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Rafiq R, Aleva FE, Schrumpf JA, Daniels JM, Bet PM, Boersma WG, Bresser P, Spanbroek M, Lips P, van den Broek TJ, Keijser BJF, van der Ven AJAM, Hiemstra PS, den Heijer M, de Jongh RT. Vitamin D supplementation in chronic obstructive pulmonary disease patients with low serum vitamin D: a randomized controlled trial. Am J Clin Nutr 2022; 116:491-499. [PMID: 35383823 PMCID: PMC9348978 DOI: 10.1093/ajcn/nqac083] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 03/30/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Vitamin D deficiency is frequently found in patients with chronic obstructive pulmonary disease (COPD). Vitamin D has antimicrobial, anti-inflammatory, and immunomodulatory effects. Therefore, supplementation may prevent COPD exacerbations, particularly in deficient patients. OBJECTIVES We aimed to assess the effect of vitamin D supplementation on exacerbation rate in vitamin D-deficient patients with COPD. METHODS We performed a multicenter, double-blind, randomized controlled trial. COPD patients with ≥1 exacerbations in the preceding year and a vitamin D deficiency (15-50 nmol/L) were randomly allocated in a 1:1 ratio to receive either 16,800 International Units (IU) vitamin D3 or placebo once a week during 1 y. Primary outcome of the study was exacerbation rate. Secondary outcomes included time to first and second exacerbations, time to first and second hospitalizations, use of antibiotics and corticosteroids, pulmonary function, maximal respiratory mouth pressure, physical performance, skeletal muscle strength, systemic inflammatory markers, nasal microbiota composition, and quality of life. RESULTS The intention-to-treat population consisted of 155 participants. Mean ± SD serum 25-hydroxyvitamin D [25(OH)D] concentration after 1 y was 112 ± 34 nmol/L in the vitamin D group, compared with 42 ± 17 nmol/L in the placebo group. Vitamin D supplementation did not affect exacerbation rate [incidence rate ratio (IRR): 0.90; 95% CI: 0.67, 1.21]. In a prespecified subgroup analysis in participants with 25(OH)D concentrations of 15-25 nmol/L (n = 31), no effect of vitamin D supplementation was found (IRR: 0.91; 95% CI: 0.43, 1.93). No relevant differences were found between the intervention and placebo groups in terms of secondary outcomes. CONCLUSIONS Vitamin D supplementation did not reduce exacerbation rate in COPD patients with a vitamin D deficiency.This trial was registered at clinicaltrials.gov as NCT02122627.
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Affiliation(s)
| | - Floor E Aleva
- Department of Pulmonology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Jasmijn A Schrumpf
- Department of Pulmonology, Leiden University Medical Center, Leiden, Netherlands
| | - Johannes M Daniels
- Department of Pulmonology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Pierre M Bet
- Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Wim G Boersma
- Department of Pulmonology, NorthWest Clinics, Alkmaar, Netherlands
| | - Paul Bresser
- Department of Pulmonology, Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands
| | - Michiel Spanbroek
- Department of Pulmonology, Canisius Wilhelmina Hospital, Nijmegen, Netherlands
| | - Paul Lips
- Department of Internal Medicine and Endocrinology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | | | | | | | - Pieter S Hiemstra
- Department of Pulmonology, Leiden University Medical Center, Leiden, Netherlands
| | - Martin den Heijer
- Department of Internal Medicine and Endocrinology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Renate T de Jongh
- Department of Internal Medicine and Endocrinology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - PRECOVID-study group
den HeijerMartinDepartment of Internal Medicine and Endocrinology, Amsterdam UMC Vrije Universiteit Amsterdam, Amsterdam, NetherlandsT de JonghRenateDepartment of Internal Medicine and Endocrinology, Amsterdam UMC Vrije Universiteit Amsterdam, Amsterdam, NetherlandsLipsPaulDepartment of Internal Medicine and Endocrinology, Amsterdam UMC Vrije Universiteit Amsterdam, Amsterdam, NetherlandsRafiqRachidaDepartment of Internal Medicine and Endocrinology, Amsterdam UMC Vrije Universiteit Amsterdam, Amsterdam, NetherlandsAlevaFloor EDepartment of Pulmonology, Radboud University Medical Center, Nijmegen, Netherlandsvan der VenAndréDepartment of Internal Medicine, Radboud University Medical Center, Nijmegen, NetherlandsHiemstraPieter SDepartment of Pulmonology, Leiden University Medical Center, Leiden, NetherlandsSchrumpfJasmijn ADepartment of Pulmonology, Leiden University Medical Center, Leiden, NetherlandsSlatsAnnelies MDepartment of Pulmonology, Leiden University Medical Center, Leiden, NetherlandsDaniëlsJohannes M ADepartment of Pulmonology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, NetherlandsBetPierre MDepartment of Clinical Pharmacology and Pharmacy, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, NetherlandsBoersmaWim GDepartment of Pulmonology, NorthWest Clinics, Alkmaar, NetherlandsBresserPaulDepartment of Pulmonology, Onze Lieve Vrouwe Gasthuis, Amsterdam, NetherlandsSpanbroekMichielDepartment of Pulmonology, Canisius Wilhelmina Hospital, Nijmegen, NetherlandsHuismanPetraDepartment of Pulmonology, Amstelland Hospital, Amstelveen, Netherlandsvan WolferenSerge ADepartment of Pulmonology, Zaans Medical Center, Zaandam, NetherlandsBroedersMarielle E A CDepartment of Pulmonology, Jeroen Bosch Hospital, Den Bosch, Netherlandsvan HengelPeterDepartment of Pulmonology, Flevoziekenhuis, Almere, NetherlandsBraunstahlGert-JanDepartment of Pulmonology, Sint Franciscus Gasthuis, Rotterdam, Netherlands
- Department of Internal Medicine and Endocrinology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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Khatchadourian C, Sisliyan C, Nguyen K, Poladian N, Tian Q, Tamjidi F, Luong B, Singh M, Robison J, Venketaraman V. Hyperlipidemia and Obesity's Role in Immune Dysregulation Underlying the Severity of COVID-19 Infection. Clin Pract 2021; 11:694-707. [PMID: 34698139 PMCID: PMC8544571 DOI: 10.3390/clinpract11040085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/17/2021] [Accepted: 09/17/2021] [Indexed: 12/23/2022] Open
Abstract
Obesity and hyperlipidemia are known to be risk factors for various pathological disorders, including various forms of infectious respiratory disease, including the current Coronavirus outbreak termed Coronavirus Disease 19 (COVID-19). This review studies the effects of hyperlipidemia and obesity on enhancing the inflammatory response seen in COVID-19 and potential therapeutic pathways related to these processes. In order to better understand the underlying processes of cytokine and chemokine-induced inflammation, we must further investigate the immunomodulatory effects of agents such as Vitamin D and the reduced form of glutathione as adjunctive therapies for COVID-19 disease.
