Dissertationen zum Thema „Vitamin D Metabolism“

In addition to its established role in bone health, vitamin D (2S(OH)D) may also have a role in modulating immune function and early life development. Despite recent advances, there is a lack of consensus with regards to the optimal vitamin D cut-offs for multiple health outcomes and this uncertainty is further compounded by the wide measurement variability for the vitamin. Consequently, the work described in this thesis aimed to explore these areas of controversy. Using data from ongoing studies at the University of Ulster, a comparison study (n 131), of vitamin D status in the two most widely used methods (liquid chromatography mass spectrometry (LC-MS/MS) and enzyme immunoassay (ELISA)) of measurement was undertaken. Significant variation in definition of status was observed, with overestimation of vitamin D concentrations by ELISA >2S% compared to LC-MS/MS. In a second study, using LC-MS IMS, the vitamin D status and markers of bone health of a sample of older Irish adults (n 1936) form the Trinity, Ulster Department of Agriculture (TUDA) study was assessed. A total of 16% were vitamin D deficient «2Snmolll) and 42% were deemed to be insufficient (2S-S0nmolll). These levels of nonoptimal vitamin D concentrations were coupled with high rates of impaired bone health (31 % classified as osteopenic and 18% osteoporotic from BMD measures). A higher prevalence of impaired bone health and vitamin D inadequacy was observed in females compared to males while individuals who were vitamin D deficient or insufficient were significantly more likely to be osteoporotic than those who were sufficient (>SO nmol/l). These data provide additional evidence to support the recent 10M recommendation of a 2S(OH)D concentration of 50 nmol/l for optimal bone health. In a third study, the association between vitamin D status, immune markers of inflammation and the ratio of pro: anti-cytokines was investigated in a sub-sample of TUDA participants (n 998). Vitamin D was significantly correlated with pro-inflammatory markers and a 25(OH)D concentration >75nmol was associated with an improved inflammatory (profile as determined by the pro:anti cytokine ratio) compared to individuals with a 25(OH)D status <25 or 25-75nmol/l. In a fourth study, vitamin D status was assessed within a sample (n 260) of pregnant women from a sunny equatorial country (5degS) (Seychelles). Maternal vitamin D status was observed to be >75nmol/l through all sample periods of pregnancy and was significantly associated with higher birth weight and length with no apparent upper limit of effect. These results demonstrate the importance of optimal vitamin D status during pregnancy and the need for adequate dietary recommendations in order to achieve this level within far latitude populations that are exposed to low UVB sun light. In conclusion, the results within the current thesis suggest concentrations of vitamin D greater than recently recommended cut-offs for bone health (50nmol/l) are associated with extra-skeletal health benefits. Furthermore, consideration needs to be given to the current vitamin D dietary recommendations within the UK and Ireland in order to address the high level of deficiency observed in the older adult population and to achieve the optimal vitamin D concentration in terms of benefits for bone health, immune function and neonatal health outcomes for the whole population

Involvement of Cellular Retinoic Acid (CRABP) or Retinol (CRBP) Binding Proteins and 1,25-dihydroxyvitamin D₃ (1,25(OH)₂D₃) receptors in the response of cultured cells to retinoic acid and 1,25(OH)₂D₃ was examined. A new method for saturation analysis of CRABP and CRBP was applied to human tumors, human neuroblastoma cells, which retinoic acid causes to differentiate, and a bioselected subline resistant to retinoic acid. These data suggest that CRABP may not mediate cell differentiation by retinoic acid. In other studies, 1,25(OH)₂D₃ receptors and bioresponses were characterized in cultured primate cells. Rhesus monkey kidney cells (LLC-MK₂) were resistant to 1,25(OH)₂D₃-dependent induction of 25(OH)D-24-hydroxylase enzyme. The ED₅₀ in LLC-MK₂ cells was 10-100 fold higher than in other cultured cells. This resistance resulted from a low affinity receptor. Since the LLC-MK₂ variant receptor did not differ in size from the wild type rhesus 1,25(OH)₂D₃ receptor, (Mᵣ = 52 kDa) a subtle alteration in the receptor likely caused the decreased ligand affinity. Also of interest was the possible cellular resistance to 1,25(OH)₂D₃, in the owl monkey (Aotus trivurgatus), which generally occurs in new world primates. Owl monkey kidney (OMK) cells had the same content of receptors for 1,25(OH)₂D₃ and sensitivity to this hormone as cells from the rhesus monkey (old world primate). The ED₅₀ for induction of 24hydroxylase was 2-3 nM in both the OMK cells and the rhesus monkey fibroblasts. Both cells contained 2300 high affinity receptor molecules per cell, which bound DNA and were characterized by immunoblot as 52 kDa proteins. 1,25(OH)₂D₃ treatment increased the content of 1,25(OH)₂D₃ receptors in OMK cells, by increasing the synthesis of receptor mRNA. These data indicate the owl monkey is not resistant to 1,25(OH)₂D₃, unlike other new world primates. This finding was confirmed independently by demonstration that the owl monkey maintained mean serum 1,25(OH)₂D₃ levels (29 pg/ml) in the range of old world primates (33 pg/ml) and humans, in contrast to the elevated 1,25(OH)₂D₃ in other new world primates (97-129 pg/ml). This result suggests the alteration of 1,25(OH)₂D₃-endocrine dynamics in new world primates occurred subsequent to the evolutionary divergence of the owl monkey.

Includes bibliographical references (leaves 226-273.) Investigates the regulation of the expression of CYP27B1, CYP24 and vitamin D receptor (VDR) mRNA, both in the bone and in the kidney, with the aim to determine whether the regulation of the vitamin D metabolism in the bone is independent from that in the kidney. The effects of age, dietary calcium and vitamin D status on the expression of these genes in both the kidney and the bone, as well as on a number of biochemical factors known to regulate the renal metabolism of 1,25D, such as PTH, calcium and 1,25D itself, were examined. CYP27B1 mRNA expression was also studied in histological sections of rat femoral bone.

Kyoto University (京都大学)
0048
新制・課程博士
博士(農学)
甲第10900号
農博第1406号
新制||農||890(附属図書館)
学位論文||H16||N3911(農学部図書室)
UT51-2004-G747
京都大学大学院農学研究科食品生物科学専攻
(主査)教授 井上 國世, 教授 大東 肇, 教授 伏木 亨
学位規則第4条第1項該当

The CYP27B1 enzyme that synthesizes 1alpha,25-(OH) 2D, is expressed in chondrocytes, suggesting that local production of 1alpha,25-(OH)2D could play an autocrine or paracrine role in the differentiation of these cells. To test this hypothesis, we have engineered mutant mice that do not express the Cyp27b1 gene in chondrocytes. This led to increased width of the hypertrophic zone of the growth plate at E15.5, increased bone mass in neonatal long bones, and increased expression of the chondrocytic differentiation markers Indian Hedgehog and PTH/PTHrP receptor. VEGF mRNA levels were decreased, accompanied by decreased PECAM-1 immunostaining, suggesting a delay in vascularization. We have also engineered mice overexpressing a Cyp27b1 transgene in chondrocytes. The transgenic mice showed a partial mirror image phenotype compared to the tissue-specific inactivation model. These results support an autocrine/paracrine role of 1alpha,25-(OH) 2D in endochondral ossification and chondrocyte development in vivo.
The CYP24A1 enzyme is involved in the catabolic breakdown of 1alpha,25-(OH)2D but also synthesizes the 24R,25-(OH) 2D metabolite. Studies in chicken suggest a role for 24R,25-(OH) 2D in fracture repair. We induced stabilized transverse mid-diaphysial fractures of the tibia in four-month-old wild-type and Cyp24a1-deficient mice. Examination of the callus sections showed delayed hard callus formation in the homozygous mutant animals compared to wild-type littermates. RT-qPCR showed perturbed levels of type X collagen transcripts in mutant mice at 14 and 21 days post-fracture, reflecting the delayed healing. Rescue of the impaired healing by subcutaneous injection of 24R,25-(OH)2D3 normalized the histological appearance of the callus, static histomorphometric index and type X collagen mRNA expression, while 1alpha,25-(OH)2D 3 did not. These results show that Cyp24a1 deficiency delays fracture repair and strongly suggest that vitamin D metabolites hydroxylated at position 24, such as 24R,25-(OH)2D, play an important role in the mechanisms leading to normal fracture healing.

Para avaliar o efeito da suplementação parenteral com vitamina D sobre a sensibilidade à insulina, metabolismo oxidativo e energético, foram utilizados 29 cordeiros recém-nascidos, mestiços (Santa Inês x Dorper) e hígidos. Estes animais foram distribuídos em quatro grupos, DD- cordeiros filhos de ovelhas suplementadas com 70.000 UI/kg de vitamina D, pela via IM, no 108o dia da gestação e que também receberam suplementação com 24 horas de vida; DC cordeiros filhos de ovelhas suplementadas com a mesma dose e no mesmo dia de gestação e que não receberam vitamina D; CD- cordeiros filhos de ovelhas que não receberam vitamina, mas receberam vitamina D, pela via IM, na dose de 70.000 UI/kg no primeiro dia de vida; e CC- cordeiros filhos de ovelhas que não receberam vitamina D e que também não receberam suplementação vitamínica. Foram realizadas coletas de sangue aos dois (T0) e aos 28 (T1) dias de vida dos cordeiros para a determinação dos teores de ureia, creatinina, proteína total, albumina, colesterol, triglicérides, ácido úrico, cálcio total, cálcio iônico, AGNEs, BHB, glicose, cortisol, insulina, das vitaminas D e E e das atividades das enzimas CK, AST, GGT. Foram determinados os valores de RQUICK e RQUICK BHB. Do metabolismo oxidativo foram avaliados SOD, GSH-Px, HRFP, TBARS, TAS. Foi realizado também, teste de tolerância à glicose nos cordeiros com 30 dias de vida, e foram determinadas as áreas abaixo da curva para a glicose, BHB, AGNEs e insulina. Semanalmente os cordeiros foram pesados e o escore de condição corporal foi avaliado. A administração de vitamina D em cordeiros saudáveis foi eficiente em aumentar as concentrações plasmáticas da 25 hidroxivitamina D, porém não influenciou nas concentrações de ureia, creatinina, proteína total, AST, GGT, ácido úrico, cálcio total e cálcio iônico, colesterol, triglicérides, cortisol, insulina, AGNEs e BHB que que tiveram influência apenas do fator etário. Não influenciou o ganho de peso semanal nem o ECC dos cordeiros. O uso parenteral da vitamina D na ovelha, independente do seu uso no cordeiro aumentou a concentração plasmática de vitamina E e diminuiu a atividade da CK, no cordeiro. O uso parenteral de vitamina D no cordeiro, independente do uso na ovelha, reduziu a glicemia e aumentou a albumina sérica dos cordeiros; e agiu diminuindo a sensibilidade à insulina em cordeiros filhos de ovelhas que receberam suplementação vitamínica durante a gestação, independente da suplementação diretamente no cordeiro, quando avaliada pelo teste RQUICK BHB. O teste RQUICK não se mostrou efetivo em mensurar a sensibilidade a insulina nesse experimento. Quando desafiados pelo teste de tolerância à glicose, a suplementação de cordeiros com a vitamina D, sem haver suplementação prévia da ovelha, reduziu a sensibilidade insulínica destes indivíduos.
To evaluate the effect of parenteral supplementation with vitamin D on insulin sensitivity, oxidative and energetic metabolism, we used 29 newborns, crossbreed (Santa Inês x Dorper) and healthy lambs. These animals were divided into four groups, DD- lambs of sheep supplemented with 70,000 IU /kg of vitamin D, IM, on the 108th day of gestation and also received supplementation with 24 hours of life; DC - lambs of sheep supplemented with the same dose and on the same day of gestation and who did not receive vitamin D; CD- lambs from sheep that did not receive vitamin D but received vitamin D, by IM, at a dose of 70,000 IU / kg on the first day of life; and CC- lambs born to ewes who did not receive vitamin D and who also did not receive vitamin supplementation. Blood samples were collected at two (T0) and 28 (T1) days of life for determination of urea, creatinine, total protein, albumin, cholesterol, triglycerides, uric acid, total calcium, ionic calcium, AGNEs , BHB, glucose, cortisol, insulin, vitamins D and E and the activities of enzymes CK, AST, GGT. The values of RQUICK and RQUICK BHB were determined. From the oxidative metabolism were evaluated SOD, GSH-Px, HRFP, TBARS, TAS. Glucose tolerance test was also performed in lambs with 30 days of age, and the areas under the curve were determined for glucose, BHB, AGNEs and insulin. The lambs were weighed weekly and the body condition score was evaluated. The administration of vitamin D in healthy lambs was efficient in increasing the plasma concentrations of 25-hydroxyvitamin D, but did not influence the concentrations of urea, creatinine, total protein, AST, GGT, uric acid, total calcium and ionic calcium, cholesterol, triglycerides , cortisol, insulin, AGNEs and BHB that had influence only of the age. It did not influence the weekly weight gain or ECC of the lambs. The parenteral use of vitamin D in sheep, regardless of its use in lamb increased the plasma concentration of vitamin E and decreased CK activity in the lamb. The use of parenteral vitamin D in lamb, regardless of use in sheep, reduced glycemia and increased serum albumin in lambs; and decreasing insulin sensitivity in lambs of sheep that received vitamin supplementation during gestation, independent of supplementation directly in the lamb, when evaluated by the RQUICK BHB test. The RQUICK test was not effective in measuring insulin sensitivity in this experiment. When challenged by the glucose tolerance test, supplementation of lambs with vitamin D, without previous supplementation of the sheep, reduced the insulin sensitivity of these subjects

