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Kim JW, Baek WY, Jung JY, Kim HA, In Yang C, Kim SJ, Suh CH. Seasonal vitamin D levels and lupus low disease activity state in systemic lupus erythematosus. Eur J Clin Invest 2024; 54:e14092. [PMID: 37725441 DOI: 10.1111/eci.14092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/29/2023] [Accepted: 09/07/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Seasonal variation and sunlight exposure can impact serum vitamin D levels, potentially influencing lupus symptoms. We investigated seasonal vitamin D levels and their correlation with clinical manifestations and disease activity in systemic lupus erythematosus (SLE). METHODS Serum 25(OH) vitamin D3 (25(OH)D3) levels were categorised as deficient (25(OH)D3 < 10 ng/mL), insufficient (10-30 ng/mL) and sufficiency (>30 ng/mL) in participants analysed in winter (n = 407) and summer (n = 377). Logistic regression analysis was performed to assess the impact of vitamin D levels on achieving a lupus low disease activity state (LLDAS), stratified by season. RESULTS The mean serum 25(OH)D3 levels differed significantly between the winter and summer measurement groups (22.4 vs. 24.2 ng/mL; p = .018). The prevalences of vitamin D deficiency, insufficiency and sufficiency in the winter group were 12.8%, 66.6% and 20.6%, respectively, compared with 4.5%, 67.9% and 27.6% in the summer group. Achieving LLDAS was highest in the vitamin D sufficiency group (winter: 56.6%, summer: 55%) and lowest in the vitamin D deficiency group (winter: 15.4%, summer: 13.6%), with significant differences (all p < .001). Multivariate analysis identified SLE disease activity index ≤4, normal anti-double-stranded DNA and vitamin D sufficiency as significant factors for achieving LLDAS in both seasons. CONCLUSIONS Sufficient vitamin D levels are important for achieving LLDAS in patients with SLE during winter and summer. Therefore, physicians should pay attention to the adequacy of vitamin D levels and consider recommending vitamin D supplementation for patients with vitamin D insufficiency.
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Affiliation(s)
- Ji-Won Kim
- Department of Rheumatology, Ajou University School of Medicine, Suwon, Korea
| | - Wook-Young Baek
- Department of Rheumatology, Ajou University School of Medicine, Suwon, Korea
| | - Ju-Yang Jung
- Department of Rheumatology, Ajou University School of Medicine, Suwon, Korea
| | - Hyoun-Ah Kim
- Department of Rheumatology, Ajou University School of Medicine, Suwon, Korea
| | - Cheong In Yang
- Department of Rheumatology, Ajou University School of Medicine, Suwon, Korea
| | - Seung-Ju Kim
- Department of Molecular Science and Technology, Ajou University, Suwon, Korea
| | - Chang-Hee Suh
- Department of Rheumatology, Ajou University School of Medicine, Suwon, Korea
- Department of Molecular Science and Technology, Ajou University, Suwon, Korea
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Jiang L, Zhi S, Wei C, Rong Z, Zhang H. Serum 25(OH)D levels are associated with disease activity and renal involvement in initial-onset childhood systemic lupus erythematosus. Front Pediatr 2023; 11:1252594. [PMID: 38111622 PMCID: PMC10725985 DOI: 10.3389/fped.2023.1252594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 11/06/2023] [Indexed: 12/20/2023] Open
Abstract
Background Vitamin D deficiency is common in patients with systemic lupus erythematosus (SLE) and may affect their disease activity and severity. Objective This study aims to assess the vitamin D status in patients with initial-onset SLE during childhood and its association with the clinical and laboratory markers of disease activity. Method This is a retrospective study that includes 168 patients with initial-onset SLE during childhood and 109 healthy children as controls. Clinical and laboratory data were recorded. The area under the curve (AUC) method was used to evaluate the efficacy of double-stranded deoxyribonucleic acid (dsDNA), lower 25(OH)D and complement 3 (C3) alone and in combination to diagnose the presence of renal damage in children with SLE. Result Compared with the controls (25.53 ± 7.02 ng/ml), patients with initial-onset SLE during childhood have lower serum 25(OH)D levels (18.63 ± 5.32 ng/ml) (P < 0.05). Among patients with initial-onset SLE during childhood, SLEDAI-2K scores are significantly higher in the vitamin D insufficiency (median = 14.5) and vitamin D deficiency (median = 14.0) groups than in the vitamin D sufficiency group (median = 9.0) (P < 0.05). Patients with initial-onset SLE during childhood with lower 25(OH)D levels are more likely to have lupus nephritis (LN) and a higher SDI score (P < 0.05). Compared with patients with other types of LN (16.69 ± 3.90 ng/ml), patients with type V LN have lower levels of 25(OH)D (12.27 ± 3.53 ng/ml) (P < 0.05). The AUC was 0.803 when dsDNA antibody, 25(OH)D level and C3 were used in combination to diagnose LN in patients with SLE. Conclusion Vitamin D deficiency and insufficiency are closely related to an increase in SLEDAI and SDI scores. Significant decrease in vitamin D level is a risk factor for LN.
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Affiliation(s)
| | | | | | - Zanhua Rong
- Department of Pediatrics, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Huifeng Zhang
- Department of Pediatrics, The Second Hospital of Hebei Medical University, Shijiazhuang, China
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Kavadichanda C, Singh P, Maurya S, Tota S, Kiroubagarin A, Kounassegarane D, Anand S, Negi VS, Aggarwal A. Clinical and serological association of plasma 25-hydroxyvitamin D (25(OH)D) levels in lupus and the short-term effects of oral vitamin D supplementation. Arthritis Res Ther 2023; 25:2. [PMID: 36597127 PMCID: PMC9807987 DOI: 10.1186/s13075-022-02976-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 12/12/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Data on the association of vitamin D levels and clinical phenotype and disease activity in systemic lupus erythematosus (SLE) is controversial. Further, the optimal dose of oral vitamin D supplementation in SLE is not clear. Thus, the present study was designed to determine the association of plasma vitamin D levels with clinical phenotype, disease variables and serology in a large, cohort of SLE from South Asia and to evaluate the short-term effect of two different dosage regimens of oral vitamin D supplementation on disease flares and plasma vitamin D levels. METHODS This is a two-phase study. Phase I was a cross-sectional analytical study of patients from north (26.85° N) and south India (11.94° N). Plasma 25-hydroxyvitamin-D(25(OH)D) was measured, and its association with demography, serology, disease activity, Galectin-9 and CXCL-10 was analysed. In phase II, patients with SLEDAI-2KG < 10 and on stable immunosuppression were randomised to receive either high dose (weekly 60,000 U*5, followed by 60,000 U monthly) or routine dose (30,000 U monthly) oral vitamin D. Outcomes were assessed at 6 months RESULTS: Phase I included 702 patients with a mean age of 29.46 + 10.7 years. The median plasma vitamin D was 22.83 (13.8-31.8) ng/ml. Deficiency (< 20 ng/ml) was seen in 41.5% of patients. Patients from South India had higher vitamin D levels (27.06 ± 20.21 ng/dl) as compared to North India (17.15 ± 16.07 ng/ml) (p < 0.01). Univariate analyses demonstrated weak negative correlation of vitamin D with SLEDAI2K and positive correlation with age. Galactin-9 had modest correlation with SLEDAI2K but not with vitamin D levels. On multiple linear regression, centre of recruitment (β = 4.37) and age (β = 0.18) predicted (p < 0.05) plasma vitamin D levels. In the phase II, 91 randomised to 2 groups completed 6 months. Median change in plasma vitamin D levels was more in high dose (9.5 versus 2.6 ng/ml; p = 0.04). There were 14 SLE flares and six minor adverse events which were equal across both groups. CONCLUSION Vitamin D deficiency is common in SLE. Geographical location of residence is the major determinant rather than the disease activity. The IFN regulated proteins reflect disease activity independent of vitamin D levels. High-dose oral vitamin D supplementation seems safe and more effective in improving vitamin D levels in SLE. TRIAL REGISTRATION The second phase of this study was a registered randomised controlled trial CTRI/2019/06/019658 [registered on: 14/06/2019].
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Affiliation(s)
- Chengappa Kavadichanda
- grid.414953.e0000000417678301Department of Clinical Immunology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Pratibha Singh
- grid.263138.d0000 0000 9346 7267Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Supriya Maurya
- grid.263138.d0000 0000 9346 7267Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Sneha Tota
- grid.263138.d0000 0000 9346 7267Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Aberaame Kiroubagarin
- grid.414953.e0000000417678301Department of Clinical Immunology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Deepika Kounassegarane
- grid.414953.e0000000417678301Department of Clinical Immunology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Swathi Anand
- grid.414953.e0000000417678301Department of Clinical Immunology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Vir Singh Negi
- grid.414953.e0000000417678301Department of Clinical Immunology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India ,grid.413618.90000 0004 1767 6103All India Institute of Medical Sciences, Bilaspur, Himachal Pradesh India
| | - Amita Aggarwal
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
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Bilgin M, Keskin A, Aci R, Baklacioglu HS, Arslanbek Erdem M. Darkness hormone or daylight hormone in women with systemic lupus erythematosus? Clin Rheumatol 2023; 42:93-99. [PMID: 36125575 DOI: 10.1007/s10067-022-06379-6] [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: 03/21/2022] [Revised: 08/19/2022] [Accepted: 09/13/2022] [Indexed: 01/11/2023]
Abstract
INTRODUCTION In this study, it was aimed to compare the effects of both melatonin and 25-hydroxyvitamin D3, defined as an immune modulator, on laboratory diagnostic criteria parameters and disease activity in patients with systemic lupus erythematosus (SLE). METHODS The study included 56 women with SLE and 40 healthy women (control group). Melatonin and 25-hydroxyvitamin D3 levels of patients and healthy individuals included in the study were examined. In addition, leukocytes, lymphocytes, platelets, C3, C4, anti-double-stranded DNA (Anti-dsDNA), antinuclear antibody, and SLE disease activity index (SLEDAI) were analyzed in women with SLE. Patients were divided into four subgroups according to SLEDAI. RESULTS Melatonin and 25-hydroxyvitamin D3 levels of women with SLE were lower than healthy women (p < 0.001). Both melatonin and 25-hydroxyvitamin D3 levels were not correlated with laboratory diagnostic criteria parameters. Only 25-hydroxyvitamin D3 levels were correlated with leukocyte levels (p < 0.01). There was no significant difference between the melatonin levels of the subgroups. The 25-hydroxyvitamin D3 levels of the subgroup without disease activity were higher than levels of the subgroups with disease activity (p < 0.05). There was a negative correlation between SLEDAI score and 25-hydroxyvitamin D3 levels (p < 0.05). CONCLUSION Women with SLE had lower melatonin and 25-hydroxyvitamin D3 levels than healthy women. On the other hand, parameters of laboratory diagnostic criteria of SLE disease were not related. Only 25-hydroxyvitamin D3 levels were inversely related leukocyte levels. SLE disease activity was not correlated with melatonin levels but negatively correlated with 25-hydroxyvitamin D3 levels. Key Points • Women with SLE have low levels of melatonin and 25-hydroxyvitamin D3. • Melatonin and 25-hydroxyvitamin D3 levels are not related to the laboratory diagnostic criteria parameters for SLE disease. • Low levels of melatonin and 25-hydroxyvitamin D3 may be a factor in the unbalanced immune system of SLE. • Supplementation of melatonin and 25-hydroxyvitamin D3 may be recommended for women patients with SLE.
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Affiliation(s)
- Melek Bilgin
- Department of Microbiology, Samsun Training and Research Hospital, 199 Barıs Boulevard, Kadıkoy Neighborhood, Ilkadım, Samsun, 55090, Turkey.
| | - Adem Keskin
- Department of Medicine Biochemistry, Institute of Health Sciences, Aydin Adnan Menderes University, Aydın, Turkey
| | - Recai Aci
- Department of Biochemistry, Samsun Training and Research Hospital, Samsun, Turkey
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Kraemer AN, Schäfer AL, Sprenger DTL, Sehnert B, Williams JP, Luo A, Riechert L, Al-Kayyal Q, Dumortier H, Fauny JD, Winter Z, Heim K, Hofmann M, Herrmann M, Heine G, Voll RE, Chevalier N. Impact of dietary vitamin D on immunoregulation and disease pathology in lupus-prone NZB/W F1 mice. Front Immunol 2022; 13:933191. [PMID: 36505422 PMCID: PMC9730823 DOI: 10.3389/fimmu.2022.933191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 10/17/2022] [Indexed: 11/27/2022] Open
Abstract
Vitamin D (VD) deficiency is a highly prevalent worldwide phenomenon and is extensively discussed as a risk factor for the development of systemic lupus erythematosus (SLE) and other immune-mediated diseases. In addition, it is now appreciated that VD possesses multiple immunomodulatory effects. This study aims to explore the impact of dietary VD intake on lupus manifestation and pathology in lupus-prone NZB/W F1 mice and identify the underlying immunological mechanisms modulated by VD. Here, we show that low VD intake accelerates lupus progression, reflected in reduced overall survival and an earlier onset of proteinuria, as well higher concentrations of anti-double-stranded DNA autoantibodies. This unfavorable effect gained statistical significance with additional low maternal VD intake during the prenatal period. Among examined immunological effects, we found that low VD intake consistently hampered the adoption of a regulatory phenotype in lymphocytes, significantly reducing both IL-10-expressing and regulatory CD4+ T cells. This goes along with a mildly decreased frequency of IL-10-expressing B cells. We did not observe consistent effects on the phenotype and function of innate immune cells, including cytokine production, costimulatory molecule expression, and phagocytic capacity. Hence, our study reveals that low VD intake promotes lupus pathology, likely via the deviation of adaptive immunity, and suggests that the correction of VD deficiency might not only exert beneficial functions by preventing osteoporosis but also serve as an important module in prophylaxis and as an add-on in the treatment of lupus and possibly other immune-mediated diseases. Further research is required to determine the most appropriate dosage, as too-high VD serum levels may also induce adverse effects, possibly also on lupus pathology.
