Význam vitaminu D pro lidské zdraví

Significance of vitamin D for human health

Vitamin D is usually perceived as a nutrition component necessary for correct skeletogenesis in the period of growth and for the sustainment of healthy bones in adults. However, it is of much greater significance. The active from of vitamin D, calcitriol, is a product of the metabolism of vitamin D in the organism. As to the structure, metabolism and mechanisms of action, calcitriol is closely related to steroid hormones. An interaction between calcitriol and its receptor takes place in the cell nucleus. Vitamin D receptor is actually a nuclear transcription factor, which is present in virtually every human cell with a nucleus. Following complicated interactions in the cell nucleus with the participation of complexes of coregulatory molecules, the gene transcription of more than 500 target genes is modulated. Calcitriol circulating in the blood stream is produced by the cells of the proximal tubule of the kidney. This secretion is regulated by the serum levels of calcium and phosphate, calcium releasing hormones and mediators, and, most of all, by the serum level of calcitriol alone. Hydroxylases, enzymes necessary for both the synthesis and degradation of calcitriol, can be expressed in a large number of tissues and cells. However, this paracrine/autocrine secretion of calcitriol is subject to other regulatory mechanisms, which explains the pleiotropic effects of vitamin D on the human organism. Lack of vitamin D is linked with higher occurrence of malignant tumours, most of all breast, prostate, and colorectal cancer, with higher occurrence of some cardiovascular risk factors, and increased occurrence of heart failure and sudden cardiac death. Calcitriol has a significant immunomodulatory effect. It plays a protective role in the development of autoimmune diseases such as type I diabetes, multiple sclerosis or idiopathic inflammatory bowel disease. It also plays a dominant role in innate immune reactions. It induces the antimicrobial peptide cathelicidin, which decreases the viability of intracellular pathogens, e.g. Mycobacterium tuberculosis. Calcium-phosphate metabolism and metabolism of the bone and the growth plate are regarded as the typical sphere of action of calcitriol. The right vitamin D saturation is essential for an optimal strength and coordination of muscles. Vitamin D supplementation, which leads to a calcidiol serum level of 75 nmol/l at least, is effective in prevention of fractures.

Key words:
vitamin D, calcitriol, VDR

Autoři: S. Skácelová
Působiště autorů: Revmatologický ústav Praha
Vyšlo v časopise: Čes. Revmatol., 18, 2010, No. 1, p. 26-40.
Kategorie: Přehledné referáty

Souhrn

Vitamin D bývá tradičně chápán jako nutriční složka nezbytná pro správný vývoj skeletu v období růstu a pro udržení zdravé kosti v dospělosti. Jeho význam je však daleko širší. Metabolizací v organismu vzniká kalcitriol, vlastní aktivní forma vitaminu D. Svou strukturou, metabolismem a mechanismem účinku je kalcitriol blízce příbuzný steroidním hormonům. V buněčném jádře dochází k interakci mezi kalcitriolem a jeho receptorem. Vitamin D receptor je vlastně nukleární transkripční faktor, kterým disponuje prakticky každá jaderná buňka lidského těla. Po složitých interakcích uvnitř buněčného jádra, na kterých se účastní komplexy koregulačních molekul, je modulována genová transkripce více než 500 cílových genů. Kalcitriol cirkulující v krevním oběhu je produkován v buňkách proximálního tubulu ledvin. Tato sekrece je regulována hladinami kalcia, fosfátu, kalciotropními hormony a působky a zejména sérovou koncentrací kalcitriolu samotného. Velké množství tkání a buněk je schopno exprimovat hydroxylázy nutné k syntéze i degradaci kalcitriolu. Tato parakrinní/autokrinní sekrece kalcitriolu však podléhá jiným regulačním mechanismům. To vysvětluje pleotropní účinky vitaminu D na lidský organismus.

Nedostatek vitaminu D je spojen s vyšší incidencí zhoubných nádorů, zejména prsu, prostaty a kolorektálního karcinomu, s vyšším výskytem některých kardiovaskulárních rizikových faktorů a se zvýšenou incidencí srdečního selhání a náhlé smrti z kardiovaskulárních příčin.

Kalcitriol má významný imunomodulační efekt. Působí protektivně před rozvojem autoimunitních chorob jako jsou diabetes mellitus 1. typu, roztroušená skleróza či idiopatické střevní záněty. Podstatnou roli hraje i ve vrozených imunitních reakcích. Indukuje antimikrobiální peptid cathelicidin, který snižuje viabilitu intracelulárních patogenů, např. Mycobacterium tuberculosis. Za klasickou oblast působnosti kalcitriolu je považován kalcium-fosfátový metabolismus, metabolismus kosti a růstové chrupavky. Správná saturace vitaminem D je nezbytná pro optimální svalovou sílu a koordinaci. Suplementace vitaminem D, při které je dosaženo sérové hladiny kalcidiolu alespoň 75 nmol/l, je účinná v prevenci fraktur.

Klíčová slova:
vitamin D, kalcitriol, VDR

dávání i tak „obyčejných léčiv“, jakým jsou doplňky s vitaminem D.

Poděkování
Tato práce vznikla za podpory VZ MZ ČR 0002372801.

MUDr. Simona Skácelová
Revmatologický ústav
Na Slupi 4
128 50
Praha 2
e-mail:skac@revma.cz

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