This PhD thesis describes the effects of Vitamin D on skeletal muscle and includes details of two main research projects. The first study validated a physiologically significant effect of VitD3 in proliferation, differentiation, protein synthesis and mitochondrial metabolism in primary human skeletal muscle cells, in cell culture. The second study demonstrated that VitD3 supplementation does not result in additional benefits on muscle strength, power, resting metabolic rate and body composition in VitD sufficient physically active adults.

In recent years, studies have investigated the clinical importance of VitD levels in human fertility, but little is known about how VitD impacts women undergoing IVF or reproductive cells at the molecular level. This study has demonstrated that VitD significantly impacts the development of blastocysts and key molecular pathways involved in steroidogenesis and cellular metabolism. In the future these findings could help us improve clinical procedures in IVF to optimise patient clinical outcomes.

We studied adaptive thermogenesis, both diet and cold-induced, in the setting of vitamin D status and leucine supplementation. Vitamin D supplementation did not increase fat loss, but higher 25OHD favoured metabolic flexibility. Cold exposure increased thermogenesis only in those with metabolic syndrome. Skin blood flow strongly predicted RMR and RQ. Leucine supplementation had no added effect, over caloric restriction but incidental improvements in 25OHD increased loss of fat mass and retained skeletal muscle mass.

The first three studies in this thesis address the mechanism for the aberrant fall in serum 1,25-dihydroxyvitamin D$ sb3$ (1,25-(OH)$ sb2$D$ sb3 rbrack$ and increase in renal 1,25-(OH)$ sb2$D$ sb3$-24-hydroxylase(24-hydroxylase) activity in X-linked hypophosphatemic mice (Hyp). The 24-hydroxylase is the first enzyme in the C-24 oxidation pathway that degrades the vitamin D hormone to its final inactivation product, calcitroic acid. We demonstrated that: (i) the aberrant increase in 24-hydroxylase activity in Pi-deprived Hyp mice is specific to the kidney and is the result of an increase in enzyme Vmax, immunoreactive protein and mRNA abundance; (ii) the increase in 24-hydroxylase mRNA in both Pi-deprived Hyp mice and 1,25-(0H)$ sb2$D$ sb3$-treated normal littermates can be ascribed to an increase in the transcriptional activity of the 24-hydroxylase gene; (iii) 24-hydroxylase transcripts in normal mice, Pi-deprived Hyp and normal mice and 1,25-(OH)$ sb2$D$ sb3$-treated normal mice are localized to the proximal tubule by in situ hybridization; and (iv) recombinant human growth hormone administration normalizes the aberrant increase in 24-hydroxylase but that this response is not sufficient to correct serum 1,25-(OH)$ sb2$D$ sb3$ levels in Pi-deprived Hyp mice.
The fourth study addresses the mechanism whereby EB 1089, an analogue of 1,25-(OH)$ sb2$D$ sb3,$ is less calcemic than the vitamin D hormone, while being more potent in its antiproliferative action. We demonstrate that: (i) EB 1089 has a 50-fold lower affinity than 1,25-(OH)$ sb2$D$ sb3$ for the vitamin D catabolic enzyme, 24-hydroxylase; and (ii) EB 1089 and 1,25-(OH)$ sb2$D$ sb3$ exhibit tissue-specific differences in vitamin D receptor-mediated responses in vivo that may be ascribed, at least in part, to differences in binding affinities for the vitamin D receptor.

Introdução Atualmente a osteoporose é a doença mais freqüente do metabolismo ósseo. Diversos nutrientes estão relacionados com a massa óssea, com destaque para o cálcio e a vitamina D. Apesar de 80 a 90% dos estoques de vitamina D serem provenientes da síntese cutânea, estudos mostram que mesmo em países ensolarados a deficiência de vitamina D é muito comum. Considerando que a dieta da população brasileira tem se mostrado muitas vezes inadequada com relação ao consumo do cálcio e vitamina D, a suplementação desses componentes pode ser necessária em indivíduos que apresentam alterações no metabolismo do cálcio e osso. Objetivo Avaliar o efeito da suplementação de cálcio e vitamina D em marcadores bioquímicos do metabolismo ósseo de mulheres na pós-menopausa com osteoporose. Métodos Esta dissertação é composta por 2 estudos: revisão sobre cálcio dietético e estudo de intervenção. Para revisão foram selecionados artigos publicados no Medline e Scielo nos últimos 10 anos, incluindo estudos realizados no Brasil. O estudo de intervenção foi do tipo ensaio clínico randomizado e controlado, pelo período de 90 dias. Foram avaliadas 64 mulheres com osteoporose na pós-menopausa randomizadas em dois grupos: Grupo 1 - Suplementação de cálcio (1200mg/dia) e vitamina D3 (400UI ou 10g/dia); Grupo 2 Controle. No início do estudo foi realizada a densitometria óssea (DXA) para diagnóstico da osteoporose e avaliação da composição corporal. Dados coletados no início e final do estudo incluiram: registro alimentar de 3 dias para avaliação da ingestão alimentar e soro para realização de exames bioquímicos (cálcio, fósforo, magnésio, PTH, 25(OH)D e BAP). Resultados O estudo de revisão descreveu fatores relacionados ao baixo consumo de cálcio como: hábito alimentar e alto custo dos alimentos. Como estratégias para melhorar o consumo destacam-se: esclarecer a população sobre a importância do nutriete; aumentar a disponibilidade; e o uso de suplementos em situações específicas. No estudo intervenção observou-se reduzido consumo de cálcio e vitamina D em mais de 90% das participantes. Além disso, 91,4% das participantes apresentaram vitamina D sérica consideradas sub-ótimas para saúde óssea. As concentrações séricas da 25(OH)D aumentaram significantemente (p=0,023) após 3 meses de suplementação. Porém, a dose utilizada apresentou efeito limitado uma vez que 86,2% do grupo suplementação não atingiu concentrações ótimas da 25(OH)D. Conclusão Considerando ingestão insuficiente de cálcio, bem como sua importância para a saúde óssea, estratégias nutricionais devem ser implementadas. A suplementação de cálcio e vitamina D elevou os níveis séricos da 25(OHD entretanto, a dose utilizada não foi suficiente para atingir as concentrações ótimas para manter a saúde óssea.
Background Osteoporosis is the most frequent disease of bone metabolism. Several nutrients are related to bone mass; the micronutrients of greatest importance are calcium and vitamin D. Although sunlight exposure is responsible for 80-90% of vitamin D storages, numerous studies conducted in sunny countries have observed a high prevalence of vitamin D insufficiency. Considering that, there is a significant proportion of the Brazilian population failing to achieve the recommended dietary calcium and vitamin D intakes, supplementation can be necessary for individuals with alterations on bone metabolism. Objective Evaluate the effect of calcium and vitamin D supplementation on bone metabolism in postmenopausal women with osteoporosis. Methods The present dissertation is composed of 2 studies: a review focuses on the dietary calcium and a clinical trial. For the review, articles published in Medline and Scielo in the past ten years were selected, including Brazilian studies. For the intervention, a 3-month controlled clinical trial with 64 postmenopausal women with osteoporosis was done. They were randomly assigned to either the supplement group, who received 1200mg of calcium and 400IU (10g) of vitamin D3, or the control group. Dietary intake assessment was performed, bone mineral density and body composition were measured, and blood was analyzed. At baseline, bone mineral density and body composition were measured by DXA, dietary data were collected and blood was analyzed (calcium, phosphorus, magnesium, PTH, 25(OH)D and BAP). At the end of the study, another blood exam and dietary intake assessment was performed. Results The review article aimed to described factors that can influence calcium absorption, the main methods used for evaluating calcium absorption and bioavailability, and strategies to optimize calcium intake. In the clinical trial, considering all participants at baseline, more than 90% of the subjects presented low calcium and vitamin D intakes. Besides, 91.4% of the participants presented sub-optimal vitamin D status (<75nmol/l). The concentration of serum 25(OH)D increased significantly (p=0.023) after 3 months of supplementation. However, the dose given was limited in effect, and 86.2% of the supplement group did not reach optimal levels of 25(OH)D. Conclusion in view of the low calcium intake, and the importance of this nutrient to bone health, nutritional strategies must be implemented. Calcium and vitamin D supplementation increased serum 25(OH)D, however the dose given (400IU/d) was not enough to achieve 25(OH)D concentration consider optimal for bone health.