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Affiliation(s)
- Christopher Khatchadourian
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA; (C.K.); (C.S.); (K.N.); (N.P.); (Q.T.); (F.T.); (B.L.)
| | - Christina Sisliyan
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA; (C.K.); (C.S.); (K.N.); (N.P.); (Q.T.); (F.T.); (B.L.)
| | - Kevin Nguyen
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA; (C.K.); (C.S.); (K.N.); (N.P.); (Q.T.); (F.T.); (B.L.)
| | - Nicole Poladian
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA; (C.K.); (C.S.); (K.N.); (N.P.); (Q.T.); (F.T.); (B.L.)
| | - Qi Tian
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA; (C.K.); (C.S.); (K.N.); (N.P.); (Q.T.); (F.T.); (B.L.)
| | - Faraaz Tamjidi
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA; (C.K.); (C.S.); (K.N.); (N.P.); (Q.T.); (F.T.); (B.L.)
| | - Bao Luong
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA; (C.K.); (C.S.); (K.N.); (N.P.); (Q.T.); (F.T.); (B.L.)
| | - Manpreet Singh
- Department of Emergency Medicine, St. Barnabas Hospital Health System, Bronx, NY 10457, USA; (M.S.); (J.R.)
| | - Jeremiah Robison
- Department of Emergency Medicine, St. Barnabas Hospital Health System, Bronx, NY 10457, USA; (M.S.); (J.R.)
| | - Vishwanath Venketaraman
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA; (C.K.); (C.S.); (K.N.); (N.P.); (Q.T.); (F.T.); (B.L.)
- Department of Basic Medical Sciences, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, 309 E Second Street, Pomona, CA 91766, USA
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3
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Vitamin D supplements: The pharmacists' perspective. J Am Pharm Assoc (2003) 2021; 61:e191-e201. [PMID: 33674204 DOI: 10.1016/j.japh.2021.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/04/2021] [Accepted: 02/04/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The purpose of this narrative review was to provide guidance for pharmacists concerning vitamin D supplementation. METHODS Relevant studies were identified in a search of MEDLINE/PubMed, EBSCOhost, and Google Scholar from January 1966 to September 2020 using the search terms vitamin D, vitamin D2, vitamin D3, calcitriol, and vitamin D deficiency. Abstracts were reviewed for relevance and, if relevant, full-text articles were retrieved and reviewed. References were checked, and citation searches using identified studies were conducted. The literature search included English-language studies involving administration of vitamin D monotherapy compared with placebo. RESULTS Serum 25-hydroxyvitamin D levels of less than 12 ng/mL indicate a vitamin D deficiency. The Institute of Medicine recommends a daily intake of 600 IU of vitamin D in individuals aged up to 70 years and 800 IU in those aged above 70 years. Vitamin D is labeled for rickets, osetomalacia, hypophosphatemia (familial or secondary), renal osteodystrophy, and corticosteroid-induced osteoporosis. When used for these indications, vitamin D should be prescribed with appropriate monitoring by a qualified health care practitioner. There is evidence for vitamin D supplementation in individuals aged 75 years or older and in those with problems associated with mobility, gait, or balance. There is insufficient evidence to support vitamin D supplementation in the prevention of cardiovascular disease, cancer, asthma, chronic obstructive pulmonary disease exacerbations, new-onset type 2 diabetes, infectious lung diseases, cognitive dysfunction, Alzheimer disease, and depression, or in prenatal use. CONCLUSION Pharmacists can provide evidence-based recommendations concerning the indications, dosing, monitoring, and adverse effects of vitamin D supplements.
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Saleem A, Sharif S, Jarvis S, Madouros N, Koumadoraki E, Khan S. A Comprehensive Review on Vitamin D as a Novel Therapeutic Agent in Chronic Obstructive Pulmonary Disease. Cureus 2021; 13:e13095. [PMID: 33728117 PMCID: PMC7935199 DOI: 10.7759/cureus.13095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Vitamin D has been playing an important role in the treatment of lung diseases. The non-calcemic effects of this vitamin and its role in chronic obstructive pulmonary disease (COPD) has drawn significant attention recently. Many studies have been conducted to explore the relationship between the two. We tested the hypothesis that vitamin D can act as an effective therapeutic agent for COPD by reviewing the correlation between the two and effectiveness along with the safety of supplemental vitamin D when used to treat chronic bronchitis and emphysema through clinical trials. An electronic search was conducted using combinations of keywords “vitamin D” and “COPD” from PubMed and Google scholar. Only relevant, human studies of all types were included from the last decade. A total of 36 articles were selected for review. Observational studies indicate a correlation between low serum 25(OH)D levels and obstructive lung disease pathology as well as clinical outcomes. Moreover, clinical trials were aimed to understand the impact of the use of vitamin D in improving disease indexes. These clinical trials used different drug regimes, mode of administration, and intervention duration with contrasting outcomes. Hypovitaminosis D is a common and harmful variant of this group of obstructive lung diseases, and correcting this deficiency can improve exacerbations, inflammation, lung functions, symptoms, and quality of life. These benefits are more prevalent in patients with low baseline serum 25 hydroxyvitamin D(25(OH)D) levels. Peroral is the most frequently used route of drug administration, however, further work is required to explore the pharmacological properties of vitamin D. There was not enough literature available about the safety of the drug of intervention.
