Vitamin D deficiency

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Vitamin D deficiency inflammatory bowel disease
(IBD)

• Søren Peter German Jørgensen, MD
• Department of Hepatology and Gastroenterology
• Aarhus University Hospital

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IBD

• Ulcerous colitis
• Crohns disease
• Broken tolerance towards resident intestinal
  bacteria results in mucosal inflammation
• Can be located some where from mouth to anus -
  but resides frequently at the ileo-coekal
  transition

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Inflammation
DC Dentritic cell (antigen presenting cell) T
lymphocytes Dependent of cytokine signaling
different subsets dominate
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Inflammation
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Crohns disease - Aetiology

• Genes
• NOD 2/CARD15 mutations
• Environment
• Smoking
• Western life style
• Vitamin D deficiency?

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Environmental factors playing a crucial role

• CD incidence increased approximately 4 fold in
  Denmark the past 3 to 4 decades
• Despite similarity in gene composition associated
  with CD in different countries a considerable
  difference in incidence was reported

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NOD2/CARD15 Denmark versus Portugal

• Incidens i Danmark 10 per 100.000 per år versus 2
  in Portugal

Controls 9
CD patients 22
Controls 15
CD patients 20
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Denmark
Portugal
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Vitamin D in cellular studies
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Vitamin D in transgenic murine models
IL-10 and vitamin D receptor deficient mice
suffers from severe disease with deadly outcome
Vitamin D feeding in IL-10 deficient mice
improves survival
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Vitamin D levels in CD patients

• Cross sectional study of 110 patients and 64
  controls
• Aim To compare vitamin D levels and examine if
  low vitamin D level was associated with active CD
• Active disease measured by Crohns disease
  activity index (CDAI) and C-reactive protein (CRP)

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Results
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Vitamin D treatment to CD patients

• Randomized double-blind placebo controlled trial
• Inclusion criteria CD patients with quiscent
  disease
• Follow-up period 1 year
• Treatment 1200 IU vitamin D3 or placebo
• Primary endpoint Disease activity measured by
  CDAI

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Results
Kaplan Meier plot and Cox regression
Primary endpoint CDAI 150
Post hoc defined endpoint CDAI 220
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CDAI increase in placebo versus vitamin D when
primary endpoint was reached
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Conclussion

• Vitamin D deficiency might modify the
  gastrointestinal immunological response in an
  pro-inflammatory direction
• Vitamin D supplementation in relative high doses
  could be of value in keeping IBD patients in
  remission

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• Thank you for your attention