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Also see Vitamin D beyond bones- was it all just a hype- Balanced view of current status

- Q. Enlist the Non-Calciotropic actions of Vitamin D
- Action on the skin is not known, but VDDR type 2 have had alopecia totalis
- Hypertension- Vitamin D reduces renin levels
- CV risk :Vitamin D Deficiency increase risk of thrombosis
- Glucose metabolism: 1,25 Dihydroxyvitamin D has a favorable effect on glucose metabolism
- Cancer: Vitamin D reduces cell proliferation and increases cell differentiation
- Immune action
- Muscles  - Vitamin D Deficiency produces proximal muscle weakness an increased risk of falls
- Neuro-psychiatric functions
-

- Q. Summarize the cardiovascular and metabolic actions of vitamin D?
- Heart
- Increase cardiac contractility
- Reduces cardiac remodeling
- Blood vessels
- Increase release of endothelial Nitrous oxide
- Reduce thrombogeneticity
- Promotes vascular repair via increase vascular smooth muscle differentiation
- Modulation of vascular calcification
- Reduces local inflammation
- Kidney
- Reduces Renin  reduces BP
- Reduces proteinuria
- Lipid
- Reduces Apo AI
- Pancreas
- Increases insulin release
- Reduces insulin resistance
-

- Q. Does current evidence suggest the replacement of vitamin D to reduce CV risk?
- No

- Q. Summarize the anticancer actions of vitamin D?
- Reduces Cell differentiation
- Cell cycle arrest
- Apoptosis
- Anti-angiogenesis
- Immune rejection of the tumor
-

- Q. Summarize the action of vitamin D on the cell growth pathway?
- Vitamin D Increases
- TGF beta which controls cells growth cycle
- E- Cadherin- induces cell differentiation
- 2. Vitamin D reduces
- E2F pathway – reduce cell cycle
- Growth factors- IGF1, EGF, PGE2 – reduce cell growth
-

- Q., vitamin D polymorphism, is associated with which cancers?
- Breast
- Prostate
- Thyroid
- Melanoma
- Colorectal

- Q. Benefit of vitamin D has been demonstrated in which cancers?
- Breast
- Prostate
- Melanoma
- Colon
- Value <20 ng/ml- increased risk of breast cancer and melanoma

- Q. Summarize the actions of vitamin D on the immune system?
- Enhances innate immunity
- Modulates Adaptive immunity
- Reduces Th1 response
- Increases Th2 response
- Reduces production of IgG by B cells
- Increases Treg cell function

- Q. vitamin D has been tried in which immune-mediated disorders?
- Multiple sclerosis
- Asthma
- Type 1 diabetes
-

- Q. Summarize the actions of vitamin D on the muscle?
- Vitamin D may have non-genomic actions on muscles
- Some of the action on muscle may be mediated by vitamin D binding protein
- Vitamin D is proposed to activate cell surface receptors on muscles which can trigger the MAPKinase pathway – leading the increase myogenesis

- Q. What is the evidence of the direct impact of vitamin D on muscles?
- 1. VDR knock out mice have muscle atrophy
- 2. patients with vitamin D dependent rickets- defect in vitamin D receptor have myopathy
- Recent experiment has shown that treatment with 25 hydroxyvitamin D increases the VDR mRNA expression in C2C12 myoblasts
- In recent experiments – treatment with vitamin D increased the number of vitamin D receptor in the muscle by 29%

- Q. What are the evidence of the indirect impact of vitamin D in muscles?
- 1. Some studies have shown the clear absence of vitamin D receptors in muscles and have challenged this notion
- 2. not all patients with low vitamin D have myopathy
- 3. some experiments have shown knock out of intestinal vitamin D receptor leads to muscle atrophy
- A high dose of calcium can reverse features of osteomalacic myopathy in some patients
- High PTH can lead to myopathy and poor contractility

- Q. What does RCT for vitamin D supplementation say?
- There is a meta-analysis that says that if the starting vitamin D is <10 ng/ml- there is an improvement in the muscle function with treatment
- However, If the starting vitamin D > 10 ng/ml, there is a slight improvement in muscle function with treatment
- Another RCT explored the role of vitamin D in preventing falls
- They grouped the studies according to a dose of vitamin D used
- They found that studies that used a low dose of vitamin D – 200 IU found no benefit in preventing falls
- Studies showing a higher dose of vitamin D of 700-100 IU/day found risk reduction in falls with vitamin D supplementation

Vitamin D analogs

Vitamin D and Diabetes

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