Steroid requirements and immune associations with vitamin D are stronger in children than adults with asthma

Abstract

Background: The effects of serum vitamin D status on atopy, steroid requirement, and functional responsiveness to corticosteroids in children versus adults with asthma have not been studied systematically.

Objective: We sought to explore the age-specific effects of vitamin D in asthmatic patients.

Methods: Serum vitamin D levels were examined in a prospective study of adults and children (102 healthy control subjects and 103 asthmatic patients). PBMCs were cultured for 3 hours with or without 100 nmol/L dexamethasone, and the expression of corticosteroid-regulated genes was detected by using real-time PCR. Serum IgE levels were measured, and information about asthmatic patients' steroid requirements was collected.

Results: Deficient serum vitamin D levels (<20 ng/mL) were found in 47.6% of asthmatic patients and 56.8% of healthy control subjects, with means ± SDs of 20.7 ± 9.8 and 19.2 ± 7.7 ng/mL, respectively. In multivariate regression models a significant positive correlation between serum vitamin D levels and the expression of vitamin D-regulated targets, cytochrome P450, family 24, subfamily a (cyp24a) expression by PBMCs (P = .0084, pediatric asthma group only) and serum LL-37 levels (P = .0006 in the pediatric group but P = .0067 in the adult asthma group), was found. An inverse association between vitamin D and serum IgE levels was observed in the pediatric (P = .006) asthma group. Serum vitamin D level (P = .05), as well as PBMC cyp24a expression (P = .0312), demonstrated a significant inverse relationship with daily inhaled corticosteroid dose in the pediatric asthma group only. Cyp24a expression in PBMCs correlated positively with in vitro suppression of TNF-α by dexamethasone (P = .05) and IL-13 (P = .0094) in PBMCs in the pediatric asthma group only.

Conclusions: This study demonstrated significant associations between serum vitamin D status and steroid requirement and in vitro responsiveness to corticosteroids in the pediatric but not the adult asthma group. Vitamin D was also related to IgE levels in children but not in adults.

Figure 1

Associations between serum vitamin D levels and vitamin D regulated targets (serum LL-37 levels (A, C) and cyp24a expression (B, D)) in pediatric and adult asthma groups.

Figure 2

Significant inverse relationship between serum vitamin D levels and serum IgE levels in the pediatric asthma group (A), but not in the adult asthma group (B).

Figure 3

Pediatric asthma group (A, C) but not the adult asthma group (B, D) demonstrates significant inverse relationship between serum vitamin D levels, PBMC expression of the vitamin D regulated target cyp24a and daily ICS dose (in budesonide equivalents).

Figure 4

A significant positive correlation between cyp24a expression by PBMC and the degree of TNFα and IL-13 suppression by DEX in PBMC of pediatric asthma group (A, C), but not adult asthma group (B, D).