Vitamin D and Multiple Sclerosis

The term vitamin D generally refers to two very similar molecules, vitamin D2 (Ergocalciferol) and Vitamin D3 (Cholecalciferol), which is created by skin cells in response to ultra-violet B light1.

Multiple Sclerosis: Disease of immune system, which normally protect our body, instead attacks the covering (myelin sheath) surrounding the nerve in our body and spinal cord2.

Introduction:

Synonym: Anti-rachitic factor Sunshine vitamin

Vitamin D

Sunlight Oily fish Egg yolk Butter Milk Cheese Pulses etc.

Sources:

7 dehydrocholesterol

Skin ↓Sunlight

Cholecalciferol

↓Calciol 25-hydroxylase

25- Hydroxycholecalciferol

↓Calcidiol 1 α-hydroxylase

1, 25-Dihydroxycholecalciferol

(1,25-DHCC or Calcitriol)→ active form

Synthesis and Activation of vitamin D3:

Functions:

Rickets Bone deformities Incomplete mineralization Softening of bone etc.

Osteomalacia in adults.

Hypervitaminosis: Renal calculi Increased blood calcium level etc. Hypercalcemia Polyuria Polydypsia

Deficiency:

Chronic, autoimmune, inflammatory, neurodegenerative condition

Anti auto-immunity

Multiple Sclerosis:

Active Vit. D→IL-10 cells↑(Anti-inflammative)

↓↓IL–6

↓IL–17↓

↑(CD4 + CD25)

↓Stabilizes the immunity4.

How does the immunity stabilize in the body?

Environmental link Genetic link

Environmental link: Several studies suggests that maintaining

adequate level of vitamin D may have protective effect and lower risk of MS6.

MS more common in areas farther away from the equator where there is less sunshine, which suggest that there is a relationship between vitamin D and the risk of developing MS. E.g. UK, Scotland etc6.

Link between Vitamin D and Multiple Sclerosis:

Recent research suggests that the lack of vitamin D in early childhood or before birth might increase the risk of developing MS later in life6.

Very large dose may cause toxicity6.

Studies have found that more people with MS would be expected are born in May than in November6.

Genetic link: The demonstration that rare variants in CYP27B1, which

encodes the enzyme that converts vitamin D to its active form, are strongly associated with MS risk supports a casual role of vitamin D deficiency as a risk factor for MS.

The study found that an important gene implicated in susceptibility to MS, the variant gene HLA-DRB1*1501, can be switched on by vitamin D in laboratory experiments6.

Randomized controlled trials (RCT) are considered to produce the most reliable scientific data. RCT have been needed to confirm the association between vitamin D and MS suggested by these previous studies and to determine if vitamin D supplementation may help patient with MS7.

The study was also designed so that the authors and patients were both “blinded” to which patients were in the high dose vitamin D7.

Research in the field of Vitamin D and Multiple Sclerosis

In the journal of clinical investigation, researchers led by Magdalena Huber at the university of Marburg in Germany use a mouse model of MS to determined the role of Tc 17 cells.

They found that Tc17 cells help Th17 immune cells to invade CNS by secreting the protein IL-17.

Without Tc17 cells,the Th17 cells did not accumulate in the CNS, preventing development of MS.

With supplementation, the median vitamin D level in the low dose group rose from 22ng/dl to 28ng/dl at the end of study7.

The median vitamin D level in the high dose group rose from 24ng/ml to 48ng/ml7.

While the high dose group did reach higher level of vitamin D, there seemed to be no advantages from high dose vitamin D supplementation in patients with MS compared to supplementation for adequate vitamin D levels7.

What were the results?

These studies did not find that high vitamin levels were more protective for patients with MS than adequate level7.

More research is needed to determine the best level of vitamin D for patients with MS. Several additional studies are underway now. While we wait for these results, research so far suggest that it may be beneficial for patients with MS with vitamin D insufficiency to take vitamin D supplementation for a goal level of greater than 30ng/ml7.

Further research is needed?

1.Food standers agency.Eat well, be well-Vitamin D[ cited 2010 16 Feb]Available from: www.eatwell.gov.uk

2.www.mayoclinic.org/multiple-sclerosis3.Test Book of Biochemistry U.Satyanarayana

U.Chakrapani4.American Journal of Clinical Nutrition 1992,5.Hypponen E, Power C. American Journal of Clinical Nutrition 2007,6.www.mstrust.org.uk7.American Academy of Neurology8.Ramagopalan SV et al,Expression of the MS-associated MHC

class ii Allele HLA_DRB1*1501 is regulated by vitamin D.

References:

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