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MacDonald H, Bézaire V. Leveraging systematic review practice for research skill development in an undergraduate science course: a case study. ADVANCES IN PHYSIOLOGY EDUCATION 2024; 48:518-526. [PMID: 38660716 DOI: 10.1152/advan.00171.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 04/11/2024] [Accepted: 04/17/2024] [Indexed: 04/26/2024]
Abstract
Information literacy skills are an important part of research skills for undergraduate science students. This case study presents a novel approach to developing these types of research skills. By deconstructing the research process into separate steps, explicitly defining, and practicing the skills involved, students can progressively develop these skills and apply them. In this course, systematic reviews are used as exemplars for the research process. We align the Research Skills Development Framework with the steps of a systematic review and present specific skills and accompanying activities for each step. This workshop-based course emphasizes skill development and can help overcome assessments that rely solely on a final paper, with no record or evidence of the student research process, that could be created by a generative artificial intelligence tool.NEW & NOTEWORTHY This study presents a novel approach to teaching undergraduate science students rigorous research skills with scaffolded systematic review practice.
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Affiliation(s)
| | - Véronic Bézaire
- Department of Chemistry, Carleton University, Ottawa, Ontario, Canada
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Wagnew F, Gray D, Tsheten T, Kelly M, Clements ACA, Alene KA. Effectiveness of nutritional support to improve treatment adherence in patients with tuberculosis: a systematic review. Nutr Rev 2024; 82:1216-1225. [PMID: 37759339 PMCID: PMC11317773 DOI: 10.1093/nutrit/nuad120] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023] Open
Abstract
CONTEXT Nutritional interventions substantially improve tuberculosis (TB) treatment outcomes and prevent complications. However, there is limited evidence about the connections between having nutritional support and TB treatment adherence. OBJECTIVE The aim of this study was to determine the effectiveness of nutritional support in improving treatment adherence among patients with TB. DATA SOURCES Databases, including PubMed, Embase (Ovid), Web of Science, and Scopus, were comprehensively reviewed to identify relevant studies reporting the impacts of nutritional support on TB treatment adherence. DATA EXTRACTION Two authors independently screened the title, abstracts, and full article texts to identify eligible studies and assess the risk of bias. Observational and interventional studies were included. DATA ANALYSIS A narrative synthesis approach was used to summarize the findings qualitatively. RESULTS From the search, 3059 publications were identified; of these, 8 studies were included in this systematic review. Three types of nutritional interventions were identified: food baskets (eg, energy, micronutrient- or macronutrient-enriched food support), nutritional advice and guidance, and incentives for buying foods. Although 5 studies reported that nutritional support significantly improved treatment adherence in patients with TB, 3 studies showed that nutritional support had no effect on TB treatment adherence. CONCLUSIONS Providing nutritional support may improve adherence to TB treatment. However, more well-powered, high-quality trials are warranted to demonstrate the effect of nutrition support on cost-effectively improving adherence to TB treatment. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration no. CRD42023392162.
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Affiliation(s)
- Fasil Wagnew
- National Centre for Epidemiology and Population Health, College of Health and Medicine, The Australian National University, Canberra, Australian Capital Territory, Australia
- College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Darren Gray
- Population Health Program, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Tsheten Tsheten
- National Centre for Epidemiology and Population Health, College of Health and Medicine, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Matthew Kelly
- National Centre for Epidemiology and Population Health, College of Health and Medicine, The Australian National University, Canberra, Australian Capital Territory, Australia
| | | | - Kefyalew Addis Alene
- Geospatial and Tuberculosis Research Team, Telethon Kids Institute, Nedlands, Western Australia, Australia
- Faculty of Health Sciences, School of Population Health, Curtin University, Bentley, Western Australia, Australia
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Eletreby R, Elsharkawy A, Mohamed R, Hamed M, Kamal Ibrahim E, Fouad R. Prevalence of vitamin D deficiency and the effect of vitamin D3 supplementation on response to anti-tuberculosis therapy in patients with extrapulmonary tuberculosis. BMC Infect Dis 2024; 24:681. [PMID: 38982373 PMCID: PMC11232269 DOI: 10.1186/s12879-024-09367-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 04/29/2024] [Indexed: 07/11/2024] Open
Abstract
BACKGROUND We aimed to assess serum 25-hydroxyvitamin D3 (25(OH)D3) concentrations in extrapulmonary tuberculosis (EPTB) patients and to evaluate the effect of vitamin D3 supplementation on their treatment course. METHODS Serum 25(OH)D3concentrations were measured in 47 newly diagnosed EPTB patients and 42 controls. Vitamin D-deficient EPTB patients were randomly assigned to receive 50,000 IU of vitamin D3 (cholecalciferol) orally once a week for 6 weeks (total 300,000 IU), followed by maintenance doses of 1000 IU a day besides anti-TB drugs or the first line anti-TB treatment only. Follow up serum 25(OH)D3 concentrations were measured after 3 months of starting vitamin D3 supplementation. Both groups were evaluated for clinical, laboratory, and radiological outcomes after treatment. RESULTS Serum 25(OH)D3 concentrations were significantly lower among TB cases (17.1 ± 5.5 nmol/L) compared to healthy controls (51.8 ± 27.3 nmol/L), and vitamin D deficiency was observed in all EPTB patients (n = 47). Patients in VD3 supplementation group had significantly higher weight gain and serum albumin level at 2 months and end of treatment, higher hemoglobin concentration at the end of treatment, significantly lower CRP and ESR at 2 months and at the end of treatment. In cases with TB pleurisy, a significant higher rate of full resolution of pleural fluid after 6 months of anti-TB treatment and shorter treatment duration were noted compared to the other group. CONCLUSIONS Vitamin D deficiency is prevalent in EPTB patients, in whom, vitamin D supplementation is a useful adjunctive therapy to anti-TB drugs and improves treatment course.
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Affiliation(s)
- Rasha Eletreby
- Endemic Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Aisha Elsharkawy
- Endemic Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Rahma Mohamed
- Endemic Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
| | - Mai Hamed
- Clinical and Chemical Pathology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Eman Kamal Ibrahim
- Pulmonology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Rabab Fouad
- Endemic Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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Mbanje C, Kuhn I, Musakwa N, Calvi M, Boccia D, Muhwa JC, Mvusi L, Jaramillo E, Evans D, Meghji J. A scoping review of interventions to address TB associated respiratory disability. EClinicalMedicine 2024; 73:102646. [PMID: 38846067 PMCID: PMC11154123 DOI: 10.1016/j.eclinm.2024.102646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/30/2024] [Accepted: 04/30/2024] [Indexed: 06/09/2024] Open
Abstract
There is a growing body of data describing a high burden of respiratory morbidity amongst pulmonary TB patients and survivors, with up to half thought to experience residual respiratory symptoms, abnormal spirometry, or structural pathology after TB treatment completion. Many patients experiencing marked impacts on their lives and livelihoods. However, there remain no guidelines or evidence-based frameworks for integrated TB-respiratory care during or post TB treatment completion. In this scoping review, completed in collaboration with the WHO Global Tuberculosis Programme, we have identified a lack of primary data on the clinical efficacy, cost effectiveness or feasibility of six potential interventions for the prevention and management of TB-associated respiratory impairment and disability, with a lack of studies in children and adolescents. There is a need for robust interventional trials to improve the long-term respiratory outcomes of people affected by pulmonary TB disease, and to explore how these might be implemented within resource-limited settings.
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Affiliation(s)
- Cassandra Mbanje
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Isla Kuhn
- Cambridge University Medical Library, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Nozipho Musakwa
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Marzia Calvi
- Global Tuberculosis Programme, WHO, Geneva, Switzerland
| | - Delia Boccia
- Global Tuberculosis Programme, WHO, Geneva, Switzerland
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Jeremiah Chakaya Muhwa
- Department of Medicine, Therapeutics, Dermatology and Psychiatry, Kenyatta University, Nairobi, Kenya
| | - Lindiwe Mvusi
- National Department of Health, Johannesburg, South Africa
| | | | - Denise Evans
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jamilah Meghji
- National Heart and Lung Institute, Imperial College London, London, UK
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Santos-Mena A, González-Muñiz OE, Jacobo-Delgado YM, Rivas-Santiago B. Shedding light on vitamin D in tuberculosis: A comprehensive review of clinical trials and discrepancies. Pulm Pharmacol Ther 2024; 85:102300. [PMID: 38723942 DOI: 10.1016/j.pupt.2024.102300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 09/27/2023] [Accepted: 05/06/2024] [Indexed: 05/12/2024]
Abstract
Over the past few decades, there has been extensive research on the use of vitamin D as an adjunctive therapy in the treatment and prevention of tuberculosis. In vitro studies have provided valuable insights into the mechanisms by which vitamin D activates the immune response to combat Mycobacterium tuberculosis. These encouraging findings have spurred clinical investigations globally to assess the effectiveness of vitamin D as a preventive measure and as an adjunctive treatment for tuberculosis. However, the results from these clinical studies have been contradictory, with some demonstrating clear efficacy while others report only modest or no activity. In this review, we aim to analyze the clinical studies on vitamin D and examine the possible discrepancies observed in their outcomes.
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Affiliation(s)
- Alan Santos-Mena
- Biomedical Research Unit Zacatecas-IMSS, Instituto Mexicano Del Seguro Social, Zacatecas, Mexico
| | - Oscar E González-Muñiz
- Biomedical Research Unit Zacatecas-IMSS, Instituto Mexicano Del Seguro Social, Zacatecas, Mexico
| | - Yolanda M Jacobo-Delgado
- Biomedical Research Unit Zacatecas-IMSS, Instituto Mexicano Del Seguro Social, Zacatecas, Mexico
| | - Bruno Rivas-Santiago
- Biomedical Research Unit Zacatecas-IMSS, Instituto Mexicano Del Seguro Social, Zacatecas, Mexico.
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Chandra H, Rahman A, Yadav P, Maurya G, Kumar Shukla S. Effect of adjunct Vitamin D treatment in vitamin D deficient pulmonary tuberculosis patients: A randomized, double blind, active controlled clinical trial. Indian J Tuberc 2024; 71:170-178. [PMID: 38589121 DOI: 10.1016/j.ijtb.2023.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 04/15/2023] [Accepted: 04/28/2023] [Indexed: 04/10/2024]
Abstract
BACKGROUND Since, Vitamin D [1α,25(OH)2D)] enhances antimicrobial activity of Innate immunity and modulate Adaptive immune responses, simultaneously, so it play a potential role for balanced immune activity against Mycobacterium tuberculosis and restricting tissue injuries within the TB patients.(Chun et al., 2011) 9 We aimed to determine the role of adjunct Vitamin D treatment on the outcome of pulmonary tuberculosis patients and evaluated the effect of Vitamin D administration on Differential Leucocyte Count, Erythrocyte Sedimentation Rate, serum Adenosine deaminase, serum C- reactive protein, Oxygen saturation (SpO2) and Body Weight in Vitamin D deficient pulmonary tuberculosis patients. METHODS We conducted a prospective, interventional, randomized, double blind, parallel group, active controlled clinical trial. Newly diagnosed Vitamin D deficient pulmonary tuberculosis patients were randomly assigned to intervention group (received standard anti-tubercular treatment with adjunct Vitamin D3) and control group (received standard anti-tubercular treatment without adjunct Vitamin D3). Total four doses [each dose of 2.5 mg (100000 IU)] of Vitamin D3 were given, orally. First dose was given within 7 days of starting anti-tubercular treatment and second, third, fourth dose were given at 2, 4 and 6 weeks respectively. At the time of enrollment, we measured all baseline characteristics. During follow-up, we measured the study variables and monitored adverse events at 2, 4, 6, 8 and 12 weeks. Our safety parameter was serum corrected calcium level to assess the risk of hypercalcemia. RESULTS Total 130 pulmonary TB patients, 65 patients in each group, were analyzed. Our study results showed that decrease in Neutrophil count was statistically significant with small effect sizes at every time point of measurement and increase in Lymphocyte count was statistically significant with small and moderate effect sizes at 4, 6 and 8 week for intervention group than for control group. Decrease in erythrocyte sedimentation rate was statistically significant with small effect sizes at 6 and 8 week, decrease in serum adenosine deaminase and serum C- reactive protein was statistically significant with moderate effect sizes at 4, 6 and 8 week for intervention group than for control group. Increase in Oxygen saturation was statistically significant at 4 week with small effect size and increase in body weight was statistically significant with small effect sizes for intervention group than for control group. No case of hypercalcemia was reported. CONCLUSION Our findings suggest a potential role of adjunctive Vitamin D3 to accelerate resolution of inflammatory responses and improvement in clinical outcomes of pulmonary TB patients. TRIAL REGISTRATION This trial is registered with Clinical Trials Registry - INDIA (http://ctri.nic.in) with CTRI Number - CTRI/2021/11/037914. PLACE OF STUDY Room Number 27, first floor out-patients department (OPD) and inpatient Wards, fourth floor, Department of Respiratory Medicine, Uttar Pradesh University of Medical Sciences, Saifai, Etawah (U.P.), INDIA.
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Affiliation(s)
- Harish Chandra
- Department of Biochemistry, Academic Block, Uttar Pradesh University of Medical Sciences, Saifai, Etawah, (U.P), 206130, India.
| | - Adil Rahman
- Department of Biochemistry, Academic Block, Uttar Pradesh University of Medical Sciences, Saifai, Etawah, (U.P), 206130, India
| | - Prashant Yadav
- Department of Respiratory Medicine, Uttar Pradesh University of Medical Sciences, Saifai, Etawah, (U.P.), 206130, India
| | - Geeta Maurya
- Department of Pathology, Academic Block, Uttar Pradesh University of Medical Sciences, Saifai, Etawah, (U.P.), 206130, India
| | - Sushil Kumar Shukla
- Department of Community Medicine, Academic Block, Uttar Pradesh University of Medical Sciences, Saifai, Etawah, (U.P.), 206130, India
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Xie K, Zhang Y, Zhang M, Wu H, Zheng L, Ji J, Li Z, Wang W, Zhang T. Association of vitamin D with HIV infected individuals, TB infected individuals, and HIV-TB co-infected individuals: a systematic review and meta-analysis. Front Public Health 2024; 12:1344024. [PMID: 38439754 PMCID: PMC10910524 DOI: 10.3389/fpubh.2024.1344024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 01/29/2024] [Indexed: 03/06/2024] Open
Abstract
Background Vitamin D deficiency (VDD) is a worldwide disease. VDD is also associated with an increased risk of HIV-related comorbidities and mortality, and patients have a tendency to develop active tuberculosis compared to those with latent tuberculosis infection. Vitamin D supplementation may modulate HIV replication, improve TB inflammation and reduce progression of HIV-TB co-infection. Methods We meta-analyzed individual participant data from cohort studies, cross-sectional study, and RCTs of vitamin D in HIV group, TB group, and HIV-TB group. The primary outcomes were differences in vitamin D level and VDD prevalence between three groups, the secondary outcomes were CD4 count, HIV viral load, time to sputum smear conversion, time to culture conversion, relapse, morality, and TB score. Results For vitamin D levels, the overall mean difference (MD) between HIV group and TB group was -0.21 (95% CI, -20.80-20.38; p = 0.9, I2 = 84%), HIV group and HIV-TB group was 0.87 (95% CI, -11.45-13.20; p = 0.89, I2 = 87%), and TB group and HIV-TB group was 1.17 (95% CI, -5.21-7.55; p = 0.72, I2 = 85%). For vitamin D deficiency prevalence, the overall odds ratio (OR) for HIV group versus TB group was 1.23 (95% CI, 0.46-3.31; p = 0.68; I2 = 70%), HIV group versus HIV-TB group was 1.53 (95% CI, 1.03-2.29; p = 0.04; I2 = 0%), and TB group versus HIV-TB group was 0.85 (95% CI, 0.61-1.20; p = 0.36; I2 = 22%). In HIV-TB group, the overall OR for vitamin D group versus placebo group was 0.78 (95% CI, 0.34-1.67; p = 0.52; I2 = 60%). Conclusion Our findings indicated that there were no variations in vitamin D levels between three groups. The prevalence of vitamin D deficiency was higher in the HIV-TB group than in the HIV group. Additionally, the administration of vitamin D supplements did not have obvious impact on CD4 count and viral load. Likewise, vitamin D had no effect on time to sputum smear conversion, time to culture conversion, relapse, 12-month morality, and TB score.
