN OUTCOME MEASURE Serum 25-hydroxy-vitamin D levels and size of the thyroid nodules. SAMPLE SIZE AND CHARACTERISTICS Of 849 individuals, 453 were patients with thyroid nodules and 396 were healthy individuals. RESULTS The mean serum vitamin D levels of patients with thyroid nodules were significantly lower than controls (P<.001). Serum vitamin D levels along with serum total protein levels and eGFR were independent variables associated with the presence of a thyroid nodule (P<.001, p=.005 and P=.017, respectively). CONCLUSION These findings suggest vitamin D deficiency might be one of the pathophysiologic factors in development of thyroid nodules. LIMITATION Single-center and possible information bias. CONFLICTS OF INTEREST None.
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Affiliation(s)
- Hacı Bolat
- From the Department of General Surgery, Faculty of Medicine, Niğde Ömer Halisdemir University, Niğde, Turkey
| | - Aliriza Erdoğan
- From the Department of General Surgery, Faculty of Medicine, Niğde Ömer Halisdemir University, Niğde, Turkey
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3
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Vitamin D supplementation could reduce the risk of acute cellular rejection and infection in vitamin D deficient liver allograft recipients. Int Immunopharmacol 2019; 75:105811. [DOI: 10.1016/j.intimp.2019.105811] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 08/04/2019] [Accepted: 08/05/2019] [Indexed: 01/26/2023]
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Anastasilakis AD, Tsourdi E, Makras P, Polyzos SA, Meier C, McCloskey EV, Pepe J, Zillikens MC. Bone disease following solid organ transplantation: A narrative review and recommendations for management from The European Calcified Tissue Society. Bone 2019; 127:401-418. [PMID: 31299385 DOI: 10.1016/j.bone.2019.07.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 07/07/2019] [Accepted: 07/08/2019] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Solid organ transplantation is an established therapy for end-stage organ failure. Both pre-transplantation bone disease and immunosuppressive regimens result in rapid bone loss and increased fracture rates. METHODS The European Calcified Tissue Society (ECTS) formed a working group to perform a systematic review of existing literature on the consequences of end-stage kidney, liver, heart, and lung disease on bone health. Moreover, we assessed the characteristics of post-transplant bone disease and the skeletal effects of immunosuppressive agents and aimed to provide recommendations for the prevention and treatment of transplantation-related osteoporosis. RESULTS Characteristics of bone disease may differ depending on the organ that fails, but patients awaiting solid organ transplantation frequently depict a wide spectrum of bone and mineral abnormalities. Common features are a decreased bone mass and impaired bone strength with consequent high fracture risk, all of which are aggravated in the early post-transplantation period. CONCLUSION Both the underlying disease leading to end-stage organ failure and the immunosuppression regimens implemented after successful organ transplantation have detrimental effects on bone mass, quality and strength. Given existing ample data confirming the high frequency of bone disease in patients awaiting solid organ transplantation, we recommend that all transplant candidates should be assessed for osteoporosis and fracture risk and, if indicated, treated before and after transplantation. Since bone loss in the early post-transplantation period occurs in virtually all solid organ recipients and is associated with glucocorticoid administration, the goal should be to use the lowest possible dose and to taper and withdraw glucocorticoids as early as possible.
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Affiliation(s)
| | - Elena Tsourdi
- Department of Medicine III, Technische Universität Dresden Medical Center, Dresden, Germany; Center for Healthy Aging, Technische Universität Dresden Medical Center, Dresden, Germany
| | - Polyzois Makras
- Department of Endocrinology and Diabetes, 251 Hellenic Force & VA General Hospital, Athens, Greece
| | - Stergios A Polyzos
- First Department of Pharmacology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christian Meier
- Division of Endocrinology, Diabetology and Metabolism, University Hospital and University of Basel, Switzerland
| | - Eugene V McCloskey
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK; Centre for Integrated research in Musculoskeletal Ageing (CIMA), Mellanby Centre for Bone Research, University of Sheffield, Sheffield, UK
| | - Jessica Pepe
- Department of Internal Medicine and Medical Disciplines, "Sapienza" University, Rome, Italy
| | - M Carola Zillikens
- Bone Center, Department of Internal Medicine, Erasmus MC, Rotterdam, the Netherlands.
