Recent advances in our understanding of the vitamin D endocrine system

Vitamin D nutritional policy needs a vision for the future

Historically vitamin D is known to be essential for normal bone growth and quality, and thus appropriate dietary vitamin D supplementation can eliminate vitamin D deficiency childhood rickets and adult osteomalacia. In spite of many government and medical associations' worldwide guidelines for the reference daily intake (RDI) of vitamin D, scientists and nutritionists from many countries agree that at present about half of elderly North Americans and Western Europeans and probably also of the rest of the world are not receiving enough vitamin D to maintain healthy bone. In addition, over the past decade there has been a dramatic increase in our understanding of the many biological actions that result from vitamin D acting through its daughter steroid hormone, 1alpha,25-dihydroxyvitamin D(3) [1alpha,25(OH)(2)D(3)] in collaboration with its cognate vitamin D receptor (VDR). Consequently, evidence has accumulated that beside intestine and bone, there are five additional physiological systems where the VDR with 1alpha,25(OH)(2)D generates biological responses. These include the immune system (both the innate and adaptive), pancreas and metabolic homeostasis, heart-cardiovascular, muscle and brain systems as well as the control of the cell cycle, and thus of the disease process of cancer. Acting through the VDR, 1alpha,25(OH)(2)D(3) can produce a wide array of favorable biological effects that collectively are projected to contribute to the improvement of human health. Responsible medicine demands that worldwide vitamin D nutritional guidelines reflect current scientific knowledge about vitamin D's spectrum of activities. Thus, worldwide vitamin D nutritional policy is now at a crossroads. This paper presents several proposed policy changes with regard to the amount of vitamin D daily intake that if implemented will maximize vitamin D's contribution to reducing the frequency of many diseases, which would then increase the quality and longevity of life and significantly reduce the cost of medical care worldwide.

Validation of a radioreceptor assay for 1,25-dihydroxyvitamin D using selected ion monitoring GC-MS

This report describes two methods for the measurement of 1,25-dihydroxyvitamin D [1,25(OH)2D] in serum: A modified radio receptor assay (RRA), employing a 1,25(OH)2D receptor from calf thymus, and selected ion monitoring (SIM) with combined capillary gas chromatography (GC)-mass spectrometry (MS). The intra-assay coefficient of variation was close to 13% for both methods, and the inter-assay coefficients of variation were 14.0 and 6.5% for RRA and SIM (GC-MS), respectively. Aliquots of 2 ml (RRA) and 20 ml (SIM) serum were used, and the limits of detection were 10 and 6 pmol/l, respectively. The analytical recovery of each method was assessed, and a maximum deviation from the expected value of 10 and 2% was found for RRA and SIM, respectively. A correlation coefficient of 0.93 (slope 0.97) was obtained when 27 different serum samples were analyzed by both methods. Included in this study were serum samples from healthy subjects and patients with subnormal as well as supranormal 1,25(OH)2D levels. This result showed that the RRA accurately measured the serum levels of 1,25(OH)2D and therefore should be useful in the diagnosis and control of vitamin D dependent diseases.

Effects of estrone and estradiol-17 beta on 25-hydroxycholecalciferol hydroxylase activities in female Japanese quail

Equimolar amounts of estrone and estradiol-17 beta injected into sexually immature female Japanese quail caused comparable increases and decreases in the renal activity of 25-hydroxycholecalciferol (25HCC) 1 alpha-hydroxylase and 25-hydroxycholecalciferol 24-hydroxylase, respectively. Peak activity of the former enzyme was induced by both estrogens within 6 hr and had declined by 24 hr. Plasma concentrations of estrone and estradiol following the injection were maximal within 3-6 hr of injecting the steroid i.m. Following [3H]estradiol injection, 25% of the radioactivity was located with estrone in the plasma following separation by TLC. Conversely, following [3H]estrone injection 30% of the radioactivity in plasma was located with estradiol. Thus, both estrone and estradiol may have physiological effects in quail, which in part may be due to their in vivo interconversion. Evidence that prolactin may be mediating the estrogenic stimulation of the 25HCC 1 alpha-hydroxylase is also presented.