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Affiliation(s)
- Kaidi Xie
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Yang Zhang
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory for HIV/AIDS Research, Beijing, China
| | - Mei Zhang
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory for HIV/AIDS Research, Beijing, China
| | - Hao Wu
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory for HIV/AIDS Research, Beijing, China
| | - Luyao Zheng
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory for HIV/AIDS Research, Beijing, China
| | - Jiahao Ji
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Zhen Li
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory for HIV/AIDS Research, Beijing, China
| | - Wen Wang
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory for HIV/AIDS Research, Beijing, China
| | - Tong Zhang
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory for HIV/AIDS Research, Beijing, China
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Ashenafi S, Loreti MG, Bekele A, Aseffa G, Amogne W, Kassa E, Aderaye G, Brighenti S. Inflammatory immune profiles associated with disease severity in pulmonary tuberculosis patients with moderate to severe clinical TB or anemia. Front Immunol 2023; 14:1296501. [PMID: 38162636 PMCID: PMC10756900 DOI: 10.3389/fimmu.2023.1296501] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 11/28/2023] [Indexed: 01/03/2024] Open
Abstract
Background Immune control of Mycobacterium tuberculosis (Mtb) infection is largely influenced by the extensive disease heterogeneity that is typical for tuberculosis (TB). In this study, the peripheral inflammatory immune profile of different sub-groups of pulmonary TB patients was explored based on clinical disease severity, anemia of chronic disease, or the radiological extent of lung disease. Methods Plasma samples were obtained from n=107 patients with active pulmonary TB at the time of diagnosis and after start of standard chemotherapy. A composite clinical TB symptoms score, blood hemoglobin status and chest X-ray imaging were used to sub-group TB patients into 1.) mild and moderate-severe clinical TB, 2.) anemic and non-anemic TB, or 3.) limited and extensive lung involvement. Plasma levels of biomarkers associated with inflammation pathways were assessed using a Bio-Plex Magpix 37-multiplex assay. In parallel, Th1/Th2 cytokines were quantified with a 27-multiplex in matched plasma and cell culture supernatants from whole blood stimulated with M. tuberculosis-antigens using the QuantiFERON-TB Gold assay. Results Clinical TB disease severity correlated with low blood hemoglobin levels and anemia but not with radiological findings in this study cohort. Multiplex protein analyses revealed that distinct clusters of inflammation markers and cytokines separated the different TB disease sub-groups with variable efficacy. Several top-ranked markers overlapped, while other markers were unique with regards to their importance to differentiate the TB disease severity groups. A distinct immune response profile defined by elevated levels of BAFF, LIGHT, sTNF-R1 and 2, IP-10, osteopontin, chitinase-3-like protein 1, and IFNα2 and IL-8, were most effective in separating TB patients with different clinical disease severity and were also promising candidates for treatment monitoring. TB patients with mild disease displayed immune polarization towards mixed Th1/Th2 responses, while pro-inflammatory and B cell stimulating cytokines as well as immunomodulatory mediators predominated in moderate-severe TB disease and anemia of TB. Conclusions Our data demonstrated that clinical disease severity in TB is associated with anemia and distinct inflammatory immune profiles. These results contribute to the understanding of immunopathology in pulmonary TB and define top-ranked inflammatory mediators as biomarkers of disease severity and treatment prognosis.
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Affiliation(s)
- Senait Ashenafi
- Department of Pathology, School of Medicine, College of Health Sciences, Tikur Anbessa Specialized Hospital and Addis Ababa University, Addis Ababa, Ethiopia
- Department of Medicine Huddinge, Center for Infectious Medicine (CIM), ANA Futura, Karolinska Institutet, Stockholm, Sweden
| | - Marco Giulio Loreti
- Department of Medicine Huddinge, Center for Infectious Medicine (CIM), ANA Futura, Karolinska Institutet, Stockholm, Sweden
| | - Amsalu Bekele
- Department of Internal Medicine, School of Medicine, College of Health Sciences, Tikur Anbessa Specialized Hospital and Addis Ababa University, Addis Ababa, Ethiopia
| | - Getachew Aseffa
- Department of Radiology, School of Medicine, College of Health Sciences, Tikur Anbessa Specialized Hospital and Addis Ababa University, Addis Ababa, Ethiopia
| | - Wondwossen Amogne
- Department of Internal Medicine, School of Medicine, College of Health Sciences, Tikur Anbessa Specialized Hospital and Addis Ababa University, Addis Ababa, Ethiopia
| | - Endale Kassa
- Department of Internal Medicine, School of Medicine, College of Health Sciences, Tikur Anbessa Specialized Hospital and Addis Ababa University, Addis Ababa, Ethiopia
| | - Getachew Aderaye
- Department of Internal Medicine, School of Medicine, College of Health Sciences, Tikur Anbessa Specialized Hospital and Addis Ababa University, Addis Ababa, Ethiopia
| | - Susanna Brighenti
- Department of Medicine Huddinge, Center for Infectious Medicine (CIM), ANA Futura, Karolinska Institutet, Stockholm, Sweden
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Rathored J, Sharma SK, Chauhan A, Singh B, Banavaliker JN, Sreenivas V, Srivastava AK. Low serum vitamin D in North Indian multi-drug resistant pulmonary tuberculosis patients: the role of diet and sunlight. Ann Med 2023; 55:2291554. [PMID: 38079515 PMCID: PMC10880569 DOI: 10.1080/07853890.2023.2291554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 11/30/2023] [Indexed: 12/18/2023] Open
Abstract
Background: Tuberculosis (TB) and malnutrition are major global health problems, with multidrug-resistant (MDR) TB complicating international efforts. The role of vitamin D in susceptibility to and as an adjunctive treatment for TB is being studied extensively, although no study has included MDR-TB patients in context to dietary profile with vitamin D levels and sunlight exposure.Objective: This study aimed to estimate vitamin D serum levels and examine their association with dietary intake of vitamin D and sun exposure in patients with MDR-TB.Methods: North Indian participants were enrolled in three groups: MDR-TB, drug-susceptible pulmonary TB (DS-PTB), and healthy controls. All consenting participants underwent the estimation of macro- and micronutrient intake and sunlight exposure using structured questionnaires. Serum biochemistry, including 25-hydroxyvitamin D and calcium levels, was measured, and the correlation between variables was determined.Results: 747 participants were enrolled. Significant differences among the three groups were found in mean serum 25-hydroxyvitamin D levels, body mass index, macronutrient intake, dietary vitamin D and calcium content, and sun exposure index (SEI). All except sun exposure (SEI was highest in DS-PTB patients) were found to follow the trend: MDR-TB < DS-PTB < healthy controls. The mean serum vitamin D levels of all groups were deficient and correlated positively with dietary intake and SEI.Conclusion: In this study's we found significant association of serum vitamin D concentrations, dietary intake and sunlight exposure in MDR-TB, DS-PTB patients and healthy controls. Dietary intake may be more important than sun exposure in determining serum levels. However, the significance of this finding is uncertain. Further studies are required to confirm the association, direction, and potential for vitamin D supplementation to treat or prevent MDR-TB infection.
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Affiliation(s)
- Jaishriram Rathored
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
- Department of ‘School of Allied Health Sciences’, Datta Meghe Institute of Higher Education and Research, Sawangi (Meghe), Wardha, India
| | | | - Aarti Chauhan
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Bhagteshwar Singh
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Jayant Nagesh Banavaliker
- Department of Tuberculosis and Respiratory Diseases, Rajan Babu Institute of Pulmonary Medicine and Tuberculosis (RBIPMT), New Delhi, India
| | - V. Sreenivas
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
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Cao M, He C, Gong M, Wu S, He J. The effects of vitamin D on all-cause mortality in different diseases: an evidence-map and umbrella review of 116 randomized controlled trials. Front Nutr 2023; 10:1132528. [PMID: 37426183 PMCID: PMC10325578 DOI: 10.3389/fnut.2023.1132528] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 06/08/2023] [Indexed: 07/11/2023] Open
Abstract
Purpose To conduct a solid evidence by synthesizing meta-analyses and updated RCTs about the effects of vitamin D on all-cause mortality in different health conditions. Methods Data sources: Pubmed, Embase, Web of Science, the Cochrane Library, Google Scholar from inception until 25th April, 2022. Study selection: English-language, meta-analyses and updated RCTs assessing the relationships between vitamin D and all-cause mortality. Data synthesis: Information of study characteristics, mortality, supplementation were extracted, estimating with fixed-effects model. A Measurement Tool to Assess Systematic Reviews, Grading of Recommendations Assessment, Development and Evaluation, and funnel plot was used to assess risk of bias. Main outcomes: All-cause mortality, cancer mortality, cardiovascular disease mortality. Results In total of 27 meta-analyses and 19 updated RCTs were selected, with a total of 116 RCTs and 149, 865 participants. Evidence confirms that vitamin D reduces respiratory cancer mortality (RR, 0.56 [95%CI, 0.33 to 0.96]). All-cause mortality is decreased in patients with COVID-19 (RR, 0.54[95%CI, 0.33 to 0.88]) and liver diseases (RR, 0.64 [95%CI, 0.50 to 0.81]), especially in liver cirrhosis (RR, 0.63 [95%CI, 0.50 to 0.81]). As for other health conditions, such as the general health, chronic kidney disease, critical illness, cardiovascular diseases, musculoskeletal diseases, sepsis, type 2 diabetes, no significant association was found between vitamin D and all-cause mortality. Conclusions Vitamin D may reduce respiratory cancer mortality in respiratory cancer patients and all-cause mortality in COVID-19 and liver disorders' patients. No benefits showed in all-cause mortality after vitamin D intervention among other health conditions. The hypothesis of reduced mortality with vitamin D still requires exploration. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=252921, identifier: CRD42021252921.
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Affiliation(s)
- Mingyu Cao
- Department of Orthopaedic Surgery, Third Xiangya Hospital of Central South University, Changsha, China
| | - Chunrong He
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Matthew Gong
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Song Wu
- Department of Orthopaedic Surgery, Third Xiangya Hospital of Central South University, Changsha, China
| | - Jinshen He
- Department of Orthopaedic Surgery, Third Xiangya Hospital of Central South University, Changsha, China
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11
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Ockenga J, Fuhse K, Chatterjee S, Malykh R, Rippin H, Pirlich M, Yedilbayev A, Wickramasinghe K, Barazzoni R. Tuberculosis and malnutrition: The European perspective. Clin Nutr 2023; 42:486-492. [PMID: 36857957 DOI: 10.1016/j.clnu.2023.01.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 01/22/2023] [Accepted: 01/26/2023] [Indexed: 02/12/2023]
Abstract
Tuberculosis (TB) is a leading infectious cause of death worldwide, despite ongoing efforts to limit its incidence and mortality. Although the European Region has made gains in TB incidence and mortality, it now contends with increasing numbers of multidrug- and rifampicin-resistant tuberculosis (MDR/RR-TB). Malnutrition is a major contributor to the burden of TB and may also be directly caused or enhanced by the onset of TB. The presence of malnutrition may worsen TB and MDR/RR-TB related treatment outcomes and contribute to growing TB drug-resistance. Preventing and treating all forms of malnutrition is an important tool to limit the spread of TB worldwide and improve TB outcomes and treatment efficacy. We carried out a scoping review of the existing evidence that addresses malnutrition in the context of TB. Our review found malnutrition increased the risk of developing TB in high-burden settings and increased the likelihood of developing unfavorable treatment outcomes, including treatment failure, loss to follow-up, and death. The potential impact of nutritional care and improved nutritional status on patient prognosis was more difficult to evaluate due to heterogeneity of patient populations, treatment protocols, and treatment durations and goals. High-quality trials that consider malnutrition as a major risk factor and relevant treatment target when designing effective strategies to limit TB spread and mortality are needed to inform evidence-based practice. In TB patients, we suggest that widespread and regular nutritional screening, assessment, and counselling, has the potential to increase effectiveness of TB management strategies and improve patient quality of life, overall outcomes, and survival.
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Affiliation(s)
- J Ockenga
- Department of Gastroenterology, Endocrinology and Clinical Nutrition, Klinikum Bremen Mitte, Bremen, Germany.
| | - K Fuhse
- Department of Gastroenterology, Endocrinology and Clinical Nutrition, Klinikum Bremen Mitte, Bremen, Germany.
| | - S Chatterjee
- Division of Country Health Programmes, WHO Regional Office for Europe, Copenhagen, Denmark.
| | - R Malykh
- Division of Country Health Programmes, WHO Regional Office for Europe, Copenhagen, Denmark.
| | - H Rippin
- Division of Country Health Programmes, WHO Regional Office for Europe, Copenhagen, Denmark.
| | - M Pirlich
- Imperial Oak Outpatient Clinic, Endocrinology, Gastroenterology and Clinical Nutrition, Berlin, Germany.
| | - A Yedilbayev
- Division of Country Health Programmes, WHO Regional Office for Europe, Copenhagen, Denmark.
| | - K Wickramasinghe
- Division of Country Health Programmes, WHO Regional Office for Europe, Copenhagen, Denmark.
| | - R Barazzoni
- Department of Medical, Technological and Translational Sciences, University of Trieste, Ospedale di Cattinara, Trieste, Italy.
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12
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Reddy DVS, Shafi H, Bharti R, Roy T, Verma S, Raman SK, Verma K, Azmi L, Ray L, Singh J, Singh AK, Mugale MN, Misra A. Preparation and Evaluation of Low-Dose Calcitriol Dry Powder Inhalation as Host-Directed Adjunct Therapy for Tuberculosis. Pharm Res 2022; 39:2621-2633. [PMID: 35962268 PMCID: PMC9374297 DOI: 10.1007/s11095-022-03360-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 08/05/2022] [Indexed: 11/24/2022]
Abstract
Background It is unclear whether Vitamin D is efficacious as a host-directed therapy (HDT) for patients of tuberculosis (TB). We investigated pulmonary delivery of the active metabolite of Vitamin D3, i.e., 1, 25-dihydroxy vitamin D3 (calcitriol) in a mouse model of infection with Mycobacterium tuberculosis (Mtb). Methods We optimized a spray drying process to prepare a dry powder inhalation (DPI) of calcitriol using a Quality by Design (QbD) approach. We then compared outcomes when Mtb-infected mice were treated with inhaled calcitriol at 5 ng/kg as a stand-alone intervention versus DPI as adjunct to standard oral anti-tuberculosis therapy (ATT). Results The DPI with or without concomitant ATT markedly improved the morphology of the lungs and mitigated histopathology in both the lungs and the spleens. The number of nodular lesions on the lung surface decreased from 43.7 ± 3.1 to 22.5 ± 3.9 with the DPI alone and to 9.8 ± 2.5 with DPI + ATT. However, no statistically significant induction of host antimicrobial peptide cathelicidin or reduction in bacterial burden was seen with the DPI alone. DPI + ATT did not significantly reduce the bacterial burden in the lungs compared to ATT alone. Conclusions We concluded that HDT using the low dose calcitriol DPI contributed markedly to mitigation of pathology, but higher dose may be required to evoke significant induction of bactericidal host response and bactericidal activity in the lung.
Supplementary Information The online version contains supplementary material available at 10.1007/s11095-022-03360-5.
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Affiliation(s)
- D V Siva Reddy
- CSIR-Central Drug Research Institute, Lucknow, 226031, India.,Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, U.P, India
| | - Hasham Shafi
- CSIR-Central Drug Research Institute, Lucknow, 226031, India
| | - Reena Bharti
- CSIR-Central Drug Research Institute, Lucknow, 226031, India
| | - Trisha Roy
- CSIR-Central Drug Research Institute, Lucknow, 226031, India.,Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, U.P, India
| | - Sonia Verma
- CSIR-Central Drug Research Institute, Lucknow, 226031, India.,Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, U.P, India
| | | | - Khushboo Verma
- CSIR-Central Drug Research Institute, Lucknow, 226031, India.,Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, U.P, India
| | - Lubna Azmi
- CSIR-Central Drug Research Institute, Lucknow, 226031, India
| | - Lipika Ray
- CSIR-Central Drug Research Institute, Lucknow, 226031, India
| | - Jyotsna Singh
- CSIR-Indian Institute of Toxicology Research, Lucknow, 226001, India
| | - Amit Kumar Singh
- National JALMA Institute for Leprosy and Other Mycobacterial Diseases, Agra, 282004, India
| | - Madhav N Mugale
- CSIR-Central Drug Research Institute, Lucknow, 226031, India
| | - Amit Misra
- CSIR-Central Drug Research Institute, Lucknow, 226031, India.
