Vitamin D: Nutrient, Not A Drug/2010 - VIDEO

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Vitamin D: Nutrient, Not A Drug/2010 - VIDEO

Is vitamin D the wonder vitamin?

Can it prevent certain cancers and chronic diseases? Find these answers and more in this series brought to you by UCSD School of Medicine and GrassrootsHealth where experts discuss the latest research on vitamin D. In this program, Heaney, MD, talks about vitamin D as a nutrient, not a drug. Series: Vitamin D Deficiency - Treatment and Diagnosis June/2010

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Also Of Interest..............

lVitamin D Increases Sustained Response to Interferon-based Therapy for Hepatitis C, May Improve Liver Fibrosis

SUMMARY: Vitamin D supplementation increased the likelihood of sustained response to pegylated interferon plus ribavirin therapy for chronic hepatitis C, leading researchers to suggest that vitamin D deficiency may help explain well-known racial/ethnic disparities in treatment response, according to a presentation at the 45th Annual Meeting of the European Association for the Study of the Liver (EASL 2010) last month in Vienna. A recently published related study found that low vitamin D levels were associated with more severe liver fibrosis and poor treatment response.

By Liz HighleymanIn the EASL study, S. Abu Mouch and colleagues from Israel assessed whether adding a vitamin D supplement to standard hepatitis C therapy using pegylated interferon plus ribavirin could improve rates of sustained virological response (SVR), or continued undetectable HCV viral load 24 weeks after completion of treatment.

Vitamin D is a potent immune modulator that has a direct effect on T-cells and antigen-presenting immune cells, and can directly or indirectly influence the differentiation and activity of CD4 T-cells, the researchers noted as background. They hypothesized that vitamin D has an important role in innate immune response against HCV. In addition, some studies have shown that vitamin D improves insulin sensitivity (a predictor of better treatment response) and inhibits HCV replication.

The investigators first measured vitamin D levels in a group of 157 chronic hepatitis C patients treated at their liver clinic in Israel, and found that fully 84% had low levels, and one-third had "severe deficiency.

"They then performed a randomized study of 67 patients. About half were men, the average age was 48 years, and most were of Russian origin, with only a few being of Israeli or Arabic origin. Participants were randomly assigned to receive 1.5 mcg/kg pegylated interferon alfa-2b (PegIntron) plus 1000-1200 mg/daily weight-adjusted ribavirin for 48 weeks, with or without 1000-4000 IU/day vitamin D3, enough to bring serum levels up to 32 ng/mL. By chance, patients in the vitamin D group were more difficult to treat than those in the control group, having a higher body mass index and larger percentages with high baseline viral load and advanced liver fibrosis.

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Results

'Serum 25-hydroxyvitamin D levels were significantly lower on average in chronic hepatitis C patients compared with healthy control subjects (25.07 vs 43.06 mcg/L; P less then 0.001).Lower vitamin D levels were independently associated with female sex and liver necro-inflammation. Levels of CYP27A1, but not CYP2R1, were directly related to vitamin D levels and inversely correlated with necro-inflammation.Independent predictors of severe liver fibrosis or cirrhosis (stage F3-F4) included:Liver necro-inflammation (OR 2.235);Older age (OR 1.043);High ferritin (a protein that stores iron) (OR 1.003);Low cholesterol (OR 0.981);Low 25-hydroxyvitamin D (odds ratio [OR] 0.942).Overall, 70 patients (41%) achieved SVR.In a multivariate analysis, factors independently associated with poor response, or failure to achieve SVR, included;Lower 25-hydroxyvitamin D (OR 1.039);Lower cholesterol (OR 1.009);Liver steatosis (fatty liver) (OR, 0.971).Based on these findings, the study authors concluded, "Genotype 1 chronic hepatitis C patients had low [25-hydroxyvitamin D] serum levels, possibly because of reduced CYP27A1 expression.""Low vitamin D is linked to severe fibrosis

and low SVR on interferon-based therapy," they added.Investigator affiliations:

