Immune system and vitamin D ( N viewpoint) – Feb 2014
ISRN Endocrinology, Volume 2014 (2014), Article ID 105456, 11 pages. http://dx.doi.org/10.1155/2014/105456
Cheng-Lin Lang,1 Min-Hui Wang,2 Chih-Kang Chiang,3 and Kuo-Cheng Lu2
1Department of Internal Medicine, Cardinal Tien Hospital, Yonghe Branch, New Taipei 23445, Taiwan
2Division of Nephrology, Department of Internal Medicine, Cardinal Tien Hospital, School of Medicine, Fu-Jen Catholic University, 362 Chung-Cheng Road, Hsin-Tien District, New Taipei 23148, Taiwan
3Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei 10002, Taiwan
Received 25 October 2013; Accepted 4 December 2013; Published 22 January 2014
Vitamin D and its analogues are widely used as treatments by clinical nephrologists, especially when treating chronic kidney disease (CKD) patients with secondary hyperparathyroidism. As CKD progresses, the ability to compensate for elevations in parathyroid hormone (PTH) and fibroblast growth factor-23 and for decreases in 1,25(OH)2D3 becomes inadequate, which results in hyperphosphatemia, abnormal bone disorders, and extra-skeletal calcification. In addition to its calciotropic effect on the regulation of calcium, phosphate, and parathyroid hormone, vitamin D has many other noncalciotropic effects, including controlling cell differentiation/proliferation and having immunomodulatory effects. There are several immune dysregulations that can be noted when renal function declines. Physicians need to know well both the classical and nonclassical functions of vitamin D. This review is an analysis from the nephrologist's viewpoint and focuses on the relationship between the vitamin D and the immune system, together with vitamin's clinical use to treat kidney diseases.
Vitamin D and adaptive immune system. The adaptive immune system is like Tai-Chi, namely, that it separates the Yin and the Yang.
1,25(OH) 2D3 directly modulates T cell responses and polarization related to the inflammatory molecules Th1 and Th17 in order to give rise to protective Th2 and Treg cells. In addition, 1,25(OH) 2D3 also inhibits the inflammatory Th1 and Th17 cytokines and upregulates the protective Th2 and Treg cytokines. When these effects are integrated, the adaptive immune system may produce lower levels of inflammation, atherosclerosis, and autoimmunity.
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