Tuberculosis and vitamin D

Year 2014, Volume: 27 Issue: 2, 85 - 88, 20.05.2014

Arzu Akşit İlki

Abstract

Tuberculosis (TB) is still highly prevalent world-wide accounting
for over one million deaths annually. Especially the multi drugresistant Mycobacterium tuberculosis necessitates the development
of new agents to enhance the response to antimicrobial therapy for
active TB. In the pre-antibiotic era, vitamin D was used to treat
TB. However, after the development of antituberculosis agents, it
lost its importance. Recently, its active metabolite,
1,25-dihydoxyvitamin D, was shown to enhance the immune
response to mycobacteria. Vitamin D does not have a direct killing
effect but 1,25-dihydoxyvitamin D, is a modulater of the immune
system. The synthesis of 1,25-dihydroxyvitamin D promotes the
production of endogen defensin and cathelicidin. These products
have a direct lethal effect on bacteria and intracellular
microorganisms like M.tuberculosis.
In this review, the role of vitamin D in host resistance to
M.tuberculosis infection and its effect for supplementation therapy
is discussed.

Keywords

Tuberculosis, Vitamin D, 1, 25-dihydoxyvitamin D, Immune response, Defensin, Cathelicidin

Tüberküloz ve D vitamini

Abstract

Tüberküloz, hala tüm dünyada yılda bir milyondan fazla kişinin
ölümüne yol açan en yaygın hastalıklardan biridir. Özellikle çoklu
ilaca dirençli Mycobacterium tuberculosis enfeksiyonlarında
antimikrobiyal tedavi cevabını arttırmak için yeni ajanların
gelişimine ihtiyaç duyulmaktadır. Antibiyotik öncesi dönemde
tüberküloz tedavisinde kullanılan D vitamini, antitüberküloz
ilaçların gelişimiyle önemini yitirmiştir. Son zamanlarda D vitamini
aktif metaboliti, 1,25-dihydroxyvitamin D’nin mikobakterilerde
bağışık yanıtı arttırdığı bilinmektedir. D vitamininin direkt
öldürücü etkisi yoktur, ancak 1,25-dihydoxyvitamin D, bağışık
yanıt üzerinde modülator görevi yapar. 1,25-dihydroxyvitamin D
sentezi endojen defensin ve katelisidin sentezini arttırır. Bu
ürünlerin bakterilere ve M.tuberculosis gibi hücre içi yerleşimli
mikroorganizmalara direkt ölümcül etkileri vardır.
Bu derlemede, D vitamininin, M.tuberculosis enfeksiyonunda
konak direncindeki rolü ve destek tedavisi ile ilgili etkileri
tartışılmıştır. 

Keywords

Tüberküloz, D Vitamini, 1, 25-dihydoxyvitamin D, Bağışık yanıt, Defensin, Katelisidin