Production, purification and characterization of antibodies to 1,25-dihydroxyvitamin D raised in chicken egg yolk

For this sensitive RIA for 1 alpha,25-dihydroxyvitamin D, we used antibodies to 1 alpha,25-dihydroxycholecalciferol-3-hemisuccinate conjugated to bovine serum albumin, raised in eggs by immunization of chickens. We describe an efficient method for purification of IgG from egg yolk. We characterized these antibodies with immunoelectrophoresis and by radioimmunoassay. These antibodies show a high affinity for 1 alpha,25-dihydroxyvitamin D3 but cross react with other vitamin D metabolites as well. Extraction and liquid chromatography are necessary to isolate the 1 alpha,25-dihydroxyvitamin D from human serum or plasma before determination by RIA. The sensitivity of the assay is estimated at 5 pg/tube.

Responsiveness of human carcinoma cells of gynecologic origin to 1,25-dihydroxycholecalciferol

In responsive tissues the induction of 25-hydroxycholecalciferol 24-hydroxylase activity is a marker of 1,25-dihydroxycholecalciferol action. In this study we investigated the responsiveness of various malignant cells, which were derived from carcinomas of gynecologic origin, to 1,25-dihydroxycholecalciferol; we did so because it has been demonstrated that replication of certain malignant human cells that are 1,25-dihydroxycholecalciferol-responsive is inhibited by treatment with this substance. We found that 1,25-dihydroxycholecalciferol treatment caused an increase in 25-hydroxycholecalciferol 24-hydroxylase activity in gynecologic carcinoma cells that were maintained in monolayer culture. The cells were established from ovarian, endometrial, cervical, and vaginal neoplasms. After treatment with 1,25-dihydroxycholecalciferol (10 nmol/L) for 18 hours, the specific activity of 25-hydroxycholecalciferol 24-hydroxylase increased between 2,4- and 49-fold in these cells. This increase in 25-hydroxycholecalciferol 24-hydroxylase activity is suggestive that certain gynecologic malignancies are responsive to 1,25-dihydroxycholecalciferol. We also found, however, that 1,25-dihydroxycholecalciferol did not act to decrease the rate of replication of these cells; indeed in ovarian adenocarcinoma cells, 1,25-dihydroxycholecalciferol caused a decrease in doubling time; in the other cells of this study, there was no effect of 1,25-dihydroxycholecalciferol on cell replication.

A computerized histomorphometric study of the effects of intoxication with vitamin D3 or 1,25 (OH)2D3 on growth and dentin production of impeded and unimpeded rat incisors

The effects of Vitamin D3 and 1,25(OH)2D3 intoxication on growth and dentinogenesis were studied in impeded and unimpeded rat incisors. Animals were intoxicated either with Vitamin D3 (2 mg/kg/day) or 1,25(OH)2D3 (400 ng/kg/day) for 19 days. Undecalcified transverse sections were obtained from all lower incisors. The outlines of all dental tissues were traced and fed into a computer which depicted the changes in all variables measured (circumference and cross-sectional area of tooth, pulp and dentin, width of dentin, CEJ [cemento-enamel junction] diameter and maximal labio-lingual diameter). Eruption rates, which had been recorded previously every 48 h, were used to compute the physiological age of each tooth site, so that only areas of similar age be compared. Growth. External dimensions of all intoxicated teeth decreased as the experiment progressed in contrast with control incisors which continued to increase in size. This effect was more pronounced in unimpeded incisors and may be due to the inhibitory influence of 1,25(OH)2D3 on cellular proliferation at the apical progenitor end. Dentinogenesis. 1,25(OH)2D3 intoxication had no significant effect on the rate of eruption and dentin formation in both impeded and unimpeded incisors. The same was true for impeded incisors intoxicated with Vitamin D3 but, both eruption and dentin production rates were impaired in Vitamin D3 unimpeded incisors.