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Affiliation(s)
- Antoine N. Kraemer
- Department of Rheumatology and Clinical Immunology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany,Center for Chronic Immunodeficiency (CCI), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Anna-Lena Schäfer
- Department of Rheumatology and Clinical Immunology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany,Center for Chronic Immunodeficiency (CCI), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Dalina T. L. Sprenger
- Department of Rheumatology and Clinical Immunology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany,Center for Chronic Immunodeficiency (CCI), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Bettina Sehnert
- Department of Rheumatology and Clinical Immunology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany,Center for Chronic Immunodeficiency (CCI), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Johanna P. Williams
- Department of Rheumatology and Clinical Immunology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany,Center for Chronic Immunodeficiency (CCI), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Aileen Luo
- Department of Rheumatology and Clinical Immunology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany,Center for Chronic Immunodeficiency (CCI), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Laura Riechert
- Department of Rheumatology and Clinical Immunology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany,Center for Chronic Immunodeficiency (CCI), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Qusai Al-Kayyal
- Department of Rheumatology and Clinical Immunology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany,Center for Chronic Immunodeficiency (CCI), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Hélène Dumortier
- Centre national de la recherche scientifique (CNRS) UPR3572, Immunology, Immunopathology and Therapeutic Chemistry, Institute of Molecular and Cellular Biology, Strasbourg, France
| | - Jean-Daniel Fauny
- Centre national de la recherche scientifique (CNRS) UPR3572, Immunology, Immunopathology and Therapeutic Chemistry, Institute of Molecular and Cellular Biology, Strasbourg, France
| | - Zoltan Winter
- Institute of Radiology, Preclinical Imaging Platform Erlangen (PIPE), Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Kathrin Heim
- Department of Gastroenterology, Hepatology, Endocrinology and Infectious Diseases, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Maike Hofmann
- Department of Gastroenterology, Hepatology, Endocrinology and Infectious Diseases, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Martin Herrmann
- Department of Internal Medicine 3, and Deutsches Zentrum Immuntherapie (DZI), University Medical Center Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Guido Heine
- Division of Allergy, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Reinhard E. Voll
- Department of Rheumatology and Clinical Immunology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany,Center for Chronic Immunodeficiency (CCI), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany,*Correspondence: Nina Chevalier, ; Reinhard E. Voll,
| | - Nina Chevalier
- Department of Rheumatology and Clinical Immunology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany,Center for Chronic Immunodeficiency (CCI), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany,*Correspondence: Nina Chevalier, ; Reinhard E. Voll,
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Kanokrungsee S, Patcharapojanart C, Suchonwanit P, Chanprapaph K. High Prevalence of Hypovitaminosis D in Cutaneous and Systemic Lupus Erythematosus Patients and Its Associated Factors: A Cross-Sectional Study in Thailand. CLINICAL, COSMETIC AND INVESTIGATIONAL DERMATOLOGY 2022; 15:1663-1671. [PMID: 36003529 PMCID: PMC9393111 DOI: 10.2147/ccid.s373117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 07/29/2022] [Indexed: 11/23/2022]
Abstract
Objective To investigate the prevalence of low vitamin D levels in patients with cutaneous lupus erythematosus (CLE) and systemic lupus erythematosus (SLE) in Thailand and determine the influential factors associated with inadequate levels. Methods The medical records of patients diagnosed with SLE and/or CLE and evaluated for serum 25-OH vitamin D were retrospectively reviewed from January 2014 to January 2021. Vitamin D deficiency (<20 ng/mL) and insufficiency (21-29 ng/mL) were indicated, and predictors of hypovitaminosis D were identified by multiple linear regression analysis. Results In total, 414 patients with SLE and/or CLE were included in the study. Vitamin D deficiency was predominant in the CLE-only group (33.3%), followed by SLE without CLE (15.6%) and SLE with CLE (8%), p < 0.001. Likewise, vitamin D insufficiency was more prevalent in the CLE-only group (44.4%) compared to SLE with (35.8%) and without CLE (40%). Multivariate analysis showed that a higher SLEDAI-2K score and female sex had a negative association with vitamin D levels, while an intake of every 10,000 IU of vitamin D2 per week increased serum vitamin D levels by up to 2.37 ng/mL. Furthermore, forty-five percent of patients continued to have vitamin D depletion despite commencing the recommended doses of vitamin D replacement. Conclusion Approximately half of Thai patients with SLE and 80% of CLE had vitamin D inadequacy. Vitamin D replacement is a good predictor of high serum vitamin D levels, while lower serum levels were associated with higher disease severity. Therefore, serum vitamin D monitoring and supplementation are suggested for all lupus erythematosus cases, especially those with CLE.
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Affiliation(s)
- Silada Kanokrungsee
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chanikarn Patcharapojanart
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Poonkiat Suchonwanit
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Kumutnart Chanprapaph
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Hayashi K, Sada KE, Asano Y, Katayama Y, Ohashi K, Morishita M, Miyawaki Y, Watanabe H, Katsuyama T, Narazaki M, Matsumoto Y, Yajima N, Yoshimi R, Shimojima Y, Ohno S, Kajiyama H, Ichinose K, Sato S, Fujiwara M, Wada J. Real-world data on vitamin D supplementation and its impacts in systemic lupus erythematosus: Cross-sectional analysis of a lupus registry of nationwide institutions (LUNA). PLoS One 2022; 17:e0270569. [PMID: 35767524 PMCID: PMC9242469 DOI: 10.1371/journal.pone.0270569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 06/13/2022] [Indexed: 12/25/2022] Open
Abstract
Background Although vitamin D concentration is reportedly associated with the pathogenesis and pathology of systemic lupus erythematosus (SLE), benefits of vitamin D supplementation in SLE patients have not been elucidated, to our knowledge. We investigated the clinical impacts of vitamin D supplementation in SLE. Methods A cross-sectional analysis was performed using data from a lupus registry of nationwide institutions. We evaluated vitamin D supplementation status associated with disease-related Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI) as a parameter of long-term disease activity control. Results Of the enrolled 870 patients (mean age: 45 years, mean disease duration: 153 months), 426 (49%) received vitamin D supplementation. Patients with vitamin D supplementation were younger (43.2 vs 47.5 years, P < 0.0001), received higher doses of prednisolone (7.6 vs 6.8 mg/day, P = 0.002), and showed higher estimated glomerular filtration rates (79.3 vs 75.3 mL/min/1.73m2, P = 0.02) than those without supplementation. Disease-related SDI (0.73 ± 1.12 vs 0.73 ± 1.10, P = 0.75), total SDI, and SLE Disease Activity Index (SLEDAI) did not significantly differ between patients receiving and not receiving vitamin D supplementation. Even after excluding 136 patients who were highly recommended vitamin D supplementation (with age ≥ 75 years, history of bone fracture or avascular necrosis, denosumab use, and end-stage renal failure), disease-related SDI, total SDI, and SLEDAI did not significantly differ between the two groups. Conclusions Even with a possible Vitamin D deficiency and a high risk of bone fractures in SLE patients, only half of our cohort received its supplementation. The effect of vitamin D supplementation for disease activity control was not observed.
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Affiliation(s)
- Keigo Hayashi
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Ken-Ei Sada
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
- Department of Clinical Epidemiology, Kochi Medical School, Nankoku, Japan
- * E-mail:
| | - Yosuke Asano
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yu Katayama
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Keiji Ohashi
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Michiko Morishita
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yoshia Miyawaki
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Haruki Watanabe
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Takayuki Katsuyama
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Mariko Narazaki
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yoshinori Matsumoto
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Nobuyuki Yajima
- Department of Medicine, Division of Rheumatology, Showa University School of Medicine, Tokyo, Japan
- Center for Innovative Research for Communities and Clinical Excellence, Fukushima Medical University, Fukushima, Japan
| | - Ryusuke Yoshimi
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yasuhiro Shimojima
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Matsumoto, Japan
| | - Shigeru Ohno
- Center for Rheumatic Diseases, Yokohama City University Medical Center, Yokohama, Japan
| | - Hiroshi Kajiyama
- Department of Rheumatology and Applied Immunology, Faculty of Medicine, Saitama Medical University, Saitama, Japan
| | - Kunihiro Ichinose
- Department of Immunology and Rheumatology, Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Shuzo Sato
- Department of Rheumatology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Michio Fujiwara
- Department of Rheumatology, Yokohama Rosai Hospital, Yokohama, Japan
| | - Jun Wada
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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De Azevêdo Silva J, de Lima SC, Fragoso TS, Cavalcanti CAJ, Barbosa AD, Borborema MEDA, de Lucena TMC, Duarte ALBP, Crovella S, Sandrin-Garcia P. Differential distribution of vitamin D receptor (VDR) gene variants and its expression in systemic lupus erythematosus. Int J Immunogenet 2022; 49:181-192. [PMID: 35560516 DOI: 10.1111/iji.12576] [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: 10/25/2021] [Revised: 02/23/2022] [Accepted: 04/25/2022] [Indexed: 11/30/2022]
Abstract
Systemic lupus erythematosus (SLE) is a multifactorial autoimmune disorder that displays an important genetic background. Vitamin D3 (VD3 ) through its receptor (VDR) plays an important immunomodulatory role in autoimmune misbalance, being capable of modulating immune responses. Genetic alterations in VDR gene may contribute to an altered risk in SLE development and clinical manifestations. We investigated VDR SNPs (single nucleotide polymorphisms) frequencies in 128 SLE patients and 138 healthy controls (HC) and mRNA differential expression in 29 patients and 17 HC regarding SLE susceptibility as well as clinical features. We observed that rs11168268 G allele (OR = 1.55, p = .01) and G/G genotype (OR = 2.69, p = .008) were associated with increased SLE susceptibility. The rs2248098 G allele and A/G and G/G genotypes were associated to lower SLE susceptibility (OR = 0.66, p = .01; OR = 0.46, p = .01; OR = 0.44, p = .02, respectively). Regarding clinical features, we observed lower risk for: rs11168268 A/G genotype and nephritis (OR = 0.31, p = .01); rs4760648 T/T genotype and photosensitivity (OR = 0.24, p = .02); rs1540339 T/T genotype and antibody anti-dsDNA (OR = 0.19, p = .015); rs3890733 T/T genotype and serositis (OR = 0.10, p = .01). We identified a significant downregulation in VDR expression levels when compared patients and controls overall (p = 1.04e-7 ), in Cdx-2 A/G and G/G (p = .008 and p = .014, respectively) and in patients with nephritis (p = .016) Our results suggested that VDR SNPs influence upon SLE susceptibility and in particular clinical features, acting on mRNA expression in SLE patients overall and the ones with nephritis.
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Affiliation(s)
| | - Suelen Cristina de Lima
- Laboratório de Imunopatologia Keizo Asami, Universidade Federal de Pernambuco, Recife, Brazil
| | - Thiago Sotero Fragoso
- Serviço de Reumatologia do Hospital das Clínicas, Universidade Federal de Alagoas, Maceió, Brazil
| | | | | | | | - Thays Maria Costa de Lucena
- Laboratório de Genética e Biologia Molecular Humana, Departamento de Genética, Universidade Federal de Pernambuco, Recife, Brazil
| | | | - Sergio Crovella
- Department of Biological and Environmental Sciences, College of Arts and Sciences, Qatar University, Doha, State of Qatar
| | - Paula Sandrin-Garcia
- Departamento de Genética / Laboratório de Imunopatologia Keizo Asami, Universidade Federal de Pernambuco, Recife, Brazil
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9
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Adel Y, Elgamal M, Adel Abdelsalam S. Impact of vitamin D level and supplementation on systemic lupus erythematosus patients during COVID-19 pandemic. Arch Rheumatol 2022; 37:288-299. [PMID: 36017215 PMCID: PMC9377176 DOI: 10.46497/archrheumatol.2022.8996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 08/02/2021] [Indexed: 11/06/2022] Open
Abstract
Objectives
In this study, we aimed to assess the impact of serum vitamin D level in systemic lupus erythematosus (SLE) patients with novel coronavirus-2019 (COVID-19) disease on severity of infection, duration of COVID-19 disease course, and fatigue development as a complication of both SLE and COVID-19. Patients and methods
Between April 2020 and January 2021, a total of 38 patients (31 males, 7 females; mean age: 49.2±8.1 years; range, 38 to 65 years) who were previously diagnosed with SLE and on different lines of lupus management were included. The patients presented to chest outpatient clinic and emergency hospital with manifestations suggesting COVID-19 infection. Vitamin D levels were measured in serum by enzymelinked immunosorbent assay (ELISA). Vitamin D supplement was added to treatment protocols for COVID-19. Results
Thirteen (34.2%) patients had normal baseline serum vitamin D levels (≥30 ng/mL), nine (23.7%) patients had vitamin D insufficiency (21 to 29 ng/mL), and 16 (42.1%) patients had vitamin D deficiency (≤20 ng/mL). Low vitamin D levels (insufficiency & deficiency) patients had long SLE disease duration (p=0.06). Also, there was a significant long time spent until recovery from COVID-19 infection in low vitamin D levels (insufficiency & deficiency) patient groups versus those with normal vitamin D (p=0.019). Low baseline vitamin D level patients mainly presented with severe COVID19 symptoms (p=0.04). Patients recovered from COVID-19 had normal vitamin D levels than those who died or were lost to follow-up (p=0.07). After recovery from COVID-19, fatigue was more common in SLE patients with low baseline vitamin D level. Conclusion
Vitamin D seems to play a certain role in the management of COVID-19 infection in SLE patients. Patients with normal vitamin D levels have less severe symptoms, shorter time to recovery, improved COVID-19 outcomes, and less development of fatigue after COVID-19 infection.