Vitamin B6, or more specifically the active form pyridoxal 5ʹ-phosphate (PLP), plays a crucial role as a cofactor for numerous enzymes linked to carbohydrate, fatty acid, and amino acid metabolism. There is a high prevalence of moderate vitamin B6 deficiency in the population that may be further exacerbated through the ingestion of vitamin B6 antagonists present in the food supply. For example, flaxseed contains the anti-pyridoxine factor 1-amino D-proline (1ADP) in the form of a dipeptide called linatine. In order to address these issues, the current study was designed to: 1) characterize and quantify the total amount of anti-pyridoxine factors present in flaxseed through the use of UPLC/ESI-MS analysis, 2) investigate the in vivo effects of synthetic and flaxseed-derived 1ADP on amino acid metabolism using a rat model of moderate B6 deficiency, and 3) identify novel biomarkers of vitamin B6 inadequacy using a LC-Qtof-MS based non-targeted metabolomics approach. The total anti-pyridoxine content, measured as 1ADP equivalents, in the flaxseed extract was found to be 177-437 μg/g of whole flaxseed, depending on the variety tested. Plasma biochemical analyses revealed that B6 vitamers, particularly PLP concentrations were reduced (P≤0.001), due to 1ADP ingestion (10 mg/kg diet) irrespective of the sources. Oral ingestion of flaxseed-derived 1ADP in moderately vitamin B6-deficient rats increased plasma cystathionine (P≤0.001), and decreased plasma α-aminobutyric acid (P≤0.001) and glutamic acid (P=0.017) concentrations compared to the controls. However, the ingestion of synthetic 1ADP elicited greater perturbations in amino acid profile compared to the flaxseed-derived 1ADP, which was predominantly in the form of the dipeptide linatine. Additionally, oral ingestion of the synthetic as well as the flaxseed-derived 1ADP significantly (P≤0.05) inhibited the activities of hepatic PLP-dependent enzymes involved in transsulphuration reactions of methionine metabolism. The use of a non-targeted metabolomics approach identified ten potential lipophilic markers of vitamin B6-insufficiency: glycocholic acid, glycoursodeoxycholic acid, murocholic acid, N-docosahexaenoyl GABA, N-arachidonoyl GABA, lumula, nandrolone, orthothymotinic acid, cystamine and 3-methyleneoxindole. These data serve to highlight potential deleterious effects of anti-pyridoxine factors linked to flaxseed in a population at risk for moderate vitamin B6 deficiency.
October 2015

Vitamin D is a precursor to a steroid hormone, 1,25 dihydroxyvitamin D (1,25(OH)2D). After its discovery and the characterization of its receptor, the vitamin D receptor (VDR), it was initially thought only to be involved in calcium homeostasis, but further research revealed an important role for vitamin D in the regulation of cell growth and differentiation of such cells as osteoblasts and bone marrow adipocytes. 1,25(OH)2D has also been shown to be a strong inhibitor and pro-differentiator of keratinocytes. The anti-proliferative and pro-differentiative properties of this hormone have led to studies where 1,25(OH)2D anticancer properties were assessed and initial findings that showed a requirement of other factors beyond VDR to induce 1,25(OH)2D signaling led to the identification of the retinoid X receptor, a common heterodimeric partner for several hormone receptors. The focus of thesis was to further elucidate the structure-function relationship of both the vitamin D receptor and the retinoid X receptor. Additionally, contributions to work directed towards further identifying the effects of vitamin D on osteoblast differentiation and survival. Interactions of 1,25(OH) 2D3 with its cognate receptor, identifying a key amino acid (Tryptophan 286) required for ligand contact and transcriptional activation, are described in Chapter 2. Mechanisms of vitamin D action on mesenchymal stem cell differentiation, promotion of osteoblast induction and maturation, and inhibition of adipocyte differentiation, are eluicidated in Chapter 3. Chapter 4 illustrates the effects of RAS/RAF/Mitogen-activated protein kinase mediated RXRalpha phosphorylation on the three-dimensional structure of the RXR/nuclear receptor partner heterodimers. Furthermore, this chapter reveals the inhibitory effect of the phosphorylation of a critical amino acid (serine 260) on the interaction of the AF-2 domain of the RXR with several coactivators, resulting in a decrease in the signaling potential of multiple steroid hormone receptors. The findings of this thesis further the knowledge of several areas of vitamin D biology, including both the canonical areas of bone formation, and the non-canonical area of vitamin D and cancer.

Bakgrund: Det finns läkemedel som ger ökad risk för vitamin D-brist. En kartläggningsstudie av hur patientgrupper med olika riskläkemedel hanteras i Landstinget i Kalmar län har inte gjorts tidigare. En sådan studie är önskvärd, för att få en nulägesanalys och öka medvetenheten bland hälso-och sjukvårdspersonal om hur läkemedel påverkar D-vitaminstatus. Syfte: Syftet var att undersöka omfattningen av ordinerade riskläkemedel hos samtliga patienter, samt hos patientgruppen ≥75år och hur dessa handläggs avseende ordination av supplementering (samtidig behandling med läkemedel innehållande vitamin D3 / kalcium och vitamin D3,), provtagning och analysresultat avseende kalcidiol i serum. Metod: Riskläkemedel för vitamin D-brist identifierades. Inklusionskriterier för studien var patienter med de fördefinierade riskläkemedlen med ordinationer under 2012 och/eller 2013. Populationen som ingick i studien var patienter i Landstinget i Kalmar län. Data hämtades från patientdatasystemet Cambio Cosmic. Utifrån dessa data analyserades förekomst av supplementering, provtagning för S-25(OH)D kalcidiol och analyssvar. Materialet strukturerades efter respektive läkemedel avseende kön och ålder (≥75 år.) Resultat: 9118 individer ordinerades något av riskläkemedelen orlistat, sevelamer, kolestyramin, kolestipol, efavirenz, prednison, prednisolon, fenytoin, fenobarbital eller karbamazepin. 31% av patienterna som ordinerats riskläkemedel var ≥75 år. Totalt behandlades 22% med supplementationspreparat av de som ordinerats riskläkemedel. I åldersgruppen ≥75 år behandlades 43% med supplement. 61% av de supplementerade patienterna var ≥75 år. Totalt provtogs enbart 4,1% avseende kalcidiol av de som ordinerats riskläkemedel. Av dessa hade 37% av de provtagna en bristnivå av S-25(OH)D (≤50 nmol/L) vid första provtillfället. 57% av de som visade brist supplementerades. Endast 8,3% av de som hade en brist följdes upp med ytterligare en eller flera provtagningar. Av patienterna ≥75 år provtogs 4,1% av patienterna i åldersgruppen. Detta innebär att 31% av de som provtogs var ≥75år. 39% led brist. Av de patienter ≥75 år som hade led brist supplementerades 65% av individerna. Konklusion: Det finns förbättringsutrymme för implementering av kunskap kring riskläkemedel i Landstinget i Kalmar län.
Introduction: Some drugs increase the risk for vitamin D deficiency. To date, no survey has been performed in Kalmar County about how patients medicated with risk pharmaceuticals are handled. Such a survey would be desirable in order to increase knowledge among healthcare workers about how substances interfere with vitamin D status. Aim: The aim was to examine the extent to which risk pharmaceuticals are prescribed among all patients and among patients aged ≥75, and to investigate how these patients are treated with respect to supplementation (drugs containing vitamin D3 / Calcuim and vitamin D3), blood sampling and analysis of serum calcidiol levels. Method: Drugs interfering with vitamin D were identified. Inclusion criteria for the survey were patients that had been prescribed the pre-defined risk pharmaceuticals during 2012 and/ or 2013. The surveyed population was residents in Kalmar County. Data were collected from the patient database Cambio Cosmic. From these data analyzes were made about the occurrence of: supplementation, sampling of S-25(OH)D calcidiol and test results. The collected data were arranged by substance, gender and age (elderly aged ≥75). Results: 9118 patients were prescribed at least one of the risk pharmaceuticals; orlistat, sevelamer, cholestyramine, colestipol, efavirenz, prednisol, prednison, phenytoin, phenobarbital or carbamazepine. 31% of these were aged ≥75. Overall, 22% of the patients were prescribed supplements. Out of these, 61% were elderly. Among the patients that had been prescribed risk pharmaceuticals a minority, 4,1% of the patients were sampled for calcidiol. 37% of these had deficiency in S-25(OH)D (≤50 nmol/L). 8.3% of patients with a vitamin D deficiency were sampled more than once. Out of the patients with deficiency 57% were treated with supplements. Out of the elderly patients prescribed risk pharmaceuticals, 4.1% of the patients were tested for calcidiol. This means that 31% of the tested patients were aged ≥75 and 39% of these had a deficiency. Out of the elderly patients with deficiency, 65% were treated with supplements. Conclusion: In Kalmar County, much can be done in order to better implement the existing knowledge about drugs that increase the risk for vitamin D deficiency.
Betydelsen av bra D-vitaminstatus för äldres hälsa – Hur stor är förekomsten av D-vitaminbrist hos äldre i Kalmar län och hur påverkar läkemedel D-vitaminstatus

La VD (VD) est impliquée dans de nombreux processus physiologiques, dont le contrôle de certains paramètres de la biologie du tissu adipeux, son site principal de stockage. Ainsi elle y exerce des effets anti-inflammatoires et métaboliques forts, mais de nombreux aspects de ces régulations n’ont jamais été étudiés. Le but de cette thèse est d’avancer dans la connaissance de l’interrelation entre la VD, le tissu adipeux et l’obésité.Dans un premier temps, nous avons donc mis en évidence que la VD limitait l’expression de 3 miRs (miR-146a, miR-150 et miR-155) en inhibant la voie de signalisation NF-κB, in vitro et in vivo, au niveau du tissu adipeux et de l’adipocyte, lors d’un stress inflammatoire. Ensuite, nous avons mis en évidence que la VD modulait l’expression génique de certaines enzymes impliquées dans son propre métabolisme au niveau du tissu adipeux et de l’adipocyte et que la cubiline était impliquée dans l’absorption de la 25(OH)D au niveau des adipocytes. De plus, nous avons montré qu’un régime riche en graisse pendant 4 jours, 7 et 11 semaines engendrait une modulation de la concentration plasmatique de certains métabolites de la VD ainsi que des ARNm de certains acteurs impliqués dans le métabolisme de la VD, suggérant un stockage de la VD sous forme de 25(OH)D dans le tissu adipeux. Enfin, un retour à l’état basal des niveaux d’expressions géniques au niveau du tissu adipeux des différents acteurs mis en jeu dans le métabolisme de la VD ainsi que les dosages plasmatiques et adipocytaires dee métabolites de la VD a été mis en évidence chez les souris ayant subi une prise puis une perte de poids, démontrant ainsi la réversibilité des résultats
Vitamin D (VD) is involved in many physiological processes, including the control of parameters of adipose tissue biology, its main storage site. Thus, it exerts strong anti-inflammatory and metabolic effects, but many other aspects of this regulation have never been studied. The aim of this thesis is to advance in the knowledge of the interrelation between VD, adipose tissue and obesity.Firstly, we have therefore demonstrated that VD limits the expression of 3 miRs (miR-146a, miR-150 and miR-155) by inhibition of NF-κB signaling pathway, in vitro and in vivo, in adipose tissue and adipocyte, during inflammatory stress. We showed that VD modulated gene expression of enzymes involved in its own metabolism in adipose tissue and adipocyte, during a treatment of VD, in vivo and in vitro, known only in the liver and kidney. Moreover, the involvement of cubiline in 25(OH)D uptake in adipocytes has been demonstrated. Then, we showed that a high fat diet for 4 days, 7 and 11 weeks leads to a modulation of plasma concentration of VD metabolites as well as mRNAs of some actors involved in VD metabolism, suggested a possible storage of VD under 25(OH)D form in adipose tissue. Finally, the effect of weight gain induced by a high-fat diet followed by a return to a control diet was studied in mice. The levels of gene expression in the adipose tissue of the actors involved in VD metabolism as well as the plasma and adipocyte dosages of VD and its metabolites show a return to the basal state in mice having undergone weight loss. These results demonstrate the reversibility of changes induced by an obesogenic diet on VD metabolism

