Vitamin D and multiple sclerosis: review of a possible association

Gut microbiome in multiple sclerosis-related cognitive impairment

Cognition is one of the most evaluated neurologic subjects with which the gut microbiome is supposed to be associated. Cognitive impairment is a prevalent finding in patients with multiple sclerosis (MS). Here, we are about to study the current evidence on the effect of gut microbiota on cognition and MS. Although no direct evidence is in hand, putting all indirect research together, one could think of the hypothetical benefit of brain-gut axis interventions (possibly diet changes, probiotic administration, microbiota transplant) to solve the drastic problem of cognitive impairment in MS. Hence, researchers are encouraged to scan this horizon in order to fill the knowledge gaps in the field.

Relationship between the Severity of Inflammatory Changes in Chronic Sinusitis and the Level of Vitamin D before and after the FESS Procedure

There have been a few reports confirming that vitamin D (VD3) deficiency increases inflammation in the paranasal sinuses. The work brings new information that, despite the presence of inflammation before surgery, patients with higher vitamin D levels had less inflammation, and this has been proven on three levels. We show that vitamin D levels clearly correlate with the severity of the disease in chronic sinusitis. These results have been confirmed in imaging studies (Lund MacKay scale), endoscopy (Lund-Kennedy scale) and in the SNOT 20 questionnaire. 40 patients suffering from chronic sinusitis were divided into two equal groups: group 1: with less severe radiological changes (10 or less points on the Lund-Mackay scale), group 2: with a more advanced form (>10 points). The relationship between VD3 and the severity of the disease (clinical and nasal endoscopy) was assessed. The mean VD3 level in patients in group 2 before surgery was lower (23.01 ng/mL) than in group 1 (28.02 ng/mL) (p < 0.05). They presented a higher degree of advanced changes in all the above scales, i.e., before the SNOT 20 procedure, the mean was: group 1: 30.33, group 2: 31.80 (p < NS); Lund-Kennedy: group 1: 3.21, group 2: 6.30 (p < 0.05). After surgery an increase in VD3 levels was observed in both study groups: in group 1 to the value of 37.98 ng/mL (p < 0.002) and in group 2 to 27.67 ng/mL (p < 0.004). Lower VD3 levels were found in patients with a higher stage of the disease. Reduction of inflammation increases the level of VD3 and reduces subjective and objective symptoms of chronic inflammation.

Estimated Incidence Rate of Multiple Sclerosis and Its Relationship with Geographical Factors in Isfahan Province between the Years 2001 and 2014

BACKGROUND

Multiple sclerosis (MS) is an autoimmune disease associated with inflammation of the central nervous system in humans. This disease is the most common neurological disease, especially in young people. Various factors, including biological, genetic, and environmental factors, are effective on the prevalence of MS disease. This study intends to determine the relationship between geographical factors, and the prevalence of MS disease was performed.

METHODS

This ecological study was carried out on 2000 patients with diagnosis of MS during the years 2001-2014 in Isfahan province. All patients' data including age, sex, marital status, year, and location of patients were extracted from the files. Arc geographic information systems version 10.3 software was used for geographical maps, and for statistical analysis of data, SPSS.16 software ANOVA tests, independent t-test, and Kruskal-Wallis were used.

RESULTS

Based on recorded cases of MS, the highest and lowest cumulative incidence of diseases was related to the city of Isfahan (75.92 in one hundred thousand) and Aran Bidgol (1.16 in one hundred thousand), respectively. A significant relationship was observed between the incidence and height above sea level (P = 0.001), the average annual rainfall (P = 0.001), and land use (P = 0.001). With increase in the height above sea level and the average annual precipitation, the incidence of disease decreased.

CONCLUSIONS

MS disease incidence is high in Isfahan province. The distribution of the disease is not the same in the cities of this province, and some cities have a higher incidence. Furthermore, the incidence of the disease is influenced by geographical factors such as height above sea level, average annual rainfall, and land use. Therefore, it is recommended that relevant authorities by the implementation of screening programs in high-risk areas take action to identify and treat patients in the early stages.

