Il ruolo della vitamina D

nelle malattie infiammatorie

Palma Scolieri

UOC Medicina Interna e Reumatologia

PTP Nuovo Regina Margherita

Roma

Agenda

Vitamin D deficiency Vitamin D in systemic and organ-specific autoimmune diseases Vitamin D and immune regulation Vitamin D and inflammation/infection Vitamin D and rheumatic diseases Vitamin D and inflammatory bowel diseases Vitamin D and biologic therapy

Obtaining vitamin D from dietis still critical for mostvertebrates for their skeletalhealth.

Vitamin D deficiency

The major cause for vitamin Ddeficiency is the lack ofappreciation that sunexposure has been andcontinues to be the majorsource of vitamin D forchildren and adults of all ages.

Intestinal mucosa integrityfor both calcium andvitamin D absorption.

Agenda

Vitamin D deficiency Vitamin D in systemic and organ-specific autoimmune diseases Vitamin D and immune regulation Vitamin D and inflammation/infection Vitamin D and rheumatic diseases Vitamin D and inflammatory bowel diseases Vitamin D and biologic therapy

Vitamin D in autoimmune diseases

Epidemiological, genetic,and basic studies indicateda potential role of vitaminD in the pathogenesis ofcertain systemic and organ-specific autoimmunediseases. These studiesdemonstrate correlationbetween low vitamin D andprevalence of diseases.

In addition, VDRs'polymorphisms observed insome of these autoimmunediseases may furthersupport a plausiblepathogenic link.

Vitamin D deficiency Vitamin D in systemic and organ-specific autoimmune diseases Vitamin D and immune regulation Vitamin D and inflammation/infection Vitamin D and rheumatic diseases Vitamin D and inflammatory bowel diseases Vitamin D and biologic therapy

Agenda

Vitamin D in immune regulation

Vitamin D in immune regulation

Vitamin D in immune regulation

Vitamin D deficiency Vitamin D in systemic and organ-specific autoimmune diseases Vitamin D and immune regulation Vitamin D and inflammation/infection Vitamin D and rheumatic diseases Vitamin D and inflammatory bowel diseases Vitamin D and biologic therapy

Agenda

Vitamin D and inflammation/infection

118 voluntary females

Vit D CRP IL-1 IL-6 IL-8 IL-17 IFN TNF

The hypothesis proposes that lowvitamin D is the consequence of achronic inflammatory processcaused by persistent infection.

Vitamin D deficiency Vitamin D in systemic and organ-specific autoimmune diseases Vitamin D and immune regulation Vitamin D and inflammation/infection Vitamin D and rheumatic diseases Vitamin D and inflammatory bowel diseases Vitamin D and biologic therapy

Agenda

Vitamin D and Rheumatoid Arthritis

A correlation between the prevalence ofrheumatoid arthritis (RA) and latitude has beendescribed to confirm a potential associationbetween hypovitaminosis D and the risk of RA.

It has been observed that subjects with a highervitamin D intake have a lower risk of developingRA despite this finding has not been confirmedby subsequent studies.

A negative correlation between ultraviolet-B (UV-B)light exposure and the risk of developing RA hasbeen observed. Rossini M et al. Arthritis Res Ther 2010

Arkema EV et al. Ann Rheum Dis 2013Hitchon CA et al. J Rheumatol 2012

Vitamin D and Rheumatoid Arthritis

Vitamin D and Psoriatic Arthritis

Despite some exceptions attributable to better environmentalconditions in terms of sun exposure, low levels of vitamin Dwere found also in patients with psoriatic arthritis (PsA).

Some studies have also identified a correlation with the diseaseactivity.

Vitamin D and Spondiloarthritis

Although no association between hypovitaminosis D andspondyloarthritis (SA) has been found, some studies havedemonstrated a negative association between some diseaseactivity indices and serum levels of 25OHD and 1-25OHD.

A proteomic study has found a correlation between a vitamin Dmetabolite and the disease activity, even though the cause-effect relationship is not yet well-understood.

Lange U et al. Osteoporos Int 2001

Vitamin D deficiency Vitamin D in systemic and organ-specific autoimmune diseases Vitamin D and immune regulation Vitamin D and inflammation/infection Vitamin D and rheumatic diseases Vitamin D and inflammatory bowel diseases Vitamin D and biologic therapy

Agenda

Vitamin D and IBD

Vitamin D and IBD

Vitamin D and IBD

Vitamin D deficiency Vitamin D in systemic and organ-specific autoimmune diseases Vitamin D and immune regulation Vitamin D and inflammation/infection Vitamin D and rheumatic diseases Vitamin D and inflammatory bowel diseases Vitamin D and biologic therapy

Agenda

Vitamin D and biologic therapy

Vitamin D and biologic therapy

Factor OR 95% CI P value

Biologic therapy 4.61 1.9-11 0.001

Age 0.98 0.96-1.75 NS

Gender 0.83 0.34-1.75 NS

Disease group(rheumatic or IBD)

1.01 0.45-2.25 NS

MULTIVARIATE ANALYSIS

Vitamin D and biologic therapy

Clinical Gastroenterology and Hepatology 2016 (in press)

Conclusions - 1

Vitamin D is considered a steroid hormone with immuno-modulatory activities

Vitamin D is implicated in the prevention and protection against infections

Vitamin D plays a role in rheumatic diseases and inflammatory bowel diseases

Conclusions - 2

Patients with IBD and rheumatic diseases are at risk of developing vitamin D deficiency

Wether vitamin D deficiency worses disease severity or is merely is a consequence of severe disease should be still investigated

The subgroup of patients at higher risk for Vitamin D deficiencyshould be identified to prevent disease relapse and/or loss ofresponse to biologic therapy