Pınar BEKDİK ŞİRİNOCAK, Neslihan EŞKUT, Ayfer ÇOLAK, Ufuk ŞENER, Yaşar ZORLU

VITAMIN D, PARATHORMONE, GENDER, INTERLEUKIN 10 AND TUMOR NECROSIS ALPHA RELATIONSHIP IN MULTIPLE SCLEROSIS PATIENTS

Introduction: Vitamin D is thought to have a role on multiple sclerosis hence MS cases are less frequent in the areas where exposure to sunlight is high. The idea that vitamin D is related to clinical features and this effect is more prominent in female patients is controversial. In this study, the relationship between vitamin D levels, pro and anti-inflammatory cytokine levels and gender in relapsing-remitting multiple sclerosis patients were investigated. Materials and Methods: 74 patients with relapsing-remitting multiple sclerosis who were in the remission period were included in the study. The control group consisted of 50 healthy individuals with similar age and gender. Serum vitamin D, parathormone, interleukin-10 and tumor necrosis factor-α levels were tested in the patient and control groups. The relationship of vitamin D with gender, clinical features and cytokine levels was also investigated. Results: The mean vitamin D level was 14.4 ng/ml in the patient group and 16 ng/ml in the control group. The levels of vitamin D (p: 0,206), Interleukin-10 (p: 0,081), Tumor necrosis factor-α (p: 0,340) and parathormone (p: 0,107) were similar in the patient and control groups. Although vitamin D values tended to decrease as clinical severity was worsening, this relationship was not statistically significant. Vitamin D levels found to be lower in female . Conclusion: Vitamin D levels were low in both the patient and control group. There was no correlation between vitamin D levels and clinical features.

MULTİPL SKLEROZ HASTALARINDA VİTAMİN D, PARATHORMON, CİNSİYET, İNTERLÖKİN 10 VE TÜMÖR NEKROZ FAKTÖR ALFA İLİŞKİSİ

Giriş: Güneş ışığına maruziyetin fazla olduğu bölgelerde Multipl Skleroz’un daha az sıklıkla görülmesinde D vitamininin rolü olduğu düşünülmektedir. Vitamin D’nin klinik özellikler ile ilişkisi ve bu etkisinin kadın hastalarda daha belirgin olduğu görüşü tartışmalıdır. Bu çalışmada relapsing-remitting multipl skleroz hastalarında vitamin D, sitokin ve cinsiyet arasındaki ilişki araştırıldı. Gereç ve yöntem: Çalışmaya remisyon döneminde olan 74 Relapsing-remitting multiple skleroz hastası alındı. Kontrol grubu benzer yaş ve cinsiyette 50 sağlıklı bireyden oluşturuldu. Hasta ve kontrol gruplarında serum vitamin D, interlökin-10, tümör nekroz faktör-α ve parathormon düzeyleri ölçüldü. Vitamin D’nin cinsiyet ve klinik özellikler ile ilişkisi araştırıldı. Bulgular: Ortalama vitamin D düzeyi hasta grubunda 14.4 ng/ml, kontrol grubunda 16 ng/ml olarak saptandı. Hasta ve kontrol gruplarında vitamin D (p:0.206), Interlökin-10 (p:0.081), tümör nekroz faktör-α (p: 0,340) ve parathormon (p:0.107) düzeyleri benzer bulundu. Klinik ağırlaştıkça vitamin D düzeyinin düşme eğiliminde olduğu gözlendi ise de bu ilişki istatistiksel anlamlılığa ulaşmadı. Kadınlarda vitamin D düzeyi daha düşük saptandı. Sonuç: Hem hasta hem de kontrol grubunda vitamin D düzeyi düşüktü ve vitamin D klinik özellikler ile ilişkili bulunmadı.

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1. Ascherio A, Munger KL, White R, Köchert K, Simon KC, Polman CH, et al. Vitamin D as an early predictor of multiple sclerosis activity and progression. JAMA Neurol 2014; 71(3): 306-14.

2. Mowry EM, Waubant E, Mc Culloch CE, Okuda DT, Evangelista AA, Lincoln RR et al. Vitamin D predicts new brain MRI activity in multiple sclerosis. Ann Neurol 2012; 72(2): 234-40

3. Pierrot-Deseilligny C, Souberbielle J. Vitamin D and multiple sclerosis: An update. Mult Scler Relat Disor 2017; 14: 35-45.

4. Runia TF, Hop WC, de Rijke YB, Buljevoc D, Hintzen RQ. Lower serum vitamin D levels are associated with a higher relapse risk in multiple sclerosis. Neurology 2012; 79(3): 261-6.

5. Sintzel MB, Rametta M, Reder AT. Vitamin D and multiple sclerosis: A comprehensive review. Neurol Ther 2018; 7: 59-85

6. Sellner J, Kraus J, Awad A, Milo R, Henner B, Stüve O. The increasing incidence and prevalence of female multiple sclerosis – A critical analysis of potential environmental factors. Autoimmun Rev 2011; 10(8): 495-502.

7. Eskandari G, Ghajarzadeh M, Yekaninejad MS, Sahraian MA, Gorji R, Rajaei F, et al. Comparison of serum vitamin D level in multiple sclerosis patients, their siblings, and healthy controls. Iran J Neurol 2015; 14(2): 81-5.