Role of Vitamin D and Its Receptors in the Pathophysiology of Chronic Rhinosinusitis

OBJECTIVES

Chronic rhinosinusitis (CRS) is a disease that represents a challenging therapeutic problem. Vitamin D and its receptors (VDR) are involved in the regulation of the immune system and may play role in CRS. Objectives of this study were to assess the relationships between the total concentration of vitamin D (25VD3) in sera, vitamin D receptor (VDR) expression, 1α-hydroxylase expression, and clinical data, including age, gender, Sino-Nasal Outcome Test (SNOT-22), computerized tomography (CT) scan, allergy status, and vitamin D supplementation in CRS patients with (CRSwNP) and without nasal polyps (CRSsNP), and in a control group.

METHODS

The studied group comprised 52 patients with CRS without nasal polyps (sNP), 55 with CRS with nasal polyps (wNP), and 59 in the control group. The endpoints were determined by appropriate methods. We conducted immunohistochemical staining of gathered tissue from the ostiomeatal complex for determination of VDR and 1α-hydroxylase. Analytical results were compared with clinical data as already noted.

RESULTS

A decrease in VDR nuclear staining occurred in CRS patients as compared to controls. Insignificant differences were observed in 1α-hydroxylase, expression in all studied groups, while VDR and cytochrome CYP27B1 protein expression (1α-hydroxylase) correlated with clinical data.

CONCLUSIONS

The data provide evidence that indicates that vitamin D and its receptor and enzymes may play a role in CRS.

Role of gene polymorphisms in vitamin D metabolism and in multiple sclerosis

Multiple sclerosis (MS) is a complex inflammatory disease of the central nervous system (CNS) resulting in neurological impairment and disability. There is evidence that adequate vitamin D levels may lower the risk of MS development. The aetiology of MS is complex and involves both genetic and environmental factors. In fact, not one but several genes are believed to lead to the disease. As for environmental factors, one of the most important risk factors is vitamin D deficiency, which, in turn, is closely related to gene polymorphisms that play a role in vitamin D metabolism and regulation. However, information about these gene polymorphisms is quite contradictory. The aim of this review is to discuss the association between some of the vitamin D-related gene variants and MS.

Role of Vitamin D in Cognitive Function in Chronic Kidney Disease

Both vitamin D deficiency and cognitive impairment are common in patients with chronic kidney disease (CKD). Vitamin D exerts neuroprotective and regulatory roles in the central nervous system. Hypovitaminosis D has been associated with muscle weakness and bone loss, cardiovascular diseases (hypertension, diabetes and hyperlipidemia), inflammation, oxidative stress, immune suppression and neurocognitive impairment. The combination of hypovitaminosis D and CKD can be even more debilitating, as cognitive impairment can develop and progress through vitamin D-associated and CKD-dependent/independent processes, leading to significant morbidity and mortality. Although an increasingly recognized comorbidity in CKD, cognitive impairment remains underdiagnosed and often undermanaged. Given the association of cognitive decline and hypovitaminosis D and their deleterious effects in CKD patients, determination of vitamin D status and when appropriate, supplementation, in conjunction with neuropsychological screening, should be considered integral to the clinical care of the CKD population.

Emerging Concepts on the Gut Microbiome and Multiple Sclerosis

Microbiota of the human body perform fundamental tasks that contribute to normal development, health, and homeostasis and are intimately associated with numerous organ systems, including the gut. Microbes begin gut inhabitance immediately following birth and promote proper gut epithelial construction and function, metabolism and nutrition, and immune system development. Inappropriate immune recognition of self-tissue can lead to autoimmune disease, including conditions such as multiple sclerosis (MS), in which the immune system recognizes and attacks central nervous system tissue. Preclinical studies have demonstrated a requirement of gut microbiota for neuroinflammatory autoimmune disease in animal models, and a growing number of clinical investigations are finding associations between MS status and the composition of the gut microbiota. In this review, we examine current undertakings into better understanding the role of gut bacteria and their phages in MS development, review associations of the gut microbiota makeup and MS, and discuss potential mechanisms by which the gut microbiota may be manipulated for therapeutic benefit.

