Vitamin D was first identified as a cure for nutritional rickets, a disease of bone growth caused by an inadequate uptake of dietary calcium. It is now known that vitamin D can be obtained through two independent pathways: limited dietary sources and the photochemical action of solar UV light in the skin. Cod liver oil was discovered to be an excellent source of antirachitic activity in 1827, although it was not until several decades later that the active ingredient was identified as vitamin D 3 . Even earlier, in 1822, a Polish physician studying children reached the remarkable conclusion that sunlight cured rickets after noting that rickets was relatively rare in the clearer air of rural areas. Almost 100 years later, in 1919, it was shown that artificial UV light cured rickets (49; www .beyonddiscovery.org/Includes/DBLink.asp?IDϭ1176). Indeed, secosteroidal vitamin D 3 is produced in the skin via photochemical and thermal conversion of 7-dehydrocholesterol in the presence of UVB light (ϳ295 to 320 nm). While it seems that vitamin D is readily accessible via dietary or solar routes, vitamin D insufficiency or deficiency is, in fact, quite widespread. Solar UVB irradiation is absorbed by atmospheric ozone; consequently, the surface intensity of UVB varies markedly with latitude and time of year. Moreover, as vitamin D intake is generally inadequate in most diets (38-40), the rate of vitamin D insufficiency or deficiency increases with increasing latitude.The term vitamin D refers collectively to vitamin D 3 and vitamin D 2 , which is derived from irradiation of the steroid ergosterol in yeast. Biologically active vitamin D is generated via largely hepatic 25-hydroxylation catalyzed by CYP2R1, CYP27A1, and possibly other enzymes to produce 25-hydroxvitamin D (25D) (21,40,43,67,81), which has a long half-life and is the major circulating vitamin D metabolite. 25D is modified by 1␣-hydroxylation catalyzed by CYP27B1, which produces hormonal 1,25-dihydroxyvitamin D (1,25D) (40,43,67). Vitamin D compounds are catabolized via 24-hydroxylation by CYP24, whose expression is strongly inducible by 1,25D, which constitutes a negative feedback loop (40,43,67).While the kidneys are a major site of 1␣-hydroxylation of 25D, it has recently become clear that generation of hormonal 1,25D in peripheral tissues is critical to the full scope of the physiological actions of this compound. Renal 1␣-hydroxylation is tightly controlled by calcium homeostatic signals, particularly circulating parathyroid hormone (PTH). Although initially characterized as a calcium homeostatic agent, vitamin D is now known to have pleiotropic actions, including a key role in immune system regulation (49). Importantly in this regard, recent research detailed here has uncovered critical, cell-specific differences in both the regulation of 1␣-hydroxylation of 25D and 24-hydroxylation that are relevant to the role of 1,25D as an immune system regulator.
VITAMIN D INSUFFICIENCY/DEFICIENCY AND DISEASEWhile there is no strict definition, vitamin D deficiency i...