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Prytuła A, Cransberg K, Raes A. Drug-metabolizing enzymes CYP3A as a link between tacrolimus and vitamin D in renal transplant recipients: is it relevant in clinical practice? Pediatr Nephrol 2019; 34:1201-1210. [PMID: 30058048 DOI: 10.1007/s00467-018-4030-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 07/10/2018] [Accepted: 07/20/2018] [Indexed: 01/08/2023]
Abstract
CYP3A enzymes are involved in the metabolism of calcineurin inhibitor tacrolimus as well as vitamin D. In this review, we summarize the clinical aspects of CYP3A-mediated metabolism of tacrolimus and vitamin D with emphasis on the influence of single-nucleotide polymorphisms on tacrolimus disposition. We describe the utility of 4β hydroxycholesterol as a marker of CYP3A activity. Then, we discuss the possible interaction between calcineurin inhibitors and vitamin D in solid organ transplant recipients. Also, we review other mechanisms which may contribute to side effects of calcineurin inhibitors on bone. Lastly, suggestions for future research and clinical perspectives are discussed.
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Affiliation(s)
- Agnieszka Prytuła
- Paediatric Nephrology and Rheumatology Department, Ghent University Hospital, C Heymanslaan 10, 9000, Ghent, Belgium.
| | - Karlien Cransberg
- Paediatric Nephrology Department, Erasmus MC- Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Ann Raes
- Paediatric Nephrology and Rheumatology Department, Ghent University Hospital, C Heymanslaan 10, 9000, Ghent, Belgium.,Safepedrug Unit, Ghent, Belgium
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Ruiz JL, François A. Primeros registros precisos de <em>Trox strandi</em> Balthasar, 1936 (Coleoptera: Trogidae) en Marruecos y observaciones sobre su hábitat y variabilidad morfológica. GRAELLSIA 2018. [DOI: 10.3989/graellsia.2018.v74.214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Trox strandi es una especie rara cuyo estatus taxonómico ha sido controvertido y hasta el momento únicamente se conoce de la localidad tipo, Sidi-bel-Abbes, en el noroeste de Argelia. No obstante, ha sido señalada genéricamente de Libia, Túnez y Marruecos, pero sin que se aporten localidades concretas o material adicional. En el transcurso de diversos muestreos en el sureste de Marruecos durante los últimos años, hemos hallado dos ejemplares atribuibles a esta especie en otras tantas localidades (Tameslemt, en las estribaciones nororientales del Alto Atlas, y Ksabi, en el tramo alto del río Muluya), que constituyen los primeros registros precisos para este país. Estas localidades se sitúan en regiones con bioclima árido y semiárido y escasa cobertura vegetal. Se aportan datos sobre el hábitat, caracteres diagnósticos y variabilidad morfológica de la especie.
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Schiavo L, Busetto L, Cesaretti M, Zelber-Sagi S, Deutsch L, Iannelli A. Nutritional issues in patients with obesity and cirrhosis. World J Gastroenterol 2018; 24:3330-3346. [PMID: 30122874 PMCID: PMC6092576 DOI: 10.3748/wjg.v24.i30.3330] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 06/15/2018] [Accepted: 06/25/2018] [Indexed: 02/06/2023] Open
Abstract
Obesity and metabolic syndrome are considered as responsible for a condition known as the non-alcoholic fatty liver disease that goes from simple accumulation of triglycerides to hepatic inflammation and may progress to cirrhosis. Patients with obesity also have an increased risk of primary liver malignancies and increased body mass index is a predictor of decompensation of liver cirrhosis. Sarcopenic obesity confers a risk of physical impairment and disability that is significantly higher than the risk induced by each of the two conditions alone as it has been shown to be an independent risk factor for chronic liver disease in patients with obesity and a prognostic negative marker for the evolution of liver cirrhosis and the results of liver transplantation. Cirrhotic patients with obesity are at high risk for depletion of various fat-soluble, water-soluble vitamins and trace elements and should be supplemented appropriately. Diet, physical activity and protein intake should be carefully monitored in these fragile patients according to recent recommendations. Bariatric surgery is sporadically used in patients with morbid obesity and cirrhosis also in the setting of liver transplantation. The risk of sarcopenia, micronutrient status, and the recommended supplementation in patients with obesity and cirrhosis are discussed in this review. Furthermore, the indications and contraindications of bariatric surgery-induced weight loss in the cirrhotic patient with obesity are discussed.