Comparison of a cytosol radioreceptor assay with a radioimmunoassay for 1,25-dihydroxyvitamin D in serum or plasma

Human plasma and serum levels for 1 alpha,25-dihydroxyvitamin D were determined by a cytosol radioreceptor assay (RRA) and a radioimmunoassay (RIA). For both assays, 1.5 ml of human serum or plasma is used. Prior to RRA or RIA, extraction with benzene is performed followed by 'high-performance' liquid chromatography (HPLC) on a silica column (25 X 0.46 cm) with hexane/isopropanol (9/1 by vol), to isolate 1 alpha,25-dihydroxyvitamin D from the other vitamin D metabolites. The cytosol receptor was isolated from the intestine of healthy chickens. The antisera were raised in rabbits to 1 alpha,25-dihydroxyvitamin D3-3-hemisuccinate coupled to bovine serum albumin. The standard curves for RRA and RIA are prepared with 1 alpha,25-dihydroxyvitamin D3. 1 alpha,25-dihydroxy[3H]vitamin D3 of high spec act (158 kCi/mol) is used as tracer. The reactants are incubated for 16 h at 4 degrees C. Then, bound and free ligand are separated after the addition of dextran-coated charcoal. Both assays have a sensitivity of 2 pg/tube. The cytosol receptor and the antibodies have about the same absolute affinity for 1 alpha,25-dihydroxyvitamin D3 but the cytosol receptor has a higher relative affinity for 1 alpha,25-dihydroxyvitamin D3 (compared with other vitamin D metabolites). Reproducibility and precision are better for the RIA. The between- and within-assay CVs are 16.0% (mean = 58.7 ng/l, n = 16) and 11.2% (mean = 52.1 ng/l, n = 15), respectively, for RRA and 12.6% (mean = 61.8 ng/l, n = 27) and 7.4% (mean = 61.8 ng/l, n = 15), respectively using RIA. Reference values obtained by both assays on healthy males and healthy premenopausal females are the same for both sexes; 53.9 +/- 31.0 ng/l (n = 46) using RRA and 51.8 +/- 30.2 ng/l (n = 91) for RIA (mean +/- 2 SD).

24,25-Dihydroxyvitamin D3 administration increases incidence of parturient paresis

Fifty percent (7/14) of aged cows treated with 4 mg 24,25-dihydroxyvitamin D3 intramuscularly precalving developed parturient paresis shortly after calving compared with 7% (1/14) of controls. Injection of 24,25-dihydroxyvitamin D3 increased concentrations in blood plasma 15 times that in control cows. Blood plasma 1,25-dihydroxyvitamin D concentrations were elevated in all groups on day of calving but were not different. Injection of 24,25-dihydroxyvitamin D3 did not alter the typical plasma profile for calcium, phosphorus, or 1,25-dihydroxyvitamin D of paretic or nonparetic cows around parturition. Although injection of 24,25-dihydroxyvitamin D3 was associated with an increased incidence of parturient paresis, the mechanism remains unknown.

A rapid and sensitive invitro assay of 25-hydroxyvitamin D3-1α-hydroxylase and 24-hydroxylase using rat kidney homogenates

A sensitive and rapid in vitro assay of 25-hydroxyvitamin D3 [25-(OH)D3]-1 alpha- and 24-hydroxylase activities was developed using rat kidney homogenates. A potent inhibitor of the enzymes in rat plasma was removed by thoroughly perfusing rats with saline. Kidney homogenates prepared from vitamin D-deficient rats preferentially produced tritiated 1 alpha,25-dihydroxyvitamin D3 [1 alpha,25(OH)2D3] from 25(OH) [3H]D3. Addition of 10 microliter or more of rat plasma to 3 ml of 10% kidney homogenates suppressed 1 alpha-hydroxylase activity dose-dependently. Thyroparathyroidectomy (TPTX) of vitamin D-deficient rats greatly abolished 1 alpha-hydroxylase activity. Administration of parathyroid hormone to the TPTX rats increased 1 alpha-hydroxylase activity and that of 1 alpha,25(OH)2D3 enhanced 24-hydroxylase markedly. Since this assay is technically simple, rapid and sensitive, it will be useful in studying the regulatory mechanism in the renal metabolism of 25(OH)D3 in mammals.

