MUDr. Dana Maňasková


Vyhledávání na medicinman.cz
 

Idnikace a léčebné použití vitamínu D

Indikace podávání



Parkinsonova choroba

  • Inadequate levels of circulating vitamin D
    • Could lead to dysfunction in the substantia nigra
      • Degeneration occurs in parkinsonian disorders [29]
  • High prevalence of vitamin D deficiency
    • Reported in Parkinson’s patients
  • Parkinson
    • Associated with decreased bone mineral density [29]

Acne

  • Stimulates antimicrobial activity against Propionibacterium acnes (Youssef et al., 2011)
  • Suppresses development of Propionibacterium acnes–induced Th17 differentiation (Agak et al., 2014) [12]

VDR agonist administration

  • Has prevented and/or treated the disease process
    • Autoimmune diabetes (eg. NOD mice)
    • Systemic lupus erythematosis (SLE)
    • Experimental allergic encephalitis (EAE) (a model for multiple sclerosis)
    • Inflammatory bowel disease (IBD)
    • Prostatitis
    • Thyroiditis [24]

Inflammatory autoimmune diseases involve Th17 activation

  • Rheumatoid arthritis
  • Inflammatory bowel disease
  • Psoriasis [24]
  • Respond to 1,25(OH)2D3 and its analogs [24]
  • Number of these conditions are associated with bone loss
    • Directly (eg. inflammatory arthritis)
    • Indirectly
      • Increased serum levels of inflammatory cytokines [24]

Calcitriol is prescribed for

  • Hypocalcaemia
    • Hypoparathyroidism
    • Osteomalacia (adults)
    • Rickets (infants, children)
    • Renal osteodystrophy
    • Chronic kidney disease
  • Treatment of osteoporosis
  • Prevention of corticosteroid-induced osteoporosis

Vitamin D supplements and Cancer

  • Unclear if taking additional vitamin D in the diet or as supplements affects the risk of cancer
    • Evidence as "inconsistent, inconclusive
  • 2014 review
    • Supplements had no significant effect on cancer risk
    • Another 2014 review concluded that vitamin D3 may decrease the risk of death from cancer
    • Fewer death in 150 people treated over 5 years
  • Insufficient evidence exists to recommend vitamin D supplements for people with cancer
    • Some evidence suggests that low vitamin D may be associated with a worse outcome for some cancers [11]
    • Higher 25-hydroxy vitamin D levels at the time of diagnosis are associated with better outcomes [11]

Ekzém

  • Vitamin D enhances skin barrier functions
    • Modulating keratinocyte proliferation/differentiation and hair follicle cycles (Bikle et al., 2004; Hawker et al., 2007; Demay et al., 2007) [12]

Vitamin D supplements

  • Seem to have a positive impact on serum HDL-C levels
    • May be effective in reducing the risk of cardiovascular diseases in the long term [18]

Infectious diseases

  • Increases production of cathelicidin and beta-defensins (Gombart et al., 2005; Youssef et al., 2011) [12]

Infectious diseases and suppl. vitamin D

  • Activate the innate immune systems
  • Dampen the adaptive immune systems [11]
  • Supplementation slightly decreases the
    • Risk of respiratory tract infections
    • Exacerbation of asthma [11]
    • Evidence is lacking on whether it does so in children under 5 years of age [11]

Cardiovascular disease and vitamin D supplements

  • Does not meaningfully reduce the risk of stroke, cerebrovascular disease, cardial infarction, or ischaemic heart disease
  • May have no effect on blood pressure [11]
  • Pokud se podává pouze vápník a vitamín D, ektopické kalcifikace aterosklerotických plátů, šlach aj. se mohou vyskytovat častěji

Lupénka

  • Léčba lupénky kalcitriolem [1]


Melanoma

  • Promotes growth inhibition of melanoma cells (Evans et al., 1996) [12]

Nonmelanoma cancer

  • Inhibits the hedgehog signaling pathway (Bijlsma et al., 2006) [12]

Prevence osteoporozy a vitamin D supplementation

  • Older people with osteoporosis
    • vitamin D with calcium may help prevent hip fractures
    • Slightly increases the risk of stomach and kidney problems [11]
  • Supplementation with higher doses of vitamin D in older than 65 years
    • May decrease fracture risk [11]
  • Low serum vitamin D levels have been associated with
    • Falls
    • Low bone mineral density
    • Taking extra vitamin D, however, does not appear to change the risk [11]
  • Athletes who are vitamin D deficient
    • Increased risk of stress fractures
    • Major breaks
      • Particularly those engaging in contact sports [11]
  • Greatest benefit with supplementation
    • Athletes who are deficient (25(OH)D serum levels <30 ng/mL)
    • Severely deficient (25(OH)D serum levels <25 ng/mL)
    • Incremental decreases in risks
      • Rising serum 25(OH)D concentrations plateauing at 50 ng/mL
      • no additional benefits seen in levels beyond this point [11]

Psoriasis

  • Calcitriol in an ointment for the treatment of
    • vitamin D analogue calcipotriol (calcipotriene) is more commonly used
  • By mouth for the treatment of psoriasis and psoriatic arthritis [10]
  • Noncalcemic actions of calcitriol and other VDR-ligand analogs and their possible therapeutic applications has been reviewed [10]
  • Reduces expression of beta-defensins (Peric et al., 2009) [12]
  • Suppresses development of Th1 and Th17 cells (Prietl et al., 2013) [12]
  • Increases the ratio of Treg relative to Th17 cell population (Jeffery et al., 2009) [12]

Suplementaace

2013 review

  • Did not find any effect from supplementation on the rates of disease
    • Only tentative decrease in mortality in the elderly
  • Do not alter the outcomes for
    • Myocardial infarction
    • Stroke
    • Cerebrovascular disease
    • Cancer
    • Bone fractures
    • Knee osteoarthritis
  • Low vitamin D levels may result from disease rather than cause disease.[53]

A United States Institute of Medicine report

  • "Outcomes related to cancer, cardiovascular disease and hypertension, and diabetes and metabolic syndrome, falls and physical performance, immune functioning and autoimmune disorders, infections, neuropsychological functioning, and preeclampsia
    • Could not be linked reliably with calcium or vitamin D intake and were often conflicting" [11]

Transplantace

  • Experimental allograft models of the aorta, bone, bone marrow, heart, kidney, liver, pancreatic islets, skin, and small bowel
    • VDR agonists have shown benefit generally in combination with other immunosuppressive agents such as
      • Cyclosporine, tacrolimus, sirolimus, and glucocorticoids [24]
    • Reduction in infiltration of
      • Th1 cells
      • Macrophages
      • DC into the grafted tissue [24]
    • Associated with a reduction in chemokines
      • CXCL10
        • Ligand for CXCR3
        • May be of particular importance for acute rejection in a number of tissues [24]
      • CXCL9
        • Ligand for CXCR3
        • May be more important for chronic rejection in the heart and kidney [24]
      • CCL2
      • CCL5 [24]
  • Several retrospective studies in patients with renal transplants treated with 1,25(OH)2D3
    • Suggested benefit
      • Prolonged graft survival
      • Reduced numbers of acute rejection episodes [24]

Ostatní

  • Lupus/SLE
  • Arthritis
  • Scleroderma
  • Sarcoidosis
  • Sjogren’s
  • Autoimmune thyroid disease (Hashimoto’s, Grave’s)
  • Ankylosing spondylitis
  • Reiter’s syndrome
  • Uveitis
O úroveň výše

Poslední aktualizace: 17. 3. 2018 19:36:44