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Affiliation(s)
- Luigi Schiavo
- Department of Translational Medical Science, University of Campania “Luigi Vanvitelli”, Naples 80131, Italy
- IX Division of General Surgery, Vascular Surgery and Applied Biotechnology, Naples University Policlinic, Naples 80131, Italy
| | - Luca Busetto
- Department of Medicine, University of Padua, Padua 35128, Italy
- Center for the Study and the Integrated Management of Obesity, University Hospital of Padua, Padua 35128, Italy
| | - Manuela Cesaretti
- Department of HPB Surgery and Liver Transplantation, Hôpital Beaujon, AP-HP, Clichy 92110, France
- Department of Nanophysics, Italian Institute of Technology, Genova 16163, Italy
| | - Shira Zelber-Sagi
- School of Public Health, University of Haifa, Haifa 3498838, Israel
- Department of Gastroenterology and Liver disease, Tel Aviv Medical Center, 62431, Tel-Aviv 62431, Israel
| | - Liat Deutsch
- Department of Gastroenterology and Liver disease, Tel Aviv Medical Center, 62431, Tel-Aviv 62431, Israel
- The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 62431, Israel
| | - Antonio Iannelli
- Digestive Unit, Archet 2 Hospital, University Hospital of Nice, F-06202, Nice, France; Inserm, U1065, Team 8 “Hepatic complications of obesity”, Nice F-06204, France
- University of Nice Sophia-Antipolis, Nice F-06107, France
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Jassil NK, Sharma A, Bikle D, Wang X. VITAMIN D BINDING PROTEIN AND 25-HYDROXYVITAMIN D LEVELS: EMERGING CLINICAL APPLICATIONS. Endocr Pract 2017; 23:605-613. [PMID: 28095044 PMCID: PMC9000994 DOI: 10.4158/ep161604.ra] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
UNLABELLED The precursor of the active form of vitamin D, 25-hydroxyvitamin D (25(OH)D), is recognized as the optimal indicator of vitamin D status. Vitamin D3 undergoes conversion through a multitude of enzymatic reactions described within the paper, and vitamin D levels are dependent on many factors including the vitamin D binding protein (DBP). The free hormone hypothesis postulates that protein-bound hormones are not biologically available and that unbound hormones are biologically active. The majority of circulating 25(OH)D and 1,25-dihydroxyvitamin D is tightly bound to DBP and albumin, with less than 1% circulating in an unbound form. As a result, factors affecting DBP alter the interpretation of 25(OH)D levels. The aim of this review is to assess the current methodology used to measure total and free 25(OH)D, and DBP. Additionally, we analyze the effects of other endocrine hormones and disease processes on DBP levels and subsequently, the interpretation of 25(OH)D levels. ABBREVIATIONS CF = cystic fibrosis DBP = vitamin D binding protein ELISA = enzyme-linked immunosorbent assay ESLD = end-stage liver disease HC = hormone contraceptives iPTH = intact parathyroid hormone LC-MS = liquid chromatography-mass spectrometry MS = multiple sclerosis 25(OH)D = 25-hydroxyvitamin D PHPT = primary hyperparathyroidism RIA = radioimmunoassay.
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Affiliation(s)
- Navinder K Jassil
- Division of Endocrinology, Metabolism and Nutrition, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08903
| | - Anupa Sharma
- Division of Endocrinology, Metabolism and Nutrition, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08903
| | - Daniel Bikle
- Departments of Medicine and Dermatology University of California, San Francisco, CA 94142
| | - Xiangbing Wang
- Division of Endocrinology, Metabolism and Nutrition, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08903
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CYP3A4 is a crosslink between vitamin D and calcineurin inhibitors in solid organ transplant recipients: implications for bone health. THE PHARMACOGENOMICS JOURNAL 2017; 17:481-487. [PMID: 28418012 DOI: 10.1038/tpj.2017.15] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Revised: 12/23/2016] [Accepted: 01/18/2017] [Indexed: 11/08/2022]
Abstract
The use of calcineurin inhibitors (CNIs) and vitamin D deficiency may contribute to the pathogenesis of post-transplant bone disease. CNIs and 1,25-dihydroxyvitamin D₃ (1,25(OH)2D3) are substrates of the drug-metabolizing enzyme CYP3A4. This review summarizes the indications for the use of activated vitamin D analogs in post-transplant care and the current knowledge on the impact of CNIs on bone. We searched for clinical evidence of the interaction between CNIs and 1,25(OH)2D3. We also provide an overview of the literature on the interplay between vitamin D metabolism and CYP3A4 in experimental and clinical settings and discuss its possible implications for solid organ transplant recipients. In conclusion, there is a body of evidence on the interplay between vitamin D and the drug-metabolizing enzyme CYP3A4, which may have therapeutic implications.