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13
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Cai L, Wang G, Zhang P, Hu X, Zhang H, Wang F, Tong Y. The Progress of the Prevention and Treatment of Vitamin D to Tuberculosis. Front Nutr 2022; 9:873890. [PMID: 35662926 PMCID: PMC9159148 DOI: 10.3389/fnut.2022.873890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 04/05/2022] [Indexed: 11/13/2022] Open
Abstract
The progressions of a number of lung diseases, including acute lung injury, cystic fibrosis, asthma, chronic obstructive pulmonary disease, pneumonia and tuberculosis (TB) are found to be highly associated with inflammatory responses. As a signaling nutrient, Vitamin D modulates the activities of dendritic cells, monocytes/macrophages, T and B cells, and tissue epithelial cells in the body to induce inflammatory responses and boost immune functions. Given the high prevalence of vitamin D deficiency among pulmonary insufficiency and inflammation-related cases, researchers indicated vitamin D supplementation could have a potential role in the prevention and treatment of lung disease, especially tuberculosis. In this paper, we reviewed published studies on the role of vitamin D in the prevention and treatment of tuberculosis. The paper identified vitamin D’s potential as an adjunctive therapy and demonstrated its safety so as to provide an impetus for further studies and clinical applications.
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Affiliation(s)
- Li Cai
- Wuhan Center for Disease Control and Prevention, Wuhan, China.,School of Health Sciences, Wuhan University, Wuhan, China
| | - Gaoming Wang
- East and West Lake District Center for Disease Control and Prevention, Wuhan, China
| | - Peijun Zhang
- Hubei Center for Disease Control and Prevention, Wuhan, China
| | - Xinyi Hu
- Global Study Institute, University of Geneva, Geneva, Switzerland
| | - Hao Zhang
- School of Public Health, Wuhan University of Science and Technology, Wuhan, China
| | - Fan Wang
- Hubei Center for Disease Control and Prevention, Wuhan, China
| | - Yeqing Tong
- Hubei Center for Disease Control and Prevention, Wuhan, China
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14
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Goyal JP, Singh S, Bishnoi R, Bhardwaj P, Kaur RJ, Dhingra S, Yadav D, Dutta S, Charan J. Efficacy and safety of vitamin D in tuberculosis patients: a systematic review and meta-analysis. Expert Rev Anti Infect Ther 2022; 20:1049-1059. [PMID: 35477334 DOI: 10.1080/14787210.2022.2071702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Evidence from the basic research and epidemiological studies indicates a beneficial effect of vitamin D in the treatment of tuberculosis (TB). However, the evidence from randomized controlled trials (RCTs) is inconsistent. OBJECTIVES This systematic review and meta-analysis was performed to synthesize evidence regarding role of vitamin D versus placebo for the management of TB. MATERIALS AND METHODS We searched PubMed and Cochrane Clinical Trial Registry for RCTs comparing vitamin D versus placebo for the treatment of TB. RCTs enrolling adult patients with TB receiving vitamin D in addition to standard treatment were included. Data were pooled using random effects model. The study was conducted according to PRISMA guidelines and protocol was registered with PROSPERO (CRD42016052841). RESULTS Of 605 identified references, 12 RCTs were included. The overall risk of bias in included studies was low or unclear. There was no significant difference between vitamin D and placebo group for any outcomes of efficacy (time to culture conversion, time to smear conversion, rate of culture conversion, and rate of smear conversion) or safety (mortality, serious adverse events, and nonserious adverse events). CONCLUSION Vitamin D administered with standard treatment has no beneficial effect in the TB patients as compared to the placebo.
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Affiliation(s)
- Jagdish Prasad Goyal
- Department of Pediatrics, All India Institute of Medical Science, Jodhpur, India
| | - Surjit Singh
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, India
| | | | - Pankaj Bhardwaj
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Rimple Jeet Kaur
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, India
| | - Sameer Dhingra
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research (NIPER), Hajipur, India
| | - Dharmveer Yadav
- Department of Biochemistry, All India Institute of Medical Science, Jodhpur, India
| | - Siddhartha Dutta
- Department of Pharmacology, All India Institute of Medical Sciences, Rajkot, India
| | - Jaykaran Charan
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, India
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15
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Wen Y, Li L, Deng Z. Calcitriol supplementation accelerates the recovery of patients with tuberculosis who have vitamin D deficiency: a randomized, single-blind, controlled clinical trial. BMC Infect Dis 2022; 22:436. [PMID: 35513795 PMCID: PMC9074353 DOI: 10.1186/s12879-022-07427-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 04/21/2022] [Indexed: 12/03/2022] Open
Abstract
Background This study aimed to evaluate whether calcitriol supplementation enhances CD4+ T cell count and prognosis in patients with tuberculosis and low 25(OH)D levels. Methods This randomized controlled clinical trial enrolled treatment-naïve patients with tuberculosis admitted to Zigong First People’s Hospital (June 2016 to April 2017). The patients were grouped as the serum 25(OH)D ≥ 75 nmol/L (Normal-25(OH)D) and 25(OH)D < 75 nmol/L (Low-25(OH)D) groups. The Low-Vit-D group was randomized to the Low-25(OH)D and Low-25(OH)D-Calcitriol groups. All patients were treated with the 2HRZE/4HR regimen. The patients in the Low-25(OH)D-Calcitriol group received calcitriol 0.25 µg bid. The main endpoints were CD4+ T cell count during treatment, time to sputum culture conversion, time to 50% lesion absorption, and a 6-month cure rate. Results This study included 30 patients in each group. Baseline 25-(OH) D levels and CD4+ T cell counts were higher in the Normal-25(OH)D group than in the Low-25(OH)D and Low-25(OH)D-Calcitriol groups (25(OH)D: 79.3 ± 3.4 vs. 37.8 ± 13.4 vs. 11.9 nmol/L, P < 0.05; 671 ± 287 vs. 200 ± 110 vs. 194 ± 119 cell/µL, P < 0.05). 25-(OH) D levels and CD4+ T cell counts increased in the Low-25(OH)D-Calcitriol group during treatment to reach higher levels than in the Low-25(OH)D group at 1, 4, 8, and 24 weeks (all P < 0.05). Compared with the Low-25(OH)D group, the Low-25(OH)D-Calcitriol group showed shorter time to sputum culture conversion (3.2 ± 1.4 vs. 5.9 ± 2.5 days, P < 0.001) and time to 50% lesion absorption (7.4 ± 1.5 vs. 10.9 ± 4.0 days, P = 0.014) and similar to those in the Normal-25(OH)D group (3.1 ± 1.2 and 7.3 ± 1.5 days, respectively. The cure rate was 86.7% in the Low-25(OH)D group and 96.7% in the two other groups. Conclusions Calcitriol supplementation can elevate CD4+ T cell levels, shorten the time to sputum culture conversion, and accelerate lesion absorption in patients with tuberculosis and 25(OH)D deficiency. Trial registration The study is registered at the Chinese Clinical Trial Registry (ChiCTR2000039832)
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Affiliation(s)
- Youli Wen
- Department of Respiratory Medicine, Zigong First People's Hospital, Zigong, 643000, Sichuan Province, People's Republic of China
| | - Lian Li
- Department of Internal Medicine, Department of Obstetrics, Shenzhen Baoan Women's and Children's Hospital, Jinan University, No. 56 Yulv Road, Baoan District, Shenzhen, 518102, Guangdong Province, People's Republic of China.
| | - Zhiping Deng
- Department of Respiratory Medicine, Zigong First People's Hospital, Zigong, 643000, Sichuan Province, People's Republic of China
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16
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Buonsenso D, Pata D, Turriziani Colonna A, Ferrari V, Salerno G, Valentini P. Vitamin D and tuberculosis in children: a role in the prevention or treatment of the disease? Monaldi Arch Chest Dis 2022; 92. [PMID: 35352542 DOI: 10.4081/monaldi.2022.2112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 03/24/2022] [Indexed: 11/23/2022] Open
Abstract
Despite the growing number of published studies, the role of vitamin D in the prevention or treatment of tuberculosis remains unclear. In this review we analyze current scientific literature to provide evidence about the relationship between vitamin D and TB, with a special focus on the pediatric population. While in vitro studies have shown relevant antimycobacterial immune-stimulatory and immunosuppressive effects of vitamin D, this has not panned out in vivo with active TB. On the contrary, there is some evidence that this tool could work as prevention - both against TB infection as well as progression from latent to active infection. However, only a few studies have evaluated this correlation in children. The potential link between tuberculosis and vitamin D levels is promising. If effective, vitamin D supplementation of at-risk populations would be an affordable public health intervention, particularly in light of the worldwide increase in identified TB cases and drug-resistance. Vitamin D might represent a new, affordable, safe and easy to access drug for the prevention and treatment of TB. For stronger evidence, considering the features of infection (relative low incidence of reactivation of latent infection in immunocompetent patients) we need clinical trials with large numbers of participants conducted in endemic regions with a prolonged follow-up time.
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Affiliation(s)
- Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "Agostino Gemelli", Rome.
| | - Davide Pata
- Institute of Pediatrics, Catholic University of Sacred Heart, Rome.
| | | | - Vittoria Ferrari
- Institute of Pediatrics, Catholic University of Sacred Heart, Rome.
| | - Gilda Salerno
- Institute of Pediatrics, Catholic University of Sacred Heart, Rome.
| | - Piero Valentini
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "Agostino Gemelli", Rome; Institute of Pediatrics, Catholic University of Sacred Heart, Rome.
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17
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Cho H, Myung SK, Cho HE. Efficacy of Vitamin D Supplements in Treatment of Acute Respiratory Infection: A Meta-Analysis for Randomized Controlled Trials. Nutrients 2022; 14:nu14061144. [PMID: 35334804 PMCID: PMC8955452 DOI: 10.3390/nu14061144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 02/28/2022] [Accepted: 03/03/2022] [Indexed: 12/10/2022] Open
Abstract
BACKGROUND Recent randomized controlled trials (RCTs) have reported inconsistent findings regarding the efficacy of vitamin D supplementation in the treatment of acute respiratory infections (ARIs). This study aimed to investigate the efficacy of vitamin D supplementation in the treatment of ARIs using a meta-analysis of RCTs. METHODS PubMed, EMBASE, and the Cochrane Library were searched for relevant articles in June 2021. Two of the authors independently assessed the eligibility of the trials. RESULTS Out of 390 articles retrieved from the databases, we included 18 RCTs, which involved 3648 participants, with 1838 in an intervention group and 1810 in a control group in the final analysis. In the meta-analysis of all the trials, vitamin D supplements had a beneficial effect in the treatment of ARIs (relative risk (RR) = 1.07; 95% confidence interval (CI), 1.01-1.13; I2 = 66.9%). Publication bias was observed in the funnel plot. In the subgroup meta-analysis of high-quality RCTs, no significant efficacy of vitamin D supplements was found (RR = 1.02; 95% CI, 0.98-1.06; I2 = 24.0%). Although statistically significant changes of 7% in the treatment effects were observed, they are not considered as clinically substantial ones. CONCLUSIONS The current meta-analysis suggests that vitamin D supplements are not clinically effective in the treatment of ARIs.
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Affiliation(s)
- Herim Cho
- Department of Medicine, College of Medicine, Ewha Womans University, Seoul 07804, Korea; (H.C.); (H.-E.C.)
| | - Seung-Kwon Myung
- Department of Cancer Biomedical Science, National Cancer Center Graduate School of Cancer Science and Policy, Goyang 10408, Korea
- Cancer Epidemiology Branch, Division of Cancer Data Science, National Cancer Center Research Institute, Goyang 10408, Korea
- Department of Family Medicine and Center for Cancer Prevention and Detection, National Cancer Center Hospital, Goyang 10408, Korea
- Correspondence: ; Tel.: +82-31-920-0479
| | - Hae-Eun Cho
- Department of Medicine, College of Medicine, Ewha Womans University, Seoul 07804, Korea; (H.C.); (H.-E.C.)
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18
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Cannata-Andía JB, Díaz-Sottolano A, Fernández P, Palomo-Antequera C, Herrero-Puente P, Mouzo R, Carrillo-López N, Panizo S, Ibañez GH, Cusumano CA, Ballarino C, Sánchez-Polo V, Pefaur-Penna J, Maderuelo-Riesco I, Calviño-Varela J, Gómez MD, Gómez-Alonso C, Cunningham J, Naves-Díaz M, Douthat W, Fernández-Martín JL. A single-oral bolus of 100,000 IU of cholecalciferol at hospital admission did not improve outcomes in the COVID-19 disease: the COVID-VIT-D-a randomised multicentre international clinical trial. BMC Med 2022; 20:83. [PMID: 35177066 PMCID: PMC8853840 DOI: 10.1186/s12916-022-02290-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 02/09/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Vitamin D status has been implicated in COVID-19 disease. The objective of the COVID-VIT-D trial was to investigate if an oral bolus of cholecalciferol (100,000 IU) administered at hospital admission influences the outcomes of moderate-severe COVID-19 disease. In the same cohort, the association between baseline serum calcidiol levels with the same outcomes was also analysed. METHODS The COVID-VIT-D is a multicentre, international, randomised, open label, clinical trial conducted throughout 1 year. Patients older than 18 years with moderate-severe COVID-19 disease requiring hospitalisation were included. At admission, patients were randomised 1:1 to receive a single oral bolus of cholecalciferol (n=274) or nothing (n=269). Patients were followed from admission to discharge or death. Length of hospitalisation, admission to intensive care unit (ICU) and mortality were assessed. RESULTS In the randomised trial, comorbidities, biomarkers, symptoms and drugs used did not differ between groups. Median serum calcidiol in the cholecalciferol and control groups were 17.0 vs. 16.1 ng/mL at admission and 29.0 vs. 16.4 ng/mL at discharge, respectively. The median length of hospitalisation (10.0 [95%CI 9.0-10.5] vs. 9.5 [95%CI 9.0-10.5] days), admission to ICU (17.2% [95%CI 13.0-22.3] vs. 16.4% [95%CI 12.3-21.4]) and death rate (8.0% [95%CI 5.2-12.1] vs. 5.6% [95%CI 3.3-9.2]) did not differ between the cholecalciferol and control group. In the cohort analyses, the highest serum calcidiol category at admission (>25ng/mL) was associated with lower percentage of pulmonary involvement and better outcomes. CONCLUSIONS The randomised clinical trial showed the administration of an oral bolus of 100,000 IU of cholecalciferol at hospital admission did not improve the outcomes of the COVID-19 disease. A cohort analysis showed that serum calcidiol at hospital admission was associated with outcomes. TRIAL REGISTRATION COVID-VIT-D trial was authorised by the Spanish Agency for Medicines and Health products (AEMPS) and registered in European Union Drug Regulating Authorities Clinical Trials (EudraCT 2020-002274-28) and in ClinicalTrials.gov ( NCT04552951 ).
