Vitamin D status in patients with multiple sclerosis: an association with insolation, disease course, and HLA-DRB1 gene polymorphism
https://doi.org/10.14412/2074-2711-2020-3-63-68
Abstract
Recent systematic reviews and a meta-analysis have shown that there is insufficient evidence on the relationship of multiple sclerosis (MS) to vitamin D supplementation
Objective: to assess the relationship of vitamin D status in MS patients to insolation, disease course, and HLA-DRB1 gene polymorphism. Patients and methods. The one-stage study enrolled 90 patients with relapsing-remitting MS (a study group) and 87 volunteers without this disease (a control group). The enrolled were born and live in the Altai Territory of the Russian Federation. The serum level of 25(OH)D was measured by enzyme immunoassay.
Results and discussion. 25(OH)D <30 ng/ml was more common in patients with MS than that in the controls. There were no intergroup differences in the time spent in the sun for 6 months before inclusion in the study (p=0.020). The level of 25(OH)D was higher in the high insolation period from April to September than that in the low insolation period from October to March in both patients with MS (p<0.005) and controls (p<0.001). There was no association of 25(OH)D levels with urban and rural residence, gender, age at MS onset, severity of neurological disorders, their progression rate, and MS risk alleles within the HLA-DRB1 gene (03, 13, 15).
Conclusion. Vitamin D deficiency is more common in patients with MS than in those without this disease. This is unlikely to be due to the differences in the radiation received from the sun. The final conclusion on the relationship of vitamin D to MS can be made after obtaining the results of a prospective follow-up.
About the Authors
I. V. SmaginaRussian Federation
Inna Vadimovna Smagina.
40, Lenin Prospect, Barnaul 656038.
Competing Interests:
There are no conflicts of interest.
K. V. Lunev
Russian Federation
40, Lenin Prospect, Barnaul 656038.
Competing Interests:
There are no conflicts of interest.
S. A. Elchaninova
Russian Federation
40, Lenin Prospect, Barnaul 656038.
Competing Interests:
There are no conflicts of interest.
References
1. Shmidt TE, Jahno NN. Rasseyannyi skleroz [Multiple sclerosis]. Moscow: MEDpressinform; 2016.
2. International Multiple Sclerosis Genetics Consortium. Low-Frequency and Rare-Coding Variation Contributes to Multiple Sclerosis Risk. Cell. 2018 Nov 29;175(6):1679-1687.e7. doi: 10.1016/j.cell.2018.09.049. Epub 2018 Oct 18.
3. Christakos S, Dhawan P, Verstuyf A, et al. Vitamin D: metabolism, molecular mechanism of action, and pleiotropic effects. Physiol Rev. 201 6 Jan; 96(1):365-408. doi: 10.1152/physrev.00014.2015.
4. Alharbi FM. Update in vitamin D and multiple sclerosis. Neurosciences (Riyadh). 2015 Oct; 20(4):329-35. doi: 10.17712/nsj.2015.4.20150357.
5. Agliardi C, Guerini FR, Saresella M, et al. Vitamin D receptor (VDR) gene SNPs influence VDR expression and modulate protection from multiple sclerosis in HLA-DRB1*15-positive individuals. Brain Behav Immun. 2011 Oct; 25(7):1460-7. doi: 10.1016/j.bbi.2011.05.015. Epub 2011 Jun 12.
6. Munger KL, Chitnis T, Frazier AL, et al. Dietary intake of vitamin D during adolescence and risk of multiple sclerosis. J Neurol. 2011 Mar; 258(3):479-85. doi: 10.1007/s00415-010-5783-1. Epub 2010 Oct 14.
7. Weinstock-Guttman B, Zivadinov R, Qu J, et al. Vitamin D metabolites are associated with clinical and MRI outcomes in multiple sclerosis patients. J Neurol Neurosurg Psychiatry. 2011 Feb; 82(2):189-95. doi: 10.1136/jnnp.2010.227942. Epub 2010 Nov 3.
8. Shahbeigi S, Pakdaman H, Fereshtehnejad SM, et al. Vitamin D3 concentration correlates with the severity of multiple sclerosis. Int J Prev Med. 2013 May;4(5):585-91.
