Abstrakt
Witamina D (VD) to steroidowy prohormon, uczestniczący w regulacji homeostazy wapniowo-fosforanowej, kluczowy dla mineralizacji kości. W ostatnich latach wykazano także szereg pozakostnych działań witaminy D, m.in. ważną rolę w immunomodulacji, regulacji produkcji cytokin i proliferacji i różnicowaniu się komórek układu odpornościowego. Niedobór VD jest związany z podatnością na zakażenia wirusowe i bakteryjne a także zwiększonym ryzykiem rozwoju chorób autoimmunologicznych. W niniejszej pracy dokonano przeglądu danych na temat roli witaminy D w genezie różnych zaburzeń immunologicznych. Możliwa rola witaminy D w zwalczaniu zakażeń wynika z jej modyfikującego wpływu na bierną i czynną odpowiedzi immunologiczne. Istotnym działaniem witaminy D jest hamowanie procesów zapalnych, ale jednocześnie zwiększa transkrypcję "endogennych antybiotyków", takich jak katelicydyna i defensyny. VD zmniejsza prezentację antygenów przez komórki dendrytyczne, hamuje polaryzację komórek Th0 do komórek Th1 lub -2 i ogranicza produkcję cytokin prozapalnych, zwłaszcza INFγ, a jednocześnie ułatwia tworzenie się Treg, co w efekcie ogranicza i umożliwia wygaśnięcie reakcji immunologicznej. Istnieją dane wskazujące że VD może łagodzić objawy chorób autoimmunologicznych zależnych od Th1 (np. stwardnienie rozsiane, cukrzyca typu 1, choroba Leśniowskiego-Crohna, reumatoidalne zapalenie stawów itp.) w modelach zwierzęcych i u ludzi. VD wydaje się być również użytecznym uzupełnieniem w zapobieganiu odrzuceniu przeszczepu. Na uwagę zasługują sercowo-naczyniowe i zakrzepowe elementy choroby SARS-CoV-2, które mogą być łączone z gorszym zaopatrzeniem w witaminę D. Istnieją również dane wskazujące na rolę niedoboru witaminy D w patogenezie "burzy cytokinowej", jedną z najpoważniejszych konsekwencji zakażenia COVID-19. Należy jednak podkreślić, że pomimo coraz liczniejszych danych klinicznych silnie łączących witaminę D z ryzykiem i przebiegiem infekcji SARS-CoV-2, to muszą one być traktowane z ostrożnością, a domniemany związek powinien być nadal uważany za hipotetyczny.
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