Giuseppe
Emeritus
[Source: The Lancet Infectious Diseases, full page: (LINK). Abstract, edited.]
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The Lancet Infectious Diseases, Volume 13, Issue 1, Pages 77 - 88, January 2013 / doi:10.1016/S1473-3099(12)70275-X
Vitamin D and solar ultraviolet radiation in the risk and treatment of tuberculosis
Original Text
Dr Anna R Ralph PhD a b c, Robyn M Lucas PhD d, Mary Norval DSc e
Summary
Improved understanding of the association between tuberculosis and vitamin D is needed to inform clinical practice. Vitamin D has both immunostimulatory and immunosuppressive effects relevant to human antimycobacterial responses. Ultraviolet radiation, the main source of vitamin D, also induces immunomodulation and could affect the relation between vitamin D and tuberculosis. Clinical trials of vitamin D supplementation in patients with tuberculosis have produced largely negative results, prompting the review of dosing regimens?an explanation for low 25-hydroxyvitamin D status in patients with active tuberculosis is also needed. The reporting of vitamin D deficiency needs to address assay inaccuracies, rising thresholds to define sufficiency, and scarce knowledge of the concentrations needed for optimum immune responses. Future research to measure the effect of the inflammatory setting on serum concentrations of 25-hydroxyvitamin D, at tuberculosis diagnosis and during recovery, could help to account for 25-hydroxyvitamin D changes in these concentrations in patients with tuberculosis. Studies into the role of vitamin D supplementation in latent tuberculosis justify clinical trials in this population, but pose methodological challenges. Vitamin D trials in patients with active tuberculosis should be done in well selected populations using adequate vitamin D doses, although such doses remain undefined.
a Global and Tropical Health, Menzies School of Health Research, Darwin, NT, Australia; b Sydney Institute for Emerging Infections and Biosecurity, University of Sydney, NSW, Australia; c Department of Medicine, Blacktown Hospital, Blacktown, NSW, Australia; d National Centre for Epidemiology and Population Health, The Australian National University, Canberra, ACT, Australia; e Biomedical Sciences, University of Edinburgh Medical School, Edinburgh, UK
Correspondence to: Dr Anna R Ralph, Menzies School of Health Research, Casuarina, NT 0835, Australia
-Vitamin D and solar ultraviolet radiation in the risk and treatment of tuberculosis
Original Text
Dr Anna R Ralph PhD a b c, Robyn M Lucas PhD d, Mary Norval DSc e
Summary
Improved understanding of the association between tuberculosis and vitamin D is needed to inform clinical practice. Vitamin D has both immunostimulatory and immunosuppressive effects relevant to human antimycobacterial responses. Ultraviolet radiation, the main source of vitamin D, also induces immunomodulation and could affect the relation between vitamin D and tuberculosis. Clinical trials of vitamin D supplementation in patients with tuberculosis have produced largely negative results, prompting the review of dosing regimens?an explanation for low 25-hydroxyvitamin D status in patients with active tuberculosis is also needed. The reporting of vitamin D deficiency needs to address assay inaccuracies, rising thresholds to define sufficiency, and scarce knowledge of the concentrations needed for optimum immune responses. Future research to measure the effect of the inflammatory setting on serum concentrations of 25-hydroxyvitamin D, at tuberculosis diagnosis and during recovery, could help to account for 25-hydroxyvitamin D changes in these concentrations in patients with tuberculosis. Studies into the role of vitamin D supplementation in latent tuberculosis justify clinical trials in this population, but pose methodological challenges. Vitamin D trials in patients with active tuberculosis should be done in well selected populations using adequate vitamin D doses, although such doses remain undefined.
a Global and Tropical Health, Menzies School of Health Research, Darwin, NT, Australia; b Sydney Institute for Emerging Infections and Biosecurity, University of Sydney, NSW, Australia; c Department of Medicine, Blacktown Hospital, Blacktown, NSW, Australia; d National Centre for Epidemiology and Population Health, The Australian National University, Canberra, ACT, Australia; e Biomedical Sciences, University of Edinburgh Medical School, Edinburgh, UK
Correspondence to: Dr Anna R Ralph, Menzies School of Health Research, Casuarina, NT 0835, Australia
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