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Affiliation(s)
- Yasmin Adel
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Mansoura University Hospital,Faculty of Medicine, Mansoura, Egypt
| | - Mohamed Elgamal
- Department of Chest, Mansoura University Hospital, Faculty of Medicine, Mansoura, Egypt
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10
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ERTUĞRUL G, AKTAŞ H. Serum 25-hydroxy vitamin D level does not reflect the severity of warts: a cross-sectional study. KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNIVERSITESI TIP FAKÜLTESI DERGISI 2021. [DOI: 10.17517/ksutfd.987056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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11
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Seet D, Allameen NA, Tay SH, Cho J, Mak A. Cognitive Dysfunction in Systemic Lupus Erythematosus: Immunopathology, Clinical Manifestations, Neuroimaging and Management. Rheumatol Ther 2021; 8:651-679. [PMID: 33993432 PMCID: PMC8217391 DOI: 10.1007/s40744-021-00312-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 04/22/2021] [Indexed: 12/23/2022] Open
Abstract
Cognitive dysfunction (CD) is a common yet often clinically subtle manifestation that considerably impacts the health-related quality of life in patients with systemic lupus erythaematosus (SLE). Given the inconsistencies in CD assessment and challenges in its attribution to SLE, the reported prevalence of CD differs widely, ranging from 3 to 88%. The clinical presentation of CD in SLE is non-specific and may manifest concurrently with overt neuropsychiatric illness such as psychosis or mood disorders or as isolated impairment of attention, working memory, executive dysfunction or processing speed. Despite the lack of standardized and sensitive neuropsychological tests and validated diagnostic biomarkers of CD in SLE, significant progress has been made in identifying pathogenic neural pathways and neuroimaging. Furthermore, several autoantibodies, cytokines, pro-inflammatory mediators and metabolic factors have been implicated in the pathogenesis of CD in SLE. Abrogation of the integrity of the blood-brain barrier (BBB) and ensuing autoantibody-mediated neurotoxicity, complement and microglial activation remains the widely accepted mechanism of SLE-related CD. Although several functional neuroimaging modalities have consistently demonstrated abnormalities that correlate with CD in SLE patients, a consensus remains to be reached as to their clinical utility in diagnosing CD. Given the multifactorial aetiology of CD, a multi-domain interventional approach that addresses the risk factors and disease mechanisms of CD in a concurrent fashion is the favourable therapeutic direction. While cognitive rehabilitation and exercise training remain important, specific pharmacological agents that target microglial activation and maintain the BBB integrity are potential candidates for the treatment of SLE-related CD.
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Affiliation(s)
- Dominic Seet
- Division of Rheumatology, Department of Medicine, University Medicine Cluster, National University Health System, 1E Kent Ridge Road, Level 10, NUHS Tower Block, Singapore, 119228 Singapore
| | - Nur Azizah Allameen
- Division of Rheumatology, Department of Medicine, University Medicine Cluster, National University Health System, 1E Kent Ridge Road, Level 10, NUHS Tower Block, Singapore, 119228 Singapore
| | - Sen Hee Tay
- Division of Rheumatology, Department of Medicine, University Medicine Cluster, National University Health System, 1E Kent Ridge Road, Level 10, NUHS Tower Block, Singapore, 119228 Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jiacai Cho
- Division of Rheumatology, Department of Medicine, University Medicine Cluster, National University Health System, 1E Kent Ridge Road, Level 10, NUHS Tower Block, Singapore, 119228 Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Anselm Mak
- Division of Rheumatology, Department of Medicine, University Medicine Cluster, National University Health System, 1E Kent Ridge Road, Level 10, NUHS Tower Block, Singapore, 119228 Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Osman EMA, Abu El Nazar SY, Maharem DA, Al-Jebouri DM, Naga IS. Relation between Vitamin D Level and Cyclin-Dependent Kinase-1 Gene Expression in Egyptian Patients with Lupus Nephritis and their Impact on Disease Activity. Indian J Nephrol 2021; 31:163-168. [PMID: 34267439 PMCID: PMC8240929 DOI: 10.4103/ijn.ijn_359_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 02/04/2020] [Accepted: 03/08/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction: Lupus nephritis (LN) is a common complication of systemic lupus erythematosus. Vitamin D and cycline-dependent kinase-1 (CDK1) have been implicated in its pathogenesis. The aim of this study was to determine the relation between vitamin D level and CDK-1 in lupus nephritis patients and their impact on disease activity. Patients and Methods: The current study was conducted on 50 LN patients and 20 control subjects from Egyptian population using ELISA to assess vitamin D level in serum and TaqMan assay for CDK1 gene expression. Results: Serum vitamin D level was significantly lower in LN patients and CDK-1 gene was down expressed in the majority of LN patients. A significant inverse correlation was found between vitamin D level and 24 h protein in urine, ANA, anti-dsDNA, CRP, with a significant positive correlation with renal biopsy indices, eGFR. There was a non-significant inverse correlation between vitamin D and CDK-1 (before RO-3306 addition) and a positive correlation after RO-3306. A significant positive correlation was found between CDK-1 gene expressions with urinary albumin/creatinine ratio. However, a significant positive correlation was found between CDK-1 (after RO-3306 addition) and proteinuria. While a significant positive correlation was found between CDK-1 expression (after RO-3306 addition) and ANA, a significant positive correlation was found between CDK-1 expression (before RO-3306 addition) and anti-dsDNA but CDK-1 is not associated with renal biopsy indices nor with activity indices of SLE. There was a positive correlation between CDK-1 gene expression and CRP before and after RO-3306 addition. Conclusions: Vitamin D deficiency acts as a risk factor for developing LN. CDK-1 may have an association with the diagnosis of LN but its association with the progression of staging of LN is still confusing
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Affiliation(s)
- Eman M A Osman
- Department of Immunology and Allergy Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Salma Y Abu El Nazar
- Department of Immunology and Allergy Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Dalia A Maharem
- Internal Medicine, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | | | - Iman S Naga
- Microbiology, Medical Research Institute, Alexandria University, Alexandria, Egypt
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Ponticelli C, Moroni G, Fornoni A. Lupus Membranous Nephropathy. GLOMERULAR DISEASES 2021; 1:10-20. [PMID: 36751488 PMCID: PMC9677716 DOI: 10.1159/000512278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 10/09/2020] [Indexed: 11/19/2022]
Abstract
Background Lupus membranous nephropathy (LMN) is a rare disease, usually associated with nephrotic syndrome. Methods We reviewed the literature by searching for the following terms on Pubmed.gov: lupus nephritis, membranous nephropathy (MN), lupus membranous nephropathy, nephrotic syndrome, and Class V lupus nephritis. Results The histology of LMN at light microscopy is similar to that of primary MN. Cases of MN associated with focal or diffuse proliferation are not considered LMN by the International Society of Nephrology/Renal Pathology Society classification. Immunofluorescence study of LMN shows deposits of all immunoglobulins and complement. Tubulo-reticular structures, extraglomerular deposits, subepithelial, and scanty subendothelial deposits can be seen on electron microscopy. Phospholipase A2 receptor deposits are usually but not necessarily absent in LMN. The pathogenesis is still not completely understood. The inflammatory milieu of lupus may favor the development of autoantigens and intraglomerular assembly of immune complexes. These are more often associated with mesangial or endocapillary hypercellular lesions. Alternatively, autoantibodies may bind autoantigens in the glomerular subepithelium, triggering a signaling cascade leading to LMN. A central role in the development of podocyte injury and proteinuria is played by the components of complement C5b-C9. CKD progression in LMN is slow but may be accelerated by the frequency of renal flares. Persistent nephrotic syndrome and/or the frequent use of corticosteroids may lead to a series of life-threatening complications. Discussion Treatment of arterial hypertension, dyslipidemia, and diabetes are of paramount importance. Besides specific therapies of these complications, hydroxychloroquine and vitamin D supplementation are recommended. Immunosuppression should be limited to patients with nephrotic proteinuria. The most frequently used drugs are corticosteroids, calcineurin inhibitors, cyclophosphamide, mycophenolate, and rituximab, alone or combined. Early detection and treatment of renal flares is of paramount importance to prevent CKD progression.
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Affiliation(s)
- Claudio Ponticelli
- Nephrology, IRCCS Ospedale Maggiore Policlinico (retired), Milan, Italy,*Claudio Ponticelli, Via Ampere 126, IT–20131 Milan (Italy),
| | - Gabriella Moroni
- Nephrology Unit Fondazione IRCCS Ca' Granda Ospedale Maggiore Milano, Milan, Italy
| | - Alessia Fornoni
- Katz Family Division of Nephrology and Hypertension and Peggy and Harold Katz Family Drug Discovery Center, University of Miami, Miami, Florida, USA
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Correa-Rodríguez M, Pocovi-Gerardino G, Callejas-Rubio JL, Ríos-Fernández R, Martín-Amada M, Cruz-Caparrós MG, DelOlmo-Romero S, Ortego-Centeno N, Rueda-Medina B. Vitamin D Levels are Associated with Disease Activity and Damage Accrual in Systemic Lupus Erythematosus Patients. Biol Res Nurs 2020; 23:455-463. [PMID: 33380211 DOI: 10.1177/1099800420983596] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Vitamin D has immunosuppressive properties and is considered a therapeutic option, although there is controversy about the role of this vitamin in the pathogenesis of systemic lupus erythematosus (SLE). We aimed to determine the prevalence of vitamin D insufficiency and deficiency and their potential association with disease activity, damage accrual, SLE-related clinical manifestations, and cardiovascular risk factors in SLE patients. A cross-sectional study of 264 patients was conducted (89.4% females; mean age 46.7 ± 12.9 years). The SLE Disease Activity Index (SLEDAI-2 K) and the SDI Damage Index were used to assess disease activity and disease-related damage, respectively. The mean 25(OH)D value was 25.1 ± 13.0 ng/ml. Eleven patients (4.2%) had 25(OH)D <10 (deficiency) and 178 patients (70.6%) had 25(OH)D <30 (insufficiency). In the 25(OH)D deficiency group, SLEDAI was significantly higher than the insufficiency (p = 0.001) and normal groups (p < 0.001). Also, patients with vitamin D deficiency presented significantly higher SDI scores than patients with 25(OH)D insufficiency (p = 0.033) and 25(OH)D normal levels (p = 0.029). There is a high prevalence of both vitamin D deficiency and insufficiency in Caucasian SLE patients and this status was associated with higher SLEDAI and SDI scores, supporting the impact of vitamin D levels on disease activity and damage accrual in SLE patients. Longitudinal studies on the relationship between vitamin D status and disease activity and progression are therefore required.
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Affiliation(s)
- María Correa-Rodríguez
- Instituto de Investigación Biosanitaria, IBS, Granada, Spain.,Department of Nursing, Health Sciences Faculty, 16741University of Granada (UGR), Spain
| | - Gabriela Pocovi-Gerardino
- Instituto de Investigación Biosanitaria, IBS, Granada, Spain.,Department of Nursing, Health Sciences Faculty, 16741University of Granada (UGR), Spain
| | - José-Luis Callejas-Rubio
- Instituto de Investigación Biosanitaria, IBS, Granada, Spain.,Unidad de Enfermedades Autoinmunes Sistémicas, Servicio de Medicina Interna, 16581Hospital Universitario San Cecilio, Granada, Spain
| | - Raquel Ríos-Fernández
- Instituto de Investigación Biosanitaria, IBS, Granada, Spain.,Unidad de Enfermedades Autoinmunes Sistémicas, Servicio de Medicina Interna, 16581Hospital Universitario San Cecilio, Granada, Spain
| | - María Martín-Amada
- Unidad de Enfermedades Autoinmunes Sistémicas, Servicio de Medicina Interna, Complejo Hospitalario de Jaén, Spain
| | - María-Gracia Cruz-Caparrós
- Unidad de Enfermedades Autoinmunes Sistémicas, Servicio de Medicina Interna, 16579Hospital de Poniente, Carretera de Almerimar, Almería, Spain
| | - Sara DelOlmo-Romero
- Department of Nursing, Health Sciences Faculty, 16741University of Granada (UGR), Spain
| | - Norberto Ortego-Centeno
- Instituto de Investigación Biosanitaria, IBS, Granada, Spain.,Unidad de Enfermedades Autoinmunes Sistémicas, Servicio de Medicina Interna, 16581Hospital Universitario San Cecilio, Granada, Spain
| | - Blanca Rueda-Medina
- Instituto de Investigación Biosanitaria, IBS, Granada, Spain.,Department of Nursing, Health Sciences Faculty, 16741University of Granada (UGR), Spain
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15
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Khairallah MK, Makarem YS, Dahpy MA. Vitamin D in active systemic lupus erythematosus and lupus nephritis: a forgotten player. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2020. [DOI: 10.1186/s43162-020-00016-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Systemic lupus erythematosus (SLE) is an autoimmune disorder associated with immunological abnormalities (Aringer et al., Arthritis Rheumatol 71:1400-1412, 2019). Vitamin D (VD) has an important role in SLE pathogenesis, as it controls cell cycle progression besides its anti-proliferative effects (Liu et al., J Cell Commun Signal 71, 2019). Determining the relationship between VD with SLE activity and lupus nephritis (LN) can establish a new role for VD in SLE management (Liu et al., J Cell Commun Signal 71, 2019). In our study, we aimed to assess the relationship between levels of VD in patients with SLE activity and with LN and to verify the relationship between VD levels with clinical and laboratory parameters in those patients, in order to assess the validity of adding serum VD level in the routine follow-up as a marker that may lead to earlier diagnosis of SLE activity and LN in adult SLE patients.
