Serum vitamin D level is associated with disease severity and response to ursodeoxycholic acid in primary biliary cirrhosis

Guo, Guanya; Shi, Yongquan; Wang, L.; Ren, Xiaochuan; Han, Zheyi; Guo, Changcun; Cui, Lina; Wang, J.-B.; Zhu, Jianfei; Wang, N.; Zhang, J.; Cai, Yunqiang; Han, Ying; Zhou, Xinmin; Fan, Daiming

doi:10.1111/apt.13244

Cited by 45 publications

(50 citation statements)

References 44 publications

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“…These findings are in contrast to a recent publication demonstrating that 25(OH)D concentrations were significantly associated with response to UDCA among patients with primary biliary cirrhosis, with lower concentrations of 25(OH)D observed in non-responders(40). The different study population and endpoints employed in that study may account for the contrasting results observed herein, as the primary findings of the UDCA trial revealed overall effect of the intervention on recurrent adenomas.…”

Section: Discussioncontrasting

confidence: 99%

Association between Circulating Vitamin D Metabolites and Fecal Bile Acid Concentrations

Jacobs

Haussler

Alberts

et al. 2016

Cancer Prevention Research

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While hydrophobic bile acids have been demonstrated to exhibit cytotoxic and carcinogenic effects in the colorectum, ursodeoxycholic acid (UDCA) has been investigated as a potential chemopreventive agent. Vitamin D has been shown to play a role in both bile acid metabolism and in the development of colorectal neoplasia. Employing a cross-sectional design, we sought to determine whether baseline circulating concentrations of the vitamin D metabolites 25(OH)D and 1,25(OH)2D were associated with baseline fecal bile acid concentrations in a trial of UDCA for the prevention of colorectal adenoma recurrence. We also prospectively evaluated whether vitamin D metabolite concentrations modified the effect of UDCA on adenoma recurrence. After adjustment for age, sex, BMI, physical activity, and calcium intake, adequate concentrations of 25(OH)D (> 30 ng/ml) were statistically significantly associated with reduced odds for high levels of total (OR=0.61; 95% CI=0.38-0.97), and primary (OR=0.61; 95% CI=0.38-0.96) bile acids, as well as individually with chenodeoxycholic acid (OR=0.39; 95% CI=0.24-0.63) and cholic acid (OR=0.56; 95% CI=0.36-0.90). No significant associations were observed for 1,25(OH)2D and high vs. low fecal bile acid concentrations. In addition, neither 25(OH)D nor 1,25(OH)2D modified the effect of UDCA on colorectal adenoma recurrence. In conclusion, this is the first study to demonstrate an inverse relationship between circulating levels of 25(OH)D and primary fecal bile acid concentrations. These results support prior data demonstrating that vitamin D plays a key role in bile acid metabolism, and suggest a potential mechanism of action for 25(OH)D in colorectal cancer prevention.

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Section: Discussioncontrasting

confidence: 99%

Association between Circulating Vitamin D Metabolites and Fecal Bile Acid Concentrations

Jacobs

Haussler

Alberts

et al. 2016

Cancer Prevention Research

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“…Patients with PBC normally suffer from itching and fatigue, regardless of disease severity[14,37,38]. Serum fat-soluble vitamin D deficiency may be detected, particularly in advanced PBC patients[39,40]. Metabolic bone disease includes osteoporosis and, more rarely, osteomalacia, which have been considered important complications of PBC[41,42].…”

Section: Risk Factorsmentioning

confidence: 99%

“…Malabsorption, steatorrhea, and fat-soluble vitamin D deficiency are uncommon, except in cases of advanced liver disease and long-standing, severe cholestasis[9,10,39,40,43]. In addition to vitamin D deficiency, as luminal bile acid levels in severe cholestasis are below the critical concentration required for micelle formation and subsequent lipid absorption, clinically-relevant fat-soluble vitamin (vitamin A, E and K) deficiencies may also exist in PBC[43].…”

