Vitamin D status predicts new brain magnetic resonance imaging activity in multiple sclerosis

Abstract

Objective We sought to determine if vitamin D status is associated with developing new T2 lesions or contrast-enhancing lesions on brain MRI in relapsing multiple sclerosis (MS). Methods EPIC is a five-year longitudinal MS cohort study at the University of California, San Francisco. Participants had clinical evaluations, brain MRI, and blood draws annually. From the overall cohort, we evaluated patients with clinically isolated syndrome or relapsing-remitting MS at baseline. In univariate and multivariate (adjusted for age, sex, ethnicity, smoking, and MS treatments) repeated measures analyses, annual 25-hydroxyvitamin D levels were evaluated for their association with subsequent new T2-weighted and gadolinium-enhancing T1-weighted lesions on brain MRI, clinical relapses, and disability (Expanded Disability Status Scale [EDSS]). Results 2,362 3T brain MRI scans were acquired from 469 subjects. In multivariate analyses, each 10 ng/mL higher 25-hydroxyvitamin D was associated with a 15% lower risk of a new T2 lesion (incidence rate ratio [IRR]= 0.85, 95% CI [0.76, 0.95], p=0.004) and a 32% lower risk of a gadolinium-enhancing lesion (IRR=0.68, 95% CI [0.53, 0.87], p=0.002). Each 10 ng/mL higher vitamin D level was associated with lower subsequent disability (−0.047, 95% CI [−0.091, −0.003], p=0.037). Higher vitamin D levels were associated with lower, but not statistically significant, relapse risk. Except for the EDSS model, all associations were stronger when the within-person change in vitamin D level was the predictor. Interpretation Vitamin D levels are inversely associated with MS activity on brain MRI. These results provide further support for a randomized trial of vitamin D supplementation.

Vitamin D Level in Multiple Sclerosis Patients. Could Vitamin D Level Be Routine Investigation for Multiple Sclerosis Patients?

“…• A longitudinal cohort study of 469 subjects with MS found that vitamin D levels were inversely associated with the risk of new T2-weighted or gadolinium-enhancing T1-weighted lesions on brain MRI [13].…”

“…A number of studies have found an inverse relationship between sun exposure, ultraviolet radiation exposure, or serum vitamin D levels, and the risk or prevalence of MS [7]- [12], while others have shown that serum vitamin D levels are inversely related to MS disease activity [13] [14].…”

Illuminating vitamin D effects on B-cells - the multiple sclerosis perspective

“…During relapses, serum 25(OH)D levels appeared to be lower, 71 and lower serum 25(OH)D levels have also been associated with an increased risk of relapses (Muris et al unpublished data) and new lesions on MRI. [79][80][81] A 50 nmol/l increase in 25(OH)D level has been calculated to result in a decrease in the relapse rate of 41-55%. 80,82 Furthermore, inverse correlations between 25(OH)D levels and the level of disability have been found.…”

1,25-Dihydroxyvitamin D3selectively and reversibly impairs T helper-cell CNS localization

“…Higher levels of circulating 25-hydroxyvitamin D 3 have been recently shown to correlate with a reduction in the number of new T2 and gadoliniumenhancing lesions (3). Moreover, the bioactive form of vitamin D, 1,25-dihydroxyvitamin D 3 [1,25(OH) 2 D 3 ], can completely prevent and treat established experimental autoimmune encephalomyelitis (EAE) (4), a murine MS model. Nonetheless, the mechanism of 1,25(OH) 2 D 3 ' s in vivo action remains incompletely understood.…”