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Vitamin D metabolites are associated with clinical and MRI outcomes in multiple sclerosis patients
  1. Bianca Weinstock-Guttman1,
  2. Robert Zivadinov1,3,
  3. Jun Qu2,
  4. Diane Cookfair1,
  5. Xiaotao Duan2,
  6. Eunjin Bang2,
  7. Niels Bergsland3,
  8. Sara Hussein3,
  9. Mariya Cherneva3,
  10. Laura Willis3,
  11. Mari Heininen-Brown3,
  12. Murali Ramanathan1,2
  1. 1Department of Neurology, State University of New York, Buffalo, New York, USA
  2. 2Department of Pharmaceutical Sciences, State University of New York, Buffalo, New York, USA
  3. 3Buffalo Neuroimaging Analysis Center, Department of Neurology, State University of New York, Buffalo, New York, USA
  1. Correspondence to Dr M Ramanathan, 427 Cooke Hall, Department of Pharmaceutical Sciences, State University of New York, Buffalo, NY 14260, USA; murali{at}buffalo.edu

Abstract

Purpose The associations between vitamin D and MRI measures of brain tissue injury have not been previously investigated in multiple sclerosis (MS). This research evaluates the significance of vitamin D and its active metabolites in brain tissue injury and clinical disability in MS patients.

Methods The study population consisted of 193 MS patients (152 women and 41 men; mean age 46.1 (SD 8.4) years; disease duration 13.8 (SD 8.4) years). Serum levels of 25-hydroxyvitamin D3 (25(OH)VD3), 25-hydroxyvitamin D2 (25(OH)VD2), 1α, 25-dihydroxyvitamin D3 (1, 25(OH)2VD3) and 24(R), 25-dihydroxyvitamin D3 (24, 25(OH)2VD3) were measured using a novel capillary liquid–chromatography–mass spectrometry method. Disability was assessed with the Expanded Disability Status Scale (EDSS) and the MS Severity Scale (MSSS). MRI measures included T2 lesion volume (LV), T1-LV and brain parenchymal fraction. The associations between deseasonalised levels of vitamin D metabolites and clinical and MRI measurements were assessed using regression analyses.

Results Lower deseasonalised levels of total 25(OH)VD (p=0.029), 25(OH)VD3 (p=0.032) and 24, 25(OH)2VD3 (p=0.005) were associated with higher MSSS. Similarly, lower deseasonalised levels of 24, 25(OH)2VD3 (p=0.012) were associated with higher EDSS. Higher values of the 25(OH)VD3 to 24, 25(OH)2VD3 ratio were associated with higher MSSS (p=0.041) and lower brain parenchymal fraction (p=0.008).

Conclusions Vitamin D metabolites have protective associations with disability and brain atrophy in MS. In particular, the results indicate strong associations for the 24, 25(OH)2VD3 metabolite, which has not been extensively investigated in MS patients.

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Footnotes

  • Funding Support from the National Multiple Sclerosis Society (RG3743 and a Pediatric MS Center of Excellence Center Grant) and the Department of Defense Multiple Sclerosis Program (MS090122) is gratefully acknowledged.

  • Competing interests BW-G received personal compensations for consulting, speaking and serving on a scientific advisory board for Biogen Idec, Teva Neuroscience and EMD Serono. She also received financial support for research activities from the National Multiple Sclerosis Society, National Institutes of Health, ITN, Teva Neuroscience, Biogen Idec, EMD Serono and Aspreva. RZ received personal compensation from Teva Neuroscience, Biogen Idec, EMD Serono and Questcor Pharmaceuticals for speaking and consultant fees. RZ received financial support for research activities from Biogen Idec, Teva Neuroscience, Genzyme, Bracco, Questcor Pharmaceuticals, EMD Serono, Direct MS Foundation, Jacquemine Foundation and Bracco. MR served as an editor for the American Association of Pharmaceutical Scientists Journal; receives royalties for publishing The Pharmacy Calculations Workbook (Pinnacle, Summit and Zenith, 2008); and receives research support from EMD Serono, Novartis, Pfizer, the National Multiple Sclerosis Society, the Department of Defense and the National Science Foundation. He has served as a consultant for Biogen Idec, Allergan and Netezza.

  • Ethics approval This study was conducted with the approval of the University at Buffalo.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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