COPD, Epstein-Barr Virus(EBV) and Vitamin D -- letter

[Guest guest]

To the Editors

Abstract: _http://erj.ersjournals.com/content/32/5/1412.long_

(http://erj.ersjournals.com/content/32/5/1412.long)

Full _http://erj.ersjournals.com/content/32/5/1412.full.pdf+html_

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by W. B. Grant

Sunlight, Nutrition, and Health Research Center (SUNARC),

San Francisco, CA, USA.

The recent paper by McManus et al. 1 linking high levels of Epstein–Barr

virus (EBV) to chronic obstructive pulmonary disease (COPD) is important as

it appears to provide additional evidence supporting a connection between

low serum 25-hydroxyvitamin D (calcidiol) and risk of COPD, and thus a

possible simple way to reduce the risk of COPD. In an observational study, low

pulmonary function was found to correlate with low serum calcidiol levels 2.

Statistically significant higher values of forced expiratory volume in one

second (FEV1) were found in: both sexes; those >60 yrs of age; White and

Black subjects; subjects of any smoking status; subjects with a lack of

asthma; those with or without bronchitis or emphysema.

There is additional support for a vitamin D–COPD link. Indeed, frequent

cases of acute bronchitis increase the risk of COPD 3. Respiratory syncytial

virus (RSV) is an important risk factor for acute bronchitis. Solar

ultraviolet (UV)B has been found to explain some of the seasonal and

latitudinal

variation in RSV activity. In a recent study, solar UVB explained 13% of the

RSV activity in Miami (FL, USA), 5% in Buffalo (NY, USA) and 0.6% in

Winnipeg (MB, Canada) 4. The relevant action of vitamin D is the induction of

human cathelicidin, LL-37 5. LL-37 is an important component of the innate

immune system and vitamin D supplementation was demonstrated to reduce the

risk of viral infections in a post hoc analysis of a randomised controlled

trial. Black postmenopausal women living in the state of New York (USA) had

one-tenth the incidence rate of seasonal influenza and common cold when

taking 2,000 IU·day-1 of vitamin D3 compared with those taking a placebo;

those

taking 800 IU·day-1 had 40% the incidence rate of those taking a placebo 6.

There is growing evidence that EBV is a virus that is subject to the

effects of vitamin D and LL-37. EBV is an important risk factor for multiple

sclerosis 7. The prevalence of multiple sclerosis increases with latitude in a

manner related to wintertime solar UVB and vitamin D production. In the

USA, those living at 28° N had 31% as much prevalence of multiple sclerosis

as those living at 48° N, based on a study of veterans at the time of

enlistment into World War II and the Korean conflict 8. Summertime solar UVB

doses are much higher from the Rocky Mountains (USA) to the west, than from the

east of the Rocky Mountains at the same latitude due to higher surface

elevation and thinner stratospheric ozone layer, and do not explain the

observed prevalence findings. Multiple sclerosis is often preceded by

infectious

mononucleosis (IM) 9, and EBV is a risk factor for IM. Both IM and Hodgkin's

lymphoma, another disease linked to EBV, have a peak incidence rate in

spring, a time when calcidiol levels are lowest, amongst those <40 yrs of age

10.

It would therefore be worthwhile recommending increased serum calcidiol

levels at the population level, especially in winter, in order to reduce the

risk of chronic obstructive pulmonary disease. Those with chronic

obstructive pulmonary disease may also be likely to benefit from increasing

their

serum calcidiol levels.

References

1 McManus TE, Marley A-M, Baxter N, et al. High levels of Epstein–Barr

virus in COPD.

Eur Respir J 2008; 31: 1221–1226.

2 Black PN, Scragg R. Relationship between serum 25-hydroxyvitamin D and

pulmonary function in the third national health and nutrition examination

survey.

Chest 2005; 128: 3792–3798.

3 Piperno D, Bart F, Serrier P, Zureik M, Finkielsztejn L.[General

practice patients at risk of chronic obstructive pulmonary disease:

epidemiologic

survey of 3,411 patients].

Presse Med 2005; 34: 1617–1622.

4 Yusuf S, Piedimonte G, Auais A, et al. The relationship of

meteorological conditions to the epidemic activity of respiratory syncytial

virus.

Epidemiol Infect 2007; 135:1077–1090.

5 Liu PT, Stenger S, Tang DH, Modlin RL. Cutting edge: vitamin D-mediated

human antimicrobial activity against Mycobacterium tuberculosis is

dependent on the induction of

cathelicidin.

J Immunol 2007; 179: 2060–2063.

6 Aloia JF, Li-Ng M. Re: epidemic influenza and vitamin D.

Epidemiol Infect 2007; 135: 1095–1096; author reply 1097–1098.

7 Ascherio A. Epstein-Barr virus in the development of multiple sclerosis.

Expert Rev Neurother 2008; 8: 331–333.

8 Grant WB, Holick MF. Benefits and requirements of vitamin D for optimal

health: a review. Altern Med Rev 2005; 10: 94–111.

9 Thacker EL, Mirzaei F, Ascherio A. Infectious mononucleosis and risk for

multiple sclerosis: a meta-analysis.

Ann Neurol 2006; 59: 499–503.

10 AS, Brown T, Reid D. Infectious mononucleosis and Hodgkin’s

disease - a similar seasonality.

Leuk Lymphoma 1996; 23: 323–331.