Los niveles séricos de vitamina D en el paciente asmático: ¿un factor a tener en cuenta?
Resumen
En los últimos años, se ha relacionado la vitamina D con numerosas patologías no relacionadas con el metabolismo fosfo-cálcico, entre ellas, algunas enfermedades respiratorias entre las que destaca el asma. Existen varios mecanismos de acción de la vitamina D en el asma, influyendo en la inmunidad innata y adaptativa, en la resistencia a los corticoides e incluso en el remodelado de la vía aérea. Algunos estudios han tratado de aportar evidencias clínicas sobre la influencia de la vitamina D sérica en el asma, sin embargo, solo parecen haberse demostrado en la mejora de la función pulmonar, la respuesta a los corticoides, y en la disminución de las necesidades de corticoides sistémicos durante las crisis. No obstante, los estudios existentes son escasos y con una alta variabilidad en sus diseños, con distintos perfiles de paciente, con distintos puntos de corte en los niveles séricos de 25-OH-D3 y con distintas pautas de suplementación con vitamina D en los distintos ensayos clínicos aleatorizados, no permitiendo la extracción de evidencias sólidas sobre este tema. Por tanto, es necesaria la estandarización en los estudios y la realización de nuevos estudios que permitan dilucidar evidencias sobre la influencia de la vitamina D en el asma.
Referencias
Shapiro IM, Boyde A. Mineralization of normal and
rachitic chick growth cartilage: vascular canals, cartilage
calcification and osteogenesis. Scanning Microsc.
;1:599–606.
Wang Y, Zhu J, DeLuca HF. Where is the vitamin D
receptor? Arch Biochem Biophys. 2012;523:123–33.
Ryan JW, Anderson PH, Morris HA. Pleiotropic Activities
of Vitamin D Receptors - Adequate Activation for Multiple
Health Outcomes. Clin Biochem Rev. 2015;36:53–61.
García de Tena J, El Hachem Debek A, Hernández
Gutiérrez C, Izquierdo Alonso JL. Papel de la vitamina
D en enfermedad pulmonar obstructiva crónica, asma y
otras enfermedades respiratorias. Arch Bronconeumol.
;50:179–84.
Ginde AA, Mansbach JM, Camargo CA Jr. Association
between serum 25-hydroxyvitamin D level and upper
respiratory tract infection in the Third National Health
and Nutrition Examination Survey. Arch Intern Med.
;169:384–90.
Cannell JJ, Vieth R, Umhau JC, Holick MF, Grant WB,
Madronich S, et al. Epidemic influenza and vitamin D.
Epidemiol Infect. 2006;134:1129–40.
Urashima M, Segawa T, Okazaki M, Kurihara M, Wada Y,
Ida H. Randomized trial of vitamin D supplementation to
prevent seasonal influenza A in schoolchildren. Am J Clin
Nutr. 2010;91:1255–60.
Hansdottir S, Monick MM, Hinde SL, Lovan N, Look
DC, Hunninghake GW. Respiratory epithelial cells convert
inactive vitamin D to its active form: potential effects on
host defense. J Immunol. 2008;181:7090–9.
Liu PT, Stenger S, Li H, Wenzel L, Tan BH, Krutzik SR,
et al. Toll-like receptor triggering of a vitamin D-mediated
human antimicrobial response. Science. 2006;311:1770–3.
López-García B, Lee PH, Yamasaki K, Gallo RL. Antifungal
activity of cathelicidins and their potential role
in Candida albicans skin infection. J Invest Dermatol.
;125:108–15.
Beard JA, Bearden A, Striker R. Vitamin D and the antiviral
state. J Clin Virol. 2011;50:194–200.
Hansdottir S, Monick MM, Lovan N, Powers L, Gerke
A, Hunninghake GW. Vitamin D decreases respiratory
syncytial virus induction of NF-kappaB-linked chemokines
and cytokines in airway epithelium while maintaining the
antiviral state. J Immunol. 2010;184:965–74.
Cantorna MT. Mechanisms underlying the effect of vitamin
D on the immune system. Proc Nutr Soc. 2010;69:286–9.
Lange NE, Litonjua A, Hawrylowicz CM, Weiss S.
Vitamin D, the immune system and asthma. Expert Rev
Clin Immunol. 2009;5:693–702.
