TB treatment helped with Vitamin D – RCT Sept 2012

Vitamin D accelerates resolution of inflammatory responses during tuberculosis treatment

PNAS September 18, 2012 vol. 109 no. 38 15449-15454
Anna K. Coussensa, Robert J. Wilkinsona,b, Yasmeen Hanifac, Vladyslav Nikolayevskyyd, Paul T. Elkingtone, Kamrul Islamc, Peter M. Timmsf, Timothy R. Ventonf, Graham H. Bothamleyf, Geoffrey E. Packeg, Mathina Darmalingamh, Robert N. Davidsoni, Heather J. Milburnj, Lucy V. Bakerk, Richard D. Barkerl, Charles A. Meinm, Leena Bhaw-Rosunm, Rosamond Nuamahm, Douglas B. Younga, Francis A. Drobniewskid, Christopher J. Griffithsc, and Adrian R. Martineauc,a,b, a.martineau@qmul.ac.uk
A Division of Mycobacterial Research, Medical Research Council National Institute for Medical Research, London NW7 1AA, United Kingdom;
B Division of Medicine, Imperial College London, London W2 1PG, United Kingdom;
C Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AB, United Kingdom;
D Health Protection Agency National Mycobacterium Reference Laboratory, Barts and The London School of Medicine and Dentistry, London E1 2AT, United Kingdom;
E Department of Infectious Diseases and Immunity, Imperial College London, London W12 0NN, United Kingdom;
F Homerton University Hospital, London E9 6SR, United Kingdom;
G Newham Chest Clinic, Forest Gate, London E7 8QP, United Kingdom;
H Department of Respiratory Medicine, Whipps Cross University Hospital, London E11 1NR, United Kingdom;
I Tuberculosis Clinic, Northwick Park Hospital, Harrow HA1 3UJ, United Kingdom;
J Department of Respiratory Medicine, Guy’s and St Thomas’ Hospitals, London SE1 9RT, United Kingdom;
K Department of Respiratory Medicine, Lewisham Hospital, London SE13 6LH, United Kingdom;
L Department of Respiratory Medicine, Kings College Hospital, London SE5 9RS, United Kingdom; and
M Genome Centre, Barts and The London School of Medicine, Queen Mary University of London, London EC1M 6BQ, United Kingdom
Edited* by Barry R. Bloom, Harvard School of Public Health, Boston, MA, and approved July 25, 2012 (received for review January 18, 2012)

Calcidiol, the major circulating metabolite of vitamin D, supports induction of pleiotropic antimicrobial responses in vitro. Vitamin D supplementation elevates circulating calcidiol concentrations, and thus has a potential role in the prevention and treatment of infection. The immunomodulatory effects of administering vitamin D to humans with an infectious disease have not previously been reported.

To characterize these effects, we conducted a detailed longitudinal study of circulating and antigen-stimulated immune responses in ninety-five patients receiving antimicrobial therapy for pulmonary tuberculosis who were randomized to receive adjunctive high-dose vitamin D or placebo in a clinical trial, and who fulfilled criteria for per-protocol analysis.

Vitamin D supplementation accelerated sputum smear conversion and enhanced treatment-induced resolution of

• lymphopaenia,
• monocytosis,
• hypercytokinaemia, and
• hyperchemokinaemia.

Administration of vitamin D also suppressed antigen-stimulated proinflammatory cytokine responses, but attenuated the suppressive effect of antimicrobial therapy on antigen-stimulated secretion of IL-4, CC chemokine ligand 5, and IFN-?.

We demonstrate a previously unappreciated role for vitamin D supplementation in accelerating resolution of inflammatory responses during tuberculosis treatment. Our findings suggest a potential role for adjunctive vitamin D supplementation in the treatment of pulmonary infections to accelerate resolution of inflammatory responses associated with increased risk of mortality.
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Details are behind a $10 paywall (fairly low cost)

A few highlights from the PDF

• This is clinical trial: NCT00419068
• Everyone got standard TB treatment (Vitamin D speeded up standard treatment)
• The Vitamin D3 arm also got 100,000 IU every two weeks for 8 weeks (virtually the same of 50,000 IU once a week)
• 90 % of the participants started with less than 30 nanograms of vitamin D
• Did not seem to measure the final level of vitamin D
• Spot conversion time was reduced to 35 days by vitamin D3 from the 46 days in the control arm.

See also VitaminDWiki

• Overview TB and Vitamin D
• All items in TB and vitamin D 125 items
• Probability of getting TB reduced 60 % with just 800 IU of vitamin D – RCT Aug 2012
• TB 10X less likely to catch if have sufficient vitamin D – Dec 2011

See also web

• Clinical Trials: Tuberculosis AND "Vitamin D" INTERVENTION 14 trials Sept 2012
• Pulmonary Tuberculosis and Vitamin D - 60,000 IU weekly with Calcium
• A Clinical Trial to Study the Effect of the Addition of Vitamin D to Conventional Treatment in New Pulmonary Tuberculosis Patients 100,000 IU single dose