Resumen
Objetivo: Analice la relación entre los niveles de vitamina D y el riesgo de desarrollar RRMS, así como sus efectos inmunorreguladores y su posible contribución terapéutica. Revisión bibliográfica: La esclerosis múltiple (EM) es una enfermedad inflamatoria, autoinmune, desmielinizante y crónica del sistema nervioso central, que afecta predominantemente a mujeres jóvenes, siendo clasificada en EM remitente-recurrente (EMRR), primaria progresiva y secundaria progresiva. Evidencias científicas sugieren una asociación entre la deficiencia de vitamina D y el aumento del riesgo de desarrollo de enfermedades autoinmunes, incluida la EMRR. Los estudios analizados indican que la vitamina D ejerce un papel inmunomodulador importante, especialmente por la modulación de la actividad de los linfocitos T, favoreciendo un perfil antiinflamatorio e inhibiendo citoquinas involucradas en la patogénesis de la EM. Consideraciones finales: Estos hallazgos sugieren un papel potencial de la vitamina D en el tratamiento de la EMRR. Sin embargo, se necesitan nuevos ensayos clínicos con muestras más grandes para definir las dosis ideales y aclarar de manera más consistente la influencia de la vitamina D en la progresión de la enfermedad.
Referencias
ABBAS AK, et al. Imunologia celular e molecular. 7. ed. Rio de Janeiro: Elsevier, 2012.
ADORINI L, PENNA G. Control of autoimmune diseases by the vitamin D endocrine system. Nature Clinical Practice Rheumatology, 2008; 4: 404–412.
ALTIERI B, et al. Does vitamin D play a role in autoimmune endocrine disorders? Reviews in Endocrine and Metabolic Disorders, 2017; 18 (3): 335–346.
ALVES M, et al. Vitamina D: importância da avaliação laboratorial. Revista Portuguesa de Endocrinologia, Diabetes e Metabolismo, 2013; 8(1): 32–39.
ARANOW C. Vitamin D and the immune system. Journal of Investigative Medicine, 2011; 59(6): 881–886.
BAEKE F, et al. Vitamin D: modulator of the immune system. Current Opinion in Pharmacology, 2010; 10(4): 482–496.
BAEKE F, et al. Vitamin D insufficiency: implications for the immune system. Pediatric Nephrology, 2010; 25(9): 1597–1606.
BORST MH, et al. Vitamin D deficiency: universal risk factor for multifactorial diseases? Current Drug Targets, 2011; 12(1): 97–106.
CAMU W, et al. Cholecalciferol in relapsing-remitting multiple sclerosis: a randomized clinical trial. Neurology: Neuroimmunology & Neuroinflammation, 2019; 6(5): e597.
CANTORNA MT, et al. Vitamin D and 1,25(OH)₂D regulation of T cells. Nutrients, 2015; 7(4): 3011–3021.
CANTORNA MT, MAHON BD. Mounting evidence for vitamin D as an environmental factor affecting autoimmune disease prevalence. Experimental Biology and Medicine, 2004; 229(11): 1136–1142, 2004.
CARDOSO E, et al. Clinical and epidemiological profile of multiple sclerosis in a reference center in the State of Bahia, Brazil. Arquivos de Neuro-Psiquiatria, 2006; 64(3): 727–730.
CASTRO LCG. O sistema endocrinológico vitamina D. Arquivos Brasileiros de Endocrinologia & Metabologia, 2011; 55(8): 566–575.
COLOTTA F, et al. Modulation of inflammatory and immune responses by vitamin D. Journal of Autoimmunity, 2017; 85: 78–97.
CORREALE J, et al. Vitamin D-mediated immune regulation in multiple sclerosis. Journal of the Neurological Sciences, 2011; 311(1–2): 23–31.
DARWISH H, et al. Effect of vitamin D replacement on cognition in multiple sclerosis patients. Scientific Reports, 2017; 7.
GALVÃO LO, et al. Considerações atuais sobre a vitamina D. Revista Brasília Médica, 2013; 50(4): 324–332.
HEWISON M, et al. Differential regulation of vitamin D receptor and its ligand in human monocyte-derived dendritic cells. Journal of Immunology, 2003; 170(11): 5382–5390.
HOSSEIN-NEZHAD A, HOLICK MF. Vitamin D for health: a global perspective. Mayo Clinic Proceedings, 2013; 88(7): 720–755.
KRIEGEL MA, et al. Does vitamin D affect risk of developing autoimmune disease? Seminars in Arthritis and Rheumatism, 2011, 40(6): 512–531.
LEHMANN B e MEURER M. Vitamin D metabolism. Dermatologic Therapy, 2010; 23(1): 2–12.
LIU PT, et al. Vitamin D-mediated human antimicrobial activity against Mycobacterium tuberculosis. Journal of Immunology, 2007; 179(4): 2060–2063.
NORMAN AW. From vitamin D to hormone D: fundamentals of the vitamin D endocrine system. The American Journal of Clinical Nutrition, 2008; 88(2): 491–499.
PEDERSEN AW, et al. Phenotypic and functional markers for vitamin D-modified regulatory dendritic cells. Clinical and Experimental Immunology, 2009; 157(1).
PREMAOR MO, FURLANETTO TW. Hipovitaminose D em adultos. Arquivos Brasileiros de Endocrinologia & Metabologia, 2006; 50(1): 25–37.
PRIETL B, et al. Vitamin D and immune function. Nutrients, 2013; 5(7): 2502–2521.
SKROBOT A, et al. Immunomodulatory role of vitamin D. Advances in Experimental Medicine and Biology, 2018; 1118: 13–23.
SMOLDERS J, et al. Vitamin D3 supplementation and neurofilament light chain in multiple sclerosis. Acta Neurologica Scandinavica, 2019; 141(1): 77–80.
