I.A. SHMONINA¹, O.V. GALKINA¹, N.A. TOTOLYAN¹, T.L. KARONOVA^1,2

¹The First St. Petersburg State Medical University named after acad. I.P. Pavlov, 6-8 L. Tolstoy St., St. Petersburg, Russian Federation, 197022

²North-Western Federal Medical Research Center of the Ministry of Health of the Russian Federation, 15 Parkhomenko St., Saint-Petersburg, Russian Federation, 194156 

Shmonina I.A. — postgraduate student of the Department of faculty therapy with a course of endocrinology, cardiology and functional diagnostics with the clinic, tel. +7-911-979-52-92, e-mail: iashmonina@gmail.com

Galkina O.V. — Cand. Biol. Sc., Head of the Laboratory of Biochemical Homeostasis of Nephrology Research Institute, tel. (812) 338-69-31, e-mail: ovgalkina@mail.ru

Totolian N.A. — D. Med. Sc., Professor of the Department of Neurology and Neurosurgery with Clinic, tel. +7-921-992-24-58, e-mail: ntotolyan@mail.ru

Karonova T.L. — D. Med. Sc., Head of Scientific Research Laboratory of Clinical Endocrinology of the Institute of Endocrinology, associate professor of the Department of faculty therapy with a course of endocrinology, cardiology and functional diagnostics with the clinic, tel. +7-921-310-60-41, e-mail: karonova@mail.ru

In assessing the concentration of 25-hydroxyvitamin D in the blood serum of 33 patients with multiple sclerosis, vitamin D deficiency has been diagnosed in 27 patients (81%), insufficiency — in 5 patients (15%). In patients with multiple sclerosis insufficiency and deficiency of vitamin D was more frequent than in general population of St. Petersburg (p <0,05). The article also gives data on the association of vitamin D deficiency with the development and progression of multiple sclerosis, clinical effectiveness and advisability of vitamin D prescription to patients with multiple sclerosis. Taking into account the contradictory of data available, it was concluded that further research in this area is necessary, which will help to clarify not only the role of vitamin D deficiency in the development and progression of multiple sclerosis, but also to justify the need for therapy with vitamin D drugs, as well as to chose the optimal doses, regimen and duration of treatment in these patients.

Key words: vitamin D deficiency, vitamin D insufficiency, multiple sclerosis, treatment.