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Affiliation(s)
- Jorge B Cannata-Andía
- Hospital Universitario Central de Asturias (HUCA), Avda. Roma s/n., 33011, Oviedo, Spain. .,Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain. .,Universidad de Oviedo, Oviedo, Spain. .,Retic REDinREN-ISCIII, Madrid, Spain.
| | - Augusto Díaz-Sottolano
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain.,Centro de Salud Roces Montevil, Gijón, Spain
| | - Pehuén Fernández
- Hospital Privado Universitario de Córdoba, Córdoba, Argentina.,Hospital Raúl Ángel Ferreyra, Córdoba, Argentina.,Instituto Universitario de Ciencias Biomédicas de Córdoba (IUCBC), Córdoba, Argentina
| | - Carmen Palomo-Antequera
- Hospital Universitario Central de Asturias (HUCA), Avda. Roma s/n., 33011, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain.,Universidad de Oviedo, Oviedo, Spain
| | - Pablo Herrero-Puente
- Hospital Universitario Central de Asturias (HUCA), Avda. Roma s/n., 33011, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain.,Universidad de Oviedo, Oviedo, Spain
| | | | - Natalia Carrillo-López
- Hospital Universitario Central de Asturias (HUCA), Avda. Roma s/n., 33011, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain.,Retic REDinREN-ISCIII, Madrid, Spain
| | - Sara Panizo
- Hospital Universitario Central de Asturias (HUCA), Avda. Roma s/n., 33011, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain.,Retic REDinREN-ISCIII, Madrid, Spain
| | | | | | - Carolina Ballarino
- Hospital Militar Central Cirujano Mayor Dr. Cosme Argerich, Buenos Aires, Argentina
| | - Vicente Sánchez-Polo
- Hospital General de Enfermedades del Instituto Guatemalteco de Seguridad Social (IGSS), Ciudad de Guatemala, Guatemala
| | | | | | | | | | - Carlos Gómez-Alonso
- Hospital Universitario Central de Asturias (HUCA), Avda. Roma s/n., 33011, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain.,Universidad de Oviedo, Oviedo, Spain.,Retic REDinREN-ISCIII, Madrid, Spain
| | - John Cunningham
- Centre for Nephrology, Royal Free Hospital and University College London, London, UK
| | - Manuel Naves-Díaz
- Hospital Universitario Central de Asturias (HUCA), Avda. Roma s/n., 33011, Oviedo, Spain. .,Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain. .,Retic REDinREN-ISCIII, Madrid, Spain.
| | - Walter Douthat
- Hospital Privado Universitario de Córdoba, Córdoba, Argentina.,Hospital Raúl Ángel Ferreyra, Córdoba, Argentina.,Instituto Universitario de Ciencias Biomédicas de Córdoba (IUCBC), Córdoba, Argentina
| | - José L Fernández-Martín
- Hospital Universitario Central de Asturias (HUCA), Avda. Roma s/n., 33011, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain.,Retic REDinREN-ISCIII, Madrid, Spain
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19
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Ganmaa D, Enkhmaa D, Nasantogtokh E, Sukhbaatar S, Tumur-Ochir KE, Manson JE. Vitamin D, respiratory infections, and chronic disease: Review of meta-analyses and randomized clinical trials. J Intern Med 2022; 291:141-164. [PMID: 34537990 DOI: 10.1111/joim.13399] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Observational studies have suggested associations of vitamin D deficiency (VDD) with respiratory tract infections, impaired bone health, and myriad chronic diseases. OBJECTIVE To assess potential causal relationships between vitamin D supplementation and a reduced risk of these conditions, a review of the evidence across available meta-analyses of randomized control trials (RCTs) and RCTs was performed. METHOD PubMed, Embase, Cochrane Library, and Web of Science were searched from their inception to March 2021. We included only RCTs and meta-analyses of RCTs focusing on the association between vitamin D and respiratory disease, bone health, cardiovascular disease (CVD), diabetes mellitus, and cancer. RESULTS A total of 107 RCTs and 62 meta-analysis of RCTs were included. Although most RCTs did not support benefits of vitamin D supplementation, suggestive evidence for benefit was found in populations at greater risk of VDD and for acute respiratory infections, fractures in institutionalized older adults, type 2 diabetes among patients with prediabetes, and cancer mortality. In contrast, no compelling evidence for benefit was found for other respiratory conditions, fractures in community-dwelling adults, falls, cancer incidence, or CVD. CONCLUSIONS Current evidence from RCTs and meta-analyses of RCTs is inconsistent regarding the effects of vitamin D supplementation on respiratory infections and chronic diseases. Individuals most likely to benefit are those with baseline VDD or with selected high-risk conditions. Public health initiatives are needed to eliminate VDD globally, and future research will be enhanced by a 'precision prevention' approach to identify those most likely to benefit from vitamin D supplementation.
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Affiliation(s)
- Davaasambuu Ganmaa
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | | | | | | | | | - J E Manson
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Analysis of the Research Hotspot of Drug Treatment of Tuberculosis: A Bibliometric Based on the Top 50 Cited Literatures. BIOMED RESEARCH INTERNATIONAL 2022; 2022:9542756. [PMID: 35071602 PMCID: PMC8769855 DOI: 10.1155/2022/9542756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 11/23/2021] [Accepted: 12/18/2021] [Indexed: 02/05/2023]
Abstract
Objective The objective of the current study was to analyze the research hotspot of drug treatment for tuberculosis via top literatures. Materials and Methods A retrospective analysis was performed on June 7th, 2021. Literatures were searched on the Web of Science Core Collection to identify the top 50 cited literatures related to drug treatment of tuberculosis. The characteristics of the literatures were identified. The outcomes included authorship, journal, study type, year of publication, and institution. Cooccurrence network analysis and visualization were conducted using the VOS viewer (Version 1.6.16; Leiden University, Leiden, The Netherlands). Results The top 50 cited literatures were cited 308 to 2689 times and were published between 1982 and 2014. The most studied drugs were the first-line drugs such as isoniazid and rifampicin (n = 22), and drug-resistant tuberculosis was most frequently reported (n = 16). They were published in 18 journals, and the New England Journal of Medicine published the most literatures (n = 18), followed by the American Journal of Respiratory and Critical Care Medicine (n = 7), and the Lancet (n = 6). The authors were from 13 countries, and the authors from the USA published most of the literatures (n = 30), while authors from other countries published less than five literatures. The CDC in the USA (n = 4), the World Health Organization (WHO) (n = 3), and the American Philosophical Society (n = 3) were the leading institutions, and only two authors published at least two top-cited literatures as first authors. Conclusions This study provides insights into the development and most important literatures on drug therapy for tuberculosis and evidence for future research on tuberculosis treatment.
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21
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Ramos-Espinosa O, Mata-Espinosa D, Francisco-Cruz A, López-Torres MO, Hernández-Bazán S, Barrios-Payán J, Marquina-Castillo B, Carretero M, Del Río M, Hernández-Pando R. Immunotherapeutic effect of adenovirus encoding antimicrobial peptides in experimental pulmonary tuberculosis. J Leukoc Biol 2021; 110:951-963. [PMID: 33682193 DOI: 10.1002/jlb.4ma0920-627r] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 12/14/2020] [Accepted: 01/02/2021] [Indexed: 11/11/2022] Open
Abstract
As components of the innate immune response, antimicrobial peptides (AMPs) efficiently contribute to infection control and maintenance of a latent state in pulmonary tuberculosis (TB). As a therapeutic strategy, the administration of recombinant AMPs could be limited by enzymatic degradation and high production costs. Likewise, strategies based on the induction of AMPs have generated controversial results. In this study, 2 recombinant type-5 adenoviruses (Ad) expressing the human β-defensin 3 (HβD3) or cathelicidin (LL37) were assessed in a murine pulmonary TB model. Mice infected with either a high dose of a drug-sensitive (H37Rv) or a multidrug-resistant (MDR) strain of Mycobacterium tuberculosis (Mtb) were treated with a single administration of AdHβD3, AdLL37, AdGFP (control vector expressing a green fluorescent protein), or saline solution (SS). Lungs were obtained to determine the bacterial burden, histologic damage, and cytokine expression at different time points. Mice treated with AdHβD3 or AdLL37 showed significantly lower bacterial load and pneumonia, and higher proinflammatory cytokine expression than the control groups AdGFP and SS. A synergistic therapeutic effect could be observed when first- or second-line antibiotics (ABs) were administered with adenoviral therapy in animals infected with H37Rv or MDR strains, respectively. Adenovirus-delivered AMP's administration constitutes a promising adjuvant therapy for current anti-TB drugs by enhancing a protective immune response and potentially reducing current AB regimes' duration.
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Affiliation(s)
- Octavio Ramos-Espinosa
- Experimental Pathology Section, Department of Pathology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Dulce Mata-Espinosa
- Experimental Pathology Section, Department of Pathology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Alejandro Francisco-Cruz
- Department of Translational Molecular Pathology, Division of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Manuel Othoniel López-Torres
- Experimental Pathology Section, Department of Pathology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Sujhey Hernández-Bazán
- Experimental Pathology Section, Department of Pathology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Jorge Barrios-Payán
- Experimental Pathology Section, Department of Pathology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Brenda Marquina-Castillo
- Experimental Pathology Section, Department of Pathology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Marta Carretero
- Epithelial Damage, Repair and Tissue Engineering, Ciemat-Fundación Marcelino Botín, Complutense University, Madrid, Spain.,IIS-Fundación Jiménez Díaz, Madrid, Spain
| | - Marcela Del Río
- Epithelial Damage, Repair and Tissue Engineering, Ciemat-Fundación Marcelino Botín, Complutense University, Madrid, Spain.,IIS-Fundación Jiménez Díaz, Madrid, Spain
| | - Rogelio Hernández-Pando
- Experimental Pathology Section, Department of Pathology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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Gutiérrez-González LH, Juárez E, Carranza C, Carreto-Binaghi LE, Alejandre A, Cabello-Gutiérrrez C, Gonzalez Y. Immunological Aspects of Diagnosis and Management of Childhood Tuberculosis. Infect Drug Resist 2021; 14:929-946. [PMID: 33727834 PMCID: PMC7955028 DOI: 10.2147/idr.s295798] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 02/11/2021] [Indexed: 12/24/2022] Open
Abstract
The diagnosis of tuberculosis (TB) in children is difficult because of the low sensitivity and specificity of traditional microbiology techniques in this age group. Whereas in adults the culture of Mycobacterium tuberculosis (M. tuberculosis), the gold standard test, detects 80% of positive cases, it only detects around 30-40% of cases in children. The new methods based on the immune response to M. tuberculosis infection could be affected by many factors. It is necessary to evaluate the medical record, clinical features, presence of drug-resistant M. tuberculosis strains, comorbidities, and BCG vaccination history for the diagnosis in children. There is no ideal biomarker for all TB cases in children. A new strategy based on personalized diagnosis could be used to evaluate specific molecules produced by the host immune response and make therapeutic decisions in each child, thereby changing standard immunological signatures to personalized signatures in TB. In this way, immune diagnosis, prognosis, and the use of potential immunomodulators as adjunct TB treatments will meet personalized treatment.
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Affiliation(s)
| | - Esmeralda Juárez
- Microbiology Department, National Institute for Respiratory Diseases Ismael Cosío Villegas, Mexico City, Mexico
| | - Claudia Carranza
- Microbiology Department, National Institute for Respiratory Diseases Ismael Cosío Villegas, Mexico City, Mexico
| | - Laura E Carreto-Binaghi
- Microbiology Department, National Institute for Respiratory Diseases Ismael Cosío Villegas, Mexico City, Mexico
| | - Alejandro Alejandre
- Pediatric Clinic, National Institute for Respiratory Diseases Ismael Cosío Villegas, Mexico City, Mexico
| | - Carlos Cabello-Gutiérrrez
- Virology and Mycology Department, National Institute for Respiratory Diseases Ismael Cosío Villegas, Mexico City, Mexico
| | - Yolanda Gonzalez
- Microbiology Department, National Institute for Respiratory Diseases Ismael Cosío Villegas, Mexico City, Mexico
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23
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Rao Muvva J, Ahmed S, Rekha RS, Kalsum S, Groenheit R, Schön T, Agerberth B, Bergman P, Brighenti S. Immunomodulatory Agents Combat Multidrug-Resistant Tuberculosis by Improving Antimicrobial Immunity. J Infect Dis 2021; 224:332-344. [PMID: 33606878 PMCID: PMC8280489 DOI: 10.1093/infdis/jiab100] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 02/13/2021] [Indexed: 12/15/2022] Open
Abstract
Background Multidrug-resistant (MDR) tuberculosis has low treatment success rates, and new treatment strategies are needed. We explored whether treatment with active vitamin D3 (vitD) and phenylbutyrate (PBA) could improve conventional chemotherapy by enhancing immune-mediated eradication of Mycobacterium tuberculosis. Methods A clinically relevant model was used consisting of human macrophages infected with M. tuberculosis isolates (n = 15) with different antibiotic resistance profiles. The antimicrobial effect of vitD+PBA, was tested together with rifampicin or isoniazid. Methods included colony-forming units (intracellular bacterial growth), messenger RNA expression analyses (LL-37, β-defensin, nitric oxide synthase, and dual oxidase 2), RNA interference (LL-37-silencing in primary macrophages), and Western blot analysis and confocal microscopy (LL-37 and LC3 protein expression). Results VitD+PBA inhibited growth of clinical MDR tuberculosis strains in human macrophages and strengthened intracellular growth inhibition of rifampicin and isoniazid via induction of the antimicrobial peptide LL-37 and LC3-dependent autophagy. Gene silencing of LL-37 expression enhanced MDR tuberculosis growth in vitD+PBA–treated macrophages. The combination of vitD+PBA and isoniazid were as effective in reducing intracellular MDR tuberculosis growth as a >125-fold higher dose of isoniazid alone, suggesting potent additive effects of vitD+PBA with isoniazid. Conclusions Immunomodulatory agents that trigger multiple immune pathways can strengthen standard MDR tuberculosis treatment and contribute to next-generation individualized treatment options for patients with difficult-to-treat pulmonary tuberculosis.
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Affiliation(s)
- Jagadeeswara Rao Muvva
- Center for Infectious Medicine (CIM), Department of Medicine, ANA Futura, Karolinska Institutet, Huddinge, Sweden
| | - Sultan Ahmed
- Clinical Microbiology, Department of Laboratory Medicine (Labmed), ANA Futura, Karolinska Institutet, Huddinge, Sweden
| | - Rokeya Sultana Rekha
- Clinical Microbiology, Department of Laboratory Medicine (Labmed), ANA Futura, Karolinska Institutet, Huddinge, Sweden
| | - Sadaf Kalsum
- Center for Infectious Medicine (CIM), Department of Medicine, ANA Futura, Karolinska Institutet, Huddinge, Sweden
| | - Ramona Groenheit
- Department of Microbiology, Public Health Agency of Sweden , Solna, Sweden
| | - Thomas Schön
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, and Department of Clinical Microbiology and Infectious Diseases, Kalmar County Hospital, Kalmar, Sweden
| | - Birgitta Agerberth
- Clinical Microbiology, Department of Laboratory Medicine (Labmed), ANA Futura, Karolinska Institutet, Huddinge, Sweden
| | - Peter Bergman
- Clinical Microbiology, Department of Laboratory Medicine (Labmed), ANA Futura, Karolinska Institutet, Huddinge, Sweden
| | - Susanna Brighenti
- Center for Infectious Medicine (CIM), Department of Medicine, ANA Futura, Karolinska Institutet, Huddinge, Sweden
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24
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Kalia V, Studzinski GP, Sarkar S. Role of vitamin D in regulating COVID-19 severity-An immunological perspective. J Leukoc Biol 2021; 110:809-819. [PMID: 33464639 PMCID: PMC8014852 DOI: 10.1002/jlb.4covr1020-698r] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 11/30/2020] [Accepted: 12/30/2020] [Indexed: 12/23/2022] Open
Abstract
Vitamin D, a key nutrient/prohormone classically associated with skeletal health, is also an important immunomodulator, with pleotropic effects on innate and adaptive immune cells. Outcomes of several chronic, autoimmune, and infectious diseases are linked to vitamin D. Emergent correlations of vitamin D insufficiency with coronavirus‐induced disease 2019 (COVID‐19) severity, alongside empirical and clinical evidence of immunoregulation by vitamin D in other pulmonary diseases, have prompted proposals of vitamin D supplementation to curb the COVID‐19 public health toll. In this review paper, we engage an immunological lens to discuss potential mechanisms by which vitamin D signals might regulate respiratory disease severity in severe acute respiratory syndrome coronavirus 2 (SARS‐CoV2) infections, vis a vis other pulmonary infections. It is proposed that vitamin D signals temper lung inflammatory cascades during SARS‐CoV2 infection, and insufficiency of vitamin D causes increased inflammatory cytokine storm, thus leading to exacerbated respiratory disease. Additionally, analogous to studies of reduced cancer incidence, the dosage of vitamin D compounds administered to patients near the upper limit of safety may serve to maximize immune health benefits and mitigate inflammation and disease severity in SARS‐CoV2 infections. We further deliberate on the importance of statistically powered clinical correlative and interventional studies, and the need for in‐depth basic research into vitamin D‐dependent host determinants of respiratory disease severity.
