Cholecalciferol classification
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Cholecalciferol Classification and Its Immunomodulatory Effects
Introduction to Cholecalciferol
Cholecalciferol, commonly known as vitamin D3, is a fat-soluble vitamin that plays a crucial role in calcium homeostasis and bone metabolism. It is synthesized in the skin upon exposure to ultraviolet B (UVB) radiation from sunlight and can also be obtained from dietary sources and supplements. Cholecalciferol is converted in the liver to 25-hydroxyvitamin D, the main circulating form, which is then further hydroxylated in the kidneys to its active form, calcitriol.
Cholecalciferol in Multiple Sclerosis (MS)
Safety and Immunologic Effects
Research has shown that cholecalciferol supplementation can have significant immunomodulatory effects in patients with multiple sclerosis (MS). A study comparing high-dose (10,400 IU daily) and low-dose (800 IU daily) cholecalciferol supplementation in patients with relapsing-remitting MS found that high-dose cholecalciferol was safe and well-tolerated. It led to a substantial increase in 25-hydroxyvitamin D levels and exhibited pleiotropic immunomodulatory effects, including a reduction in interleukin-17 production by CD4+ T cells and a decrease in the proportion of effector memory CD4+ T cells, with a concomitant increase in central memory and naive CD4+ T cells .
Efficacy in Relapsing-Remitting MS
Another study, the CHOLINE trial, evaluated the safety and efficacy of high-dose cholecalciferol (100,000 IU every other week) in patients with relapsing-remitting MS (RRMS) over a two-year period. Although the primary endpoint of reducing the annualized relapse rate (ARR) was not met, secondary outcomes suggested potential benefits. Patients receiving cholecalciferol showed a reduction in ARR, fewer new hypointense T1-weighted lesions, and lower progression of disability as measured by the Expanded Disability Status Scale (EDSS). The safety profile was favorable, indicating that cholecalciferol could be a beneficial adjunct therapy for RRMS patients with low serum 25-hydroxyvitamin D levels .
Cholecalciferol in Type 1 Diabetes Mellitus (T1D)
Regulatory T-Cell Function
Cholecalciferol has also been studied for its effects on regulatory T cells (Tregs) in young patients with new-onset type 1 diabetes mellitus (T1D). A randomized clinical trial demonstrated that cholecalciferol supplementation (70 IU/kg body weight/day) significantly improved the suppressive capacity of Tregs over a 12-month period. This improvement suggests that cholecalciferol could play a role in modulating immune responses in T1D, potentially serving as part of an immunomodulatory combination therapy .
Conclusion
Cholecalciferol, or vitamin D3, is not only essential for bone health but also exhibits significant immunomodulatory properties. In multiple sclerosis, high-dose cholecalciferol supplementation has been shown to be safe and may reduce disease activity and progression. In type 1 diabetes, it enhances the function of regulatory T cells, indicating potential benefits in immune regulation. These findings support the continued exploration of cholecalciferol as a therapeutic agent in autoimmune diseases.
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