Editorial
Vitamin D and autoimmune rheumatic disease
Vitamina D y enfermedades autoinmunes reumáticas
a Departamento de Inmunología y Reumatología de la Facultad de Medicina, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico
b Unidad de Investigación de Enfermedad Autoinmunes Sistémicas, Hospital General Regional #36 Instituto Mexicano del Seguro Social, Puebla, Mexico
c Servicio de Alergología e Inmunología, Hospital Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Puebla, Mexico
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It has been proposed that, being a secosteroid, vitamin D could reduce the immunological response in a way similar to the steroids.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Clinical, epidemiological and experimental studies demonstrate the potential role of vitamin D in the development and perpetuation of different autoimmune diseases, such as systemic lupus erythematosus (SLE), type 1 diabetes mellitus (T1D), multiple sclerosis (MS) and rheumatoid arthritis (RA).<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The cornerstone of immunoregulation by this vitamin is the vitamin D receptor (VDR), which is present in several cells of the immune system. The binding of 1,25(OH)2D3 to the receptor induces an improvement in phagocytosis and a decrease in the expression of major histocompatibility complex class II DR in dendritic cells, as well as a decrease in the expression and response of costimulatory molecules that regulate the maturation and migration of these cells, blocking their final differentiation. Other actions are the induction to maturity of natural killer (NK) cells and of TCD4+CD25+Foxp3 cells (regulatory T cells or Tregs) capable of mediating immune tolerance and, in consequence, reducing the development of autoimmune disorders; and decreasing the differentiation and proliferation of B lymphocytes to plasma cells and their apoptosis. Regarding its action on inflammatory cytokines, it reduces the production of the proinflammatory cytokines IL-17A, IL-17F, IL-22, IL-23, IL-12, IL-2, IL-6, tumor necrosis factor alpha (TNFα) and interferon γ (IFN γ); at the same time, it increases the production of the anti-inflammatory cytokines IL-10 and transforming growth factor beta (TGFβ).<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3–10</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The molecular mechanism by which the vitamin D/VDR interaction functions involves interfering with the nuclear factor of activated T cells (NF-AT) and with the nuclear factor of κB (NF-κB), as well as directly modulating the promoter regions in the genes of different cytokines.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> Moreover, it increases the IL-4 concentration,<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> and the mRNA of IL-2, as well as that of cytokines produced by the Treg cells (CD4+CD25+); the expression of Toll-like receptor 4 (TLR4) is also notable.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13,14</span></a> These are the most important mechanisms that indicate the protective capacity of vitamin D against autoimmunity.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The serum vitamin D concentration depends on several factors: sunlight exposure, age, ethnicity, body mass index and use of drugs (steroids and immunosuppressive agents), as well as supplements.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Despite the fact that there are several factors associated with a low serum vitamin D concentration, from the epidemiological point of view, vitamin D deficiency has been related to the presence and activity of autoimmune rheumatic diseases, as well as other chronic diseases, the major ones being cardiovascular diseases, hypertension and cancer.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Thus, SLE patients not only show changes in bone metabolism; there are also alterations related to the immunological function of vitamin D through vitamin D receptor genes, major histocompatibility complex class II genes, microRNA, the renin-angiotensin-aldosterone system, apolipoprotein E, liver X receptor and Toll-like receptors. Vitamin D also exerts a protective influence on SLE patients, as it is a defense against the damage caused by ultraviolet light, metalloproteases, heme oxygenase-1, prostaglandins, cyclooxygenase-2 and oxidative stress.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">On the other hand, different studies in SLE patients show deficiency or insufficiency in the serum vitamin D concentrations, which are correlated with disease activity. There is also a correlation with the season of the year, cumulative glucocorticoids and serum creatinine concentration.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> Similarly, there is evidence to support the notion of vitamin D deficiency as a possible risk factor for the development of SLE, and that supplementation with this vitamin could be useful for the prevention of SLE, or perhaps have a role in the treatment of SLE; even when added <span class="elsevierStyleItalic">in vitro</span>, vitamin D reverts several of the immunological abnormalities that characterize this disease.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> Vitamin D supplementation is indicated in patients with SLE for the management of the changes related to bone mineral loss and, in the case of deficiency, can help to reduce the severity of the disease expression.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Several vitamin D receptor gene polymorphisms have been reported and their relationship to lupus activity has been described. The variants associated with the onset of the disease are Bsml and Fokl, which appear to be conditional upon chronic infections and low serum vitamin D concentrations.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> Synthetic agonists of vitamin D receptor have antiproliferative, anti-inflammatory, immunomodulatory and antimicrobial properties. The use of these agonists will probably be an additional tool in the management of autoimmune diseases.