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Battista C, Guarnieri V, Carnevale V, Baorda F, Pileri M, Garrubba M, Salcuni AS, Chiodini I, Minisola S, Romagnoli E, Eller-Vainicher C, Santini SA, Parisi S, Frusciante V, Fontana A, Copetti M, Hendy GN, Scillitani A, Cole DEC. Vitamin D status in primary hyperparathyroidism: effect of genetic background. Endocrine 2017; 55:266-272. [PMID: 27154872 DOI: 10.1007/s12020-016-0974-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Accepted: 04/25/2016] [Indexed: 10/21/2022]
Abstract
Primary hyperparathyroidism (PHPT) is associated with hypovitaminosis D as assessed by serum total 25-hydroxyvitamin D (TotalD) levels. The aim of this study is to evaluate whether this is also the case for the calculated bioavailable 25-hydroxyvitamin D (BioD) or free 25-hydroxyvitamin D (FreeD), and whether the vitamin D status is influenced by genetic background. We compared vitamin D status of 88 PHPT patients each with a matched healthy family member sharing genetic background, i.e., first-degree relative (FDR), or not, namely an in-law relative (ILR). We compared TotalD and vitamin D-binding protein (DBP), using the latter to calculate BioD and FreeD. We also genotyped two common DBP polymorphisms (rs7041 and rs4588) likely to affect the affinity for and levels of vitamin D metabolites. TotalD was lower (p < 0.001) in PHPT (12.3 ± 6.6 ng/mL) than either family member group (FDR: 19.4 ± 12.1 and ILR: 23.2 ± 14.1), whether adjusted for DBP or not. DBP levels were also significantly lower (p < 0.001) in PHPT (323 ± 73 mg/L) versus FDR (377 ± 98) or ILR (382 ± 101). The differences between PHPT and control groups for TotalD, BioD, and FreeD were maintained after adjustment for season, gender, and serum creatinine. 25-hydroxyvitamin D, evaluated as total, free, or bioavailable fractions, is decreased in PHPT. No difference was seen between first-degree relative and in-law controls, suggesting that neither genetic nor non-genetic background greatly influences the genesis of the hypovitaminosis D seen in PHPT.
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Affiliation(s)
- Claudia Battista
- Unit of Endocrinology, Medical Genetics, Internal Medicine, Clinical Pathology, Radiotherapy, Nuclear Medicine, Biostatistics, IRCCS "Casa Sollievo della Sofferenza", 71013, San Giovanni Rotondo, Foggia, Italy
| | - Vito Guarnieri
- Unit of Endocrinology, Medical Genetics, Internal Medicine, Clinical Pathology, Radiotherapy, Nuclear Medicine, Biostatistics, IRCCS "Casa Sollievo della Sofferenza", 71013, San Giovanni Rotondo, Foggia, Italy
| | - Vincenzo Carnevale
- Unit of Endocrinology, Medical Genetics, Internal Medicine, Clinical Pathology, Radiotherapy, Nuclear Medicine, Biostatistics, IRCCS "Casa Sollievo della Sofferenza", 71013, San Giovanni Rotondo, Foggia, Italy
| | - Filomena Baorda
- Unit of Endocrinology, Medical Genetics, Internal Medicine, Clinical Pathology, Radiotherapy, Nuclear Medicine, Biostatistics, IRCCS "Casa Sollievo della Sofferenza", 71013, San Giovanni Rotondo, Foggia, Italy
| | - Mauro Pileri
- Unit of Endocrinology, Medical Genetics, Internal Medicine, Clinical Pathology, Radiotherapy, Nuclear Medicine, Biostatistics, IRCCS "Casa Sollievo della Sofferenza", 71013, San Giovanni Rotondo, Foggia, Italy
| | - Maria Garrubba
- Unit of Endocrinology, Medical Genetics, Internal Medicine, Clinical Pathology, Radiotherapy, Nuclear Medicine, Biostatistics, IRCCS "Casa Sollievo della Sofferenza", 71013, San Giovanni Rotondo, Foggia, Italy
| | - Antonio S Salcuni
- Unit of Endocrinology, Medical Genetics, Internal Medicine, Clinical Pathology, Radiotherapy, Nuclear Medicine, Biostatistics, IRCCS "Casa Sollievo della Sofferenza", 71013, San Giovanni Rotondo, Foggia, Italy
| | - Iacopo Chiodini
- Unit of Endocrinology and Metabolic Diseases, Fondazione IRCCS Cà Granda, Department of Clinical Sciences and Community Health, University of Milan, 20122, Milan, Italy
| | - Salvatore Minisola
- Department of Internal Medicine and Medical Discipline, "Sapienza" Rome University, 00185, Rome, Italy
| | - Elisabetta Romagnoli
- Department of Experimental Medicine, "Sapienza" Rome University, 00185, Rome, Italy
| | - Cristina Eller-Vainicher
- Unit of Endocrinology and Metabolic Diseases, Fondazione IRCCS Cà Granda, Department of Clinical Sciences and Community Health, University of Milan, 20122, Milan, Italy
| | - Stefano A Santini
- Unit of Endocrinology, Medical Genetics, Internal Medicine, Clinical Pathology, Radiotherapy, Nuclear Medicine, Biostatistics, IRCCS "Casa Sollievo della Sofferenza", 71013, San Giovanni Rotondo, Foggia, Italy
| | - Salvatore Parisi
- Unit of Endocrinology, Medical Genetics, Internal Medicine, Clinical Pathology, Radiotherapy, Nuclear Medicine, Biostatistics, IRCCS "Casa Sollievo della Sofferenza", 71013, San Giovanni Rotondo, Foggia, Italy
| | - Vincenzo Frusciante
- Unit of Endocrinology, Medical Genetics, Internal Medicine, Clinical Pathology, Radiotherapy, Nuclear Medicine, Biostatistics, IRCCS "Casa Sollievo della Sofferenza", 71013, San Giovanni Rotondo, Foggia, Italy
