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Kumar J, Roem J, Furth SL, Warady BA, Atkinson MA, Flynn JT. Vitamin D and its associations with blood pressure in the Chronic Kidney Disease in Children (CKiD) cohort. Pediatr Nephrol 2024:10.1007/s00467-024-06434-1. [PMID: 38970659 DOI: 10.1007/s00467-024-06434-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 05/13/2024] [Accepted: 06/06/2024] [Indexed: 07/08/2024]
Abstract
BACKGROUND Vitamin D (25OHD) can modulate pathways and mechanisms that regulate blood pressure (BP). Observational studies in children and adults have shown an inverse association between 25OHD and BP. Studies evaluating associations between 25OHD and BP in pediatric chronic kidney disease are limited. METHODS We evaluated the associations between 25OHD and BP using data from the Chronic Kidney Disease in Children (CKiD) study. Clinic or ambulatory BP index was defined as participant's BP divided by 95th age-sex-height-specific BP percentile, an index > 1 suggests hypertension. Primary outcomes of interest were changes in systolic and diastolic clinic and ambulatory BP indices over follow-up. Linear mixed-effects models were used to evaluate associations between BP indices and 25OHD. RESULTS The study cohort consisted of 370 participants who contributed 970 person-visits. A subset of 194 participants with ambulatory BP data contributed 465 person-visits. There was an association between baseline 25OHD levels and clinic systolic BP index such that for every 10 ng/ml lower 25OHD, clinic systolic BP index was 1.0% higher (95%CI: 0.2-1.8, p = 0.016) between participants. The association between clinic diastolic BP index with baseline 25OHD was not significant. For within-person changes, longitudinal decreases in 25OHD were not significantly associated with concomitant increases in clinic systolic or diastolic BP index. There were no significant associations between 25OHD levels at baseline or longitudinally with 24-h ABPM indices. CONCLUSIONS Low 25OHD levels were associated with higher clinic systolic BP in children with CKD. Vitamin D supplementation to maintain normal 25OHD levels might be a useful adjunctive treatment in optimizing BP control in these high-risk patients.
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Affiliation(s)
- Juhi Kumar
- Department of Pediatrics, University of Pittsburgh Medical Center/Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
| | - Jennifer Roem
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Susan L Furth
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Bradley A Warady
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | | | - Joseph T Flynn
- Department of Pediatrics, Seattle Children's Hospital, Seattle, WA, USA
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2
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Baeza C, Pintor-Chocano A, Carrasco S, Sanz A, Ortiz A, Sanchez-Niño MD. Paricalcitol Has a Potent Anti-Inflammatory Effect in Rat Endothelial Denudation-Induced Intimal Hyperplasia. Int J Mol Sci 2024; 25:4814. [PMID: 38732029 PMCID: PMC11084681 DOI: 10.3390/ijms25094814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 04/24/2024] [Accepted: 04/25/2024] [Indexed: 05/13/2024] Open
Abstract
Neointimal hyperplasia is the main cause of vascular graft failure in the medium term. Vitamin D receptor activation modulates the biology of vascular smooth muscle cells and has been reported to protect from neointimal hyperplasia following endothelial injury. However, the molecular mechanisms are poorly understood. We have now explored the impact of the selective vitamin D receptor activator, paricalcitol, on neointimal hyperplasia, following guidewire-induced endothelial cell injury in rats, and we have assessed the impact of paricalcitol or vehicle on the expression of key cell stress factors. Guidewire-induced endothelial cell injury caused neointimal hyperplasia and luminal stenosis and upregulated the expression of the growth factor growth/differentiation factor-15 (GDF-15), the cytokine receptor CD74, NFκB-inducing kinase (NIK, an upstream regulator of the proinflammatory transcription factor NFκB) and the chemokine monocyte chemoattractant protein-1 (MCP-1/CCL2). Immunohistochemistry confirmed the increased expression of the cellular proteins CD74 and NIK. Paricalcitol (administered in doses of 750 ng/kg of body weight, every other day) had a non-significant impact on neointimal hyperplasia and luminal stenosis. However, it significantly decreased GDF-15, CD74, NIK and MCP-1/CCL2 mRNA expression, which in paricalcitol-injured arteries remained within the levels found in control vehicle sham arteries. In conclusion, paricalcitol had a dramatic effect, suppressing the stress response to guidewire-induced endothelial cell injury, despite a limited impact on neointimal hyperplasia and luminal stenosis. This observation identifies novel molecular targets of paricalcitol in the vascular system, whose differential expression cannot be justified as a consequence of improved tissue injury.
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Affiliation(s)
- Ciro Baeza
- Department of Vascular Surgery, IIS-Fundacion Jimenez Diaz UAM, 28040 Madrid, Spain;
| | - Arancha Pintor-Chocano
- RICORS2040, 28049 Madrid, Spain
- Department of Nephrology and Hypertension, IIS-Fundacion Jimenez Diaz UAM, 28040 Madrid, Spain
| | - Susana Carrasco
- RICORS2040, 28049 Madrid, Spain
- Department of Nephrology and Hypertension, IIS-Fundacion Jimenez Diaz UAM, 28040 Madrid, Spain
| | - Ana Sanz
- RICORS2040, 28049 Madrid, Spain
- Department of Nephrology and Hypertension, IIS-Fundacion Jimenez Diaz UAM, 28040 Madrid, Spain
| | - Alberto Ortiz
- RICORS2040, 28049 Madrid, Spain
- Department of Nephrology and Hypertension, IIS-Fundacion Jimenez Diaz UAM, 28040 Madrid, Spain
- Departamento de Medicina, Facultad de Medicina, Universidad Autónoma de Madrid, 28049 Madrid, Spain
| | - Maria Dolores Sanchez-Niño
- RICORS2040, 28049 Madrid, Spain
- Department of Nephrology and Hypertension, IIS-Fundacion Jimenez Diaz UAM, 28040 Madrid, Spain
- Departamento de Farmacología, Facultad de Medicina, Universidad Autónoma de Madrid, 28049 Madrid, Spain
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Argano C, Mirarchi L, Amodeo S, Orlando V, Torres A, Corrao S. The Role of Vitamin D and Its Molecular Bases in Insulin Resistance, Diabetes, Metabolic Syndrome, and Cardiovascular Disease: State of the Art. Int J Mol Sci 2023; 24:15485. [PMID: 37895163 PMCID: PMC10607188 DOI: 10.3390/ijms242015485] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/11/2023] [Accepted: 10/18/2023] [Indexed: 10/29/2023] Open
Abstract
In the last decade, an increasing awareness was directed to the role of Vitamin D in non-skeletal and preventive roles for chronic diseases. Vitamin D is an essential hormone in regulating calcium/phosphorous balance and in the pathogenesis of inflammation, insulin resistance, and obesity. The main forms of vitamin D, Cholecalciferol (Vitamin D3) and Ergocalciferol (Vitamin D2) are converted into the active form (1,25-dihydroxyvitamin D) thanks to two hydroxylations in the liver, kidney, pancreas, and immune cells. Some anti-inflammatory cytokines are produced at higher levels by vitamin D, while some pro-inflammatory cytokines are released at lower levels. Toll-Like Receptor (TLR) expression is increased, and a pro-inflammatory state is also linked to low levels of vitamin D. Regardless of how it affects inflammation, various pathways suggest that vitamin D directly improves insulin sensitivity and secretion. The level of vitamin D in the body may change the ratio of pro- to anti-inflammatory cytokines, which would impact insulin action, lipid metabolism, and the development and function of adipose tissue. Many studies have demonstrated an inverse relationship between vitamin D concentrations and pro-inflammatory markers, insulin resistance, glucose intolerance, metabolic syndrome, obesity, and cardiovascular disease. It is interesting to note that several long-term studies also revealed an inverse correlation between vitamin D levels and the occurrence of diabetes mellitus. Vitamin D supplementation in people has controversial effects. While some studies demonstrated improvements in insulin sensitivity, glucose, and lipid metabolism, others revealed no significant effect on glycemic homeostasis and inflammation. This review aims to provide insight into the molecular basis of the relationship between vitamin D, insulin resistance, metabolic syndrome, type 1 and 2 diabetes, gestational diabetes, and cardiovascular diseases.
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Affiliation(s)
- Christiano Argano
- Department of Internal Medicine, National Relevance and High Specialization Hospital Trust ARNAS Civico Di Cristina Benfratelli, 90127 Palermo, Italy; (L.M.); (S.A.); (V.O.); (A.T.); (S.C.)
| | - Luigi Mirarchi
- Department of Internal Medicine, National Relevance and High Specialization Hospital Trust ARNAS Civico Di Cristina Benfratelli, 90127 Palermo, Italy; (L.M.); (S.A.); (V.O.); (A.T.); (S.C.)
| | - Simona Amodeo
- Department of Internal Medicine, National Relevance and High Specialization Hospital Trust ARNAS Civico Di Cristina Benfratelli, 90127 Palermo, Italy; (L.M.); (S.A.); (V.O.); (A.T.); (S.C.)
| | - Valentina Orlando
- Department of Internal Medicine, National Relevance and High Specialization Hospital Trust ARNAS Civico Di Cristina Benfratelli, 90127 Palermo, Italy; (L.M.); (S.A.); (V.O.); (A.T.); (S.C.)
| | - Alessandra Torres
- Department of Internal Medicine, National Relevance and High Specialization Hospital Trust ARNAS Civico Di Cristina Benfratelli, 90127 Palermo, Italy; (L.M.); (S.A.); (V.O.); (A.T.); (S.C.)
| | - Salvatore Corrao
- Department of Internal Medicine, National Relevance and High Specialization Hospital Trust ARNAS Civico Di Cristina Benfratelli, 90127 Palermo, Italy; (L.M.); (S.A.); (V.O.); (A.T.); (S.C.)
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties, [PROMISE], University of Palermo, 90127 Palermo, Italy
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Nemeth Z, Patonai A, Simon-Szabó L, Takács I. Interplay of Vitamin D and SIRT1 in Tissue-Specific Metabolism-Potential Roles in Prevention and Treatment of Non-Communicable Diseases Including Cancer. Int J Mol Sci 2023; 24:ijms24076154. [PMID: 37047134 PMCID: PMC10094444 DOI: 10.3390/ijms24076154] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/13/2023] [Accepted: 03/16/2023] [Indexed: 04/14/2023] Open
Abstract
The importance of the prevention and control of non-communicable diseases, including obesity, metabolic syndrome, type 2 diabetes, cardiovascular diseases, and cancer, is increasing as a requirement of the aging population in developed countries and the sustainability of healthcare. Similarly, the 2013-2030 action plan of the WHO for the prevention and control of non-communicable diseases seeks these achievements. Adequate lifestyle changes, alone or with the necessary treatments, could reduce the risk of mortality or the deterioration of quality of life. In our recent work, we summarized the role of two central factors, i.e., appropriate levels of vitamin D and SIRT1, which are connected to adequate lifestyles with beneficial effects on the prevention and control of non-communicable diseases. Both of these factors have received increased attention in relation to the COVID-19 pandemic as they both take part in regulation of the main metabolic processes, i.e., lipid/glucose/energy homeostasis, oxidative stress, redox balance, and cell fate, as well as in the healthy regulation of the immune system. Vitamin D and SIRT1 have direct and indirect influence of the regulation of transcription and epigenetic changes and are related to cytoplasmic signaling pathways such as PLC/DAG/IP3/PKC/MAPK, MEK/Erk, insulin/mTOR/cell growth, proliferation; leptin/PI3K-Akt-mTORC1, Akt/NFĸB/COX-2, NFĸB/TNFα, IL-6, IL-8, IL-1β, and AMPK/PGC-1α/GLUT4, among others. Through their proper regulation, they maintain normal body weight, lipid profile, insulin secretion and sensitivity, balance between the pro- and anti-inflammatory processes under normal conditions and infections, maintain endothelial health; balance cell differentiation, proliferation, and fate; and balance the circadian rhythm of the cellular metabolism. The role of these two molecules is interconnected in the molecular network, and they regulate each other in several layers of the homeostasis of energy and the cellular metabolism. Both have a central role in the maintenance of healthy and balanced immune regulation and redox reactions; therefore, they could constitute promising targets either for prevention or as complementary therapies to achieve a better quality of life, at any age, for healthy people and patients under chronic conditions.
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Affiliation(s)
- Zsuzsanna Nemeth
- Department of Internal Medicine and Oncology, Semmelweis University, Koranyi S. u 2/a, 1083 Budapest, Hungary
| | - Attila Patonai
- Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, Ulloi u. 78, 1082 Budapest, Hungary
| | - Laura Simon-Szabó
- Department of Molecular Biology, Semmelweis University, Tuzolto u. 37-47, 1094 Budapest, Hungary
| | - István Takács
- Department of Internal Medicine and Oncology, Semmelweis University, Koranyi S. u 2/a, 1083 Budapest, Hungary
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Jensen NS, Wehland M, Wise PM, Grimm D. Latest Knowledge on the Role of Vitamin D in Hypertension. Int J Mol Sci 2023; 24:ijms24054679. [PMID: 36902110 PMCID: PMC10003079 DOI: 10.3390/ijms24054679] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 02/24/2023] [Accepted: 02/26/2023] [Indexed: 03/06/2023] Open
Abstract
Hypertension is the third leading cause of the global disease burden, and while populations live longer, adopt more sedentary lifestyles, and become less economically concerned, the prevalence of hypertension is expected to increase. Pathologically elevated blood pressure (BP) is the strongest risk factor for cardiovascular disease (CVD) and related disability, thus making it imperative to treat this disease. Effective standard pharmacological treatments, i.e., diuretics, angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blocker (ARBs), beta-adrenergic receptor blockers (BARBs), and calcium channel blockers (CCBs), are available. Vitamin D (vitD) is known best for its role in bone and mineral homeostasis. Studies with vitamin D receptor (VDR) knockout mice show an increased renin-angiotensin-aldosterone system (RAAS) activity and increased hypertension, suggesting a key role for vitD as a potential antihypertensive agent. Similar studies in humans displayed ambiguous and mixed results. No direct antihypertensive effect was shown, nor a significant impact on the human RAAS. Interestingly, human studies supplementing vitD with other antihypertensive agents reported more promising results. VitD is considered a safe supplement, proposing its great potential as antihypertensive supplement. The aim of this review is to examine the current knowledge about vitD and its role in the treatment of hypertension.
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Affiliation(s)
- Niklas S. Jensen
- Department of Biomedicine, Aarhus University, Ole Worms Allé 4, 8000 Aarhus, Denmark
| | - Markus Wehland
- Department of Microgravity and Translational Regenerative Medicine, University Clinic for Plastic, Aesthetic and Hand Surgery, Otto von Guericke University, Universitätsplatz 2, 39106 Magdeburg, Germany
- Research Group “Magdeburger Arbeitsgemeinschaft für Forschung unter Raumfahrt- und Schwerelosigkeitsbedingungen” (MARS), Otto von Guericke University, 39106 Magdeburg, Germany
| | - Petra M. Wise
- The Saban Research Institute, Children’s Hospital Los Angeles, University of Southern California, 4650 Sunset Blvd, Los Angeles, CA 90027, USA
| | - Daniela Grimm
- Department of Biomedicine, Aarhus University, Ole Worms Allé 4, 8000 Aarhus, Denmark
- Department of Microgravity and Translational Regenerative Medicine, University Clinic for Plastic, Aesthetic and Hand Surgery, Otto von Guericke University, Universitätsplatz 2, 39106 Magdeburg, Germany
- Research Group “Magdeburger Arbeitsgemeinschaft für Forschung unter Raumfahrt- und Schwerelosigkeitsbedingungen” (MARS), Otto von Guericke University, 39106 Magdeburg, Germany
- Correspondence: ; Tel.: +45-21379702
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Role of Vitamin D Deficiency in the Pathogenesis of Cardiovascular and Cerebrovascular Diseases. Nutrients 2023; 15:nu15020334. [PMID: 36678205 PMCID: PMC9864832 DOI: 10.3390/nu15020334] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 12/29/2022] [Accepted: 12/30/2022] [Indexed: 01/12/2023] Open
Abstract
Deficiency in vitamin D (VitD), a lipid-soluble vitamin and steroid hormone, affects approximately 24% to 40% of the population of the Western world. In addition to its well-documented effects on the musculoskeletal system, VitD also contributes importantly to the promotion and preservation of cardiovascular health via modulating the immune and inflammatory functions and regulating cell proliferation and migration, endothelial function, renin expression, and extracellular matrix homeostasis. This brief overview focuses on the cardiovascular and cerebrovascular effects of VitD and the cellular, molecular, and functional changes that occur in the circulatory system in VitD deficiency (VDD). It explores the links among VDD and adverse vascular remodeling, endothelial dysfunction, vascular inflammation, and increased risk for cardiovascular and cerebrovascular diseases. Improved understanding of the complex role of VDD in the pathogenesis of atherosclerotic cardiovascular diseases, stroke, and vascular cognitive impairment is crucial for all cardiologists, dietitians, and geriatricians, as VDD presents an easy target for intervention.