Results
Serum VD was significantly lower in SLE patients (3.38 ± 2.55 ng/ml) versus healthy controls (5.36 ± 2.88 ng/ml) (P < 0.002). Interestingly, serum VD was significantly lower in patient with active SLE according to SLEDAI (3.00 ± 2.27 ng/ml) versus those with inactive SLE (5.10 ± 3.19 ng/ml) (P < 0.02). Significant negative correlation was found between serum level of VD and each of mucocutaneous, malar rash, and renal manifestations. Significant negative correlation was also noticed among SLEDAI (P value = 0.01) and renal SLEDAI scores (P value = 0.021) with serum level of VD.
Conclusion
Low levels of VD were found to be frequent in SLE patients especially during phases of SLE activity and nephritis. Potent markers of low serum VD level in SLE patients were found to be mucocutaneous, malar rash, and LN. Our results support that VD levels could act as independent risk factors for activity and LN in SLE patients; moreover, treatment with VD supplementation could decrease the incidence of activity and nephritis in SLE patients.
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16
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Cardona-Cardona AF, Cerón y Cerón JA. Vitamin D in Colombian patients with systemic lupus erythematosus and its correlation with disease activity. Lupus 2020; 29:1297-1304. [DOI: 10.1177/0961203320937783] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Introduction Patients with systemic lupus erythematosus (SLE) frequently present low levels of vitamin D. However, studies that have evaluated its association with disease activity have generated contradictory results. Methods A cross-sectional study was carried out on patients diagnosed with SLE in two hospitals in Manizales, Colombia. Disease activity was evaluated by the SLE disease activity index 2000 (SLEDAI-2K) and serum concentration of 25-hydroxyvitamin D (25(OH)D) was measured by chemiluminescence. The correlation analysis was accomplished with the Spearman correlation coefficient. Results The study included 51 patients. The median SLEDAI-2K score was 8 points. The mean serum level of 25(OH)D was 24.5 ng/ml. Of the participants, 37.3% had vitamin D insufficiency and 35.3% had deficiency. An inverse correlation was found between the levels of the 25(OH)D and the SLEDAI-2K score ( r = –0.578, p < 0.001), being greater in late-onset lupus, with absence of polyautoimmunity and in patients using glucocorticoids. Conclusions Low levels of vitamin D are frequent in SLE, presenting an inverse correlation with the disease activity. This is influenced by the use of glucocorticoids, the presence of late-onset lupus and the absence of polyautoimmunity.
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17
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Berardi S, Giardullo L, Corrado A, Cantatore FP. Vitamin D and connective tissue diseases. Inflamm Res 2020; 69:453-462. [PMID: 32172354 DOI: 10.1007/s00011-020-01337-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 03/04/2020] [Accepted: 03/09/2020] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE AND DESIGN Recently, many studies have shown that the biologically active form of vitamin D-1,25(OH)2 D-is involved in many biological processes, including immune system modulation, and patients affected by various autoimmune diseases, such as connective tissue diseases (CTD), showed low levels of vitamin D. It is not clear if vitamin D deficiency is involved in the pathogenesis of autoimmune diseases or it is a consequence. MATERIAL We carried out a review of literature to summarize the existing connections between 25-OH vitamin D and CTD. METHODS We searched for articles on PubMed by keywords: vitamin D, connective tissue diseases, systemic lupus erythematosus, Sjogren's syndrome, systemic sclerosis, undifferentiated connective tissue disease. RESULTS The relationship between vitamin D and CTD is still not very clear, despite many studies having been performed and some data suggest a connection between these diseases and 25-OH vitamin D levels. CONCLUSIONS The limitations of the study, such as the heterogeneity of patients, methods used to measure vitamin D serum concentration and other biases, do not lead to unequivocal results to demonstrate a direct link between low vitamin D serum levels and autoimmune diseases. Further studies are needed to resolve conflicting results.
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Affiliation(s)
- Stefano Berardi
- Department of Medical and Surgical Sciences, Rheumatology Clinic, Ospedali Riuniti Foggia, University of Foggia, Viale Pinto 1, 71121, Foggia, Italy.
| | - Liberato Giardullo
- Department of Medical and Surgical Sciences, Rheumatology Clinic, Ospedali Riuniti Foggia, University of Foggia, Viale Pinto 1, 71121, Foggia, Italy
| | - Addolorata Corrado
- Department of Medical and Surgical Sciences, Rheumatology Clinic, Ospedali Riuniti Foggia, University of Foggia, Viale Pinto 1, 71121, Foggia, Italy
| | - Francesco Paolo Cantatore
- Department of Medical and Surgical Sciences, Rheumatology Clinic, Ospedali Riuniti Foggia, University of Foggia, Viale Pinto 1, 71121, Foggia, Italy
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18
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Carbone T, Pafundi V, Bizzaro N, Infantino M, Padula MC, Padula AA, D'Angelo S. Assessing vitamin D levels in an anti-DFS70 positive population: New insights emerging. Autoimmunity 2020; 53:231-236. [PMID: 32164458 DOI: 10.1080/08916934.2020.1736048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: Anti-dense fine speckled 70 (DFS70) autoantibodies have more often been described in apparently healthy individuals than in patients with systemic autoimmune rheumatic diseases (SARD). The aim of this study was to explore the link between anti-DFS70 autoantibodies and vitamin D (25(OH)D) levels in an Italian adult cohort.Methods: Serum samples from 34 (five males and 29 females) anti-DFS70 positive patients (index cases), 34 ANA-negative healthy controls, 34 ANA-positive anti-DFS70 negative SLE patients, both groups age- and gender-matched with the index cases, 23 ANA-positive anti-DFS70 negative healthy blood donors and six female SARD patients showing mixed DFS positive pattern were collected and tested for 25(OH)D levels. Relevant demographics and lifestyle practices, body mass index (BMI), comorbidities, and use of medication were recorded for patients and healthy controls.Results: Mean serum levels of 25(OH)D were significantly higher in anti-DFS70 positive subjects (mean ± SD: 22.1 ± 9.8 ng/ml) than in ANA-negative healthy controls (mean ± SD: 17.3 ± 6.7 ng/ml; p = .03), ANA-positive healthy controls (mean ± SD: 15.2 ± 6.8 ng/ml; p = .01), SLE patients (16.6 ± 11.0 ng/ml; p = .01) and in patients with SARD (15.0 ± 5.6 ng/ml; p = .01). No statistically relevant differences in BMI, clinical, or demographic parameters were found.Conclusions: Our findings showed higher levels of vitamin D in anti-DFS70 positive subjects than in the controls, which is compatible with the hypothesis of the "benign" nature of anti-DFS70 antibodies.
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Affiliation(s)
- Teresa Carbone
- IReL - Rheumatology Institute of Lucania, San Carlo Hospital, Potenza, Italy.,Immunopathology Laboratory, San Carlo Hospital, Potenza, Italy
| | - Vito Pafundi
- Immunopathology Laboratory, San Carlo Hospital, Potenza, Italy
| | - Nicola Bizzaro
- Laboratory of Clinical Pathology, San Antonio Hospital, Tolmezzo, Italy
| | - Maria Infantino
- Laboratory of Immunology-Allergology, San Giovanni di Dio Hospital, Firenze, Italy
| | | | - Angela Anna Padula
- IReL - Rheumatology Institute of Lucania, San Carlo Hospital, Potenza, Italy
| | - Salvatore D'Angelo
- IReL - Rheumatology Institute of Lucania, San Carlo Hospital, Potenza, Italy
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Teng X, Brown J, Choi SC, Li W, Morel L. Metabolic determinants of lupus pathogenesis. Immunol Rev 2020; 295:167-186. [PMID: 32162304 DOI: 10.1111/imr.12847] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 02/20/2020] [Accepted: 02/24/2020] [Indexed: 12/12/2022]
Abstract
The metabolism of healthy murine and more recently human immune cells has been investigated with an increasing amount of details. These studies have revealed the challenges presented by immune cells to respond rapidly to a wide variety of triggers by adjusting the amount, type, and utilization of the nutrients they import. A concept has emerged that cellular metabolic programs regulate the size of the immune response and the plasticity of its effector functions. This has generated a lot of enthusiasm with the prediction that cellular metabolism could be manipulated to either enhance or limit an immune response. In support of this hypothesis, studies in animal models as well as human subjects have shown that the dysregulation of the immune system in autoimmune diseases is associated with a skewing of the immunometabolic programs. These studies have been mostly conducted on autoimmune CD4+ T cells, with the metabolism of other immune cells in autoimmune settings still being understudied. Here we discuss systemic metabolism as well as cellular immunometabolism as novel tools to decipher fundamental mechanisms of autoimmunity. We review the contribution of each major metabolic pathway to autoimmune diseases, with a focus on systemic lupus erythematosus (SLE), with the relevant translational opportunities, existing or predicted from results obtained with healthy immune cells. Finally, we review how targeting metabolic programs may present novel therapeutic venues.
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Affiliation(s)
- Xiangyu Teng
- Department of Pathology, Immunology, and Laboratory Medicine, University of Florida, Gainesville, FL, USA
| | - Josephine Brown
- Department of Pathology, Immunology, and Laboratory Medicine, University of Florida, Gainesville, FL, USA
| | - Seung-Chul Choi
- Department of Pathology, Immunology, and Laboratory Medicine, University of Florida, Gainesville, FL, USA
| | - Wei Li
- Department of Pathology, Immunology, and Laboratory Medicine, University of Florida, Gainesville, FL, USA
| | - Laurence Morel
- Department of Pathology, Immunology, and Laboratory Medicine, University of Florida, Gainesville, FL, USA
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Sapkota S, Baig S, Hess T, O'Connell AM, Menk J, Shyne M, Fazeli P, Ensrud K, Shmagel A. Vitamin D and bisphosphonate therapy in systemic lupus erythematosus patients who receive glucocorticoids: are we offering the best care? Lupus 2020; 29:263-272. [PMID: 31996109 DOI: 10.1177/0961203320903086] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE This study aimed to evaluate management practices for glucocorticoid (GC)-induced osteoporosis (GIOP) in systemic lupus erythematosus (SLE) patients using 2017 American College of Rheumatology guidelines as a gold standard. METHODS We conducted a retrospective cohort study using a clinical database from the years 2011 to 2016. SLE cases with >90 days continuous prednisone use at doses of ≥7.51 mg daily were identified. Osteoporosis risk factors were assessed via chart review. The Fracture Risk Assessment (FRAX) score was estimated for patients > 40 years of age. Vitamin D, bisphosphonate prescriptions, and osteoporotic (OP) fractures were ascertained through chart review. A classification tree was used to identify the key patient-related predictors of bisphosphonate prescription. RESULTS A total of 203 SLE patients met the inclusion criteria. The recommended dose of vitamin D supplement was prescribed to 58.9% of patients < 40 years of age and 61.5% of patients ≥ 40 years of age. Among patients aged ≥ 40 years, 25% were prescribed bisphosphonates compared to 36% who met indications for bisphosphonates per the ACR guidelines. Another 10% were prescribed a bisphosphonate, despite not having indication per the ACR guidelines, which was considered as overtreatment. Among patients aged ≥ 40 years, older age and a higher FRAX score for major OP fracture and hip fracture predicted bisphosphonate prescription. In a classification tree analysis, patients with FRAX scores (for major OP fracture) of ≥ 23.5% predicted bisphosphonate prescription in this SLE population. Among patients who had OP fractures in the follow-up period, nine (6.50%) were inpatients receiving appropriate GIOP care versus 12 (13.6%) who were inpatients not receiving ACR-appropriate care (p = 0.098). CONCLUSIONS In clinical practice, fewer SLE patients with or at risk for GIOP are prescribed vitamin D and bisphosphonates than recommended by the 2017 ACR guidelines. Also, in this study, another 10% were prescribed a bisphosphonate, despite not having an indication per the ACR guidelines. Patients were most likely to receive a bisphosphonate prescription if they had a major OP FRAX score of > 23.5%.
