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Alterations in vitamin D status and anti-microbial peptide levels in patients in the intensive care unit with sepsis.

Jeng L, Yamshchikov AV, Judd SE, Blumberg HM, Martin GS, Ziegler TR, Tangpricha V - J Transl Med (2009)

Bottom Line: There was a significant positive association between circulating 25(OH)D and LL-37 levels.Optimal vitamin D status may be important for innate immunity especially in the setting of sepsis.Further invention studies to examine this association are warranted.

View Article: PubMed Central - HTML - PubMed

Affiliation: Division of Endocrinology, Diabetes & Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA. jengleo@gmail.com

ABSTRACT

Background: Vitamin D insufficiency is common in hospitalized patients. Recent evidence suggests that vitamin D may enhance the innate immune response by induction of cathelicidin (LL-37), an endogenous antimicrobial peptide produced by macrophages and neutrophils. Thus, the relationship between vitamin D status and LL-37 production may be of importance for host immunity, but little data is available on this subject, especially in the setting of human sepsis syndrome and other critical illness.

Methods: Plasma concentrations of 25-hydroxyvitamin D (25(OH)D), vitamin D binding protein (DBP) and LL-37 in critically ill adult subjects admitted to intensive care units (ICUs) with sepsis and without sepsis were compared to healthy controls.

Results: Critically ill subjects had significantly lower plasma 25(OH)D concentrations compared to healthy controls. Mean plasma LL-37 levels were significantly lower in critically ill subjects compared to healthy controls. Vitamin D binding protein levels in plasma were significantly lower in critically ill subjects with sepsis compared to critically ill subjects without sepsis. There was a significant positive association between circulating 25(OH)D and LL-37 levels.

Conclusion: This study demonstrates an association between critical illness and lower 25(OH)D and DBP levels in critically ill patients as compared to healthy controls. It also establishes a positive association between vitamin D status and plasma LL-37, which suggests that systemic LL-37 levels may be regulated by vitamin D status. Optimal vitamin D status may be important for innate immunity especially in the setting of sepsis. Further invention studies to examine this association are warranted.

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Related in: MedlinePlus

Plasma vitamin D binding protein in critically ill subjects with sepsis, critically ill subjects without sepsis and healthy subjects. Plasma vitamin D binding protein concentrations were significantly lower in critically ill subjects with sepsis (hatched bar) compared to critically ill control subjects (dark bar) (white bar) (ANOVA, p = 0.014). † p = < 0.05, critically ill sepsis subjects compared to critically ill control subjects.
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Figure 2: Plasma vitamin D binding protein in critically ill subjects with sepsis, critically ill subjects without sepsis and healthy subjects. Plasma vitamin D binding protein concentrations were significantly lower in critically ill subjects with sepsis (hatched bar) compared to critically ill control subjects (dark bar) (white bar) (ANOVA, p = 0.014). † p = < 0.05, critically ill sepsis subjects compared to critically ill control subjects.

Mentions: There was a statistically significant difference in plasma vitamin D binding protein between the three groups of subjects (ANOVA, p = 0.014) (Figure 2). Subjects with sepsis had significantly lower DBP concentrations compared to subjects without sepsis (Figure 2). Race was not associated with DBP levels. Cathelicidin (LL-37) concentrations differed in the three groups (p = 0.002, ANOVA). Both groups of critically ill subjects had similar plasma LL-37 concentrations (Figure 3, 13.7 ± 2.1 ng/mL vs. 10.6 ± 1.4 ng/mL; P = 0.59). However, mean plasma LL-37 levels in healthy controls (27.2 ± 4.9 ng/mL) were significantly higher than compared to the critically ill groups (p < 0.001, Tukey-Kramer for both comparisons) (Figure 3). While adiposity has been associated with 25(OH)D levels, we tested the association of BMI with LL-37 and showed no statistical significant relationship (p = 0.20). Therefore, BMI was not used in any of our models. Plasma LL-37 levels also were not significantly associated with age or race.