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Affiliation(s)
- Amber Saleem
- Family Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Shayka Sharif
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Sommer Jarvis
- Anatomy/Cell Biology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Nikolaos Madouros
- Surgery, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Evgenia Koumadoraki
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Safeera Khan
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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Hiemstra PS, de Jongh RT. Vitamin D Deficiency in Asthma and Chronic Obstructive Pulmonary Disease. A Chicken-or-Egg Story. Am J Respir Crit Care Med 2020; 202:312-313. [PMID: 32352312 PMCID: PMC7397786 DOI: 10.1164/rccm.202004-1012ed] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Pieter S Hiemstra
- Department of PulmonologyLeiden University Medical CenterLeiden, the Netherlandsand
| | - Renate T de Jongh
- Department of Internal Medicine and EndocrinologyAmsterdam University Medical CenterAmsterdam, the Netherlands
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6
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Schrumpf JA, van der Does AM, Hiemstra PS. Impact of the Local Inflammatory Environment on Mucosal Vitamin D Metabolism and Signaling in Chronic Inflammatory Lung Diseases. Front Immunol 2020; 11:1433. [PMID: 32754156 PMCID: PMC7366846 DOI: 10.3389/fimmu.2020.01433] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 06/03/2020] [Indexed: 02/06/2023] Open
Abstract
Vitamin D plays an active role in the modulation of innate and adaptive immune responses as well as in the protection against respiratory pathogens. Evidence for this immunomodulatory and protective role is derived from observational studies showing an association between vitamin D deficiency, chronic airway diseases and respiratory infections, and is supported by a range of experimental studies using cell culture and animal models. Furthermore, recent intervention studies have now shown that vitamin D supplementation reduces exacerbation rates in vitamin D-deficient patients with chronic obstructive pulmonary disease (COPD) or asthma and decreases the incidence of acute respiratory tract infections. The active vitamin D metabolite, 1,25-dihydroxy-vitamin D (1,25(OH)2D), is known to contribute to the integrity of the mucosal barrier, promote killing of pathogens (via the induction of antimicrobial peptides), and to modulate inflammation and immune responses. These mechanisms may partly explain its protective role against infections and exacerbations in COPD and asthma patients. The respiratory mucosa is an important site of local 1,25(OH)2D synthesis, degradation and signaling, a process that can be affected by exposure to inflammatory mediators. As a consequence, mucosal inflammation and other disease-associated factors, as observed in e.g., COPD and asthma, may modulate the protective actions of 1,25(OH)2D. Here, we discuss the potential consequences of various disease-associated processes such as inflammation and exposure to pathogens and inhaled toxicants on vitamin D metabolism and local responses to 1,25(OH)2D in both immune- and epithelial cells. We furthermore discuss potential consequences of disturbed local levels of 25(OH)D and 1,25(OH)2D for chronic lung diseases. Additional insight into the relationship between disease-associated mechanisms and local effects of 1,25(OH)2D is expected to contribute to the design of future strategies aimed at improving local levels of 1,25(OH)2D and signaling in chronic inflammatory lung diseases.
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Affiliation(s)
- Jasmijn A Schrumpf
- Department of Pulmonology, Leiden University Medical Center, Leiden, Netherlands
| | - Anne M van der Does
- Department of Pulmonology, Leiden University Medical Center, Leiden, Netherlands
| | - Pieter S Hiemstra
- Department of Pulmonology, Leiden University Medical Center, Leiden, Netherlands
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7
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Mathyssen C, Aelbrecht C, Serré J, Everaerts S, Maes K, Gayan-Ramirez G, Vanaudenaerde B, Janssens W. Local expression profiles of vitamin D-related genes in airways of COPD patients. Respir Res 2020; 21:137. [PMID: 32493333 PMCID: PMC7268690 DOI: 10.1186/s12931-020-01405-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 05/24/2020] [Indexed: 12/30/2022] Open
Abstract
Treatment of Chronic Obstructive Pulmonary Disease (COPD) is based on bronchodilation, with inhaled corticosteroids or azithromycin associated when frequent exacerbations occur. Despite the proven benefits of current treatment regimens, the need for new interventions in delineated subgroups remains. There is convincing evidence for oral vitamin D supplementation in reducing exacerbations in COPD patients severely deficient for circulating vitamin D. However, little is known about local vitamin D metabolism in the airways and studies examining expression of the vitamin D receptor (VDR), the activating enzyme (CYP27B1) and inactivating enzyme (CYP24A1) of vitamin D in lung tissue of COPD patients are lacking. Therefore, the expression and localization of key enzymes and the receptor of the vitamin D pathway were examined in tissue of 10 unused donor lungs and 10 COPD explant lungs. No differences in the expression of CYP27B1 and CYP24A1 were found. Although protein expression of VDR was significantly lower in COPD explant tissue, there was no difference in downstream expression of the antimicrobial peptide cathelicidin. Whereas CYP27B1 and CYP24A1 were present in all layers of the bronchial epithelium, VDR was only expressed at the apical layer of a fully differentiated bronchial epithelium with no expression in vascular endothelial cells. By contrast, CYP24A1 expression was highly present in lung endothelial cells suggesting that systemic vitamin D can be inactivated before reaching the epithelial compartment and the tissue immune cells. These data support the idea of exploring the role of vitamin D inhalation in patients with COPD.
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Affiliation(s)
- Carolien Mathyssen
- Department CHROMETA, Laboratory of Respiratory diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Celine Aelbrecht
- Department CHROMETA, Laboratory of Respiratory diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Jef Serré
- Department CHROMETA, Laboratory of Respiratory diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Stephanie Everaerts
- Clinical department of Respiratory Diseases, UZ Leuven, Campus Gasthuisberg, ON I Herestraat 49 - bus, 706 3000, Leuven, Belgium
| | - Karen Maes
- Department CHROMETA, Laboratory of Respiratory diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Ghislaine Gayan-Ramirez
- Department CHROMETA, Laboratory of Respiratory diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Bart Vanaudenaerde
- Department CHROMETA, Laboratory of Respiratory diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Wim Janssens
- Department CHROMETA, Laboratory of Respiratory diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium. .,Clinical department of Respiratory Diseases, UZ Leuven, Campus Gasthuisberg, ON I Herestraat 49 - bus, 706 3000, Leuven, Belgium.