Regulation of Dendritic Cell Function by Vitamin D

Studies over the last two decades have revealed profound immunomodulatory aspects of vitamin D on various aspects of the immune system. This review will provide an overview of Vitamin D metabolism, a description of dendritic cell subsets, and highlight recent advances on the effects of vitamin D on dendritic cell function, maturation, cytokine production and antigen presentation. The active form of vitamin D, 1,25(OH)₂D₃, has important immunoregulatory and anti-inflammatory effects. Specifically, the 1,25(OH)₂D₃-Vitamin D₃ complex can affect the maturation and migration of many dendritic cell subsets, conferring a special immunoregulatory role as well as tolerogenic properties affecting cytokine and chemokine production. Furthermore, there have been many recent studies demonstrating the effects of Vitamin D on allergic disease and autoimmunity. A clear understanding of the effects of the various forms of Vitamin D will provide new opportunities to improve human health.

Calcium-phosphate metabolism in patients with multiple sclerosis

INTRODUCTION AND OBJECTIVES

The purpose of this study was to evaluate the concentration of 25-hydroxycholecalciferol and parameters of calcium-phosphate metabolism at different periods of relapsing-remitting multiple sclerosis (RRMS).

MATERIALS AND METHODS

Forty-five patients, residents of Poland (49°-50°, N), were enrolled in the study, i.e. 15 immediately after the diagnosis of RRMS, 15 at the early stage and 15 at the advanced stage of RRMS. The results were compared to values obtained in 20 age- and sex-matched controls.

RESULTS

Lower serum concentrations of 25-hydroxycholecalciferol and ionised calcium were found in patients compared to the control group. In patients with the disease duration of 5-6 years, concentrations of 25-hydroxycholecalciferol and ionised calcium were lower than in patients in the earlier period of RRMS. The inverse and clearer direction of changes was found in parathormone serum concentration in patients compared to the controls. In patients with a longer disease duration, a significantly lower 25-hydroxycholecalciferol concentration was found in female patients compared to male patients. In patients, more frequent 25-hydroxycholecalciferol and unsaturated fatty acids' supplementation was observed compared to the controls.

CONCLUSIONS

In RRMS patients, calcium-phosphate metabolism is disturbed which increases during disease progression.

Dietary Vitamin D3 Restriction Exacerbates Disease Pathophysiology in the Spinal Cord of the G93A Mouse Model of Amyotrophic Lateral Sclerosis

Background

Dietary vitamin D₃ (D₃) restriction reduces paw grip endurance and motor performance in G93A mice, and increases inflammation and apoptosis in the quadríceps of females. ALS, a neuromuscular disease, causes progressive degeneration of motor neurons in the brain and spinal cord.

Objective

We analyzed the spinal cords of G93A mice following dietary D₃ restriction at 2.5% the adequate intake (AI) for oxidative damage (4-HNE, 3-NY), antioxidant enzymes (SOD2, catalase, GPx1), inflammation (TNF-α, IL-6, IL-10), apoptosis (bax/bcl-2 ratio, cleaved/pro-caspase 3 ratio), neurotrophic factor (GDNF) and neuron count (ChAT, SMI-36/SMI-32 ratio).

Methods

Beginning at age 25 d, 42 G93A mice were provided food ad libitum with either adequate (AI;1 IU D₃/g feed; 12 M, 11 F) or deficient (DEF; 0.025 IU D₃/g feed; 10 M, 9 F) D₃. At age 113 d, the spinal cords were analyzed for protein content. Differences were considered significant at P ≤ 0.10, since this was a pilot study.

Results

DEF mice had 16% higher 4-HNE (P = 0.056), 12% higher GPx1 (P = 0.057) and 23% higher Bax/Bcl2 ratio (P = 0.076) vs. AI. DEF females had 29% higher GPx1 (P = 0.001) and 22% higher IL-6 (P = 0.077) vs. AI females. DEF males had 23% higher 4-HNE (P = 0.066) and 18% lower SOD2 (P = 0.034) vs. AI males. DEF males had 27% lower SOD2 (P = 0.004), 17% lower GPx1 (P = 0.070), 29% lower IL-6 (P = 0.023) and 22% lower ChAT (P = 0.082) vs. DEF females.

Conclusion

D₃ deficiency exacerbates disease pathophysiology in the spinal cord of G93A mice, the exact mechanisms are sex-specific. This is in accord with our previous results in the quadriceps, as well as functional and disease outcomes.

