Written by Greg Arnold, DC, CSCS. High dose vitamin D (10,400 IU), taken daily for 6 months, significantly reduced TH17, CD161, and Effector memory CD4 cells in multiple sclerosis patients. As well their vitamin D levels almost tripled compared to a 30 % increase in vitamin D levels in the control group.
Multiple Sclerosis is thought to be an autoimmune disease where the body attacks itself, as is seen in rheumatoid arthritis and lupus (1). It is described as “an unpredictable disease of the central nervous system and the exact cause remains unknown. It affects an estimated 400,000 Americans (2) and costs our healthcare system nearly $7 billion per year (3).
Vitamin D has gained increased attention as a way to help patients with multiple sclerosis. Previous research has focused on the vitamin D blood levels of multiple sclerosis patients. In over 4 years of follow-up, a 2014 study (4) showed that every 50-nanomole/Liter (20-nanogram/milliliter) increase in average vitamin D blood levels resulted in:
- A 57% lower rate of new active lesions (p < .001),
- A 57% lower relapse rate (p = .03),
- A 25% lower yearly increase in T2 lesion volume (p < .001), and
- A 0.41% lower yearly loss in brain volume (p = .07*).
Now a new study (5) has started to look at specific doses of vitamin D for multiple sclerosis patients.
In the study, 35 patients (21 men, 14 women) with relapsing-remitting multiple sclerosis received either 10,400 IU (18 patients) or 800 IU (17 patients) of vitamin D each day for 6 months. Vitamin D blood levels were measured, as well as immune system cells. The patients gave feedback on relapses for their symptoms.
While vitamin D levels in the high-dose group nearly tripled from the start of the study (22 to 56.9 ng/mL) nanograms/milliliter) compared to a 30% increase in the placebo group (23 to 29.9 ng/mL), there were no differences between the two groups regarding symptoms, with each group having 1 patient suffering a relapse in their symptoms.
What was significantly different between groups was a change in certain white blood cells:
| High-dose | Low-dose | p-value | |
|---|---|---|---|
| Th17 cells | 39.7% decrease (9.32 to 5.62) | 6.7% decrease (6.57 to 6.13) | 0.016 |
| CD161:CD4+ T-cell ratio | 14.8% decrease (5.51 4.7) | 6.8% decrease (6.11 to 5.70) | 0.03 |
| Effector Memory CD4+ T-cells | 24.4% decrease (40.56 to 30.69) | 2.1% decrease (38.51 to 37.71) | 0.021 |
| Naïve CD4+ T-cells | 8.3% increase (38.94 to 42.2) | 5.3% increase (34.18 to 36) | 0.04 |
The decrease in Th17 cells is significant, as these cells “are a major contributor to the pathogenesis of multiple sclerosis” (6), as are the CD161 cells (7). As for Effector Memory CD4+ T-cells, they are thought to play a “pivotal role” in multiple sclerosis and are “prominent” in multiple sclerosis lesions (8) while naïve cells increase with vitamin D supplementation (9).
For the researchers, “Vitamin D supplementation with 10,400 IU daily is safe and tolerable in patients with multiple sclerosis” but that “Future studies are warranted to further elucidate the molecular mechanisms of these effects and ongoing randomized controlled clinical trials will be instrumental to establish the clinical utility of cholecalciferol as a novel immunomodulatory therapy for multiple sclerosis.”
*P values greater than 0.05 are not considered statistically significant.
Source: Sotirchos et al 2016. Safety and immunologic effects of high- vs low-dose cholecalciferol in multiple sclerosis. Neurology® 2016;86:1–9
© 2015 American Academy of Neurology
Posted June 8, 2016.
Greg Arnold is a Chiropractic Physician practicing in Hauppauge, NY. You can contact Dr. Arnold directly by emailing him at PitchingDoc@msn.com or visiting his web site at www.PitchingDoc.com.
References:
- Multiple Sclerosis Information Page” posted on the NIH website
- Information obtained from the Multiple Sclerosis Association of America website
- Whetten-Goldstein K. A comprehensive assessment of the cost of multiple sclerosis in the United States. Mult Scler. 1998 Oct;4(5):419-25
- Ascherio A. Vitamin D as an Early Predictor of Multiple Sclerosis Activity and Progression. JAMA Neurol. 2014 Jan 20. doi: 10.1001/jamaneurol.2013.5993. [Epub ahead of print]
- Sotirchos ES. Safety and immunologic effects of high- vs low-dose cholecalciferol in multiple sclerosis. Neurology. 2016 Jan 26;86(4):382-90. doi: 10.1212/WNL.0000000000002316. Epub 2015 Dec 30
- Tzartos JS, Friese MA, Craner MJ, et al. Interleukin-17 production in central nervous system-infiltrating T cells and glial cells is associated with active disease in multiple sclerosis. Am J Pathol 2008;172:146–155
- Cosmi L, De Palma R, Santarlasci V, et al. Human interleukin 17-producing cells originate from a CD1611CD4+ T cell precursor. J Exp Med 2008;205:1903–1916
- Kivisakk P, Mahad DJ, Callahan MK, et al. Expression of CCR7 in multiple sclerosis: Implications for CNS immunity. Ann Neurol 2004;55:627–638
- Bhargava P, Gocke A, Calabresi PA. 1,25-dihydroxyvitamin D3 impairs the differentiation of effector memory T cells in vitro in multiple sclerosis patients and healthy controls. J Neuroimmunol 2015;279:20–24