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Affiliation(s)
- S Sapkota
- Department of Medicine, University of Minnesota, Minneapolis, USA.,Division of General Internal Medicine, University of Minnesota, Minneapolis, USA
| | - S Baig
- Department of Medicine, University of Minnesota, Minneapolis, USA
| | - T Hess
- University of Minnesota Medical School, University of Minnesota, Minneapolis, USA
| | | | - J Menk
- Biostatistical Design and Analysis Center, Clinical and Translational Science Institute, University of Minnesota, Minneapolis, USA
| | - M Shyne
- Biostatistical Design and Analysis Center, Clinical and Translational Science Institute, University of Minnesota, Minneapolis, USA
| | - P Fazeli
- Department of Medicine, University of Minnesota, Minneapolis, USA.,Division of Rheumatic and Autoimmune Diseases, University of Minnesota, Minneapolis, USA
| | - K Ensrud
- Department of Medicine and Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, USA.,Center for Care Delivery and Outcome Research, Minneapolis VA Health Care System, Minneapolis, USA
| | - A Shmagel
- Department of Medicine, University of Minnesota, Minneapolis, USA.,Division of Rheumatic and Autoimmune Diseases, University of Minnesota, Minneapolis, USA
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21
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Cyprian F, Lefkou E, Varoudi K, Girardi G. Immunomodulatory Effects of Vitamin D in Pregnancy and Beyond. Front Immunol 2019; 10:2739. [PMID: 31824513 PMCID: PMC6883724 DOI: 10.3389/fimmu.2019.02739] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 11/08/2019] [Indexed: 12/19/2022] Open
Abstract
In addition to its role in calcium homeostasis and bone formation, a modulatory role of the active form of vitamin D on cells of the immune system, particularly T lymphocytes, has been described. The effects of vitamin D on the production and action of several cytokines has been intensively investigated in recent years. In this connection, deficiency of vitamin D has been associated with several autoimmune diseases, including rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), antiphospholipid syndrome (APS), Hashimoto Thyroiditis (HT), and multiple sclerosis (MS). In a successful pregnancy, the maternal immune response needs to adapt to accommodate the semiallogeneic fetus. Disturbances in maternal tolerance are implicated in infertility and pregnancy complications such as miscarriages (RM) and preeclampsia (PE). It is well-known that a subset of T lymphocytes, regulatory T cells (Tregs) exhibit potent suppressive activity, and have a crucial role in curtailing the destructive response of the immune system during pregnancy, and preventing autoimmune diseases. Interestingly, vitamin D deficiency is common in pregnant women, despite the widespread use of prenatal vitamins, and adverse pregnancy outcomes such as RM, PE, intrauterine growth restriction have been linked to hypovitaminosis D during pregnancy. Research has shown that autoimmune diseases have a significant prevalence within the female population, and women with autoimmune disorders are at higher risk for adverse pregnancy outcomes. Provocatively, dysregulation of T cells plays a crucial role in the pathogenesis of autoimmunity, and adverse pregnancy outcomes where these pathologies are also associated with vitamin D deficiency. This article reviews the immunomodulatory role of vitamin D in autoimmune diseases and pregnancy. In particular, we will describe the role of vitamin D from conception until delivery, including the health of the offspring. This review highlights an observational study where hypovitaminosis D was correlated with decreased fertility, increased disease activity, placental insufficiency, and preeclampsia in women with APS.
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Affiliation(s)
- Farhan Cyprian
- Department of Basic Medical Sciences, College of Medicine, Member of QU Health, Qatar University, Doha, Qatar
| | - Eleftheria Lefkou
- Institute of Obstetric Hematology, Perigenesis, Thessaloniki, Greece
| | - Katerina Varoudi
- Institute of Obstetric Hematology, Perigenesis, Thessaloniki, Greece
| | - Guillermina Girardi
- Department of Basic Medical Sciences, College of Medicine, Member of QU Health, Qatar University, Doha, Qatar
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22
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Ospina-Caicedo AI, Cardona-Rincón AD, Bello-Gualtero JM, Valle-Oñate R, Romero-Sánchez C, Chalem-Choueka P, Vásquez-D G. Lower Levels of Vitamin D Associated with Disease Activity in Colombian Patients with Systemic Lupus Erythematosus. Curr Rheumatol Rev 2019; 15:146-153. [PMID: 30324882 DOI: 10.2174/1573397114666181015161547] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 10/02/2018] [Accepted: 10/07/2018] [Indexed: 01/26/2023]
Abstract
BACKGROUND Systemic Lupus Erythematosus (SLE) involves genetic, environmental, and hormonal alterations, including Vitamin D deficiency. OBJECTIVE To evaluate the association between vitamin D levels with anti-dsDNA, complement proteins, immunoglobulins levels and disease activity scores. METHODS A cross-sectional study was performed. The levels of 25-OH vitamin D were measured in patients older than 18 years with SLE according to ACR/97 [American College of Rheumatology 1997] from 2013 to 2015. The association was assessed by Mann-Whitney U and Kruskal Wallis tests for continuous variables, and by the Chi or Fisher exact test for the nominal variables. RESULTS Sixty-nine patients were included; 82% were women; the mean age was 38.5 years; 36.2% had low levels of vitamin D with higher consumption [p=0.006] of C4 and C3 complement proteins, plus higher levels of anti-dsDNA. Lower values of vitamin D were observed in patients with moderate to severe activity [p=0.0001] by SLEDAI [Systemic Lupus Erythematosus Activity Index] and general domain [p=0.039] and renal domain [p=0.009] by BILAG [British Isles Lupus Assessment Group] 2004. The mean vitamin D levels were higher in the group not receiving steroids when compared to those groups with dosages of 0.5-1mg/kg/d [p=0.048]. CONCLUSION Lower levels of vitamin D are associated with greater complement protein consumption and higher disease activity rates. Therefore, it is important to evaluate vitamin D supplementation in patients with SLE as part of the treatment, especially when it includes the use of steroids.
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Affiliation(s)
- Ana Isabel Ospina-Caicedo
- Fellow of Rheumatology Program, Clinical Immunology Group School of Medicine, Universidad Militar Nueva Granada, 3rd Transversal # 49-00, Hospital Militar Central, Bogota, Colombia
| | - Alex Darío Cardona-Rincón
- Fellow of Rheumatology Program, Clinical Immunology Group School of Medicine, Universidad Militar Nueva Granada, 3rd Transversal # 49-00, Hospital Militar Central, Bogota, Colombia
| | - Juan Manuel Bello-Gualtero
- Rheumatology and Immunology Department Hospital Militar Central, Clinical Immunology Group School of Medicine, Universidad Militar Nueva Granada 3rd Transversal # 49-00, Hospital Militar Central, Bogota, Colombia
| | - Rafael Valle-Oñate
- Rheumatology and Immunology Department Hospital Militar Central, Clinical Immunology Group School of Medicine, Universidad Militar Nueva Granada 3rd Transversal # 49-00, Hospital Militar Central, Bogota, Colombia
| | - Consuelo Romero-Sánchez
- Rheumatology and Immunology Department Hospital Militar Central, Clinical Immunology Group School of Medicine, Universidad Militar Nueva Granada 3rd Transversal # 49-00, Hospital Militar Central, Bogota, Colombia
| | | | - Vásquez-D G
- Cell Immunology and Immunogenetics Group. School of Medicine Universidad de Antioquia, 67 Street # 53-108, Medellin, Colombia
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23
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Freedman BR, Mooney DJ. Biomaterials to Mimic and Heal Connective Tissues. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2019; 31:e1806695. [PMID: 30908806 PMCID: PMC6504615 DOI: 10.1002/adma.201806695] [Citation(s) in RCA: 107] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 01/27/2019] [Indexed: 05/11/2023]
Abstract
Connective tissue is one of the four major types of animal tissue and plays essential roles throughout the human body. Genetic factors, aging, and trauma all contribute to connective tissue dysfunction and motivate the need for strategies to promote healing and regeneration. The goal here is to link a fundamental understanding of connective tissues and their multiscale properties to better inform the design and translation of novel biomaterials to promote their regeneration. Major clinical problems in adipose tissue, cartilage, dermis, and tendon are discussed that inspire the need to replace native connective tissue with biomaterials. Then, multiscale structure-function relationships in native soft connective tissues that may be used to guide material design are detailed. Several biomaterials strategies to improve healing of these tissues that incorporate biologics and are biologic-free are reviewed. Finally, important guidance documents and standards (ASTM, FDA, and EMA) that are important to consider for translating new biomaterials into clinical practice are highligted.
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Affiliation(s)
- Benjamin R Freedman
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, 02138, USA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, 02115, USA
| | - David J Mooney
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, 02138, USA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, 02115, USA
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24
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Abstract
Systemic lupus erythematosus (SLE) is an autoimmune rheumatic disease with a prevalence of approximately 1 in 1000. Over the last 30 years, advances in treatment such as use of corticosteroids and immunosuppressants have improved life expectancy and quality of life for patients with lupus and the key unmet needs have therefore changed. With the reduced mortality from disease activity, development of cardiovascular disease (CVD) has become an increasingly important cause of death in patients with SLE. The increased CVD risk in these patients is partly, but not fully explained by standard risk factors, and abnormalities in the immune response to lipids may play a role. Invariant natural killer T cells, which are triggered specifically by lipid antigens, may protect against progression of subclinical atherosclerosis. However, currently our recommendation is that clinicians should focus on optimal management of standard CVD risk factors such as smoking, blood pressure and lipid levels. Fatigue is one of the most common and most limiting symptoms suffered by patients with SLE. The cause of fatigue is multifactorial and disease activity does not explain this symptom. Consequently, therapies directed towards reducing inflammation and disease activity do not reliably reduce fatigue and new approaches are needed. Currently, we recommend asking about sleep pattern, optimising pain relief and excluding other causes of fatigue such as anaemia and metabolic disturbances. For the subgroup of patients whose disease activity is not fully controlled by standard treatment regimes, a range of different biologic agents have been proposed and subjected to clinical trials. Many of these trials have given disappointing results, though belimumab, which targets B lymphocytes, did meet its primary endpoint. New biologics targeting B cells, T cells or cytokines (especially interferon) are still going through trials raising the hope that novel therapies for patients with refractory SLE may be available soon.
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25
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Mousa A, Naderpoor N, Wilson K, Plebanski M, de Courten MPJ, Scragg R, de Courten B. Vitamin D supplementation increases adipokine concentrations in overweight or obese adults. Eur J Nutr 2019; 59:195-204. [PMID: 30649593 DOI: 10.1007/s00394-019-01899-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 01/08/2019] [Indexed: 01/26/2023]
Abstract
PURPOSE Vitamin D regulates adipokine production in vitro; however, clinical trials have been inconclusive. We conducted secondary analyses of a randomized controlled trial to examine whether vitamin D supplementation improves adipokine concentrations in overweight/obese and vitamin D-deficient adults. METHODS Sixty-five individuals with a BMI ≥ 25 kg/m2 and 25-hydroxyvitamin D (25(OH)D) ≤ 50 nmol/L were randomized to oral cholecalciferol (100,000 IU single bolus followed by 4,000 IU daily) or matching placebo for 16 weeks. We measured BMI, waist-to-hip ratio, % body fat (dual X-ray absorptiometry), serum 25(OH)D (chemiluminescent immunoassay) and total adiponectin, leptin, resistin, and adipsin concentrations (multiplex assay; flow cytometry). Sun exposure, physical activity, and diet were assessed using questionnaires. RESULTS Fifty-four participants completed the study (35M/19F; mean age = 31.9 ± 8.5 years; BMI = 30.9 ± 4.4 kg/m2). After 16 weeks, vitamin D supplementation increased 25(OH)D concentrations compared with placebo (57.0 ± 21.3 versus 1.9 ± 15.1 nmol/L, p < 0.001). There were no differences between groups for changes in adiponectin, leptin, resistin, or adipsin in unadjusted analyses (all p > 0.05). After adjustment for baseline values, season, sun exposure, and dietary vitamin D intake, there was a greater increase in adiponectin (β[95%CI] = 13.7[2.0, 25.5], p = 0.02) and leptin (β[95%CI] = 22.3[3.8, 40.9], p = 0.02) in the vitamin D group compared with placebo. Results remained significant after additional adjustment for age, sex, and % body fat (p < 0.02). CONCLUSIONS Vitamin D may increase adiponectin and leptin concentrations in overweight/obese and vitamin D-deficient adults. Further studies are needed to clarify the molecular interactions between vitamin D and adipokines and the clinical implications of these interactions in the context of obesity. CLINICAL TRIAL REGISTRATION clinicaltrials.gov: NCT02112721.
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Affiliation(s)
- Aya Mousa
- Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, Level 1, 43-51 Kanooka Grove, Clayton, Melbourne, VIC, 3168, Australia
| | - Negar Naderpoor
- Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, Level 1, 43-51 Kanooka Grove, Clayton, Melbourne, VIC, 3168, Australia
| | - Kirsty Wilson
- Department of Immunology and Pathology, Monash University, 89 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Magdalena Plebanski
- Department of Immunology and Pathology, Monash University, 89 Commercial Road, Melbourne, VIC, 3004, Australia
- School of Health and Biomedical Sciences, RMIT University, 124 La Trobe St, Melbourne, VIC, 3000, Australia
| | - Maximilian P J de Courten
- Centre for Chronic Disease, Victoria University, 176 Furlong Road, St Albans, Melbourne, VIC, 3021, Australia
| | - Robert Scragg
- School of Population Health, University of Auckland, 261 Morrin Road, Glen Innes, Auckland, 1072, New Zealand
| | - Barbora de Courten
- Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, Level 1, 43-51 Kanooka Grove, Clayton, Melbourne, VIC, 3168, Australia.
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26
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Nerviani A, Mauro D, Gilio M, Grembiale RD, Lewis MJ. To Supplement or not to Supplement? The Rationale of Vitamin D Supplementation in Systemic Lupus Erythematosus. Open Rheumatol J 2018. [DOI: 10.2174/1874312901812010226] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background:
Systemic Lupus Erythematosus (SLE) is a systemic autoimmune disease characterised by abnormal activation of the immune system, chronic inflammation and organ damage. Lupus patients are more prone to be vitamin D deficient. However, current evidence is not conclusive with regards to the role played by vitamin D in SLE development, progression, and clinical manifestations.
Objective:
Here, we will summarise the current knowledge about vitamin D deficiency prevalence, risk factors, molecular effects, and potential pathogenic role in SLE. We will focus on the link between vitamin D deficiency and lupus clinical manifestations, and on the clinical trials assessing the effects of vitamin D supplementation in SLE.
Method:
A detailed literature search was performed exploiting the available databases, using “vitamin D and lupus/SLE” as keywords. The relevant interventional trials published over the last decade have been considered and the results are reported here.
Conclusion:
Several immune cells express vitamin D receptors. Thus, an immunomodulatory role for vitamin D in lupus is plausible. Numerous observational studies have investigated the relationship between vitamin D levels and clinical/serological manifestations of SLE with contrasting results. Negative correlations between vitamin D levels and disease activity, fatigue, renal and cardiovascular disease, and anti-dsDNA titres have been described but not conclusively accepted. In experimental models of lupus, vitamin D supplementation can improve the disease. Interventional trials have assessed the potential therapeutic value of vitamin D in SLE, but further larger studies are needed.