Uvod: Hepatička osteodistrofija je termin koji obuhvata metaboličke bolesti kosti udružene sa hroničnim bolestima jetre. U alkoholnoj cirozi (AC) jetre postoji visoka zastupljenost deficijencije vitamina D proporcionalna stepenu disfunkcije jetre, ali njena uloga u patogenezi hepatičke osteodistrofije nije dovoljno objašnjena. Nivo 25(OH)D odražava status vitamina D. Kod AC jetre izmenjena je metabolička aktivnost kosti i suprimirano je formiranje kosti što dovodi do smanjenja koštane mase. U centru interesovanja je postizanje optimalnog statusa vitamina D. Stavovi o suplementaciji vitaminom D kod AC jetre nisu jasno definisani. Cilj rada: Utvrditi nivo vitamina D, ispitati metaboličku aktivnost kosti i mineralnu gustinu kosti kod bolesnika sa AC jetre. Utvrditi efekte suplementacije sa 1000 IU vitamina D3 na dan tokom godinu dana u odnosu na metaboličku aktivnost kosti i mineralnu gustinu kosti kod ispitivanih bolesnika. Bolesnici i metode: Istraživanje je sprovedeno na Klinici za gastroenterologiju i hepatologiju Kliničkog centra Vojvodine u Novom Sadu kao prospektivna intervencijska studija sa primenom suplementacije sa 1000 IU vitamina D3 na dan kod bolesnika sa AC jetre. Grupu bolesnika koja je uključena u istraživanje (1) činilo je 70 bolesnika muškog pola sa dijagnozom AC jetre. Bolesnici su imali četiri pregleda (P), odnosno tačke studije: P1-uključivanje bolesnika i započinjanje suplementacije vitaminom D; P2, P3 i P4 posle tri, šest i dvanaest meseci suplementacije vitaminom D, redom. Prilikom svakog pregleda rađene su analize funkcije jetre, metabolizma kosti i statusa vitamina D. Na početku (P1) i na kraju istraživanja (P4) vršeno je merenje mineralne gustine kosti (BMD) DXA metodom. Gubitak bolesnika od P1 do P4 bio je dvadeset, na različitim tačkama studije. Prvi deo istraživanja odnosi se na Grupu bolesnika koja je uključena u istraživanje (1) i završila prvi pregled (P1). Pedeset bolesnika je završilo kompletno istraživanje po predviđenom protokolu i oni se zbog realizacije svih pregleda i ponovljenih merenja posmatraju kao: Grupa bolesnika koja je završila istraživanje (2). Rezultati: (1): Kod bolesnika sa AC jetre utvrđena je deficijencija vitamina D, snižen nivo osteokalcina, normalni nivoi CrossLapsa, PTH, ukupnog i jonizovanog kalcijuma, fosfora i magnezijuma. Osteopeniju je imalo 42,65% a osteoporozu 14,71% ispitanika. Kod svih ispitanika najniži BMD izmeren je na vratu femura. (2): Suplementacija vitaminom D dovela je do značajnog porasta 25(OH)D. U odnosu na osteokalcin konstatovana je pozitivna razlika vrednosti P1/P4, iako je nivo ostao ispod donje granice normale. Kod nivoa CrossLapsa i PTH razlika P1/P4 je negativna, ali su nivoi u sva četiri merenja u okviru referentnih vrednosti. Na lumbalnoj kičmi došlo je do poboljšanja BMD za 0.87%, a pogoršanja su na vratu femura -1.87 % i kuku -1.65%. Konstatovano je i poboljšanje funkcije jetre. Zaključci: Kod bolesnika sa AC jetre poboljšanje statusa vitamina D dovodi do povećanja formiranja kosti i poboljšanja koštane mase na lumbalnoj kičmi. Neophodno je određivanje statusa vitamina D kod svih bolesnika sa AC jetre i uvođenje suplementacije vitaminom D kod bolesnika koji imaju nivo 25(OH)D < 80 nmol/l, uz tromesečne kontrole efekta. Kod postavljanja dijagnoze AC jetre potrebno je inicijalno određivanje BMD. Kod suplementacije vitaminom D nakon inicijalnog DXA pregleda sledeći se preporučuje nakon jedne do dve godine.
Introduction: The term Hepatic osteodystrophy defines a group of metabolic bone diseases associated with underlying chronic liver disease. Alcoholic liver cirrhosis (ALC) is characterized by high incidence of vitamin D deficiency that is proportional to the level of liver failure; however, its role in the pathogenesis of hepatic osteodystrophy has not yet been fully elucidated. The level of 25(OH)D best reflects the vitamin D status. ALC is characterized by changed bone metabolic activity and suppressed bone formation, resulting in the decrease in bone mass. The key topic of interest is the achievement of optimal vitamin D status. The attitude of health professionals towards vitamin D supplementation in alcoholic liver cirrhosis has not yet been clearly defined. The aim of the research: Determining of vitamin D levels, investigating the metabolic activity of the bone and bone mass in patients with alcoholic liver cirrhosis (ALC); Determining the effects of vitamin D3 supplementation at the dose 1000 IU/day during a one-year period in relation to metabolic activity of the bone and bone mineral density (BMD) in the investigated patient population. Patients and methods: The research was conducted at the Clinic for Gastroenterology and Hepatology of the Clinical Centre of Vojvodina in Novi Sad. The research was designed as a prospective interventional study implicating vitamin D3 supplementation at the dose 1000 IU/day to patients with ALC. The investigated patient population (1) encompassed 70 male patients diagnosed with ALC. The patients underwent four examinations (P), that is, research phases: P1 – inclusion of the patient into the study and introduction of vitamin D supplementation; P2, P3 and P4 after 3, 6 and 12 months of vitamin D supplementation treatment, respectively. Each examination included the analysis of liver function, bone metabolism and vitamin D status. At the beginning (P1) and at the end (P4) of the investigation period, bone mineral density (BMD) was measured by means of dual-energy x-ray absorptiometry (DXA) method. Twenty patients dropped out from the research at different stages throughout the investigation period (P1 to P4). The first part of the investigation pertains to the Group of patients who were included into the study (1) and completed the first examination (P1). Fifty patients have completed the entire research according to the foreseen protocol encompassing all examinations and repeated measurements. These patients are considered a Group of patients who completed the research (2) Results: (1): In ALC patients, vitamin D deficiency and decreased osteocalcin levels were established, as well as normal levels of CrossLaps, PTH, total and ionized calcium, phosphorus and magnesium. Osteopenia and osteoporosis were established in 42.65% and 14.71% of patients, respectively. The lowest BMD was measured in the femoral neck in all patients. (2): Vitamin D supplementation resulted in significant increase in 25(OH)D. Analysis of osteocalcin level revealed positive P1/P4 difference, even though the level remained below the lower normal limit. The levels of CrossLaps and PTH revealed negative P1/P4 difference; however, the levels determined at all four measurements were within the reference values. An improvement of BMD for 0.87% was established in lumbar spine, whereas a decrease was noticed in femoral neck (1.87%) and hip (1.65%). Furthermore, an improvement of liver function was established. Conclusions: Improvement of vitamin D status in ALC patients results in an increase of bone formation and improvement of body mass in lumbar spine. Determining the vitamin D status in all patients with ALC is of outmost importance, as well as the vitamin D supplementation of patients with levels of 25(OH)D < 80 nmol/l along with the monitoring of treatment outcome at three-month intervals. Establishment of the diagnosis of alcoholic liver cirrhosis should encompass initial measurement of BMD. In case of vitamin D supplementation treatment, the initial DXA examination should be repeated after the period of one to two years.

Pregnancy due to several factors may predispose women to insufficient and poor sleep quality. Sleep is an important regulator of body metabolism and energy homeostasis. Vitamin D, along with its classical action in mineral homeostasis plays an important role in metabolic regulation. Both sleep deprivation and vitamin D deficiency have been linked independently and separately to hyperglycemia and pathogenesis of type 2 diabetes. To date, the potential association between sleep, vitamin D level and glycemic level in pregnancy have received little attention. This study aimed to investigate the relationship between subjectively and objectively measured night-time sleep duration and quality, vitamin D level and glucose homeostasis in pregnancy and birth outcomes. Forty-two women were enrolled in this study. Maternal blood glucose, insulin and 25 (OH)D were measured at 24-28 weeks of pregnancy. Sleep outcomes were measured using Actigraphy, the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS). Birth outcomes were extracted from medical records post-delivery. The results of this study showed that low serum levels of 25(OH)D levels are associated with longer sleep duration while blood glucose levels and insulin resistance and secretion are associated with poorer sleep outcomes, including daytime dysfunction, sleep efficiency and sleep disturbances. Our findings confirmed the association between vitamin D level and sleep and glucose homeostasis during pregnancy.Furthermore,we found that, sleep duration greater than 8 hours in the second trimester of pregnancy and pre-pregnancy BMI are associated with shorter gestational duration. Maternal 25(OH)D level is associated with the 5-minute APGAR score. Our findings add to the existing literature on the role of vitamin D deficiency and its association with APGAR scores, though further studies are needed to establish causation.

Vitamin D has been connected with increased intramyocellular lipid (IMCL) mitochondrial function in skeletal muscle. It is also shown to prevent lipotoxicity in several tissues, but this has not yet been examined in skeletal muscle. Perilipin 2 (PLIN2), a lipid droplet protein upregulated with vitamin D treatment, is integral to managing IMCL capacity and lipid oxidation in skeletal muscle. Increased lipid storage and oxidation is associated with increased tolerance to a hyperlipidic environment and resistance to lipotoxicity. Therefore, I hypothesized that vitamin D increases β-oxidation and lipid turnover though a PLIN2 mediated mechanism, thereby preventing lipotoxicity. This hypothesis was divided into two specific aims: 1) Characterize the effect of vitamin D and PLIN2 on lipid turnover and β-oxidation in mature myotubes, and 2) Determine the role of vitamin D and PLIN2 in regulating key markers of lipotoxicity. To address these aims, cells were treated with or without vitamin D, palmitate, and PLIN2 siRNA in an eight group, 2x2x2 design. Key experiments included quantitative real time polymerase chain reaction for markers of lipid accumulation, lipolysis, and lipotoxicity; Seahorse oxygen consumption assay; 14C-palmitate oxidation assay; and analyses of lipid accumulation and profile. Failure of the palmitate treatment to produce a reliable model for lipotoxicity resulted in negative data for Aim 2 of this dissertation and a focus on vitamin D and PLIN2 knockdown treatments as a four group, 2x2 model. Aim 1 showed that vitamin D reliably increases markers of lipolysis and lipid accumulation. Most of these markers were in turn decreased after PLIN2 knockdown, and DGAT2 exhibited an interaction effect between the two treatments. Contrary to our hypothesis and some published research, PLIN2 knockdown did not prevent lipid accumulation. Vitamin D increased oxygen consumption, especially consumption driven by mitochondrial complex II. PLIN2 knockdown decreased oxygen consumption and demonstrated an interaction effect specific to mitochondrial complex II. Data in this dissertation show that vitamin D increases mitochondrial function, and these effects are at least in part accomplished through a PLIN2 mediated mechanism. However, this work lacks the data required to make specific claims regarding β-oxidation and lipid turnover. This research is some of the first to show that PLIN2 knockdown carries negative impacts for skeletal muscle mitochondria and makes valuable contributions to general knowledge of how vitamin D and lipid storage impact muscle health and function. This ultimately provides additional evidence to advocate for vitamin D supplementation as a means of improving musculoskeletal health and function. Future research should investigate how vitamin D and PLIN2 impact markers of lipotoxicity in skeletal muscle.