| | - Andrea Fontana
- Unit of Endocrinology, Medical Genetics, Internal Medicine, Clinical Pathology, Radiotherapy, Nuclear Medicine, Biostatistics, IRCCS "Casa Sollievo della Sofferenza", 71013, San Giovanni Rotondo, Foggia, Italy
| | - Massimiliano Copetti
- Unit of Endocrinology, Medical Genetics, Internal Medicine, Clinical Pathology, Radiotherapy, Nuclear Medicine, Biostatistics, IRCCS "Casa Sollievo della Sofferenza", 71013, San Giovanni Rotondo, Foggia, Italy
| | - Geoffrey N Hendy
- Experimental Therapeutics and Metabolism, McGill University Health Centre-Research Institute, and Departments of Medicine, Physiology and Human Genetics, McGill University, Montreal, QC, H4A 3J1, Canada
| | - Alfredo Scillitani
- Unit of Endocrinology, Medical Genetics, Internal Medicine, Clinical Pathology, Radiotherapy, Nuclear Medicine, Biostatistics, IRCCS "Casa Sollievo della Sofferenza", 71013, San Giovanni Rotondo, Foggia, Italy.
| | - David E C Cole
- Departments of Laboratory Medicine and Pathobiology, Medicine and Genetics, University of Toronto, Toronto, ON, M4N 3M5, Canada
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Prytuła A, Walle JV, Van Vlierberghe H, Kaufman JM, Fiers T, Dehoorne J, Raes A. Factors associated with 1,25-dihydroxyvitamin D3 concentrations in liver transplant recipients: a prospective observational longitudinal study. Endocrine 2016; 52:93-102. [PMID: 26433738 DOI: 10.1007/s12020-015-0757-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 09/22/2015] [Indexed: 01/08/2023]
Abstract
The aim of the study was to identify factors associated with 1,25(OH)2D3 concentrations in liver transplant recipients with emphasis on the renal function and catabolism. We also tested the hypothesis that tacrolimus increases 1,25(OH)2D3 concentrations. Serum 25(OH)D3, 1,25(OH)2D3, and 24,25(OH)2D3 were measured in 41 patients before, at 2 weeks and 3 months after transplantation. Dose-adjusted tacrolimus concentration was used as a surrogate marker of CYP3A4 activity. Factors associated with 1,25(OH)2D3 were identified using multivariate linear regression analysis. The median 1,25(OH)2D3 levels remained stable: 55 versus 46 pg/ml (P = 0.36) despite an increase in 25(OH)D3 from 18 ng/ml at baseline to 26 ng/ml (P = 0.03), serum albumin (34 to 41 g/l, P = 0.02), and comparable eGFR at baseline and month 3 (94 and 92 ml/min, respectively, P = 0.15). At 3 months 19 % of patients had 1,25(OH)2D3 < 25 pg/ml. Low eGFR and a low dose-adjusted tacrolimus concentration were both independently associated with 1,25(OH)2D3 at 3 months. Liver transplant recipients with impaired renal function or a low dose-adjusted tacrolimus concentration suggesting a high CYP3A4 are at risk of low 1,25(OH)2D3 concentrations. The use of tacrolimus does not lead to an increase in 1,25(OH)2D3 concentrations in a clinical setting.
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Affiliation(s)
- Agnieszka Prytuła
- Pediatric Nephrology and Rheumatology Department, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium.
| | - Johan Vande Walle
- Pediatric Nephrology and Rheumatology Department, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium
| | - Hans Van Vlierberghe
- Department of Gastroenterology and Hepatology, Ghent University Hospital, Ghent, Belgium
| | - Jean-Marc Kaufman
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - Tom Fiers
- Department of Clinical Chemistry, Ghent University Hospital, Ghent, Belgium
| | - Jo Dehoorne
- Pediatric Nephrology and Rheumatology Department, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium
| | - Ann Raes
- Pediatric Nephrology and Rheumatology Department, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium
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Normalized vitamin D metabolite concentrations are better correlated to pharmacological effects than measured concentrations. Future Sci OA 2015; 1:FSO83. [PMID: 28031931 PMCID: PMC5137860 DOI: 10.4155/fso.15.83] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 09/28/2015] [Indexed: 12/31/2022] Open
Abstract
Background: Vitamin D deficiency has been associated with a multitude of diseases, ranging from fractures to cancer. Nearly 99% of vitamin D metabolites are bound to proteins, altering the relationship between concentration and activity. Methods & results: Normalized concentrations were calculated and validated using published data regarding the correlation of 25-hydroxyvitamin D with bone mineral density. In addition, healthy and kidney disease subjects were recruited for preliminary investigations. Use of the normalizing equations resulted in statistically significant improvements in the relationship between vitamin D metabolites and several markers of health status. Conclusion: Normalized concentrations are similar to clinically reported values and are easier to interpret than free or bioavailable concentrations, since their values match the range of measured total concentrations.