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Affiliation(s)
- Vandana Kalia
- Department of Pediatrics, Division of Hematology and Oncology, University of Washington School of Medicine, Seattle, Washington, USA.,Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle, Washington, USA
| | - George P Studzinski
- Department of Pathology, New Jersey Medical School, Rutgers University, Newark, New Jersey, USA
| | - Surojit Sarkar
- Department of Pediatrics, Division of Hematology and Oncology, University of Washington School of Medicine, Seattle, Washington, USA.,Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle, Washington, USA.,Department of Pathology, University of Washington School of Medicine, Seattle, Washington, USA
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25
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Hayford FEA, Dolman RC, Blaauw R, Nienaber A, Smuts CM, Malan L, Ricci C. The effects of anti-inflammatory agents as host-directed adjunct treatment of tuberculosis in humans: a systematic review and meta-analysis. Respir Res 2020; 21:223. [PMID: 32847532 PMCID: PMC7448999 DOI: 10.1186/s12931-020-01488-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 08/17/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The potential role of adjunctive anti-inflammatory therapy to enhance tuberculosis (TB) treatment has recently received increasing interest. There is, therefore, a need to broadly examine current host-directed therapies (HDTs) that could accelerate treatment response and improve TB outcomes. METHODS This systematic review and meta-analysis included randomised controlled trials of vitamin D and other HDT agents in patients receiving antibiotic treatment for pulmonary TB. Sputum smear conversion rate at 4-8 weeks was the primary outcome. Secondary outcomes included blood indices associated with infectivity and inflammation, chest radiology and incidence of adverse events. RESULTS Fifty-five studies were screened for eligibility after the initial search, which yielded more than 1000 records. Of the 2540 participants in the 15 trials included in the meta-analysis, 1898 (74.7%) were male, and the age at entry ranged from 18 to 70 years. There was a 38% significantly (RR 1.38, 95% CI = 1.03-1.84) increased sputum smear negativity in patients administered with vitamin D in addition to standard TB treatment than those receiving only the TB treatment. Patients treated with other HDT anti-inflammatory agents in addition to TB treatment also had a 29% significantly increased sputum smear conversion rate (RR 1.29, 95% CI = 1.09-1.563). Lymphocyte to monocyte ratio was significantly higher in the vitamin D treatment groups compared to the controls (3.52 vs 2.70, 95% CI for difference 0.16-1.11, p = 0.009) and (adjusted mean difference 0.4, 95% CI 0.2 -- 0.6; p = 0.001); whilst tumour necrosis factor-alpha (TNF-α) showed a trend towards a reduction in prednisolone (p < 0.001) and pentoxifylline (p = 0.27) treatment groups. Vitamin D and N-acetylcysteine also accelerated radiographic resolution in treatment compared to placebo at 8 weeks. No differences were observed in the occurrence of adverse events among all HDT treatments. CONCLUSIONS Vitamin D and other anti-inflammatory HDT medications used as adjunct TB treatment may be well tolerated and effective. They significantly improved sputum smear conversion rate and chest radiological appearance, and also exhibited an inflammation resolution effect.
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Affiliation(s)
- Frank Ekow Atta Hayford
- Centre of Excellence for Nutrition, Faculty of Health Sciences, Building G16, North- West University, Potchefstroom Campus, Potchefstroom, South Africa. .,Department of Nutrition and Dietetics, School of Biomedical and Allied Health Sciences, College of Health Sciences, University of Ghana, Accra, Ghana.
| | - Robin Claire Dolman
- Centre of Excellence for Nutrition, Faculty of Health Sciences, Building G16, North- West University, Potchefstroom Campus, Potchefstroom, South Africa
| | - Renee Blaauw
- Division of Human Nutrition, Stellenbosch University, Cape Town, South Africa
| | - Arista Nienaber
- Centre of Excellence for Nutrition, Faculty of Health Sciences, Building G16, North- West University, Potchefstroom Campus, Potchefstroom, South Africa
| | - Cornelius Mattheus Smuts
- Centre of Excellence for Nutrition, Faculty of Health Sciences, Building G16, North- West University, Potchefstroom Campus, Potchefstroom, South Africa
| | - Linda Malan
- Centre of Excellence for Nutrition, Faculty of Health Sciences, Building G16, North- West University, Potchefstroom Campus, Potchefstroom, South Africa
| | - Cristian Ricci
- Centre of Excellence for Nutrition, Faculty of Health Sciences, Building G16, North- West University, Potchefstroom Campus, Potchefstroom, South Africa.,Department of Pediatric Epidemiology, Department of Pediatrics, Medical Faculty , University/Institution: Leipzig University, Leipzig, Germany
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26
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Immunologic Effects of Vitamin D on Human Health and Disease. Nutrients 2020; 12:nu12072097. [PMID: 32679784 PMCID: PMC7400911 DOI: 10.3390/nu12072097] [Citation(s) in RCA: 430] [Impact Index Per Article: 107.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/09/2020] [Accepted: 07/12/2020] [Indexed: 02/06/2023] Open
Abstract
Vitamin D is responsible for regulation of calcium and phosphate metabolism and maintaining a healthy mineralized skeleton. It is also known as an immunomodulatory hormone. Experimental studies have shown that 1,25-dihydroxyvitamin D, the active form of vitamin D, exerts immunologic activities on multiple components of the innate and adaptive immune system as well as endothelial membrane stability. Association between low levels of serum 25-hydroxyvitamin D and increased risk of developing several immune-related diseases and disorders, including psoriasis, type 1 diabetes, multiple sclerosis, rheumatoid arthritis, tuberculosis, sepsis, respiratory infection, and COVID-19, has been observed. Accordingly, a number of clinical trials aiming to determine the efficacy of administration of vitamin D and its metabolites for treatment of these diseases have been conducted with variable outcomes. Interestingly, recent evidence suggests that some individuals might benefit from vitamin D more or less than others as high inter-individual difference in broad gene expression in human peripheral blood mononuclear cells in response to vitamin D supplementation has been observed. Although it is still debatable what level of serum 25-hydroxyvitamin D is optimal, it is advisable to increase vitamin D intake and have sensible sunlight exposure to maintain serum 25-hydroxyvitamin D at least 30 ng/mL (75 nmol/L), and preferably at 40-60 ng/mL (100-150 nmol/L) to achieve the optimal overall health benefits of vitamin D.
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Effectiveness of vitamin D supplementation on the outcome of pulmonary tuberculosis treatment in adults: a meta-analysis of randomized controlled trials. Chin Med J (Engl) 2020; 132:2950-2959. [PMID: 31833904 PMCID: PMC6964947 DOI: 10.1097/cm9.0000000000000554] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Supplemental Digital Content is available in the text Background: Tuberculosis (TB) is one of the most debilitating diseases worldwide. Current studies have shown that vitamin D plays a significant role in host immune defense against Mycobacterium tuberculosis, but clinical trials reported inconsistent results. Therefore, we systematically reviewed the literature to investigate whether vitamin D supplementation could improve the effect of anti-TB therapy. Methods: We systematically searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials from their inception to February 8th, 2019 for randomized controlled trials on vitamin D supplementation in patients with pulmonary TB receiving anti-TB therapy. The primary outcomes were time to sputum culture and smear conversion and proportion of participants with negative sputum culture. The secondary outcomes were clinical response to treatment and adverse events. A random-effects model was used to pool studies. Data were analyzed using RevMan 5.3 software. Results: Five studies with a total of 1126 participants were included in our meta-analysis. Vitamin D supplementation did not shorten the time to sputum culture and smear conversion (hazard ratio [HR] 1.04, 95% confidence interval [CI] 0.89–1.23, P = 0.60; HR 1.15, 95% CI 0.93–1.41, P = 0.20, respectively) and did not lead to an increase in the proportion of participants with negative sputum culture (relative risk [RR] 1.04, 95% CI 0.97–1.11, P = 0.32). However, it reduced the time to sputum culture conversion in the sub-group of participants with TaqI tt genotype (HR 8.09, 95% CI 1.39–47.09, P = 0.02) and improved the multidrug-resistant (MDR) TB sputum culture conversion rate (RR 2.40, 95% CI 1.11–5.18, P = 0.03). There was no influence on secondary outcomes. Conclusions: Vitamin D supplementation had no beneficial effect on anti-TB treatment, but it reduced the time to sputum culture conversion in participants with tt genotype of the TaqI vitamin D receptor gene polymorphism and improved the MDR TB sputum culture conversion rate.
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Lin SY, Chiu YW, Yang HR, Chen TC, Hsieh MH, Wang WH, Chen YH. Association of vitamin D levels and risk of latent tuberculosis in the hemodialysis population. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2020; 54:680-686. [PMID: 32593557 DOI: 10.1016/j.jmii.2020.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 05/04/2020] [Accepted: 06/02/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND Vitamin D is essential in the host defense against tuberculosis (TB). Suboptimal vitamin D status is common in the hemodialysis population. Hemodialysis patients have an increased risk compared to the general population latent tuberculosis infection (LTBI). However, the association between vitamin D deficiency and LTBI in this population remains unclear. MATERIALS AND METHODS We conducted a cross-sectional study between March and May 2017. Interferon-gamma release assay (IGRA) through QuantiFERON-TB Gold In-Tube was used to assess LTBI. Plasma 25-hydroxycholecalciferol (25-OHD) levels were measured by Elecsys Vitamin D Total assay. Suboptimal vitamin D levels included vitamin D insufficiency 20-29 ng/mg and vitamin D deficiency <20 ng/mL. Predictors for LTBI were analyzed. RESULTS A total of 287 participants were enrolled. The suboptimal vitamin D level was 31.4% (90/287), which including the vitamin D deficiency was 13.9% (40/287). A total of 49.1% (141/287) people received nutritional vitamin D supplementation. The prevalence of IGRA positivity in this study was 25.1% (72/287). There was no significant difference in vitamin D concentrations or the proportion of vitamin D supplementation among the IGRA-positive and IGRA-negative groups (p = 0.789 and 0.496, respectively). In multivariate analysis, age >65 years old (odds ratio (OR), 1.89; 95% CI, 1.08-3.31; p = 0.026) and TB history (OR, 3.51; 95% CI, 1.38-8.91; p = 0.008) were independent predictors of IGRA positivity. CONCLUSION This is the first study to report that vitamin D deficiency was not associated with IGRA positivity in a hemodialysis population. Aging and TB history were both independent predictors for LTBI.
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Affiliation(s)
- Shang-Yi Lin
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Sepsis Research Center, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Laboratory Medicine, Kaohsiung Medical University Hospital, Taiwan
| | - Yi-Wen Chiu
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hui-Ru Yang
- Department of Laboratory Medicine, Kaohsiung Medical University Hospital, Taiwan
| | - Tun-Chieh Chen
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Min-Han Hsieh
- Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wen-Hung Wang
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Center for Tropical Medicine and Infectious Disease, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yen-Hsu Chen
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Center for Tropical Medicine and Infectious Disease, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Biological Science and Technology, College of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan.
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29
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Wang J, Xiong K, Wang Q, Zhao S, Liu Y, Ma A. Adjunctive vitamin A and D during pulmonary tuberculosis treatment: a randomized controlled trial with a 2 × 2 factorial design. Food Funct 2020; 11:4672-4681. [PMID: 32406431 DOI: 10.1039/c9fo02751c] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND OBJECTIVE Vitamin A and D have immunoregulatory effects and may improve the response to pulmonary tuberculosis treatment. The interaction of vitamin A and D on pulmonary tuberculosis treatment has not been studied. The objective is to investigate the effects of adjunctive supplementation of vitamin A, D and their interaction on the outcome of pulmonary tuberculosis treatment, primarily time to sputum smear conversion. METHODS We conducted a randomized controlled trial with a 2 × 2 factorial design in Qingdao, China. Eight hundred patients were enrolled to receive standard pulmonary tuberculosis therapy alone (control), or together with vitamin A (2000 IU d-1), or vitamin D (400 IU d-1) or a combination of vitamin A (2000 IU d-1) and D (400 IU d-1) during the intensive-phase of pulmonary tuberculosis treatment. RESULTS 761 patients were included in the tuberculosis symptom analysis; 521 patients with positive baseline sputum smear results were included in the sputum smear analysis. The allocation to vitamin A or D did not significantly influence the time to sputum smear conversion [vitamin A: adjusted hazard ratio: 1.021, 95% CI: (0.821, 1.271); vitamin D: adjusted hazard ratio: 0.949, 95% CI: (0.760, 1.185)]. No significant interaction was observed between vitamin A and D supplementation (p = 0.660). Vitamin D supplementation significantly relieved the tuberculosis symptoms as indicated by decreased TBscore [mean difference: -0.2, 95% CI: (-0.4, 0)] in week 2 to 4. CONCLUSIONS Adjunctive supplementation of vitamin A and/or D did not improve the time to smear conversion in pulmonary tuberculosis patients. However vitamin D supplementation significantly improved tuberculosis symptoms during the first month of pulmonary tuberculosis treatment.
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Affiliation(s)
- Jinyu Wang
- Institute of Nutrition and Health, School of Public Health, Qingdao University, Qingdao, Shandong 266021, China.
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30
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Young C, Walzl G, Du Plessis N. Therapeutic host-directed strategies to improve outcome in tuberculosis. Mucosal Immunol 2020; 13:190-204. [PMID: 31772320 PMCID: PMC7039813 DOI: 10.1038/s41385-019-0226-5] [Citation(s) in RCA: 102] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 10/15/2019] [Accepted: 10/23/2019] [Indexed: 02/04/2023]
Abstract
Bacille Calmette-Guérin (BCG) is the only licenced tuberculosis (TB) vaccine, but has limited efficacy against pulmonary TB disease development and modest protection against extrapulmonary TB. Preventative antibiotic treatment for Mycobacterium tuberculosis (Mtb) infections in high-prevalence settings is unfeasible due to unclear treatment durability, drug toxicity, logistical constraints related to directly observed treatment strategy (DOTS) and the lengthy treatment protocols. Together, these factors promote non-adherence, contributing to relapse and establishment of drug-resistant Mtb strains. Although antibiotic treatment of drug-susceptible Mtb is generally effective, drug-resistant TB has a treatment efficacy below 50% and can, in a proportion, develop into progressive, untreatable disease. Other immune compromising co-infections and/or co-morbidities require more complex prevention/treatment approaches, posing huge financial burdens to national health services. Novel TB treatment strategies, such as host-directed therapeutics, are required to complement pathogen-targeted approaches. Pre-clinical studies have highlighted promising candidates that enhance endogenous pathways and/or limit destructive host responses. This review discusses promising pre-clinical candidates and forerunning compounds at advanced stages of clinical investigation in TB host-directed therapeutic (HDT) efficacy trials. Such approaches are rationalized to improve outcome in TB and shorten treatment strategies.
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Affiliation(s)
- C Young
- South African Medical Research Council, Centre for Tuberculosis Research, Department of Science and Technology/DST-NRF Centre of Excellence for Biomedical Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - G Walzl
- South African Medical Research Council, Centre for Tuberculosis Research, Department of Science and Technology/DST-NRF Centre of Excellence for Biomedical Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - N Du Plessis
- South African Medical Research Council, Centre for Tuberculosis Research, Department of Science and Technology/DST-NRF Centre of Excellence for Biomedical Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
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Frank DJ, Horne DJ, Dutta NK, Shaku MT, Madensein R, Hawn TR, Steyn AJC, Karakousis PC, Kana BD, Meintjes G, Laughon B, Tanvir Z. Remembering the Host in Tuberculosis Drug Development. J Infect Dis 2020; 219:1518-1524. [PMID: 30590592 DOI: 10.1093/infdis/jiy712] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 12/18/2018] [Indexed: 01/15/2023] Open
Abstract
New therapeutics to augment current approaches and shorten treatment duration are of critical importance for combating tuberculosis (TB), especially those with novel mechanisms of action to counter the emergence of drug-resistant TB. Host-directed therapy (HDT) offers a novel strategy with mechanisms that include activating immune defense mechanisms or ameliorating tissue damage. These and related concepts will be discussed along with issues that emerged from the workshop organized by the Stop TB Working Group on New Drugs, held at the Gordon Research Conference for Tuberculosis Drug Development in Lucca, Italy in June 2017, titled "Strategic Discussion on Repurposing Drugs & Host Directed Therapies for TB." In this review, we will highlight recent data regarding drugs, pathways, and concepts that are important for successful development of HDTs for TB.
