Tüberküloz ve D vitamini

Tüberküloz, hala tüm dünyada yılda bir milyondan fazla kişinin ölümüne yol açan en yaygın hastalıklardan biridir. Özellikle çoklu ilaca dirençli Mycobacterium tuberculosis enfeksiyonlarında antimikrobiyal tedavi cevabını arttırmak için yeni ajanların gelişimine ihtiyaç duyulmaktadır. Antibiyotik öncesi dönemde tüberküloz tedavisinde kullanılan D vitamini, antitüberküloz ilaçların gelişimiyle önemini yitirmiştir. Son zamanlarda D vitamini aktif metaboliti, 1,25-dihydroxyvitamin D’nin mikobakterilerde bağışık yanıtı arttırdığı bilinmektedir. D vitamininin direkt öldürücü etkisi yoktur, ancak 1,25-dihydoxyvitamin D, bağışık yanıt üzerinde modülator görevi yapar. 1,25-dihydroxyvitamin D sentezi endojen defensin ve katelisidin sentezini arttırır. Bu ürünlerin bakterilere ve M.tuberculosis gibi hücre içi yerleşimli mikroorganizmalara direkt ölümcül etkileri vardır. Bu derlemede, D vitamininin, M.tuberculosis enfeksiyonunda konak direncindeki rolü ve destek tedavisi ile ilgili etkileri tartışılmıştır.

Anahtar Kelimeler:

Tüberküloz, D Vitamini, 1, 25-dihydoxyvitamin D, Bağışık yanıt, Defensin, Katelisidin

Tuberculosis and vitamin D

Tuberculosis (TB) is still highly prevalent world-wide accounting for over one million deaths annually. Especially the multi drugresistant Mycobacterium tuberculosis necessitates the development of new agents to enhance the response to antimicrobial therapy for active TB. In the pre-antibiotic era, vitamin D was used to treat TB. However, after the development of antituberculosis agents, it lost its importance. Recently, its active metabolite, 1,25-dihydoxyvitamin D, was shown to enhance the immune response to mycobacteria. Vitamin D does not have a direct killing effect but 1,25-dihydoxyvitamin D, is a modulater of the immune system. The synthesis of 1,25-dihydroxyvitamin D promotes the production of endogen defensin and cathelicidin. These products have a direct lethal effect on bacteria and intracellular microorganisms like M.tuberculosis. In this review, the role of vitamin D in host resistance to M.tuberculosis infection and its effect for supplementation therapy is discussed.

Keywords:

Tuberculosis, Vitamin D, 1, 25-dihydoxyvitamin D, Immune response, Defensin, Cathelicidin,

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