The world pandemic of vitamin D deficiency could possibly be explained by cellular inflammatory response activity induced by the renin-angiotensin system

Abstract

This review attempts to show that there may be a relationship between inflammatory processes induced by chronic overstimulation of the renin-angiotensin system (RAS) and the worldwide deficiency of vitamin D (VitD) and that both disorders are probably associated with environmental factors. Low VitD levels represent a risk factor for several apparently different diseases, such as infectious, autoimmune, neurodegenerative, and cardiovascular diseases, as well as diabetes, osteoporosis, and cancer. Moreover, VitD insufficiency seems to predispose to hypertension, metabolic syndrome, left ventricular hypertrophy, heart failure, and chronic vascular inflammation. On the other hand, inappropriate stimulation of the RAS has also been associated with the pathogenesis of hypertension, heart attack, stroke, and hypertrophy of the left ventricle and vascular smooth muscle cells. Because VitD receptors (VDRs) and RAS receptors are almost distributed in the same tissues, a possible link between VitD and the RAS is even more plausible. Furthermore, from an evolutionary point of view, both systems were developed simultaneously, actively participating in the regulation of inflammatory and immunological mechanisms. Changes in RAS activity and activation of the VDR seem to be inversely related; thus any changes in one of these systems would have a completely opposite effect on the other, making it possible to speculate that the two systems could have a feedback relationship. In fact, the pandemic of VitD deficiency could be the other face of increased RAS activity, which probably causes lower activity or lower levels of VitD. Finally, from a therapeutic point of view, the combination of RAS blockade and VDR stimulation appears to be more effective than either RAS blockade or VDR stimulation individually.

Keywords: angiotensin receptor blocker; cardiovascular disease; mitochondria; oxidative stress; vitamin D receptor.

Fig. 1.

Occurrence of angiotensin receptors and vitamin D (VitD) receptors (VDRs) in nature.

Fig. 2.

Cellular interactions of angiotensin and VitD receptors. RXR, retinoid X receptor; RAS, renin-angiotensin system; VDRE, VitD response element; 1,25(OH)₂D₃, 1,25-dihydroxyvitamin D₃.

Fig. 3.

Potential interaction between RAS receptor and VDR, with focus on oxidative stress and inflammatory balance (1, 39). Proposed interaction between angiotensin type 1 receptor (AT₁R), angiotensin type 2 receptor (AT₂R), and VDR may occur throughout the cell.