Importancia de la Vitamina D en la época del COVID-19 / Importance of Vitamin D in the time of COVID-19

"Los coronavirus pertenecen a una gran familia de virus (Coronaviridae) que infectan aves y varios mamíferos. El coronavirus actualmente denominado SARS-CoV-2, fue descubierto en diciembre de 2019 en Wuhan, provincia de Hubei, China, y es el agente causal de la epidemia de neumonía atípica actual" (COVID-19; Coronavirus Disease 2019). Los casos más graves presentan un síndrome de dificultad respiratoria aguda que puede conducir a la muerte. La vitamina D (VD), además del efecto bien conocido y positivo sobre la salud ósea y la homeostasis del calcio, tiene efecto pleiotrópico en varios órganos, con distribución casi universal del receptor de VD y de las enzimas de metabolización de 25 hidroxivitamina D (25OHD) en las células del organismo. Estas acciones extraesqueléticas dependen de la síntesis en dichas células del metabolito activo 1,25 dihidroxivitamina D por regulación paracrina y autocrina, dependiente de niveles circulantes óptimos de 25OHD. Por sus acciones inmunomoduladora, antiinflamatoria, antimicrobiana, reguladora del sistema renina-angiotensina-aldosterona, favorecedora de la indemnidad del epitelio respiratorio y la homeostasis redox celular, la VD podría tener efecto protector en la infección por COVID-19. Entre los grupos de riesgo para COVID-19 figuran los adultos mayores, obesos, diabéticos, hipertensos, con afecciones cardiovasculares, patologías con mayor incidencia en individuos con hipovitaminosis VD. La suplementación con VD, para alcanzar niveles óptimos de 25OHD de 40-60 ng/ml, podría reducir la incidencia, severidad y riesgo de muerte en la actual pandemia por COVID-19, como medida complementaria mientras se desarrollan la vacuna y otras medicaciones específicas. (AU)

Coronaviruses belong to a large family of viruses (Coronaviridae) that infect birds and various mammals. The novel coronavirus currently known as SARS-CoV-2 was discovered in December 2019 in Wuhan, Hubei province, China and is the causal agent of the current atypical pneumonia epidemic (COVID-19: Coronavirus Disease 2019); The most severe cases present with acute respiratory distress syndrome that can lead to death. Vitamin D (VD) has a pleiotropic effect on several organs, in addition to its wellknown and positive effect on bone health and calcium homeostasis, with an almost universal distribution of the VD receptor and the metabolites of 25hydroxyvitamin D (25OHD) in all cells of the body. These extra-skeletal actions depend on the synthesis of the active metabolite 1,25dihydroxyvitamin D in the cells depending on the optimal circulating levels of 25OHD and though paracrine and autocrine regulation. Due to its immunomodulatory, anti-inflammatory, antimicrobial, and regulatory actions on the renin angiotensin aldosterone system, which favors the compensation of the respiratory epithelium and cellular redox homeostasis, the VD could have a protective effect on COVID-19 infection. Among the risk groups for COVID-19 are obese, diabetic, and hypertensive patients, subjects with cardiovascular conditions, and elderly people. All these pathologies show a higher incidence in individuals with VD hypovitaminosis. VD supplementation, to achieve optimal 25OHD levels of 40-60 ng/ml, could reduce the incidence, severity, and risk of death in the current COVID-19 pandemic, as a complementary measure while the vaccine and other specific therapies are being developed. (AU)

UVB therapy increases 25(OH) vitamin D syntheses in postmenopausal women with psoriasis.