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Shcheblykin DV, Bolgov AA, Pokrovskii MV, Stepenko JV, Tsuverkalova JM, Shcheblykina OV, Golubinskaya PA, Korokina LV. Endothelial dysfunction: developmental mechanisms and therapeutic strategies. RESEARCH RESULTS IN PHARMACOLOGY 2022. [DOI: 10.3897/rrpharmacology.8.80376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Introduction: Every year the importance of the normal functioning of the endothelial layer of the vascular wall in maintaining the health of the body becomes more and more obvious.
The physiological role of the endothelium: The endothelium is a metabolically active organ actively involved in the regulation of hemostasis, modulation of inflammation, maintenance of hemovascular homeostasis, regulation of angiogenesis, vascular tone, and permeability.
Risk factors for the development of endothelial dysfunction: Currently, insufficient bioavailability of nitric oxide is considered the most significant risk factor for endothelial dysfunction.
Mechanisms of development of endothelial dysfunction: The genesis of endothelial dysfunction is a multifactorial process. Among various complex mechanisms, this review examines oxidative stress, inflammation, hyperglycemia, vitamin D deficiency, dyslipidemia, excess visceral fat, hyperhomocysteinemia, hyperuricemia, as well as primary genetic defect of endotheliocytes, as the most common causes in the population underlying the development of endothelial dysfunction.
Markers of endothelial dysfunction in various diseases: This article discusses the main biomarkers of endothelial dysfunction currently used, as well as promising biomarkers in the future for laboratory diagnosis of this pathology.
Therapeutic strategies: Therapeutic approaches to the endothelium in order to prevent or reduce a degree of damage to the vascular wall are briefly described.
Conclusion: Endothelial dysfunction is a typical pathological process involved in the pathogenesis of many diseases. Thus, pharmacological agents with endothelioprotective properties can provide more therapeutic benefits than a drug without such an effect.
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Erdem S, Ucmak F, Karahan M, Ava S, Dursun ME, Dursun B, Hazar L, Yolaçan R, Keklikci U. Evaluation of Retinal Microvascular Perfusion Changes in Patients with Celiac Disease. Ocul Immunol Inflamm 2022; 30:1876-1882. [PMID: 34477488 DOI: 10.1080/09273948.2021.1968001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE We aimed to determine whether there are retinal microvascular changes in patients with celiac disease (CD). METHODS A total of 30 patients with CD (group 1) and 30 healthy controls (group 2) were included in this study. AngioVue optical coherence tomography angiography (OCTA) device was used to evaluate the retinal microvascular structure. RESULTS Some of the values of both optic nerve head (ONH) vessel density (VD) and radial peripapillary capillary VDs were found to be significantly lower in group 1 than in group 2. These 2 groups were similar except for one of the parameters of superficial capillary plexus VD (SCP-VD), whereas it was found that deep capillary plexus VD (DCP-VD) was lower in group 1 than in group 2 except for the foveal area. CONCLUSION It was determined that some VDs obtained from the ONH and DCP-VD obtained from most areas of the macular region were significantly lower.
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Affiliation(s)
- Seyfettin Erdem
- Department Ophthalmology, Dicle University Medical Faculty, Diyarbakır, Turkey
| | - Feyzullah Ucmak
- Department of Gastroenterology, Dicle University Medical Faculty, Diyarbakır, Turkey
| | - Mine Karahan
- Department Ophthalmology, Dicle University Medical Faculty, Diyarbakır, Turkey
| | - Sedat Ava
- Department Ophthalmology, Dicle University Medical Faculty, Diyarbakır, Turkey
| | - Mehmet Emin Dursun
- Department Ophthalmology, Dicle University Medical Faculty, Diyarbakır, Turkey
| | - Birgul Dursun
- Department of Ophthalmology, Diyarbakır Gazi Yasargil Training and Research Hospital, Diyarbakır, Turkey
| | - Leyla Hazar
- Department Ophthalmology, Dicle University Medical Faculty, Diyarbakır, Turkey
| | - Ramazan Yolaçan
- Department of Gastroenterology, Dicle University Medical Faculty, Diyarbakır, Turkey
| | - Ugur Keklikci
- Department Ophthalmology, Dicle University Medical Faculty, Diyarbakır, Turkey
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What Links an Increased Cardiovascular Risk and Inflammatory Bowel Disease? A Narrative Review. Nutrients 2021; 13:nu13082661. [PMID: 34444821 PMCID: PMC8398182 DOI: 10.3390/nu13082661] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 07/27/2021] [Accepted: 07/27/2021] [Indexed: 02/08/2023] Open
Abstract
Several studies have shown increased rates of cardiovascular disease (CVD) in patients suffering from inflammatory bowel disease (IBD), particularly in cases of early atherosclerosis and myocardial infarction. IBD most frequently begins at an early age, patients usually present normal weight and remain under constant care of a physician, as well as of a nutritionist. Therefore, the classical risk factors of CVD are not reflected in the higher prevalence of CVD in the IBD population. Still, both groups are characterised by chronic inflammation and display similar physiopathological mechanisms. In the course of IBD, increased concentrations of pro-inflammatory cytokines, such as C-reactive protein (CRP) and homocysteine, may lead to endothelial dysfunctions and the development of CVD. Furthermore, gut microbiota dysbiosis in patients with IBD also constitutes a risk factor for an increased susceptibility to cardiovascular disease and atherosclerosis. Additionally, diet is an essential factor affecting both positively and negatively the course of the aforementioned diseases, whereas several dietary patterns may also influence the association between IBD and CVD. Thus, it is essential to investigate the factors responsible for the increased cardiovascular (CV) risk in this group of patients. Our paper attempts to review the role of potential inflammatory and nutritional factors, as well as intestinal dysbiosis and pharmacotherapy, in the increased risk of CVD in IBD patients.
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Fontányi Z, Sziva RE, Pál É, Hadjadj L, Monori-Kiss A, Horváth EM, Benkő R, Magyar A, Heinzlmann A, Benyó Z, Nádasy GL, Masszi G, Várbíró S. Vitamin D Deficiency Reduces Vascular Reactivity of Coronary Arterioles in Male Rats. Curr Issues Mol Biol 2021; 43:79-92. [PMID: 34066967 PMCID: PMC8928984 DOI: 10.3390/cimb43010007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 04/20/2021] [Accepted: 04/28/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Vitamin D deficiency (VDD) may be considered an independent cardiovascular (CV) risk factor, and it is well known that CV risk is higher in males. Our goal was to investigate the pharmacological reactivity and receptor expression of intramural coronary artery segments of male rats in cases of different vitamin D supply. METHODS Four-week-old male Wistar rats were divided into a control group (n = 11) with optimal vitamin D supply (300 IU/kgbw/day) and a VDD group (n = 11, <0.5 IU/kgbw/day). After 8 weeks of treatment, intramural coronary artery segments were microprepared, their pharmacological reactivity was examined by in vitro microangiometry, and their receptor expression was investigated by immunohistochemistry. RESULTS Thromboxane A2 (TXA2)-agonist induced reduced vasoconstriction, testosterone (T) and 17-β-estradiol (E2) relaxations were significantly decreased, a significant decrease in thromboxane receptor (TP) expression was shown, and the reduction in estrogen receptor-α (ERα) expression was on the border of significance in the VDD group. CONCLUSIONS VD-deficient male coronary arteries showed deteriorated pharmacological reactivity to TXA2 and sexual steroids (E2, T). Insufficient vasoconstrictor capacity was accompanied by decreased TP receptor expression, and vasodilator impairments were mainly functional. The decrease in vasoconstrictor and vasodilator responses results in narrowed adaptational range of coronaries, causing inadequate coronary perfusion that might contribute to the increased CV risk in VDD.
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Affiliation(s)
- Zoltán Fontányi
- Department of Obstetrics and Gynaecology, Semmelweis University, Üllői Street 78/a, 1082 Budapest, Hungary; (Z.F.); (S.V.)
| | - Réka Eszter Sziva
- Department of Obstetrics and Gynaecology, Semmelweis University, Üllői Street 78/a, 1082 Budapest, Hungary; (Z.F.); (S.V.)
- Department of Physiology, Semmelweis University, Tűzoltó Street 37-47, 1094 Budapest, Hungary; (E.M.H.); (R.B.); (G.L.N.)
- Correspondence:
| | - Éva Pál
- Department of Translational Medicine, Semmelweis University, Üllői Street 78/a, 1082 Budapest, Hungary; (É.P.); (L.H.); (A.M.-K.); (Z.B.)
| | - Leila Hadjadj
- Department of Translational Medicine, Semmelweis University, Üllői Street 78/a, 1082 Budapest, Hungary; (É.P.); (L.H.); (A.M.-K.); (Z.B.)
| | - Anna Monori-Kiss
- Department of Translational Medicine, Semmelweis University, Üllői Street 78/a, 1082 Budapest, Hungary; (É.P.); (L.H.); (A.M.-K.); (Z.B.)
| | - Eszter Mária Horváth
- Department of Physiology, Semmelweis University, Tűzoltó Street 37-47, 1094 Budapest, Hungary; (E.M.H.); (R.B.); (G.L.N.)
| | - Rita Benkő
- Department of Physiology, Semmelweis University, Tűzoltó Street 37-47, 1094 Budapest, Hungary; (E.M.H.); (R.B.); (G.L.N.)
| | - Attila Magyar
- Department of Anatomy, Histology and Embriology, Semmelweis University, Tűzoltó Street 58, 1094 Budapest, Hungary;
| | - Andrea Heinzlmann
- Department of Anatomy and Histology, University of Veterinary Medicine, István Street 2, 1078 Budapest, Hungary;
| | - Zoltán Benyó
- Department of Translational Medicine, Semmelweis University, Üllői Street 78/a, 1082 Budapest, Hungary; (É.P.); (L.H.); (A.M.-K.); (Z.B.)
| | - György L. Nádasy
- Department of Physiology, Semmelweis University, Tűzoltó Street 37-47, 1094 Budapest, Hungary; (E.M.H.); (R.B.); (G.L.N.)
| | - Gabriella Masszi
- Department of Internal Medicine, National Institute of Mental Health, Neurology and Neurosurgery, Lehel Street 59-61, 1135 Budapest, Hungary;
| | - Szabolcs Várbíró
- Department of Obstetrics and Gynaecology, Semmelweis University, Üllői Street 78/a, 1082 Budapest, Hungary; (Z.F.); (S.V.)
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Wu-Wong JR, Wessale JL, Chen YW, Chen T, Oubaidin M, Atsawasuwan P. A Novel Vitamin D Receptor Agonist, VS-105, Improves Bone Mineral Density without Affecting Serum Calcium in a Postmenopausal Osteoporosis Rat Model. JOURNAL OF EXPLORATORY RESEARCH IN PHARMACOLOGY 2020; 5:73-80. [PMID: 34589670 PMCID: PMC8478347 DOI: 10.14218/jerp.2020.00020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES VS-105, a novel vitamin D receptor agonist with significantly less hypercalcemic side effects than calcitriol, is a useful tool to investigate whether or not a vitamin D receptor agonist at non-hypercalcemic doses could improve bone mineral density (BMD). METHODS VS-105 and calcitriol were evaluated in an ovariectomized (OVX) osteoporosis rat model and in calvariae bone organ culture. RESULTS Treatment of OVX rats by VS-105 (0.1, 0.2 or 0.5 μg/kg, intraperitoneal, 3×/week, for 90 days) significantly improved BMD in the L3 lumbar vertebra in a dose-dependent manner (sham vs. OVX/vehicle: 324 ± 14 vs. 279 ± 10 mg/cm2; VS-105 at 0.1, 0.2 and 0.5 μg/kg: 306 ± 9, 329 ± 12, and 327 ± 10 mg/cm2, respectively) without affecting serum calcium (Ca). Calcitriol at 0.1 μg/kg significantly increased BMD but it also increased serum Ca. VS-105 and calcitriol at the test doses significantly suppressed serum parathyroid hormone and promoted tibia bone growth. With respect to biomarkers of bone remodeling, calcitriol and VS-105 both significantly elevated serum osteocalcin. In the calvariae bone organ culture, net Ca release was significantly less in VS-105-treated groups (vs. calcitriol). CONCLUSIONS VS-105 is efficacious in improving BMD in a dose range that does not affect serum Ca in OVX rats; the improvement in BMD by VS-105 is attributable to increased osteoblastic activity and reduced osteoclastic bone resorption.
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Affiliation(s)
- J. Ruth Wu-Wong
- Vidasym, Sioux Falls, SD, USA
- Correspondence to: J. Ruth Wu-Wong, Vidasym Inc., 2329 N Career Ave, #303, Sioux Falls, South Dakota, SD 57107 Tel: +1-847-863-9818; Fax: +1-847-260-8432.
| | | | | | | | - Maysaa Oubaidin
- Department of Orthodontics, University of Illinois, Chicago, IL, USA
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Vitamin D and Cardiovascular Disease, with Emphasis on Hypertension, Atherosclerosis, and Heart Failure. Int J Mol Sci 2020; 21:ijms21186483. [PMID: 32899880 PMCID: PMC7555466 DOI: 10.3390/ijms21186483] [Citation(s) in RCA: 123] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 08/24/2020] [Accepted: 08/31/2020] [Indexed: 12/14/2022] Open
Abstract
Vitamin D deficiency is the most common nutritional deficiency, affecting almost one billion people worldwide. Vitamin D is mostly known for its role in intestinal calcium absorption and bone mineralization. However, the observation of seasonal changes in blood pressure and the subsequent identification of vitamin D receptor (VDR) and 1α-hydroxylase in cardiomyocytes, as well as endothelial and vascular smooth muscle cells, implicated a role of vitamin D in the cardiovascular system. Animal studies provided compelling evidence that vitamin D signaling is essential for cardiovascular integrity, especially for the regulation of vascular tone and as an antifibrotic and antihypertrophic signaling pathway in the heart. In addition, observational studies reported an association between vitamin D deficiency and risk of hypertension, atherosclerosis, and heart failure. However, recent clinical intervention studies failed to prove the causal relationship between vitamin D supplementation and beneficial effects on cardiovascular health. In this review, we aim to highlight our current understanding of the role of vitamin D in the cardiovascular system and to find potential explanations for the large discrepancies between the outcome of experimental studies and clinical intervention trials.
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Çakır OM. Low vitamin D levels predict left atrial thrombus in nonvalvular atrial fibrillation. Nutr Metab Cardiovasc Dis 2020; 30:1152-1160. [PMID: 32456946 DOI: 10.1016/j.numecd.2020.03.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 03/14/2020] [Accepted: 03/27/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND AIMS We determined the association between left atrial (LA) thrombus occurrence and a non-classic risk marker, plasma levels of vitamin D, in atrial fibrillation (AF) patients on continuous non-vitamin K antagonist oral anticoagulant (NOAC) therapy for ≥4 weeks. Low levels of plasma 25-hydroxy vitamin D (25-OHD) are predictive of fatal stroke. Vitamin D has anticoagulant effects on the coagulation cascade, which are indirectly targeted by NOAC therapy. The impact of plasma levels of vitamin D on the rate of LA thrombus detected by transesophageal echocardiography (TEE) in AF patients is unknown. METHODS AND RESULTS We enrolled 201 (133 female) AF patients who were using continuous NOAC therapy for ≥4 weeks. All patients underwent transthoracic and TEE examination. Serum concentrations of 25-OHD, C-reactive protein (CRP) levels, CHA2DS2-VASc scores and parameters, LA size, and left ventricle ejection fraction (LVEF) were examined before the TEE procedure. LA thrombus occurrence was independently associated with serum levels of 25-OHD (OR: 0.884; 95% CI: 0.839-0.932; P < 0.001), LA diameter (OR: 1.120; 95% CI: 1.038-1.209; P = 0.003), and LVEF(OR: 0.944; 95% CI: 0.896-0.995; P = 0.032). Dense spontaneous echo contrast (SEC) presence was also inversely associated with 25-OHD concentrations. CONCLUSIONS Low 25-OHD levels, as a non-classic risk factor, were independently and significantly associated with dense SEC and LA thrombus occurrence in AF patients under NOAC therapy, as well as LA enlargement and decreased LVEF. Further large-scale studies are needed to explain the role of vitamin D deficiency, or efficacy of replacement, on LA thrombus occurrence.