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Affiliation(s)
- Daniel J Frank
- Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - David J Horne
- University of Washington School of Medicine, Seattle
| | - Noton K Dutta
- Center for Tuberculosis Research and Center for Systems Approaches to Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Moagi Tube Shaku
- DST/NRF Centre of Excellence for Biomedical TB Research, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand and the National Health Laboratory Service, Johannesburg, South Africa
| | - Rajhmun Madensein
- Inkosi Albert Luthuli Central Hospital and University of KwaZulu-Natal, Durban, South Africa
| | - Thomas R Hawn
- University of Washington School of Medicine, Seattle
| | - Adrie J C Steyn
- Department of Microbiology, University of Alabama at Birmingham, Durban, KwaZulu Natal, South Africa.,Africa Health Research Institute, Durban, KwaZulu Natal, South Africa
| | - Petros C Karakousis
- Center for Tuberculosis Research and Center for Systems Approaches to Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Bavesh Davandra Kana
- DST/NRF Centre of Excellence for Biomedical TB Research, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand and the National Health Laboratory Service, Johannesburg, South Africa.,MRC-CAPRISA HIV-TB Pathogenesis and Treatment Research Unit, Centre for the AIDS Programme of Research in South Africa, CAPRISA, Durban, South Africa
| | - Graeme Meintjes
- Wellcome Centre for Infectious Diseases Research in Africa, Cape Town, South Africa.,Institute of Infectious Diseases and Molecular Medicine and Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Barbara Laughon
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland.,Stop TB Partnership Working Group on New Drugs, New York, New York
| | - Zaid Tanvir
- Stop TB Partnership Working Group on New Drugs, New York, New York.,Global Alliance for TB Drug Development, New York, New York
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Jensen ME, Ducharme FM, Alos N, Mailhot G, Mâsse B, White JH, Sadatsafavi M, Khamessan A, Tse SM, Alizadehfar R, Bock DE, Daigneault P, Lemire C, Yang C, Radhakrishnan D. Vitamin D in the prevention of exacerbations of asthma in preschoolers (DIVA): protocol for a multicentre randomised placebo-controlled triple-blind trial. BMJ Open 2019; 9:e033075. [PMID: 31892662 PMCID: PMC6955525 DOI: 10.1136/bmjopen-2019-033075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Preschoolers have the highest rate of emergency visits and hospitalisations for asthma exacerbations of all age groups, with most triggered by upper respiratory tract infections (URTIs) and occurring in the fall or winter. Vitamin D insufficiency is highly prevalent in Canadian preschoolers with recurrent asthma exacerbations, particularly in winter. It is associated with more URTIs and, in patients with asthma, more oral corticosteroid (OCS) use. Although evidence suggests that vitamin D supplements significantly decrease URTIs and asthma exacerbations requiring OCS, there is insufficient data in preschoolers. This study aims to determine the impact of vitamin D3 supplementation on exacerbations requiring OCS, in preschoolers with recurrent URTI-induced asthma exacerbations. METHODS AND ANALYSIS This is a phase III, randomised, triple-blind, placebo-controlled, parallel-group multicentre trial of vitamin D3 supplementation in children aged 1-5 years, with asthma triggered by URTIs and a recent history of frequent URTIs and OCS use. Children (n=865) will be recruited in the fall and early winter and followed for 7 months. They will be randomised to either the (1) intervention: two oral boluses of 100 000 international unit (IU) vitamin D3 (3.5 months apart) with 400 IU vitamin D3 daily; or (2) control: identical placebo boluses with daily placebo. The primary outcome is the number of exacerbations requiring OCS per child, documented by medical and pharmacy records. Secondary outcomes include number of laboratory-confirmed viral URTIs, exacerbation duration and severity, parent functional status, healthcare use, treatment deintensification, cost and safety. ETHICS AND DISSEMINATION This study has received ethical approval from all sites. Results will be disseminated via international conferences and manuscripts targeting paediatricians and respirologists, and to families of asthmatic children via our Quebec parents-partners outreach programme. If proven effective, findings may markedly influence the management of URTI-induced asthma in high-morbidity preschoolers and could be directly implemented into practice with an update to clinical guidelines. TRIAL REGISTRATION NUMBER NCT03365687.
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Affiliation(s)
- Megan E Jensen
- Priority Research Centre Grow Up Well, School of Medicine & Public Health, Faculty of Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Francine M Ducharme
- Department of Social & Preventive Medicine, University of Montreal, Montreal, Québec, Canada
- Clinical Research and Knowledge Transfer Unit on Childhood Asthma, Research Centre, CHU Sainte-Justine, Montreal, Québec, Canada
- Department of Pediatrics, University of Montreal, Montreal, Québec, Canada
| | - Nathalie Alos
- Department of Social & Preventive Medicine, University of Montreal, Montreal, Québec, Canada
- Pediatric Endocrinology Service, CHU Sainte-Justine, Montreal, Québec, Canada
| | - Geneviève Mailhot
- Department of Nutrition, Faculty of Medicine, University of Montreal, Montreal, Québec, Canada
| | - Benoît Mâsse
- Research Centre, CHU Sainte-Justine, Montreal, Québec, Canada
- School of Public Health, University of Montreal, Montreal, Québec, Canada
| | - John H White
- Department of Physiology, McGill University, Montreal, Québec, Canada
| | - Mohsen Sadatsafavi
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Ali Khamessan
- Euro-Pharm International Canada Inc, Montreal, Québec, Canada
| | - Sze Man Tse
- Department of Social & Preventive Medicine, University of Montreal, Montreal, Québec, Canada
- Clinical Research and Knowledge Transfer Unit on Childhood Asthma, Research Centre, CHU Sainte-Justine, Montreal, Québec, Canada
| | - Reza Alizadehfar
- Department of Pediatrics, Montreal Children's Hospital, Montreal, Québec, Canada
| | - Dirk E Bock
- Department of Pediatrics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Patrick Daigneault
- Department of Pediatrics, Centre Mère-Enfant du CHU de Québec, Quebec City, Quebec, Canada
| | - Chantal Lemire
- Division of Allergy and Immunology, Department of Pediatrics, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Connie Yang
- Department of Pediatrics, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Dhenuka Radhakrishnan
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
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Cabrera Andrade BK, Garcia-Perdomo HA. Effectiveness of micronutrients supplement in patients with active tuberculosis on treatment: Systematic review/Meta-analysis. Complement Ther Med 2019; 48:102268. [PMID: 31987251 DOI: 10.1016/j.ctim.2019.102268] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 10/15/2019] [Accepted: 11/26/2019] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Multiple researchers have suggested the influence of micronutrients in the cure and survival of tuberculosis. OBJECTIVE To determine the effectiveness of micronutrients in the cure and treatment of pulmonary tuberculosis. METHODS Systematic search of randomized controlled trials (RCTs) in databases of people under treatment for active pulmonary tuberculosis, that must have received oral micronutrients for at least four weeks compared with placebo. The synthesis of the variables was shown in standardized mean difference (MD) and/or risk difference (RD). The random effects model was used and was reported in forest plot of the estimates of the effect with a 95 % CI. RESULTS Sixteen of 246 studies were included, in total 4398 people. Zinc showed (RD, 0.04; 95 % CI, 0.00-0.08) in mortality, increases muscle mass index (MD, 1.20; 95 % CI, 0.04-2.36) and gains weight (MD, 3.10; 95 % CI, 0.66-5.54). Zinc plus vitamin A increases the weight (MD, 3.10; 95 % CI, 2.78-3.42), improving karnofsky scale (MD, 2.50; 95 % CI, 2.22-2.78). Additionally, vitamin D accelerate the sputum conversión time (RD, 0.38; 95 % CI, 0.03-0.73). Hemoglobin (Hb) with vitamin A and zinc achieves statistically significant changes (MD, 0.69; 95 % CI, 0.28-1.09) and (MD, 0.52; 95 % CI, 0.21-0.83) and reduces area of cavitations in chest X-ray (MD, -0.33; 95 % CI, -0.60--0.06). CONCLUSIONS The consumption of micronutrients could achieve weight gain, hemoglobin, accelerated sputum conversion and improvement in quality of life. There are no changes in mortality that may be attributable to the suboptimal dose, larger studies are suggested with adequate doses.
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Affiliation(s)
- Betty Katherin Cabrera Andrade
- Universidad del Valle and Phisycal therapist in Intensive Care Unit in Centro Médico Imbanaco, Cra 38bis # 5b-152 Centro Médico Imbanaco, Second Floor UCI, Adult, Cali, Colombia.
| | - Herney Andrés Garcia-Perdomo
- School of Public Health, Universidad del Valle - Cl. 4b #36b3, Cali, Colombia; Universidad del Valle Director "UROGIV" Research Group, Colombia.
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Risalde MA, Roy Á, Bezos J, Pineda C, Casal C, Díez-Guerrier A, Lopez-Villalba I, Fernández-Manzano Á, Moreno I, De Juan L, Domínguez L, Gortazar C. Hypervitaminosis D has no positive effects on goat tuberculosis and may cause chronic renal lesions. Vet Rec 2019; 185:759. [PMID: 31690642 DOI: 10.1136/vr.105411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 08/12/2019] [Accepted: 10/18/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND There is evidence for a link between vitamin D deficiency and active tuberculosis (TB). In human beings, several trials have evaluated the role of vitamin D supplementation in TB treatment with conflicting results. However, the role of vitamin D supplementation in animal TB control has received less attention. The authors evaluated the benefit of vitamin D supplementation for preventing mycobacterial infection or reducing TB lesions (TBL) in a controlled trial with goats naturally exposed to Mycobacterium caprae. METHODS Two groups of goats, a vitamin D-supplemented group and a non-supplemented control group, were housed for 10 months in direct contact with M caprae-infected adult goats. Upon contact with the infected adult goats, all animals were TB-tested every two months. RESULTS No experimental evidence of a protective effect of vitamin D supplementation based on M caprae culture prevalence, TBL prevalence, median TBL score or the proportion of single versus multiple organs presenting TBL was observed. CONCLUSION The results indicate that, in the conditions used in this study, vitamin D supplementation in goats does not reduce TB infection risk nor the diffusion and severity of TBL. In addition, vitamin D-supplemented goats presented hyperphosphataemia and renal injury with calcifications suggestive of vitamin D intoxication.
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Affiliation(s)
- Maria Angeles Risalde
- Department of Comparative Pathology, University of Córdoba-Agrifood Campus of International Excellence (ceiA3), Cordoba, Spain.,Infectious Diseases Unit. Instituto Maimonides de Investigación Biomédica de Córdoba (IMIBIC). Hospital Universitario Reina Sofía de Córdoba - Universidad de Córdoba, Córdoba, Spain
| | - Álvaro Roy
- Centro de Vigilancia Sanitaria Veterinaria (VISAVET), Universidad Complutense, Madrid, Spain.,CZ Vaccines, Porriño, Pontevedra, Spain
| | - Javier Bezos
- Centro de Vigilancia Sanitaria Veterinaria (VISAVET), Universidad Complutense, Madrid, Spain.,Dpto. de Sanidad Animal, Facultad de Veterinaria, Universidad Complutense de Madrid, Madrid, Spain
| | - Carmen Pineda
- Departamento de Medicina y Cirugía Animal, Universidad de Córdoba, Córdoba, Spain
| | - Carmen Casal
- Laboratorios SYVA S.A.U. Technological Park, León, Spain
| | - Alberto Díez-Guerrier
- Dpto. de Sanidad Animal, Facultad de Veterinaria, Universidad Complutense de Madrid, Madrid, Spain.,MAEVA SERVET S.L, Alameda del Valle, Madrid, Spain
| | | | | | - Inmaculada Moreno
- Servicio de Inmunología Microbiana, Centro Nacional de Microbiología, Instituto de Investigación Carlos III, Majadahonda, Madrid
| | - Lucía De Juan
- Centro de Vigilancia Sanitaria Veterinaria (VISAVET), Universidad Complutense, Madrid, Spain.,Dpto. de Sanidad Animal, Facultad de Veterinaria, Universidad Complutense de Madrid, Madrid, Spain
| | - Lucas Domínguez
- Centro de Vigilancia Sanitaria Veterinaria (VISAVET), Universidad Complutense, Madrid, Spain.,Dpto. de Sanidad Animal, Facultad de Veterinaria, Universidad Complutense de Madrid, Madrid, Spain
| | - Christian Gortazar
- SaBio (Health and Biotechnology), Instituto de Investigación en Recursos Cinegéticos IREC (CSIC-UCLM), Ciudad Real, Spain
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Delyuzar D, Sinulingga AB, Suryadi D. Association between Fine-needle Aspiration Cytological Features and CD4 Level in Human Immunodeficiency Virus-Associated Tuberculous Lymphadenitis Patients Admitted to Haji Adam Malik Hospital in 2017. Open Access Maced J Med Sci 2019; 7:3475-3477. [PMID: 32002078 PMCID: PMC6980810 DOI: 10.3889/oamjms.2019.449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 09/15/2019] [Accepted: 09/16/2019] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND: World Health Organization stated that one-third of the world’s population has tuberculosis with one infected person in every second. In 2015 there were 330,910 tuberculosis cases in Indonesia. This number increased compared to 2014, which amounted to 324,539 cases. HIV-positive patients with extrapulmonary tuberculosis accounted for 50% of TB cases, of which 35% were lymphadenitis. Lymph node fine-needle aspiration (FNA) is considered effective in determining the early diagnosis of lymphadenopathy. AIM: This study aims to evaluate the association between cytological features and CD4 level in HIV-associated tuberculous lymphadenitis patients in Haji Adam Malik Hospital in 2017. METHODS: This is an analytical study with a cross-sectional approach involving 42 samples. Cytological features were obtained by slide reviewed and CD4 level were obtained from the medical record. RESULTS: Analysis of the association of cytological features with CD4 level association revealed p-value of 0.353. CONCLUSION: This indicates that there is no significant association between FNA cytological features and CD4 level in HIV-associated tuberculous lymphadenitis patients.
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Affiliation(s)
- Delyuzar Delyuzar
- Department of Anatomical Pathology, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
| | | | - Dedy Suryadi
- Department of Anatomical Pathology, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
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Abstract
Background: Tuberculosis is a leading cause of morbidity and mortality in humans worldwide. There is an urgent need for new and effective drugs to treat tuberculosis and shorten the duration of tuberculosis therapy. 1, 25-dihydroxy vitamin D3 (1,25 (OH)2D3) has been reported to have a synergistic effect with pyrazinamide (PZA) in killing tubercle bacilli in vitro. The addition of 1,25 (OH)2D3 to standard tuberculosis treatment should benefit patients if the adjunctive drug has a synergistic effect in vivo. Thus, in this study, calcitriol (bioactive 1,25 (OH)2D3) was administered to mice undergoing treatment for Mycobacterium tuberculosis (M.tb) infection with PZA, a first-line anti-tuberculosis drug, to determine whether vitamin D3 enhances the therapeutic effect. Methods: C57BL/6 female mice were infected with the M.tb H37Rv strain through aerosol exposure. Calcitriol and PZA, either alone or in combination, were orally administered to the M.tb infected mice. The effect of calcitriol on PZA activity was determined by evaluating the bacterial burden and analyzing the histopathological lesions in the lungs and spleen. To investigate the expression of inflammatory cytokines and anti-microbial peptide genes, we determined the transcriptional levels of interferon-γ (IFN-γ), interleukin-4 (IL-4), mouse β-defensin-2 (mBD2), and cathelicidin LL-37 through real-time quantitative polymerase chain reaction. The protein levels of IFN-γ were detected by enzyme-linked immunosorbent assay. Differences between groups were analyzed with independent samples t-test or one-way analysis of variance. Results: Calcitriol alone had little effect on tuberculosis infection, whereas PZA, compared with saline control treatment, decreased the bacterial burden (spleens: PZA vs. saline, 4.82 ± 0.22 vs. 5.22 ± 0.40 Log10 colony-forming units [CFU]/gram, t = 2.13, P < 0.05; lungs: PZA vs. saline, 5.55 ± 0.15 vs. 6.83 ± 0.46 Log10 CFU/gram, t = 6.56, P < 0.01) and pathological lesions in the lungs. Simultaneous administration of calcitriol with PZA, compared with PZA alone, decreased the bacterial load (spleen: calcitriol + PZA vs. PZA, 4.37 ± 0.13 vs. 4.82 ± 0.22 Log10 CFU/gram, t = 4.36, P < 0.01; lung: calcitriol + PZA vs. PZA, 5.03 ± 0.32 vs. 5.55 ± 0.15 Log10 CFU/gram, t = 3.58, P < 0.01) and attenuated the lung lesions (gross pathological score: calcitriol + PZA vs. PZA, 3.25 ± 0.50 vs. 2.50 ± 0.58, t = 1.96, P < 0.05; affected area of total lung area: calcitriol + PZA vs. PZA, 30.75% ± 6.50% vs. 21.55% ± 2.99%, t = 2.66, P < 0.05). Further studies demonstrated calcitriol significantly increased the expression of anti-inflammatory cytokine IL-4 but suppressed production of the pro-inflammatory cytokine IFN-γ (IL-4: calcitriol vs. saline, 5.69 ± 0.50 vs. 2.80 ± 0.56 fold of control, t = 6.74, P < 0.01; IFN-γ: calcitriol vs. saline, 1.36 ± 0.11 vs. 4.13 ± 0.83 fold of control, t = 5.77, P < 0.01). In addition, calcitriol alone or in combination with PZA significantly enhanced the transcriptional level of anti-microbial peptides (cathelicidin LL-37: calcitriol vs. saline, 10.59 ± 1.03 vs. 2.80 ± 0.90 fold of control, t = 9.85, P < 0.01; mBD2: calcitriol vs. saline, 7.92 ± 0.62 vs. 1.79 ± 0.45 fold of control, t = 13.82, P < 0.01), whereas PZA exerted a negative effect on anti-microbial peptide gene expression. Conclusions: Calcitriol as adjunctive treatment can result in beneficial treatment outcomes in M.tb infection by suppressing the inflammatory response and up-regulating the expression of anti-microbial peptides. These results indicate the feasibility of using calcitriol adjunctively with standard chemotherapy for the treatment of M.tb infection.