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Malliaraki N, Lakiotaki K, Vamvoukaki R, Notas G, Tsamardinos I, Kampa M, Castanas E. Translating vitamin D transcriptomics to clinical evidence: Analysis of data in asthma and chronic obstructive pulmonary disease, followed by clinical data meta-analysis. J Steroid Biochem Mol Biol 2020; 197:105505. [PMID: 31669573 DOI: 10.1016/j.jsbmb.2019.105505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 09/29/2019] [Accepted: 10/22/2019] [Indexed: 12/29/2022]
Abstract
Vitamin D (VitD) continues to trigger intense scientific controversy, regarding both its bi ological targets and its supplementation doses and regimens. In an effort to resolve this dispute, we mapped VitD transcriptome-wide events in humans, in order to unveil shared patterns or mechanisms with diverse pathologies/tissue profiles and reveal causal effects between VitD actions and specific human diseases, using a recently developed bioinformatics methodology. Using the similarities in analyzed transcriptome data (c-SKL method), we validated our methodology with osteoporosis as an example and further analyzed two other strong hits, specifically chronic obstructive pulmonary disease (COPD) and asthma. The latter revealed no impact of VitD on known molecular pathways. In accordance to this finding, review and meta-analysis of published data, based on an objective measure (Forced Expiratory Volume at one second, FEV1%) did not further reveal any significant effect of VitD on the objective amelioration of either condition. This study may, therefore, be regarded as the first one to explore, in an objective, unbiased and unsupervised manner, the impact of VitD levels and/or interventions in a number of human pathologies.
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Affiliation(s)
- Niki Malliaraki
- Laboratory of Experimental Endocrinology, University of Crete, School of Medicine, Heraklion, Greece; Laboratory of Clinical Chemistry/Biochemistry, University Hospital, Heraklion, Greece
| | - Kleanthi Lakiotaki
- Department of Computer Science, University of Crete, School of Sciences, Heraklion, Greece
| | - Rodanthi Vamvoukaki
- Laboratory of Experimental Endocrinology, University of Crete, School of Medicine, Heraklion, Greece
| | - George Notas
- Laboratory of Experimental Endocrinology, University of Crete, School of Medicine, Heraklion, Greece
| | - Ioannis Tsamardinos
- Department of Computer Science, University of Crete, School of Sciences, Heraklion, Greece; Gnosis Data Analysis PC, Heraklion, Greece
| | - Marilena Kampa
- Laboratory of Experimental Endocrinology, University of Crete, School of Medicine, Heraklion, Greece
| | - Elias Castanas
- Laboratory of Experimental Endocrinology, University of Crete, School of Medicine, Heraklion, Greece.
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Maes K, Serré J, Mathyssen C, Janssens W, Gayan-Ramirez G. Targeting Vitamin D Deficiency to Limit Exacerbations in Respiratory Diseases: Utopia or Strategy With Potential? Calcif Tissue Int 2020; 106:76-87. [PMID: 31350569 DOI: 10.1007/s00223-019-00591-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 07/18/2019] [Indexed: 12/16/2022]
Abstract
Patients with respiratory diseases such as cystic fibrosis, chronic obstructive pulmonary disease, or asthma often experience an acute worsening of respiratory symptoms, termed exacerbations. Although the course of exacerbations is disease specific, they are mostly triggered by a respiratory infection. Exacerbations often require hospitalization and are an important cause of mortality. Treatments of exacerbations aim to minimize the negative impact and to prevent subsequent events. Despite many existing therapy options, many patients do not benefit from therapy and suffer from recurrent events. Vitamin D deficiency is a worldwide problem and is extremely prevalent in these patients. Vitamin D, known for its calcemic effects, also has immunomodulatory and anti-infectious actions and can therefore be a possible agent to treat or prevent exacerbations. This review will focus on vitamin D as a potential candidate to treat or prevent exacerbations in CF, COPD, and asthma.
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Ilyas M, Agussalim A, Megawati M, Massi N, Djaharuddin I, Bakri S, As'ad S, Arief M, Bahar B, Seweng A, Prihantono P. Relationship between Vitamin D Level and Serum TNF-α Concentration on the Severity of Chronic Obstructive Pulmonary Disease. Open Access Maced J Med Sci 2019; 7:2298-2304. [PMID: 31592277 PMCID: PMC6765078 DOI: 10.3889/oamjms.2019.663] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 06/11/2019] [Accepted: 06/14/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND: Chronic Obstructive Pulmonary Disease (COPD) is a chronic inflammatory disease and disturbed bacterial clearance. Vitamin D deficiency is sometimes observed in COPD patients and as significant roles in increasing inflammation of airway obstruction and systemic obstruction, increasing pro-inflammatory cytokine including TNF-α, reduction of bacterial clearance and increase exacerbation risk due to infection. Also, vitamin D plays significant roles in the metabolism of calcium and mineralisation of bones and regulation system of immune. TNF-α also has essential roles in pathogenesis and inflammation of COPD. Several studies that investigate the relationship between vitamin D level and serum TNF-α concentration in COPD patients are relatively uncommon, including in Indonesia. AIM: This study aimed to assess the relationship between vitamin D level and TNF-α concentration in patients on the severity of the chronic obstructive pulmonary disease. METHODS: This study was a hospital-based descriptive cross-sectional study. Total samples were 50 COPD patients with the average age of older than 60 years during their enrollments at the Department of Pulmonology and Respiratory Medicine of the Dr Wahidin Sudirohusodo General Hospital Makassar in September 2018-January 2019. All procedures of the present study were reviewed and approved by the Research Ethics Committee of Medicine Faculty of Hasanuddin University. The severity of COPD was assessed according to the combination of COPD assessment stages that referred to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) Guideline 2015 that consisted of the combination of scoring COPD Assessment Test (CAT), the modified Medical Research Council (mMRC) questionnaire and results of the spirometry measurement. Assessment of airway obstruction levels referred to the GOLD spirometry criteria. Determination of thoracic photographs was conducted to verify the COPD diagnosis of the severity of COPD. Determination of serum TNF-α concentration and vitamin D3 [1,25(OH)2D3] level used the ELISA method. RESULTS: The majority of COPD patients were observed in the category of older than 60 years old accounted for 34 COPD patients (68%), and the majority of COPD patients were males accounted for 47 males with COPD (94%). The majority of COPD patients were observed in the group of D (38%). All the study subjects observed in this study were smokers, and 82% of them were in the category of heavy smokers. 21 study subjects had higher concentration of serum TNF-α (tertile 3 = 0.21-1.83 pg/dl), 20 study subjects and lower level of vitamin D (tertile 1 = 182.1-364.5 pg/dl). The majority of the study subjects (38%) were in the category of severe COPD (category D of the severity of COPD at the tertile 3) according to the GOLD Combine Assessment. Given the relationship between vitamin D level and serum TNF-α concentration on the airway obstruction, there were significant positive correlations between the increase of vitamin D levels and the increase of serum TNF-α concentrations on airway obstruction. Given the relationship between vitamin D level and serum TNF-α concentration on the severity of COPD, there were significant positive correlations between the increase of vitamin D levels (tertiles 1, 2 and 3) and the increase of serum TNF-α concentrations on the severity of COPD at p-value < 0.05. Overall, there were non-linear relationships between vitamin D level and serum TNF-α concentration on the severity of COPD. CONCLUSIONS: Serum TNF-α concentration was positively associated with airway obstruction level and severity of COPD. Low level of vitamin D was negatively associated with airway obstruction level and severity of COPD. Vitamin D3 level (1,25(OH)2D) was negatively associated with serum TNF-α concentration and airway obstruction level and severity of COPD.
