Vitamin D in rheumatoid arthritis
Section snippets
Vitamin D physiology
Vitamin D exists in several forms, each with a different level of activity [1]. Technically vitamin D is classified as a seco-steroid. Seco-steroids are those in which one of the rings has been broken in this case by ultra violet B light (UV-B, sunlight). Calciferol is the most active form of vitamin D. Other forms are relatively inactive in the body [1]. Once vitamin D is produced in the skin or consumed in food, it requires chemical conversion in the liver and kidney to form 1,25
Vitamin D as an immunoregulatory hormone
The discovery of the vitamin D receptor (VDR) in the cells of the immune system and the fact that activated dendritic cells produce the vitamin D hormone suggested that vitamin D could have immunoregulatory properties [3]. VDR, a member of the nuclear hormone receptor superfamily, was identified in mononuclear cells, dendritic cells, antigen-presenting cells, and activated T-B lymphocytes [2], [3].
A physiological role for vitamin D in the immune system is supported by the presence of the VDR in
Vitamin D and autoimmune diseases
Autoimmune diseases are diseases where the immune system's ability to discriminate between self- and non-self tissue fails. People with diseases like multiple sclerosis (MS), arthritis, and inflammatory bowel diseases (IBD) have T cells that target self and drive the immune system to induce inflammation in the peripheral tissues. The causes of the inappropriate immune attacks are not known; however, it is clear that several risk factors play a role. Vitamin D status has been linked to
Vitamin D and rheumatoid arthritis
It is clear that both genetic and environmental factors affect prevalence of autoimmune diseases. Therefore, the fact that vitamin D has been implicated as a factor in several different autoimmune diseases suggests that vitamin D might be one of the environmental factor that among others normally participates in the control of selftolerance [2]. The significant role of vitamin D compounds as selective immunosuppressants is also illustrated by their ability to either prevent or markedly suppress
Conclusions
25(OH)D3 plasma levels seem inversely correlated at least with the RA disease activity showing a circannual rhythm. Low serum levels of vitamin D3 might be partially related, among other factors, to prolonged daily darkness, different genetic background (i.e. vitamin D receptor polymorphism) and nutritional factors, and explain to the latitute-related prevalence of autoimmune diseases such as RA, by considering the potential immunosuppressive roles of vitamin D.
Acknowledgements
The research was partially supported by the First executive programme of the cultural, educational, scientific, and technological cooperation between Italy and Estonia (2005–2008, program 5) and supported by the Ministry for Foreign Affairs of Italy and Culture, Education and Research of Estonia.
Take home messages
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The most evident effects of the D-hormone on the immune system seem to be in the control (dowregulation) of Th1-driven autoimmunity
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Latitude-related ecological features (i.e. different
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