Vitamin D in inflammatory diseases

Changes in vitamin D serum levels have been associated with inflammatory diseases, such as inflammatory bowel disease (IBD), rheumatoid arthritis, systemic lupus erythematosus, multiple sclerosis (MS), atherosclerosis, or asthma. Genome- and transcriptome-wide studies indicate that vitamin D signaling modulates many inflammatory responses on several levels. This includes (i) the regulation of the expression of genes which generate pro-inflammatory mediators, such as cyclooxygenases or 5-lipoxygenase, (ii) the interference with transcription factors, such as NF-κB, which regulate the expression of inflammatory genes and (iii) the activation of signaling cascades, such as MAP kinases which mediate inflammatory responses. Vitamin D targets various tissues and cell types, a number of which belong to the immune system, such as monocytes/macrophages, dendritic cells (DCs) as well as B- and T cells, leading to individual responses of each cell type. One hallmark of these specific vitamin D effects is the cell-type specific regulation of genes involved in the regulation of inflammatory processes and the interplay between vitamin D signaling and other signaling cascades involved in inflammation. An important task in the near future will be the elucidation of the regulatory mechanisms that are involved in the regulation of inflammatory responses by vitamin D on the molecular level by the use of techniques such as chromatin immunoprecipitation (ChIP), ChIP-seq, and FAIRE-seq.

Vitamin D, folate, and potential early lifecycle environmental origin of significant adult phenotypes

Solar radiation early in pregnancy interacts with light sensitive vitamins to influence an embryo's genetic profile. This influences both adult disease risk and may play a role in the evolution of skin colour.

Background and objectives: Vitamin D and folate are highly UV sensitive, and critical for maintaining health throughout the lifecycle. This study examines whether solar irradiance during the first trimester of pregnancy influences vitamin D receptor (VDR) and nuclear folate gene variant occurrence, and whether affected genes influence late-life biochemical/clinical phenotypes.

Methodology: 228 subjects were examined for periconceptional exposure to solar irradiance, variation in vitamin D/folate genes (polymerase chain reaction (PCR)), dietary intake (food frequency questionnaire (FFQ)) and important adult biochemical/clinical phenotypes.

Results: Periconceptional solar irradiance was associated with VDR-BsmI (P = 0.0008^wk7), TaqI (P = 0.0014^wk7) and EcoRV (P = 0.0030^wk6) variant occurrence between post-conceptional weeks 6–8, a period when ossification begins. Similar effects were detected for other VDR gene polymorphisms. Periconceptional solar irradiance was also associated with 19 bp del-DHFR (P = 0.0025^wk6), and to a lesser extent C1420T-SHMT (P = 0.0249^wk6), a folate-critical time during embryogenesis. These same genes were associated with several late-life phenotypes: VDR-BsmI, TaqI and ApaI determined the relationship between dietary vitamin D and both insulin (P < 0.0001/BB, 0.0007/tt and 0.0173/AA, respectively) and systolic blood pressure (P = 0.0290/Bb, 0.0299/Tt and 0.0412/AA, respectively), making them important early and late in the lifecycle. While these and other phenotype associations were found for the VDR variants, folate polymorphism associations in later-life were limited to C1420T-SHMT (P = 0.0037 and 0.0297 for fasting blood glucose and HbA1c levels, respectively). We additionally report nutrient–gene relationships with body mass index, thiol/folate metabolome, cognition, depression and hypertension. Furthermore, photoperiod at conception influenced occurrence of VDR-Tru9I and 2R3R-TS genotypes (P = 0.0120 and 0.0360, respectively).

Conclusions and implications: Findings identify environmental and nutritional agents that may interact to modify gene–phenotype relationships across the lifecycle, offering new insight into human ecology. This includes factors related to both disease aetiology and the evolution of skin pigmentation.

Vitamin A: yet another player in multiple sclerosis pathogenesis?

A combination of genetic and environmental factors probably plays a role in determining an increased susceptibility to multiple sclerosis (MS). Among these factors, vitamin D and A metabolites are likely to play a role given their immunomodulatory properties. Decreased serum vitamin D levels have been associated with clinical and MRI activity of MS. Løken-Amsrud et al. evaluated the association of retinol concentration with clinical and MRI measures of disease activity in MS patients over a 2-year period. Serum retinol levels correlated with MRI metrics of disease activity, but not with clinical findings. Following IFN-β-1a treatment, the association with MRI metrics was lost. These results support a role of vitamin A metabolites in influencing disease activity in MS.

