Vitamin D: Immuno-modulation and tuberculosis treatment.
Tuberculosis (TB) is a major global health problem and often coincides with vitamin D deficiency. High doses of vitamin D were widely used to treat TB during the pre-antibiotic era. Vitamin D exerts its action through vitamin D receptor (VDR), and VDR gene polymorphisms are associated with susceptibility or resistance to tuberculosis as well as sputum smear and culture conversion during anti-TB treatment. In-vitro studies have revealed that 1,25-dihydroxyvitamin D3 enhances innate immunity by increased expression of various antimicrobial peptides, including cathelicidin, and induction of autophagy of the infected cells thus restricts the intracellular growth of Mycobacterium tuberculosis in macrophages. On the other hand, vitamin D has been shown to suppress the pro-inflammatory cytokine response and enhance the anti-inflammatory response. Supplementation with vitamin D in concert with treatment for TB may be beneficial with respect to minimizing the excessive tissue damage that occurs during the active stage of tuberculosis disease. Several clinical trials have evaluated vitamin D supplementation as an adjunct therapy in the treatment for tuberculosis. However, results are conflicting, owing to variations in dose regimens and outcomes. Further investigations are needed to find the optimal concentration of vitamin D for supplementation with standard anti-TB drugs to optimize treatment, which could help to effectively manage both drug-sensitive and drug-resistant tuberculosis.
Department of Immunology, National Institute for Research in Tuberculosis, (Formerly Tuberculosis Research Centre), Indian Council of Medical Research, 1, Mayor Sathyamoorthy Road, Chetput, Chennai 600 031, India.
Paramasivam
P
Selvaraj
Murugesan
M
Harishankar
Kolloli
K
Afsal
D056704:Adaptive Immunity / Q000276:immunology; D000818:Animals; D002986:Clinical Trials as Topic / Q000379:methods; D019587:Dietary Supplements; D006801:Humans; D007113:Immunity, Innate / Q000276:immunology; D007155:Immunologic Factors / Q000276:immunology / Q000627:therapeutic use*; D016896:Treatment Outcome; D014376:Tuberculosis / Q000188:drug therapy* / Q000276:immunology; D014807:Vitamin D / Q000276:immunology / Q000627:therapeutic use*
D007155:Immunologic Factors; D014807:Vitamin D
1,25-dihydroxyvitamin D3; 1,25-dihydroxyvitamine D3; antimicrobial peptides; clinical trials; essais cliniques; immunity; immunité; peptides antimicrobiens; récepteur de la vitamine D; vitamin D receptor