8. Gelfand JM, Cree BA, McElroy J, Okseberg J, Green R, Mowry EM, et al. Vitamin D in African Americans with multiple sclerosis. Neurology 2011; 76(21): 1824-30.

9. Karampoor S, Zahednasab H, Ramagopalan S, Mehrpour M, Safornejad Tameshkel F, et al. 25-hydroxyvitamin D levels are associated with multiple sclerosis in Iran: A cross-sectional study. J Neuroimmunol 2016; 290; 47-8.

10. Kumar RS, Syed S, Kumar AA, Kumari KNS, Sajitha K. Serum vitamin D levels in Indian patients with multiple sclerosis. Ind J Clin Biochem 2013; 28(3): 255-8.

11. Wawrzyniak S, Mikolajewska E, Kuczko-Piekarska E, Niezgozinska-Maciejek A, Goch A. Association of vitamin D status and clinical and radiological outcomes in a treated MS population in Poland. Brain Behav 2017;7(2):e00609.

12. Zhang Y, Liu G, Han X, Dong H, Geng J. The association of serum 25-hydroxyvitamin D levels with multiple sclerosis severity and progression in a case-control study from China. J Neuroimmunol 2016; 297: 127-31.

13. Hussain AN, Alkhenizan AH, El Shaker M, Raef H, Gabr A. Increasing trends and significance of hipovitaminosis D: a population-based study in Kingdom of Saudi Arabia. Arch Osteoporos 2014; 9: 2-5

14. Holick MF. High prevalance of vitamin D inadequacy and implications for health. Mayo Clin Proc 2006; 81(3): 353-73.

15. Harandi AA, Shahbeigi S, Pakdaman H, Fereshteehnejad SM, Nikravesh E, Jalilzadeh R. Association of serum 25(OH) vitamin D3 concentration with severity of multiple sclerosis. Ir J Neurol 2012; 11(2): 54-8.

16. Becker J, Callegaro D, Lana-Peixoto MA, Talim N, Vidaletti T, de Paula Correa M,et al. Hypovitaminosis D association with disease activity in relapsing remitting multiple sclerosis in Brazil. J Neurol Sci 2016; 363: 236-9.

17. Niino M, Sato S, Fukazawa T, Masaki K, Miyazaki Y, Matsuse D, et al. Decreased serum vitamin D in Japanese patients with multiple sclerosis. J Neuroimmunol. 2015; 279: 40-5.

18. Nikanfar M, Taheri-Aghdam AA, Yazdani M, Sahaffi S, MasaudianN, Akbari H, et al. Serum 25(OH) vitamin D levels is not associated with disability in multiple sclerosis patients: A case-control study. Iran J Neurol 2015; 14(1): 17-21.

19. Kragt J, van Amerongen B, Killestein J, Dikjstra C, Vitdehaa B, Pohan Ch, et al. Higher levels of 25-hydroxyvitamin D are associated with a lower incidence of multiple sclerosis only in women. Mult Scler 2009; 15(1): 9-15.

20. Thouvenot E, Orsini M, Daures JP, Comu W. Vitamin D is associated with degree of disability in patients with fully ambulatory relapsing-remitting multiple sclerosis. Eur J Neurol 2015;22(3):564-9.

21. Farsani ZS, Behmanesh M, Sahraian MA. Interleukin-10 but not transforming growth factor-β1 gene expression is upregulated by vitamin D treatment in multiple sclerosis patients. J Neurol Sci 2015; 350(1-2):18-23.

22. Correale J, Aguirre MEB, Farez MF. Sex-specific environmental influences affecting MS development. Clin Immunol 2013; 149(2):176-81.

23. Correale J, Ysrraelit MC, Gaitan MI. Gender differences in 1,25 dihydroxyvitamin D3 immunomodulatory effects in multiple sclerosis patients and healthy subjects. J Immunol 2010; 185: 4948-58.

24. Barnes MS, Bonham MP, Robson PJ, Strain JJ, Wallace JM. Assessment of 25-hydroxyvitamin D and 1,25- dihydroxivitamin D3 concentrations in male and female multiple sclerosis patients and control volunteers. Mult Scler 2007; 13(5): 670-2.

25. Pascale AV, Finelli R, Giannotti R, Visco V, Fabbricatore D, Matula I, et al. Vitamin D, parathyroid hormone and cardiovascular risk: the good, the bad and the ugly. J Cardiovasc Med (Hagerstown) 2018; 19(2): 62-6.

26. Dadaei T, Safapoor MH, Aghdaei HA, Balaii H, Pourhoseinghali MA, Naderi N, et al. Effect of vitamin D3 supplementation on TNF-α serum level and disease activity index in Iranian IBD patients. Gastroenterol Hepatol Bed Bench 2015; 8(1): 49- 55.

27. Kuo YT, Kuo CH, Lam KP, Chu YT, Wang WL, Huang CH, et al. Effects of vitamin D3 on expression of tumor necrosis factor-alpha and chemokines by monocytes. J Food Sci 2010; 75(6): 200-4.

28. Mrad MF, El Ayoubi NK, Esmerian MO, Kajan JM, Khoury SJ. Effect of vitamin D replacement on immunological biomarkers in patients with multiple sclerosis. Clin Immunol 2017; 181: 9-15.

29. Van Etten E, Mathieu C. Immunoregulation by 1,25-dihydroxyvitamin D3: basic concepts. J Steroid Biochem Mol Biol 2005;97(1-2):93-101.