Low Serum Vitamin D Levels and Recurrent Inflammatory Spinal Cord Disease

Abstract

Background: Low 25-hydroxyvitamin D levels have been associated with a higher risk of developing multiple sclerosis and increased relapse rates in patients with multiple sclerosis. As a sterol hormone involved in multiple immunologic pathways, vitamin D may play a role in preventing monophasic immune-mediated central nervous system attacks from developing into recurrent disease.Objective: To investigate the association between low serum vitamin D levels and recurrent spinal cord disease.Design, Setting, and Patients: We performed a retrospective analysis at Johns Hopkins Transverse Myelitis Center, Baltimore, Maryland, evaluating 25hydroxyvitamin D levels in 77 patients with monophasic and recurrent inflammatory diseases of the spinal cord.Main Outcome Measure: Levels of 25-hydroxyvitamin D.Results: Vitamin D levels are significantly lower in patients who developed recurrent spinal cord disease, adjusting for season, age, sex, and race. Conclusions:This study provides a basis for a prospective trial of measuring 25-hydroxyvitamin D levels in these patient populations and assessing the influence of vitamin D supplementation on the frequency of relapses in those with recurrent inflammatory spinal cord disease.

Reduced serum vitamin D levels in neuromyelitis optica

“…Whether this might lead to autoreactive B cell increase in the intrathecal compartment and OCB positivity in 25OH-VitD-deficient NMO patients requires to be investigated. In contrast with our findings recent studies have found no significant correlation with disease duration and vitamin D levels [3]. Potential reasons for this discrepancy are different patient inclusion criteria (e.g., recurrent transverse myelitis vs. NMO patients) and ethnic-geographical differences.…”

Reduced serum vitamin D levels in neuromyelitis optica

“…Whether this might lead to autoreactive B cell increase in the intrathecal compartment and OCB positivity in 25OH-VitD-deficient NMO patients requires to be investigated. In contrast with our findings recent studies have found no significant correlation with disease duration and vitamin D levels [3]. Potential reasons for this discrepancy are different patient inclusion criteria (e.g., recurrent transverse myelitis vs. NMO patients) and ethnic-geographical differences.…”

Low Levels of Vitamin D in Neuromyelitis Optica Spectrum Disorder: Association with Disease Disability

“…This paper showed that vitamin D levels were not correlated with length of time between disease onset and blood draw in patients with inflammatory spinal cord disease, of whom some were positive for NMO-IgG [13]. However, 25(OH)D 3 levels were related to disease duration in our patients, and in MS patients [22].…”

“…Recently, it was reported that vitamin D levels were lower in patients with recurrent transverse myelitis (TM) (n = 33; 61% AQP4-Ab positive) than in those with monophasic TM (n = 44; 0% AQP4-Ab positive) [13]. This paper showed that vitamin D levels were not correlated with length of time between disease onset and blood draw in patients with inflammatory spinal cord disease, of whom some were positive for NMO-IgG [13].…”

Immunopathogenesis in Myasthenia Gravis and Neuromyelitis Optica

“…As shown in the study by Alahgholi-Hajibehzad et al, vitamin D significantly increases the function of regulatory T cells (Treg) derived from patients with MG in vitro ( 80 ), and complete remission of severe refractory MG was reported after treatment with a massive-dose of vitamin D; however, this finding remains to be confirmed by additional high-quality clinical trials ( 81 ). According to Mealy et al, vitamin D levels are significantly lower in patients with recurrent spinal cord disease, mainly including NMO/NMOSD ( 82 ); the finding was reproducible in other NMO/NMOSD studies ( 83 – 86 ). Among these studies, a group from south China found that vitamin D levels were inversely correlated with disease-related disability, clinical activity, and prognosis ( 83 ); however, Thai, Turkish, and Korean groups did not observe a correlation ( 84 – 86 ).…”

Reduced serum vitamin D levels in neuromyelitis optica

“…Whether this might lead to autoreactive B cell increase in the intrathecal compartment and OCB positivity in 25OH-VitD-deficient NMO patients requires to be investigated. In contrast with our findings recent studies have found no significant correlation with disease duration and vitamin D levels [3]. Potential reasons for this discrepancy are different patient inclusion criteria (e.g., recurrent transverse myelitis vs. NMO patients) and ethnic-geographical differences.…”

