In this prospective controlled study, we examined 25 adults with adequately controlled (HbA1c level < 8.0%) type 1 diabetes mellitus (T1DM) and 49 conditionally healthy adults, intending to reveal the diversity of vitamin D metabolism in the setting of cholecalciferol intake at a therapeutic dose. All patients received a single dose (150,000 IU) of cholecalciferol aqueous solution orally. Laboratory assessments including serum vitamin D metabolites (25(OH)D3, 25(OH)D2, 1,25(OH)2D3, 3-epi-25(OH)D3 and 24,25(OH)2D3), free 25(OH)D, vitamin D-binding protein (DBP) and parathyroid hormone (PTH) as well as serum and urine biochemical parameters were performed before the intake and on Days 1, 3 and 7 after the administration. The studied groups had no significant differences in baseline parameters except that the patients with diabetes showed higher baseline levels of free 25(OH)D (p < 0.05). They also lacked a correlation between the measured and calculated free 25(OH)D in contrast to the patients from the control group (r = 0.41, p > 0.05 vs. r = 0.88, p < 0.05), possibly due to the glycosylation of binding proteins, which affects the affinity constant for 25(OH)D. The elevation of vitamin D levels after the administration of cholecalciferol was comparable in both groups, with slightly higher 25(OH)D3 levels observed in the diabetes group throughout the study since Day 1 (p < 0.05). Overall, our data indicate that in patients with adequately controlled T1DM 25(OH)D3 levels and the therapeutic response to cholecalciferol is similar to that in healthy individuals.
There is increasing data regarding the association between vitamin D and COVID-19. This study aimed to reveal the alterations of vitamin D metabolism in the setting of COVID-19. We examined 119 adult COVID-19 inpatients and 44 apparently healthy adult individuals with similar serum 25OH-D3 levels as a reference group. The assessment included serum biochemical parameters (total calcium, albumin, phosphorus, creatinine), parathyroid hormone (PTH), vitamin D-binding protein (DBP), vitamin D metabolites (25OH-D3, 25OH-D2, 1,25(OH)2D3, 3-epi-25OH-D3, 24,25(OH)2D3 and D3) and free 25OH-D. COVID-19 patients had in general very low vitamin D levels (median 25OH-D3 equals 10.8 ng/mL), accompanied by an increased production of the active vitamin D metabolite (1,25(OH)2D3), estimated as higher 1,25(OH)2D3 serum levels (61 [44; 81] vs. 40 [35; 50] pg/mL, p < 0.001) and lower 25OH-D3/1,25(OH)2D3 ratio (175 [112; 260] vs. 272 [200; 433], p < 0.001) which is presumably aimed at preventing hypocalcemia. Patients with COVID-19 also had elevated DBP (450 [386; 515] vs. 392 [311; 433] mg/L, p < 0.001) and low free 25OH-D levels (<LoB vs. 3.9 [3.2; 4.4] pg/mL, p < 0.001). Follow-up assessment of the COVID-19 inpatients showed recovery of the observed changes. Overall, hospitalized patients with an acute course of COVID-19 have not only very low levels of 25OH-D but also profound abnormalities in the metabolism of vitamin D regardless of the clinical course of the disease. These alterations might exacerbate existing vitamin D deficiency and its negative impact.
ОБОСНОВАНИЕ. Республика Тыва-регион с доказанным тяжелым природным йодным дефицитом и высокой распространенностью ЙДЗ (йододефицитных заболеваний). Однако в регионе в определенные периоды времени предпринимались меры по ликвидации дефицита йода в питании населения. В статье представлены результаты проведенного в октябре 2020 г. специалистами ФГБУ «НМИЦ эндокринологии» Минздрава России контрольно-эпидемиологического исследования, направленного на оценку современного состояния йодной обеспеченности населения Республики Тыва. Исследование проведено по поручению Министерства здравоохранения России в рамках государственного задания «Научная оценка необходимости принятия дополнительных нормативных правовых и иных мер по ликвидации йодного дефицита в пилотных регионах с тяжелым йодным дефицитом» (фрагмент, посвященный контрольно-эпидемиологическим исследованиям в регионе), «Эпидемиологические и молекулярно-клеточные характеристики опухолевых, аутоиммунных и йододефицитных тиреопатий как основа профилактики осложнений и персонализации лечения» (аналитический обзор мероприятий, предшествующих контрольно-эпидемиологическим исследованиям в регионе). ЦЕЛЬ. Оценка йодной обеспеченности населения Республики Тыва. МАТЕРИАЛЫ И МЕТОДЫ. Исследование проводилось в трех населенных пунктах республики-гг. Кызыл, Шагонар, п. Сарыг-Сеп. Обследованы 227 школьников допубертатного возраста (8-10 лет) с проведением сбора анамнеза, осмотра