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Teixeira HC, Dias LDS, Bizarro HDDS, Castro JMDA. Efeitos contrastantes da vitamina D sobre a resposta imune inata e adquirida e seu impacto na recuperação da tuberculose. HU REVISTA 2019. [DOI: 10.34019/1982-8047.2018.v44.22232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A vitamina D é um hormônio essencial para o organismo, podendo ser obtida da dieta ou, principalmente, gerada pela pele após exposição à luz solar ultravioleta B. Na sua forma ativa (1,25(OH)2D) ela controla a absorção de cálcio e fósforo do intestino para a corrente sanguínea e participa de diversos processos celulares e fisiológicos. A ligação da 1,25(OH)2D ao receptor da vitamina D (VDR) presente em diversas células, como as células do sistema imunológico, induz a transcrição de genes que podem, por exemplo, modular a resposta imune inata e adquirida. A deficiência de vitamina D ou do VDR é associada a problemas de saúde como desordens esqueléticas, hipertensão, doenças cardiovasculares, diabetes mellitus, dislipidemias, doenças autoimunes e doenças infecciosas. Neste sentido, a suplementação com vitamina D tem sido proposta como uma possível medida preventiva, podendo ser aplicada em muitas patologias, em especial na tuberculose. Principal causa de morte por um único agente infeccioso, a tuberculose é responsável por cerca de 1,3 milhões de óbitos por ano no mundo. Publicações recentes apontam efeitos diversos da vitamina D na resposta imune inata e adquirida. A 1,25(OH)2D3 na presença do interferon (IFN)-γ é capaz de aumentar a atividade bactericida do macrófago contra o M. tuberculosis, aumentando a produção de peptídios antimicrobianos e estimulando a autofagia, favorecendo assim a lise de bacilos localizados em fagossomos. Por outro lado, a vitamina D em linfócitos T mostra efeito tolerogênico que favorece o controle de respostas inflamatórias excessivas. Neste trabalho de revisão são apresentados estudos recentes envolvendo efeitos da vitamina D na resposta imune inata e adquirida. Além disso, considerações sobre deficiência de vitamina D e maior risco de contrair tuberculose, e efeitos contrastantes da suplementação com vitamina D na prevenção e tratamento da TB, são discutidos.
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Malihi Z, Lawes CMM, Wu Z, Huang Y, Waayer D, Toop L, Khaw KT, Camargo CA, Scragg R. Monthly high-dose vitamin D supplementation does not increase kidney stone risk or serum calcium: results from a randomized controlled trial. Am J Clin Nutr 2019; 109:1578-1587. [PMID: 31005969 DOI: 10.1093/ajcn/nqy378] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 12/10/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND A growing number of randomized controlled trials (RCTs) are investigating the potential health benefits of high-dose vitamin D supplementation. However, there are limited RCT data on the safety of calcium-related adverse effects. OBJECTIVE We investigated the incidence of kidney stone and hypercalcemia events in a large, population-based RCT of vitamin D supplementation. DESIGN The Vitamin D Assessment (ViDA) study was a randomized, double-blind, placebo-controlled trial of vitamin D supplementation in 5110 participants in Auckland, New Zealand. This trial investigated the impact of monthly 100,000 IU vitamin D3 supplementation over several years on cardiovascular events, respiratory infections, and falls/fractures. Participants provided information about recent kidney stone events in regular questionnaires sent to them with study capsules. Hospitalization data for kidney stones were collected from health authorities. Serum calcium was measured in an 8% subsample of participants who returned annually for blood tests. HRs of time to the first kidney stone event were calculated by Cox regression. RESULTS During a median follow-up of 3.3 y, 158 participants reported a kidney stone event (76 vitamin D, 82 placebo). The HR of reporting the first kidney stone event was 0.90 (95% CI: 0.66, 1.23; P = 0.51) for participants in the vitamin D arm compared with the placebo arm. There were 18 urolithiasis events in the hospitalization records: 7 in the vitamin D arm and 11 from the placebo arm. The HR to the first hospitalization urolithiasis event was 0.62 (95% CI: 0.24, 1.26; P = 0.30) in the vitamin D arm compared with the placebo arm. From the subsample annual blood test, there was no case of hypercalcemia in the vitamin D arm, compared with 1 in the placebo arm. CONCLUSION Over a median of 3.3 y, monthly supplementation with 100,000 IU vitamin D3 did not affect the incidence rate of kidney stone events, or hypercalcemia. This study was registered at clinicaltrials.gov as ACTRN12611000402943.
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Affiliation(s)
- Zarintaj Malihi
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Carlene M M Lawes
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Zhenqiang Wu
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Ying Huang
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Debbie Waayer
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Les Toop
- Department of General Practice, University of Otago, Christchurch, New Zealand
| | - Kay-Tee Khaw
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Robert Scragg
- School of Population Health, University of Auckland, Auckland, New Zealand
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Sinha S, Gupta K, Mandal D, Das BK, Pandey RM. Serum and Bronchoalveolar Lavage Fluid 25(OH)Vitamin D3 Levels in HIV-1 and Tuberculosis: A Cross-Sectional Study from a Tertiary Care Center in North India. Curr HIV Res 2019; 16:167-173. [PMID: 29807518 DOI: 10.2174/1570162x16666180528112924] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 05/03/2018] [Accepted: 05/24/2018] [Indexed: 01/20/2023]
Abstract
BACKGROUND Vitamin D is an immunomodulator, and its deficiency is associated with Tuberculosis (TB) infection. Bronchoalveolar lavage fluid (BALF) is a rich milieu of macrophages that form the first line of defense against invading TB bacilli. As there is an increased prevalence of vitamin D deficiency in TB and human immunodeficiency virus-1 (HIV-1) subjects, we intend exploring the possibility of a localized deficiency of vitamin D metabolites in BALF of these patients. OBJECTIVE The primary objective was to assess the level of 25D3 in serum and BALF of subjects and look for a significant difference among patients and controls. The secondary objective was to find a correlation between serum and BALF 25D3 levels. METHODS We performed a cross-sectional study with subjects divided into four groups: Controls (group 1), HIV positive without active TB (group 2), active TB without HIV (group 3), and HIV-TB coinfection (group 4). BALF and serum 25D3 levels were compared between the groups. RESULTS Among the 149 (an immunomodulator) successive subjects enrolled, there were 40 subjects in group 1 (HIV-TB-), 48 in group 2 (HIV+TB-), 37 in group 3 (HIV-TB+), and 24 in group 4 (HIV+TB+). Females constituted 31.6% of the study subjects. In groups 3 and 4, there were significantly lower serum 25D3 levels compared to group 1 (p-value group 3: 0.002; group 4: 0.012). In groups 2, 3, and 4, there were significantly lower BALF 25D3 levels compared to group 1 (p-value group 2: 0.000; group 3: 0.000; group 4: 0.001). There was a significant correlation between serum and BALF 25D3 levels (Spearman's rank correlation coefficient 0.318, p-value = 0.0001). CONCLUSION Lower levels of serum and BALF 25D3 were observed in HIV, TB, and HIV-TB coinfected patients. Localized deficiency of vitamin D metabolites might be associated with increased vulnerability to TB infection.
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Affiliation(s)
- Sanjeev Sinha
- Department of Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Kartik Gupta
- Department of Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Dibyakanti Mandal
- Department of Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - B K Das
- Department of Microbiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - R M Pandey
- Department of Biostatistics, Biostatistics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
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Tzilas V, Bouros E, Barbayianni I, Karampitsakos T, Kourtidou S, Ntassiou M, Ninou I, Aidinis V, Bouros D, Tzouvelekis A. Vitamin D prevents experimental lung fibrosis and predicts survival in patients with idiopathic pulmonary fibrosis. Pulm Pharmacol Ther 2019; 55:17-24. [DOI: 10.1016/j.pupt.2019.01.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 01/13/2019] [Accepted: 01/14/2019] [Indexed: 12/22/2022]
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Jolliffe DA, Ganmaa D, Wejse C, Raqib R, Haq MA, Salahuddin N, Daley PK, Ralph AP, Ziegler TR, Martineau AR. Adjunctive vitamin D in tuberculosis treatment: meta-analysis of individual participant data. Eur Respir J 2019; 53:13993003.02003-2018. [DOI: 10.1183/13993003.02003-2018] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 12/12/2018] [Indexed: 01/12/2023]
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Bivona G, Agnello L, Lo Sasso B, Scazzone C, Butera D, Gambino CM, Iacolino G, Bellia C, Ciaccio M. Vitamin D in malaria: more hypotheses than clues. Heliyon 2019; 5:e01183. [PMID: 30793054 PMCID: PMC6370580 DOI: 10.1016/j.heliyon.2019.e01183] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 01/22/2019] [Accepted: 01/25/2019] [Indexed: 12/15/2022] Open
Abstract
Vitamin D is a secosteroid hormone regulating calcium and phosphate metabolism, immune response and brain development. Low blood 25(OH)D levels have been reported in patients affected by infectious diseases caused by parasites, including malaria. Despite the high effectiveness of antimalarials, malaria is burdened with high morbidity and mortality, and the search for additional therapies is rapidly growing. Furthermore, available preventive measures have proved to be barely effective so far. Finding new prevention and therapy tools is a matter of urgency. Studies on animal models and humans have hypothesized some mechanisms by which the hormone can influence malaria pathogenesis, and the role of Vitamin D supplementation in preventing and treating this disease has been suggested. Few studies on the association between Vitamin D and malaria are available and disagreeing results have been reported. Studies in humans reporting an association between low 25(OH)D circulating levels and Malaria have a small sample size and observational study-set. Randomized controlled trials are needed in order to understand if Vitamin D administration might play a role in preventing and treating malaria.
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Affiliation(s)
- Giulia Bivona
- Section of Clinical Biochemistry and Clinical Molecular Medicine, Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Italy
| | - Luisa Agnello
- Section of Clinical Biochemistry and Clinical Molecular Medicine, Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Italy
| | - Bruna Lo Sasso
- Section of Clinical Biochemistry and Clinical Molecular Medicine, Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Italy
| | - Concetta Scazzone
- Section of Clinical Biochemistry and Clinical Molecular Medicine, Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Italy
| | - Daniela Butera
- Section of Clinical Biochemistry and Clinical Molecular Medicine, Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Italy
| | - Caterina Maria Gambino
- Section of Clinical Biochemistry and Clinical Molecular Medicine, Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Italy
| | - Giorgia Iacolino
- Section of Clinical Biochemistry and Clinical Molecular Medicine, Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Italy
| | - Chiara Bellia
- Section of Clinical Biochemistry and Clinical Molecular Medicine, Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Italy
| | - Marcello Ciaccio
- Section of Clinical Biochemistry and Clinical Molecular Medicine, Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Italy
- Department and U.O.C. Laboratory Medicine, University Hospital “Paolo Giaccone” of Palermo, Italy
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Hasanain AFA, Zayed AAAH, Abd-Ellatief RB, Nafee AMA. Efficacy and safety of cholecalciferol-augmented anti-tuberculosis therapy for treatment of naïve patients with pulmonary tuberculosis: A randomized, controlled, clinical study. Indian J Tuberc 2019; 66:111-117. [PMID: 30797266 DOI: 10.1016/j.ijtb.2018.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 06/18/2018] [Accepted: 06/22/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND/OBJECTIVE Vitamin D deficiency may contribute to the therapeutic failure of antituberculosis therapy (ATT). The aim of this study is to explore the role of adding cholecalciferol to the standard ATT in improving the therapeutic outcome among the naïve patients with pulmonary tuberculosis (TB). METHODS A randomized, controlled, clinical study, which included 496 naïve patients with pulmonary TB, was carried out. The patients were randomly allocated to two groups. Group-A included 247 patients who received ATT, while group-B included 249 patients who received ATT with cholecalciferol. RESULTS The rate of therapeutic failure among the study population was 29.4%; it was significantly lower among patients of group-B compared to those of group-A (22.1% (95% CI 14.7-26.2) vs 38.1% (95% CI 31.5-46.1), p 0.036). In addition, the rate of early therapeutic response was significantly higher among patients of group-B compared to those of group-A (35.3% (95% CI 29.6-42.3) vs 19.4% (95% CI 15.1-24.6), p 0.041). Incidence rate of adverse effects was 19.3%; it was higher (although not statistically significant) among patients of group-A compared to those of group-B (21.9% vs 16.9%). CONCLUSIONS In conclusion, cholecalciferol-augmented ATT can be more efficacious in treating naïve patients with pulmonary TB compared to the standard ATT. In addition, adding vitamin D3 to ATT provides extra protection against the hepatic and muscular adverse effects of ATT.
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Savonius O, Pelkonen T, Roine I, Viljakainen H, Andersson S, Fernandez J, Peltola H, Helve O. Vitamin D was not associated with survival or cerebrospinal fluid cathelicidin levels in children with bacterial meningitis. Acta Paediatr 2018; 107:2131-2136. [PMID: 29751358 DOI: 10.1111/apa.14393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 04/11/2018] [Accepted: 05/03/2018] [Indexed: 12/28/2022]
Abstract
AIM Vitamin D deficiency impairs the immunological system and has been associated with worse outcomes of infectious diseases, but its role in bacterial meningitis remains unknown. We investigated whether serum 25-hydroxyvitamin D concentrations related to disease outcomes and to cerebrospinal fluid (CSF) cathelicidin concentrations in childhood bacterial meningitis. METHODS All consecutively enrolled patients in a clinical trial on childhood bacterial meningitis in Latin America in 1996-2003 were considered, and 142 children, with a median age of seven months who had a confirmed bacterial aetiology and frozen serum available for further analyses, were included in this study. Serum 25-hydroxyvitamin D concentrations were determined with a chemiluminescence immunoassay analyser, while CSF cathelicidin was measured by enzyme-linked immunosorbent assay. RESULTS The median serum 25-hydroxyvitamin D concentration was 96 (range 19-251) nmol/L. No relationship was found with patient survival, but children with any neurological sequelae had lower serum 25-hydroxyvitamin D levels than children without sequelae. Serum 25-hydroxyvitamin D was unrelated to cathelicidin concentrations in CSF. CONCLUSION Although serum 25-hydroxyvitamin D in children with bacterial meningitis was not associated with survival or CSF cathelicidin concentrations, its relationship with more detailed disease outcomes warrants further study.