Little is known about the mechanisms of vitamin D actions in the brain and bone. In this study, the metabolism of vitamin D and its regulation in various cell cultures of the nervous and skeletal systems were examined. Human osteosarcoma Saos-2 cells, human primary osteoblasts (hOB) and murine motor neuron-like NSC-34 cells were found to express mRNA for all enzymes required in vitamin D3 metabolism as well as the vitamin D receptor (VDR) that mediates vitamin D actions. Also, production of 24,25-dihydroxyvitamin D3 was found in these cells. Studies on vitamin D metabolism in NSC-34 cells and in primary neuron-enriched cells from rat cerebral cortex indicate formation of a previously unknown major metabolite formed from 25-hydroxyvitamin D3. Evaluation of the NSC-34 cells suggests that this cell line could be a novel model for studies of neuronal vitamin D metabolism and its regulation by endogenous and exogenous compounds. Treatment with glucocorticoids down regulated mRNA expression for the CYP24A1 gene in Saos-2 and hOB cells. Additionally, the glucocorticoid prednisolone showed suppression of CYP24A1-mediated metabolism and CYP24A1 promoter activity in Saos-2 cells. In NSC-34 cells, CYP24A1 mRNA levels were up-regulated by prednisolone, 1α,25-dihydroxyvitamin D3 and its synthetic analogues, EB1089 and tacalcitol. Formation of an endogenous glucocorticoid, 11-deoxycortisol, was observed in Saos-2 cells. Effects of glucocorticoids on the vitamin D system in bone cells may contribute to the adverse side effects in long-term treatment with glucocorticoids. Also, there may be a correlation between the administration of corticosteroids and adverse effects in the CNS. Expression and effects of vitamin D on steroidogenic enzymes were studied in primary neuron-enriched rat cortex cells, primary rat astrocytes and human neuroblastoma SH-SY5Y cells. These different cell cultures all expressed CYP17A1, whereas only astrocytes expressed 3β-hydroxysteroid dehydrogenase (3β-HSD). 1α,25-Dihydroxyvitamin D3 suppressed mRNA levels and enzyme activity of CYP17A1 in SH-SY5Y cells and astrocytes. 1α,25-Dihydroxyvitamin D3 suppressed enzyme activity and mRNA levels of 3β-HSD in astrocytes. The results suggest that vitamin D-mediated regulation of CYP17A1 and 3β-HSD may play a role in the nervous system. The results presented here contribute to our understanding of vitamin D metabolism and effects of glucocorticoids in the brain and bone.

Age-related macular degeneration (AMD) is the leading cause of severe visual impairment and blindness in the developed world. The exact pathogenesis of AMD is unknown, however, in common with cardiovascular disease, AMD may be underpinned by chronic inflammatory processes which lead to prolonged activation of both resident and recruited macrophage-like microglial (MG) cells. Vitamin D is a prohormone which can be produced in the skin following exposure to UVB radiation. It can also be obtained from dietary sources such as oily fish and from supplements. The main circulating metabolite, 25-hydroxyvitamin D (250HD) is used to assess vitamin D status, whilst the biologically active metabolite, 1,25-dihydroxyvitamin D (1,25(OHhD) is responsible for exerting the physiological effects of vitamin D in target tissues. The main physiological role of vitamin D is in maintaining skeletal health, however, it has been suggested that vitamin D deficiency may be associated with several other health outcomes including CVD and AMD. The current study established a gold standard UPLC/MS/MS assay and used this to determine the 250HD levels of an elderly European population originally recruited to investigate the prevalence and risk factors for AMD (EUREYE). Analysis determined that no association was present between 250HD levels and late AMD in this cohort. Additionally, DNA from EUREYE subjects was used for genotyping analysis of 93 SNPs and 112 haplotypes located across 7 genes believed to be involved in the vitamin D metabolic pathway. When vitamin D status confounders were adjusted for in a linear regression model, the homozygous minor allele genotype for rs1491718 and rs16847050 in the GC gene, together with seven haplotypes in the GC gene, one in the RXRA gene and one in the CYP2R1 gene, were found to be significantly associated with 250HD levels. Further, 1,25(OH)2D3 was found to exert no significant effect on lipopolysaccharide-induced cycloxygenase-2 expression or inducible nitric oxide synthase expression or activity in the BV2 microglial cell line.

Most of the load-bearing demand placed on the human body is transduced by skeletal tissue, and the capacity of the skeleton to articulate in various opposing directions is essential for body movement and locomotion. Consequently, cartilage and bone defects due to trauma, disease, and developmental abnormalities result in disabling pain and immobility for millions of people worldwide. A novel way of promoting cartilage and bone regeneration is through the incorporation of either primary cells or multipotent progenitor cells in a three-dimensional (3D) biomaterial scaffold, and/or the addition of exogenous growth and differentiation factors. The first part of this study reports a protocol for using freshly isolated mature chondrocytes seeded in a 3D hydrogel biomaterial scaffold, developed to explore mechanotransduction of engineered cartilage constructs cultured in a designed bioreactor. The bioreactor was designed to allow the application of physiological mechanical forces (compression and fluid flow), as well as a non-invasive/non-destructive method for analyzing regenerating tissue in real time through ultrasound transducers and a computerized monitoring system. In the second part of this study, an engineered immortalized osteoprecursor cell line, designated OPC1 (osteoblastic precursor cell line 1), was used as a culture model system for exploring the effects of exogenous growth and differentiation factors, mainly vitamin D, on early bone development. OPC1 was previously designed to provide a consistent reproducible culture system for direct comparisons of engineered bone constructs, evaluating bone development and cell/biomaterial interactions, and for investigating putative bone differentiating factors. One of the objectives of this research effort was to explore tissue development and regeneration by culturing OPC1 in the presence of vitamin D metabolites vitaD3 and 1,25OH2D3, while assaying the concomitant biological response. Results indicate that OPC1 is capable of metabolizing the parental metabolite vitaD3, and thus 25OHD3, to the active vitamin D form 1,25OH2D3. The metabolism of vita3 resulted in an anti-proliferative and pro-differentiative influence on OPC-1. These results support the hypothesis that extra-endocrine synthesis of 1,25OH2D3 functions in a tissue specific manner to regulate growth and differentiation, in addition to the classic calcimic actions of the vitamin D endocrine pathway. Understanding the influence of vitamin D on bone development will have significant implications on healthy aging, including the susceptibility to skeletal disorders involved in development and aging, such as osteoarthritis (OA) and osteoporosis.

