Anthony Nolan Research Institute, Royal Free Hospital, University College London, London, UK.
Department of Haemato-Oncology, The Royal Marsden Hospital, Sutton, UK.
Bone Marrow Transplant. 2019 Jun;54(6):810-820. doi: 10.1038/s41409-018-0377-0. Epub 2018 Nov 6.
Vitamin D has effects on several body systems, from well-established role in bone metabolism to emerging effects on the immune system. Increasing evidence supports an immunomodulatory effect including inhibition of the pro-inflammatory lymphocyte subsets while enhancing their anti-inflammatory counterpart, in favour of a more tolerogenic status. Vitamin D deficiency is increasingly recognised in association with autoimmune and inflammatory diseases, also with evidence from the field of asthma where vitamin D supplementation may overcome steroid resistance. In the HSCT setting, vitamin D deficiency has been variably associated with increased complications, including graft-versus-host disease (GvHD), with a potential impact on survival outcomes. In this review we provide an overview and critical appraisal of the current literature of the role of vitamin D (and its deficiency) in relation to immunity in both allogeneic and autologous HSCT settings. We conclude that the evidence base is mixed, but a greater understanding of the role of vitamin D in relation to immune reconstitution following HSCT is warranted. Given its potential benefits, its inexpensive cost and favourable side effect profile, consideration of vitamin D levels and its supplementation could be easily incorporated into prospective studies in GvHD, including clinical trials of novel therapeutics, supportive care and biomarkers.
维生素 D 对人体多个系统有影响，其作用已得到充分证实，不仅在骨骼代谢方面，而且在免疫系统方面也有新的作用。越来越多的证据支持其免疫调节作用，包括抑制促炎淋巴细胞亚群，同时增强其抗炎对应物，以促进更耐受的状态。维生素 D 缺乏症与自身免疫性和炎症性疾病的关系日益得到认可，哮喘领域也有证据表明，补充维生素 D 可能克服类固醇耐药性。在 HSCT 环境中，维生素 D 缺乏症与多种并发症有关，包括移植物抗宿主病（GvHD），并可能对生存结果产生影响。在这篇综述中，我们概述并批判性地评估了目前关于维生素 D（及其缺乏）在异体和自体 HSCT 环境中与免疫相关的作用的文献。我们得出的结论是，证据基础参差不齐，但需要进一步了解维生素 D 在 HSCT 后免疫重建中的作用。鉴于其潜在的益处、低廉的成本和良好的副作用特征，考虑维生素 D 水平及其补充剂可以很容易地纳入 GvHD 的前瞻性研究中，包括新型治疗药物、支持性护理和生物标志物的临床试验。