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Affiliation(s)
- Okko Savonius
- Children's Hospital; Helsinki University Hospital; University of Helsinki; Helsinki Finland
| | - Tuula Pelkonen
- Children's Hospital; Helsinki University Hospital; University of Helsinki; Helsinki Finland
| | - Irmeli Roine
- Medical Faculty; University Diego Portales; Santiago Chile
| | - Heli Viljakainen
- Children's Hospital; Helsinki University Hospital; University of Helsinki; Helsinki Finland
- Folkhälsan Research Centre; Helsinki Finland
| | - Sture Andersson
- Children's Hospital; Helsinki University Hospital; University of Helsinki; Helsinki Finland
| | - Josefina Fernandez
- Clínica Infantil Dr. Robert Reid Cabral; Santo Domingo Dominican Republic
| | - Heikki Peltola
- Children's Hospital; Helsinki University Hospital; University of Helsinki; Helsinki Finland
| | - Otto Helve
- Children's Hospital; Helsinki University Hospital; University of Helsinki; Helsinki Finland
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The arms race between man and Mycobacterium tuberculosis: Time to regroup. INFECTION GENETICS AND EVOLUTION 2018; 66:361-375. [DOI: 10.1016/j.meegid.2017.08.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 08/21/2017] [Accepted: 08/22/2017] [Indexed: 12/12/2022]
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Intrinsic activation of the vitamin D antimicrobial pathway by M. leprae infection is inhibited by type I IFN. PLoS Negl Trop Dis 2018; 12:e0006815. [PMID: 30300363 PMCID: PMC6177120 DOI: 10.1371/journal.pntd.0006815] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 09/03/2018] [Indexed: 12/12/2022] Open
Abstract
Following infection, virulent mycobacteria persist and grow within the macrophage, suggesting that the intrinsic activation of an innate antimicrobial response is subverted by the intracellular pathogen. For Mycobacterium leprae, the intracellular bacterium that causes leprosy, the addition of exogenous innate or adaptive immune ligands to the infected monocytes/macrophages was required to detect a vitamin D-dependent antimicrobial activity. We investigated whether there is an intrinsic immune response to M. leprae in macrophages that is inhibited by the pathogen. Upon infection of monocytes with M. leprae, there was no upregulation of CYP27B1 nor its enzymatic activity converting the inactive prohormone form of vitamin D (25-hydroxyvitamin D) to the bioactive form (1,25α-dihydroxyvitamin D). Given that M. leprae-induced type I interferon (IFN) inhibited monocyte activation, we blocked the type I IFN receptor (IFNAR), revealing the intrinsic capacity of monocytes to recognize M. leprae and upregulate CYP27B1. Consistent with these in vitro studies, an inverse relationship between expression of CYP27B1 vs. type I IFN downstream gene OAS1 was detected in leprosy patient lesions, leading us to study cytokine-derived macrophages (MΦ) to model cellular responses at the site of disease. Infection of IL-15-derived MΦ, similar to MΦ in lesions from the self-limited form of leprosy, with M. leprae did not inhibit induction of the vitamin D antimicrobial pathway. In contrast, infection of IL-10-derived MΦ, similar to MΦ in lesions from patients with the progressive form of leprosy, resulted in induction of type I IFN and suppression of the vitamin D directed pathway. Importantly, blockade of the type I IFN response in infected IL-10 MΦ decreased M. leprae viability. These results indicate that M. leprae evades the intrinsic capacity of human monocytes/MΦ to activate the vitamin D-mediated antimicrobial pathway via the induction of type I IFN. Our macrophages are equipped with the ability to detect and kill invading pathogens, and yet, these cells of the innate immune system are still subject to infection by intracellular bacterium. In particular, mycobacterium, the type of intracellular bacteria responsible for diseases such as tuberculosis and leprosy, are very successful at establishing infection within macrophages. By studying Mycobacterium leprae, the etiological agent of leprosy, we describe an immune evasion mechanism whereby this bacterial pathogen utilizes our own antiviral immune response against the macrophage. Type I interferons (IFN) are a major part of our immune response to viral infections; however, this response will also suppress our ability to fight opportunistic bacterial infection. During infection of our macrophages, M. leprae induces an aberrant type I IFN response that subsequently suppresses our macrophage’s ability to activate the vitamin D-mediated antimicrobial pathway, a critical antimicrobial response for containment of mycobacterium. Thus, understanding how these pathogens can evade our immune response will be important for the development of new therapies against these chronic infections.
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Bolland MJ, Grey A, Avenell A. Assessment of research waste part 2: wrong study populations- an exemplar of baseline vitamin D status of participants in trials of vitamin D supplementation. BMC Med Res Methodol 2018; 18:101. [PMID: 30285729 PMCID: PMC6171194 DOI: 10.1186/s12874-018-0555-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Accepted: 09/10/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Research waste can occur when trials are conducted in the wrong populations. Vitamin D deficient populations are most likely to benefit from vitamin D supplementation. We investigated waste attributable to randomised controlled trials (RCTs) of supplementation in populations that were not vitamin D deficient. METHODS In December 2015, we searched Pubmed, recent systematic reviews, and three trial registries for RCTs of vitamin D with clinical endpoints in adults, and 25-hydroxvitamin D (25OHD) survey data relevant to large (N ≥ 1000) RCTs. We investigated the proportion of RCTs that studied vitamin D deficient populations, temporal trends in baseline 25OHD, and whether investigators in large RCTs considered relevant 25OHD survey data or systematic reviews in their trial justifications. RESULTS Of 137 RCTs of vitamin D with clinical endpoints, 118 (86%) reported baseline mean/median 25OHD, which was < 25, 25-49, 50-74, and ≥ 75 nmol/L in 12 (10%), 62 (53%), 36 (31%), and 8 (7%) RCTs, respectively. In 70% of RCTs, baseline 25OHD was > 40 nmol/L. Baseline 25OHD increased over time. Before 2006, 38%, 62%, 0% and 0% of RCTs had baseline 25OHD < 25, 25-49, 50-74, and ≥ 75 nmol/L respectively; in 2011-15, the respective proportions were 9%, 49%, 37%, and 6%. Of 12 RCTs with baseline 25OHD < 25 nmol/L, 8 had neutral findings. Of 25 large RCTs (18 completed, 7 ongoing), 1 was undertaken in a vitamin D deficient population, 3 in vitamin D insufficient populations, and 17 had, or probably will have, baseline 25OHD > 40 nmol/L. 44% (8/18) of large completed RCTs cited relevant prior population 25OHD data, and only 3/10 (30%) relevant prior systematic reviews. CONCLUSIONS Up to 70% of RCTs of vitamin D with clinical endpoints, 71% of large completed RCTs, and 100% of ongoing large RCTs could be considered research waste because they studied cohorts that were not vitamin D deficient.
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Affiliation(s)
- Mark J. Bolland
- Department of Medicine, Bone and Joint Research Group, University of Auckland, Private Bag 92 019, Auckland, 1142 New Zealand
| | - Andrew Grey
- Department of Medicine, Bone and Joint Research Group, University of Auckland, Private Bag 92 019, Auckland, 1142 New Zealand
| | - Alison Avenell
- Health Services Research Unit, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD Scotland
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Wang M, Kong W, He B, Li Z, Song H, Shi P, Wang J. Vitamin D and the promoter methylation of its metabolic pathway genes in association with the risk and prognosis of tuberculosis. Clin Epigenetics 2018; 10:118. [PMID: 30208925 PMCID: PMC6136159 DOI: 10.1186/s13148-018-0552-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 09/04/2018] [Indexed: 12/24/2022] Open
Abstract
Background A variety of abnormalities in vitamin D metabolism have been reported in patients with active tuberculosis. However, intervention trials have produced inconsistent results. We hypothesized that genetic and epigenetic changes in the key genes of the vitamin D metabolic pathway may partly explain the differences between studies. Methods We performed a case-control study followed by a prospective cohort study. We recruited 122 patients with pulmonary tuberculosis and 118 healthy controls. The serum 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D levels were measured. The methylation of the promoter regions of key genes in the vitamin D metabolic pathway (CYP24A1, CYP27A1, CYP27B1, CYP2R1, and VDR) was detected using the Illumina MiSeq platform. The specific methylation profiles were examined as epigenetic biomarkers. The sensitivity, specificity, and receiver operating characteristic (ROC) curves were used to estimate the predictive value of the biomarkers. Results The baseline serum 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D concentrations in the cases were significantly lower than those in the controls (51.60 ± 27.25 nmol/L vs. 117.50 ± 75.50 nmol/L, Z = − 8.515, P < 0.001; 82.63 ± 51.43 pmol/L vs. 94.02 ± 49.26 pmol/L, Z = − 2.165, P = 0.03). We sequenced 310 CpG sites in five candidate genes. After Bonferroni correction, there were 55 differentially methylated CpG sites between cases and controls; 41.5% were in the CYP27B1 gene, 31.7% were in the CYP24A1 gene, 14.7% were in the VDR gene, and 12.3% were in the CYP27A1 gene. When we designated the CpG sites that remained significant after the Bonferroni correction as the biomarkers, the area under the curve (AUC) for the cumulative methylation was 0.810 (95% CI 0.754–0.866). There was an interaction between CYP27A1 methylation level and 1,25-dihydroxyvitamin D concentration associated with the risk of TB (ORinteraction = 4.11, 95% CI 1.26–13.36, P = 0.019). The serum 1,25-dihydroxyvitamin D concentration at the end of the intensive treatment stage was related to a patient’s prognosis (P = 0.008). There were 23 CpG sites that were individually related to the treatment outcomes, but the relationships were not significant after the Bonferroni correction. Conclusion Both serum vitamin D concentrations and the methylation levels of key genes in the vitamin D metabolic pathway are related to the risk and prognosis of tuberculosis. Electronic supplementary material The online version of this article (10.1186/s13148-018-0552-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Min Wang
- Department of Epidemiology, School of Public Health, Nanjing Medical University, 101 Longmian Ave, Nanjing, 211166, People's Republic of China.,Department of Preventive Health Care, People's Hospital of Suzhou High-tech Zone, Suzhou, People's Republic of China
| | - Weimin Kong
- Department of Nursing, The First People's Hospital of Yancheng City, Yancheng, People's Republic of China
| | - Biyu He
- Department of Epidemiology, School of Public Health, Nanjing Medical University, 101 Longmian Ave, Nanjing, 211166, People's Republic of China
| | - Zhongqi Li
- Department of Epidemiology, School of Public Health, Nanjing Medical University, 101 Longmian Ave, Nanjing, 211166, People's Republic of China
| | - Huan Song
- Department of Epidemiology, School of Public Health, Nanjing Medical University, 101 Longmian Ave, Nanjing, 211166, People's Republic of China
| | - Peiyi Shi
- Department of Epidemiology, School of Public Health, Nanjing Medical University, 101 Longmian Ave, Nanjing, 211166, People's Republic of China
| | - Jianming Wang
- Department of Epidemiology, School of Public Health, Nanjing Medical University, 101 Longmian Ave, Nanjing, 211166, People's Republic of China. .,Key Laboratory of Infectious Diseases, School of Public Health, Nanjing Medical University, Nanjing, People's Republic of China.
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Medrano M, Carrillo-Cruz E, Montero I, Perez-Simon JA. Vitamin D: Effect on Haematopoiesis and Immune System and Clinical Applications. Int J Mol Sci 2018; 19:ijms19092663. [PMID: 30205552 PMCID: PMC6164750 DOI: 10.3390/ijms19092663] [Citation(s) in RCA: 97] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 08/31/2018] [Accepted: 09/04/2018] [Indexed: 12/19/2022] Open
Abstract
Vitamin D is a steroid-like hormone which acts by binding to vitamin D receptor (VDR). It plays a main role in the calcium homeostasis and metabolism. In addition, vitamin D display other important effects called “non-classical actions.” Among them, vitamin D regulates immune cells function and hematopoietic cells differentiation and proliferation. Based on these effects, it is currently being evaluated for the treatment of hematologic malignancies. In addition, vitamin D levels have been correlated with patients’ outcome after allogeneic stem cell transplantation, where it might regulate immune response and, accordingly, might influence the risk of graft-versus-host disease. Here, we present recent advances regarding its clinical applications both in the treatment of hematologic malignancies and in the transplant setting.
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Affiliation(s)
- Mayte Medrano
- Department of Hematology, University Hospital Virgen del Rocio, Instituto de Biomedicina de Sevilla (IBIS/CSIC/CIBERONC), Universidad de Sevilla, 41013 Sevilla, Spain.
| | - Estrella Carrillo-Cruz
- Department of Hematology, University Hospital Virgen del Rocio, Instituto de Biomedicina de Sevilla (IBIS/CSIC/CIBERONC), Universidad de Sevilla, 41013 Sevilla, Spain.
| | - Isabel Montero
- Department of Hematology, University Hospital Virgen del Rocio, Instituto de Biomedicina de Sevilla (IBIS/CSIC/CIBERONC), Universidad de Sevilla, 41013 Sevilla, Spain.
| | - Jose A Perez-Simon
- Department of Hematology, University Hospital Virgen del Rocio, Instituto de Biomedicina de Sevilla (IBIS/CSIC/CIBERONC), Universidad de Sevilla, 41013 Sevilla, Spain.
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Bekele A, Gebreselassie N, Ashenafi S, Kassa E, Aseffa G, Amogne W, Getachew M, Aseffa A, Worku A, Raqib R, Agerberth B, Hammar U, Bergman P, Aderaye G, Andersson J, Brighenti S. Daily adjunctive therapy with vitamin D 3 and phenylbutyrate supports clinical recovery from pulmonary tuberculosis: a randomized controlled trial in Ethiopia. J Intern Med 2018; 284:292-306. [PMID: 29696707 PMCID: PMC6202271 DOI: 10.1111/joim.12767] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Immunotherapy using vitamin D (vitD3 ) and phenylbutyrate (PBA) may support standard drug regimens used to treat infectious diseases. We investigated if vitD3 + PBA enhanced clinical recovery from pulmonary tuberculosis (TB). METHODS A randomized controlled trial was conducted in Addis Ababa, Ethiopia. Patients with smear-positive or smear-negative TB received daily oral supplementation with 5000 IU vitD3 and 2 × 500 mg PBA or placebo for 16 weeks, together with 6-month chemotherapy. Primary end-point: reduction of a clinical composite TB score at week 8 compared with baseline using modified intention-to-treat (mITT, n = 348) and per-protocol (n = 296) analyses. Secondary end-points: primary and modified TB scores (week 0, 4, 8, 16, 24), sputum conversion, radiological findings and plasma 25(OH)D3 concentrations. RESULTS Most subjects had low baseline plasma 25(OH)D3 levels that increased gradually in the vitD3 + PBA group compared with placebo (P < 0.0001) from week 0 to 16 (mean 34.7 vs. 127.4 nmol L-1 ). In the adjusted mITT analysis, the primary TB score was significantly reduced in the intervention group at week 8 (-0.52, 95% CI -0.93, -0.10; P = 0.015) while the modified TB score was reduced at week 8 (-0.58, 95% CI -1.02, -0.14; P = 0.01) and 16 (-0.34, 95% CI -0.64, -0.03; P = 0.03). VitD3 + PBA had no effect on longitudinal sputum-smear conversion (P = 0.98). Clinical adverse events were more common in the placebo group (24.3%) compared with the vitD3 + PBA group (12.6%). CONCLUSION Daily supplementation with vitD3 + PBA may ameliorate clinical TB symptoms and disease-specific complications, while the intervention had no effect on bacterial clearance in sputum.
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Affiliation(s)
- A Bekele
- Department of Internal Medicine, Faculty of Medicine, Black Lion University Hospital, Addis Ababa University, Addis Ababa, Ethiopia
| | - N Gebreselassie
- Center for Infectious Medicine (CIM), F59, Department of Medicine, Karolinska University Hospital Huddinge, Karolinska Institutet, Stockholm, Sweden.,Armauer Hansen Research Institute (AHRI), Addis Ababa, Ethiopia
| | - S Ashenafi
- Center for Infectious Medicine (CIM), F59, Department of Medicine, Karolinska University Hospital Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - E Kassa
- Department of Internal Medicine, Faculty of Medicine, Black Lion University Hospital, Addis Ababa University, Addis Ababa, Ethiopia
| | - G Aseffa
- Department of Radiology, Faculty of Medicine, Black Lion University Hospital, Addis Ababa University, Addis Ababa, Ethiopia
| | - W Amogne
- Department of Internal Medicine, Faculty of Medicine, Black Lion University Hospital, Addis Ababa University, Addis Ababa, Ethiopia
| | - M Getachew
- Department of Internal Medicine, Faculty of Medicine, Black Lion University Hospital, Addis Ababa University, Addis Ababa, Ethiopia
| | - A Aseffa
- Armauer Hansen Research Institute (AHRI), Addis Ababa, Ethiopia
| | - A Worku
- Department of Public Health, Faculty of Medicine, Black Lion University Hospital, Addis Ababa University, Addis Ababa, Ethiopia
| | - R Raqib
- Infectious Diseases Division (IDD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - B Agerberth
- Clinical Microbiology, Department of Laboratory Medicine (Labmed), Karolinska Institutet, Stockholm, Sweden
| | - U Hammar
- Institute of Environmental Medicine (IMM), Karolinska Institutet, Stockholm, Sweden
| | - P Bergman
- Clinical Microbiology, Department of Laboratory Medicine (Labmed), Karolinska Institutet, Stockholm, Sweden
| | - G Aderaye
- Department of Internal Medicine, Faculty of Medicine, Black Lion University Hospital, Addis Ababa University, Addis Ababa, Ethiopia
| | - J Andersson
- Center for Infectious Medicine (CIM), F59, Department of Medicine, Karolinska University Hospital Huddinge, Karolinska Institutet, Stockholm, Sweden.,Division of Infectious Diseases, Department of Medicine, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - S Brighenti
- Center for Infectious Medicine (CIM), F59, Department of Medicine, Karolinska University Hospital Huddinge, Karolinska Institutet, Stockholm, Sweden
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