REFERENCES

1. Holick M.F. Vitamin D deficiency. N Engl J Med, 2007, vol. 357, no. 3, pp. 266-81.
2. Hagenau T., Vest R., Gissel T.N. et al. Global vitamin D levels in relation to age, gender, skin pigmentation and latitude: an ecologic meta-regression analysis. Osteoporos Int, 2009, vol. 20, no. 1, pp. 133-140.
3. Karonova T. L., Grineva E.N., Nikitina I.L. et al. The prevalence of vitamin D deficiency in the Northwest region of the Russian Federation among the residents of St. Petersburg and Petrozavodsk. Osteoporoz i osteopatii, 2013, no. 3, pp. 3-7 (in Russ.).
4. Adams J.S., Hewison M. Update in vitamin D. J. Clin. Endocrinol. Metab, 2010, vol. 95, no. 2, pp. 471-478.
5. Mithal A. Global status and determinants of hypovitaminosis D. Osteoporos. Int, 2009, vol. 20, pp. 1807-1820.
6. Ovesen L., Andersen R., Jakobsen J. Geografical differences in vitamin D status with particular reference to European countries. Proc. Nutr. Soc, 2003, vol. 62, no. 4, pp. 813-821.
7. Uitterlinden A.G., Fang Y., Meurs J.B. et al. Vitamin D receptor gene polymorphisms in relation to vitamin D related disease states. J. Steroid Biochem. Mol. Biol, 2004, vol. 89-90, pp. 187-193.
8. Vitebskaya A. V., Smirnova G. E., Il’in A. V. Vitamin D and calcium indicators phosphorus metabolism in children living in central Russia during the period of maximum insolation. Osteoporoz i osteopatii, 2010, no. 2, pp. 2-6 (in Russ.).
9. Looker A.C., Pfeiffer C.M., Lacher D.A., Schleicher R.L., Picciano M.F., Yetley E.A. Serum 25-hydroxyvitamin D status of the US population: 1988-1994 compared with 2000-2004. Am J Clin Nutr, 2008, vol. 88, pp. 1519-1527.
10. http://www.endocrincentr.ru/images/material-images/D%2019042014.pdf (accessed: 20.07.2015).
11. Holick M.F. Evaluation, treatment and Prevention of Vitamin D deficiency: an Endocrine society clinical practice guideline. J Clin Metab, 2011, vol. 9, pp. 1911-1930.
12. Rasseyannyy skleroz: spravochnik, pod red. E.I. Guseva, A.N. Boyko, I.D. Stolyarova [Multiple Sclerosis: A Guide. Ed. by E.I. Gusev, A.N. Boyko, I.D. Stolyarov]. Saint Petersburg: ELBI-M, 2009. Pp. 29-33.
13. Shmidt T.E., Yakhno N.N. Rasseyannyy skleroz: rukovodstvo dlya vrachey. 2-e izd. [Multiple Sclerosis: A Guide for Physicians. 2nd ed.]. Moscow: MEDpress-inform, 2010. 272 p.
14. Skoromets A.A., Totolyan N.A., Barbas I.M. Multiple Sclerosis: the criteria for the diagnosis and modern therapy. Novye Sankt-Peterburgskie vrachebnye vedomosti, 2005, no. 3, p. 66 (in Russ.).
15. Handel A.E., Giovannoni G., Ebers G.C., Ramagopalan S.V. Environmental factors and their timing in adult-onset multiple sclerosis. Nat Rev Neurol, 2010, vol. 6, no. 3, pp. 156-166.
16. Ascherio A., Munger K.L., Simon K.C. Vitamin D and multiple sclerosis. Lancet Neurol, 2010, vol. 9, no. 6, pp. 599-612.
17. Acheson E.D., Bachrach C.A., Wright F.M. Some comments on the relationship of the distribution of multiple sclerosis to latitude, solar radiation, and other variables. Acta Psychiatr Scand Suppl, 1960, vol. 35, pp. 132-147.
18. Munger K.L., Ascherio A. Risk factors in the development of multiple sclerosis. Expert Rev Clin Immunol, 2007, vol. 3, Sep, no. 5, pp. 739-748.
19. Pierrot-Deseilligny C., Souberbielle J.C. Is hypovitaminosis D one of the environmental risk factors for multiple sclerosis?. Brain, 2010, vol. 133, no. 7, pp. 1869-1888.
20. Baeke F., Takiishi T., Korf H. et al. Vitamin D: modulator of the immune system. Curr Opin Pharmacol, 2010, vol. 10, pp. 482-496.
21. Willer C.J., Dyment D.A., Sadovnick A.D. et al. Timing of birth and risk of multiple sclerosis: population based study. BMJ, 2005, vol. 330, p. 120.
22. Munger K.L., Levin L.I., Hollis B.W. et al. Serum 25-hydroxyvitamin D levels and risk of multiple sclerosis. JAMA, 2006, Dec 20, vol. 296, no. 23, pp. 2832-2838.
23. Ascherio A., Munger K.L., White R. et al. Vitamin D as an early predictor of multiple sclerosis activity and progression. JAMA Neurol, 2014, vol. 71, no. 3, pp. 306-314.
24. Soilu-Hänninen M., Aivo J., Lindström B.M. et al. A randomised, double blind, placebo controlled trial with vitamin D3 as an add on treatment to interferon β-1b in patients with multiple sclerosis. J Neurol Neurosurg Psychiatry, 2012, vol. 83, pp. 565-571.
25. Goldberg P., Fleming M., Picard E. Multiple sclerosis: decreased relapse rate through dietary supplementation with calcium, magnesium and vitamin D. Med Hypotheses, 1986, vol. 21, no. 2, pp. 193-200.
26. Wingerchuk, Lesaux J., Rice G. et al. A pilot study of oral calcitriol (1,25-dihydroxyvitamin D3) for relapsing–remitting multiple sclerosis. Br Med J, 2005, vol. 76, no. 9, p. 1294.
27. Smolders J., Peelen E., Thewissen M. et al. Safety and T cell modulating effects of high dose vitamin D3 supplementation in multiple sclerosis. PLoS One, 2010, vol. 5, no. 12, p. 15235.
28. Mosayebi G., Ghazavi A., Ghasami K., Jand Y., Kokhaei P. Therapeutic effect of vitamin D3 in multiple sclerosis patients. Immunological investigations, 2011, vol. 40, pp. 627-639.
29. Stein M.S., Liu Y., Gray O.M. et al. A randomized trial of high-dose vitamin D2 in relapsing-remitting multiple sclerosis. Neurology, 2011, vol. 77, pp. 1611-1618.
30. Shaygannejad V, Janghorbani M, Ashtari F, Dehghan H. Effects of adjunct low-dose vitamin D on relapsing-remitting multiple sclerosis progression: Preliminary findings of a randomized placebo-controlled trial. Multiple sclerosis international, 2012, vol. 2012. — rr. 452-541.
31. Kampman M.T., Steffensen L.H., Mellgren S.I., Jørgensen L. Effect of vitamin D3 supplementation on relapses, disease progression, and measures of function in persons with multiple sclerosis: exploratory outcomes from a double-blind randomised controlled trial. Mult Scler, 2012, vol. 18, pp. 1144-1151.
32. Brum D.G., Comini-Frota E.R., Vasconcelos C.C.F., Dias-Tosta E. Supplementation and therapeutic use of vitamin D in patients with multiple sclerosis: Consensus of the Scientific Department of Neuroimmunology of the Brazilian Academy of Neurology. Arq Neuropsiquiatr, 2014, vol. 72, no. 2, pp. 152-156.
33. Sue Hughes. Vitamin D for All to Prevent MS? 29th Congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS). Medscape. October 03, 2013, available at: http://www.medscape.com/viewarticle/812045#vp_1 (accessed: 20.07.2015).
34. Etemadifar M, Janghorbani M. Efficacy of high-dose vitamin D3 supplementation in vitamin D deficient pregnant women with multiple sclerosis. Preliminary findings of a randomized controlled trial. Iran J Neurol, 2015, vol. 14(2), pp. 67-73.
35. https://www.clinicaltrials.gov/ct2/results?term=Vitamin+D+and+multiple+sclerosis&Search=Search (accessed: 20.07.2015)