Vitamin D supplementation mediates a shift towards anti-inflammatory cytokine response in Multiple Sclerosis.

Abstract

Objective: In this study, we assessed the regulatory effect of Vitamin-D supplementation on cytokine profile in newly diagnosed drug-naïve Multiple Sclerosis (MS) patients.

Methods: We recruited 16 patients with incident MS, and they were followed up for 12 months. Serum levels of 25-hydroxy-vitamin-D were measured at recruitment and follow-up. Peripheral blood mononuclear cells were isolated from blood samples and stimulated with a mitogen in tissue culture to elicit cytokine production. Culture supernatants were tested after 4 days of culture for levels of pro-inflammatory (TNFα, IFN γ, IL-6, IL-12) and anti-inflammatory cytokines (IL-4, IL-5, IL-10).

Results: Baseline blood samples analysis revealed that patients(n=16) had low Vitamin-D levels [16.77(12.41-31.38)nmol/L]. Thirteen Patients expressed a normal iPTH [5.53(4.2-6.9)] and were given Caltrate D twice a day; 3 patients having elevated iPTH (mean± sd:12.83±1.47) were prescribed 50,000IU vitamin-D once weekly and Caltrate D twice daily. Interferon-β1α was prescribed after a confirmed diagnosis of relapsing-remitting MS in 13 patients, 3 patients declined immunotherapy. Irrespective of immunotherapy, we observed a gradual and significant decrease in pro-inflammatory cytokine levels and a steady significant decline in ratios of several pro-inflammatory to anti-inflammatory cytokines. The patients with a higher pro: anti-inflammatory cytokine ratios were more prone to have relapses.

Conclusions: High pro-inflammatory cytokine and low vitamin D levels in drug-naïve patients support the contention that hypovitaminosis D may play an immune-pathogenetic role in the development of MS. Moreover, Vitamin D supplementation possibly plays a protective role in the prognosis of MS through an immune-pathologic pathway and is of therapeutic importance.