Význam vitaminu D pro lidské zdraví
:
S. Skácelová
:
Revmatologický ústav Praha
:
Čes. Revmatol., 18, 2010, No. 1, p. 26-40.
:
Overview Reports
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
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
Sources
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