Lay abstract: Vitamin D deficiency has been associated with a multitude of diseases, ranging from fractures to cancer. Most vitamin D metabolites are bound to various body components, altering the relationship between reported concentration and biological effects. To compensate for differences in binding between individuals, normalized concentrations were calculated. Use of the normalizing equations resulted in significant improvements in the relationship between the concentration of vitamin D metabolites and health status. The newly developed normalized concentrations are therefore better indicators of vitamin D status and are easier to interpret than free or bioavailable concentrations, since their values match the range of measured total concentrations.
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Glendenning P, Inderjeeth CA. Controversy and consensus regarding vitamin D: Recent methodological changes and the risks and benefits of vitamin D supplementation. Crit Rev Clin Lab Sci 2015; 53:13-28. [DOI: 10.3109/10408363.2015.1074157] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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14
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Anty R, Tonohouan M, Ferrari-Panaia P, Piche T, Pariente A, Anstee QM, Gual P, Tran A. Low Levels of 25-Hydroxy Vitamin D are Independently Associated with the Risk of Bacterial Infection in Cirrhotic Patients. Clin Transl Gastroenterol 2014; 5:e56. [PMID: 24871371 PMCID: PMC4042021 DOI: 10.1038/ctg.2014.6] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 03/10/2014] [Accepted: 04/10/2014] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES: Low levels of vitamin D are associated with a higher mortality in cirrhotic patients, but the role of this deficiency is still unknown. The purpose of this study was to assess the levels of vitamin D in cirrhotic patients with and without bacterial infection. METHODS: 25-hydroxy (25-OH) vitamin D was assessed by immunoassay in 88 patients hospitalized in our hepatology unit. RESULTS: The causes of cirrhosis were mainly alcohol (70%), hepatitis C (10%), or both (9%). Infections (n=38) mainly included bacteriemia (21%), urinary tract infections (24%), and spontaneous bacterial peritonitis (29%). A severe deficiency in vitamin D (<10 ng/ml) was observed in 56.8% of patients. Infections were more frequent in patients with a severe deficiency compared with the others (54 vs. 29%, P=0.02). A severe deficiency in vitamin D was a predictive factor of infection (odds ratio=5.44 (1.35–21.97), P=0.017) independently of the Child–Pugh score (odds ratio=2.09 (1.47–2.97) P=0.00004) and the C-reactive protein level (odds ratio=1.03 (1.002–1.052), P=0.03) in a logistic regression also including the alanine amino transferase (not significant). By a Cox regression analysis, only the presence of an infection was significantly associated with mortality (relative risk=3.24 (1.20–8.76), P=0.02) in a model also associating the Child–Pugh score (not significant) and the presence of a severe deficiency in vitamin D (not significant). CONCLUSIONS: Low levels of 25-OH vitamin D were independently associated with bacterial infections in cirrhotic patients. The impact of 25-OH vitamin D supplementation on the infection rate and death of cirrhotic patients should be assessed in randomized trials.
