Vitamin D3 is well Correlated with Anti- Helicobacter pylori Immunoglobulins and could be a well Biomarker for Immunity Competence against the Disease

Abstract

Background: Helicobacter pylori (HPY) provokes gastrointestinal disorders and gastric cancer. We supposed that HPY disrupts the 25-OH-Vitamin-D3 (Vit.D3) absorption. We evaluated the association between Vit.D3 and anti-HPY immunoglobulins (Igs) and the Vit.D3 potency as a predictive biomarker for HPY infection.

Materials and methods: 603 patients' raw data were gathered from a private clinical laboratory. Anti-HPY Igs including serum IgG, IgA, and IgM, in addition to HPY-stool antigen, were assessed by the immunoassay methods. Vit.D3 was determined by high-pressure liquid chromatography. Correlations, ordinal comparisons, cutoff points (COP), and odds ratio (OR) were estimated.

Results: The age mean ± standard deviation was 39.83 ± 18.426 for female and 38.82 ± 16.937 for male participants (P = 0.521). Significant correlations existed after age and gender adjustment between Vit.D3 serum levels and the HPY IgG (R = 0.298) and IgA (R = 0.271) but not for IgM (R = -0.103). Approximately, 48% of males and 36% of females had insufficient/deficient Vit.D3 serum levels (male/female OR: 1.65; 1.16-2.33; P = 0.0051). After age and gender adjustment, the best COP of Vit.D3 to predict an HPY IgG-positive patient was Vit.D3 >32.80 ng/mL with 66.23% diagnostic accuracy (DAAC), 30.43% specificity (SPC), and 90.41% sensitivity (SEN). For the HPY IgA, the values were Vit.D3 >37.83 ng/mL, DAAC = 60.45%, SPC = 58.82%, SEN = 64.20%. For HPY IgM, the values were Vit.D3 >37.32 ng/mL, DAAC = 58.97%, SPC = 57.33%, and SEN = 100%.

Conclusions: Vit.D3 had a good association with anti-HPY Igs and may be a good biomarker for immunity competence against HPY infection if the patient's age and gender are considered when interpreting the laboratory results.

Keywords: Biomarker; Helicobacter pylori; cholecalciferol; chromatography; immunoglobulins.

Figure 1

The flowchart of study steps and sample size from patient's admission to test results. In total, 603 patients from a database containing 11,892 records of different tests were explored. We did not do any test except based on his/her physician request. Only data sets were considered that include the Vitamin D3 request. All 603 patients had at least serum Vitamin D3 and one Helicobacter pylori antibody or Helicobacter pylori antigen-requested tests

Figure 2

A sample of chromatogram for 25-OH-Vitamin-D3 assay; upper part showing a screenshot of software and the lower part showing the magnification of chromatogram. Areas under the curves, separation times are shown in this sample chromatogram

Figure 3

The Vitamin D3 levels between males and females. Based on Mann–Whitney statistical test results, females had significantly higher Vitamin D3 levels than males (P = 0.005)

Figure 4

Comparative box plot of age- and gender-adjusted Helicobacter pylori immunoglobulin G, immunoglobulin A, and immunoglobulin M among Vitamin D3-sufficient and -insufficient/deficient patients. There was a significant difference between Vitamin D3-sufficient and -insufficient/deficient participants for Helicobacter pylori immunoglobulin G (mean ± SD in the sufficient group = 90.17 ± 11.24 AU/mL and in the insufficient/deficient group = 84.46 ± 10.19 AU/mL; P < 0.001) and immunoglobulin A (mean ± SD in the sufficient group = 34.59 ± 10.7 AU/mL and in the insufficient/deficient group = 30.26 ± 9.83 AU/mL; P = 0.002) but not for immunoglobulin M (mean ± SD in sufficient group = 4.54 ± 0.72 AU/mL and in the insufficient/deficient group = 4.57 ± 0.82 U/mL; P = 0.740). Note that the reported mean ± SDs are adjusted values and the comparisons were done using Mann–Whitney U statistical method. Unadjusted values are reported in Table 1. SD: Standard deviation

Figure 5

Left side: Comparative dot-plot of age- and gender-adjusted Vitamin D3 serum levels between Helicobacter pylori immunoglobulin G (a), immunoglobulin A (b), and immunoglobulin M (c) positive or negative patients. The most Helicobacter pylori immunoglobulin G-, immunoglobulin A-, and all immunoglobulin M-positive patients had higher Vitamin D3 serum levels compared with immunoglobulin-negative patients. Using receiver-operating curve analysis, the best cutoff values were calculated for Vitamin D3 serum levels and receiver-operating curve immunoglobulins. Right side: The receiver-operating curve curves plotted to determine the best cutoff values and accuracy data of Vitamin D3 as a differential diagnosis/prediction biomarker for Helicobacter pylori infection. Details are presented in the body text