Vitamin D deficiency contributes directly to the acute respiratory distress syndrome (ARDS)

Citation:

Rachel CA Dancer, Dhruv Parekh, Sian Lax, Vijay D'Souza, Shengxing Zheng, Chris R Bassford, Daniel Park, DG Bartis, Rahul Mahida, Alice M Turner, Elizabeth Sapey, Wen Bin Wei, Babu Naidu, Paul M Stewart, William D Fraser, Kenneth B Christopher, Mark S Cooper, Fang Gao, David M Sansom, Adrian R Martineau, Gavin D Perkins, and David R Thickett. 2015. “Vitamin D deficiency contributes directly to the acute respiratory distress syndrome (ARDS).” Thorax, 70, 7, Pp. 617-24.

Abstract:

RATIONALE: Vitamin D deficiency has been implicated as a pathogenic factor in sepsis and intensive therapy unit mortality but has not been assessed as a risk factor for acute respiratory distress syndrome (ARDS). Causality of these associations has never been demonstrated. OBJECTIVES: To determine if ARDS is associated with vitamin D deficiency in a clinical setting and to determine if vitamin D deficiency in experimental models of ARDS influences its severity. METHODS: Human, murine and in vitro primary alveolar epithelial cell work were included in this study. FINDINGS: Vitamin D deficiency (plasma 25(OH)D levels <50 nmol/L) was ubiquitous in patients with ARDS and present in the vast majority of patients at risk of developing ARDS following oesophagectomy. In a murine model of intratracheal lipopolysaccharide challenge, dietary-induced vitamin D deficiency resulted in exaggerated alveolar inflammation, epithelial damage and hypoxia. In vitro, vitamin D has trophic effects on primary human alveolar epithelial cells affecting >600 genes. In a clinical setting, pharmacological repletion of vitamin D prior to oesophagectomy reduced the observed changes of in vivo measurements of alveolar capillary damage seen in deficient patients. CONCLUSIONS: Vitamin D deficiency is common in people who develop ARDS. This deficiency of vitamin D appears to contribute to the development of the condition, and approaches to correct vitamin D deficiency in patients at risk of ARDS should be developed. TRIAL REGISTRATION: UKCRN ID 11994.