title: Reduced 25-OH vitamin D in patients with autoimmune cytopenias, clinical correlations and literature review.
abstract: Vitamin D deficiency is widespread in Western Countries and has been found related to autoimmune and hematologic disease incidence and clinical course. We evaluated vitamin D levels, vitamin D receptor (VDR) and T helper (Th)1, Th2 and Th17 immunomodulatory cytokines in patients with immune thrombocytopenic purpura (ITP, N=44), primary autoimmune hemolytic anemia (AIHA, n=35), Evans' syndrome (n=5) and chronic idiopathic neutropenia (CIN, n=19) and also tested vitamin D effect on the in vitro production of anti-erythrocyte autoantibodies. 25-OH-vitamin D levels were significantly lower and vitamin D receptor higher in patients than in controls. Among ITP cases, those with very low vitamin D levels displayed reduced platelet counts, irrespective of the bleeding history. In AIHA patients, LDH values negatively correlated with vitamin D levels in mixed forms, and reticulocyte counts were positively related with vitamin D. Considering treatment, AIHA patients who had been treated with 2 therapy lines or more showed lower mean 25-OH-vitamin D levels than those untreated or treated with one line of therapy only. IL-6, IL-10, IL-17 and IFN-γ levels were higher in patients versus controls, whereas TNF-α was significantly reduced. Finally, vitamin D at concentrations of 10, 20, and 40ng/mL reduced the in vitro production of anti-erythrocyte autoantibodies both in pokeweed-stimulated and unstimulated cultures. In conclusion, vitamin D is reduced in autoimmune cytopenias and correlate with disease severity, supporting its possible protective role against the development of autoimmunity. Literature review showed vitamin D deficiency reports both in onco- and in non onco-hematologic diseases with a relationship with disease severity/activity in myeloid and lymphoid neoplasms, as well as in sickle cell disease. Supplementation has produced weak results in autoimmune and hematologic diseases, and further studies are needed.
authors.affiliation: UO Onco-hematology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, via F. Sforza 35, 20100 Milano, Italy.
authors.forename: Bruno
authors.initials: B
authors.lastname: Fattizzo
authors.affiliation: UO Onco-hematology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, via F. Sforza 35, 20100 Milano, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Zaninoni
authors.affiliation: UO Onco-hematology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, via F. Sforza 35, 20100 Milano, Italy.
authors.forename: Juri A
authors.initials: JA
authors.lastname: Giannotta
authors.affiliation: UO Onco-hematology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, via F. Sforza 35, 20100 Milano, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Binda
authors.affiliation: UO Onco-hematology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, via F. Sforza 35, 20100 Milano, Italy; Università degli Studi di Milano, Italy.
authors.forename: Agostino
authors.initials: A
authors.lastname: Cortelezzi
authors.affiliation: UO Onco-hematology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, via F. Sforza 35, 20100 Milano, Italy. Electronic address: wbarcel@policlinico.mi.it.
authors.forename: Wilma
authors.initials: W
authors.lastname: Barcellini
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000743:Anemia, Hemolytic / Q000378:metabolism*; D001327:Autoimmune Diseases; D016207:Cytokines / Q000378:metabolism*; D006801:Humans; D008875:Middle Aged; D014807:Vitamin D / Q000378:metabolism*; D014808:Vitamin D Deficiency / Q000150:complications*; D055815:Young Adult
chemical_list: D016207:Cytokines; D014807:Vitamin D
keywords: Autoimmune hemolytic anemia; Chronic idiopathic neutropenia; Immune thrombocytopenia; Immunomodulatory cytokines; Vitamin D; Vitamin D receptor