Cystic Fibrosis exacerbation reduced by Vitamin D (250,000 IU) – RCT May 2017

Plasma metabolomics in adults with cystic fibrosis during a pulmonary exacerbation: A pilot randomized study of high-dose vitamin D3 administration.

Metabolism. 2017 May;70:31-41. doi: 10.1016/j.metabol.2017.02.006. Epub 2017 Feb 11.


Alvarez JA1, Chong EY2, Walker DI3, Chandler JD4, Michalski ES5, Grossmann RE6, Uppal K3, Li S3, Frediani JK5, Tirouvanziam R7, Tran VT3, Tangpricha V 8, Jones DP3, Ziegler TR8.

  • 1 Division of Endocrinology, Metabolism & Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA; Center for Cystic Fibrosis and Airways Disease Research, Children's Healthcare of Atlanta, Atlanta, GA, USA. Electronic address: jessica.alvarez@emory.edu.
  • 2 Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
  • 3 Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
  • 4 Center for Cystic Fibrosis and Airways Disease Research, Children's Healthcare of Atlanta, Atlanta, GA, USA; Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
  • 5 Division of Endocrinology, Metabolism & Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA; Nutrition and Health Sciences Graduate Program, Laney Graduate School, Emory University, Atlanta, GA, USA.
  • 6 College of Nursing, The University of Iowa, Ames, IA, USA.
  • 7 Center for Cystic Fibrosis and Airways Disease Research, Children's Healthcare of Atlanta, Atlanta, GA, USA; Division of Pulmonary, Allergy & Immunology, Cystic Fibrosis and Sleep, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.
  • 8 Division of Endocrinology, Metabolism & Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA; Center for Cystic Fibrosis and Airways Disease Research, Children's Healthcare of Atlanta, Atlanta, GA, USA; Section of Endocrinology, Atlanta Veterans Affairs Medical Center, Atlanta, GA, USA.


BACKGROUND:
Cystic fibrosis (CF) is a chronic catabolic disease often requiring hospitalization for acute episodes of worsening pulmonary exacerbations. Limited data suggest that vitamin D may have beneficial clinical effects, but the impact of vitamin D on systemic metabolism in this setting is unknown.

OBJECTIVE:
We used high-resolution metabolomics (HRM) to assess the impact of baseline vitamin D status and high-dose vitamin D3 administration on systemic metabolism in adults with CF with an acute pulmonary exacerbation.

DESIGN:
Twenty-five hospitalized adults with CF were enrolled in a randomized trial of high-dose vitamin D3 (250,000IU vitamin D3 bolus) versus placebo. Age-matched healthy subjects served as a reference group for baseline comparisons. Plasma was analyzed with liquid chromatography/ultra-high resolution mass spectrometry. Using recent HRM bioinformatics and metabolic pathway enrichment methods, we examined associations with baseline vitamin D status (sufficient vs. deficient per serum 25-hydroxyvitamin D concentrations) and the 7-day response to vitamin D3 supplementation.

RESULTS:
Several amino acids and lipid metabolites differed between CF and healthy control subjects, indicative of an overall catabolic state. In CF subjects, 343 metabolites differed (P<0.05) by baseline vitamin D status and were enriched within 7 metabolic pathways including fatty acid, amino acid, and carbohydrate metabolism. A total of 316 metabolites, which showed enrichment for 15 metabolic pathways-predominantly representing amino acid pathways-differed between the vitamin D3- and placebo-treated CF subjects over time (P<0.05). In the placebo group, several tricarboxylic acid cycle intermediates increased while several amino acid-related metabolites decreased; in contrast, little change in these metabolites occurred with vitamin D3 treatment.

CONCLUSIONS:
Numerous metabolic pathways detected by HRM varied in association with vitamin D status and high-dose vitamin D3 supplementation in adults with CF experiencing a pulmonary exacerbation. Overall, these pilot data suggest an anti-catabolic effect of high-dose vitamin D3 in this clinical setting.

PMID: 28403943 DOI: 10.1016/j.metabol.2017.02.006

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References include

  • Grossmann, R.E., Zughaier, S.M., Kumari, M., Seydafkan, S., Lyles, R.H., Liu, S. et al, Pilot study of vitamin D supplementation in adults with cystic fibrosis pulmonary exacerbation: a randomized, controlled trial. Dermatoendocrinol. 2012;4:191–197. Crossref | PubMed | Scopus (29)
  • Grossmann, R.E., Zughaier, S.M., Liu, S., Lyles, R.H., Tangpricha, V. Impact of vitamin D supplementation on markers of inflammation in adults with cystic fibrosis hospitalized for a pulmonary exacerbation. Eur J Clin Nutr. 2012;66:1072–1074. Crossref | PubMed | Scopus (46)
  • Green, D., Carson, K., Leonard, A., Davis, J.E., Rosenstein, B., Zeitlin, P. et al, Current treatment recommendations for correcting vitamin D deficiency in pediatric patients with cystic fibrosis are inadequate. J Pediatr. 2008;153:554–559 (e2). Abstract | Full Text | Full Text PDF | PubMed | Scopus (45)
  • McCauley, L.A., Thomas, W., Laguna, T.A., Regelmann, W.E., Moran, A., Polgreen, L.E. vitamin D deficiency is associated with pulmonary exacerbations in children with cystic fibrosis. Ann Am Thorac Soc. 2013;11:198–204. Crossref | Scopus (17)
  • Marcondes, N.A., Raimundo, F.V., Vanacor, R., Corte, B.P., Ascoli, A.M., de Azambuja, A.Z. et al, Hypovitaminosis D in patients with cystic fibrosis: a cross-section study in South Brazil. Clin Respir J. 2014;8:455–459. Crossref | PubMed | Scopus (1)
  • Pincikova, T., Nilsson, K., Moen, I.E., Fluge, G., Hollsing, A., Knudsen, P.K. et al, vitamin D deficiency as a risk factor for cystic fibrosis-related diabetes in the Scandinavian cystic fibrosis nutritional study. Diabetologia. 2011;54:3007–3015. Crossref | PubMed | Scopus (18)
  • Pincikova, T., Nilsson, K., Moen, I.E., Karpati, F., Fluge, G., Hollsing, A. et al, Inverse relation between vitamin D and serum total immunoglobulin G in the Scandinavian cystic fibrosis nutritional study. Eur J Clin Nutr. 2011;65:102–109. Crossref | PubMed | Scopus (32)
  • Simoneau, T., Bazzaz, O., Sawicki, G.S., Gordon, C. vitamin D status in children with cystic fibrosis. Associations with inflammation and bacterial colonization. Ann Am Thorac Soc. 2014;11:205–210. Crossref | PubMed | Scopus (13)
  • Tangpricha, V., Kelly, A., Stephenson, A., Maguiness, K., Enders, J., Robinson, K.A. et al, An update on the screening, diagnosis, management, and treatment of vitamin D deficiency in individuals with cystic fibrosis: evidence-based recommendations from the cystic fibrosis Foundation. J Clin Endocrinol Metab. 2012;97:1082–1093. Crossref | PubMed | Scopus (66)
  • West, N.E., Lechtzin, N., Merlo, C.A., Turowski, J.B., Davis, M.E., Ramsay, M.Z. et al, Appropriate goal level for 25-hydroxyvitamin D in cystic fibrosis. Chest. 2011;140:469–474. Abstract | Full Text | Full Text PDF | PubMed | Scopus (16)
  • Chesdachai, S., Tangpricha, V. Treatment of vitamin D deficiency in cystic fibrosis. J Steroid Biochem Mol Biol. 2016;164:36–39. Crossref | PubMed | Scopus (1)

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