calcitriol and Liver-Diseases

The development of autoimmune disease is based on the interaction of genetic susceptibility and environmental causes. Environmental factors include infectious and non-infectious agents, with some of these factors being implicated in several autoimmune diseases. Vitamin D is now believed to play a role in the development (or prevention) of several autoimmune diseases, based on its immunomodulatory properties. As well, the increasing incidence of autoimmune disease as one moves away from the equator, may be due to the lack of sunlight, which is crucial for the maintenance of normal vitamin D levels. A deficiency in vitamin D levels or vitamin D receptors is commonly indicated in autoimmune diseases, with multiple sclerosis (MS) being one of the best-studied and well-known examples. However, the role of vitamin D in other autoimmune diseases is not well defined, including autoimmune liver diseases such as primary biliary cirrhosis, autoimmune hepatitis, and primary sclerosing cholangitis. This review will examine the role of vitamin D as an immunomodulator, followed by a comparison of vitamin D in MS versus autoimmune liver disease. From this comparison, it will become clear that vitamin D likely plays a role in the development of autoimmune liver disease, but this area requires further investigation.

Topics: Autoimmune Diseases; Cell Proliferation; Cytokines; Genotype; Humans; Immunomodulation; Liver Diseases; Multiple Sclerosis; Polymorphism, Single Nucleotide; Receptors, Calcitriol; T-Lymphocytes; Vitamin D; Vitamin D Deficiency; Vitamin D-Binding Protein

Women are at higher risk for osteoporosis, but most of the literature examining the effect of alcohol abuse on bone mineral density (BMD) has been in men. The aim of this study was to determine differences in BMD and fracture prevalence among women in treatment for alcohol abuse, in recovery and non-alcohol-dependent women. This cross-sectional study was completed at two residential substance abuse centers in Iowa (USA). The patients were Caucasian women, aged 18-70 years, in treatment for alcohol abuse and dependence ( n=228); in recovery and abstaining from alcohol ( n=156); and women with no history of alcohol abuse ( n=447). The main outcome measures were femoral neck and lumbar spine BMD measured by dual-energy X-ray absorptiometry (DXA); self-reported lifetime fracture prevalence. After adjusting for age and menopausal status, women in treatment had BMDs that were 7.7% ( p<0.01) and 6.3% ( p<0.01) lower at the femoral neck and lumbar spine, respectively, than non-alcohol-abusing women, and 4.8% lower at both bone sites ( p<0.01) than women in recovery. Femoral neck BMD of women in recovery was 3.1% lower ( p<0.01) than in non-alcohol-dependent women; however, the difference was not significant following multivariate analysis. Women in treatment and recovery reported more fractures during childhood and early adolescence than non-alcohol-dependent women ( p<0.01). Women in recovery also reported significantly greater numbers of fractures following sobriety than their paired non-alcohol-dependent counterparts. Alcohol abuse and dependence was associated with lower femoral neck and lumbar spine BMD. Women with histories of alcohol dependence had a higher lifetime prevalence of fractures, including time periods before the onset of problem drinking and following abstinence, suggesting that factors other than acute intoxication contributed to the greater fracture prevalence.

Topics: Adolescent; Adult; Aged; Alcoholism; Amenorrhea; Body Mass Index; Bone Density; Contraceptives, Oral; Cross-Sectional Studies; Female; Fractures, Bone; Humans; Liver Diseases; Middle Aged; Pregnancy; Pregnancy in Adolescence; Smoking; Vitamin D