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Affiliation(s)
- Muhammad Ilyas
- Department of Pulmonology and Respiratory Medicine, Medicine Faculty, Hasanuddin University, Makassar, Indonesia
| | - Agussalim Agussalim
- Department of Internal Medicine, Medicine Faculty, Hasanuddin University, Makassar, Indonesia
| | | | - Nasrum Massi
- Medical Research Center, Hasanuddin University, Makassar, Indonesia
| | - Irawaty Djaharuddin
- Department of Pulmonology and Respiratory Medicine, Medicine Faculty, Hasanuddin University, Makassar, Indonesia
| | - Syakib Bakri
- Department of Internal Medicine, Medicine Faculty, Hasanuddin University, Makassar, Indonesia
| | - Suryani As'ad
- Department of Clinical Pathology, Medicine Faculty, Hasanuddin University, Makassar, Indonesia
| | - Mansyur Arief
- Department of Clinical Pathology, Medicine Faculty, Hasanuddin University, Makassar, Indonesia
| | - Burhanuddin Bahar
- Department of Biostatistics, Public Health Faculty, Hasanuddin University, Makassar, Indonesia
| | - Arifin Seweng
- Department of Biostatistics, Public Health Faculty, Hasanuddin University, Makassar, Indonesia
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11
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Jolliffe DA, Greenberg L, Hooper RL, Mathyssen C, Rafiq R, de Jongh RT, Camargo CA, Griffiths CJ, Janssens W, Martineau AR. Vitamin D to prevent exacerbations of COPD: systematic review and meta-analysis of individual participant data from randomised controlled trials. Thorax 2019; 74:337-345. [PMID: 30630893 DOI: 10.1136/thoraxjnl-2018-212092] [Citation(s) in RCA: 108] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 11/20/2018] [Accepted: 11/26/2018] [Indexed: 11/03/2022]
Abstract
BACKGROUND Randomised controlled trials (RCTs) of vitamin D to prevent COPD exacerbations have yielded conflicting results.Individual participant data meta-analysis could identify factors that explain this variation. METHODS PubMed, Embase, the Cochrane Central Register of Controlled Trials and Web of Science were searched from inception up to and including 5 October 2017 to identify RCTs of vitamin D supplementation in patients with COPD that reported incidence of acute exacerbations. Individual participant data meta-analysis was performed using fixed effects models adjusting for age, sex, Global Initiative for Chronic Obstructive Lung Disease spirometric grade and trial. RESULTS Four eligible RCTs (total 560 participants) were identified; individual participant data were obtained for 469/472 (99.4%) participants in three RCTs. Supplementation did not influence overall rate of moderate/severe COPD exacerbations (adjusted incidence rate ratio (aIRR) 0.94, 95% CI 0.78 to 1.13). Prespecified subgroup analysis revealed that protective effects were seen in participants with baseline 25-hydroxyvitamin D levels <25 nmol/L (aIRR 0.55, 95% CI 0.36 to 0.84) but not in those with baseline 25-hydroxyvitamin D levels ≥25 nmol/L (aIRR 1.04, 95% CI 0.85 to 1.27; p for interaction=0.015). Vitamin D did not influence the proportion of participants experiencing at least one serious adverse event (adjusted OR 1.16, 95% CI 0.76 to 1.75). CONCLUSIONS Vitamin D supplementation safely and substantially reduced the rate of moderate/severe COPD exacerbations in patients with baseline 25-hydroxyvitamin D levels <25 nmol/L but not in those with higher levels. TRIAL REGISTRATION NUMBER CRD42014013953.