Introdução - O receptor de vitamina D (VDR) é expresso em vários tecidos e quando este se encontra na sua forma ativada, modula a expressão de diversos genes. Esses incluem variações dos níveis circulantes de 1,25(OH) 2 D , variações na densidade mineral óssea, secreção e sensibilidade à insulina em resposta à glicose, suscetibilidade à diabetes tipo 1 e 2, obesidade, dislipidemias e hipertensão arterial. Atualmente, evidências têm sugerido o envolvimento da vitamina D com a síndrome metabólica. Objetivo - Investigar a concentração sérica da vitamina D e sua relação com a síndrome metabólica e avaliar a potencial associação entre estes fatores com a presença de polimorfismos no gene do receptor de vitamina D (VDR) em indivíduos adultos. Métodos - Trata-se de um estudo transversal, onde foram avaliados 372 indivíduos adultos. Foram coletadas amostras sanguíneas para dosagens laboratoriais da 25(OH)D 3 , PTH e exames bioquímicos relacionados à SM, além disso foram realizadas avaliações antropométricas (peso, altura, IMC). A síndrome metabólica (SM) foi classificada usando o critério proposto pelo National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III). A resistência a insulina foi estimada pelo cálculo de HOMA IR e a função da célula pelo cálculo de HOMA . A 25(OH)D foi dosada por HPLC e a insuficiência foi determinada pelo ponto de corte da curva Roc (52,6nmol/l). Foram avaliados também PTH intacto e cálcio sérico. Os polimorfismos BsmI e FokI foram detectados através da digestão das enzimas de restrições específicas para cada polimorfismo e confirmados através da técnica PCR alelo específico (ASPCR) ou amplificação de mutação refratária (ARMs) nos indivíduos com e sem SM (52 por cento vs. 48 por cento , respectivamente). A análise estatística inclui construção da curva ROC, teste T de Student, testes de correlação, teste de equilíbrio de Hardy-Weinberg, ANOVA, regressão logística binária (Odds Ratio). Estas análises foram conduzidas no software SPSS para Windows, versão 18 e p < 0,05 foi considerado significante. Resultados - A idade média dos participantes foi 51(15) anos, o IMC médio 29(6) kg/m 3 2 e 48 por cento apresentaram SM. Como esperado, os 3 indivíduos com SM apresentaram maiores valores de idade 57(12) anos, IMC 32(6) Kg/m , circunferência de cintura 103(13) cm, pressão sistólica 138(17) mmHg e diastólica 83(10) mmHg, glicemia de jejum 98(12) mg/dl, triglicérides 165(76) mg/dl, índices HOMA-IR 2.2(1.7) e 116(95), e menores valores de colesterol HDL colesterol 41(11) mg/dl. Com relação às concentrações séricas de 25(OH)D propostas pela análise da curva ROC, 43 por cento dos indivíduos com SM e 57 por cento dos indivíduos sem SM apresentam insuficiência desta vitamina. Correlações entre 25(OH)D 3 3 com PTH (r = -0.153; p = 0.005) e com circunferência da cintura (r = -0.106; p = 0.05) foram observada em todos os participantes. Considerando os polimorfismos do gene VDR, nos pacientes com SM, não houve associação entre o polimorfismo BsmI e os componentes da SM, HOMA e IR, 25(OH)D e PTH. No entanto, indivíduos sem SM, mas com homozigose para polimorfismo BsmI (genótipo recessivo bb ), apresentaram concentrações mais baixas de 25(OH)D 3 3 do que aqueles com o genótipo BB normal. Além disso, os indivíduos com SM e heterozigose para o polimorfismo FokI (genótipo Ff) têm maiores concentrações de PTH e HOMA do que aqueles com genótipo normal FF. Nesse mesmo grupo, os indivíduos com o genótipo recessivo ff têm maior resistência à insulina do que aqueles com genótipo Ff. Por outro lado, os pacientes sem SM, mas carregando o genótipo Ff, apresentaram maiores concentrações de triglicerídeos e baixos níveis de HDL do que aqueles com genótipo FF. A presença de um alelo f no genótipo (Ff ou ff) é, aparentemente, o suficiente para aumentar os níveis de triglicérides e resistência à insulina, quando comparados ao genótipo normal FF. Conclusão - Os resultados demonstram que o polimorfismo FokI no gene VDR associa-se a resistência à insulina e maiores concentrações de PTH em pacientes que apresentam SM. Além disso, o polimorfismo BsmI associa-se a menores concentrações de 25(OH)D em indivíduos sem SM. Portanto, esses novos dados indicam que polimorfismos no gene do VDR estão associados a diferentes fenótipos dos componentes da SM
Introduction - The vitamin D receptor (VDR) is expressed in many tissues and when it is in its activated form modulates the expression of several genes. These include changes in circulating levels of 1,25(OH)2D3, variations in bone mineral density, sensitivity and secretion of insulin in response to glucose, susceptibility to type 1 and 2 diabetes mellitus, obesity, dyslipidemia and hypertension. Currently, evidences have suggested the involvement of vitamin D with the metabolic syndrome. Objective - To investigate the serum concentrations of vitamin D and its relationship with metabolic syndrome (MS) and to evaluate the potential association between these factors with the presence of polymorphisms in vitamin D receptor gene in individuals adults. Methods - This is a cross-sectional study, which evaluated 243 adults and elderly. We collected blood samples for measurements of 25(OH)D3, iPTH, biochemical tests related to MS, and anthropometric evaluation (weight, height, BMI) were also assessed. MS was classified using the criteria proposed by the National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III). Insulin resistance and cell secretion were estimated by calculating HOMA IR and HOMA , respectively. The 25(OH)D3 was measured by HPLC and insufficiency was determined by the Roc curve cut-off (52.6 nmol/L). Intact PTH and serum calcium were also evaluated. The BsmI and FokI polymorphisms were detected by enzymatic digestion with specific enzymes and confirmed by allele specific PCR (ASPCR) or amplification of refractory mutation (ARM) in individuals with or without MS (52 per cent vs. 48 per cent , respectively). Statistical analyses include construction of Roc curves, Student T test, correlation tests, Hardy-Weinberg test, ANOVA, binary logistic regression (odds ratio), and TwoStep Cluster. These analyses were conducted with SPSS for Windows, version 18 and p < 0.05 was considered significant. Results - The mean age of participants was 51(15) years, mean BMI was 29(6) kg/m2, and 48 per cent of individuals presented MS. As expected, subjects with MS showed higher values of age (57(12) years), BMI was 32(6) kg/m2, waist circumference was 103(13) cm, systolic blood pressure was 138(17) mmHg, diastolic was 83(10) mmHg, fasting glucose was 98(12) mg/dl, triglycerides was 165(76) mg/dl, HOMA-IR was 2.2(1.7), HOMA was 116(95), and lower levels of HDL cholesterol was observed (41 mg/dl(11)). With respect to serum 25(OH)D3 proposed by ROC curve analysis, 43 per cent of individuals with MS and 57 per cent of individuals without MS presented insufficiency of this vitamin. Correlations between 25(OH)D3, iPTH (r = -0,153, p = 0.005), and waist circumference (r = -0,106, p = 0.05) were observed in all participants. Considering the VDR gene polymorphisms, in patients with MetSyn, there is no association among BsmI polymorphism and components of MetSyn, HOMA IR and , 25(OH)D3, and PTH. However, subjects without MetSyn, but with homozygosis for BsmI polymorphism (recessive bb genotype), presented lower levels of 25(OH)D3 than those with normal BB genotype. In addition, individuals with MetSyn and heterozygosis for FokI polymorphism (Ff genotype) have higher concentrations of PTH and HOMA than those with normal FF genotype. In this same group, subjects with the recessive ff genotype have higher insulin resistance than those with Ff genotype. On the other hand, patients without MetSyn, but carrying the Ff genotype, have higher concentration of triglycerides and lower levels of HDL than those with FF genotype. Interestingly, the presence of one allele f in the (Ff or ff) genotype is apparently enough to increase triglycerides levels and insulin resistance, when compared to the normal FF genotype. Conclusion - The results show that FokI polymorphism in the VDR gene is associated to insulin resistance and higher concentrations of PTH in patients with MetSyn. Moreover, BsmI polymorphism is related to a lower concentration of 25(OH)D3 in individuals without MetSyn. Therefore, the results indicated that VDR gene polymorphisms are associated to different phenotypes of MetSyn components

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Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)
Objetivo: avaliar a associação entre deficiência de vitamina D e os marcadores de risco para síndrome metabólica (SM) em mulheres na pós-menopausa. Métodos: Realizou-se estudo clínico de corte transversal com 466 mulheres, idade entre 45-75 anos, atendidas em Hospital Universitário. Foram incluídas mulheres em amenorréia >12 meses e idade ≥ 45 anos, sem uso de medicações ou condições clínicas que interfiram nos valores da vitamina D e sem doença cardiovascular estabelecida. Foram coletados dados clínicos, antropométricos e laboratoriais [colesterol total (CT), HDL, LDL, triglicerídeos (TG), glicose, insulina e 25(OH) vitamina D]. Foram consideradas com SM as mulheres que apresentaram três ou mais critérios diagnósticos: circunferência da cintura (CC) > 88 cm; TG  150 mg/dL; HDL colesterol < 50 mg/dL; pressão arterial  130/85 mmHg; glicose  100 mg/dL. Foi considerada deficiência de vitamina D valores séricos de 25(OH)D < 30ng/mL. Para análise estatística foram empregados o teste t-student, a Distribuição Gama (variáveis assimétricas), teste do Qui-quadrado e a regressão logística (odds ratio-OR). Resultados: Valores suficientes de vitamina D foram detectados em 148 pacientes (31,8%) e deficientes em 318 pacientes (68,2%). As mulheres com baixos valores séricos de 25(OH)D eram mais velhas, com maior tempo de menopausa e apresentavam maiores valores de colesterol total, triglicerídeos, insulina e HOMA-IR (p<0.05). A SM foi diagnosticada em 57,9% (184/318) das mulheres com hipovitaminose D e em 39,8% (59/148) com valores de 25(OH)D suficientes (p=0.003). Na análise de risco ajustado para idade, tempo de menopausa e índice de massa corpórea, as pacientes com deficiência de vitamina D apresentaram maior risco para ocorrência da síndrome metabólica (OR 1.90; IC 95% 1.26-2.85), hipertrigliceridemia (OR 1.55; IC 95% 1.13-2.35) e HDL abaixo do desejável (OR 1.60; IC 95% 1.19-2.40) (p<0.05). Observou-se que a concentração média de 25(OH) D diminuiu de acordo com o aumento do número de componentes da SM (p=0.016). Conclusão: Em mulheres na pós-menopausa observou-se associação entre a hipovitaminose D e a síndrome metabólica. Em relação às mulheres com valores adequados de vitamina D, aquelas com deficiência apresentaram maior risco para ocorrência da síndrome metabólica, hipertrigliceridemia e baixos valores de HDL.
Objective: to evaluate the association between vitamin D deficiency and risk markers for metabolic syndrome (MetS) in postmenopausal women. Methods: An analytical cross sectional study was conducted with 466 women, aged 45-75 years, attended at University Hospital. Women in amenorrhea >12 months and age >45 years, without medication use or clinical conditions that interfere with vitamin D values, and without established cardiovascular disease were included. Clinical and anthropometric data were collected. Laboratory parameters, including total cholesterol, HDL, LDL, triglycerides (TG), glucose, insulin and 25 (OH) vitamin D were measured. Women showing three or more diagnostic criteria were diagnosed as having MetS: waist circumference > 88 cm, TG ≥ 150 mg/dL, HDL cholesterol <50 mg/dL, blood pressure  130/85 mmHg, glucose  100 mg/dL. Serum values of 25 (OH) D <30ng / mL were considered as vitamin D deficiency. For statistical analysis, the t-student test, the Gamma Distribution (asymmetric variables), the chi-square test and the logistic regression (OR-odds ratio) were used. Results: Sufficient vitamin D values were detected in 148 patients (31.8%) and deficiency in 318 patients (68.2%). Women with low serum 25 (OH) D levels were older, with a longer time since menopause, and had higher total cholesterol, TG, insulin and HOMA-IR levels (p <0.05). MetS was detected in 57.9% (184/318) of women with hypovitaminosis D and 39.8% (59/148) of those with sufficient 25 (OH) D values (p = 0.003). In the multivariate logistic regression analysis, the lowest 25(OH)D level (<30 ng/mL) was significantly associated with MetS (OR 1.90, 95% CI 1.26-2.85), high triglycerides (OR 1.55, 95% CI 1.13 -2.35) and low HDL (OR 1.60, 95% CI 1.19-2.40) (p <0.05), compared with 25(OH)D levels ≥30 ng/mL after adjusting for age, time since menopausa and body mass index. It was observed that the mean concentration of 25 (OH) D decreased according to the increase in the number of components of MetS (p = 0.016). Conclusions: Vitamin D deficiency in postmenopausal women was associated with higher prevalence of metabolic syndrome. Compared to women with adequate vitamin D levels, those with deficiency had a higher risk of metabolic syndrome, hypertriglyceridemia and low HDL values.
FAPESP: 2014/19832-3

Orientador: Eliana Aguiar Petri Nahas
Resumo: Objetivo: avaliar a associação entre deficiência de vitamina D e os marcadores de risco para síndrome metabólica (SM) em mulheres na pós-menopausa. Métodos: Realizou-se estudo clínico de corte transversal com 466 mulheres, idade entre 45-75 anos, atendidas em Hospital Universitário. Foram incluídas mulheres em amenorréia >12 meses e idade ≥ 45 anos, sem uso de medicações ou condições clínicas que interfiram nos valores da vitamina D e sem doença cardiovascular estabelecida. Foram coletados dados clínicos, antropométricos e laboratoriais [colesterol total (CT), HDL, LDL, triglicerídeos (TG), glicose, insulina e 25(OH) vitamina D]. Foram consideradas com SM as mulheres que apresentaram três ou mais critérios diagnósticos: circunferência da cintura (CC) > 88 cm; TG  150 mg/dL; HDL colesterol < 50 mg/dL; pressão arterial  130/85 mmHg; glicose  100 mg/dL. Foi considerada deficiência de vitamina D valores séricos de 25(OH)D < 30ng/mL. Para análise estatística foram empregados o teste t-student, a Distribuição Gama (variáveis assimétricas), teste do Qui-quadrado e a regressão logística (odds ratio-OR). Resultados: Valores suficientes de vitamina D foram detectados em 148 pacientes (31,8%) e deficientes em 318 pacientes (68,2%). As mulheres com baixos valores séricos de 25(OH)D eram mais velhas, com maior tempo de menopausa e apresentavam maiores valores de colesterol total, triglicerídeos, insulina e HOMA-IR (p<0.05). A SM foi diagnosticada em 57,9% (184/318) das mulheres com h... (Resumo completo, clicar acesso eletrônico abaixo)
Mestre