BACKGROUND: Vitamin D3 is produced in the epidermis by ultraviolet (UV) radiation (290-315 nm) of 7-dehydrocholesterol. A similar range of 290-320 nm (broadband UVB) has been successfully used for years to treat psoriasis. The aim of this study was to investigate whether UVB therapy was able to influence vitamin D synthesis in psoriasis patients. METHODS: Twenty-four postmenopausal, white Caucasian women, aged 69 +/- 5.9 (mean +/- SD), with active plaque psoriasis, were treated with broadband UVB two to three times per week for 8-12 weeks. The serum concentrations of calcidiol (25(OH)D3), calcitriol (1,25(OH)2D3), intact parathyroid hormone (PTH), thyroid hormones, osteocalcin, calcium and creatinine were measured before the first and after the last dose of radiation. Bone density was measured using Dual-Energy X-ray Absorptiometry (Hologic Delphi A) at the hip and lumbar spine. RESULTS: Serum levels of 25(OH)D3 increased from 36.8 +/- 17 ng/ml (mean +/- SD) to 59.6 +/- 18.7 ng/ml (P<0.001) after the UVB treatment period. Serum PTH decreased from 62.8 +/- 25.7 ng/l to 48.2 +/- 17.4 ng/l (P<0.001). Secondary hyperparathyroidism (PTH>65 ng/l) was revealed in seven patients (29%) in whom PTH values were suppressed by the UVB therapy. The serum levels of calcitriol, calcium, osteocalcin, thyroid hormones and creatinine were unaltered. CONCLUSION: UVB therapy in elderly psoriatic women improved psoriasis, increased serum 25(OH)D3 synthesis and reduced serum PTH concentrations.

Effect of vitamin D-containing plant extracts on osteoporotic bone.

Adequate supply of vitamin D(3) is not sufficient for the prevention of post-menopausal osteoporosis, because of a tightly regulated critical step in formation of the most active vitamin D metabolite 1,25-dihydroxyvitamin D(3). Direct application of 1,25(OH)(2)D(3), however, was effective in reducing fracture rate and increasing bone mineral density as has been shown in large clinical studies. Extracts from Solanum glaucophyllum and Trisetum flavescens plants containing 1,25(OH)(2)D(3)-glycosides were characterized by their vitamin D-activity in a quail eggshell bioassay and applied in an osteoporosis model in ovariectomized rats. An extract from the grass T. flavescens and a purified extract from S. glaucophyllum were characterized by the absence of alkaloids and the analytically determined content of 1,25(OH)(2)D(3). In the ovariectomized rat model after 6 months duration, the bone metabolism relevant markers serum calcium, 1,25(OH)(2)D(3), urinary crosslinks and calcium were measured. At termination tibial mineral content was determined and as imaging procedure micro-computerized tomography was applied. The bisphosphonate alendronate was used as a positive standard. While alendronate reduced bone resorption, as seen in a reduced urinary crosslink excretion, both vitamin D metabolite-containing extracts were able to improve bone mineral density by an enhanced calcium turnover.

Effect of indomethacin on plasma levels of vitamin D metabolites, oestradiol and progesterone in rabbits during early pregnancy.

1. Inhibition of prostaglandin (PG) synthesis by indomethacin (Id) during early pregnancy in rabbits apparently disrupts the process of sex steroid production by the ovaries. 2. The role of PGs as mediators in steroidogenesis was tested by investigating the effect of Id alone or in combination with progesterone, with oestradiol and progesterone, or with a mixture of PGs, on plasma levels of 25-hydroxyvitamin D (25(OH)D) and 1,25-dihydroxyvitamin D (1,25(OH)2D) in rabbits at an early stage of pregnancy. 3. Id alone significantly reduced plasma levels of both 25(OH) D and 1,25(OH)2D. Treatment with Id in combination with either oestradiol and progesterone, or with a mixture of PGs, resulted in the restoration of plasma levels of both vitamin D metabolites as well as the restoration of plasma levels of progesterone, to their control values.

[Metabolism of 25-hydroxyvitamin D3 and its regulation in rats during hypokinesis]. / Metabolizm 25-oksivitamina D3 i ego reguliatsiia u krys pri gipokinezii.