References

• 1. World Health Organization. Global tuberculosis control 2012 – Surveillance,Planning, Financing. WHO Report 2012. Geneva:World Health Organization, 2012. www.who.int accessed on 11.01.2014.
• 2. Chesney RW. Vitamin D and the magic mountain: the anti-infectious role of the vitamin. J Pediatr 2010;156:698-703. doi: 10.1016/j. jpeds.2010.02.002
• 3. Park EA. The etiology of rickets. Physiol Rev 1923; 3:106-63. 4. Roelandts R. A new light on Niels Finsen, a century after his Nobel Prize. Photodermatol Photoimmunol Photomed 2005; 21: 115-7.
• 5. Askew FA, Bruce HM, Callow RK, Philpot J ST L, Webster T A. Crystalline vitamin D. Nature 1931;128:758. doi:10.1038/128758a0
• 6. Lang PO, Samaras N, Samaras D, et al. How important is vitamin D in preventing infections? Osteoporos Int 2013; 24:1537-53. doi: 10.1007/s00198-012-2204-6
• 7. Bikle D. Nonclassic actions of vitamin D. J Clin Endocrinol Metab 2009; 94: 26-34. doi: 10.1210/jc.2008-1454
• 8. Aranow C. Vitamin D and the immune system. J Investig Med 2011;59: 881–6. doi:10.231/JIM.0b013e31821b8755
• 9. Liu PT, Stenger S, Li H, et al. Toll-like receptor triggering of a vitamin D-mediated human antimicrobial response. Science 2006; 311: 1770–3.
• 10. Dini C, Bianchi A. The potential role of vitamin D for prevention and treatment of tuberculosis and infectious diseases. Ann Ist Super Sanità 2012; 48: 319-27.
• 11. Khoo AL, Chai L, Koenen HJ, Joosten I, Netea MG, Ven A Van der. Translating the role of vitamin D3 in infectious diseases. Crit Rev Microbiol 2012; 38: 122–35.
• 12. Rook GA, Steele J, Fraher L, et al. Vitamin D3, gamma interferon, and control of proliferation of Mycobacterium tuberculosis by human monocytes. Immunology 1986;57: 159–63.
• 13. Sly LM, Lopez M, Nauseef WM, Reiner NE. 1alpha,25- Dihydroxyvitamin D3-induced monocyte antimycobacterial activity is regulated by phosphatidylinositol 3-kinase and mediated by the NADPH-dependent phagocyte oxidase. J Biol Chem 2001; 276: 35482–93. doi:10.1074/jbc.M102876200
• 14. Chocano-Bedoya P, Ronnenberg A G. Vitamin D and tuberculosis. Nutr Rev 2009; 67:289–93. doi: 10.1111/j.1753-4887.2009.00195.x 13
• 15. Khoo AL, Chai LY, Koenen HJ, et al. 1,25-dihydroxyvitamin D3 modulates cytokine production induced by Candida albicans: impact of seasonal variation of immune responses. J Infect Dis 2011;203: 122–30. doi: 10.1093/infdis/jiq008
• 16. Sadeghi K, Wessner B, Laggner U, et al. Vitamin D3 down-regulates monocyte TLR expression and triggers hyporesponsiveness to pathogen-associated molecular patterns. Eur J Immunol 2006; 36: 361–70.
• 17. Sita-Lumsden A, Lapthorn G, Swaminathan R, Milburn HJ. Reactivation of tuberculosis and vitamin D deficiency: the contribution of diet and exposure to sunlight. Thorax 2007; 62:1003– 7. doi: 10.1136/thx.2006.070060
• 18. Nnoaham KE, Clarke A. Low serum vitamin D levels and tuberculosis: a systematic review and meta-analysis. Int J Epidemiol 2008; 37: 113–9. doi: 10.1093/ije/dym247 Marmara Medical Journal 2014; 27: 85-8
• 19. Wejse C, Olesen R, Rabna P, et al. Serum 25-hydroxyvitamin D in a West African population of tuberculosis patients and unmatched healthy controls. Am J Clin Nutr 2007; 86: 1376–83.
• 20. Nursyam EW, Amin Z, Rumende CM. The effect of vitamin D as supplementary treatment in patients with moderately advanced pulmonary tuberculosis lesion. Acta Med Indones 2006; 38: 3–5.
• 21. Wilkinson RJ, Liewelyn M, Toosi Z, et al. Influence of vitamin D deficient and vitamin D receptor polymorphisms on tuberculosis in Gujarati Asians inwest London: a case control study. Lancet 2000; 365: 618-21.
• 22. Alataş F, Alataş Ö, Çolak Ö, ark. Aktif akciğer tüberkülozlu olgularda serum 25(OH) vitamin D düzeyleri. Türk Klinik Biyokimya Derg 2004; 2: 91-5.
• 23. Martineau AR, Honecker FU, Wilkinson RJ, Griffiths CJ. Vitamin D in the treatment of pulmonary tuberculosis. J Steroid Biochem Mol Biol 2007; 103:793-8. doi.org/10.1016/j.jsbmb.2006.12.052
• 24. Yamshchikov AV, Oladele A, Leonard MK Jr, et al. Vitamin D as adjunctive therapy in refractory pulmonary tuberculosis: A case report. South Med J 2009; 102: 649-52. doi: 10.1097/ SMJ.0b013e3181a5d37e
• 25. Nawal S, Farheen A, Zahra H, et al. Vitamin D accelerates clinical recovery from tuberculosis: results of the SUCCINCT Study [Supplementary Cholecalciferol in recovery from tuberculosis]. A randomized, placebo-controlled, clinical trial of vitamin D supplementation in patients with pulmonary tuberculosis. BMC Infect Dis 2013;19:13-22. doi: 10.1186/1471-2334-13-22