Low Levels of Vitamin D in Neuromyelitis Optica Spectrum Disorder: Association with Disease Disability

“…This paper showed that vitamin D levels were not correlated with length of time between disease onset and blood draw in patients with inflammatory spinal cord disease, of whom some were positive for NMO-IgG [13]. However, 25(OH)D 3 levels were related to disease duration in our patients, and in MS patients [22].…”

“…Recently, it was reported that vitamin D levels were lower in patients with recurrent transverse myelitis (TM) (n = 33; 61% AQP4-Ab positive) than in those with monophasic TM (n = 44; 0% AQP4-Ab positive) [13]. This paper showed that vitamin D levels were not correlated with length of time between disease onset and blood draw in patients with inflammatory spinal cord disease, of whom some were positive for NMO-IgG [13].…”

Immunopathogenesis in Myasthenia Gravis and Neuromyelitis Optica

“…As shown in the study by Alahgholi-Hajibehzad et al, vitamin D significantly increases the function of regulatory T cells (Treg) derived from patients with MG in vitro ( 80 ), and complete remission of severe refractory MG was reported after treatment with a massive-dose of vitamin D; however, this finding remains to be confirmed by additional high-quality clinical trials ( 81 ). According to Mealy et al, vitamin D levels are significantly lower in patients with recurrent spinal cord disease, mainly including NMO/NMOSD ( 82 ); the finding was reproducible in other NMO/NMOSD studies ( 83 – 86 ). Among these studies, a group from south China found that vitamin D levels were inversely correlated with disease-related disability, clinical activity, and prognosis ( 83 ); however, Thai, Turkish, and Korean groups did not observe a correlation ( 84 – 86 ).…”

Reduced serum vitamin D levels in neuromyelitis optica

“…Whether this might lead to autoreactive B cell increase in the intrathecal compartment and OCB positivity in 25OH-VitD-deficient NMO patients requires to be investigated. In contrast with our findings recent studies have found no significant correlation with disease duration and vitamin D levels [3]. Potential reasons for this discrepancy are different patient inclusion criteria (e.g., recurrent transverse myelitis vs. NMO patients) and ethnic-geographical differences.…”

Low Levels of Vitamin D in Neuromyelitis Optica Spectrum Disorder: Association with Disease Disability

“…This paper showed that vitamin D levels were not correlated with length of time between disease onset and blood draw in patients with inflammatory spinal cord disease, of whom some were positive for NMO-IgG [13]. However, 25(OH)D 3 levels were related to disease duration in our patients, and in MS patients [22].…”

“…Recently, it was reported that vitamin D levels were lower in patients with recurrent transverse myelitis (TM) (n = 33; 61% AQP4-Ab positive) than in those with monophasic TM (n = 44; 0% AQP4-Ab positive) [13]. This paper showed that vitamin D levels were not correlated with length of time between disease onset and blood draw in patients with inflammatory spinal cord disease, of whom some were positive for NMO-IgG [13].…”

Immunopathogenesis in Myasthenia Gravis and Neuromyelitis Optica

“…As shown in the study by Alahgholi-Hajibehzad et al, vitamin D significantly increases the function of regulatory T cells (Treg) derived from patients with MG in vitro ( 80 ), and complete remission of severe refractory MG was reported after treatment with a massive-dose of vitamin D; however, this finding remains to be confirmed by additional high-quality clinical trials ( 81 ). According to Mealy et al, vitamin D levels are significantly lower in patients with recurrent spinal cord disease, mainly including NMO/NMOSD ( 82 ); the finding was reproducible in other NMO/NMOSD studies ( 83 – 86 ). Among these studies, a group from south China found that vitamin D levels were inversely correlated with disease-related disability, clinical activity, and prognosis ( 83 ); however, Thai, Turkish, and Korean groups did not observe a correlation ( 84 – 86 ).…”