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27
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Sarkissian A, Sivaraman V, Bout-Tabaku S, Ardoin SP, Moore-Clingenpeel M, Mruk V, Steigelman H, Morris K, Bowden SA. Bone turnover markers in relation to vitamin D status and disease activity in adults with systemic lupus erythematosus. Lupus 2018; 28:156-162. [PMID: 30509154 DOI: 10.1177/0961203318815593] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Patients with systemic lupus erythematosus (SLE) have altered bone metabolism and are at risk of osteoporosis. The aim of this study was to examine bone turnover markers in relation to vitamin D, disease activity, and clinical risk factors in patients with established SLE. METHODS Clinical registry and biorepository data of 42 SLE patients were assessed. Serum samples were analyzed for osteocalcin as a marker of bone formation, C-terminal telopeptide of type 1 collagen (CTX) as a marker for bone resorption, and 25-hydroxy vitamin D. RESULTS Patients with a Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI) score of 3 or greater had a lower median osteocalcin level ( P = 0.02) and lower 25-hydroxy vitamin D levels ( P = 0.03) than those with a score of less than 3. No significant differences in bone turnover markers were observed between patients dichotomized into subgroups using a 25-hydroxy vitamin D cut-off of 30 ng/mL or by a daily prednisone dose greater than or 5 mg or less. Osteocalcin levels were negatively correlated with SLEDAI scores ( P = 0.034), and were positively correlated with the CTX index (a ratio of measured CTX value to the upper limit of the normal value for age and gender) ( P < 0.01). No association between the CTX index and SLEDAI scores was found. CONCLUSION SLE disease activity may have direct effects on bone formation, but no effects on bone resorption in this cohort of established SLE patients, probably related to the inflammation-suppressing effects of glucocorticoids, thereby inhibiting cytokine-induced osteoclast activity. A fine balance exists between disease control and the use of glucocorticoids with regard to bone health.
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Affiliation(s)
- A Sarkissian
- 1 Pediatric Rheumatology, Nationwide Children's Hospital and The Ohio State University Medical Center, Columbus, USA
| | - V Sivaraman
- 1 Pediatric Rheumatology, Nationwide Children's Hospital and The Ohio State University Medical Center, Columbus, USA
| | - S Bout-Tabaku
- 2 Pediatric Rheumatology, Sidra Medicine, Doha, Qatar
| | - S P Ardoin
- 1 Pediatric Rheumatology, Nationwide Children's Hospital and The Ohio State University Medical Center, Columbus, USA
| | | | - V Mruk
- 1 Pediatric Rheumatology, Nationwide Children's Hospital and The Ohio State University Medical Center, Columbus, USA
| | - H Steigelman
- 4 Rheumatology and Immunology, The Ohio State University Wexner Medical Center, Columbus, USA
| | - K Morris
- 4 Rheumatology and Immunology, The Ohio State University Wexner Medical Center, Columbus, USA
| | - S A Bowden
- 5 Pediatric Endocrinology, Nationwide Children's Hospital and The Ohio State University Medical Center, Columbus, USA
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28
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The utility of complement assays in clinical immunology: A comprehensive review. J Autoimmun 2018; 95:191-200. [PMID: 30391025 DOI: 10.1016/j.jaut.2018.10.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 10/17/2018] [Indexed: 12/19/2022]
Abstract
The multi-tasking organ liver, which is the major synthesis site of most serum proteins, supplies humoral components of the innate, - including proteins of the complement system; and, less intensely, also of the acquired immune system. In addition to hepatocyte origins, C1q, factor D, C3, C7 and other protein components of the complement system are produced at various body locations by monocytes/macrophages, lymphocytes, adipocytes, endometrium, enterocytes, keratinocytes and epithelial cells; but the contribution of these alternate sites to the total serum concentrations is slight. The two major exceptions are factor D, which cleaves factor B of the alternative pathway derived largely from adipocytes, and C7, derived largely from polymorphonuclear leukocytes and monocytes/macrophages. Whereas the functional meaning of the extrahepatic synthesis of factor D remains to be elucidated, the local contribution of C7 may up- or downregulate the complement attack. The liver, however, is not classified as part of the immune system but is rather seen as victim of autoimmune diseases, a point that needs apology. Recent histological and cell marker technologies now turn the hands to also conceive the liver as proactive autoimmune disease catalyst. Hosting non-hepatocytic cells, e.g. NK cells, macrophages, dendritic cells as well as T and B lymphocytes, the liver outreaches multiple sites of the immune system. Immunopharmacological follow up of liver transplant recipients teaches us on liver-based presence of ABH-glycan HLA phenotypes and complement mediated ischemia/regeneration processes. In clinical context, the adverse reactions of the complement system can now be curbed by specific drug therapy. This review extends on the involvement of the complement system in liver autoimmune diseases and should allow to direct therapeutic opportunities.
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29
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Nguyen MH, Bryant K, O'Neill SG. Vitamin D in SLE: a role in pathogenesis and fatigue? A review of the literature. Lupus 2018; 27:2003-2011. [DOI: 10.1177/0961203318796293] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Fatigue is a common, disabling problem that is highly prevalent in patients with systemic lupus erythematous (SLE). More recently, vitamin D status has been established as a potential contributor to SLE pathogenesis and manifestations, in particular fatigue. This review summarizes the literature regarding the role of vitamin D in SLE, and provides an overview of the recent literature examining the association between vitamin D and fatigue in patients with SLE. Finally, the role of vitamin D supplementation in the treatment of SLE-related fatigue is considered.
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Affiliation(s)
- MH Nguyen
- Rheumatology Department, Liverpool Hospital, Australia
- SWS Clinical School, University of New South Wales, and the Ingham Institute for Applied Medical Research, Australia
| | - K Bryant
- SWS Clinical School, University of New South Wales, and the Ingham Institute for Applied Medical Research, Australia
| | - SG O'Neill
- Rheumatology Department, Liverpool Hospital, Australia
- SWS Clinical School, University of New South Wales, and the Ingham Institute for Applied Medical Research, Australia
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30
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Shaygannejad V, Maljaei MB, Bank SS, Mirmosayyeb O, Maracy MR, Askari G. Association between Sun Exposure, Vitamin D Intake, Serum Vitamin D Level, and Immunoglobulin G Level in Patients with Neuromyelitis Optica Spectrum Disorder. Int J Prev Med 2018; 9:68. [PMID: 30167098 PMCID: PMC6106131 DOI: 10.4103/ijpvm.ijpvm_45_16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 04/05/2017] [Indexed: 11/10/2022] Open
Abstract
Background: Neuromyelitis optica spectrum disorder (NMOSD) is a central nervous system inflammatory disorder in which immunoglobulin G (IgG) autoantibodies possibly play a pathogenic role against the aquaporin-4 water channel protein. Vitamin D may modulate B-cell function and decrease the IgG synthesis and may play a role in NMOSD as a crucial factor. The aim of this study was to investigate the relation between Vitamin D intakes from food, Vitamin D intake from sunlight exposure, blood Vitamin D levels, and IgG-neuromyelitis optica (NMO) level in serum of patients with NMOSD and NMO. Method: In this cross-sectional study, food Frequency Questionnaires (FFQ) and Sun Exposure Questionnaire (SEQ) were completed to evaluate of vitamin D intakes from food and sun light exposure. Moreover, serum levels of 25(OH) vitamin D3 and IgG-NMO were assessed in patients with NMOSD and NMO. Results: We assessed IgG-NMO levels in 29 patients with NMOSD that nine patients (n = 31%) were positive and for the rest it was negative. Sunlight exposure scale (P = 0.01) and 25(OH) D3 (P = 0.04) in IgG-NMO-negative patients were significantly more than patients with positive IgG-NMO. Age, gender, and latitude were not confounder variables. A positive significant correlation was observed between the sun exposure scale and serum levels of 25(OH) D3 in all participants (r = 0.747, P ≤ 0.001). Conclusions: Physiological variation in Vitamin D may apply a significant effect on IgG-NMO synthesis in patients with NMO. Vitamin D may have significant role in pathogenesis of NMOSD and NMO.
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Affiliation(s)
- Vahid Shaygannejad
- Isfahan Neuroscience Research Center, Department of Neurology, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Bagher Maljaei
- Isfahan Neuroscience Research Center, Department of Neurology, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.,Food Security Research Center and Department of Community Nutrition, School of Nutrition and Food Sciences, Isfahan University of Medical Sciences, Isfahan, Iran.,Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Sahar Saraf Bank
- Food Security Research Center and Department of Community Nutrition, School of Nutrition and Food Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Omid Mirmosayyeb
- Isfahan Neuroscience Research Center, Department of Neurology, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.,Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Reza Maracy
- Department of Epidemiology and Biostatics, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Gholamreza Askari
- Food Security Research Center and Department of Community Nutrition, School of Nutrition and Food Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
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31
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Mak A. The Impact of Vitamin D on the Immunopathophysiology, Disease Activity, and Extra-Musculoskeletal Manifestations of Systemic Lupus Erythematosus. Int J Mol Sci 2018; 19:ijms19082355. [PMID: 30103428 PMCID: PMC6121378 DOI: 10.3390/ijms19082355] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 08/01/2018] [Accepted: 08/08/2018] [Indexed: 12/11/2022] Open
Abstract
Over the past two decades it has been increasingly recognized that vitamin D, aside from its crucial involvement in calcium and phosphate homeostasis and the dynamics of the musculoskeletal system, exerts its influential impact on the immune system. The mechanistic roles that vitamin D plays regarding immune activation for combating infection, as well as pathologically and mediating autoimmune conditions, have been progressively unraveled. In vitro and in vivo models have demonstrated that the action of vitamin D on various immunocytes is not unidirectional. Rather, how vitamin D affects immunocyte functions depends on the context of the immune response, in the way that its suppressive or stimulatory action offers physiologically appropriate and immunologically advantageous outcomes. In this review, the relationship between various aspects of vitamin D, starting from its adequacy in circulation to its immunological functions, as well as its autoimmune conditions, in particular systemic lupus erythematosus (SLE), a prototype autoimmune condition characterized by immune-complex mediated inflammation, will be discussed. Concurring with other groups of investigators, our group found that vitamin D deficiency is highly prevalent in patients with SLE. Furthermore, the circulating vitamin D levels appear to be correlated with a higher disease activity of SLE as well as extra-musculoskeletal complications of SLE such as fatigue, cardiovascular risk, and cognitive impairment.
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Affiliation(s)
- Anselm Mak
- Department of Medicine, National University of Singapore, Singapore 119228, Singapore.
- Division of Rheumatology, University Medicine Cluster, National University Health System, Singapore 119228, Singapore.
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Mok CC, Bro ET, Ho LY, Singh RJ, Jannetto PJ. Serum 25-hydroxyvitamin D3 levels and flares of systemic lupus erythematosus: a longitudinal cohort analysis. Clin Rheumatol 2018; 37:2685-2692. [PMID: 30014357 DOI: 10.1007/s10067-018-4204-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 06/29/2018] [Accepted: 07/09/2018] [Indexed: 12/31/2022]
Abstract
The aim of this study is to evaluate the relationship between baseline serum 25-hydroxyvitamin D3 levels and SLE activity/flares over time. This is a longitudinal study of 276 patients who fulfilled ≥ 4 ACR criteria for SLE and recruited in the year 2011. Serum samples were collected at baseline and assayed for 25-hydroxyvitamin D3 at the end of a mean follow-up of 32.5 months. Participants were stratified into three groups according to baseline 25-hydroxyvitamin D3 levels: group I (< 15 ng/ml, deficiency), group II (15-30 ng/ml, insufficiency), and group III (> 30 ng/ml, adequate). Baseline and summated SLE disease activity index (SLEDAI) score over time and the annual incidence of lupus flares were compared among these groups. 25-hydroxyvitamin D3 levels of < 15, 15-30, and > 30 ng/ml were present in 26, 54, and 20% of the recruited patients, respectively. Group I had significantly higher baseline SLEDAI scores. After a follow-up of 32.5 ± 5.5 months, 153 mild/moderate and 91 severe flares developed. The mean summated SLEDAI was 3.2 ± 2.0 in group I, 2.4 ± 1.9 in group II and 2.7 ± 2.1 in group III patients (P = 0.02). The annual incidence of mild/moderate and severe flares was 0.26 ± 0.39 and 0.20 ± 0.45 (group I); 0.20 ± 0.33 and 0.09 ± 0.22 (group II); and 0.20 ± 0.32 and 0.14 ± 0.46 (group III), respectively (P > 0.05). In a subgroup of 73 patients who were clinically and serologically quiescent at baseline, a similar trend of more flares was observed in group I patients. Vitamin D deficiency was frequent in Chinese SLE patients and was associated with more active disease at baseline and over time, as well as a trend of more severe lupus flares.
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Affiliation(s)
- Chi Chiu Mok
- Department of Medicine, Tuen Mun Hospital, New Territories, Hong Kong, China.
| | - Eric T Bro
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Ling Yin Ho
- Department of Medicine, Tuen Mun Hospital, New Territories, Hong Kong, China
| | - Ravinder J Singh
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Paul J Jannetto
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
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Abstract
Vitamin D plays a key role in skeletal and cardiovascular disorders, cancers, central nervous system diseases, reproductive diseases, infections, and autoimmune and dermatological disorders. The two main sources of vitamin D are sun exposure and oral intake, including vitamin D supplementation and dietary intake. Multiple factors are linked to vitamin D status, such as Fitzpatrick skin type, sex, body mass index, physical activity, alcohol intake, and vitamin D receptor polymorphisms. Patients with photosensitive disorders tend to avoid sun exposure, and this practice, along with photoprotection, can put this category of patients at risk for vitamin D deficiency. Maintaining a vitamin D serum concentration within normal levels is warranted in atopic dermatitis, psoriasis, vitiligo, polymorphous light eruption, mycosis fungoides, alopecia areata, systemic lupus erythematosus, and melanoma patients. The potential determinants of vitamin D status, as well as the benefits and risks of vitamin D (with a special focus on the skin), will be discussed in this article.