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Affiliation(s)
- Ozan M Çakır
- Department of Cardiology, Bülent Ecevit University Faculty of Medicine Medical Center, Zonguldak, Turkey.
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14
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Atamañuk AN, Litewka DF, Baratta SJ, Seropian IM, Perez Prados G, Payaslian MO, Ortiz Fragola JP, Escribano Subias P. Vitamin D deficiency among patients with pulmonary hypertension. BMC Pulm Med 2019; 19:258. [PMID: 31864342 PMCID: PMC6925472 DOI: 10.1186/s12890-019-1011-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 11/25/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is little information about vitamin D (Vit D) deficiency in patients with pulmonary hypertension (PH). The objective of this study was: 1) compare Vit D levels between patients with PH, left ventricular failure (LVF) and healthy subjects (HS); 2) correlate, in patients with PH, Vit D levels with prognosis-related variables, such as the 6-min walk test (6MWT). METHODS Vitamin D levels were measured in a cross-sectional study in 126 patients from one of three groups: patients with PH (n = 53), patients with LVF (n = 42) and healthy subjects (n = 31). In all groups, 8-h fasting blood samples were obtained in the morning. In the PH and the LVF group, functional class (WHO criteria), metres covered in the 6MWT and echocardiographic parameters were analysed. In the PH group, plasma N terminal pro B type natriuretic peptide (NT-proBNP) level was analysed and a complete haemodynamic evaluation by right heart catheterisation was made. RESULTS Mean Vit D levels were lower in PH than in both other groups (ng/ml, mean ± SD): PH 19.25 ± 10, LVF 25.68 ± 12, HS 28.8 ± 12 (PH vs LVF p = 0.017, PH vs HS p = 0.001 and HS vs LVF p = 0.46). Vit D deficiency prevalence was higher in PH as compared to the other groups (PH 53.8%, LVF 45.2%, HS 25%, p = 0.01). Patients with PH in functional class (FC; WHO criteria) III-IV had higher Vit D deficiency prevalence than those in FC I-II (86.7% vs 40.5%, p = 0.003). There was a significant linear correlation between the 6MWT and Vit D levels in PH (p < 0.01), but not in LVF (p = 0.69). CONCLUSIONS Vit D levels were lower in patients with PH as compared to patients with LVF and HS and correlated directly with 6-min walk distance.
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Affiliation(s)
- Andrés N. Atamañuk
- División Cardiología y Servicio de Neumonología, Hospital General de Agudos “Juan A. Fernández”, Ciudad Autónoma de Buenos Aires, Argentina
- Instituto de Cardiología y Terapéutica Cardiovascular, Hospital Universitario Austral, Buenos Aires, Argentina
| | - Diego F. Litewka
- División Cardiología y Servicio de Neumonología, Hospital General de Agudos “Juan A. Fernández”, Ciudad Autónoma de Buenos Aires, Argentina
| | - Sergio J. Baratta
- Instituto de Cardiología y Terapéutica Cardiovascular, Hospital Universitario Austral, Buenos Aires, Argentina
| | - Ignacio M. Seropian
- Servicio de Hemodinamia, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Graciela Perez Prados
- División Cardiología y Servicio de Neumonología, Hospital General de Agudos “Juan A. Fernández”, Ciudad Autónoma de Buenos Aires, Argentina
| | - Miguel O. Payaslian
- División Cardiología y Servicio de Neumonología, Hospital General de Agudos “Juan A. Fernández”, Ciudad Autónoma de Buenos Aires, Argentina
| | - Juan P. Ortiz Fragola
- División Cardiología y Servicio de Neumonología, Hospital General de Agudos “Juan A. Fernández”, Ciudad Autónoma de Buenos Aires, Argentina
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Ergocalciferol improves endothelial vasodilatory and vasoconstrictor function in an in vivo model of mild uraemia. Biosci Rep 2019; 39:221375. [PMID: 31789348 PMCID: PMC6923332 DOI: 10.1042/bsr20190711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 11/20/2019] [Accepted: 11/21/2019] [Indexed: 01/21/2023] Open
Abstract
Endothelial dysfunction and vitamin D deficiency are prevalent in patients with cardiovascular disease (CVD) and chronic kidney disease (CKD). Both are risk factors for cardiovascular events in patients with CKD. No studies have investigated the effect of nutritional forms of vitamin D on endothelial function in earlier stages of CKD, when vascular endothelium may be more amenable to this therapy. We studied the effect of ergocalciferol in a pre-clinical model of mild uraemia. Male Wistar rats underwent either a 5/6th nephrectomy or sham surgery. Four weeks after the final stage of the surgery, these two groups were randomly allocated to placebo or an oral dose of 1000 iu of ergocalcfierol at day 7 and 2 pre sacrifice. Vascular responses to acetylcholine, Spermine NONOate and phenylephrine were determined in aortic rings. Blood pressure, calcium, phosphate and parathyroid hormone were measured in all groups. Ergocalciferol significantly improved the endothelium-dependent responses to acetylcholine and overcame the blunting of the contractile response to phenylephrine seen in uraemic animals. Ergocalciferol improved the contractile response to potassium chloride in uraemic, but not sham animals. All effects occurred independently of changes to calcium, phosphate, parathyroid hormone and systolic blood pressure. There were no differences in endothelium-independent relaxation to Spermine NONOate. In summary, in a model of mild uraemia, ergocalciferol improved vasodilator and vasoconstrictor tone independently of blood pressure and bone mineral parameters suggesting a direct effect of ergocalciferol on the endothelium.
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Kaur G, Singh J, Kumar J. Vitamin D and cardiovascular disease in chronic kidney disease. Pediatr Nephrol 2019; 34:2509-2522. [PMID: 30374603 PMCID: PMC6488464 DOI: 10.1007/s00467-018-4088-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 09/09/2018] [Accepted: 09/13/2018] [Indexed: 12/31/2022]
Abstract
Chronic kidney disease (CKD) is considered an independent risk factor for cardiovascular disease, with increased cardiovascular morbidity and mortality seen even in the early stages of CKD. Several studies have shown a high prevalence of vitamin D deficiency in individuals with CKD. Low vitamin D levels upregulate the renin-angiotensin-aldosterone system (RAAS), cause endothelial dysfunction, and increase inflammation. Epidemiological studies show an association between vitamin D deficiency and risk factors for cardiovascular disease, but a causal relationship has not been established. The high cardiovascular morbidity and mortality associated with CKD in adults requires therapies to decrease this elevated risk. However, results from several meta-analyses and randomized clinical trials in adults have not shown convincing evidence for the use of vitamin D therapy in improving cardiovascular outcomes. Lack of high-quality evidence from randomized clinical trials in children regarding the effectiveness and long-term safety of vitamin D treatment precludes any recommendations on its use to mitigate the cardiovascular burden of CKD.
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Affiliation(s)
- Gurpreet Kaur
- State University of New York Downstate Medical Center
| | | | - Juhi Kumar
- New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, USA.
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Saponaro F, Marcocci C, Zucchi R. Vitamin D status and cardiovascular outcome. J Endocrinol Invest 2019; 42:1285-1290. [PMID: 31172459 DOI: 10.1007/s40618-019-01057-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 05/03/2019] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Vitamin D is classically involved in maintaining bone and mineral health, but it has been shown to exert many extraskeletal functions, including pleiotropic effects on cardiovascular system. MATERIALS AND METHOD This review aims to summarize evidences in literature about vitamin D and cardiovascular outcome. RESULTS AND CONCLUSIONS Calcitriol or 1,25(OH)2D, the active hormone, binds to the specific nuclear receptor VDR, which is expressed in rat and human heart and vasculature and has effects on myocardiocytes, smooth cells, and endothelial cells. 25-Hydroxy-vitamin D (25OHD) represents the biomarker of vitamin D levels and reflects vitamin D status. There is consistent evidence that low serum 25OHD levels are associated with increased risk of cardiovascular diseases, including hypertension, coronary artery disease, ischemic heart disease, heart failure, stroke, and type 2 diabetes. Randomized-controlled trials and Mendelian randomization studies so far have not succeeded in proving a benefit of vitamin D supplementation. However, the latter investigations are affected by some methodological limitations, and therefore, it is still unclear if vitamin D deficiency has a causative role in cardiovascular diseases or is rather a marker of poor health in chronic disease.
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Affiliation(s)
- F Saponaro
- Department of Pathology, University of Pisa, Via Roma 55, Biochemistry Unit, 56126, Pisa, Italy.
| | - C Marcocci
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - R Zucchi
- Department of Pathology, University of Pisa, Via Roma 55, Biochemistry Unit, 56126, Pisa, Italy
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18
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Mahmoud AM, Szczurek M, Hassan C, Masrur M, Gangemi A, Phillips SA. Vitamin D Improves Nitric Oxide-Dependent Vasodilation in Adipose Tissue Arterioles from Bariatric Surgery Patients. Nutrients 2019; 11:E2521. [PMID: 31635396 PMCID: PMC6835261 DOI: 10.3390/nu11102521] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 10/14/2019] [Accepted: 10/15/2019] [Indexed: 12/16/2022] Open
Abstract
There is a high prevalence of vitamin-D deficiency in obese individuals that could be attributed to vitamin-D sequestration in the adipose tissue. Associations between vitamin-D deficiency and unfavorable cardiometabolic outcomes were reported. However, the pathophysiological mechanisms behind these associations are yet to be established. In our previous studies, we demonstrated microvascular dysfunction in obese adults that was associated with reduced nitric oxide (NO) production. Herein, we examined the role of vitamin D in mitigating microvascular function in morbidly obese adults before and after weight loss surgery. We obtained subcutaneous (SAT) and visceral adipose tissue (VAT) biopsies from bariatric patients at the time of surgery (n = 15) and gluteal SAT samples three months post-surgery (n = 8). Flow-induced dilation (FID) and acetylcholine-induced dilation (AChID) and NO production were measured in the AT-isolated arterioles ± NO synthase inhibitor N(ω)-nitro-L-arginine methyl ester (L-NAME), hydrogen peroxide (H2O2) inhibitor, polyethylene glycol-modified catalase (PEG-CAT), or 1,25-dihydroxyvitamin D. Vitamin D improved FID, AChID, and NO production in AT-isolated arterioles at time of surgery; these effects were abolished by L-NAME but not by PEG-CAT. Vitamin-D-mediated improvements were of a higher magnitude in VAT compared to SAT arterioles. After surgery, significant improvements in FID, AChID, NO production, and NO sensitivity were observed. Vitamin-D-induced changes were of a lower magnitude compared to those from the time of surgery. In conclusion, vitamin D improved NO-dependent arteriolar vasodilation in obese adults; this effect was more significant before surgery-induced weight loss.
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Affiliation(s)
- Abeer M Mahmoud
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Illinois at Chicago, Chicago, IL 60612, USA.
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL 60612, USA.
- Integrative Physiology Laboratory, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL 60612, USA.
| | - Mary Szczurek
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL 60612, USA.
| | - Chandra Hassan
- Department of Surgery, University of Illinois at Chicago, Chicago, IL 60612, USA.
| | - Mario Masrur
- Department of Surgery, University of Illinois at Chicago, Chicago, IL 60612, USA.
| | - Antonio Gangemi
- Department of Surgery, University of Illinois at Chicago, Chicago, IL 60612, USA.
| | - Shane A Phillips
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Illinois at Chicago, Chicago, IL 60612, USA.
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL 60612, USA.
- Integrative Physiology Laboratory, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL 60612, USA.
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Abstract
Understanding of vitamin D physiology is important because about half of the population is being diagnosed with deficiency and treated with supplements. Clinical guidelines were developed based on observational studies showing an association between low serum levels and increased cardiovascular risk. However, new randomized controlled trials have failed to confirm any cardiovascular benefit from supplementation in the general population. A major concern is that excess vitamin D is known to cause calcific vasculopathy and valvulopathy in animal models. For decades, administration of vitamin D has been used in rodents as a reliable experimental model of vascular calcification. Technically, vitamin D is a misnomer. It is not a true vitamin because it can be synthesized endogenously through ultraviolet exposure of the skin. It is a steroid hormone that comes in 3 forms that are sequential metabolites produced by hydroxylases. As a fat-soluble hormone, the vitamin D-hormone metabolites must have special mechanisms for delivery in the aqueous bloodstream. Importantly, endogenously synthesized forms are carried by a binding protein, whereas dietary forms are carried within lipoprotein particles. This may result in distinct biodistributions for sunlight-derived versus supplement-derived vitamin D hormones. Because the cardiovascular effects of vitamin D hormones are not straightforward, both toxic and beneficial effects may result from current recommendations.
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Affiliation(s)
- Linda L Demer
- From the Departments of Medicine (L.L.D., J.J.H., Y.T.) .,Physiology (L.L.D., Y.T.).,Bioengineering (L.L.D.)
| | - Jeffrey J Hsu
- From the Departments of Medicine (L.L.D., J.J.H., Y.T.)
| | - Yin Tintut
- From the Departments of Medicine (L.L.D., J.J.H., Y.T.).,Physiology (L.L.D., Y.T.).,Orthopaedic Surgery (Y.T.), University of California, Los Angeles
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20
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Hiemstra T, Lim K, Thadhani R, Manson JE. Vitamin D and Atherosclerotic Cardiovascular Disease. J Clin Endocrinol Metab 2019; 104:4033-4050. [PMID: 30946457 PMCID: PMC7112191 DOI: 10.1210/jc.2019-00194] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Accepted: 03/29/2019] [Indexed: 02/07/2023]
Abstract
CONTEXT A large body of experimental and observational data has implicated vitamin D deficiency in the development of cardiovascular disease. However, evidence to support routine vitamin D supplementation to prevent or treat cardiovascular disease is lacking. EVIDENCE ACQUISITION A comprehensive literature review was performed using Pubmed and other literature search engines. EVIDENCE SYNTHESIS Mounting epidemiological evidence and data from Mendelian randomization studies support a link between vitamin D deficiency and adverse cardiovascular health outcomes, but randomized trial evidence to support vitamin D supplementation is sparse. Current public health guidelines restrict vitamin D intake recommendations to the maintenance of bone health and prevention of fractures. Two recently published large trials (VITAL and ViDA) that assessed the role of moderate-to-high dose vitamin D supplementation as primary prevention for cardiovascular outcomes in the general population had null results, and previous randomized trials have also been generally negative. These findings from general population cohorts that are largely replete in vitamin D may not be applicable to chronic kidney disease (CKD) populations, in which the use of active (1α-hydroxylated) vitamin D compounds is prevalent, or to other high-risk populations. Additionally, recent trials in the CKD population, and trials using vitamin D analogues have been limited. CONCLUSIONS Current randomized trials of vitamin D supplementation do not support benefits for cardiovascular health, but the evidence remains inconclusive. Additional randomized trials assessing larger numbers of participants with low baseline vitamin D levels, having longer follow-up periods, and testing higher vitamin D dosages, are needed to guide clinical practice.
