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Open Access Highly Accessed Research article

Restoration of regulatory and effector T cell balance and B cell homeostasis in systemic lupus erythematosus patients through vitamin D supplementation

Benjamin Terrier123, Nicolas Derian12, Yoland Schoindre4, Wahiba Chaara125, Guillaume Geri123, Noël Zahr6, Kubéraka Mariampillai7, Michelle Rosenzwajg1235, Wassila Carpentier8, Lucile Musset9, Jean-Charles Piette7, Adrien Six125, David Klatzmann1235, David Saadoun1237, Cacoub Patrice1237 and Nathalie Costedoat-Chalumeau1237*

Author Affiliations

1 UPMC Université Paris 6, UMR 7211, F-75013 Paris, France

2 Centre National de la Recherche Scientifique (CNRS), UMR 7211, Paris, France

3 INSERM, UMRS959; Groupe Hospitalier Pitié-Salpétrière, 47 boulevard de l'Hôpital, 75013 Paris, France

4 Department of Internal Medicine, Hôpital Foch, 40 rue Worth, 92150 Suresnes, France

5 Department of Biotherapy, Groupe Hospitalier Pitié-Salpétrière, 47 boulevard de l'Hôpital, 75013 Paris, France

6 Department of Pharmacology, Groupe Hospitalier Pitié-Salpétrière, 47 boulevard de l'Hôpital, 75013 Paris, France

7 Department of Internal Medicine, Groupe Hospitalier Pitié-Salpétrière, 47 boulevard de l'Hôpital, 75013 Paris, France

8 P3S post-genomic platform, Groupe Hospitalier Pitié-Salpétrière, 47 boulevard de l'Hôpital, 75013 Paris, France

9 Department of Immunology, Groupe Hospitalier Pitié-Salpétrière, 47 boulevard de l'Hôpital, 75013 Paris, France

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Arthritis Research & Therapy 2012, 14:R221  doi:10.1186/ar4060

Published: 17 October 2012

Abstract

Introduction

Systemic lupus erythematosus (SLE) is a T and B cell-dependent autoimmune disease characterized by the appearance of autoantibodies, a global regulatory T cells (Tregs) depletion and an increase in Th17 cells. Recent studies have shown the multifaceted immunomodulatory effects of vitamin D, notably the expansion of Tregs and the decrease of Th1 and Th17 cells. A significant correlation between higher disease activity and lower serum 25-hydroxyvitamin D levels [25(OH)D] was also shown.

Methods

In this prospective study, we evaluated the safety and the immunological effects of vitamin D supplementation (100 000 IU of cholecalciferol per week for 4 weeks, followed by 100 000 IU of cholecalciferol per month for 6 months.) in 20 SLE patients with hypovitaminosis D.

Results

Serum 25(OH)D levels dramatically increased under vitamin D supplementation from 18.7±6.7 at day 0 to 51.4±14.1 (p<0.001) at 2 months and 41.5±10.1 ng/mL (p<0.001) at 6 months. Vitamin D was well tolerated and induced a preferential increase of naïve CD4+ T cells, an increase of regulatory T cells and a decrease of effector Th1 and Th17 cells. Vitamin D also induced a decrease of memory B cells and anti-DNA antibodies. No modification of the prednisone dosage or initiation of new immunosuppressant agents was needed in all patients. We did not observe SLE flare during the 6 months follow-up period.

Conclusions

This preliminary study suggests the beneficial role of vitamin D in SLE patients and needs to be confirmed in randomized controlled trials.