Clinical impact of vitamin D treatment in cystic fibrosis: a pilot randomized, controlled trial

Abstract

BACKGROUND/OBJECTIVES: Vitamin D insufficiency in cystic fibrosis is common. Vitamin D3 is currently preferred over D2. We aimed to study the efficacy of vitamin D2 and D3 at increasing serum 25-hydroxyvitamin D (s25OHD) concentrations and their effect on respiratory health in cystic fibrosis. SUBJECTS/METHODS: Sixteen CF patients were randomized to receive vitamin D2 or D3 or to serve as controls. The starting dose of 5000 IU (o 16 years old) or 7143 IU/day (⩾16 years old) was further individually adjusted. Three months of intervention were followed by two of washout (ClinicalTrials.gov NCT01321905). RESULTS: To increase s25OHD, the mean daily dose of vitamin D2 and D3 had to be increased up to 15650 and 8184 IU, respectively. The combined group of vitamin D2 and D3 treated patients decreased plasma IL-8 (Po 0.05). Patients provided vitamin D3 improved FVC at the end of the trial (P o 0.05). Change in s25OHD was positively correlated with changes in the adult Quality-of-Life respiratory score at the end of supplementation (P = 0.006, r = 0.90), and with changes in FEV1 (P = 0.042, r = 0.62) and FVC (P = 0.036, r = 0.63) at one month of washout. CONCLUSIONS: Vitamin D supplementation may contribute to reduced inflammation and improved lung function in CF.

Vitamin D treatment modulates immune activation in cystic fibrosis

“…There were no statistically significant differences in the baseline demographics of the study groups, as reported previously . The pooled group of patients receiving D2 or D3 increased their tot‐s25OHD and free‐s25OHD concentrations at the end of intervention.…”

“…We speculate that D2 and D3 may both have some immunomodulatory effects, possibly affecting different pathways with different magnitude, which would speak in favour of using a combination supplement. In this pilot trial the average D2 daily dose was almost double the D3 dose, due to the lower efficacy of D2 at increasing s25OHD concentration . Local immunomodulatory effects of vitamin D in the gut are well documented , and may partially explain the difference between the effect of D2 and D3 on IgG levels.…”

“…As described previously , sixteen CF patients of age ≥ 6 years and with baseline total s25OHD (tot‐s25OHD) < 75 nmol/l were randomized to receive D2, D3 or to serve as controls. Thirteen patients completed the study and were analysed.…”

“…The weekly dose was given per os as seven once‐daily doses, and adjusted by tot‐s25OHD monitoring throughout the 3 months of intervention. The goal of the supplementation was to reach tot‐s25OHD > 100 nmol/l . There was no change in tot‐s25OHD levels in the control group .…”

Impact of nutritional status on pulmonary function after lung transplantation for cystic fibrosis

“…Exocrine pancreatic insufficiency (PI), 2 CF-related diabetes (CFRD) 3 and frequent intestinal dysbiosis, as well as intestinal inflammation, may contribute to malnutrition and deficiency of fat-soluble vitamins such as vitamin D. 4 Numerous studies have examined the association between nutritional status and lung function in CF patients prior to LT, and malnutrition has been identified as a key factor for worse prognosis. 5 Vitamin D deficiency has been associated with impaired lung function in non-transplanted CF patients, 6,7 and might be associated with an increased risk of rejection and infections after LT. 8 Subsequently, nutritional support has been shown to defer impairment of pulmonary function and improve survival in LT candidates. [9][10][11][12] However, data on the impact of nutritional status on lung function in LT recipients are limited.…”