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Affiliation(s)
- Thomas Hiemstra
- Cambridge Clinical Trials Unit, Addenbrookes Hospital, Cambridge, UK
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Kenneth Lim
- Division of Nephrology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Ravi Thadhani
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA
| | - JoAnn E. Manson
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School and Harvard T.H. Chan School of Public Health, Boston, MA
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Cerit L, Cerit Z. Vitamin D Deficiency is not Associated with Higher Levels of SYNTAX Score. Braz J Cardiovasc Surg 2019; 34:57-61. [PMID: 30810675 PMCID: PMC6385829 DOI: 10.21470/1678-9741-2018-0178] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 09/05/2018] [Indexed: 12/31/2022] Open
Abstract
Objective To evaluate the association between serum vitamin D (vitD) level and SYNTAX
(synergy between percutaneous coronary intervention with taxus and cardiac
surgery) score (SS). Methods The medical records of consecutive patients, who underwent coronary artery
bypass graft surgery, were retrospectively reviewed. The study group
consisted of 158 patients. Biochemical, clinical, and echocardiographic
parameters and SS were evaluated in all patients. The patients were divided
into 2 groups according to SS (≥23= high, <23= low). Results The high SYNTAX score (HSS) group was older and had higher body mass index,
C-reactive protein (CRP), low-density lipoprotein, and fasting plasma
glucose level than the low SYNTAX score (LSS) group. The HSS group had lower
high-density lipoprotein and vitD level than the LSS group. The HSS group
had a higher prevalence of diabetes mellitus (DM), hypertension (HT),
hyperlipidemia (HL), and current smoking patients than the LSS group. On
univariate analysis, age, HT, DM, HL, smoking, CRP, and serum vitD level
were associated with HSS. On multivariate analysis, HT, DM, and HL were
independent predictors of HSS (odds ratio [OR]: 2.137, 95% confidence
interval [CI]: 1.468-2.935, P<0.001; OR: 3.559, 95% CI:
2.763-5.927, P<0.001; OR: 2.631, 95% CI: 1.529-3.438,
P<0.001; respectively). Conclusion In our study, we have found out that HT, DM, and HL were independent
predictors of HSS. Serum vitD level was not found to be an independent
predictor of HSS.
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Affiliation(s)
- Levent Cerit
- Department of Cardiology, Near East University, Faculty of Medicine, Nicosia, Cyprus
| | - Zeynep Cerit
- Department of Pediatric Cardiology, Near East University, Nicosia, Cyprus
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Liang C, Zhang Y, Zhuo D, Lo CY, Yu L, Lau CW, Kwan YW, Tse G, Huang Y, Yao X. Endothelial cell transient receptor potential channel C5 (TRPC5) is essential for endothelium-dependent contraction in mouse carotid arteries. Biochem Pharmacol 2018; 159:11-24. [PMID: 30414390 DOI: 10.1016/j.bcp.2018.11.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 11/06/2018] [Indexed: 12/17/2022]
Abstract
Augmented endothelium-dependent contractions (EDC) contributes to endothelial dysfunction and vascular disease progression. An early signal in EDC is cytosolic [Ca2+]i rise in endothelial cells, which stimulates the production of contractile prostanoids, leading to vascular contraction. In this study, the molecular identity of Ca2+-permeable channels in endothelial cells and its function were investigated. Vascular tension was measured by wire myograph. EDCs were elicited by acetylcholine (ACH) in the presence of NG-nitro-l-arginine methyl ester (L-NAME). [Ca2+]i was measured using a Ca2+-sensitive fluorescence dye. Enzyme Immunoassay (EIA) was used for prostaglandin measurement. Immunohistochemical staining found the expression of transient receptor potential channel C5 (TRPC5) in endothelial and smooth muscle cells of mouse carotid arteries. ACH-induced EDC in male mouse carotid arteries was found to be substantially reduced in TRPC5 knockout (KO) mice than in wild-type (WT) mice. TRPC5 inhibitors clemizole and ML204 also reduced the EDC. Furthermore, ACH-induced Ca2+ entry in endothelial cells was lower in TRPC5 KO mice than in WT mice. Moreover, the EDC was abolished by a cyclooxygenase-2 (COX-2) inhibitor NS-398, but not affected by a COX-1 inhibitor valeryl salicylate (VAS). Enzyme immunoassay results showed that TRPC5 stimulated the COX-2-linked production of prostaglandin F2α (PGF2α), prostaglandin E2 (PGE2), and prostaglandin D2 (PGD2). Exogeneous PGF2α, PGE2, and PGD2 could induce contractions in carotid arteries. Our present study demonstrated that TRPC5 in endothelial cells contributes to EDC by stimulating the production of COX-2-linked prostanoids. The finding extends our knowledge about EDC.
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Affiliation(s)
- Cai Liang
- School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong, China; Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Hong Kong, China; Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
| | - Yunting Zhang
- School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong, China; Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Hong Kong, China; Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
| | - Duan Zhuo
- School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong, China; Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Hong Kong, China; Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
| | - Chun-Yin Lo
- School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong, China; Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Hong Kong, China; Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
| | - Libo Yu
- School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong, China; Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Hong Kong, China; Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
| | - Chi-Wai Lau
- School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong, China; Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
| | - Yiu-Wa Kwan
- School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Gary Tse
- School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong, China; Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Yu Huang
- School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong, China; Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Hong Kong, China
| | - Xiaoqiang Yao
- School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong, China; Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Hong Kong, China; Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China.
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Khan A, Dawoud H, Malinski T. Nanomedical studies of the restoration of nitric oxide/peroxynitrite balance in dysfunctional endothelium by 1,25-dihydroxy vitamin D 3 - clinical implications for cardiovascular diseases. Int J Nanomedicine 2018; 13:455-466. [PMID: 29416330 PMCID: PMC5788997 DOI: 10.2147/ijn.s152822] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background Clinical studies indicate that vitamin D3 improves circulation and may have beneficial effects in hypertension. This study uses nanomedical systems to investigate the role of 1,25-dihydroxy vitamin D3 in the preservation/restoration of endothelial function in an angiotensin II (Ang II) cellular model of hypertension. Methods 1,25-dihydroxy vitamin D3-stimulated nitric oxide (NO) and peroxynitrite (ONOO−) concentrations were measured in situ with nanosensors (200–300 mm diameter with a detection limit of 1 nM) in human umbilical vein endothelial cells of African American (AA) and Caucasian American (CA) donors exposed to Ang II. The balance/imbalance between NO and ONOO− concentrations ([NO]/[ONOO−]) was simultaneously monitored and used as an indicator of endothelial nitric oxide synthase (eNOS) uncoupling and endothelial dysfunction. Results [NO]/[ONOO−] imbalance in Ang II-stimulated dysfunctional endothelium was 0.20±0.16 for CAs and 0.11±0.09 for AAs. Uncoupled eNOS and overexpression of nicotinamide adenine dinucleotide phosphate (NADPH) oxidase contributed to high production of ONOO−. Vitamin D3 treatment reversed [NO]/[ONOO−] to 3.0±0.1 in CAs and 2.1±0.1 in AAs – exceeding that observed in normal endothelium. Vitamin D3 restored uncoupled eNOS and endothelial function by increasing cytoprotective NO and decreasing the cytotoxic ONOO−. The beneficial effect of vitamin D3 is associated with a favorable rate of NO and ONOO− release, restoration of the [NO]/[ONOO−] and the overall decrease in the overexpression of eNOS, inducible nitric oxide synthase and NADPH oxidase. This effect of vitamin D3 may prove to be beneficial in the treatment of hypertension and other cardiovascular diseases, including heart failure, myocardial infarction, vasculopathy, stroke and diabetes.
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Affiliation(s)
- Alamzeb Khan
- Department of Chemistry & Biochemistry, Nanomedical Research Laboratories, Ohio University, Athens, OH, USA
| | - Hazem Dawoud
- Department of Chemistry & Biochemistry, Nanomedical Research Laboratories, Ohio University, Athens, OH, USA
| | - Tadeusz Malinski
- Department of Chemistry & Biochemistry, Nanomedical Research Laboratories, Ohio University, Athens, OH, USA
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The Role of Toll-Like Receptors and Vitamin D in Cardiovascular Diseases-A Review. Int J Mol Sci 2017; 18:ijms18112252. [PMID: 29077004 PMCID: PMC5713222 DOI: 10.3390/ijms18112252] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 10/24/2017] [Accepted: 10/25/2017] [Indexed: 12/17/2022] Open
Abstract
Cardiovascular diseases are the leading cause of mortality worldwide. Therefore, a better understanding of their pathomechanisms and the subsequent implementation of optimal prophylactic and therapeutic strategies are of utmost importance. A growing body of evidence states that low-grade inflammation is a common feature for most of the cardiovascular diseases in which the contributing factors are the activation of toll-like receptors (TLRs) and vitamin D deficiency. In this article, available data concerning the association of cardiovascular diseases with TLRs and vitamin D status are reviewed, followed by a discussion of new possible approaches to cardiovascular disease management.
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Abstract
BACKGROUND Vitamin D deficiency/insufficiency is associated with hypertension. Blood pressure (BP) and circulating vitamin D concentrations vary with the seasons and distance from the equator suggesting BP varies inversely with the sunshine available (insolation) for cutaneous vitamin D photosynthesis. METHODS To determine if the association between insolation and BP is partly explained by vitamin D, we evaluated 1104 participants in the Reasons for Racial and Geographic Differences in Stroke study whose BP and plasma 25-hydroxyvitamin D [25(OH)D] concentrations were measured. RESULTS We found a significant inverse association between SBP and 25(OH)D concentration and an inverse association between insolation and BP in unadjusted analyses. After adjusting for other confounding variables, the association of solar insolation and BP was augmented, -0.3.5 ± SEM 0.01 mmHg/1 SD higher solar insolation, P = 0.01. The greatest of effects of insolation on SBP were observed in whites (-5.2 ± SEM 0.92 mmHg/1 SD higher solar insolation, P = 0.005) and in women (-3.8 ± SEM 1.7 mmHg, P = 0.024). We found that adjusting for 25(OH)D had no effect on the association of solar insolation with SBP. CONCLUSION We conclude that although 25(OH)D concentration is inversely associated with SBP, it did not explain the association of greater sunlight exposure with lower BP.
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Cholecalciferol treatment downregulates renin-angiotensin system and improves endothelial function in essential hypertensive patients with hypovitaminosid D. J Hypertens 2017; 34:2199-205. [PMID: 27648718 DOI: 10.1097/hjh.0000000000001072] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Vitamin D deficiency is related to an increased prevalence of cardiovascular disease. Renin-angiotensin-aldosterone system suppression and vascular dysfunction are considered among the main mechanisms implicated in this association. However, interventional studies demonstrating that vitamin D replacement reduces circulating renin-angiotensin-aldosterone components and improves vascular function in humans are still lacking. METHODS Thirty-three consecutive patients with essential hypertension and hypovitaminosis D underwent therapy with cholecalciferol 50 000 IU/week orally for 8 weeks. Thirty-three hypertensive patients with normal vitamin D levels and 20 normotensive individuals were also enrolled as control groups. At baseline and at the end of the study, we evaluated plasma renin activity, circulating renin, angiotensin II, aldosterone and plasma vitamin D levels. Endothelial function [flow-mediated dilation (FMD)], carotid-femoral pulse wave velocity and augmentation index, peripheral and central blood pressure were also acquired. RESULTS After 8-week cholecalciferol administration, all treated patients normalized plasma 25(OH)D values. Furthermore, a reduction in plasma levels of plasma renin activity (1.17 ± 0.3 vs 1.51 ± 0.4 ng/ml per h, P = 0.02), renin (13.4 ± 1.7 vs 19.2 ± 2.9 pg/ml, P < 0.001), angiotensin II (11.6 ± 1.6 vs 15.8 ± 2.7 pg/ml, P = 0.02) was observed at the end of the study. FMD was significantly increased after cholecalciferol treatment (4.4 ± 2.6 vs 3.3 ± 2.1%, P < 0.05), in the absence of changes of brachial artery diameter and endothelium-independent vasodilation. Carotid-femoral pulse wave velocity and augmentation index were not modified, as well peripheral and central blood pressure. CONCLUSION The restoration of normal vitamin D levels after 8-week cholecalciferol treatment is able to inhibit peripheral renin-angiotensin system and improve FMD in essential hypertensive patients with hypovitaminosis D.
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Moretti R, Caruso P, Dal Ben M, Conti C, Gazzin S, Tiribelli C. Vitamin D, Homocysteine, and Folate in Subcortical Vascular Dementia and Alzheimer Dementia. Front Aging Neurosci 2017; 9:169. [PMID: 28611659 PMCID: PMC5447683 DOI: 10.3389/fnagi.2017.00169] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 05/15/2017] [Indexed: 01/09/2023] Open
Abstract
Dementia is a worldwide health problem which affects millions of patients; Alzheimer's disease (AD) and subcortical vascular dementia (sVAD) are the two most frequent forms of its presentation. As no definite therapeutic options have been discovered, different risk factors for cognitive impairment have been searched for potential therapies. This report focuses on the possible evidence that vitamin D deficiency and hyper-homocysteinemia can be considered as two important factors for the development or the progression of neurodegenerative or vascular pathologies. To this end, we assessed: the difference in vascular risk factors and vitamin D-OH25 levels among groups of sVAD, AD, and healthy age-matched controls; the association of folate, B12, homocysteine, and vitamin D with sVAD/AD and whether a deficiency of vitamin D and an increment in homocysteine levels may be related to neurodegenerative or vessel damages. The commonly-considered vascular risk factors were collected in 543 patients and compared with those obtained from a healthy old volunteer population. ANOVA group comparison showed that vitamin D deficiency was present in demented cases, as well as low levels of folate and high levels of homocysteine, more pronounced in sVAD cases. The statistical models we employed, with regression models built, and adjustments for biochemical, demographic and neuropsychiatric scores, confirmed the association between the three measures (folate decrease, hyperhomocysteinemia and vitamin D decrease) and dementia, more pronounced in sVAD than in AD.
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Affiliation(s)
- Rita Moretti
- Neurology Clinic, Department of Medical, Surgical and Health Sciences, University of TriesteTrieste, Italy
| | - Paola Caruso
- Neurology Clinic, Department of Medical, Surgical and Health Sciences, University of TriesteTrieste, Italy
| | - Matteo Dal Ben
- Neurology Clinic, Department of Medical, Surgical and Health Sciences, University of TriesteTrieste, Italy.,Italian Liver Foundation, Centro Studi FegatoTrieste, Italy
| | - Corrado Conti
- Neurology Clinic, Department of Medical, Surgical and Health Sciences, University of TriesteTrieste, Italy
| | - Silvia Gazzin
- Italian Liver Foundation, Centro Studi FegatoTrieste, Italy
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Vanhoutte PM, Shimokawa H, Feletou M, Tang EHC. Endothelial dysfunction and vascular disease - a 30th anniversary update. Acta Physiol (Oxf) 2017; 219:22-96. [PMID: 26706498 DOI: 10.1111/apha.12646] [Citation(s) in RCA: 556] [Impact Index Per Article: 79.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 10/27/2015] [Accepted: 12/17/2015] [Indexed: 02/06/2023]
Abstract
The endothelium can evoke relaxations of the underlying vascular smooth muscle, by releasing vasodilator substances. The best-characterized endothelium-derived relaxing factor (EDRF) is nitric oxide (NO) which activates soluble guanylyl cyclase in the vascular smooth muscle cells, with the production of cyclic guanosine monophosphate (cGMP) initiating relaxation. The endothelial cells also evoke hyperpolarization of the cell membrane of vascular smooth muscle (endothelium-dependent hyperpolarizations, EDH-mediated responses). As regards the latter, hydrogen peroxide (H2 O2 ) now appears to play a dominant role. Endothelium-dependent relaxations involve both pertussis toxin-sensitive Gi (e.g. responses to α2 -adrenergic agonists, serotonin, and thrombin) and pertussis toxin-insensitive Gq (e.g. adenosine diphosphate and bradykinin) coupling proteins. New stimulators (e.g. insulin, adiponectin) of the release of EDRFs have emerged. In recent years, evidence has also accumulated, confirming that the release of NO by the endothelial cell can chronically be upregulated (e.g. by oestrogens, exercise and dietary factors) and downregulated (e.g. oxidative stress, smoking, pollution and oxidized low-density lipoproteins) and that it is reduced with ageing and in the course of vascular disease (e.g. diabetes and hypertension). Arteries covered with regenerated endothelium (e.g. following angioplasty) selectively lose the pertussis toxin-sensitive pathway for NO release which favours vasospasm, thrombosis, penetration of macrophages, cellular growth and the inflammatory reaction leading to atherosclerosis. In addition to the release of NO (and EDH, in particular those due to H2 O2 ), endothelial cells also can evoke contraction of the underlying vascular smooth muscle cells by releasing endothelium-derived contracting factors. Recent evidence confirms that most endothelium-dependent acute increases in contractile force are due to the formation of vasoconstrictor prostanoids (endoperoxides and prostacyclin) which activate TP receptors of the vascular smooth muscle cells and that prostacyclin plays a key role in such responses. Endothelium-dependent contractions are exacerbated when the production of nitric oxide is impaired (e.g. by oxidative stress, ageing, spontaneous hypertension and diabetes). They contribute to the blunting of endothelium-dependent vasodilatations in aged subjects and essential hypertensive and diabetic patients. In addition, recent data confirm that the release of endothelin-1 can contribute to endothelial dysfunction and that the peptide appears to be an important contributor to vascular dysfunction. Finally, it has become clear that nitric oxide itself, under certain conditions (e.g. hypoxia), can cause biased activation of soluble guanylyl cyclase leading to the production of cyclic inosine monophosphate (cIMP) rather than cGMP and hence causes contraction rather than relaxation of the underlying vascular smooth muscle.