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Affiliation(s)
- David A Jolliffe
- Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Lauren Greenberg
- Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Richard L Hooper
- Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Carolien Mathyssen
- Department of Respiratory Medicine, Katholieke Universiteit, Leuven, Belgium
| | - Rachida Rafiq
- Department of Internal Medicine and Endocrinology, VU University Medical Center, Amsterdam, The Netherlands
| | - Renate T de Jongh
- Department of Internal Medicine and Endocrinology, VU University Medical Center, Amsterdam, The Netherlands
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, UK
| | - Christopher J Griffiths
- Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,Asthma UK Centre for Applied Research, Blizard Institute, Queen Mary University of London, London, UK
| | - Wim Janssens
- Department of Respiratory Medicine, Katholieke Universiteit, Leuven, Belgium
| | - Adrian R Martineau
- Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,Asthma UK Centre for Applied Research, Blizard Institute, Queen Mary University of London, London, UK
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12
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Okereke OI. The Challenging Task of Addressing the Role of Vitamin D in Late-life Depression: Considerations of Measures, Confounders, Mediators, and Moderators. Am J Geriatr Psychiatry 2018; 26:1144-1146. [PMID: 30270131 PMCID: PMC6712573 DOI: 10.1016/j.jagp.2018.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 08/23/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Olivia I. Okereke
- Harvard T.H. Chan School of Public Health, 677 Huntington
Ave, Boston, MA 02115, USA,Channing Division of Network Medicine, Department of
Medicine, Brigham and Women’s Hospital and Harvard Medical School, 181
Longwood Avenue, Boston, MA, 02115, USA,Department of Psychiatry, Massachusetts General Hospital
and Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
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13
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Hicks A, Healy E, Sandeman N, Feelisch M, Wilkinson T. A time for everything and everything in its time - exploring the mechanisms underlying seasonality of COPD exacerbations. Int J Chron Obstruct Pulmon Dis 2018; 13:2739-2749. [PMID: 30233164 PMCID: PMC6130531 DOI: 10.2147/copd.s146015] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Across Europe, COPD affects 23 million people leading to annual health care costs of ~€25.1 billion. This burden is particularly severe during winter months in association with the peak incidence of exacerbation events. Seasonal variation in the health status of patients with COPD places additional and often critical pressure on already strained health care resources. COPD exacerbations are characterized by worsening day-to-day symptoms of an individual and often triggered by respiratory infections, but the process by which this occurs in a seasonal fashion is likely to be multifactorial. In this review, we discuss recent population studies that highlight the impact of seasonality in COPD and review the proposed biological mechanisms underlying this. An appraisal of the role of the host susceptibility and response, environmental triggers and the biology of respiratory pathogens is detailed. The impact of each aspect is considered, and an integrated model of the context for the whole individual and society in general is explored.
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Affiliation(s)
- Alexander Hicks
- Clinical and Experimental Sciences, University of Southampton - Faculty of Medicine, Southampton General Hospital, Southampton, UK, .,Southampton NIHR Respiratory Biomedical Research Centre, Southampton General Hospital, Southampton, UK, .,National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Wessex, Southampton General Hospital, Southampton, UK,
| | - Eugene Healy
- Clinical and Experimental Sciences, University of Southampton - Faculty of Medicine, Southampton General Hospital, Southampton, UK,
| | - Natasha Sandeman
- Clinical and Experimental Sciences, University of Southampton - Faculty of Medicine, Southampton General Hospital, Southampton, UK,
| | - Martin Feelisch
- Clinical and Experimental Sciences, University of Southampton - Faculty of Medicine, Southampton General Hospital, Southampton, UK, .,Southampton NIHR Respiratory Biomedical Research Centre, Southampton General Hospital, Southampton, UK,
| | - Tom Wilkinson
- Clinical and Experimental Sciences, University of Southampton - Faculty of Medicine, Southampton General Hospital, Southampton, UK, .,Southampton NIHR Respiratory Biomedical Research Centre, Southampton General Hospital, Southampton, UK, .,National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Wessex, Southampton General Hospital, Southampton, UK, .,Wessex Investigational Sciences Hub, University of Southampton - Faculty of Medicine, Southampton General Hospital, Southampton, UK
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14
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The relationship between Vitamin D status and exacerbation in COPD patients– a literature review. Respir Med 2018; 139:34-38. [DOI: 10.1016/j.rmed.2018.04.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 02/20/2018] [Accepted: 04/18/2018] [Indexed: 01/09/2023]
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15
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Kentson M, Leanderson P, Jacobson P, Persson HL. The influence of disease severity and lifestyle factors on the peak annual 25(OH)D value of COPD patients. Int J Chron Obstruct Pulmon Dis 2018; 13:1389-1398. [PMID: 29731626 PMCID: PMC5927355 DOI: 10.2147/copd.s156121] [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] [Indexed: 01/13/2023] Open
Abstract
Background The prevalence of individuals deficient in vitamin D (defined as a serum level of the stable metabolite 25(OH)D <50 nmol/L) is increasing in countries with low annual ultraviolet (UV) radiation and among individuals unable to perform outdoor activities, for example, COPD patients. Objective To assess the role of vitamin D deficiency, independently of seasonal variation, the peak annual value of 25(OH)D was measured in subjects with advanced COPD ± long-term oxygen therapy (LTOT) and lung healthy control subjects. A method to grade the individual annual UV light exposure was designed and tested. Subjects and methods Sixty-six Caucasians with advanced COPD (28 with LTOT) and 47 control subjects were included, and the levels of 25(OH)D were determined in late summer/early fall when the annual peak was assumed. Questionnaires about COPD symptoms, general health, lifestyle, dietary habits and QoL were used to collect data. Lung function tests and blood sampling were performed. Results The peak annual 25(OH)D of COPD subjects was significantly lower than in the control subjects, but there was no significant difference between COPD patients with and without LTOT. Ongoing vitamin D supplementation was the single most important intervention to maintain 25(OH)D levels ≥50 nmol/L. Among vitamin D-deficient COPD subjects, 25(OH) D correlated positively with forced expiratory volume in 1 second as % predicted, Modified British Medical Research Council score, blood oxygenation, food portion size, Mediterranean Diet Score and Ultraviolet Score. Conclusion Vitamin D deficiency was common among healthy individuals and COPD subjects. Peak annual 25(OH)D levels of COPD subjects correlated with clinically important outcomes. The present study emphasizes the need to routinely monitor vitamin D status among patients with advanced COPD and to consider to medicate those with vitamin D deficiency with vitamin D supplementation.