Abu Mouch study: Hepatology Unit and Internal Medicine B, Hillel Yaffe Medical Center, Hadera, Israel; Faculty of Medicine, Technion, Haifa, Israel; Gastroenterology, Hillel Yaffe Medical Center, Hadera, Israel; Liver Unit, Ziv Medical Center, Safed, Israel. Petta study: Cattedra ed Unità Operativa di Gastroenterologia, DiBiMIS, University of Palermo, Italy; Dipartimento di Biopatologia e Metodologie Biomediche, University of Palermo, Italy; IBIM Consiglio Nazionale delle Ricerche, Palermo, Italy; Dipartimento di Biotecnologie Mediche e Medicina Legale Sezione Chimica e Biochimica Medica, University of Palermo, Italy; Cattedra di Anatomia Patologica, University of Palermo, Italy; Dipartimento di Medicina e Gastroenterologia, "Alma Mater Studiorum," University of Bologna, Italy.

5/18/10ReferencesS Abu Mouch, Z Fireman, J Jarchovsky, and N Assy. Vitamin D supplement improve SVR in chronic hepatitis C (genotype 1) naive patients treated with peg interferon and ribavirin. 45th Annual Meeting of the European Association for the Study of the Liver (EASL 2010). Vienna, Austria. April 14-18, 2010. (Abstract).S Petta, C Camma, C Scazzone, and others. Low vitamin D serum level is related to severe fibrosis and low responsiveness to interferon-based therapy in genotype 1 chronic hepatitis C. Hepatology 51(4): 1158-1167(Abstract). April 2010.

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Benefits of Vitamin D

HEPATITIS JOURNAL REVIEW:

A Bi-Monthly Publication of the Hepatitis Support Project

May 24 , 2010 Volume 7, Issue 5

A low vitamin D level is associated with more severe liver fibrosis and poor treatment response, according to a study published in the April 2010 Hepatology and supporting research presented at the April meeting of the European Association for the Study of the Liver (EASL). Prior research indicates that vitamin D is an immune modulator that influences inflammatory responses and fibrogenesis (fibrosis formation); it may also improve insulin sensitivity and even inhibit HCV replication.

S. Petta and colleagues from Italy looked at the link between vitamin D and response to interferon-based therapy among 197 genotype 1 chronic hepatitis C patients (85% of whom were treated with pegylated interferon plus ribavirin) and 49 healthy HCV negative control subjects. They measured serum levels of 25-hydroxyvitamin D and tissue expression of two liver enzymes (CYP27A1 and CYP2R1) that process vitamin D. Average serum vitamin D levels were significantly lower in hepatitis C patients compared with control subjects (25.07 vs. 43.06 mcg/L). Women on average had lower vitamin D levels than men, and people with hepatic necroinflammation had lower levels than those with healthy livers. Levels of CYP27A1 (but not CYP2R1) were directly correlated with vitamin D levels. After adjusting for other factors, low vitamin D was an independent predictor of severe liver fibrosis or cirrhosis (stage F3-F4). Overall, 41% of patients achieved SVR; a low vitamin D level was likewise an independent predictor of poor treatment response.

In the study presented at EASL, S. Abu Mouch and colleagues from Israel evaluated whether vitamin D supplements would improve the likelihood of sustained response to hepatitis C therapy. In an initial analysis of 157 genotype 1 chronic hepatitis C patients treated at their clinic, fully 84% had low vitamin D levels and one-third had severe deficiency. Then, in a randomized study, 67 patients were treated with pegylated interferon alfa-2b (PegIntron) plus ribavirin for 48 weeks, with or without 1000-4000 IU/day vitamin D3. At 4 weeks, 44% of participants receiving vitamin D supplements achieved rapid virological response, compared with just 18% in the unsupplemented group. SVR rates were likewise significantly higher in the vitamin D group, 85% vs. 43%, respectively. People with dark skin produce less vitamin D when exposed to the sun and are more likely to be deficient, leading the researchers to suggested that vitamin D deficiency might contribute to the well-known strong racial/ethnic disparities in interferon response rates.

VIDEO

http://Hepatitis Cnewdrugs.blogspot.com/2010/08/vitamin-d-nutrient-not-drug2010-video.html