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Affiliation(s)
- P. M. Vanhoutte
- State Key Laboratory of Pharmaceutical Biotechnology and Department of Pharmacology and Pharmacy; Li Ka Shing Faculty of Medicine; The University of Hong Kong; Hong Kong City Hong Kong
| | - H. Shimokawa
- Department of Cardiovascular Medicine; Tohoku University; Sendai Japan
| | - M. Feletou
- Department of Cardiovascular Research; Institut de Recherches Servier; Suresnes France
| | - E. H. C. Tang
- State Key Laboratory of Pharmaceutical Biotechnology and Department of Pharmacology and Pharmacy; Li Ka Shing Faculty of Medicine; The University of Hong Kong; Hong Kong City Hong Kong
- School of Biomedical Sciences; Li Ka Shing Faculty of Medicine; The University of Hong Kong; Hong Kong City Hong Kong
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Bennett AL, Lavie CJ. Vitamin D Metabolism and the Implications for Atherosclerosis. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 996:185-192. [PMID: 29124700 DOI: 10.1007/978-3-319-56017-5_15] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Vitamin D levels and metabolism may play a role in the pathogenesis and treatment of atherosclerosis and subsequent cardiovascular health. Herein, we discuss both normal and disordered vitamin D metabolism as it pertains to atherosclerosis, and we review major clinical trials regarding vitamin D levels and effects of supplementation. Although there are no official recommendations for vitamin D as it applies to atherosclerosis, it is clear that these two entities are linked. Further study of the complex association between vitamin D and atherosclerosis, as well as the effects of supplementation, are recommended.
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Affiliation(s)
- Amanda L Bennett
- Department of Internal Medicine, Ochsner Clinic Foundation, New Orleans, LA, USA
| | - Carl J Lavie
- Department of Cardiovascular Disease, John Ochsner Heart and Vascular Institute, 1514 Jefferson Hwy, New Orleans, LA, USA, 70121.
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30
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Canpolat U, Aytemir K, Hazirolan T, Özer N, Oto A. Relationship between vitamin D level and left atrial fibrosis in patients with lone paroxysmal atrial fibrillation undergoing cryoballoon-based catheter ablation. J Cardiol 2016; 69:16-23. [PMID: 27554047 DOI: 10.1016/j.jjcc.2016.06.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 05/29/2016] [Accepted: 06/22/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND Left atrial (LA) fibrosis is known as the hallmark for arrhythmogenic substrate in atrial fibrillation (AF). Quantification of LA fibrosis by using delayed-enhanced magnetic resonance imaging (DE-MRI) in AF patients is a pioneering noninvasive technique. Vitamin D (vitD) negatively regulates the renin-angiotensin system, binds to vitD receptors on cardiac myocytes, and has antioxidant properties that may ameliorate the inflammation and proarrhythmic substrate formation. However, its role in LA fibrosis is unclear. We aimed to investigate the association of serum 25(OH)D level with the extent of LA fibrosis by using DE-MRI and also predictors for AF recurrence after cryoablation was assessed in patients with paroxysmal AF. METHODS A total of 48 patients with lone paroxysmal AF (41.7% female; age: 48.5±8.4 years) who underwent DE-MRI at 1.5T and initial cryoballoon-based catheter ablation along with 48 healthy control subjects were enrolled. Fibrosis degree was categorized according to Utah class defined in the DECAAF study. RESULTS Serum 25(OH)D levels were significantly lower in AF group compared to control group (25.8±7.6ng/ml vs. 31.0±9.5ng/ml, p=0.004). Serum 25(OH)D levels were associated with moderate-severe LA fibrosis independent of other measures (OR: 0.72, 95% CI: 0.54-0.97, p=0.028). At a mean 16.5±2.6 months follow-up, late recurrence was observed in 10 (20.8%) patients. In multivariable Cox regression analysis, LA volume index (HR: 1.42, 95% CI: 1.01-2.01, p=0.045) and the extent of LA fibrosis (HR: 1.14, 95% CI: 1.01-1.28, p=0.034) were found as independently associated with late AF recurrence during follow-up. CONCLUSION Lower levels of serum 25(OH)D are significantly associated with more extensive LA fibrosis in patients with lone paroxysmal AF and may be implicated in the pathophysiology of AF recurrence after cryoablation. Further large-scale studies are needed to elucidate the exact role of vitD deficiency and replacement on LA fibrosis.
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Affiliation(s)
- Uğur Canpolat
- Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
| | - Kudret Aytemir
- Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Tuncay Hazirolan
- Department of Radiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Necla Özer
- Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ali Oto
- Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Stojanović M, Radenković M. Vitamin D versus placebo in improvement of endothelial dysfunction: a meta-analysis of randomized clinical trials. Cardiovasc Ther 2016; 33:145-54. [PMID: 25850709 DOI: 10.1111/1755-5922.12122] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
AIMS The possible effect of vitamin D administration in humans on endothelial dysfunction (ED) still remains undetermined. The current meta-analysis was performed to evaluate if vitamin D could improve ED. METHODS Randomized, double-blind, and placebo-controlled clinical trials were identified by systematic search of the PubMed, the Cochrane Library, the Web of Science and the Scopus data bases, as well as different reviews and clinical trials articles. A random effects model was used to calculate the pooled overall effect on flow-mediated dilation (FMD) linked to the vitamin D administration. Meta-regression and subgroup analyses were performed to evaluate the impact of study characteristics on the effect of vitamin D administration on FMD. RESULTS A total of eight studies with nine relevant study arms were identified. The obtained results of pooled analysis showed that vitamin D administration did not improve FMD (eight studies, 529 subjects; weighted mean difference (WMD): 0.96%, 95% CI: -1.24% to 2.06%; P = 0.09). This was probably due to significant heterogeneity in between included trials (I(2) = 84%, P < 0.00001). On the other hand, subgroup analysis demonstrated that vitamin D improved FMD in trials that lasted <16 weeks; if systolic blood pressure (SBP) was higher than 140 mmHg and in trials where diastolic blood pressure (DBP) was <80 mmHg. CONCLUSION Although the current evidence clearly demonstrates that in certain conditions vitamin D can improve ED, a larger number of clinical trials are needed to confirm this assumption to confirm or reject the final statement on this topic.
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Affiliation(s)
- Marko Stojanović
- Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Miroslav Radenković
- Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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Groseanu L, Bojinca V, Gudu T, Saulescu I, Predeteanu D, Balanescu A, Berghea F, Opris D, Borangiu A, Constantinescu C, Negru M, Ionescu R. Low vitamin D status in systemic sclerosis and the impact on disease phenotype. Eur J Rheumatol 2016; 3:50-55. [PMID: 27708971 DOI: 10.5152/eurjrheum.2015.0065] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Accepted: 10/18/2015] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE Vitamin D has pleiotropic effects including immunomodulatory, cardioprotective, and antifibrotic properties and is thus able to modulate the three main links in scleroderma pathogenesis. The aim of the study was to evaluate the level of vitamin D in patients with systemic sclerosis and to analyze the associations between the concentration of vitamin D and the features of systemic sclerosis. MATERIAL AND METHODS Fifty-one consecutive patients were evaluated for visceral involvement, immunological profile, activity, severity scores, and quality of life. The vitamin D status was evaluated by measuring the 25hydroxy-hydroxyvitamin D serum levels. RESULTS The mean vitamin D level was 17.06±9.13 ng/dL. Only 9.8% of the patients had optimal vitamin D levels; 66.66% of them had insufficient 25(OH)D levels, while 23.52% had deficient levels. No correlation was found between vitamin D concentration and age, sex, autoantibody profile, extent of skin involvement, or vitamin D supplementation. Vitamin D levels were correlated with the diffusing capacity of the lung for carbon monoxide (p=0.019, r=0.353), diastolic dysfunction (p=0.033, r=-0.318), digital contractures (p=0.036, r=-0.298), and muscle weakness (p=0.015, r=-0.377) and had a trend for negative correlation with pulmonary hypertension (p=0.053, r=-0.29). CONCLUSION Low levels of vitamin D are very common in systemic sclerosis. Poor vitamin status seems to be related with a more aggressive disease with multivisceral and severe organ involvement, especially pulmonary and cardiac involvement.
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Affiliation(s)
- Laura Groseanu
- Department of Internal Medicine, Division of Rheumatology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Department of Internal Medicine, Division of Rheumatology, Sfanta Maria Clinical Hospital, Bucharest, Romania
| | - Violeta Bojinca
- Department of Internal Medicine, Division of Rheumatology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Department of Internal Medicine, Division of Rheumatology, Sfanta Maria Clinical Hospital, Bucharest, Romania
| | - Tania Gudu
- Department of Internal Medicine, Division of Rheumatology, Sfanta Maria Clinical Hospital, Bucharest, Romania
| | - Ioana Saulescu
- Department of Internal Medicine, Division of Rheumatology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Department of Internal Medicine, Division of Rheumatology, Sfanta Maria Clinical Hospital, Bucharest, Romania
| | - Denisa Predeteanu
- Department of Internal Medicine, Division of Rheumatology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Department of Internal Medicine, Division of Rheumatology, Sfanta Maria Clinical Hospital, Bucharest, Romania
| | - Andra Balanescu
- Department of Internal Medicine, Division of Rheumatology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Department of Internal Medicine, Division of Rheumatology, Sfanta Maria Clinical Hospital, Bucharest, Romania
| | - Florian Berghea
- Department of Internal Medicine, Division of Rheumatology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Department of Internal Medicine, Division of Rheumatology, Sfanta Maria Clinical Hospital, Bucharest, Romania
| | - Daniela Opris
- Department of Internal Medicine, Division of Rheumatology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Department of Internal Medicine, Division of Rheumatology, Sfanta Maria Clinical Hospital, Bucharest, Romania
| | - Andreea Borangiu
- Department of Internal Medicine, Division of Rheumatology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Department of Internal Medicine, Division of Rheumatology, Sfanta Maria Clinical Hospital, Bucharest, Romania
| | - Cosmin Constantinescu
- Department of Internal Medicine, Division of Rheumatology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Department of Internal Medicine, Division of Rheumatology, Sfanta Maria Clinical Hospital, Bucharest, Romania
| | - Magda Negru
- Department of Internal Medicine, Division of Rheumatology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Department of Internal Medicine, Division of Rheumatology, Sfanta Maria Clinical Hospital, Bucharest, Romania
| | - Ruxandra Ionescu
- Department of Internal Medicine, Division of Rheumatology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Department of Internal Medicine, Division of Rheumatology, Sfanta Maria Clinical Hospital, Bucharest, Romania
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Haussler MR, Whitfield GK, Haussler CA, Sabir MS, Khan Z, Sandoval R, Jurutka PW. 1,25-Dihydroxyvitamin D and Klotho: A Tale of Two Renal Hormones Coming of Age. VITAMINS AND HORMONES 2016; 100:165-230. [PMID: 26827953 DOI: 10.1016/bs.vh.2015.11.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
1,25-Dihydroxyvitamin D3 (1,25D) is the renal metabolite of vitamin D that signals through binding to the nuclear vitamin D receptor (VDR). The ligand-receptor complex transcriptionally regulates genes encoding factors stimulating calcium and phosphate absorption plus bone remodeling, maintaining a skeleton with reduced risk of age-related osteoporotic fractures. 1,25D/VDR signaling exerts feedback control of Ca/PO4 via regulation of FGF23, klotho, and CYP24A1 to prevent age-related, ectopic calcification, fibrosis, and associated pathologies. Vitamin D also elicits xenobiotic detoxification, oxidative stress reduction, neuroprotective functions, antimicrobial defense, immunoregulation, anti-inflammatory/anticancer actions, and cardiovascular benefits. Many of the healthspan advantages conferred by 1,25D are promulgated by its induction of klotho, a renal hormone that is an anti-aging enzyme/coreceptor that protects against skin atrophy, osteopenia, hyperphosphatemia, endothelial dysfunction, cognitive defects, neurodegenerative disorders, and impaired hearing. In addition to the high-affinity 1,25D hormone, low-affinity nutritional VDR ligands including curcumin, polyunsaturated fatty acids, and anthocyanidins initiate VDR signaling, whereas the longevity principles resveratrol and SIRT1 potentiate VDR signaling. 1,25D exerts actions against neural excitotoxicity and induces serotonin mood elevation to support cognitive function and prosocial behavior. Together, 1,25D and klotho maintain the molecular signaling systems that promote growth (p21), development (Wnt), antioxidation (Nrf2/FOXO), and homeostasis (FGF23) in tissues crucial for normal physiology, while simultaneously guarding against malignancy and degeneration. Therefore, liganded-VDR modulates the expression of a "fountain of youth" array of genes, with the klotho target emerging as a major player in the facilitation of health span by delaying the chronic diseases of aging.
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Affiliation(s)
- Mark R Haussler
- Department of Basic Medical Sciences, University of Arizona College of Medicine, Phoenix, Arizona, USA.
| | - G Kerr Whitfield
- Department of Basic Medical Sciences, University of Arizona College of Medicine, Phoenix, Arizona, USA
| | - Carol A Haussler
- Department of Basic Medical Sciences, University of Arizona College of Medicine, Phoenix, Arizona, USA
| | - Marya S Sabir
- School of Mathematical and Natural Sciences, Arizona State University, Glendale, Arizona, USA
| | - Zainab Khan
- School of Mathematical and Natural Sciences, Arizona State University, Glendale, Arizona, USA
| | - Ruby Sandoval
- School of Mathematical and Natural Sciences, Arizona State University, Glendale, Arizona, USA
| | - Peter W Jurutka
- Department of Basic Medical Sciences, University of Arizona College of Medicine, Phoenix, Arizona, USA; School of Mathematical and Natural Sciences, Arizona State University, Glendale, Arizona, USA
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Hamdy Al-Said N, Abd El Ghaffar Mohamed N, Salam RF, Fawzy MW. Vitamin D as a risk factor for premature atherosclerosis in patients with type 2 diabetes. Ther Adv Endocrinol Metab 2015; 6:249-57. [PMID: 26623002 PMCID: PMC4647131 DOI: 10.1177/2042018815600640] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Several cardiovascular risk factors have been recognized in patients with diabetes and vitamin D deficiency is emerging as a new risk. The aim of this study was to determine the effect of vitamin D deficiency on the incidence of premature atherosclerosis in patients with type 2 diabetes. METHODS A total of 78 patients with type 2 diabetes were subjected to history taking, physical examination, fasting glucose level, homeostasis model assessment of insulin resistance, lipid profile, 25(OH) vitamin D measurement, and carotid Doppler. RESULTS Patients with normal carotid intima-media thickness (CIMT) had sufficient vitamin D. Of those with increased CIMT 23.1% had insufficient vitamin D while 76.9% had sufficient vitamin D (six patients had plaques, one of them had vitamin D insufficiency, and the other five patients had sufficient vitamin D). There was a statistically significant difference in the serum level of vitamin D between patients with increased CIMT, and those with normal intima, with a decreased level in the first group. There was a significant negative correlation between vitamin D and fasting blood glucose. There was a statistically significant correlation in left CIMT between the vitamin D sufficiency group and the vitamin D insufficiency group, with higher values in the second group. There was no statistically significant difference in serum cholesterol, triglycerides, HDL cholesterol, and LDL cholesterol in patients with increased CIMT and those with normal intima. CONCLUSIONS Decreased vitamin D levels in patients with diabetes lead to increased CIMT. The absence of a statistically significance difference in lipid profile between increased and normal CIMT groups raises the possibility of underlying causes for atherosclerosis in patients with diabetes other than dyslipidemia.