9. Wang C, Zeng Z, Wang B, Guo S. Lower 25-Hydroxyvitamin D is associated with higher relapse risk in patients with relapsing-remitting multiple sclerosis. J Nutr Health Aging.2018;22(1): 38-43. doi: 10.1007/s12603-017-0894-3.
10. Mazdeh M, Seifirad S, Kazemi N, et al. Comparison of vitamin D3 serum levels in new diagnosed patients with multiple sclerosis versus their healthy relatives. Acta Med Iran. 201 May 30;51(5):289-92.
11. Jagannath VA, Filippini G, Di Pietrantonj C, et al. Vitamin D for the management of multiple sclerosis. Cochrane Database Syst Rev. 2018 Sep 24;9(9):CD008422. doi: 10.1002/14651858.CD008422.pub3.
12. Pierrot-Deseilligny C, Souberbielle JC. Vitamin D and multiple sclerosis: an update. Mult Scler Relat Disord. 2017 May;14:35-45. doi: 10.1016/j.msard.2017.03.014. Epub 2017 Mar 29.
13. Polman CH, Reingold SC, Banwell B, et al. Diagnostic criteria for multiple sclerosis: 2010 Revisions to the McDonald criteria. Ann Neurol. 2011 Feb;69(2):292-302. doi: 10.1002/ana.22366.
14. Kurtzke JF. Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology. 1983 Nov;33(11): 1444-52. doi: 10.1212/wnl.33.11.1444.
15. Waist circumference and waist-hip ratio: report of a WHO expert consultation, Geneva, 8-11 December 2008. World Health Organization. https://apps.who.int/iris/handle/10665/44583
16. Pigarova EA, Rozhinskaya LYa, Belaya ZhE, et al. Russian Association of Endocrinologists recommendations for diagnosis, treatment and prevention of vitamin D deficiency in adults. Problemy endokrinologii. 2016;62(4):60-84. (In Russ.).
17. Smagina IV, Elchaninova SA, Zolovkina AG, et al. Genetic risk factors for multiple sclerosis in the population of Altay. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova. 2011;111(5): 42-5. (In Russ.).
18. Smagina IV, Elchaninova EYu, Elchaninova SA. Multiple sclerosis in the Altai region of Russia: a prospective epidemiological study. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova. 2019; 119(2-2):7-11. (In Russ.).
19. Dobson R, Giovannoni G, Ramagopalan S. The month of birth effect in multiple sclerosis: systematic review, meta-analysis and effect of latitude. J Neurol Neurosurg Psychiatry. 2013 Apr;84(4):427-32. doi: 10.1136/jnnp-2012-303934. Epub 2012 Nov 14.
20. Pourshahidi LK. Vitamin D and obesity: current perspectives and future directions. Proc Nutr Soc. 2015 May;74(2):115-24. doi: 10.1017/S0029665114001578. Epub 2014 Oct 31.
21. Ascherio A, Munger KL, White R, et al. Vitamin D as an early predictor of multiple sclerosis activity and progression. JAMA Neurol. 2014 Mar;71(3):306-14. doi: 10.1001/jamaneurol.2013.5993.
22. Nolan D, Castley A, Tschochner M, et al. Contributions of vitamin D response elements and HLA promoters to multiple sclerosis risk. Neurology. 2012 Aug 7;79(6):538-46. doi: 10.1212/WNL.0b013e318263c407. Epub 2012 Jul 11.
23. Ramagopalan SV, Maugeri NJ, Handunnetthi L, et al. Expression of the multiple sclerosis-associated MHC class II Allele HLA-DRB1*1501 is regulated by vitamin D. PLoS Genet. 2009 Feb; 5(2):e1000369. doi: 10.1371/journal.pgen.1000369. Epub 2009 Feb 6.
24. Smagina IV, Elchaninova EYu, Lunev KV, et al. The vitamin D status and the calcitriol receptor gene polymorphisms VDR (rs1544410, rs2228570) in patients with pediatric-onset multiple sclerosis. Nevrologicheskii zhurnal. 2018;23(3):138-43. (In Russ.).
Review
For citations:
Smagina I.V., Lunev K.V., Elchaninova S.A. Vitamin D status in patients with multiple sclerosis: an association with insolation, disease course, and HLA-DRB1 gene polymorphism. Neurology, Neuropsychiatry, Psychosomatics. 2020;12(3):63-68. https://doi.org/10.14412/2074-2711-2020-3-63-68