Tuesday, 17 August 2010

Vitamin D could be used to treat ABPA in Cystic Fibrosis?

A research paper due to be published in September 2010 reports the observation that some patients who have Cystic Fibrosis (CF) are prone to becoming infected with Aspergillus fumigatus and then developing Allergic Bronchopulmonary Aspergillosis (ABPA - Wiki) while others are infected but do not go on to develop ABPA.

Entitled 'Vitamin D3 attenuates Th2 responses to Aspergillus fumigatus mounted by CD4+ T cells from cystic fibrosis patients with allergic bronchopulmonary aspergillosis' the research focusses on finding differences between these two types of CF patient and one of the differences noted was the lower concentration of vitamin D in the blood of patients who suffered from ABPA. In other words most patients who had ABPA also had lower levels of vitamin D.
This observation leads to an obvious next step - what happens if you increase the blood levels of vitamin D in those patients? More specifically what happens to their ABPA? That question is now open, hopefully the subject of a clinical trial and we will know the answer in due course however we have had a hint at the answer in the next part of this paper.

Some of the major symptoms of ABPA are essentially the result of an over-response to the presence of Aspergillus by part of the immune system known as Th2 - part of the inflammatory response pathway that caused inflammation when we injure ourselves of become infected.
The group carrying out this research have set up a laboratory 'model system' whereby cells from each type of patient were isolated and grown in culture. They can then be stimulated to induce the Th2 'inflammatory' signalling pathway and their response noted. The result was that those cells taken from patients with ABPA responded by initiating inflammation whereas those taken from non-ABPA patients did not respond. Intriguingly we now have a result that parallels the clinical observation that cells in the airways of ABPA-CF patients respond to stimulation by Aspergillus by becoming inflamed whereas the non-ABPA-CF patients cells do not repond.

What happens if you add in vitamin D to each culture in the laboratory? Now cells from both types of patients do not respond with signals that would initiate inflammation - the abnormal inflammatory respond has been prevented. This is encouraging and suggests that vitamin D might be a good supplement to the diet of  CF sufferers to prevent them developing ABPA, though as this is a conclusion based on a single laboratory experiment rather than on real people we cannot be sure.

Needless to say supplementation of the diet of ABPA patients would be a very cheap and thus eminently do-able, especially as vitamin D has few notable side effects when taken in moderation. Success cannot be guaranteed however as it is very simplistic to suggest that all ABPA sufferers (CF and non-CF) have low vitamin D levels in their blood and to assume that the reason for that is dietary deficiency, but it might be worth patients self-checking their diets for foods rich in vitamin D.
Foods rich in vitamin D are oily fish, liver, cod liver oil and dairy products and of course sunshine is an important source.


Bruce said...

The mention of some CF patients becoming infected developing ABPA while others are infected but do not go on to develop ABPA is very interesting if it is indeed factual information. Given the ubiquitous nature of aspergillus spores world wide, might this then suggest large numbers of people are host to aspergillus colonies who do not exhibit symptoms? Given that the human body is host to microbes numbering about ten times the number of our human cells, could aspergillus be part of this microbial colony that call our bodies home? If this holds true, wouldn't the implications for treatment suggest a different direction than eradication, looking more in the direction of a healthy balance as present knowledge is pointing to for intestinal diseases involving intestinal microbial imbalances?

Anonymous said...

The effect of Vitamin D on the immune response to aspergillus is interesting, especially as one of the routine treatments offered to CF patients is additional vitamin D supplements. CF reduces the body's abilility to absorb fat soluable vitamins so most people with CF are given extra of these vitamins. Did the patients in the study have supplements or not? If they did and still had low levels of vit D it would warrant an investigation into the correct dosage of supplements.

Anonymous said...

I am a Cystic Fibrosis patient and up until my late teens, early 20s aspergillus was never a problem. Interestingly looking back that is also around the time my vitamin D levels started to get very low. My vitamin levels have never been great as I've always been a bit slack when it came to my vitamins (never thought they were actually that important) but around that time they became very low.

I think it's very easy for CF patients to become deficient in vitamins as firstly we don't absorb them as well as most people, secondly because of frequent illness our appetite is low so we don't eat foods containing vitamins, and when we do eat we focus more on high calorie foods to keep our weight up, thirdly with all the medications we have to take it's easy to put vitamins at the bottom of the to do list as we already have a lot to do.

Perhaps vitamins are a lot more important than I thought!

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