врача-эндокринолога, пальпации щитовидной железы, забора разовых образцов мочи в одноразовые микропробирки типа Эппендорф, с последующей заморозкой до-20-25 °С для дальнейшего определения концентрации йода в моче с помощью церий-арсенитного метода в лаборатории (клинико-диагностическая лаборатория ФГБУ «НМИЦ эндокринологии» Минздрава России). Кроме того, всем школьникам выполнено ультразвуковое исследование щитовидной железы (с использованием портативного ультразвукового аппарата LOGIQe (China) с мультичастотным линейным датчиком 10-15 МГц, в положении лежа). Рост и вес детей определялись по стандартной методике в момент обследования. Проведены сбор образцов пищевой соли, которая используется в семьях школьников, и определение наличия йодата калия в ней экспресс-методом. Родители школьников подписали информированные согласия на проведение обследования детей. Разрешение локального этического комитета ФГБУ «НМИЦ эндокринологии» Минздрава России получено 25 марта 2020 г., № 5. РЕЗУЛЬТАТЫ. Обследованы 227 школьников 8-10 лет. Определена медианная концентрация йода в моче, исследовано наличие йодата калия в пищевой соли и проведено ультразвуковое исследование щитовидной железы с целью уточнения йодной обеспеченности, охвата использования йодированной соли в питании и распространенности зоба. Медианная концентрация йода в моче составила 153 мкг/л, частота зоба-7,7%, доля йодированной соли-95,2%. ЗАКЛЮЧЕНИЕ. Показатель медианной концентрации йода в моче свидетельствует об оптимальной йодной обеспеченности населения Тывы. Частота зоба у школьников значимо снизилась по сравнению с данными, полученными в ходе предыд...
BACKGROUND: Graves' Orbitopathy (GO) — also known as Thyroid Eye Disease (TED) — is an autoimmune condition in the modern sense. It is closely associated with autoimmune thyroid diseases. Cytokine-mediated mechanisms play a critical part in immunopathogenesis of autoimmune thyroid diseases including GO. Investigating cytokine profiles as well as antibodies to tissue-specific antigens is essential for explaining GO pathogenesis and developing future therapeutic strategies.AIMS: The study examines serum levels of cytokines, autoantibodies and immunoglobulins IgG and IgG4 as mediators of autoimmune inflammation in patients with GO and Graves' Disease (GD).MATERIALS AND METHODS: The study included 52 patients (104 orbits) aged 25-70 years (mean age 48,8±12,3) in the active phase of GO and GD verified with the international diagnostic standards. These patients did not get any treatment for GO before. The control group consisted of 14 individuals (28 orbits) aged 30-68 years without known autoimmune disease.Serum levels of IgG, IgG4,TNFα, IL-1α, IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, IL-17A, IL-13, sIL-6R, sTNFα- RI и TNFα- R2 IL-2R, TGFβ1, TGF β3, antibodies to TSH-receptor, free T4, free T3 and TSH were measured. A diagnostic ultrasound exam of thyroid gland, multislice computed tomography (MSCT) / magnetic resonance imaging (MRI) of orbits were performed.RESULTS: Mean duration of GO prior to being admitted to the centre was 8,8±1,5 months (range: 1 — 48 months). According to the degree of thyrotoxicosis compensation: 24 patients were clinically euthyroid, TSH 3,3±0,7 mU/L, free T4 11,9±0,59 pmol/L, free T3 3,97±0,1 pmol/L; 28 patients were considered to have subclinical thyrotoxicosis: TSH 0,03±0,01 mU/L, free T4 14,2±1,0 pmol/L, free T3 5,77±0,49 pmol/L. Serum levels of sTNFα-R2 (p=0,041, p≤0,05), sIL-2R (p=0,020, p≤0,05), TGFβ1 (p=0,000, p≤0,001) were significantly higher in patients with GO compared to the control group. Serum levels of sTNFRα2 (p=0,038, p<0,05) and TGFβ1 (P=0,011, p≤0,05) were positively correlated with the duration of GO. The positive correlations between the serum level of sIL-6R (p=0,034, p≤0,05) and the severity of GO as well as between the serum level of sTNFα- R 1 (P=0,012, p≤0,05) and activity of GO were observed. 54% of patients had elevated concentration level of IgG4 in IgG ( >5%).CONCLUSION: High levels of soluble cytokine receptors sTNFα-R2 and sIL-2R and cytokine TGFβ1 in patients with long-standing untreated GO and GD being euthyroid or having subclinical thyrotoxicosis indicate activation of regulatory T cells aimed at suppressing autoimmune processes. High concentration level of IgG4 in IgG and cytokine TGFβ1 can determine the development of fibrotic changes in the orbital tissues. A decrease in the concentration of cytokine TGFβ1 can indicate an unfavorable course of the disease GO.
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