Polyglandular autoimmune syndrome disguised as mental illness

Our case acts to highlight the numerous presentations of polyglandular autoimmune syndromes. A 62-year-old Taiwanese woman with a history of schizophrenia presented to our emergency department with a brain tumour causing her headaches. She was admitted due to severe anaemia, and after further investigation, the patient was discovered to have pernicious anaemia and autoimmune thyroiditis-consistent with the diagnosis of polyglandular autoimmune syndrome IIIb. Her underlying primary psychiatric diagnosis was then questioned. The diagnosis of her endocrinopathies were likely delayed for many years due to the psychiatric disorder which may have been due to her long-standing autoimmune hypothyroidism and/or vitamin B12 deficiency. Initial treatment brought about major behavioural improvement, and encourages physicians to investigate secondary causes of psychosis and other coexisting autoimmune diseases when a patient presents with one endocrinopathy.

Vitamin D concentration and lateral cerebral ventricle volume in older adults

SCOPE

Vitamin D deficiency is associated with an enlargement of the lateral cerebral ventricles in rodents. The effect of low serum 25-hydroxyvitamin D (25OHD) on lateral cerebral ventricle volume has not been studied yet in humans. The purpose of this cross-sectional study was to determine whether vitamin D deficiency was associated with greater lateral cerebral ventricle volume in older adults.

METHODS AND RESULTS

Ninety-two Caucasian community-dwellers with no clinical hydrocephalus (mean, 72.2 ± 6.2 years; 46.7% female) were divided into two groups according to serum 25OHD concentration (deficiency ≤ 50 nmol/L; normal > 50 nmol/L). Cerebral ventricular volume was quantified using semi-automated software from three-dimensional T1-weighted MRI. Age, gender, body mass index, blood pressure, education level, Mini-Mental State Examination, white matter lesions, and serum calcium concentrations were used as covariates. There was an inverse linear association between 25OHD concentration and ventricular volume (p = 0.049). Compared to individuals with normal 25OHD, those with 25OHD deficiency (n = 33) had 28% larger lateral ventricles (46.9 ± 26.8 mL versus 36.6 ± 16.4 mL, p = 0.026). Vitamin D deficiency was associated with an increase in ventricular volume (adjustedβ = 16.55, p = 0.023). The ventricular enlargement involved ventricle bodies (p = 0.025) but not temporal horns (p = 0.112).

CONCLUSION

Serum 25OHD deficiency was associated with larger lateral cerebral ventricles. These findings provide a scientific base for vitamin D replacement trials.

Vitamin D inquiry in hippocampal neurons: consequences of vitamin D-VDR pathway disruption on calcium channel and the vitamin D requirement

Vitamin D receptor (VDR) and the enzymes involved in bioactivation of vitamin D, shown to be expressed in the central nervous system, particularly in areas affected by neurodegenerative disorders, especially in hippocampus. We showed that amyloid beta (Aβ) pathology includes VDR protein depletion and vitamin D-VDR pathway disruption either induced by Aβ or by VDR siRNA have very similar effects on cortical neurons. The goal of this study is to show the presence of 25 hydroxy vitamin D3-24 hydroxylase (24OHase) which is essential for vitamin D catabolism in hippocampal and cortical neurons. Additional goal is to compare the expression pattern of VDR and 24OHase both in hippocampal and in cortical neurons and to investigate the effects of VDR suppression in hippocampal neurons in order to see whether similar mechanisms work in hippocampus and cerebral cortex. Primary neuronal cultures were prepared from Sprague-dawley rat embryos. qRT-PCR was performed to determine VDR, 24OHase, and LVSCC-A1C mRNA expression levels. Cytotoxicity levels were determined by ELISA. Our findings illustrate that 24OHase mRNA was present both in hippocampal and in cortical neurons. VDR and 24OHase mRNA were higher in hippocampal neurons than the cortical ones. LVSCC-A1C mRNA levels increased in hippocampal neurons when VDR is down-regulated. Our results indicate that hippocampal neurons response to VDR suppression similar as cortical neurons, regarding calcium channel regulation. Higher gene expression of 24OHase and VDR might indicate "higher requirement of vitamin D" in hippocampus and potential consequences of vitamin D deficiency in cognitive decline, neurodegeneration, and Alzheimer's disease.