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Kang SY, Kang JH, Choi JC, Song SK, Oh JH. Low serum vitamin D levels in patients with myasthenia gravis. J Clin Neurosci 2018; 50:294-297. [DOI: 10.1016/j.jocn.2018.01.047] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 01/08/2018] [Indexed: 12/14/2022]
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Giannini S, Mazzaferro S, Minisola S, De Nicola L, Rossini M, Cozzolino M. Raising awareness on the therapeutic role of cholecalciferol in CKD: a multidisciplinary-based opinion. Endocrine 2018; 59:242-259. [PMID: 28726185 PMCID: PMC5846860 DOI: 10.1007/s12020-017-1369-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 06/27/2017] [Indexed: 12/19/2022]
Abstract
Vitamin D is recognized to play an essential role in health and disease. In kidney disease, vitamin D analogs have gained recognition for their involvement and potential therapeutic importance. Nephrologists are aware of the use of oral native vitamin D supplementation, however, uncertainty still exists with regard to the use of this treatment option in chronic kidney disease as well as clinical settings related to chronic kidney disease, where vitamin D supplementation may be an appropriate therapeutic choice. Two consecutive meetings were held in Florence in July and November 2016 comprising six experts in kidney disease (N = 3) and bone mineral metabolism (N = 3) to discuss a range of unresolved issues related to the use of cholecalciferol in chronic kidney disease. The panel focused on the following six key areas where issues relating to the use of oral vitamin D remain controversial: (1) vitamin D and parathyroid hormone levels in the general population, (2) cholecalciferol in chronic kidney disease, (3) vitamin D in cardiovascular disease, (4) vitamin D and renal bone disease, (5) vitamin D in rheumatological diseases affecting the kidney, (6) vitamin D and kidney transplantation.
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Affiliation(s)
- Sandro Giannini
- Department of Medicine, Clinica Medica 1, University of Padova, Padova, Italy
| | - Sandro Mazzaferro
- Department of Cardiovascular Respiratory Nephrologic Anesthetic and Geriatric Sciences, Sapienza University of Rome, Rome, Italy
| | - Salvatore Minisola
- Department of Internal Medicine and Medical Disciplines, Sapienza University of Rome, Rome, Italy
| | - Luca De Nicola
- Division of Nephrology, Second University of Naples, Naples, Italy
| | - Maurizio Rossini
- Department of Medicine, Rheumatology Unit, University of Verona, Verona, Italy
| | - Mario Cozzolino
- Department of Health Sciences, Renal Division and Laboratory of Experimental Nephrology, San Paolo Hospital, University of Milan, Milan, Italy.
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Stagi S, Rigante D. Vitamin D and juvenile systemic lupus erythematosus: Lights, shadows and still unresolved issues. Autoimmun Rev 2018; 17:290-300. [PMID: 29353100 DOI: 10.1016/j.autrev.2018.01.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 11/13/2017] [Indexed: 02/07/2023]
Abstract
Systemic lupus erythematosus (SLE) and juvenile SLE (jSLE) are autoimmune disorders naturally associated with several genetic, environmental, hormonal, and immunological contributing factors. It has been assumed that vitamin D deficiency may have a role in the immune activation of patients with SLE and play an active part in many comorbidities and even complications. A host of clinical studies suggested that vitamin D exerts inhibitory effects on many immunological abnormalities associated with SLE, also in children and adolescents, while different reports have hypothesized that vitamin D may be associated with accelerated cardiovascular disease in SLE. This review updates and summarizes the information related to the immunoregulatory effects of vitamin D and its importance in jSLE, discusses the innumerable correlations between vitamin D and disease activity, including clinical expression and gene polymorphisms of vitamin D receptor as well as the recommendations for vitamin D supplementation in these patients. Despite the excitement raised by many data obtained about vitamin D and its influence on several aspects of the disease, further well-designed perspective trials are required to define the exact role that vitamin D may have in the management of both SLE and jSLE.
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Affiliation(s)
- Stefano Stagi
- Health Science Department, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy.
| | - Donato Rigante
- Institute of Pediatrics, Fondazione Policlinico Universitario "A. Gemelli", Università Cattolica Sacro Cuore, Rome, Italy
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Role of vitamin D deficiency in systemic lupus erythematosus incidence and aggravation. AUTOIMMUNITY HIGHLIGHTS 2017; 9:1. [PMID: 29280010 PMCID: PMC5743852 DOI: 10.1007/s13317-017-0101-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 12/01/2017] [Indexed: 12/31/2022]
Abstract
Vitamin D is one of the main groups of sterols; playing an important role in phospho-calcic metabolism. The conversion of 7-dehydrocholesterol to pre- vitamin D3 in the skin, through solar ultraviolet B radiation, is the main source of vitamin D. Since lupus patients are usually photosensitive, the risk of developing vitamin D deficiency in is high in this population. Although evidences showed the connotation between systemic lupus erythematosus (SLE) and vitamin D through which SLE can lead to lower vitamin D levels, it is also important to consider the possibility that vitamin D deficiency may have a causative role in SLE etiology. This paper analyzes existing data from various studies to highlight the role of vitamin D deficiency in SLE occurrence and aggravation and the probable efficacy of vitamin D supplementation on SLE patients. We searched “Science Direct” and “Pub Med” using “Vitamin D” and “SLE” for finding the studies focusing on the association between vitamin D deficiency and SLE incidence and consequences. Evidences show that vitamin D plays an important role in the pathogenesis and progression of SLE and vitamin D supplementation seems to ameliorate inflammatory and hemostatic markers; so, can improve clinical subsequent.
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Kokic V, Martinovic Kaliterna D, Radic M, Tandara L, Perkovic D. Association between vitamin D, oestradiol and interferon-gamma in female patients with inactive systemic lupus erythematosus: A cross-sectional study. J Int Med Res 2017; 46:1162-1171. [PMID: 29235391 PMCID: PMC5972245 DOI: 10.1177/0300060517734686] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Objectives To investigate possible associations between 25-hydroxyvitamin D3 (25(OH)D3), oestradiol (E2) and IFN-gamma (IFNγ) in female patients with inactive systemic lupus erythematosus (SLE). Methods Female patients with inactive SLE and age-matched healthy controls were recruited into this cross-sectional study. Serum concentrations of 25(OH)D3, E2 and IFNγ were measured by radioimmunoassay with gamma-counters and enzyme-linked immunosorbent assay. Results 36 patients and 37 controls were enrolled. In patients with SLE, the concentration of 25(OH)D3 was lower and E2 was higher compared with controls. In vitamin D deficient (i.e., 25(OH)D3≤20 ng/ml) patients, IFNγ was 150% higher compared with patients with 25(OH)D3>20 ng/ml and controls. The concentration of E2 was higher in all patients compared with controls independently of the vitamin D level. A difference was found between patients and controls in the correlation of 25(OH)D3 with E2 and a positive correlation was found between E2 and IFNγ in all participants. Conclusions Our results suggest that E2 may have a strong modulating effect on vitamin D function which is significant only at low concentration of E2.
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Affiliation(s)
- Visnja Kokic
- 1 Division of Endocrinology, Diabetes and Metabolic Disease, University Hospital of Split, School of Medicine, Split, Croatia
| | | | - Mislav Radic
- 2 Division of Rheumatology and Clinical Immunology, University Hospital of Split, Split, Croatia
| | - Leida Tandara
- 3 Department of Medical Laboratory Diagnostic, University Hospital of Split, Split, Croatia
| | - Dijana Perkovic
- 2 Division of Rheumatology and Clinical Immunology, University Hospital of Split, Split, Croatia
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Vanherwegen AS, Gysemans C, Mathieu C. Regulation of Immune Function by Vitamin D and Its Use in Diseases of Immunity. Endocrinol Metab Clin North Am 2017; 46:1061-1094. [PMID: 29080635 DOI: 10.1016/j.ecl.2017.07.010] [Citation(s) in RCA: 118] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Evidence exists for a role for vitamin D and its active metabolites in modulating immune functions. In animal models, vitamin D deficiency is associated with a higher risk for autoimmunity in genetically predisposed subjects and increases in susceptibility to infections. In addition, high-dose vitamin D can improve immune health, prevent autoimmunity, and improve defense against infections. In humans, evidence exists on associations between vitamin D deficiency and impaired immune function, leading to autoimmunity in genetically predisposed people and increased risk for infections; data on therapeutic immune effects of vitamin D supplementation when vitamin D levels are already sufficient are lacking.
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Affiliation(s)
- An-Sofie Vanherwegen
- Laboratory of Clinical and Experimental Endocrinology (CEE), KU Leuven, O&N1 Herestraat 49 - bus 902, Leuven 3000, Belgium
| | - Conny Gysemans
- Laboratory of Clinical and Experimental Endocrinology (CEE), KU Leuven, O&N1 Herestraat 49 - bus 902, Leuven 3000, Belgium.
| | - Chantal Mathieu
- Laboratory of Clinical and Experimental Endocrinology (CEE), KU Leuven, O&N1 Herestraat 49 - bus 902, Leuven 3000, Belgium
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40
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Salman-Monte TC, Torrente-Segarra V, Vega-Vidal AL, Corzo P, Castro-Dominguez F, Ojeda F, Carbonell-Abelló J. Bone mineral density and vitamin D status in systemic lupus erythematosus (SLE): A systematic review. Autoimmun Rev 2017; 16:1155-1159. [DOI: 10.1016/j.autrev.2017.09.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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41
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Clinical significance of vitamin D deficiency and receptor gene polymorphism in systemic lupus erythematosus patients. EGYPTIAN RHEUMATOLOGIST 2017. [DOI: 10.1016/j.ejr.2016.11.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Choi MY, Barber MRW, Barber CEH, Clarke AE, Fritzler MJ. Preventing the development of SLE: identifying risk factors and proposing pathways for clinical care. Lupus 2017; 25:838-49. [PMID: 27252260 DOI: 10.1177/0961203316640367] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Although challenging, developing evidence-based approaches to an early and accurate diagnosis of systemic lupus erythematosus is a key approach to preventing disease and lupus-associated morbidity and mortality. Advances in our understanding of preclinical and incomplete lupus erythematosus have enabled the identification of risk factors that may predict disease and the development of potential strategies aimed at primary prevention. Emerging data support the notion that there is a temporal disease progression from initial asymptomatic autoimmunity (preclinical lupus) through early clinical features of the disease (incomplete lupus erythematosus) to finally becoming fully classifiable systemic lupus erythematosus (complete lupus erythematosus). Here, we review the demographic, clinical, biomarker as well as genetic and environmental features that are reported to increase the risk of disease progression. Based on these risk factors, we propose a clinical care pathway for patients with early disease. We envisage that such a pathway, through early identification of disease, may improve patient outcomes, while reducing health care costs.
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Affiliation(s)
- M Y Choi
- University of Calgary, Cumming School of Medicine, Calgary, Canada
| | - M R W Barber
- University of Calgary, Cumming School of Medicine, Calgary, Canada
| | - C E H Barber
- University of Calgary, Cumming School of Medicine, Calgary, Canada
| | - A E Clarke
- University of Calgary, Cumming School of Medicine, Calgary, Canada
| | - M J Fritzler
- University of Calgary, Cumming School of Medicine, Calgary, Canada
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Vitamin D deficiency as a risk factor for the development of autoantibodies in patients with ASIA and silicone breast implants: a cohort study and review of the literature. Clin Rheumatol 2017; 36:981-993. [PMID: 28303359 PMCID: PMC5400796 DOI: 10.1007/s10067-017-3589-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 02/14/2017] [Accepted: 02/21/2017] [Indexed: 01/04/2023]
Abstract
The development of autoimmunity and/or autoimmune diseases is multifactorial. Vitamin D is one of the factors that might play a role. We postulated that both the presence of adjuvants and insufficient levels of vitamin D may result in the development of autoimmunity in patients with autoimmune/inflammatory syndrome induced by adjuvants (ASIA) in relation to silicone implant incompatibility. We measured vitamin D levels in 135 patients with ASIA in relation to silicone implant incompatibility and related findings to the presence of autoantibodies that are commonly used to diagnose systemic autoimmune diseases. Furthermore, we systematically reviewed the literature regarding vitamin D deficiency as a risk factor for the development of autoantibodies. Vitamin D measurements were available for analysis in 131 of 135 patients with ASIA in relation to SIIS. Twenty-three patients (18%) tested positive for autoantibodies, from which 18 patients (78%) had either a vitamin D deficiency or insufficiency (median vitamin D level 60.5 mmol/L), whereas five patients (22%) had sufficient vitamin D levels. The risk to develop autoantibodies was significantly increased in vitamin D deficient and/or insufficient patients [RR 3.14; 95% CI, 1.24–7.95; p = 0.009]. Reviewed literature suggested an association between vitamin D levels and the presence and/or titer levels of autoantibodies in different autoimmune diseases. From our current study and from our review of the literature, we conclude that vitamin D deficiency is related to the presence of autoantibodies. Whether vitamin D supplementation results in a decrease of autoimmunity needs to be studied prospectively.
