Anthro_3_17_11 vit D Tangpricha

Anthro_3_17_11 vit D Tangpricha - Vin Tangpricha M.D. Ph.D....

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Unformatted text preview: Vin Tangpricha M.D. Ph.D. Associate Professor of Medicine Emory University School of Medicine, Division of Endocrinology, Diabetes & Lipids, Department of Medicine Does Vitamin D Predict Chronic Disease? Disclosure I have no relevant conflicts of interest to declare Learning Objectives At the end of this lecture, the learner should be able to 1) To use the correct vitamin D terminology 2) To define levels of vitamin D that are optimal for health 3) To appreciate the associations of vitamin D status with many chronic diseases Historical Context Vitamin D physiology Optimal levels for vitamin D Review the prevalence of vitamin D insufficiency Extra-skeletal benefits of vitamin D Treatment of vitamin D insufficiency Agenda Vitamin D: Historical Perspective 1922 McCollum: cod liver oil retained anti-rachitic activity after destruction of vitamin A. vitamin D 1650 Glisson and Whistler describe rickets 1800s Reports of increased prevalence of rickets 1919 Mellanby demonstrated anti-rachitic activity with cod liver oil in dogs. Thought to be vitamin A Huldshinsky prevented/cured rickets in children with UV lamps CH 2 O H CH 3 C H 3 CH 3 C H 3 H CH 2 O H CH 3 C H 3 CH 3 C H 3 H CH 3 Vitamin D 3 Vitamin D 2 Skin (cholecalciferol) (ergocalciferol) Discovery Structure of Anti-Rachitic Compound Alfred Windaus 1938 Nobel Prize in Chemistry Formation of Vitamin D 2/3 CH 2 O H CH 3 C H 3 CH 3 C H 3 H CH 2 O H CH 3 C H 3 CH 3 C H 3 H CH 3 UVB Light 290 - 315 nm O H 7-dehydrocholesterol (7-DHC) Cholecalciferol (D3) Ergocalciferol (D2) O H Ergosterol Vitamin D: Historical Perspective 1960s Believed that vitamin D 3 was the active form 1968 25-hydroxyvitamin D 3 was identified Holick/Deluca isolated and identified the hormonal form 1,25-dihydroxyvitamin D 3 1973 Vitamin D receptor was reported Skin 25-hydroxyvitamin D 2/3 Liver 25-OHase (CYP27A & CYP2R1) Kidney 1-OHase (CYP27B1) 1,25-dihydroxyvitamin D 2/3 Vitamin D 2/3 Hormonal Actions of Vitamin D Holick MF. Primer on Metabolic Bone Diseases. 2004 DBP VDR Vitamin D Response Element Classic Functions Calcium absorption, bone metabolism Non-Classic Functions Cellular proliferation Cardiovascular Immune function Insulin secretion Muscle function Lung function RXR 1,25(OH) 1,25(OH) 2 D D DNA Classic Function of Vitamin D The major role for vitamin D is to improve calcium absorption in the intestine for proper mineralization of bone and maintain normal serum calcium levels Osteomalacia in Adults Rickets in Childen 1,25(OH) 2 D VDR TRPV6 Calbindin 9k PMCA1b Free Ca 2+ = 1 - 5 mM Free Ca 2+ = 1.2 mM ATP NCX1 Intestinal Lumen Enterocyte Capillary Interstitial Space 3 Na 2+ Free Ca 2+ = 100 nM Vitamin D Deficiency in Nursing Home Patients Australia 52% < 11 ng/ml France 98% <10 ng/ml Switzerland 86% < 12 ng/ml New Zealand 50% < 5 ng/ml Canada 60% <16 ng/ml Stein MS et al Clin Endocrinol (Oxf) 1996; 44(4):375-383....
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Anthro_3_17_11 vit D Tangpricha - Vin Tangpricha M.D. Ph.D....

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