Hyppönen E, Berry DJ, Wjst M, Power C. Serum
-hydroxyvitamin D and IgE - a significant but nonlinear
relationship. Allergy. 2009;64:613–20.
Heine G, Niesner U, Chang HD, Steinmeyer A, Zügel U,
Zuberbier T, et al. 1,25-dihydroxyvitamin D(3) promotes
IL-10 production in human B cells. Eur J Immunol.
;38:2210–8.
Hartmann B, Heine G, Babina M, Steinmeyer A, Zügel
U, Radbruch A, et al. Targeting the vitamin D receptor
inhibits the B cell-dependent allergic immune response.
Allergy. 2011;66:540–8.
Nanzer AM, Chambers ES, Ryanna K, Richards DF, Black
C, Timms PM, et al. Enhanced production of IL-17A in
patients with severe asthma is inhibited by 1alpha,25-
dihydroxyvitamin D3 in a glucocorticoid-independent
fashion. J Allergy Clin Immunol. 2013;132:297–304.
Palmer MT, Lee YK, Maynard CL, Oliver JR, Bikle
DD, Jetten AM, et al. Lineage-specific effects of
,25-dihydroxyvitamin D(3) on the development of
effector CD4 T cells. J Biol Chem. 2011;286:997–1004.
Zhao J, Lloyd CM, Noble A. Th17 responses in chronic
allergic airway inflammation abrogate regulatory T-cellmediated
tolerance and contribute to airway remodeling.
Mucosal Immunol. 2013;6:335–46.
McKinley L, Alcorn JF, Peterson A, Dupont RB, Kapadia
S, Logar A, et al. TH17 cells mediate steroid-resistant
airway inflammation and airway hyperresponsiveness in
mice. J Immunol. 2008;181:4089–97.
Agache I, Ciobanu C, Agache C, Anghel M. Increased
serum IL-17 is an independent risk factor for severe asthma.
Respir Med. 2010;104:1131–7.
Zijlstra GJ, Ten Hacken NH, Hoffmann RF, Van
Oosterhout AJ, Heijink IH. Interleukin-17A induces
glucocorticoid insensitivity in human bronchial epithelial
cells. Eur Respir J. 2012;39:439–45.
Wilson RH, Whitehead GS, Nakano H, Free ME,
Kolls JK, Cook DN. Allergic sensitization through
the airway primes Th17-dependent neutrophilia and
airway hyperresponsiveness. Am J Respir Crit Care Med.
;180:720–30.
Hawrylowicz CM, O›Garra A. Potential role of interleukin-
-secreting regulatory T cells in allergy and asthma. Nat
Rev Immunol. 2005;5:271–83.
Hartl D, Koller B, Mehlhorn AT, Reinhardt D, Nicolai T,
Schendel DJ, et al. Quantitative and functional impairment
of pulmonary CD4+CD25hi regulatory T cells in pediatric
asthma. J Allergy Clin Immunol. 2007;119:1258–66.
Gupta A, Dimeloe S, Richards DF, Chambers ES, Black
C, Urry Z, et al. Defective IL-10 expression and in vitro
steroid-induced IL-17A in paediatric severe therapyresistant
asthma. Thorax. 2014;69:508–15.
Xystrakis E, Kusumakar S, Boswell S, Peek E, Urry Z,
Richards DF, et al. Reversing the defective induction of IL-
-secreting regulatory T cells in glucocorticoid-resistant
asthma patients. J Clin Invest. 2006;116:146–55.
Chambers ES, Hawrylowicz CM. The impact of vitamin
D on regulatory T cells. Curr Allergy Asthma Rep.
;11:29–36.
Pfeffer PE, Mann EH, Hornsby E, Chambers ES, Chen
YH, Rice L, et al. Vitamin D influences asthmatic
pathology through its action on diverse immunological
pathways. Ann Am Thorac Soc. 2014;11 Suppl 5:S314–21.
Durrani SR, Viswanathan RK, Busse WW. What effect
does asthma treatment have on airway remodeling? Current
perspectives. J Allergy Clin Immunol. 2011;128:439–48.
Lai G, Wu C, Hong J, Song Y. 1,25-Dihydroxyvitamin
D(3) (1,25-(OH)(2)D(3)) attenuates airway remodeling in
a murine model of chronic asthma. J Asthma. 2013;50:133–
Banerjee A, Panettieri R Jr. Vitamin D modulates airway
smooth muscle function in COPD. Curr Opin Pharmacol.
