Vitamin D and antiphospholipid syndrome

Abstract

Vitamin D (vitD) has been shown to have multiple immunomodulatory properties. Hypovitaminosis D has been described in many systemic autoimmune diseases. Antiphospholipid syndrome (APS), an autoimmune disease characterized by immunemediated thrombosis and pregnancy loss, is a peculiar model for studying vitD, since these patients do not usually have a full-blown autoimmune disease, nor do they have particular restrictions regarding sun exposure. We assessed 25-OH vitD levels in 115 APS and 128 normal healthy donors (NHD) with the LIAISON Õ chemiluminescent immunoassay by DiaSorin (Italy). Median values were lower in APS patients than in NHD, with the greatest difference occurring during summertime (p < 0.01), suggesting that APS patients may be somehow prevented from vitD generation upon sun exposure. In our cohort, APS patients may have been instructed to use sunscreens in the presence of positive antinuclear antibodies (ANA). Comparing patients with positive and negative ANA, we found comparable vitD levels during the summer. By subdividing APS patients according to clinical features, thrombotic APS patients showed significantly lower levels than did pure obstetric APS patients (p < 0.01). In conclusion, our study confirms previous reports of hypovitaminosis D in APS patients, making them more similar to patients with other systemic autoimmune diseases than NHD. Hypovitaminosis D may be part of the mosaic of factors that determine autoimmunity, rather than a consequence of chronic disease and its treatment. The observation that patients with thrombotic APS, an aggressive phenotype, may be more deficient than those with exclusive obstetric manifestations fits well with the beneficial effects of vitD on thrombosis described both in vitro and in vivo. Therefore, there may be a rationale to assess the efficacy of vitD supplementation in APS patients. Lupus (2012) 21, 736-740.

Pathogenic and Therapeutic Role of Vitamin D in Antiphospholipid Syndrome Patients

“…This letter to the editor presented the results of research conducted by Brazilian investigators in the group of forty-six PAPS patients, younger than 60 years, in whom the VitD levels were assessed in the autumn, when it was expected to be highest. VitD deficiency was found in 11% and insufficiency in 74% of these PAPS patients, resembling the findings of Italian authors [88] which have reported the prevalence of VitD deficiency in 17% and insufficiency in 60% of PAPS patients. It is interesting that Brazilian authors have noticed that VitD insufficient PAPS patients tended to be more overweighed than those with adequate VitD level [87].…”

“…Seasonal variations in VitD concentrations were demonstrated in PAPS patients same as in healthy controls, with preserved differences in its level between these two groups through all seasons [88,90]. These differences were most pronounced during summer, while they were not statistically significant only during the spring.…”

“…It is interesting that Brazilian authors have noticed that VitD insufficient PAPS patients tended to be more overweighed than those with adequate VitD level [87]. Also, it seems that thrombotic APS is characterized with significantly lower concentrations of VitD than purely obstetric clinical syndrome (20.8 vs. 33.3 ng/ml, p<0.01) [88] highlighting once again the role of this vitamin in thrombosis. High prevalence of VitD deficiency among patients with APS (49.5%) and its significant correlation with thrombotic events were confirmed by Israeli authors [68].…”

Vitamin D and assisted reproduction: should vitamin D be routinely screened and repleted prior to ART? A systematic review

“…In addition, in vitro NK cytotoxicity assays demonstrated significant suppression at an E:T ratio of 50:1 when treated with Vitamin D compared to the control group, demonstrating evidence that low Vitamin D may be associated with increased NK cell activity in women with recurrent pregnancy loss. Additionally, in a retrospective cohort study of 115 women with antiphospholipid syndrome (APS), median vitamin D levels in APS patients were significantly lower compared to healthy volunteers (n=128), although the authors report possible confounding factors related to provider recommendation of increased sunscreen use in the APS cohort [22]. Tavakoli et al [23] reported similar cytokine profiles and vitamin D expression of whole endometrial cells obtained from women with unexplained recurrent pregnancy loss (n=8) compared to age matched controls (n=8), although the authors do not address the limitations of the small sample size.…”

Antiphospholipid Syndrome: primary or secondary to Systemic Lupus Erythematosus? Description of a clinical case of avitaminosis D in premenopausal woman with pseudo-Cushing syndrome

“…Tra le donne in premenopausa con pAPS più del 50% dei casi presenta ipovitaminosi D [5][6][7]: livelli < 15 ng/ml risultano significativamente associati agli eventi trombotici [8].…”