维生素D与神经学
骨化三醇受体
胆钙化醇
医学
维生素
维生素D缺乏
骨化三醇
背景(考古学)
麦角钙化醇
免疫系统
内分泌学
免疫学
内科学
生物
古生物学
作者
Dirk Lemke,Rainer J. Klement,Felix Schweiger,Beatrix Schweiger,Jörg Spitz
标识
DOI:10.3389/fimmu.2021.655739
摘要
Vitamin D 3 (cholecalciferol) is a secosteroid and prohormone which is metabolized in various tissues to the biologically most active vitamin D hormone 1,25(OH) 2 D 3 (calcitriol). 1,25(OH) 2 D 3 has multiple pleiotropic effects, particularly within the immune system, and is increasingly utilized not only within prophylaxis, but also within therapy of various diseases. In this context, the latest research has revealed clinical benefits of high dose vitamin D 3 therapy in autoimmune diseases. The necessity of high doses of vitamin D 3 for treatment success can be explained by the concept of an acquired form of vitamin D resistance. Its etiology is based on the one hand on polymorphisms within genes affecting the vitamin D system, causing susceptibility towards developing low vitamin D responsiveness and autoimmune diseases; on the other hand it is based on a blockade of vitamin D receptor signaling, e.g. through pathogen infections. In this paper, we review observational and mechanistic evidence for the acquired vitamin D resistance hypothesis. We particularly focus on its clinical confirmation from our experience of treating multiple sclerosis patients with the so-called Coimbra protocol, in which daily doses up to 1000 I.U. vitamin D 3 per kg body weight can be administered safely. Parathyroid hormone levels in serum thereby provide the key information for finding the right dose. We argue that acquired vitamin D resistance provides a plausible pathomechanism for the development of autoimmune diseases, which could be treated using high-dose vitamin D 3 therapy.
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