Introdução a redução da massa muscular esquelética relacionada à idade, denominada sarcopenia, está associada com maior incidência de quedas, fraturas e dependência funcional em idosos. Muitos são os fatores que podem contribuir para o surgimento da sarcopenia, dentre eles a deficiência de vitamina D e a inadequação do consumo alimentar, principalmente a ingestão de proteína. Objetivos investigar a relação da sarcopenia com o consumo alimentar e concentração sérica de 25(OH)D. Métodos Foram avaliadas 200 mulheres acima de 65 anos, sendo 35 com sarcopenia e 165 sem sarcopenia. Avaliou-se a densidade mineral óssea (DMO) da coluna lombar, fêmur proximal e a composição corporal (massa muscular total, massa muscular esquelética, massa adiposa, conteúdo mineral ósseo do corpo total) por meio do densitômetro de dupla emissão com fonte de raios-X (DXA), avaliação radiográfica das colunas dorsal e lombar (T4 a L4). Foi realizada também avaliação da ingestão alimentar (diário de três dias), bioquímica do metabolismo mineral e ósseo (cálcio total, fósforo, creatinina, albumina, paratormônio intacto, calcidiol) e a história clínica das pacientes. Resultados O presente estudo observou que as pacientes que apresentavam um consumo de proteína acima de 1,2g/kg/dia apresentaram massa muscular total [33,94 (4,72) vs 31,87 (3,52) kg, p=0,020], massa muscular esquelética [14,54 (2,38) vs 13,38 (1,95) kg, p=0,013], CMO do corpo total [1,945 (0,325) vs 1784 (0,265) g, p=0,005], DMO de corpo total [1,039 (0,109) vs 0,988 (0,090) g/cm2, p=0,011], DMO coluna lombar [0,983 (0,192) vs 0,903 (0,131) g/cm2, p=0,014], DMO colo de fêmur [0,813 (0,117) vs 0,760 (0,944) g/cm2, p=0,017] e DMO fêmur total [0,868 (0,135) vs 0,807 (0,116) g/cm2, p=0,026] significativamente maior quando comparado com pacientes que apresentavam consumo de proteína abaixo de 0,8g/kg/dia. Além disso, a ingestão de aminoácidos essenciais, principalmente os de cadeia ramificada como a valina [3,10 (0,89) vs 3,40 (1,04) g/dia, p=0,044] foi significantemente menor em mulheres com sarcopenia. O consumo de proteína se correlacionou positivamente com o índice de massa muscular esquelética (r=0,157; p=0,028) e a DMO do trocânter (r=0,185; p=0,010). Adicionalmente, a deficiência de vitamina D associados ao PTH elevado (> 65pg/dL), hiperparatiroidismo secundário, a prevalência de sarcopenia aumentada (77,1 vs 22,9%, p=0,032), além disso mulheres com hiperparatiroidismo secundário apresentaram massa muscular total [29,70 ( 2,99) vs 31,84 (3,65), p=0,043], índice de massa muscular esquelética [5,51 (0,55) vs 5,92 (0,78), p=0,043] significativamente menor. Alta prevalência de deficiência de vitamina D em mulheres com sarcopenia (71,4%). As mulheres com deficiência de vitamina D apresentaram massa muscular total [30,30 (2,92) vs 32,14 (3,84) kg, p=0,007], massa muscular esquelética apendicular [12,71 (1,59) vs 13,55 (0,82) kg, p=0,031]; índice de massa muscular esquelética [5,67 ( 0,60) vs 5,98 (0,82) kg/m2, p=0,030] e fêmur total BMD [0,791 (0,107) vs 0,838 (0,116) g/cm2, p=0,035] significativamente menor. Conclusões - A ingestão de proteínas acima 1,2g/kg/d, especialmente aminoácidos essenciais e suplementação de vitamina D deve ser considerada como terapia preventiva na redução da massa muscular e óssea em mulheres idosas
Introduction - Reduction of skeletal muscle mass, called sarcopenia, is associated with increased incidence of falls, fractures and functional dependence in the elderly. There are many factors that can contribute to the development of sarcopenia, among them the vitamin D deficiency and inadequate food intake, especially protein intake. Objectives - to investigate the relationship among sarcopenia, dietary intake and serum concentration of 25(OH)D. Methods - We evaluated 200 women over 65 years, 35 with sarcopenia and 165 without sarcopenia. Bone mineral density of lumbar spine, proximal femur and body composition (total muscle mass, skeletal muscle mass, fat mass, bone mineral content of the whole body) were assessed by Dual energy X-ray absorptiometry (DXA), radiological evaluation of the dorsal columns and lumbar (T4 to L4). Three-day dietary records were undertaken to estimate dietary intake and serum total albumin, calcium, phosphorus, creatinin, intact parathyroid hormone, 25(OH)D were measured. Results - Patients who presented protein intake above 1.2g/kg/day showed total muscle mass [33.94 (4.72) vs 31.87 (3.52) kg, p=0.020], muscle mass skeletal [14.54 (2.38) vs 13.38 (1.95) kg, p=0.013], total body BMC [1.945 (0.325) vs 1784 (0.265) g, p=0.005], total body BMD [1.039 (0.109) vs 0.988 (0.090) g/cm2, p=0.011], lumbar spine BMD [0.983 (0.192) vs 0.903 (0.131) g/cm2, p=0.014], femoral neck BMD [0.813 (0.117) vs 0.760 (0.944) g/cm2, p=0.017] and total femur BMD [0.868 (0.135) vs 0.807 (0.116) g/cm2, p=0.026] significantly higher when compared with patients who presented protein intake below 0.8g/kg/day. Essential amino acids intake, especially branched chain such as valine [3.10 (0.89) vs 3.40 (1.04) g/day, p=0.044] was significantly lower in women with sarcopenia. Protein intake positively correlated to skeletal muscle mass index (r=0.157, p=0.028) and trochanter BMD (r=0.185, p=0.010). Additionaly, presence of sarcopenia increases more than 20% when vitamin D deficiency is associated to PTH levels higher than 65pg/dL (77.1 vs 22.9%; p=0.032). Women with secondary hyperparathyroidism presented significantly lower total muscle mass [29.70 (2.99) vs 31.84 (3.65); p=0.043], SMMI [5.51 (0.55) vs 5.92 (0.78); p=0.043]. it was also observed high prevalence of vitamin D deficiency in women with sarcopenia (71.4%). Women with deficiency of vitamin D presented significantly lower TSMM [30.30 (2.92) vs 32.14 (3.84) kg; p=0.007], ASMM [12.71 (1.59) vs 13.55 (0.82) kg; p=0.031]; SMMI [5.67 (0.60) vs 5.98 (0.82) kg/m2; p=0.030] and total femur BMD [0.791 (0.107) vs 0.838 (0.116) g/cm2; p=0.035]. Conclusions Protein intake above 1.2g/kg/d, particularly essencial amino acids and vitamin D supplementation should be considered as preventive therapy in reducing muscle and bone mass in elderly women

Background Hypovitaminosis D is becoming recognised as an emerging threat to health, even in countries like New Zealand which enjoy plentiful sunshine. The evidence for a role for vitamin D deficiency in the aetiology of a plethora of diseases continues to accumulate, including type 2 diabetes, and the preceding insulin resistance. Objectives The primary objective of the Surya Study was to investigate the effect of improved vitamin D status (through supplementation) on insulin resistance. The secondary objectives were to investigate the vitamin D status and bone mineral density of South Asian women living in New Zealand, and to investigate the effect of vitamin D supplementation on bone turnover as measured by biochemical markers of bone resorption and formation. Method Women of South Asian origin, ≥20 years old, living in Auckland (n = 235) were recruited for the study. All were asked to complete a 4-day food diary, invited to have a bone scan, and were screened for entry into the intervention phase which required insulin resistance (HOMA-IR >1.93) and serum 25(OH)D < 50 nmol/L. Eighty-one completed a 6-month randomised controlled trial with 4000 IU vitamin D3 (n = 42) or placebo (n = 39). Primary endpoint measures included insulin resistance, insulin sensitivity (HOMA2%S), fasting C-peptide and markers of bone turnover, osteocalcin (OC) and collagen C-telopeptide (CTX). Ninety-one of the 239 had a bone scan and bone mineral density (BMD) was measured in the proximal femur and lumbar spine. Results Adequate serum 25(OH)D concentrations (>50 nmol/L) were observed in only 16% of subjects screened. Median (25th, 75th percentile) serum 25(OH)D increased significantly from 21 (11,40) to 75 (55,84) nmol/L with supplementation. Significant improvements were seen in insulin sensitivity and insulin resistance (P = 0·003, P = 0·02 respectively), and circulating serum insulin decreased (P = 0·02) with supplementation compared to placebo. There was no change in C-peptide with supplementation. Insulin resistance was most improved when endpoint serum 25(OH)D =80 nmol/L. In post-menopausal women OC and CTX levels increased in the placebo arm but CTX decreased from 0.39±0.15 to 0.36±0.17 (P = 0.012) with supplementation. Osteoporosis (T score <-2.5) was present in 32% of postmenopausal, and 3% of premenopausal women. Women 20 – 29 years (n=10) had very low BMD, calcium intake and serum 25(OH)D Conclusions Improving vitamin D status in insulin resistant women resulted in improved insulin resistance and sensitivity but no change in insulin secretion. Optimal 25(OH)D concentrations for reducing insulin resistance were shown to be ≥80 nmol/L. The prevalence of low 25(OH)D concentrations in this population was alarmingly high, especially in younger women. In post-menopausal women, vitamin D supplementation appeared to ameliorate increased bone turnover attributed to oestrogen deficiency.

