Monday, 14 April 2014

Asthma in Vitamin D points of view

By Kyle J. Norton

The widespread of incidence of asthma over large 20 years in South East Asian population, specially in children and aging group has caused some concerns to the government and scientific community. It may be due to over intake in artificial ingredients, polluted environment as well as intake foods  triggering the inflammatory allergens.
Vitamin D is a fat-soluble secosteroids found in small amount in few foods, including salmon, mackerel, sardines and tuna. The vitamin plays an important role in modulation of cellular proliferation, apoptosis induction, tumor growth suppression and promotion in absorption of minerals, including calcium, iron, magnesium, phosphate and zinc.

1. Serum of vitamin D
Epidemiological studies, linking the levels of serum 25-OH vitamin D with asthma may be inconclusive. The study of included 4,999 adults aged 30-60 years in 1999-2001. 3,032 of those included at baseline also participated at a follow-up examination 5 years later and 3,727 answered a 10 year follow-up questionnaire, showed no association of serum serum 25-OH vitamin D and the risk of asthma in Danish adults(1)(1a). Some researchers in the study of general Korean population suggested that vitamin D-insufficiency may have an increased likelihood of atopic dermatitis, but not asthma, allergic rhinitis, or IgE sensitization(2)(2a). But the study by Royal Brompton Hospital, London indicated otherwise  of relationships between serum vitamin D, lung function, and pathology in children with severe, therapy-resistant asthma (STRA)(3)(4) and 25 hydroxy vitamin D insufficiency wass associated with bronchial asthma(4a) On the other hand, the study of iMayo Clinic indicated the correlation between serum 25(OH)D concentrations and positive pneumococcal antibody levels in all subjects regardless of asthma(5).

2. The benefits
According to the study by Universitätsmedizin Berlin, oral administration of vitamin D in vitamin D deficiency induced asthma, showed an increased expression of CD38 on B cells and a decreased T-cell-dependent proinflammatory cytokine production(6). In support to above study, Vitamin D found to decreased inflammatory cytokine production from T-cell subsets implicated in asthma, according to Florida Atlantic University(7). In patient with steroid-resistant (SR) and steroid-sensitive (SS) asthma, oral administration of vitamin D, although exerted its anti-inflammatory and corticosteroid-enhancing effects in monocytes of patients with SR asthma and patients with SS asthma, the responses to corticosteroids in patients with SR asthma remained significantly lower than those in patients with SS asthma(8). Other in the study of the effect of vitamin D in severe therapy-resistant asthma (STRA) patients, showed an positive effect of 1α,25-dihydroxyvitamin D3, the active form of vitamin D in culture enhanced dexamethasone-induced IL-10 (Defective IL-10 expression causes a significantly diminished levels of anti-inflammatory interleukin (IL)-10))without marked effects on IL-13 or IL-17A production(9). Patients with severe asthma exhibited increased levels of TH17 cytokines.The study of King's College London, also suggested that 1,25(OH)2D3 inhibits TH17 cytokine production in all patients with moderate-to-severe asthma(10), enhances the frequency of Treg cells(11)and upregulates CD200 on peripheral human CD4+ T cells(12).

Taken altogether, without going into reviews,  vitamin D used conjunction with other anti asthma medicine and its the active form 1α,25-dihydroxyvitamin D3, may be associated to reduced risk and treatment of asthmatic diseases.  Over doses of vitamin D supplement may cause excessive calcium absorption, calcification, Urinary stones etc. please make sure to follow the guideline of the Institute of Medicine of the National Academies.

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(1) The association of serum 25-OH vitamin D with atopy, asthma, and lung function in a prospective study of Danish adults by Thuesen BH1, Skaaby T, Husemoen LL, Fenger M, Jørgensen T, Linneberg A.(PubMed)
(1a) Vitamin d in pediatric inpatients with respiratory illnesses by Iqbal S1, Mosenkis EV, Jain P, Wiles A, Lerner J, Benton AS, Chamberlain JM, Freishtat RJ, Teach SJ.(PubMed)
(2) Low vitamin D levels are associated with atopic dermatitis, but not allergic rhinitis, asthma, or IgE sensitization, in the adult Korean population by Cheng HM1, Kim S2, Park GH3, Chang SE4, Bang S5, Won CH4, Lee MW4, Choi JH4, Moon KC(PubMed)
(2a) Vitamin D with asthma and COPD: not a false hope? A systematic review and meta-analysis By Zhang LL1, Gong J2, Liu CT3.(PubMed)
(3) Childhood asthma and vitamin D deficiency in Turkey: is there cause and effect relationship between them? Uysalol M1, Mutlu LC, Saracoglu GV, Karasu E, Guzel S, Kayaoglu S, Uzel N.(PubMed)
(4) Relationship between serum vitamin D, disease severity, and airway remodeling in children with asthma by Gupta A1, Sjoukes A, Richards D, Banya W, Hawrylowicz C, Bush A, Saglani S.(PubMed)
(4a) Serum 25 Hydroxy Vitamin D Insufficiency Associated with Bronchial Asthma in Lucknow, India by Awasthi S1, Vikram K.(PubMed)
(5) Serum 25-hydroxyvitamin D is associated with enhanced pneumococcal antibody levels in individuals with asthma by Lee J1, Zhao H, Fenta Y, Kita H, Kumar R, Juhn YJ.(PubMed)
(6) Oral vitamin D increases the frequencies of CD38+ human B cells and ameliorates IL-17-producing T cells by Drozdenko G1, Heine G, Worm M.(PubMed)
(7) Effect of vitamin D on T-helper type 9 polarized human memory cells in chronic persistent asthma by Keating P1, Munim A2, Hartmann JX2.(PubMed)
(8) Anti-inflammatory and corticosteroid-enhancing actions of vitamin D in monocytes of patients with steroid-resistant and those with steroid-sensitive asthma by Zhang Y1, Leung DY2, Goleva E3.(PubMed)
(9) Defective IL-10 expression and in vitro steroid-induced IL-17A in paediatric severe therapy-resistant asthma by Gupta A1, Dimeloe S, Richards DF, Chambers ES, Black C, Urry Z, Ryanna K, Xystrakis E, Bush A, Saglani S, Hawrylowicz CM.(PubMed)
(10) Enhanced production of IL-17A in patients with severe asthma is inhibited by 1α,25-dihydroxyvitamin D3 in a glucocorticoid-independent fashion by Nanzer AM1, Chambers ES, Ryanna K, Richards DF, Black C, Timms PM, Martineau AR, Griffiths CJ, Corrigan CJ, Hawrylowicz CM.(PubMed)
(11) The role of 1α,25-dihydroxyvitamin D3 and cytokines in the promotion of distinct Foxp3+ and IL-10+ CD4+ T cells by Urry Z1, Chambers ES, Xystrakis E, Dimeloe S, Richards DF, Gabryšová L, Christensen J, Gupta A, Saglani S, Bush A, O'Garra A, Brown Z, Hawrylowicz CM.(PubMed)
(12) 1α,25-dihydroxyvitamin D3 promotes CD200 expression by human peripheral and airway-resident T cells by Dimeloe S1, Richards DF, Urry ZL, Gupta A, Stratigou V, Farooque S, Saglani S, Bush A, Hawrylowicz CM.(PubMed)

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