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">With respect to RA, Cutolo et al. point out the changes in the serum vitamin D concentration and the increase in the severity of joint symptoms in patients with this disease. Specifically, they found that the lowest vitamin D concentration and the highest RA activity occur in winter. On the other hand, in susceptible populations, high vitamin D intake lowers the risk of developing RA and, in individuals who already have the disease, it reduces RA activity.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> Another study in RA patients reports an inverse relationship between intake of high-dose vitamin D and disease activity, and the stimulation of regulatory T lymphocyte proliferation and self-reactive T lymphocyte apoptosis have even been observed.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Other autoimmune diseases that have some relationship to vitamin D deficiency are Sjögren's syndrome,<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">25,26</span></a> Graves’ disease,<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> Hashimoto's thyroiditis, T1D,<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> MS,<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a> primary biliary cirrhosis<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> and myasthenia gravis.<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">31,32</span></a> Bellastella et al. found significantly lower serum vitamin D levels in the 3 types of autoimmune polyendocrine syndrome (type 1, T1D; type 2, Addison's disease + T1D; and type 3, autoimmune thyroid disease + T1D + another autoimmune disease), when compared with a control group, demonstrating a direct relationship between low levels of this vitamin and the presence of autoimmune disease.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">In conclusion: (1) vitamin D is a hormone with immunomodulatory properties that improves the innate immune response and induces self-tolerance in the acquired immune response; (2) there is epidemiological evidence suggesting that low vitamin D levels are related to the severity of several autoimmune diseases; (3) the dysfunction of the vitamin D receptor appears to be one of the molecular pathways associated with the increase in autoimmune diseases; and (4) there is limited evidence concerning vitamin D supplementation and autoimmune diseases; however, with the present studies, it is still difficult to understand the clinical utility of vitamin D, as well as its dosing and adequate treatment time.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: García-Carrasco M, Romero JLG. 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Giugliano" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s40618-014-0233-z" "Revista" => array:6 [ "tituloSerie" => "J Endocrinol Invest" "fecha" => "2015" "volumen" => "38" "paginaInicial" => "629" "paginaFinal" => "633" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25576459" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735743/0000001100000006/v1_201512160151/S2173574315001240/v1_201512160151/en/main.assets" "Apartado" => array:4 [ "identificador" => "17335" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Editorial" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/21735743/0000001100000006/v1_201512160151/S2173574315001240/v1_201512160151/en/main.pdf?idApp=UINPBA00004M&text.app=https://reumatologiaclinica.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574315001240?idApp=UINPBA00004M" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 4 | 6 | 10 |
| 2024 October | 58 | 37 | 95 |
| 2024 September | 80 | 15 | 95 |
| 2024 August | 84 | 40 | 124 |
| 2024 July | 67 | 34 | 101 |
| 2024 June | 90 | 38 | 128 |
| 2024 May | 77 | 28 | 105 |
| 2024 April | 58 | 29 | 87 |
| 2024 March | 67 | 25 | 92 |
| 2024 February | 91 | 30 | 121 |
| 2024 January | 47 | 33 | 80 |
| 2023 December | 40 | 27 | 67 |
| 2023 November | 51 | 35 | 86 |
| 2023 October | 53 | 26 | 79 |
| 2023 September | 122 | 49 | 171 |
| 2023 August | 61 | 18 | 79 |
| 2023 July | 78 | 28 | 106 |
| 2023 June | 81 | 29 | 110 |
| 2023 May | 85 | 34 | 119 |
| 2023 April | 60 | 15 | 75 |
| 2023 March | 124 | 26 | 150 |
| 2023 February | 138 | 42 | 180 |
| 2023 January | 86 | 26 | 112 |
| 2022 December | 122 | 27 | 149 |
| 2022 November | 107 | 44 | 151 |
| 2022 October | 87 | 36 | 123 |
| 2022 September | 67 | 33 | 100 |
| 2022 August | 70 | 46 | 116 |
| 2022 July | 77 | 32 | 109 |
| 2022 June | 62 | 42 | 104 |
| 2022 May | 73 | 44 | 117 |
| 2022 April | 99 | 56 | 155 |
| 2022 March | 103 | 61 | 164 |
| 2022 February | 103 | 40 | 143 |
| 2022 January | 91 | 34 | 125 |
| 2021 December | 61 | 45 | 106 |
| 2021 November | 52 | 48 | 100 |
| 2021 October | 58 | 54 | 112 |
| 2021 September | 63 | 44 | 107 |
| 2021 August | 60 | 55 | 115 |
| 2021 July | 218 | 59 | 277 |
| 2021 June | 63 | 46 | 109 |
| 2021 May | 75 | 55 | 130 |
| 2021 April | 146 | 136 | 282 |
| 2021 March | 136 | 35 | 171 |
| 2021 February | 58 | 33 | 91 |
| 2021 January | 52 | 29 | 81 |
| 2020 December | 55 | 21 | 76 |
| 2020 November | 53 | 26 | 79 |
| 2020 October | 31 | 18 | 49 |
| 2020 September | 54 | 36 | 90 |
| 2020 August | 32 | 26 | 58 |
| 2020 July | 21 | 25 | 46 |
| 2020 June | 39 | 25 | 64 |
| 2020 May | 45 | 23 | 68 |
| 2020 April | 49 | 27 | 76 |
| 2020 March | 22 | 12 | 34 |
| 2018 May | 4 | 0 | 4 |
| 2018 April | 178 | 8 | 186 |
| 2018 March | 72 | 9 | 81 |
| 2018 February | 29 | 10 | 39 |
| 2018 January | 40 | 11 | 51 |
| 2017 December | 52 | 13 | 65 |
| 2017 November | 74 | 15 | 89 |
| 2017 October | 56 | 14 | 70 |
| 2017 September | 44 | 15 | 59 |
| 2017 August | 33 | 18 | 51 |
| 2017 July | 47 | 33 | 80 |
| 2017 June | 49 | 30 | 79 |
| 2017 May | 76 | 15 | 91 |
| 2017 April | 49 | 47 | 96 |
| 2017 March | 49 | 44 | 93 |
| 2017 February | 32 | 37 | 69 |
| 2017 January | 60 | 18 | 78 |
| 2016 December | 134 | 19 | 153 |
| 2016 November | 107 | 24 | 131 |
| 2016 October | 97 | 25 | 122 |
| 2016 September | 93 | 28 | 121 |
| 2016 August | 67 | 22 | 89 |
| 2016 July | 33 | 13 | 46 |
| 2016 June | 2 | 0 | 2 |
| 2016 March | 1 | 0 | 1 |
| 2016 February | 1 | 0 | 1 |
| 2016 January | 0 | 86 | 86 |
| 2015 December | 3 | 23 | 26 |
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