Section: Fat-soluble Vitamin Deficiencymentioning

confidence: 99%

“…High Mayo risk score, low serum albumin level, and elevated total bilirubin have been shown to be independently related to vitamin D deficiency[43]. Baseline vitamin D deficiency was associated with severity of disease and response to UDCA treatment[39]. Serum 25(OH)D concentrations reduced with elevating histological grading of stage ( P = 0.029) and were inversely associated with serum bilirubin and alkaline phosphatase (ALP) concentrations in PBC[39].…”

Section: Fat-soluble Vitamin Deficiencymentioning

confidence: 99%

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Recent advances in the diagnosis and treatment of primary biliary cholangitis

Huang¹

2016

WJH

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Primary biliary cholangitis (PBC), formerly referred to as primary biliary cirrhosis, is an infrequent progressive intrahepatic cholestatic autoimmune illness that can evolve into hepatic fibrosis, hepatic cirrhosis, hepatic failure, and, in some cases, hepatocellular carcinoma. The disease itself is characterized by T-lymphocyte-mediated chronic non-suppurative destructive cholangitis and elevated serum levels of extremely specific anti-mitochondrial autoantibodies (AMAs). In this article, we will not only review epidemiology, risk factors, natural history, predictive scores, radiologic approaches (e.g., acoustic radiation force impulse imaging, vibration controlled transient elastography, and magnetic resonance elastography), clinical features, serological characteristics covering biochemical markers, immunoglobulins, infections markers, biomarkers, predictive fibrosis marker, specific antibodies (including AMAs such as AMA-M2), anti-nuclear autoantibodies [such as anti-multiple nuclear dot autoantibodies (anti-sp100, PML, NDP52, anti-sp140), anti-rim-like/membranous anti-nuclear autoantibodies (anti-gp210, anti-p62), anti-centromere autoantibodies, and some of the novel autoantibodies], histopathological characteristics of PBC, diagnostic advances, and anti-diastole of PBC. Furthermore, this review emphasizes the recent advances in research of PBC in terms of therapies, including ursodeoxycholic acid, budesonide, methotrexate, obeticholic acid, cyclosporine A, fibrates such as bezafibrate and fenofibrate, rituximab, mesenchymal stem cells transplant, and hepatic transplant. Currently, hepatic transplant remains the only optimal choice with acknowledged treatment efficiency for end-stage PBC patients.

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“…Their encouraging data from an independent cohort gave our previous findings a quickly validation, and further proved that vitamin D status may be closely related to disease progression and therapy outcome in primary biliary cirrhosis (PBC). 1,2 As mentioned by Bruns et al, the relationship between vitamin D level and PBC may involve a prognostic associated symptom -fatigue, which is also connected with hypovitaminosis D. Although existing data are limited to prove this linkage, it will be interesting to see whether some special physical conditions caused by disease will affect vitamin D level, and whether changes in vitamin D have an effect on disease in turn.…”

mentioning

confidence: 96%

Letter: serum vitamin D levels in primary biliary cirrhosis – authors’ reply

Guo

Shi

Han

et al. 2015

Aliment Pharmacol Ther

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Serum vitamin D level is associated with disease severity and response to ursodeoxycholic acid in primary biliary cirrhosis

Abstract: SUMMARY BackgroundSerum vitamin D levels are associated with bone complications in patients with primary biliary cirrhosis (PBC). Increasing evidence suggests a nonskeletal role of vitamin D in various autoimmune and liver diseases.

Cited by 45 publications

References 44 publications

Association between Circulating Vitamin D Metabolites and Fecal Bile Acid Concentrations

Association between Circulating Vitamin D Metabolites and Fecal Bile Acid Concentrations

Recent advances in the diagnosis and treatment of primary biliary cholangitis

Letter: serum vitamin D levels in primary biliary cirrhosis – authors’ reply

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