La calcificació vascular és una complicació de la malaltia renal crònica i una de les principals causes de l’augment de morbiditat i mortalitat en els pacients. Aquests pacients presenten una disminució en els nivells de vitamina D (1,25(OH)2D3) i desenvolupen hiperparatiroïdisme secundari. Per aquest motiu, pacients amb MRC són tractats amb calcitriol o altres anàlegs. La 25-hidroxivitaminaD també s'utilitza, però sense cap coneixement de la seva eficàcia i toxicitat. Les recomanacions actuals indiquen que s’ha de suplementar amb 25D per assolir un llindar determinat que pugui afectar les accions clàssiques i no clàssiques de la vitamina D en l'organisme. No obstant això, l’ incidència directa en l'homeòstasi del calci (sense convertir-lo en calcitriol) no s’entèn. En el present treball, s’ha determinat l'efecte de la urèmia en la regulació de gens del metabolisme de la vitamina D i el paper de la síntesi local de calcitriol en la urèmia sobre la calcificació vascular utilitzant els ratolins KO per la 1αhidroxilasa. També, hem estudiat l'eficàcia i la seguretat del tractament amb 25D en el metabolisme mineral en un model de reducció del 75% de la massa renal en ratolins que no tenen la 1αhidroxilasa i el seu possible efecte toxic en ratolins wild-type. Resultats inicials en rates mostren que la urèmia desregula l’expressió de proteïnes implicades en el metabolisme de la vitamina D en cèl•lules de múscul llis vascular (VSMC), augmentant l'expressió de la 1αhidroxilasa. Aquesta regulació és específica de teixit i és diferent en el ronyó. Ratolins wild-type amb un model de MRC tractats amb altes dosis diàries de calcitriol (400ng/Kg) durant dues setmanes mostren una pèrdua de pes significativa, mentre que els 1αKO no perden pes. Nivells sèrics de calci, fòsfor, BUN i 1,25D augmenten i són similar en els dos grups tractats. D'altra banda, els nivells de PTH disminueixen en ambdòs grups per sota dels valors normals. La calcificació vascular augmenta de forma significativa en els ratolins WT en comparació amb ratolins 1αKO. Resultats similars s'observen amb tinció de vermell d’alizarina i l’immunohistoquímica de Runx2, que augmenta només en ratolins WT. In vitro, les CMLV WT tractades amb sèrum urèmic també mostren un augment significatiu de la calcificació i del runx2, que no s'observa en les cèl·lules 1αKO. Quan les CMLV de rata s’obrexpressen la 1αhidroxialsa també calcifiquen més en comparació amb les cèl•lules control. Aquests resultats indiquen que la 1αhidroxilasa actuaria com a mediador de la calcificació vascular en la urèmia incrementant la síntesis local de 1,25(OH)2D3. Fet que és d’especial interès en els pacients amb malaltia renal que són tractats amb 25OHD3. Per a estudiar l'efecte de la 25D, es va realitzar un estudi dosi-respostaen ratolins 1αKO nefrectomitzats amb 25, 50 i 100 ng/g de 25(OH)D3 per comparar-ho amb una dosi única de 1,25(OH)2D3 (50pg/g). L’administració de 25(OH)D3 pot normalitzar el Ca, P i PTH en sèrum amb una potència semblant a la de la 1,25D en un model de ratolí 1αKO amb MRC, un ratolí incapaç d’activar la 25D a 1,25D. Confirmant una unió directa i activació del VDR per la 25D. La 25D també pot activar el VDR per imitar la 1,25D en la up-regulació de gens i proteïnes que medien el transport transcellular de calci en el ronyó (TRPV5, Calbindin-D28k, PMCA1b) i en el duodè (TRPV6, Calbindin D9k i PMCA1b) en els 1αKO nefrectomitzats. Les dosis de 25D necessàries per imitar la 1,25D en la correcció de les anomalies en el transport de calci transcel·lular a nivell renal i duodenal causen un augment en els nivells de 25D en sèrum per sobre dels nivells recomanats en pacients amb MRC. La calcificació vascular que s'observa en ratolins WT mostra un efecte tòxic del tractament. També, hem observat que la 25D és capaç d'activar la 24hidroxilasa i el VDR en CMLV, mostrant la capacitat de la 25D d’activar directament el VDR a l'artèria. En conclusió, tots aquests resultats suggereixen que la producció local de calcitriol per la 1αhidroxilasa en l'artèria mediaria la calcificació vascular observada en la urèmia. Resultats que indiquen que els tractaments amb 25D en pacients amb MRC han de fer-se de forma controlada tant pel seu efecte directe activant el VDR com a causa de l’increment de la 1αhidroxilasa en la urèmia la qual afavoriria la seva transformació a 1,25(OH)2D3 produint toxicitat.
La calcificación vascular es una complicación de la enfermedad renal crónica y una de las principales causas del aumento en la morbilidad y mortalidad en los pacientes. Estos pacientes presentan una disminución en los niveles de vitamina D (1,25(OH)2D3) y desarrollan hiperparatiroidismo secundario. Por esta razón, los pacientes con ERC son tratados con calcitriol u otros análogos. También se utiliza la 25-hidroxivitamina D, pero sin ningún conocimiento de su eficacia y toxicidad. Las recomendaciones actuales sugieren que se complemente con 25D para alcanzar un cierto umbral que pueda afectar las acciones clásicas y no clásicas de la vitamina D. Sin embargo, el impacto directo en la homeostasis del calcio (sin convertirlo en calcitriol) no se conoce. En el presente estudio, se determinó el efecto de la uremia en la regulación de genes del metabolismo de la vitamina D y el papel de la síntesis local del calcitriol en la uremia y su efecto sobre la calcificación vascular utilizando ratones KO para la 1αhidroxilasa. También, se estudió la eficacia y la seguridad del tratamiento con 25D en el metabolismo mineral en ratones que carecen de la 1αhidroxilasa con una reducción del 75% de la masa renal y el efecto en ratones WT de la dosis efectiva para reducir los niveles de PTH en ratones KO. Los primeros resultados en ratas demuestran que en la uremia se desregula la expresión de las proteínas implicadas en el metabolismo de la vitamina D en las células musculares lisas vasculares (CMLV), aumentando la expresión de la 1αhidroxilasa. Esta regulación es específica del tejido y es diferente de la del riñón. Los ratones wild type con un modelo de ERC tratados con dosis elevadas de calcitriol (400ng/Kg) muestran una pérdida significativa de peso, mientras que los 1αKO no pierden peso. Los niveles séricos de calcio, fósforo, BUN y 1,25D suben y son similares en los dos grupos. Por otro lado, los niveles de PTH caen por debajo de los valores normales en ambos grupos. La calcificación vascular aumenta significativamente en los ratones WT en comparación con los 1αKO. Resultados similares fueron observados con la tinción rojo de alizarina y la immunohistoquímica de Runx2, aumentando sólo en los ratones WT. In vitro, las CMLV WT tratadas con suero urémico también muestran un aumento significativo de la calcificación y de la expresión de runx2, que no se observa en las células 1αKO. Cuando las CMLV de rata sobrexpresan la 1αhidroxilasa calcifican más en comparación con las células control. Estos resultados indican que la 1αhidroxilasa actuaria como mediador de la calcificación vascular en la uremia incrementando la síntesis local de la 1,25(OH)2D3. Hecho que es de especial interés en los pacientes con enfermedad renal tratados con 25OHD3. Para estudiar el efecto de la 25D, se realizó un estudio de dosis-respuesta con ratones 1αKO nefrectomizados y tratados con 25, 50 y 100 ng/g de 25(OH)D3 y se compararon con una sola dosis de 1,25(OH)2D3 (50pg/g). La administración de 25(OH)D3 puede normalizar el Ca, P y PTH en suero con una potencia similar a la del 1,25D en un modelo de ratón 1αKO con ERC. Confirmando un efecto directo y activador de la 25D sobre el VDR. La 25D también puede activar el VDR para imitar la 1,25D en la regulación de genes y proteínas que median el transporte transcelular de calcio en el riñón (Calbindin-D28k, TRPV5, PMCA1b) y en el duodeno (Calbindin D9k y TRPV6, PMCA1b) en ratones 1αKO nefrectomizados. Las dosis de 25D necesarias para imitar la 1,25D en la corrección de las alteraciones en el transporte de calcio transcelular a nivel renal i duodenal producen un aumento en los niveles de 25D en el suero por encima de los niveles recomendados en pacientes con ERC. Además, esta dosis causa calcificación vascular en ratones WT. También hemos observado que la 25D es capaz de activar la 24hidroxilasa i el VDR en las CMLV, mostrando la capacidad de la 25D de activar de forma directa el VDR en la arteria. En conclusión, estos resultados sugieren que la producción local de calcitriol por la 1αhidroxilasa en la arteria mediaría la calcificación vascular observada en la uremia. Además los tratamientos con 25D en pacientes con ERC deben hacerse de forma muy controlada
Vascular calcification is a complication of chronic kidney disease and one of the main predictors of increased morbidity and mortality in patients. These patients present a decrease in vitamin D levels (1,25(OH)2D3) leading to secondary hyperparathyroidism. For these reasons CKD patients are usually treated with calcitriol or other analogues. 25-hydroxyvitaminD is also used without any knowledge of its efficacy and toxicity. Current recommendations are to supplement with 25D to achieve a certain threshold that could affect both, classical and nonclassical actions of vitamin D in the body. However, its direct effect on calcium homeostasis (without conversion in calcitriol) is not fully understood. In the present work, we determined the effect of uremia in the regulation of vitamin D metabolism genes, and the role of the local synthesis of calcitriol on uremia-induced vascular calcification using 1αhidroxilaseKO mice. Also, we studied the efficacy and safety of 25D treatment on mineral metabolism in a model of 75% nephron mass reduction in mice lacking 1αhidroxilase and the effect in WT mice of the dose found to be effective reducing PTH levels in KO mice. Initial results in rats show that uremia deregulates proteins involved in vitamin D metabolism in vascular smooth muscle cells (VSMC), increasing the expression of 1αhydroxylase. This regulation is tissue specific and is different from the one in the kidney. Wild type mice with a CKD model treated with high daily doses of calcitriol (400ng/Kg) for two weeks show a significant weight loss, while 1αKO do not lose weight. Serum calcium levels, phosphorus, BUN, and 1,25D increase and are similar in both calcitriol-treated groups. Furthermore, PTH levels decrease in both groups below normal values. Vascular calcium content significantly increased in the WT mice compared to 1αKO mice. Similar results are observed with alizarin red staining and immunohistochemical detection of Runx2, which increase only in WT mice. In vitro, WT VSMC treated with uremic serum also show a significant increase in calcification and runx2 expression that is not observed in 1αKO cells. When VSMC from rat overexpressed 1αhydroxyalse also calcify more compared with the control cells. These results show that 1αhidroxilase acts as a mediatior of vascular calcificaton in uremia, increasing local synthesis of 1,25(OH)2D3. This fact is important in patients with renal disease treated with 25OHD3. To study the effect of 25D, a dose response study was carried out in 1αKO nephrectomized using 25, 50 and 100 ng/g of 25(OH)D3 to compare with a single dose of 1,25(OH)2D3 (50pg/g). 25(OH)D3 administration can normalize serum Ca, P, and PTH with a potency similar to that of 1,25D in the 1αKO mouse model of CKD, confirming a direct binding and activation of the VDR by 25D. Also, 25D can activate the VDR to mimic 1,25D in the up-regulation of genes and proteins mediating transcellular calcium transport in the kidney (TRPV5, Calbindin-D28k, PMCA1b) and in the duodenum (TRPV6, Calbindin-D9k, and PMCA1b) in the nephrectomized 1αKO. The doses of 25D required to mimic 1,25D in correcting the abnormalities in renal and duodenal transcellular calcium transport cause elevation in serum 25D levels far beyond the recommended levels in CKD patients. Furthermore this dose causes vascular calcification in WT mice. Also, we observed that 25D is able to activate 24hydroxylase and VDR in VSMC, showing the capacity of 25D to direct activate VDR in the artery. In conclusion, all these results suggest that local production of calcitriol by 1αhydroxylase in the artery may mediate vascular calcification observed in uremia. Furthermore, 25D treatments in patients with CKD should be done in a very controlled manner.