Alterations in vitamin D status and anti-microbial peptide levels in patients in the intensive care unit with sepsis.

Jeng L, Yamshchikov AV, Judd SE, Blumberg HM, Martin GS, Ziegler TR, Tangpricha V - J Transl Med (2009)

Plasma vitamin D binding protein in critically ill subjects with sepsis, critically ill subjects without sepsis and healthy subjects. Plasma vitamin D binding protein concentrations were significantly lower in critically ill subjects with sepsis (hatched bar) compared to critically ill control subjects (dark bar) (white bar) (ANOVA, p = 0.014). † p = < 0.05, critically ill sepsis subjects compared to critically ill control subjects.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2684740&req=5

Figure 2: Plasma vitamin D binding protein in critically ill subjects with sepsis, critically ill subjects without sepsis and healthy subjects. Plasma vitamin D binding protein concentrations were significantly lower in critically ill subjects with sepsis (hatched bar) compared to critically ill control subjects (dark bar) (white bar) (ANOVA, p = 0.014). † p = < 0.05, critically ill sepsis subjects compared to critically ill control subjects.
Mentions: There was a statistically significant difference in plasma vitamin D binding protein between the three groups of subjects (ANOVA, p = 0.014) (Figure 2). Subjects with sepsis had significantly lower DBP concentrations compared to subjects without sepsis (Figure 2). Race was not associated with DBP levels. Cathelicidin (LL-37) concentrations differed in the three groups (p = 0.002, ANOVA). Both groups of critically ill subjects had similar plasma LL-37 concentrations (Figure 3, 13.7 ± 2.1 ng/mL vs. 10.6 ± 1.4 ng/mL; P = 0.59). However, mean plasma LL-37 levels in healthy controls (27.2 ± 4.9 ng/mL) were significantly higher than compared to the critically ill groups (p < 0.001, Tukey-Kramer for both comparisons) (Figure 3). While adiposity has been associated with 25(OH)D levels, we tested the association of BMI with LL-37 and showed no statistical significant relationship (p = 0.20). Therefore, BMI was not used in any of our models. Plasma LL-37 levels also were not significantly associated with age or race.

Bottom Line: There was a significant positive association between circulating 25(OH)D and LL-37 levels.Optimal vitamin D status may be important for innate immunity especially in the setting of sepsis.Further invention studies to examine this association are warranted.

View Article: PubMed Central - HTML - PubMed

Affiliation: Division of Endocrinology, Diabetes & Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA. jengleo@gmail.com

ABSTRACT

Background: Vitamin D insufficiency is common in hospitalized patients. Recent evidence suggests that vitamin D may enhance the innate immune response by induction of cathelicidin (LL-37), an endogenous antimicrobial peptide produced by macrophages and neutrophils. Thus, the relationship between vitamin D status and LL-37 production may be of importance for host immunity, but little data is available on this subject, especially in the setting of human sepsis syndrome and other critical illness.

Methods: Plasma concentrations of 25-hydroxyvitamin D (25(OH)D), vitamin D binding protein (DBP) and LL-37 in critically ill adult subjects admitted to intensive care units (ICUs) with sepsis and without sepsis were compared to healthy controls.

Results: Critically ill subjects had significantly lower plasma 25(OH)D concentrations compared to healthy controls. Mean plasma LL-37 levels were significantly lower in critically ill subjects compared to healthy controls. Vitamin D binding protein levels in plasma were significantly lower in critically ill subjects with sepsis compared to critically ill subjects without sepsis. There was a significant positive association between circulating 25(OH)D and LL-37 levels.

Conclusion: This study demonstrates an association between critical illness and lower 25(OH)D and DBP levels in critically ill patients as compared to healthy controls. It also establishes a positive association between vitamin D status and plasma LL-37, which suggests that systemic LL-37 levels may be regulated by vitamin D status. Optimal vitamin D status may be important for innate immunity especially in the setting of sepsis. Further invention studies to examine this association are warranted.

Show MeSH
Related in: MedlinePlus