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Affiliation(s)
- Nehal Hamdy Al-Said
- Department of Internal Medicine and Endocrinology, Cairo University, Cairo, Egypt
| | | | - Randa F. Salam
- Department of Internal Medicine and Endocrinology, Cairo University, Cairo, Egypt
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Berridge MJ. Vitamin D cell signalling in health and disease. Biochem Biophys Res Commun 2015; 460:53-71. [PMID: 25998734 DOI: 10.1016/j.bbrc.2015.01.008] [Citation(s) in RCA: 128] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 01/05/2015] [Indexed: 12/13/2022]
Abstract
Vitamin D deficiency has been linked to many human diseases such as Alzheimer's disease (AD), Parkinson's disease (PD), multiple sclerosis (MS), hypertension and cardiovascular disease. A Vitamin D phenotypic stability hypothesis, which is developed in this review, attempts to describe how this vital hormone acts to maintain healthy cellular functions. This role of Vitamin D as a guardian of phenotypic stability seems to depend on its ability to maintain the redox and Ca(2+) signalling systems. It is argued that its primary action is to maintain the expression of those signalling components responsible for stabilizing the low resting state of these two signalling pathways. This phenotypic stability role is facilitated through the ability of vitamin D to increase the expression of both Nrf2 and the anti-ageing protein Klotho, which are also major regulators of Ca(2+) and redox signalling. A decline in Vitamin D levels will lead to a decline in the stability of this regulatory signalling network and may account for why so many of the major diseases in man, which have been linked to vitamin D deficiency, are associated with a dysregulation in both ROS and Ca(2+) signalling.
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Abstract
PURPOSE OF REVIEW To provide an overview of the association between vitamin D deficiency and atherosclerosis. RECENT FINDINGS Vitamin D exerts protective effects on atherosclerosis through multiple mechanisms. It has been shown to protect against endothelial dysfunction, vascular smooth muscle cell proliferation and migration, and modulation of the immune system, as well as the inflammatory response. In addition, vitamin D has been shown to have systemic effects on insulin resistance, dyslipidemia, and hypertension. SUMMARY Vitamin D deficiency is widely prevalent in the United States and worldwide. Although deficiency of this fat-soluble vitamin is usually associated with musculoskeletal disorder, it is associated with a wide range of disease processes that include multiple organ systems. Recently, there has been mounting evidence linking vitamin D deficiency to cardiovascular disease and atherosclerosis.
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Guessous I. Role of Vitamin D deficiency in extraskeletal complications: predictor of health outcome or marker of health status? BIOMED RESEARCH INTERNATIONAL 2015; 2015:563403. [PMID: 26075246 PMCID: PMC4436443 DOI: 10.1155/2015/563403] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 01/09/2015] [Indexed: 12/31/2022]
Abstract
The relationship of vitamin D with extraskeletal complications, such as cardiovascular disease, cancer, and autoimmune disease, is of major interest considering its roles in key biological processes and the worldwide high prevalence of vitamin D deficiency. However, the causal relationships between vitamin D and most extraskeletal complications are weak. Currently, a heated debate over vitamin D is being conducted according to two hypotheses. In this review, we first present the different arguments that suggest a major role of vitamin D in a very broad type of extraskeletal complications (hypothesis #1). We then present results from recent meta-analyses of randomized controlled trials indicating a lack of association of vitamin D with major extraskeletal complications (hypothesis #2). We discuss different issues (e.g., causality, confounding, reverse causation, misclassification, and Mendelian randomization) that contribute to the favoring of one hypothesis over the other. While ultimately only one hypothesis is correct, we anticipate that the results from the ongoing randomized controlled trials will be unlikely to reconcile the divided experts.
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Affiliation(s)
- Idris Guessous
- Unit of Population Epidemiology, Department of Community Medicine and Primary Care and Emergency Medicine, Geneva University Hospitals, 1214 Geneva, Switzerland
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, 1010 Lausanne, Switzerland
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 1518, USA
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Links between Vitamin D Deficiency and Cardiovascular Diseases. BIOMED RESEARCH INTERNATIONAL 2015; 2015:109275. [PMID: 26000280 PMCID: PMC4427096 DOI: 10.1155/2015/109275] [Citation(s) in RCA: 140] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 02/08/2015] [Indexed: 02/07/2023]
Abstract
The aim of the present paper was to review the most important mechanisms explaining the possible association of vitamin D deficiency and cardiovascular diseases, focusing on recent experimental and clinical data. Low vitamin D levels favor atherosclerosis enabling vascular inflammation, endothelial dysfunction, formation of foam cells, and proliferation of smooth muscle cells. The antihypertensive properties of vitamin D include suppression of the renin-angiotensin-aldosterone system, renoprotective effects, direct effects on endothelial cells and calcium metabolism, inhibition of growth of vascular smooth muscle cells, prevention of secondary hyperparathyroidism, and beneficial effects on cardiovascular risk factors. Vitamin D is also involved in glycemic control, lipid metabolism, insulin secretion, and sensitivity, explaining the association between vitamin D deficiency and metabolic syndrome. Vitamin D deficit was associated in some studies with the number of affected coronary arteries, postinfarction complications, inflammatory cytokines and cardiac remodeling in patients with myocardial infarction, direct electromechanical effects and inflammation in atrial fibrillation, and neuroprotective effects in stroke. In peripheral arterial disease, vitamin D status was related to the decline of the functional performance, severity, atherosclerosis and inflammatory markers, arterial stiffness, vascular calcifications, and arterial aging. Vitamin D supplementation should further consider additional factors, such as phosphates, parathormone, renin, and fibroblast growth factor 23 levels.
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Canpolat U, Yayla Ç, Akboğa MK, Özcan EH, Turak O, Özcan F, Topaloğlu S, Aras D. Effect of Vitamin D Replacement on Atrial Electromechanical Delay in Subjects with Vitamin D Deficiency. J Cardiovasc Electrophysiol 2015; 26:649-55. [PMID: 25772677 DOI: 10.1111/jce.12656] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Revised: 02/27/2015] [Accepted: 03/09/2015] [Indexed: 01/18/2023]
Abstract
OBJECTIVES Limited data are available regarding cardiac arrhythmias in vitamin D (VitD) deficiency. Therefore, we aimed to assess whether atrial electromechanical delay (AEMD) measured by tissue Doppler imaging (TDI), which is an indicator for atrial fibrillation (AF) development, is prolonged in patients with VitD deficiency as compared to the control group. The effect of vitD replacement on AEMD was also evaluated. METHODS In this prospective study a total of 28 VitD-deficient and 56 age-, gender-, and BMI-matched VitD-sufficient healthy participants were enrolled. P-wave dispersion (PWd) was calculated on the 12-lead electrocardiogram. Both intra- and inter-AEMD were calculated by TDI. Measurements were performed at baseline in both groups and were repeated after 6-month replacement therapy in subjects with vitD deficiency. RESULTS PWd and inter- and left intra-AEMD were significantly prolonged in patients with VitD deficiency compared to the control group (P < 0.001). While serum 25(OH)D levels were significantly and negatively correlated with left intra-AEMD (r = -0.657, P < 0.001), there was a positive correlation between serum 25(OH)D level and PWd (r = 0.523, P < 0.001). The serum 25(OH)D level was found as the independent predictor of the both left intra- and inter-AEMD in the multivariate linear regression analysis (β:-0.552, P < 0.001 and β:-0.555, P < 0.001, respectively). The serum 25(OH)D level was significantly increased after replacement therapy. While inter-AEMD was significantly decreased (P = 0.013), there was no change in PWD and left and right intra-AEMD (P > 0.05) following replacement therapy. CONCLUSION PWd and left intra- and inter-AEMD are increased in patients with VitD deficiency. The serum 25(OH)D level was found as an independent predictor for AEMD in patients with VitD deficiency. Also a significant decrement was observed in inter-AEMD following vitD replacement therapy. Studies with longer follow-up are needed to investigate whether vitD-deficient patients with prolonged AEMD develop clinical arrhythmia and vitD replacement reduces the risk of atrial arrhythmias.
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Affiliation(s)
- Uğur Canpolat
- Cardiology Clinic, Türkiye Yüksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Çağri Yayla
- Cardiology Clinic, Türkiye Yüksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Mehmet Kadri Akboğa
- Cardiology Clinic, Türkiye Yüksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Elif Hande Özcan
- Cardiology Clinic, Türkiye Yüksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Osman Turak
- Cardiology Clinic, Türkiye Yüksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Firat Özcan
- Cardiology Clinic, Türkiye Yüksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Serkan Topaloğlu
- Cardiology Clinic, Türkiye Yüksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Dursun Aras
- Cardiology Clinic, Türkiye Yüksek Ihtisas Training and Research Hospital, Ankara, Turkey
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Preparation of 2-hydroxy A-ring precursors for synthesis of vitamin D3 analogues from lyxose. Tetrahedron Lett 2015. [DOI: 10.1016/j.tetlet.2015.03.064] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Chou CL, Pang CY, Lee TJF, Fang TC. Beneficial effects of calcitriol on hypertension, glucose intolerance, impairment of endothelium-dependent vascular relaxation, and visceral adiposity in fructose-fed hypertensive rats. PLoS One 2015; 10:e0119843. [PMID: 25774877 PMCID: PMC4361671 DOI: 10.1371/journal.pone.0119843] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Accepted: 02/03/2015] [Indexed: 01/23/2023] Open
Abstract
Besides regulating calcium homeostasis, the effects of vitamin D on vascular tone and metabolic disturbances remain scarce in the literature despite an increase intake with high-fructose corn syrup worldwide. We investigated the effects of calcitriol, an active form of vitamin D, on vascular relaxation, glucose tolerance, and visceral fat pads in fructose-fed rats. Male Wistar-Kyoto rats were divided into 4 groups (n = 6 per group). Group Con: standard chow diet for 8 weeks; Group Fru: high-fructose diet (60% fructose) for 8 weeks; Group Fru-HVD: high-fructose diet as Group Fru, high-dose calcitriol treatment (20 ng / 100 g body weight per day) 4 weeks after the beginning of fructose feeding; and Group Fru-LVD: high-fructose diet as Group Fru, low-dose calcitriol treatment (10 ng / 100 g body weight per day) 4 weeks after the beginning of fructose feeding. Systolic blood pressure was measured twice a week by the tail-cuff method. Blood was examined for serum ionized calcium, phosphate, creatinine, glucose, triglycerides, and total cholesterol. Intra-peritoneal glucose intolerance test, aortic vascular reactivity, the weight of visceral fat pads, adipose size, and adipose angiotensin II levels were analyzed at the end of the study. The results showed that the fructose-fed rats significantly developed hypertension, impaired glucose tolerance, heavier weight and larger adipose size of visceral fat pads, and raised adipose angiotensin II expressions compared with the control rats. High- and low-dose calcitriol reduced modestly systolic blood pressure, increased endothelium-dependent aortic relaxation, ameliorated glucose intolerance, reduced the weight and adipose size of visceral fat pads, and lowered adipose angiotensin II expressions in the fructose-fed rats. However, high-dose calcitriol treatment mildly increased serum ionized calcium levels (1.44 ± 0.05 mmol/L). These results suggest a protective role of calcitriol treatment on endothelial function, glucose tolerance, and visceral adiposity in fructose-fed rats.
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Affiliation(s)
- Chu-Lin Chou
- Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
| | - Cheng-Yoong Pang
- Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
| | - Tony J. F. Lee
- Institutes of Life Sciences, Pharmacology & Toxicology, and Medical Sciences, Tzu Chi University, Hualien, Taiwan
- Department of Pharmacology, Southern Illinois University School of Medicine, Springfield, Illinois, United States of America
| | - Te-Chao Fang
- Division of Nephrology, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- * E-mail:
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Lee PC, Yang YY, Lee WP, Lee KC, Hsieh YC, Lee TY, Lin HC. Comparative portal hypotensive effects as propranolol of vitamin D₃ treatment by decreasing intrahepatic resistance in cirrhotic rats. J Gastroenterol Hepatol 2015; 30:628-37. [PMID: 25187428 DOI: 10.1111/jgh.12721] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/10/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIM Vitamin D₃ improves portal hypertension (PH) through the activation of vitamin D receptor (VDR) and calcium-sensing receptor (CaSR) in cirrhotic rats. Propranolol is a non-selective β-blocker that is recommended for the treatment of PH. The present study aims to investigate the detail systemic and hepatic mechanisms of vitamin D₃ and propranolol, alone or in combination, in cirrhotic rats. METHODS Common bile duct-ligated and thioacetamide cirrhotic rats were treated with vehicle, propranolol (30 mg/kg/day), vitamin D₃ (0.5 μg/100 g/day, twice weekly), or propranolol + vitamin D₃, separately. RESULTS Significantly, propranolol and vitamin D₃ produced a similar magnitude of reduction in portal venous pressure (PVP) in cirrhotic rats through different mechanisms: whereas propranolol decreased PVP by reducing splanchnic hyperemia and cardiac index, vitamin D₃ decreased PVP by decreasing intrahepatic resistance (IHR). However, propranolol + vitamin D₃ did not further decrease PVP in cirrhotic rats. Notably, a marked decrease in hepatic VDR and CaSR expressions was noted in cirrhotic human/rat livers compared with non-cirrhotic human/rat livers. In cirrhotic rats, vitamin D₃ administration decreasing IHR by inhibiting the renin-angiotensin system, hepatic oxidative stress, inflammation/fibrosis, angiotensin II (ANGII) production, CaSR-mediated ANGII hyperresponsiveness, ANGII-induced hepatic stellate cells contraction, and correcting hepatic endothelial dysfunction through upregulation of hepatic VDR, CaSR, and endothelial nitric oxide synthase expressions. CONCLUSION Chronic vitamin D₃ treatment alone results in comparative portal hypotensive effects as propranolol alone in cirrhotic rats with PH. Taken together, chronic vitamin D₃ administration was an ideal alternative strategy to effectively improve PH without unwanted systemic side-effects.
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Affiliation(s)
- Pei-Chang Lee
- Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
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Vitamin D deficiency in the pathogenesis of hypertension: still an unsettled question. Curr Hypertens Rep 2015; 16:464. [PMID: 24929953 DOI: 10.1007/s11906-014-0464-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Vitamin D deficiency is inversely associated with blood pressure and is felt to contribute to the genesis and maintenance of hypertension. Although well demonstrated in animal studies, in many clinical studies the association between vitamin D status and blood pressure has not been consistently observed or else has been quite small. These discrepancies may relate in part to methodological differences including: patient selection, study size and duration, and, in the case of vitamin D repletion studies, differences in the vitamin D supplement used, its dose, and dosing intervals. Polymorphisms in genes regulating vitamin D activation and function may explain some of the observed inconsistencies as suggested by recent studies. The present review examines experimental and clinical studies bearing on the inverse association between blood pressure and vitamin D status and concludes that a new definition of vitamin D deficiency using additional biomarkers may better select patients with hypertension who will respond to vitamin D supplementation.