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Affiliation(s)
- Magnus Kentson
- Division of Medicine, Ryhov Hospital, Jönköping, Sweden.,Department of Medical and Health Sciences (IMH), Linköping University, Linköping, Sweden
| | - Per Leanderson
- Department of Occupational and Environmental Medicine, Department of Clinical and Experimental Medicine (IKE), Linköping University, Linköping, Sweden
| | - Petra Jacobson
- Department of Respiratory Medicine.,Department of Medical and Health Sciences (IMH), Linköping University, Linköping, Sweden
| | - Hans Lennart Persson
- Department of Respiratory Medicine.,Department of Medical and Health Sciences (IMH), Linköping University, Linköping, Sweden
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16
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Halpin DMG, Miravitlles M, Metzdorf N, Celli B. Impact and prevention of severe exacerbations of COPD: a review of the evidence. Int J Chron Obstruct Pulmon Dis 2017; 12:2891-2908. [PMID: 29062228 PMCID: PMC5638577 DOI: 10.2147/copd.s139470] [Citation(s) in RCA: 144] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Severe exacerbations of COPD, ie, those leading to hospitalization, have profound clinical implications for patients and significant economic consequences for society. The prevalence and burden of severe COPD exacerbations remain high, despite recognition of the importance of exacerbation prevention and the availability of new treatment options. Severe COPD exacerbations are associated with high mortality, have negative impact on quality of life, are linked to cardiovascular complications, and are a significant burden on the health-care system. This review identified risk factors that contribute to the development of severe exacerbations, treatment options (bronchodilators, antibiotics, corticosteroids [CSs], oxygen therapy, and ventilator support) to manage severe exacerbations, and strategies to prevent readmission to hospital. Risk factors that are amenable to change have been highlighted. A number of bronchodilators have demonstrated successful reduction in risk of severe exacerbations, including long-acting muscarinic antagonist or long-acting β2-agonist mono- or combination therapies, in addition to vaccination, mucolytic and antibiotic therapy, and nonpharmacological interventions, such as pulmonary rehabilitation. Recognition of the importance of severe exacerbations is an essential step in improving outcomes for patients with COPD. Evidence-based approaches to prevent and manage severe exacerbations should be implemented as part of targeted strategies for disease management.
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Affiliation(s)
- David MG Halpin
- Department of Respiratory Medicine, Royal Devon and Exeter Hospital, Exeter, UK
| | - Marc Miravitlles
- Pneumology Department, Hospital Universitari Vall d’Hebron, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - Norbert Metzdorf
- Respiratory Medicine, Boehringer Ingelheim Pharma GmBH & Co KG, Ingelheim am Rhein, Germany
| | - Bartolomé Celli
- Pulmonary Division, Brigham and Women’s Hospital, Boston, MA, USA
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17
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Mehani SHM. Immunomodulatory effects of two different physical therapy modalities in patients with chronic obstructive pulmonary disease. J Phys Ther Sci 2017; 29:1527-1533. [PMID: 28931981 PMCID: PMC5599814 DOI: 10.1589/jpts.29.1527] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 06/05/2017] [Indexed: 11/24/2022] Open
Abstract
[Purpose] Counteracting the systemic cytokine release and its inflammatory effects by
improving respiratory muscle strength and controlling lung inflammation may be important
for improving immune system in patients with chronic obstructive pulmonary disease, So the
aim of the present study was to evaluate the effect of low level laser therapy and
inspiratory muscle training on interleukin-6 (IL-6) as a marker of inflammation and
CD4+/CD8+ ratio as a marker for T Lymphocytes in these patients. [Subjects and Methods]
Forty male patients with stable COPD participated in the study, their ages ranged between
55−65 years. They were randomly divided into group (A) who received inspiratory muscle
training and group (B) who received low level laser (LLL) acupuncture stimulation for
about 8 week. [Results] There was a reduction in the concentration of plasma IL-6
associated with an increase in CD4+/CD8+ ratio in both groups, but laser was superior to
inspiratory muscle training. IL-6 and CD4+/CD8+ were negatively correlated. [Conclusion]
Both inspiratory muscle training and low level laser therapy are effective physical
therapy modalities in promoting immune disturbances. The results also supported the
superior role of LLLT over IMT in managing immune disturbances.
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Affiliation(s)
- Sherin Hassan M Mehani
- Department of Physical Therapy for Internal Medicine, Faculty of Physical Therapy, Beni-Suef University: Benisuef Elgadata, Street no.18, Benisuef governorate, Egypt
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18
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Rafiq R, Prins HJ, Boersma WG, Daniels JM, den Heijer M, Lips P, de Jongh RT. Effects of daily vitamin D supplementation on respiratory muscle strength and physical performance in vitamin D-deficient COPD patients: a pilot trial. Int J Chron Obstruct Pulmon Dis 2017; 12:2583-2592. [PMID: 28894361 PMCID: PMC5584776 DOI: 10.2147/copd.s132117] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background Although vitamin D is well known for its function in calcium homeostasis and bone mineralization, several studies have shown positive effects on muscle strength and physical function. In addition, vitamin D has been associated with pulmonary function and the incidence of airway infections. As vitamin D deficiency is highly prevalent in chronic obstructive pulmonary disease (COPD) patients, supplementation might have a beneficial effect in these patients. Objective To assess the effect of vitamin D supplementation on respiratory muscle strength and physical performance in vitamin D-deficient COPD patients. Secondary outcomes are pulmonary function, handgrip strength, exacerbation rate, and quality of life. Methods We performed a randomized, double-blind, placebo-controlled pilot trial. Participants were randomly allocated to receive 1,200 IU vitamin D3 per day (n=24) or placebo (n=26) during 6 months. Study visits were conducted at baseline, and at 3 and 6 months after randomization. During the visits, blood was collected, respiratory muscle strength was measured (maximum inspiratory and expiratory pressure), physical performance and 6-minute walking tests were performed, and handgrip strength and pulmonary function were assessed. In addition, participants kept a diary card in which they registered respiratory symptoms. Results At baseline, the mean (standard deviation [SD]) serum 25-hydroxyvitamin D (25(OH)D) concentration (nmol/L) was 42.3 (15.2) in the vitamin D group and 40.6 (17.0) in the placebo group. Participants with vitamin D supplementation had a larger increase in serum 25(OH)D compared to the placebo group after 6 months (mean difference (SD): +52.8 (29.8) vs +12.3 (25.1), P<0.001). Primary outcomes, respiratory muscle strength and physical performance, did not differ between the groups after 6 months. In addition, no differences were found in the 6-minute walking test results, handgrip strength, pulmonary function, exacerbation rate, or quality of life. Conclusion Vitamin D supplementation did not affect (respiratory) muscle strength or physical performance in this pilot trial in vitamin D-deficient COPD patients.
