부산대학교 도서관

Tuberculosis (TB) is a major global health problem and often coincides with vitamin D deficiency. High doses of vitamin D were widely used to treat TB during the pre-antibiotic era. Vitamin D exerts its action through vitamin D receptor (VDR), and VDR gene polymorphisms are associated with susceptibility or resistance to tuberculosis as well as sputum smear and culture conversion during anti-TB treatment. In-vitro studies have revealed that 1,25-dihydroxyvitamin [D.sub.3] enhances innate immunity by increased expression of various antimicrobial peptides, including cathelicidin, and induction of autophagy of the infected cells thus restricts the intracellular growth of Mycobacterium tuberculosis in macrophages. On the other hand, vitamin D has been shown to suppress the pro-inflammatory cytokine response and enhance the anti-inflammatory response. Supplementation with vitamin D in concert with treatment for TB may be beneficial with respect to minimizing the excessive tissue damage that occurs during the active stage of tuberculosis disease. Several clinical trials have evaluated vitamin D supplementation as an adjunct therapy in the treatment for tuberculosis. However, results are conflicting, owing to variations in dose regimens and outcomes. Further investigations are needed to find the optimal concentration of vitamin D for supplementation with standard anti-TB drugs to optimize treatment, which could help to effectively manage both drug-sensitive and drug-resistant tuberculosis. Key words: 1,25-dihydroxyvitamin [D.sub.3], vitamin D receptor, antimicrobial peptides, immunity, clinical trials. La tuberculose (TB) est un probleme de sante mondial qui coincide souvent avec une deficience en vitamine D. Des doses elevees de vitamine D etaient largement utilisees pour traiter la TB avant l'ere des antibiotiques. La vitamine D exerce son action par l'intermediaire du recepteur de la vitamine D (VDR), et les polymorphismes du gene du VDR sont associes a la susceptibilite ou la resistance a la tuberculose de meme qu'a la conversion des cultures d'expectoration pendant le traitement anti-TB. Des etudes in vitro ont revele que la 1,25-dihydroxyvitamine [D.sub.3] accroit l'immunite innee en augmentant l'expression de differents peptides antimicrobiens, incluant la cathelicidine, et l'induction de l'autophagie des cellules infectees, ce qui restreint alors la croissance intracellulaire de Mycobacterium tuberculosis dans les macrophages. En revanche, on a montre que la vitamine D supprime la reponse des cytokines pro-inflammatoires et accroit la reponse anti-inflammatoire. La supplementation en vitamine D durant le traitement anti-TB peut etre benefique en minimisant le dommage tissulaire excessif durant le stade actif de la maladie. Plusieurs essais cliniques ont evalue la supplementation en vitamine D comme therapie d'appoint durant la traitement anti-TB. Cependant les resultats sont contradictoires fi cause des variations sur le plan des doses administrees et des mesures des resultats. Des recherches plus approfondies sont requises afin de trouver une concentration optimale de supplement de vitamine D a administrer parallelement aux medicaments anti-TB standard, afin de raccourcir la duree du traitement, ce qui pourrait aider a gerer efficacement tant la tuberculose sensible aux medicaments que la tuberculose resistante. [Traduit par la Redaction] Mots-cles : 1,25-dihydroxyvitamine [D.sub.3], recepteur de la vitamine D, peptides antimicrobiens, immunite, essais cliniques.
Introduction Tuberculosis (TB), caused by Mycobacterium tuberculosis (Mtb), continues to be a major threat to public health. Results from various epidemiological studies have unveiled the association between vitamin D deficiency [...]