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Affiliation(s)
- Rodolphe Anty
- 1] Institut National de la Santé et de la Recherche Médicale (INSERM), U1065, Team 8, "Hepatic Complications in Obesity", Nice, France [2] Centre Hospitalier Universitaire of Nice, Digestive Center, Pôle Référence Hépatite C, Hôpital de l'Archet 2, Nice, France [3] Faculty of Medecine, University of Nice-Sophia-Antipolis, Nice, France
| | - M Tonohouan
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1065, Team 8, "Hepatic Complications in Obesity", Nice, France
| | - P Ferrari-Panaia
- Centre Hospitalier Universitaire of Nice, Biological Center, Nice, France
| | - T Piche
- 1] Centre Hospitalier Universitaire of Nice, Digestive Center, Pôle Référence Hépatite C, Hôpital de l'Archet 2, Nice, France [2] Faculty of Medecine, University of Nice-Sophia-Antipolis, Nice, France [3] Institut National de la Santé et de la Recherche Médicale (INSERM), 576, Immunology Department, Archet 1 Hospital, Nice, France
| | - A Pariente
- Centre Hospitalier of Pau, Digestive Center, Pau, France
| | - Q M Anstee
- Institute of Cellular Medicine, The Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - P Gual
- 1] Institut National de la Santé et de la Recherche Médicale (INSERM), U1065, Team 8, "Hepatic Complications in Obesity", Nice, France [2] Faculty of Medecine, University of Nice-Sophia-Antipolis, Nice, France
| | - A Tran
- 1] Institut National de la Santé et de la Recherche Médicale (INSERM), U1065, Team 8, "Hepatic Complications in Obesity", Nice, France [2] Centre Hospitalier Universitaire of Nice, Digestive Center, Pôle Référence Hépatite C, Hôpital de l'Archet 2, Nice, France [3] Faculty of Medecine, University of Nice-Sophia-Antipolis, Nice, France
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15
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Yousefzadeh P, Shapses SA, Wang X. Vitamin D Binding Protein Impact on 25-Hydroxyvitamin D Levels under Different Physiologic and Pathologic Conditions. Int J Endocrinol 2014; 2014:981581. [PMID: 24868205 PMCID: PMC4020458 DOI: 10.1155/2014/981581] [Citation(s) in RCA: 117] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Revised: 04/03/2014] [Accepted: 04/10/2014] [Indexed: 12/15/2022] Open
Abstract
There is a high prevalence of vitamin D deficiency worldwide, but how to define vitamin D deficiency is controversial. Currently, the plasma concentration of total 25-hydroxyvitamin D [25(OH)D] is considered an indicator of vitamin D status. The free hormone hypothesis states that protein-bound hormones are inactive while unbound hormones are free to exert biological activity. The majority of circulating 25(OH)D and 1,25(OH)2D is tightly bound to vitamin D binding protein (DBP), 10-15% is bound to albumin, and less than 1% of circulating vitamin D exists in an unbound form. While DBP is relatively stable in most healthy populations, a recent study showed that there are gene polymorphisms associated with race and ethnicity that could alter DBP levels and binding affinity. Furthermore, in some clinical situations, total vitamin D levels are altered and knowing whether DBP is also altered may have treatment implications. The aim of this review is to assess DBP concentration in different physiological and pathophysiological conditions. We suggest that DBP should be considered in the interpretation of 25(OH)D levels.
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Affiliation(s)
- Pegah Yousefzadeh
- Division of Endocrinology, Metabolism & Nutrition, Department of Medicine, Rutgers University-Robert Wood Johnson Medical School, New Brunswick, NJ 08903, USA
| | - Sue A. Shapses
- Department of Nutritional Sciences, Rutgers University, New Brunswick, NJ 08901, USA
| | - Xiangbing Wang
- Division of Endocrinology, Metabolism & Nutrition, Department of Medicine, Rutgers University-Robert Wood Johnson Medical School, New Brunswick, NJ 08903, USA
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Corey RL, Whitaker MD, Crowell MD, Keddis MT, Aqel B, Balan V, Byrne T, Carey E, Douglas DD, Harrison ME, Vargas HE, Rakela J. Vitamin D deficiency, parathyroid hormone levels, and bone disease among patients with end-stage liver disease and normal serum creatinine awaiting liver transplantation. Clin Transplant 2014; 28:579-84. [PMID: 24628047 DOI: 10.1111/ctr.12351] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2014] [Indexed: 12/11/2022]
Abstract
UNLABELLED Vitamin D deficiency is common among patients with end-stage liver disease (ESLD). The primary aim of our study was to assess the prevalence of vitamin D deficiency, secondary hyperparathyroidism, and bone disease in patients with ESLD awaiting LT. METHODS We retrospectively studied 190 patients at our center. Serum total 25-hydroxyvitamin D (25-OH D), parathyroid hormone (PTH), calcium, and bone mineral analysis (BMA) were recorded. Standard World Health Organization (WHO) criteria were used to diagnose osteopenia/osteoporosis. Only patients with normal serum creatinine were analyzed. RESULTS Thirty-two of 190 patients were excluded from the final analysis (missing serum total 25-OH D levels in three patients and elevated serum creatinine, 29 patients). 105 of 158 (66.4%) evaluable patients had 25-OH D levels <25 ng/mL. Patients included in the analysis (n = 158) were divided according to serum total 25-OH D levels: 0-10 ng/mL (n = 23), 11-20 ng/mL (n = 64), and >20 ng/mL (n = 71). There were no significant differences in mean serum PTH and corrected calcium levels among the three subgroups. Only three patients had elevated serum PTH. Patients with total 25-OH D ≤ 10 ng/mL had higher model for end-stage liver disease (MELD) scores vs. those with 25-OH D > 20 ng/mL (13.3 ± 3, range 8-21, vs. 11.9 ± 3.4, range 6-29, p = 0.004). Irrespective of vitamin D status, bone disease was present in 64.6% of patients. CONCLUSION Low vitamin D levels and bone disease are common among patients with ESLD awaiting LT. Despite a high prevalence of low serum total 25-OH D, our cohort maintained normal corrected calcium levels and did not develop secondary hyperparathyroidism. We propose that free serum 25-OH D and vitamin D-binding protein may be necessary to accurately establish the diagnosis of vitamin D deficiency in the setting of ESLD. Additional studies are needed to further define mechanisms of bone disease in patients with ESLD.
