Pathophysiological Role and Therapeutic Implications of Vitamin D in Autoimmunity: Focus on Chronic Autoimmune Diseases
Abstract
:1. Introduction
2. Vitamin D and Inflammatory Arthritis
2.1. Rheumatoid Arthritis
- The effect of cholecalciferol supplementation on disease activity is controversial; however, when vitamin D was used at higher doses, the supplementation regimen was generally beneficial [61,62]. This suggests that, possibly, the effect on immune system of vitamin D requires higher plasma levels than those necessary for bone health. Indeed, plasma 25(OH)D3 approximately doubles the synovial concentration [63]; the anti-inflammatory properties of this intermediate have been demonstrated at a 50-100 nM concentration. Thus, the plasma level required for bone health is probably ineffective to elicit immune regulation [37].
2.2. Spondyloarthritis
3. Vitamin D and Autoimmune Connective Tissue Diseases
3.1. Systemic Lupus Erythematosus
3.2. Antiphospholipid Syndrome
4. Vitamin D and Autoimmune Endocrine Diseases
4.1. Type 1 Diabetes Mellitus
4.2. Thyroid Autoimmunity
4.3. Addison’s Disease
4.4. Autoimmune Polyendocrine Syndromes
5. Vitamin D and Autoimmune Liver Diseases
6. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Author (Publication Year) | Type of Study | Number of Enrolled Patients | Type of Supplementation | Main Findings |
---|---|---|---|---|
Ruiz Irastorza et al. (2010) | Longitudinal observational | 80 | Cholecalciferol, 600-800 IU day p.o. (24 mos) | Improved fatigue symptoms, no correlation with SLEDAI or SDI. Side effects: not reported |
Terrier et al. (2012) | Prospective | 20 | Cholecalciferol, 100.000 IU/wk p.o. (4 wks) | Improved naïve CD4+ T cells, regulatory T cells; reduced Th1 and Th17 cells, memory B cells, anti-DNA antibodies. No cases of hypercalcemia |
Petri et al. (2013) | Prospective | 1006 | Ergocalciferol, 50.000 IU/wk p.o., calcium/vitamin D 200 IU/twice daily p.o. | Reduced SELENA-SLEDAI, decreased urine protein-to-creatinine ratio. Hypercalcemia rate, 0.002% |
Andreoli et al. (2015) | Prospective, cross-over | 34 | Cholecalciferol Intensive Regimen: 300.000 IU bolus plus 50.000 IU/mo p.o. (850.000 IU/yr). Standard Regimen: 25.000 IU/mo p.o. (300.000 IU/yr) for 12 mos. Regimens switched in the second year. | No effect on disease activity and SLE serology. No cases of hypercalcemia. Slight transient hypercalciuria in 3 |
Piantoni et al. (2015) | Prospective, cross-over | 34 | Cholecalciferol Intensive Regimen: 300.000 IU bolus plus 50.000 IU/mo p.o. (850.000 IU/yr). Standard Regimen: 25.000 IU/mo p.o. (300.000 IU/yr) for 12 mos. Regimens switched in the second year. | Enhancement of T-reg cells and Th2 cytokines. No cases of hypercalcemia |
Aranow et al. (2015) | Randomized, double blind, placebo controlled | 57 | Cholecalciferol, 2.000 or 4.000 IU/d p.o. | Well-tolerated. No effect on IFN-alpha. No cases of hypercalcemia |
Lima et al. (2016) | Randomized, double blind, placebo controlled | 40 (JoSLE) | Cholecalciferol, 5000 IU/wk p.o. | Decreased disease activity and improved fatigue symptoms in JoSLE patients. No cases of hypercalcemia |
Rifa’i et al. (2016) | Randomized, placebo controlled | 39 | Cholecalciferol, 1.200 IU/d p.o. | Decreased SLE disease activity and fatigue symptoms. Side effects: not reported |
Karimzadeh et al. (2017) | Randomized, double blind, placebo controlled | 90 | Cholecalciferol, 50.000 IU/wk p.o. for 12 wks and 50.000 IU/mo p.o. for 6 mos. | No effect on SLE disease activity. Side effects: not reported |
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Bellan, M.; Andreoli, L.; Mele, C.; Sainaghi, P.P.; Rigamonti, C.; Piantoni, S.; De Benedittis, C.; Aimaretti, G.; Pirisi, M.; Marzullo, P. Pathophysiological Role and Therapeutic Implications of Vitamin D in Autoimmunity: Focus on Chronic Autoimmune Diseases. Nutrients 2020, 12, 789. https://doi.org/10.3390/nu12030789
Bellan M, Andreoli L, Mele C, Sainaghi PP, Rigamonti C, Piantoni S, De Benedittis C, Aimaretti G, Pirisi M, Marzullo P. Pathophysiological Role and Therapeutic Implications of Vitamin D in Autoimmunity: Focus on Chronic Autoimmune Diseases. Nutrients. 2020; 12(3):789. https://doi.org/10.3390/nu12030789
Chicago/Turabian StyleBellan, Mattia, Laura Andreoli, Chiara Mele, Pier Paolo Sainaghi, Cristina Rigamonti, Silvia Piantoni, Carla De Benedittis, Gianluca Aimaretti, Mario Pirisi, and Paolo Marzullo. 2020. "Pathophysiological Role and Therapeutic Implications of Vitamin D in Autoimmunity: Focus on Chronic Autoimmune Diseases" Nutrients 12, no. 3: 789. https://doi.org/10.3390/nu12030789