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Cai Y, Manio MM, Leung GP, Xu A, Tang EH, Vanhoutte PM. Thyroid hormone affects both endothelial and vascular smooth muscle cells in rat arteries. Eur J Pharmacol 2015; 747:18-28. [DOI: 10.1016/j.ejphar.2014.11.036] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Revised: 11/26/2014] [Accepted: 11/28/2014] [Indexed: 02/04/2023]
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Martínez-Miguel P, Valdivielso JM, Medrano-Andrés D, Román-García P, Cano-Peñalver JL, Rodríguez-Puyol M, Rodríguez-Puyol D, López-Ongil S. The active form of vitamin D, calcitriol, induces a complex dual upregulation of endothelin and nitric oxide in cultured endothelial cells. Am J Physiol Endocrinol Metab 2014; 307:E1085-96. [PMID: 25336523 DOI: 10.1152/ajpendo.00156.2014] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Despite the presence of vitamin D receptor (VDR) in endothelial cells, the effect of vitamin D on endothelial function is unknown. An unbalanced production of vasoactive endothelial factors such as nitric oxide (NO) or endothelin-1 (ET-1) results in endothelial dysfunction, which can alter the normal cardiovascular function. Present experiments were devoted to assess the effect of active vitamin D (calcitriol) on the synthesis of endothelial vasoactive factors. The results were that, in cells, calcitriol increased ET-1 and NO productions, which were measured by ELISA and fluorimetric assay, respectively. Calcitriol also increased endothelin-converting enzyme-1 (ECE-1) and endothelial-nitric oxide synthase (eNOS) activities, their mRNA (qPCR), their protein expressions (Western-blot), and their promoter activities (transfection assays). Calcitriol did not change prepro-ET-1 mRNA. The effect was specific to VDR activation because when VDR was silenced by siRNA, the observed effects disappeared. Mechanisms involved in each upregulation differed. ECE-1 upregulation depended on AP-1 activation, whereas eNOS upregulation depended directly on VDR activation. To evaluate the in vivo consequences of acute calcitriol treatment, normal Wistar rats were treated with a single ip injection of 400 ng/kg calcitriol and euthanized 24 h later. Results confirmed those observed in cells, that production and expression of both factors were increased by calcitriol. Besides, calcitriol-treated rats showed a slight rise in mean blood pressure, which decreased when pretreated with FR-901533, an ECE-1 antagonist. We conclude that calcitriol increases the synthesis of both ET-1 and NO in endothelial cells. However, the ET-1 upregulation seems to be biologically more relevant, as animals acutely treated with calcitriol show slight increases in blood pressure.
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Affiliation(s)
- Patricia Martínez-Miguel
- Research Unit and Nephrology Section, Fundación para la Investigación Biomédica del Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | | | | | - Pablo Román-García
- Servicio de Metabolismo Mineral y Óseo, Hospital Universitario Central de Asturias, Universidad de Oviedo, Oviedo, Spain; Instituto Reina Sofía de Investigación Nefrológica, Madrid, Spain; and
| | | | - Manuel Rodríguez-Puyol
- Instituto Reina Sofía de Investigación Nefrológica, Madrid, Spain; and Physiology Department, Universidad de Alcalá, Madrid, Spain
| | - Diego Rodríguez-Puyol
- Research Unit and Nephrology Section, Fundación para la Investigación Biomédica del Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain; Instituto Reina Sofía de Investigación Nefrológica, Madrid, Spain; and
| | - Susana López-Ongil
- Research Unit and Instituto Reina Sofía de Investigación Nefrológica, Madrid, Spain; and
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Ni W, Watts SW, Ng M, Chen S, Glenn DJ, Gardner DG. Elimination of vitamin D receptor in vascular endothelial cells alters vascular function. Hypertension 2014; 64:1290-8. [PMID: 25201890 DOI: 10.1161/hypertensionaha.114.03971] [Citation(s) in RCA: 119] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Vitamin D deficiency has been associated with cardiovascular dysfunction. We evaluated the role of the vitamin D receptor (VDR) in vascular endothelial function, a marker of cardiovascular health, at baseline and in the presence of angiotensin II, using an endothelial-specific knockout of the murine VDR gene. In the absence of endothelial VDR, acetylcholine-induced aortic relaxation was significantly impaired (maximal relaxation, endothelial-specific VDR knockout=58% versus control=73%; P<0.05). This was accompanied by a reduction in endothelial NO synthase expression and phospho-vasodilator-stimulated phosphoprotein levels in aortae from the endothelial-specific VDR knockout versus control mice. Although blood pressure levels at baseline were comparable at 12 and 24 weeks of age, the endothelial VDR knockout mice demonstrated increased sensitivity to the hypertensive effects of angiotensin II compared with control mice (after 1-week infusion: knockout=155±15 mm Hg versus control=133±7 mm Hg; P<0.01; after 2-week infusion: knockout=164±9 mm Hg versus control=152±13 mm Hg; P<0.05). By the end of 2 weeks, angiotensin II infusion-induced, hypertrophy-sensitive myocardial gene expression was higher in endothelial-specific VDR knockout mice (fold change compared with saline-infused control mice, type-A natriuretic peptide: knockout mice=3.12 versus control=1.7; P<0.05; type-B natriuretic peptide: knockout mice=4.72 versus control=2.68; P<0.05). These results suggest that endothelial VDR plays an important role in endothelial cell function and blood pressure control and imply a potential role for VDR agonists in the management of cardiovascular disease associated with endothelial dysfunction.
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Affiliation(s)
- Wei Ni
- From the Department of Medicine and Diabetes Center, University of California at San Francisco (W.N., M.N., S.C., D.J.G. and D.G.G); and the Department of Pharmacology and Toxicology, Michigan State University, East Lansing (S.W.W.).
| | - Stephanie W Watts
- From the Department of Medicine and Diabetes Center, University of California at San Francisco (W.N., M.N., S.C., D.J.G. and D.G.G); and the Department of Pharmacology and Toxicology, Michigan State University, East Lansing (S.W.W.)
| | - Michael Ng
- From the Department of Medicine and Diabetes Center, University of California at San Francisco (W.N., M.N., S.C., D.J.G. and D.G.G); and the Department of Pharmacology and Toxicology, Michigan State University, East Lansing (S.W.W.)
| | - Songcang Chen
- From the Department of Medicine and Diabetes Center, University of California at San Francisco (W.N., M.N., S.C., D.J.G. and D.G.G); and the Department of Pharmacology and Toxicology, Michigan State University, East Lansing (S.W.W.)
| | - Denis J Glenn
- From the Department of Medicine and Diabetes Center, University of California at San Francisco (W.N., M.N., S.C., D.J.G. and D.G.G); and the Department of Pharmacology and Toxicology, Michigan State University, East Lansing (S.W.W.)
| | - David G Gardner
- From the Department of Medicine and Diabetes Center, University of California at San Francisco (W.N., M.N., S.C., D.J.G. and D.G.G); and the Department of Pharmacology and Toxicology, Michigan State University, East Lansing (S.W.W.)
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Ryu OH, Chung W, Lee S, Hong KS, Choi MG, Yoo HJ. The effect of high-dose vitamin D supplementation on insulin resistance and arterial stiffness in patients with type 2 diabetes. Korean J Intern Med 2014; 29:620-9. [PMID: 25228838 PMCID: PMC4164726 DOI: 10.3904/kjim.2014.29.5.620] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 11/18/2013] [Accepted: 12/30/2013] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND/AIMS Recent epidemiological studies revealed a striking inverse relationship between vitamin D levels, glucose intolerance/insulin resistance (IR), and cardiovascular disease. However, few interventional studies have evaluated the effect of vitamin D supplementation on cardiovascular risk, such as IR and arterial stiffness, in diabetes. We investigated the role of vitamin D supplementation on cardiovascular risk in type 2 diabetes patients, including metabolic parameters, IR, and arterial stiffness. METHODS We enrolled patients who were taking antidiabetic medications or managed their diabetes using lifestyle changes. We excluded patients who were taking vitamin D or calcium supplements. We randomized participants into the vitamin D group (cholecalciferol 2,000 IU/day + calcium 200 mg/day, n = 40) or the placebo group (calcium 200 mg/day, n = 41). We compared their IR (homeostasis model of assessment [HOMA]-IR) and arterial stiffness (brachial-ankle pulse wave velocity and radial augmentation index) before and after 24 weeks of intervention. RESULTS The baseline characteristics of the two groups were similar. A total of 62 participants (placebo, 30; vitamin D, 32) completed the study protocol. At the end of the study period, the 25-hydroxyvitamin D [25(OH)D] levels were significantly higher in the vitamin D group than in the placebo group (35.4 ± 8.5 ng/mL vs. 18.4 ± 7.3 ng/mL, p < 0.001). There was no difference in HOMA-IR or changes in arterial stiffness (placebo, 21, vitamin D, 24) between the groups. CONCLUSIONS Our data suggest that high-dose vitamin D supplementation might be effective in terms of elevating 25(OH)D levels. However, we identified no beneficial effects on cardiovascular risk in type 2 diabetes, including IR and arterial stiffness.
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Affiliation(s)
- Ohk-Hyun Ryu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Wankyo Chung
- Department of Healthcare Management, Hallym University School of Business, Chuncheon, Korea
| | - Sungwha Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Kyung-Soon Hong
- Division of Cardiology, Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Moon-Gi Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Hyung Joon Yoo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
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Wong MSK, Leisegang MS, Kruse C, Vogel J, Schürmann C, Dehne N, Weigert A, Herrmann E, Brüne B, Shah AM, Steinhilber D, Offermanns S, Carmeliet G, Badenhoop K, Schröder K, Brandes RP. Vitamin D promotes vascular regeneration. Circulation 2014; 130:976-86. [PMID: 25015343 DOI: 10.1161/circulationaha.114.010650] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Vitamin D deficiency in humans is frequent and has been associated with inflammation. The role of the active hormone 1,25-dihydroxycholecalciferol (1,25-dihydroxy-vitamin D3; 1,25-VitD3) in the cardiovascular system is controversial. High doses induce vascular calcification; vitamin D3 deficiency, however, has been linked to cardiovascular disease because the hormone has anti-inflammatory properties. We therefore hypothesized that 1,25-VitD3 promotes regeneration after vascular injury. METHODS AND RESULTS In healthy volunteers, supplementation of vitamin D3 (4000 IU cholecalciferol per day) increased the number of circulating CD45-CD117+Sca1+Flk1+ angiogenic myeloid cells, which are thought to promote vascular regeneration. Similarly, in mice, 1,25-VitD3 (100 ng/kg per day) increased the number of angiogenic myeloid cells and promoted reendothelialization in the carotid artery injury model. In streptozotocin-induced diabetic mice, 1,25-VitD3 also promoted reendothelialization and restored the impaired angiogenesis in the femoral artery ligation model. Angiogenic myeloid cells home through the stromal cell-derived factor 1 (SDF1) receptor CXCR4. Inhibition of CXCR4 blocked 1,25-VitD3-stimulated healing, pointing to a role of SDF1. The combination of injury and 1,25-VitD3 increased SDF1 in vessels. Conditioned medium from injured, 1,25-VitD3-treated arteries elicited a chemotactic effect on angiogenic myeloid cells, which was blocked by SDF1-neutralizing antibodies. Conditional knockout of the vitamin D receptor in myeloid cells but not the endothelium or smooth muscle cells blocked the effects of 1,25-VitD3 on healing and prevented SDF1 formation. Mechanistically, 1,25-VitD3 increased hypoxia-inducible factor 1-α through binding to its promoter. Increased hypoxia-inducible factor signaling subsequently promoted SDF1 expression, as revealed by reporter assays and knockout and inhibitory strategies of hypoxia-inducible factor 1-α. CONCLUSIONS By inducing SDF1, vitamin D3 is a novel approach to promote vascular repair.
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Affiliation(s)
- Michael Sze Ka Wong
- From the Institute for Cardiovascular Physiology (M.S.K.W., M.S.L., C.K., J.V., C.S., K.S., R.P.B.), Institute of Biochemistry I (N.D., A.W., B.B.), Institute for Biostatistics and Mathematical Modeling (E.H.), Institute of Pharmaceutical Chemistry/Zentrum für Arzneimittelforschung, Entwicklung und Sicherheit (D.S.), Goethe University, Frankfurt, Germany; German Center for Cardiovascular Research, Partner Site RheinMain, Frankfurt, Germany (M.S.L., C.K., C.S., E.H., S.O., K.S., R.P.B.); Cardiovascular Division, King's College London British Heart Foundation Center of Excellence, London, United Kingdom (A.M.S.); Department of Pharmacology, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany (S.O.); Clinical and Experimental Endocrinology, KU Leuven, Leuven, Belgium (G.C.); and Department of Endocrinology and Diabetes, Internal Medicine 1, University Hospital Frankfurt, Frankfurt, Germany (K.B.)
| | - Matthias S Leisegang
- From the Institute for Cardiovascular Physiology (M.S.K.W., M.S.L., C.K., J.V., C.S., K.S., R.P.B.), Institute of Biochemistry I (N.D., A.W., B.B.), Institute for Biostatistics and Mathematical Modeling (E.H.), Institute of Pharmaceutical Chemistry/Zentrum für Arzneimittelforschung, Entwicklung und Sicherheit (D.S.), Goethe University, Frankfurt, Germany; German Center for Cardiovascular Research, Partner Site RheinMain, Frankfurt, Germany (M.S.L., C.K., C.S., E.H., S.O., K.S., R.P.B.); Cardiovascular Division, King's College London British Heart Foundation Center of Excellence, London, United Kingdom (A.M.S.); Department of Pharmacology, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany (S.O.); Clinical and Experimental Endocrinology, KU Leuven, Leuven, Belgium (G.C.); and Department of Endocrinology and Diabetes, Internal Medicine 1, University Hospital Frankfurt, Frankfurt, Germany (K.B.)
| | - Christoph Kruse
- From the Institute for Cardiovascular Physiology (M.S.K.W., M.S.L., C.K., J.V., C.S., K.S., R.P.B.), Institute of Biochemistry I (N.D., A.W., B.B.), Institute for Biostatistics and Mathematical Modeling (E.H.), Institute of Pharmaceutical Chemistry/Zentrum für Arzneimittelforschung, Entwicklung und Sicherheit (D.S.), Goethe University, Frankfurt, Germany; German Center for Cardiovascular Research, Partner Site RheinMain, Frankfurt, Germany (M.S.L., C.K., C.S., E.H., S.O., K.S., R.P.B.); Cardiovascular Division, King's College London British Heart Foundation Center of Excellence, London, United Kingdom (A.M.S.); Department of Pharmacology, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany (S.O.); Clinical and Experimental Endocrinology, KU Leuven, Leuven, Belgium (G.C.); and Department of Endocrinology and Diabetes, Internal Medicine 1, University Hospital Frankfurt, Frankfurt, Germany (K.B.)
| | - Juri Vogel
- From the Institute for Cardiovascular Physiology (M.S.K.W., M.S.L., C.K., J.V., C.S., K.S., R.P.B.), Institute of Biochemistry I (N.D., A.W., B.B.), Institute for Biostatistics and Mathematical Modeling (E.H.), Institute of Pharmaceutical Chemistry/Zentrum für Arzneimittelforschung, Entwicklung und Sicherheit (D.S.), Goethe University, Frankfurt, Germany; German Center for Cardiovascular Research, Partner Site RheinMain, Frankfurt, Germany (M.S.L., C.K., C.S., E.H., S.O., K.S., R.P.B.); Cardiovascular Division, King's College London British Heart Foundation Center of Excellence, London, United Kingdom (A.M.S.); Department of Pharmacology, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany (S.O.); Clinical and Experimental Endocrinology, KU Leuven, Leuven, Belgium (G.C.); and Department of Endocrinology and Diabetes, Internal Medicine 1, University Hospital Frankfurt, Frankfurt, Germany (K.B.)
| | - Christoph Schürmann
- From the Institute for Cardiovascular Physiology (M.S.K.W., M.S.L., C.K., J.V., C.S., K.S., R.P.B.), Institute of Biochemistry I (N.D., A.W., B.B.), Institute for Biostatistics and Mathematical Modeling (E.H.), Institute of Pharmaceutical Chemistry/Zentrum für Arzneimittelforschung, Entwicklung und Sicherheit (D.S.), Goethe University, Frankfurt, Germany; German Center for Cardiovascular Research, Partner Site RheinMain, Frankfurt, Germany (M.S.L., C.K., C.S., E.H., S.O., K.S., R.P.B.); Cardiovascular Division, King's College London British Heart Foundation Center of Excellence, London, United Kingdom (A.M.S.); Department of Pharmacology, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany (S.O.); Clinical and Experimental Endocrinology, KU Leuven, Leuven, Belgium (G.C.); and Department of Endocrinology and Diabetes, Internal Medicine 1, University Hospital Frankfurt, Frankfurt, Germany (K.B.)