The influence of short-(7 days) and long-term (28 days) hypokinesia on 25-hydroxyvitamin D3 metabolism was investigated in rats fed on a normal calcium (0.6%), normal phosphorus (0.6%), vitamin D-supplemented diet. The animals were given a single intraperitoneal dose of tritiated [26,27-3H]25(OH)D3 (200 pmol) eighteen hours before sacrifice. [3H]Labelled vitamin D3 metabolites were separated by high performance liquid chromatographic procedure, and their radioactivity levels in serum, kidney, intestinal mucosa and femoral bone were measured. Long-term hypokinesia resulted in decreased levels of [3H]1.25(OH)2D3 and increased levels of [3H]24.25(OH)2D3 in serum and kidney (3.15 +/- 0.62 vs. 4.33 +/- 0.41% and 5.34 +/- 0.69 vs. 3.76 +/- 0.29% for [3H]1.25(OH)2D3 and [3H]24.25(OH)2D3 in serum; 7.52 +/- 0.69 vs. 11.6 +/- 0.79% and 9.33 +/- 0.55 vs. 5.94 +/- 0.24% for those in kidney). The levels of [3H]1.25(OH)2D3 as well as of [3H] 24.25(OH)2D3 were decreased in intestinal mucosa and bone (21.5 +/- 1.46 vs. 30.1 +/- 3.04% and 7.30 +/- 0.58 vs. 9.18 +/- 0.78% for [3H]1.25(OH)2D3 and [3H]24.25(OH)2D3 in intestinal mucosa; 6.39 +/- 06.5 vs. 11.5 +/- 1.64% and 7.78 +/- 0.71 vs. 13.9 +/- 1.28% for those in bone). The data obtained suggest a suppressed synthesis of 1.25(OH)2D3 and enhanced production of 24.25(OH)2D3 in kidney as well as a diminished binding of 24.25(OH)2D3 in intestinal mucosa and bone in hypothetic rats. Possible causes of variations in biosynthesis of vitamin D3 active metabolites, and role of these variations in the disorders of calcium metabolism and bone state during hypokinesia are discussed.

Stereo-retained and stereo-selective lactonization of four diastereoisomers of 23,25,26-trihydroxyvitamin D3 in homogenates of kidney from vitamin D-supplemented chicks.

To elucidate the biosynthesis of 25-hydroxyvitamin D3-26,23-lactone, various vitamin D3 derivatives were incubated individually with kidney homogenates prepared from vitamin D3-supplemented chicks, a preparation known to produce the 25-hydroxyvitamin D3-26,23-lactone from 25-hydroxyvitamin D3. The 25-hydroxyvitamin D3-26, 23-lactone produced in vitro was then separated, purified, identified, and quantitated by consecutive analysis by high-pressure liquid chromatography. The naturally occurring 23(S), 25(R)-25-hydroxyvitamin D3-26,23-lactone was produced from 23(S),25-dihydroxyvitamin D3, 25(R),26-dihydroxyvitamin D3, and 23(S),25(R),26-trihydroxyvitamin D3. 23(S),25 (S)-25-Hydroxyvitamin D3-26,23-lactone was synthesized from 25(S),26-dihydroxyvitamin D3 and 23(S),25(S),26-trihydroxyvitamin D3. The relative amounts of 25-hydroxyvitamin D3-26,23-lactones generated from the following vitamin D3 derivatives used as substrate (23(S),25(S),26-trihydroxyvitamin D3; 23(R),25(R),26-trihydroxyvitamin D3; 23(S),25(R),26-trihydroxyvitamin D3; 23(R),25(S),26-trihydroxyvitamin D3; 23(S), 25-dihydroxyvitamin D3; 23(R),25-dihydroxyvitamin D3; 25(S),26-dihydroxyvitamin D3; and 25(R),26-dihydroxyvitamin D3) are, respectively, 15:1.7:24:3.3:2.5:0:1:1.7. These results indicate that when the lactonization at C-23 and C-26 positions of various vitamin D3 derivatives occurred the stereochemical configuration at their C-23 and/or C-25 positions was not changed and the difference of the stereochemical configurations determined the rate of lactonization.