;12:266–74.
Gupta A, Sjoukes A, Richards D, Banya W, Hawrylowicz
C, Bush A, et al. Relationship between serum vitamin D,
disease severity, and airway remodeling in children with
asthma. Am J Respir Crit Care Med. 2011;184:1342–9.
Damera G, Fogle HW, Lim P, Goncharova EA, Zhao H,
Banerjee A, et al. Vitamin D inhibits growth of human
airway smooth muscle cells through growth factor-induced
phosphorylation of retinoblastoma protein and checkpoint
kinase 1. Br J Pharmacol. 2009;158:1429–41.
Mai XM, Langhammer A, Camargo CA Jr, Chen Y. Serum
-hydroxyvitamin D levels and incident asthma in adults:
the HUNT Study. Am J Epidemiol. 2012;176:1169–76.
Devereux G, Wilson A, Avenell A, McNeill G, Fraser WD.
A case-control study of vitamin D status and asthma in
adults. Allergy. 2010;65:666–7.
Carroll KN, Gebretsadik T, Larkin EK, Dupont WD, Liu
Z, Van Driest S, et al. Relationship of maternal vitamin
D level with maternal and infant respiratory disease. Am J
Obstet Gynecol. 2011;205:215.
Cheng HM, Kim S, Park GH, Chang SE, Bang S, Won
CH, et al. Low vitamin D levels are associated with
atopic dermatitis, but not allergic rhinitis, asthma, or IgE
sensitization, in the adult Korean population. J Allergy
Clin Immunol. 2014;133:1048–55.
Sutherland ER, Goleva E, Jackson LP, Stevens AD,
Leung DY. Vitamin D levels, lung function, and steroid
response in adult asthma. Am J Respir Crit Care Med.
;181:699–704.
Korn S, Hübner M, Jung M, Blettner M, Buhl R. Severe
and uncontrolled adult asthma is associated with vitamin
D insufficiency and deficiency. Respir Res. 2013;14:25.
Samrah S, Khatib I, Omari M, Khassawneh B, Momany S,
Daoud A, et al. Vitamin D deficiency and level of asthma
control in women from North of Jordan: a case-control
study. J Asthma. 2014;51:832–8.
Arshi S, Fallahpour M, Nabavi M, Bemanian MH, Javad-
Mousavi SA, Nojomi M, et al. The effects of vitamin D
supplementation on airway functions in mild to moderate
persistent asthma. Ann Allergy Asthma Immunol.
;113:404–9.
De Groot JC, Van Roon EN, Storm H, Veeger NJ,
Zwinderman AH, Hiemstra PS, et al. Vitamin D reduces
eosinophilic airway inflammation in nonatopic asthma. J
Allergy Clin Immunol. 2015;135:670–5.
Ali AM, Selim S, Abbassi MM, Sabry NA. Effect of
alfacalcidol on the pulmonary function of adult asthmatic
patients: A randomized trial. Ann Allergy Asthma
Immunol. 2017;118:557–63.
Confino-Cohen R, Brufman I, Goldberg A, Feldman BS.
Vitamin D, asthma prevalence and asthma exacerbations: a
large adult population-based study. Allergy. 2014;69:1673–80.
Castro M, King TS, Kunselman SJ, Cabana MD,
Denlinger L, Holguin F, et al.; National Heart, Lung,
and Blood Institute›s AsthmaNet. Effect of vitamin D3
on asthma treatment failures in adults with symptomatic
asthma and lower vitamin D levels: the VIDA randomized
clinical trial. JAMA. 2014;311:2083–91.
Martineau AR, MacLaughlin BD, Hooper RL, Barnes NC,
Jolliffe DA, Greiller CL, et al. Double-blind randomised
placebo-controlled trial of bolus-dose vitamin D3
supplementation in adults with asthma (ViDiAs). Thorax.
;70:451–7.
Martineau AR, Cates CJ, Urashima M, Jensen M, Griffiths
AP, Nurmatov U, et al. Vitamin D for the management of
asthma. Cochrane Database Syst Rev. 2016;9:CD011511.
Jolliffe DA, Greenberg L, Hooper RL, Griffiths CJ, Camargo
CA Jr, Kerley CP, et al. Vitamin D supplementation to
prevent asthma exacerbations: a systematic review and
meta-analysis of individual participant data. Lancet Respir
Med. 2017;5:881–90.
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