Summit Behavioral Healthcare, Ohio Department of Mental Health and Addiction Services, Cincinnati, OH, 45237, USA; Department of Psychiatry, Wright State University Boonshoft School of Medicine, Dayton, OH, 45435, USA.
Summit Behavioral Healthcare, Ohio Department of Mental Health and Addiction Services, Cincinnati, OH, 45237, USA; Department of Psychiatry, Wright State University Boonshoft School of Medicine, Dayton, OH, 45435, USA.
J Steroid Biochem Mol Biol. 2018 Mar;177:21-29. doi: 10.1016/j.jsbmb.2017.07.027. Epub 2017 Jul 26.
Tuberculosis remains an epidemic throughout the world, with over 2 billion people, or more than one third of the world's population, infected with TB. In 2015, there were an estimated 10.4 million new cases of tuberculosis, and 1.8 million deaths, making TB one of the top ten causes of death worldwide. Approximately 95% of new TB cases occur in developing countries, where the costs of treatment force many patients and their families into poverty. The United Nations and the World Health Organization are working to end this global epidemic. Historically, cod liver oil in the 1840's, phototherapy in the 1890's, sunshine in the 1890's and 1930's, oral vitamin D in doses of 100,000-150,000 international units a day the 1940's, and injectable vitamin D in the 1940's were all shown to be able to safely treat tuberculosis. However, for reasons that are unclear, these treatments are no longer being used to treat tuberculosis. We will review several reports that documented the clinical efficacy of these seemingly disparate treatments in treating tuberculosis. Taken together, however, these reports show the consistent efficacy of vitamin D in treating tuberculosis infections, regardless of whether the vitamin D was produced in the skin from the effects of phototherapy or sunshine, taken orally as a pill or in cod-liver oil, or put into solution and injected directly into the body. We will discuss how vitamin D, through its action as a steroid hormone that regulates gene transcription in cells and tissues throughout the body, enables the body to eradicate TB by stimulating the formation of a natural antibiotic in white blood cells, the mechanism of which was discovered in 2006. We will speculate as to why vitamin D, cod liver oil, sunshine, and phototherapy are no longer being used to treat tuberculosis, in spite of their proven efficacy in safely treating this disease dating back to the early 1800's. In fact, in 1903 the Nobel Prize in Medicine or Physiology was awarded to a physician who was able to cure hundreds of cases of long-standing lupus vulgaris (cutaneous TB) with refracted light rays from an electric arc lamp. Vitamin D, cod liver oil, sunshine, and phototherapy have never been shown to lose their ability to safely eradicate tuberculosis infections, and deserve consideration to be re-examined as first-line treatments for tuberculosis. These treatments have the potential to help cost-effectively and safely end the global TB epidemic.
结核病仍然是全世界的一种流行疾病，全球有超过 20 亿人，即超过三分之一的人口感染了结核病菌。2015 年，全球约有 1040 万例新结核病病例，180 万人死亡，结核病成为全球十大死因之一。约 95%的新结核病病例发生在发展中国家，这些国家的治疗费用使许多患者及其家庭陷入贫困。联合国和世界卫生组织正在努力终结这一全球传染病。历史上，19 世纪 40 年代的鱼肝油、19 世纪 90 年代的光疗、19 世纪 90 年代和 30 年代的阳光、1940 年代每天 10 万至 15 万国际单位的口服维生素 D，以及 1940 年代的注射用维生素 D，都被证明可以安全地治疗结核病。然而，由于原因不明，这些治疗方法不再用于治疗结核病。我们将回顾一些报告，这些报告记录了这些看似不同的治疗方法在治疗结核病方面的临床疗效。然而，总的来说，这些报告表明维生素 D 治疗结核病感染的疗效一致，无论维生素 D 是通过光疗或阳光的作用在皮肤中产生，作为药丸或鱼肝油口服，还是制成溶液直接注入体内。我们将讨论维生素 D 如何通过作为一种类固醇激素发挥作用，调节全身细胞和组织中的基因转录，通过刺激白细胞形成天然抗生素来使身体消灭结核病菌，这一机制是在 2006 年发现的。我们将推测为什么尽管早在 19 世纪初，鱼肝油、阳光和光疗就已被证明能安全有效地治疗这种疾病，但它们现在已不再被用于治疗结核病。事实上，1903 年诺贝尔医学或生理学奖授予了一位医生，他能够用光疗治愈数百例长期存在的寻常狼疮（皮肤结核）。维生素 D、鱼肝油、阳光和光疗从未被证明失去安全消除结核病感染的能力，值得重新考虑作为结核病的一线治疗方法。这些治疗方法有可能帮助我们以具有成本效益的安全方式终结全球结核病流行。