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Affiliation(s)
- Rebecca L Corey
- Transplantation Center, Mayo Clinic Hospital, Phoenix, AZ, USA
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Speeckaert MM, Speeckaert R, van Geel N, Delanghe JR. Vitamin D binding protein: a multifunctional protein of clinical importance. Adv Clin Chem 2014; 63:1-57. [PMID: 24783350 DOI: 10.1016/b978-0-12-800094-6.00001-7] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Since the discovery of group-specific component and its polymorphism by Hirschfeld in 1959, research has put spotlight on this multifunctional transport protein (vitamin D binding protein, DBP). Besides the transport of vitamin D metabolites, DBP is a plasma glycoprotein with many important functions, including sequestration of actin, modulation of immune and inflammatory responses, binding of fatty acids, and control of bone development. A considerable DBP polymorphism has been described with a specific allele distribution in different geographic area. Multiple studies have shed light on the interesting relationship between polymorphisms of the DBP gene and the susceptibility to diseases. In this review, we give an overview of the multifunctional character of DBP and describe the clinical importance of DBP and its polymorphisms. Finally, we discuss the possibilities to use DBP as a novel therapeutic agent.
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Calcidiol deficiency in end-stage organ failure and after solid organ transplantation: status quo. Nutrients 2013; 5:2352-71. [PMID: 23857217 PMCID: PMC3738977 DOI: 10.3390/nu5072352] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 06/13/2013] [Accepted: 06/14/2013] [Indexed: 12/13/2022] Open
Abstract
Among patients with organ failure, vitamin D deficiency is extremely common and frequently does not resolve after transplantation. This review crystallizes and summarizes existing data on the status quo of vitamin D deficiency in patients with organ failure and in solid organ transplant recipients. Interventional studies evaluating different treatment strategies, as well as current clinical practice guidelines and recommendations on the management of low vitamin D status in these patients are also discussed.
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Kitson MT, Roberts SK. D-livering the message: the importance of vitamin D status in chronic liver disease. J Hepatol 2012; 57:897-909. [PMID: 22634121 DOI: 10.1016/j.jhep.2012.04.033] [Citation(s) in RCA: 155] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Revised: 03/29/2012] [Accepted: 04/01/2012] [Indexed: 02/06/2023]
Abstract
Vitamin D is synthesized predominantly in the liver and functions as an important secosteroid hormone with pleiotropic effects. While its key regulatory role in calcium and bone homeostasis is well established, recently there is increasing recognition that vitamin D also regulates cell proliferation and differentiation, and has immunomodulatory, anti-inflammatory and anti-fibrotic properties. These non-skeletal effects are relevant in the pathogenesis and treatment of many causes of chronic liver disease. Vitamin D deficiency is frequently present in chronic liver disease and may predict non-response to antiviral therapy in chronic hepatitis C. Small studies suggest that vitamin D supplementation improves sustained viral response rates, while 1α-hydroxylase polymorphisms and vitamin D-binding protein are also implicated in therapeutic outcomes. Vitamin D deficiency also closely relates to the severity of non-alcoholic fatty liver disease (NAFLD) and is implicated in the pathogenesis of insulin resistance, a key factor in the development of NAFLD. In preclinical studies, phototherapy and vitamin D supplementation ameliorate NAFLD histopathology, while vitamin D is a powerful anti-fibrotic against thioacetamide liver injury. In liver transplant recipients severe vitamin D deficiency predicts, and vitamin D supplementation prevents, acute cellular rejection. The role of vitamin D in the activation and regulation of both innate and adaptive immune systems may explain its importance in the above liver diseases. Further prospective studies are therefore warranted to investigate the therapeutic impact of vitamin D supplementation in chronic liver disease.
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Affiliation(s)
- Matthew T Kitson
- Department of Gastroenterology, The Alfred, Melbourne, Australia
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20
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Chun RF. New perspectives on the vitamin D binding protein. Cell Biochem Funct 2012; 30:445-56. [DOI: 10.1002/cbf.2835] [Citation(s) in RCA: 176] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Revised: 03/09/2012] [Accepted: 03/28/2012] [Indexed: 12/23/2022]
Affiliation(s)
- Rene F. Chun
- UCLA/Orthopaedic Hospital; Department of Orthopaedic Surgery, Orthopaedic Hospital Research Center, David Geffen School of Medicine at UCLA; Los Angeles; California; USA
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