| | - Nathalie Dehne
- From the Institute for Cardiovascular Physiology (M.S.K.W., M.S.L., C.K., J.V., C.S., K.S., R.P.B.), Institute of Biochemistry I (N.D., A.W., B.B.), Institute for Biostatistics and Mathematical Modeling (E.H.), Institute of Pharmaceutical Chemistry/Zentrum für Arzneimittelforschung, Entwicklung und Sicherheit (D.S.), Goethe University, Frankfurt, Germany; German Center for Cardiovascular Research, Partner Site RheinMain, Frankfurt, Germany (M.S.L., C.K., C.S., E.H., S.O., K.S., R.P.B.); Cardiovascular Division, King's College London British Heart Foundation Center of Excellence, London, United Kingdom (A.M.S.); Department of Pharmacology, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany (S.O.); Clinical and Experimental Endocrinology, KU Leuven, Leuven, Belgium (G.C.); and Department of Endocrinology and Diabetes, Internal Medicine 1, University Hospital Frankfurt, Frankfurt, Germany (K.B.)
| | - Andreas Weigert
- From the Institute for Cardiovascular Physiology (M.S.K.W., M.S.L., C.K., J.V., C.S., K.S., R.P.B.), Institute of Biochemistry I (N.D., A.W., B.B.), Institute for Biostatistics and Mathematical Modeling (E.H.), Institute of Pharmaceutical Chemistry/Zentrum für Arzneimittelforschung, Entwicklung und Sicherheit (D.S.), Goethe University, Frankfurt, Germany; German Center for Cardiovascular Research, Partner Site RheinMain, Frankfurt, Germany (M.S.L., C.K., C.S., E.H., S.O., K.S., R.P.B.); Cardiovascular Division, King's College London British Heart Foundation Center of Excellence, London, United Kingdom (A.M.S.); Department of Pharmacology, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany (S.O.); Clinical and Experimental Endocrinology, KU Leuven, Leuven, Belgium (G.C.); and Department of Endocrinology and Diabetes, Internal Medicine 1, University Hospital Frankfurt, Frankfurt, Germany (K.B.)
| | - Eva Herrmann
- From the Institute for Cardiovascular Physiology (M.S.K.W., M.S.L., C.K., J.V., C.S., K.S., R.P.B.), Institute of Biochemistry I (N.D., A.W., B.B.), Institute for Biostatistics and Mathematical Modeling (E.H.), Institute of Pharmaceutical Chemistry/Zentrum für Arzneimittelforschung, Entwicklung und Sicherheit (D.S.), Goethe University, Frankfurt, Germany; German Center for Cardiovascular Research, Partner Site RheinMain, Frankfurt, Germany (M.S.L., C.K., C.S., E.H., S.O., K.S., R.P.B.); Cardiovascular Division, King's College London British Heart Foundation Center of Excellence, London, United Kingdom (A.M.S.); Department of Pharmacology, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany (S.O.); Clinical and Experimental Endocrinology, KU Leuven, Leuven, Belgium (G.C.); and Department of Endocrinology and Diabetes, Internal Medicine 1, University Hospital Frankfurt, Frankfurt, Germany (K.B.)
| | - Bernhard Brüne
- From the Institute for Cardiovascular Physiology (M.S.K.W., M.S.L., C.K., J.V., C.S., K.S., R.P.B.), Institute of Biochemistry I (N.D., A.W., B.B.), Institute for Biostatistics and Mathematical Modeling (E.H.), Institute of Pharmaceutical Chemistry/Zentrum für Arzneimittelforschung, Entwicklung und Sicherheit (D.S.), Goethe University, Frankfurt, Germany; German Center for Cardiovascular Research, Partner Site RheinMain, Frankfurt, Germany (M.S.L., C.K., C.S., E.H., S.O., K.S., R.P.B.); Cardiovascular Division, King's College London British Heart Foundation Center of Excellence, London, United Kingdom (A.M.S.); Department of Pharmacology, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany (S.O.); Clinical and Experimental Endocrinology, KU Leuven, Leuven, Belgium (G.C.); and Department of Endocrinology and Diabetes, Internal Medicine 1, University Hospital Frankfurt, Frankfurt, Germany (K.B.)
| | - Ajay M Shah
- From the Institute for Cardiovascular Physiology (M.S.K.W., M.S.L., C.K., J.V., C.S., K.S., R.P.B.), Institute of Biochemistry I (N.D., A.W., B.B.), Institute for Biostatistics and Mathematical Modeling (E.H.), Institute of Pharmaceutical Chemistry/Zentrum für Arzneimittelforschung, Entwicklung und Sicherheit (D.S.), Goethe University, Frankfurt, Germany; German Center for Cardiovascular Research, Partner Site RheinMain, Frankfurt, Germany (M.S.L., C.K., C.S., E.H., S.O., K.S., R.P.B.); Cardiovascular Division, King's College London British Heart Foundation Center of Excellence, London, United Kingdom (A.M.S.); Department of Pharmacology, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany (S.O.); Clinical and Experimental Endocrinology, KU Leuven, Leuven, Belgium (G.C.); and Department of Endocrinology and Diabetes, Internal Medicine 1, University Hospital Frankfurt, Frankfurt, Germany (K.B.)
| | - Dieter Steinhilber
- From the Institute for Cardiovascular Physiology (M.S.K.W., M.S.L., C.K., J.V., C.S., K.S., R.P.B.), Institute of Biochemistry I (N.D., A.W., B.B.), Institute for Biostatistics and Mathematical Modeling (E.H.), Institute of Pharmaceutical Chemistry/Zentrum für Arzneimittelforschung, Entwicklung und Sicherheit (D.S.), Goethe University, Frankfurt, Germany; German Center for Cardiovascular Research, Partner Site RheinMain, Frankfurt, Germany (M.S.L., C.K., C.S., E.H., S.O., K.S., R.P.B.); Cardiovascular Division, King's College London British Heart Foundation Center of Excellence, London, United Kingdom (A.M.S.); Department of Pharmacology, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany (S.O.); Clinical and Experimental Endocrinology, KU Leuven, Leuven, Belgium (G.C.); and Department of Endocrinology and Diabetes, Internal Medicine 1, University Hospital Frankfurt, Frankfurt, Germany (K.B.)
| | - Stefan Offermanns
- From the Institute for Cardiovascular Physiology (M.S.K.W., M.S.L., C.K., J.V., C.S., K.S., R.P.B.), Institute of Biochemistry I (N.D., A.W., B.B.), Institute for Biostatistics and Mathematical Modeling (E.H.), Institute of Pharmaceutical Chemistry/Zentrum für Arzneimittelforschung, Entwicklung und Sicherheit (D.S.), Goethe University, Frankfurt, Germany; German Center for Cardiovascular Research, Partner Site RheinMain, Frankfurt, Germany (M.S.L., C.K., C.S., E.H., S.O., K.S., R.P.B.); Cardiovascular Division, King's College London British Heart Foundation Center of Excellence, London, United Kingdom (A.M.S.); Department of Pharmacology, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany (S.O.); Clinical and Experimental Endocrinology, KU Leuven, Leuven, Belgium (G.C.); and Department of Endocrinology and Diabetes, Internal Medicine 1, University Hospital Frankfurt, Frankfurt, Germany (K.B.)
| | - Geert Carmeliet
- From the Institute for Cardiovascular Physiology (M.S.K.W., M.S.L., C.K., J.V., C.S., K.S., R.P.B.), Institute of Biochemistry I (N.D., A.W., B.B.), Institute for Biostatistics and Mathematical Modeling (E.H.), Institute of Pharmaceutical Chemistry/Zentrum für Arzneimittelforschung, Entwicklung und Sicherheit (D.S.), Goethe University, Frankfurt, Germany; German Center for Cardiovascular Research, Partner Site RheinMain, Frankfurt, Germany (M.S.L., C.K., C.S., E.H., S.O., K.S., R.P.B.); Cardiovascular Division, King's College London British Heart Foundation Center of Excellence, London, United Kingdom (A.M.S.); Department of Pharmacology, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany (S.O.); Clinical and Experimental Endocrinology, KU Leuven, Leuven, Belgium (G.C.); and Department of Endocrinology and Diabetes, Internal Medicine 1, University Hospital Frankfurt, Frankfurt, Germany (K.B.)
| | - Klaus Badenhoop
- From the Institute for Cardiovascular Physiology (M.S.K.W., M.S.L., C.K., J.V., C.S., K.S., R.P.B.), Institute of Biochemistry I (N.D., A.W., B.B.), Institute for Biostatistics and Mathematical Modeling (E.H.), Institute of Pharmaceutical Chemistry/Zentrum für Arzneimittelforschung, Entwicklung und Sicherheit (D.S.), Goethe University, Frankfurt, Germany; German Center for Cardiovascular Research, Partner Site RheinMain, Frankfurt, Germany (M.S.L., C.K., C.S., E.H., S.O., K.S., R.P.B.); Cardiovascular Division, King's College London British Heart Foundation Center of Excellence, London, United Kingdom (A.M.S.); Department of Pharmacology, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany (S.O.); Clinical and Experimental Endocrinology, KU Leuven, Leuven, Belgium (G.C.); and Department of Endocrinology and Diabetes, Internal Medicine 1, University Hospital Frankfurt, Frankfurt, Germany (K.B.)
| | - Katrin Schröder
- From the Institute for Cardiovascular Physiology (M.S.K.W., M.S.L., C.K., J.V., C.S., K.S., R.P.B.), Institute of Biochemistry I (N.D., A.W., B.B.), Institute for Biostatistics and Mathematical Modeling (E.H.), Institute of Pharmaceutical Chemistry/Zentrum für Arzneimittelforschung, Entwicklung und Sicherheit (D.S.), Goethe University, Frankfurt, Germany; German Center for Cardiovascular Research, Partner Site RheinMain, Frankfurt, Germany (M.S.L., C.K., C.S., E.H., S.O., K.S., R.P.B.); Cardiovascular Division, King's College London British Heart Foundation Center of Excellence, London, United Kingdom (A.M.S.); Department of Pharmacology, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany (S.O.); Clinical and Experimental Endocrinology, KU Leuven, Leuven, Belgium (G.C.); and Department of Endocrinology and Diabetes, Internal Medicine 1, University Hospital Frankfurt, Frankfurt, Germany (K.B.).
| | - Ralf P Brandes
- From the Institute for Cardiovascular Physiology (M.S.K.W., M.S.L., C.K., J.V., C.S., K.S., R.P.B.), Institute of Biochemistry I (N.D., A.W., B.B.), Institute for Biostatistics and Mathematical Modeling (E.H.), Institute of Pharmaceutical Chemistry/Zentrum für Arzneimittelforschung, Entwicklung und Sicherheit (D.S.), Goethe University, Frankfurt, Germany; German Center for Cardiovascular Research, Partner Site RheinMain, Frankfurt, Germany (M.S.L., C.K., C.S., E.H., S.O., K.S., R.P.B.); Cardiovascular Division, King's College London British Heart Foundation Center of Excellence, London, United Kingdom (A.M.S.); Department of Pharmacology, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany (S.O.); Clinical and Experimental Endocrinology, KU Leuven, Leuven, Belgium (G.C.); and Department of Endocrinology and Diabetes, Internal Medicine 1, University Hospital Frankfurt, Frankfurt, Germany (K.B.).
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Dreyer G, Tucker AT, Harwood SM, Pearse RM, Raftery MJ, Yaqoob MM. Ergocalciferol and microcirculatory function in chronic kidney disease and concomitant vitamin d deficiency: an exploratory, double blind, randomised controlled trial. PLoS One 2014; 9:e99461. [PMID: 25006678 PMCID: PMC4090117 DOI: 10.1371/journal.pone.0099461] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 05/13/2014] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Vitamin D deficiency and endothelial dysfunction are non-traditional risk factors for cardiovascular events in chronic kidney disease. Previous studies in chronic kidney disease have failed to demonstrate a beneficial effect of vitamin D on arterial stiffness, left ventricular mass and inflammation but none have assessed the effect of vitamin D on microcirculatory endothelial function. STUDY DESIGN We conducted a randomised controlled trial of 38 patients with non diabetic chronic kidney disease stage 3-4 and concomitant vitamin D deficiency (<16 ng/dl) who received oral ergocalciferol (50,000 IU weekly for one month followed by 50,000 IU monthly) or placebo over 6 months. The primary outcome was change in microcirculatory function measured by laser Doppler flowmetry after iontophoresis of acetylcholine. Secondary endpoints were tissue advanced glycation end products, sublingual functional capillary density and flow index as well as macrovascular parameters. Parallel in vitro experiments were conducted to determine the effect of ergocalciferol on cultured human endothelial cells. RESULTS Twenty patients received ergocalciferol and 18 patients received placebo. After 6 months, there was a significant improvement in the ergocalciferol group in both endothelium dependent microcirculatory vasodilatation after iontophoresis of acetylcholine (p = 0.03) and a reduction in tissue advanced glycation end products (p = 0.03). There were no changes in sublingual microcirculatory parameters. Pulse pressure (p = 0.01) but not aortic pulse wave velocity was reduced. There were no significant changes in bone mineral parameters, blood pressure or left ventricular mass index suggesting that ergocalciferol improved endothelial function independently of these parameters. In parallel experiments, expression of endothelial nitric oxide synthase and activity were increased in human endothelial cells in a dose dependent manner. CONCLUSIONS Ergocalciferol improved microcirculatory endothelial function in patients with chronic kidney disease and concomitant vitamin D deficiency. This process may be mediated through enhanced expression and activity of endothelial nitric oxide synthase. TRIAL REGISTRATION Clinical trials.gov NCT00882401.
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Affiliation(s)
- Gavin Dreyer
- Department of Renal Medicine, Barts Health NHS Trust, London, United Kingdom
- Department of Translational Medicine and Therapeutics, Queen Mary University of London, London, United Kingdom
| | - Arthur T. Tucker
- Ernest Cooke Microvascular Unit, Barts Health NHS Trust, London, United Kingdom
| | - Steven M. Harwood
- Department of Translational Medicine and Therapeutics, Queen Mary University of London, London, United Kingdom
| | - Rupert M. Pearse
- Department of Critical Care Medicine, Barts Health NHS Trust, London, United Kingdom
| | - Martin J. Raftery
- Department of Renal Medicine, Barts Health NHS Trust, London, United Kingdom
| | - Muhammad M. Yaqoob
- Department of Renal Medicine, Barts Health NHS Trust, London, United Kingdom
- Department of Translational Medicine and Therapeutics, Queen Mary University of London, London, United Kingdom
- * E-mail:
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50
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Abstract
Vitamin D plays a classical hormonal role in skeletal health by regulating calcium and phosphorus metabolism. Vitamin D metabolites also have physiological functions in nonskeletal tissues, where local synthesis influences regulatory pathways via paracrine and autocrine mechanisms. The active metabolite of vitamin D, 1α,25-dihydroxyvitamin D, binds to the vitamin D receptor that regulates numerous genes involved in fundamental processes of potential relevance to cardiovascular disease, including cell proliferation and differentiation, apoptosis, oxidative stress, membrane transport, matrix homeostasis, and cell adhesion. Vitamin D receptors have been found in all the major cardiovascular cell types including cardiomyocytes, arterial wall cells, and immune cells. Experimental studies have established a role for vitamin D metabolites in pathways that are integral to cardiovascular function and disease, including inflammation, thrombosis, and the renin-angiotensin system. Clinical studies have generally demonstrated an independent association between vitamin D deficiency and various manifestations of degenerative cardiovascular disease including vascular calcification. However, the role of vitamin D supplementation in the management of cardiovascular disease remains to be established. This review summarizes the clinical studies showing associations between vitamin D status and cardiovascular disease and the experimental studies that explore the mechanistic basis for these associations.
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Affiliation(s)
- P E Norman
- From the School of Surgery, University of Western Australia, Perth, Australia (P.E.N.); and Vascular Surgery Research Group, Imperial College, Charing Cross Campus, London, United Kingdom (J.T.P.)
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