Does vitamin D play a role in autoimmune endocrine disorders? A proof of concept

Abstract

In the last few years, more attention has been given to the "non-calcemic" effect of vitamin D. Several observational studies and meta-analyses demonstrated an association between circulating levels of vitamin D and outcome of many common diseases, including endocrine diseases, chronic diseases, cancer progression, and autoimmune diseases. In particular, cells of the immune system (B cells, T cells, and antigen presenting cells), due to the expression of 1α-hydroxylase (CYP27B1), are able to synthesize the active metabolite of vitamin D, which shows immunomodulatory properties. Moreover, the expression of the vitamin D receptor (VDR) in these cells suggests a local action of vitamin D in the immune response. These findings are supported by the correlation between the polymorphisms of the VDR or the CYP27B1 gene and the pathogenesis of several autoimmune diseases. Currently, the optimal plasma 25-hydroxyvitamin D concentration that is necessary to prevent or treat autoimmune diseases is still under debate. However, experimental studies in humans have suggested beneficial effects of vitamin D supplementation in reducing the severity of disease activity. In this review, we summarize the evidence regarding the role of vitamin D in the pathogenesis of autoimmune endocrine diseases, including type 1 diabetes mellitus, Addison's disease, Hashimoto's thyroiditis, Graves' disease and autoimmune polyendocrine syndromes. Furthermore, we discuss the supplementation with vitamin D to prevent or treat autoimmune diseases.

The Role of Vitamin D in the Immune System as a Pro-survival Molecule

“…The relationship between vitamin D-associated function and T-reg cells is a fundamental hallmark of autoimmune disease, in which vitamin D plays a major role. [141][142][143] Enhancement of CD4 þ CD25 þ Foxp3 þ T-reg cells occurs if following a long treatment with vitamin D supplementation in patients with systemic lupus erythematosus, leading to an increase in the Th2-type immune response. 144 Deficiency in vitamin D status leads to impairment of many T-reg cellmediated functions; for example, in the naive T-reg cell (ie, CD4 þ CD45RA þ Foxp3 low T cell subset).…”

“…The involvement of vitamin D in autoimmune diseases has been particularly debated, 141,147,148 involving concurrent causes such as sex 142,149 and steroid hormones. 150 Its immunomodulatory role might act on the NK cell levels and the Th1/Th2 ratio to control autoimmunity.…”

Hailey-Hailey disease successfully treated with vitamin D oral supplementation

“…Numerous different treatments have been proposed in literature reflecting the high rate of dissatisfaction to current available therapy options which are not particularly effective also because they may improve inflammation but do not treat the underlying cause (Engin et al, 2015). Several observational studies and meta-analyses demonstrated an association between circulating levels of vitamin D and outcome of many common diseases, including endocrine diseases, chronic diseases, cancer progression, and autoimmune disease, highlighting the complex and wide role of vitamin D (Altieri et al, 2017). Nb-ultraviolet B therapy, photodynamic therapy, laser therapy (carbon dioxide laser, 595 nm pulsed dye laser and CO2 laser) have also been reported (Chiaravalloti & Payette, 2014;Engin et al, 2015;Farahnik et al, 2017).…”

New light on an old vitamin: The role of the sunshine vitamin D in chronic disease

“…In fact, hypovitaminosis D seems to be related to several posttransplant complications that can affect both endocrine and metabolic aspects. Altieri and colleagues [25] will illustrate new insights into the pathogenesis of autoimmune diseases, emphasizing the role of vitamin D. Nettore and colleagues [26] will provide a nice overview of observational studies and of the mechanisms that may relate vitamin D to thyroid diseases followed by an excellent review on adrenal gland diseases and vitamin D by Tirabassi and colleagues [27]. Concluding Part 2 of the vitamin D guest issues, Batthoa and colleagues [28] illustrate the last evidence on the association on vitamin D and musculoskeletal health.…”