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Affiliation(s)
- Rachida Rafiq
- Department of Internal Medicine and Endocrinology, VU University Medical Center, Amsterdam
| | - Hendrik J Prins
- Department of Pulmonary Diseases, Northwest Hospital group, Alkmaar
| | - Wim G Boersma
- Department of Pulmonary Diseases, Northwest Hospital group, Alkmaar
| | - Johannes Ma Daniels
- Department of Pulmonary Diseases, VU University Medical Center, Amsterdam, the Netherlands
| | - Martin den Heijer
- Department of Internal Medicine and Endocrinology, VU University Medical Center, Amsterdam
| | - Paul Lips
- Department of Internal Medicine and Endocrinology, VU University Medical Center, Amsterdam
| | - Renate T de Jongh
- Department of Internal Medicine and Endocrinology, VU University Medical Center, Amsterdam
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19
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Liu FH, Li SS, Li XX, Wang S, Li MG, Guan L, Luan TG, Liu ZG, Liu ZJ, Yang PC. Vitamin D3 induces vitamin D receptor and HDAC11 binding to relieve the promoter of the tight junction proteins. Oncotarget 2017; 8:58781-58789. [PMID: 28938596 PMCID: PMC5601692 DOI: 10.18632/oncotarget.17692] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 04/12/2017] [Indexed: 12/14/2022] Open
Abstract
Intestinal epithelial barrier dysfunction and vitamin D (VitD)-deficiency play a critical role in a large number of diseases. The histone deacetylases (HDAC) are associated with a large number of immune diseases. This study tests a hypothesis that the interaction between VitD and HDAC is associated with the regulation of epithelial barrier functions. In this study, human intestinal epithelial cell line, T84 cells, was cultured into monolayers to be used as a model to test the epithelial barrier functions. We observed that in a VitD-deficient environment, the T84 monolayer barrier function was compromised. Exposure to calcitriol (the active form of VitD3) in the culture increased the expression of VitD receptor (VDR) in T84 cells. In a VitD-sufficient environment, VDR formed a complex with histone deacetylase-11 (HDAC11); the complex was markedly decreased in a VitD-deficient environment. We also observed that significantly more binding of HDAC11 to the promoter of the tight junction proteins inhibit the gene transcription activities of these loci in the VitD-deficient environment, which were abolished by the presence of calcitriol in the culture. In conclusion, the interaction between VDR and HDAC11 plays a crucial role in the maintenance of the epithelial barrier integrity.
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Affiliation(s)
- Feng-Hua Liu
- The Department of Gastroenterology, The Shanghai Tenth People's Hospital of Tongji University, Shanghai 200072, China
| | - Shan-Shan Li
- The Research Center of Allergy & Immunology, Shenzhen University School of Medicine, Shenzhen 518060, China
| | - Xiao-Xi Li
- The Research Center of Allergy & Immunology, Shenzhen University School of Medicine, Shenzhen 518060, China
| | - Shuai Wang
- The Research Center of Allergy & Immunology, Shenzhen University School of Medicine, Shenzhen 518060, China.,Longgang ENT Hospital, Shenzhen ENT Institute, Shenzhen 518116, China
| | - Mao-Gang Li
- The Research Center of Allergy & Immunology, Shenzhen University School of Medicine, Shenzhen 518060, China
| | - Li Guan
- Affiliated Luohu Hospital, Shenzhen University, Shenzhen 518001, China
| | - Tian-Gang Luan
- Affiliated Luohu Hospital, Shenzhen University, Shenzhen 518001, China
| | - Zhi-Gang Liu
- The Research Center of Allergy & Immunology, Shenzhen University School of Medicine, Shenzhen 518060, China
| | - Zhan-Ju Liu
- The Department of Gastroenterology, The Shanghai Tenth People's Hospital of Tongji University, Shanghai 200072, China
| | - Ping-Chang Yang
- The Research Center of Allergy & Immunology, Shenzhen University School of Medicine, Shenzhen 518060, China
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20
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Zhu M, Wang T, Wang C, Ji Y. The association between vitamin D and COPD risk, severity, and exacerbation: an updated systematic review and meta-analysis. Int J Chron Obstruct Pulmon Dis 2016; 11:2597-2607. [PMID: 27799758 PMCID: PMC5079694 DOI: 10.2147/copd.s101382] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background In recent years, the pleiotropic roles of vitamin D have been highlighted in various diseases. However, the association between serum vitamin D and COPD is not well studied. This updated systematic review and meta-analysis aimed to assess the relationship between vitamin D and the risk, severity, and exacerbation of COPD. Methods A systematic literature search was conducted in PubMed, Medline, EMBASE, Chinese National Knowledge Infrastructure, Wanfang, and Weipu databases. The pooled risk estimates were standardized mean difference (SMD) with 95% confidence interval (CI) for vitamin D levels and odds ratio (OR) with 95% CI for vitamin D deficiency. Meta-regression and subgroup analyses were performed on latitude, body mass index, and assay method. Results A total of 21 studies, including 4,818 COPD patients and 7,175 controls, were included. Meta-analysis showed that lower serum vitamin D levels were found in COPD patients than in controls (SMD: −0.69, 95% CI: −1.00, −0.38, P<0.001), especially in severe COPD (SMD: −0.87, 95% CI: −1.51, −0.22, P=0.001) and COPD exacerbation (SMD: −0.43, 95% CI: −0.70, −0.15, P=0.002). Vitamin D deficiency was associated with increased risk of COPD (OR: 1.77, 95% CI: 1.18, 2.64, P=0.006) and with COPD severity (OR: 2.83, 95% CI: 2.00, 4.00, P<0.001) but not with COPD exacerbation (OR: 1.17, 95% CI: 0.86, 1.59, P=0.326). Assay methods had significant influence on the heterogeneity of vitamin D deficiency and COPD risk. Conclusion Serum vitamin D levels were inversely associated with COPD risk, severity, and exacerbation. Vitamin D deficiency is associated with increased risk of COPD and severe COPD but not with COPD exacerbation. It is worth considering assay methods in the heterogeneity sources analysis of association between vitamin D deficiency and COPD.
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Affiliation(s)
- Min Zhu
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Ting Wang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Chengdi Wang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Yulin Ji
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
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