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Serum 25-Hydroxyvitamin D3 and BAFF Levels Are Associated with Disease Activity in Primary Sjogren's Syndrome. J Immunol Res 2016; 2016:5781070. [PMID: 28074193 PMCID: PMC5198174 DOI: 10.1155/2016/5781070] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Accepted: 11/09/2016] [Indexed: 02/07/2023] Open
Abstract
The study investigated the association between disease activity and serum 25-hydroxyvitamin D3 (25(OH)-D3), B cell activation of the tumor necrosis factor family (BAFF), or β2 microglobulin in patients with primary Sjogren's syndrome (SS). Sixty-nine primary SS patients and 22 sicca control patients were included in the study. Disease activity was measured with EULAR Sjogren's syndrome disease activity index (ESSDAI). Serum levels of 25(OH)-D3 and β2 microglobulin were measured by radioimmunoassay and BAFF was measured by an enzyme-linked immunosorbent assay. Serum levels of 25(OH)-D3 were significantly lower in SS patients compared to the sicca controls (p = 0.036). Serum levels of BAFF tended to be higher (p = 0.225) and those of β2 microglobulin were significantly higher in patients with SS than in sicca controls (p = 0.023). In univariate regression analyses, ESSDAI was significantly associated with serum levels of 25(OH)-D3, BAFF, and β2 microglobulin. After stepwise backward multivariate linear regression analyses including age and acute phase reactants, ESSDAI was associated with 25(OH)-D3 (β = −0.042, p = 0.015) and BAFF (β = 0.001, p = 0.015) in SS patients. In SS patients, ESSDAI is negatively associated with serum levels of 25(OH)-D3 and positively associated with BAFF.
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Shahin D, El-Farahaty RM, Houssen ME, Machaly SA, Sallam M, ElSaid TO, Neseem NO. Serum 25-OH vitamin D level in treatment-naïve systemic lupus erythematosus patients: Relation to disease activity, IL-23 and IL-17. Lupus 2016; 26:917-926. [PMID: 27927883 DOI: 10.1177/0961203316682095] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives The aim of this study was to assess the vitamin D status in treatment-naïve SLE patients and its association with clinical and laboratory markers of disease activity, including serum levels of IL-17 and IL-23. Methods Fifty-seven treatment-naïve SLE patients along with 42 matched controls were included. SLEDAI score was used to estimate disease activity. Serum levels of 25(OH) D, IL-17 and IL-23 were measured. Results The median level of 25(OH) D in SLE patients (40.8; 4-70 ng/ml) was significantly lower than in the controls (47; 25-93 ng/ml) ( P = 0.001). A total of 38.6% of SLE cases had 25 (OH) D levels < 30 ng/ml (hypovitaminosis D) vs. 4.8% of the controls ( P < 0.0001). Apart from thrombocytopenia, vitamin D was not associated with clinical signs of SLE. There were negative correlations between serum 25(OH) D and serum levels of IL-17, IL-23 and ANA (rho = -0.5, -0.8, -0.5, P ≤ 0.05) in SLE patients. Conclusion Hypovitaminosis D is prevalent in treatment naïve SLE patients. It contributes to ANA antibody production and is associated with high serum levels of IL-23 and IL-17; thus they may trigger the inflammatory process in SLE.
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Affiliation(s)
- D Shahin
- 1 Rheumatology & Immunology, Internal Medicine, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - R M El-Farahaty
- 2 Clinical Pathology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - M E Houssen
- 3 Biochemistry, Faculty of Pharmacy, Damanhour University, Damanhour, Egypt
| | - S A Machaly
- 4 Rheumatology & Rehabilitation, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - M Sallam
- 5 Andrology & STDs Departments, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - T O ElSaid
- 4 Rheumatology & Rehabilitation, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - N O Neseem
- 4 Rheumatology & Rehabilitation, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Abstract
Numerous risk alleles for systemic lupus erythematosus (SLE) have now been identified. Analysis of the expression of genes with risk alleles in cells of hematopoietic origin demonstrates them to be most abundantly expressed in B cells and dendritic cells (DCs), suggesting that these cell types may be the drivers of the inflammatory changes seen in SLE. DCs are of particular interest as they act to connect the innate and the adaptive immune response. Thus, DCs can transform inflammation into autoimmunity, and autoantibodies are the hallmark of SLE. In this review, we focus on mechanisms of tolerance that maintain DCs in a non‐activated, non‐immunogenic state. We demonstrate, using examples from our own studies, how alterations in DC function stemming from either DC‐intrinsic abnormalities or DC‐extrinsic regulators of function can predispose to autoimmunity.
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Affiliation(s)
- Myoungsun Son
- The Feinstein Institute for Medical Research, Center for Autoimmune and Musculoskeletal Diseases, Manhasset, NY, USA
| | - Sun Jung Kim
- The Feinstein Institute for Medical Research, Center for Autoimmune and Musculoskeletal Diseases, Manhasset, NY, USA
| | - Betty Diamond
- The Feinstein Institute for Medical Research, Center for Autoimmune and Musculoskeletal Diseases, Manhasset, NY, USA
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Bruzzese V, Zullo A, Picchianti Diamanti A, Ridola L, Lorenzetti R, Marrese C, Scolieri P, De Francesco V, Hassan C, Migliore A, Laganà B. Vitamin D deficiency in patients with either rheumatic diseases or inflammatory bowel diseases on biologic therapy. Intern Emerg Med 2016; 11:803-7. [PMID: 26939587 DOI: 10.1007/s11739-016-1415-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 02/13/2016] [Indexed: 12/14/2022]
Abstract
Vitamin D deficiency has been reported in patients with chronic inflammatory conditions, such as rheumatic and inflammatory bowel diseases (IBD). We evaluated the role of biologic therapy on vitamin D, calcium and parathormone (PTH) levels. This cross-sectional study enrolled consecutive patients with either rheumatic diseases or IBD who underwent an ambulatory visit. Patients receiving vitamin D/calcium supplementation were excluded. Vitamin D deficiency or insufficiency was diagnosed when values were <20 ng/mL and 21-29 ng/ml, respectively. Patients were sub-grouped according to biologic therapy. A multivariate analysis was performed. Two-hundred patients, including 136 with a rheumatic disease (M/F 37/99; mean age 60.7 ± 12.9 years) and 64 with IBD (M/F 41/23; Mean age 49.6 ± 13.1 years) were enrolled. Vitamin D deficiency/insufficiency was detected in as many as 63.5 % patients, being 61.8 and 67.2 % in patients with either rheumatic diseases or IBD, respectively. The prevalence of vitamin D deficiency/insufficiency was higher in those receiving biologics than other therapies (78.3 vs 43.2 %; p < 0.0001), in either rheumatic diseases (78.7 vs 41 %; p < 0.0001) or IBD (75 vs 50 %; p = 0.03) group. At multivariate analysis, only biologic therapy was independently associated with vitamin D deficit (OR 4.61; p = 0.001). Patients with vitamin D deficiency/insufficiency had hypocalcemia more frequently than controls (22.8 vs 10.9 %; p = 0.03), while PTH values did not differ significantly. This study finds that the prevalence of vitamin D deficiency/insufficiency was very high in patients with either rheumatic diseases or IBD receiving a biologic therapy.
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Affiliation(s)
- Vincenzo Bruzzese
- Medicina Interna, Reumatologia e Gastroenterologia, Ospedale Nuovo Regina Margherita, Via E. Morosini, 30, 00153, Rome, Italy
| | - Angelo Zullo
- Medicina Interna, Reumatologia e Gastroenterologia, Ospedale Nuovo Regina Margherita, Via E. Morosini, 30, 00153, Rome, Italy.
| | - Andrea Picchianti Diamanti
- Allergy, Clinical Immunology and Rheumatology, 'Sapienza'University of Rome, S. Andrea University Hospital, Rome, Italy
| | - Lorenzo Ridola
- Gastroenterology Unit, Sapienza University of Rome "Polo Pontino" Hospital, Latina, Italy
| | - Roberto Lorenzetti
- Medicina Interna, Reumatologia e Gastroenterologia, Ospedale Nuovo Regina Margherita, Via E. Morosini, 30, 00153, Rome, Italy
| | - Cinzia Marrese
- Medicina Interna, Reumatologia e Gastroenterologia, Ospedale Nuovo Regina Margherita, Via E. Morosini, 30, 00153, Rome, Italy
| | - Palma Scolieri
- Medicina Interna, Reumatologia e Gastroenterologia, Ospedale Nuovo Regina Margherita, Via E. Morosini, 30, 00153, Rome, Italy
| | | | - Cesare Hassan
- Medicina Interna, Reumatologia e Gastroenterologia, Ospedale Nuovo Regina Margherita, Via E. Morosini, 30, 00153, Rome, Italy
| | - Alberto Migliore
- Rheumatology Unit, San Pietro Fatebenefratelli Hospital, Rome, Italy
| | - Bruno Laganà
- Allergy, Clinical Immunology and Rheumatology, 'Sapienza'University of Rome, S. Andrea University Hospital, Rome, Italy
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Carter EE, Barr SG, Clarke AE. The global burden of SLE: prevalence, health disparities and socioeconomic impact. Nat Rev Rheumatol 2016; 12:605-20. [PMID: 27558659 DOI: 10.1038/nrrheum.2016.137] [Citation(s) in RCA: 262] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease that can potentially lead to serious organ complications and even death. Its global burden - in terms of incidence and prevalence, differential impact on populations, economic costs and capacity to compromise health-related quality of life - remains incompletely understood. The reported worldwide incidence and prevalence of SLE vary considerably; this variation is probably attributable to a variety of factors, including ethnic and geographic differences in the populations being studied, the definition of SLE applied, and the methods of case identification. Despite the heterogeneous nature of the disease, distinct patterns of disease presentation, severity and course can often be related to differences in ethnicity, income level, education, health insurance status, level of social support and medication compliance, as well as environmental and occupational factors. Given the potential for the disease to cause such severe and widespread organ damage, not only are the attendant direct costs high, but these costs are sometimes exceeded by indirect costs owing to loss of economic productivity. As an intangible cost, patients with SLE are, not surprisingly, likely to endure considerably reduced health-related quality of life.
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Affiliation(s)
- Erin E Carter
- University of Calgary, Richmond Road Diagnostic and Treatment Centre, 1820 Richmond Road S.W., Calgary, Alberta T2T 5C7, Canada
| | - Susan G Barr
- University of Calgary, Richmond Road Diagnostic and Treatment Centre, 1820 Richmond Road S.W., Calgary, Alberta T2T 5C7, Canada
| | - Ann E Clarke
- University of Calgary, Health Research Innovation Centre, 3280 Hospital Drive N.W., Calgary, Alberta T2N 4N1, Canada
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Young KA, Munroe ME, Guthridge JM, Kamen DL, Niewold TB, Gilkeson GS, Weisman MH, Ishimori ML, Kelly J, Gaffney PM, Sivils KH, Lu R, Wallace DJ, Karp DR, Harley JB, James JA, Norris JM. Combined role of vitamin D status and CYP24A1 in the transition to systemic lupus erythematosus. Ann Rheum Dis 2016; 76:153-158. [PMID: 27283331 DOI: 10.1136/annrheumdis-2016-209157] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 05/06/2016] [Accepted: 05/14/2016] [Indexed: 12/26/2022]
Abstract
OBJECTIVE We examined whether measures of vitamin D were associated with transitioning to systemic lupus erythematosus (SLE) in individuals at risk for SLE. METHODS 436 individuals who reported having a relative with SLE but who did not have SLE themselves were evaluated at baseline and again an average of 6.3 (±3.9) years later. Fifty-six individuals transitioned to SLE (≥4 cumulative American College of Rheumatology criteria). 25-Hydroxyvitamin D (25[OH]D) levels were measured by ELISA. Six single-nucleotide polymorphisms in four vitamin D genes were genotyped. Generalised estimating equations, adjusting for correlation within families, were used to test associations between the vitamin D variables and the outcome of transitioning to SLE. RESULTS Mean baseline 25[OH]D levels (p=0.42) and vitamin D supplementation (p=0.65) were not different between those who did and did not transition to SLE. Vitamin D deficiency (25[OH]D <20 ng/mL) was greater in those who transitioned compared with those who did not transition to SLE (46% vs 33%, p=0.05). The association between 25[OH]D and SLE was modified by CYP24A1 rs4809959, where for each additional minor allele increased 25[OH]D was associated with decreased SLE risk: zero minor alleles (adjusted OR: 1.03, CI 0.98 to 1.09), one minor allele (adjusted OR: 1.01, CI 0.97 to 1.05) and two minor alleles (adjusted OR: 0.91, CI 0.84 to 0.98). Similarly, vitamin D deficiency significantly increased the risk of transitioning to SLE in those with two minor alleles at rs4809959 (adjusted OR: 4.90, CI 1.33 to 18.04). CONCLUSIONS Vitamin D status and CYP24A1 may have a combined role in the transition to SLE in individuals at increased genetic risk for SLE.
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Affiliation(s)
| | - Melissa E Munroe
- Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
| | - Joel M Guthridge
- Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
| | - Diane L Kamen
- Medical University of South Carolina, Charleston, South Carolina, USA
| | | | - Gary S Gilkeson
- Medical University of South Carolina, Charleston, South Carolina, USA
| | | | | | - Jennifer Kelly
- Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
| | | | - Kathy H Sivils
- Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
| | - Rufei Lu
- Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA.,Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma, USA
| | | | - David R Karp
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - John B Harley
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,US Department of Veterans Affairs Medical Center, Cincinnati, Ohio, USA
| | - Judith A James
- Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA.,Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Jill M Norris
- Colorado School of Public Health, Aurora, Colorado, USA
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50
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Prevalence and predictors of vitamin D insufficiency in supplemented and non-supplemented women with systemic lupus erythematosus in the Mediterranean region. Rheumatol Int 2016; 36:975-85. [DOI: 10.1007/s00296-016-3497-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 05/12/2016] [Indexed: 11/25/2022]
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