The sparing interaction of bone mass determinants: a hypothesis with implications for osteoporosis

Estrogen and calcium are two well described determinants of postmenopausal skeletal mass. In protecting the organism against bone erosion, the two factors interact in a reciprocally sparing fashion. This manifests in the fact, that correction of the deficiency of one of the factors, as in the case of estrogen replacement therapy, prevents further bone loss despite the persistence of unaltered calcium intakes. The obverse is also true. Large dietary calcium intakes lead to calcium balance, despite the unrelieved estrogen deficiency of the menopause. It is hypothesized that physical activity which functions as another bone mass determinant, may also exert a sparing effect, and thus lower the requirements for calcium intake and perhaps bypass the need for estrogen replacement in the menopause. Confirmation of this hypothesis could provide a method for a nonpharmacologic approach to the prevention of osteoporosis and perhaps even an effective therapy for the repletion of bone tissue in the depleted osteoporotic skeleton.

Genome-independent effects of 1,25-dihydroxy vitamin D-3 on membrane potential

Cell membrane potential, Vm, was monitored in rabbit hypertrophic cartilage metatarsals, amphibian proximal tubule and muscle cells during application of 1,25-dihydroxy vitamin D-3, 25-hydroxy vitamin D-3 or cholesterol (10(-10) M). 1,25-Dihydroxy vitamin D-3 elicited quick variations of Vm (in less than 1 min) in proximal tubular cells (whether injected in the lumen or in peritubular capillaries) and in cartilage. The precursor 25-hydroxy vitamin D-3 and cholesterol produced a small shift of Vm in proximal tubule only when applied from the luminal side, but this change was significantly smaller than that observed with 1,25-dihydroxy vitamin D-3. Muscle cells were unresponsive to both metabolites and cholesterol. It is concluded that rapid effects of 1,25-dihydroxy vitamin D-3 on Vm, in target cells, are specific, most likely due to permeability changes and not related to nuclear protein synthesis; they may contribute to early modulation of cell function.

Unilateral nephrectomy and 1,25-dihydroxyvitamin D3

Several renal functions respond to nephron loss by a compensatory adaptation. Whether the production of 1,25(OH)2D3 also adapts to a renal mass reduction is still a matter of controversy. In the present study we have investigated in rats the influence of unilateral nephrectomy, in both the acute (48 hr) and chronic (2 to 6 weeks) state, on plasma 1,25(OH)2D3 level measured by competitive protein binding assay. In the acute state no difference in plasma 1,25(OH)2D3 level between sham-operated (SHAM) and unilateral-nephrectomized (UNI-NX) rats was found. The presence of the thyroparathyroid glands was not required for maintaining plasma 1,25(OH)2D3 at a normal level 48 hr after UNI-NX. In the chronic state in rats fed at 1.1% Ca diet, plasma 1,25(OH)2D3 (means +/- SEM) was 94 +/- 4 in SHAM and 98 +/- 8 pM in UNI-NX. In rats fed a 0.1% Ca diet it was 252 +/- 16 in SHAM and 239 +/- 20 pM in UNI-NX. Analysis of 3H-1,25(OH)2D3 plasma decay curve indicated that in UNI-NX under a high calcium diet the normalization of plasma 1,25(OH)2D3 appears to be entirely due to an increase in production, whereas under a low calcium diet part of it may also result from a moderate decrease in the elimination rate. In conclusion, this study indicates that unilateral nephrectomy does not affect the level of plasma 1,25(OH)2D3 even under a calcium restriction challenge. This compensatory adaptation appears to be independent of parathyroid hormone.

1,25-Dihydroxyvitamin D3 receptor from Japanese quail intestine; kinetic studies

The cytosolic receptor from Japanese quail intestine has been partially purified and selected kinetic properties of the receptor preparation have been characterized. The receptor--chromatin complex technique developed by Haussler and his associates for separation of the bound from free 1,25-dihydroxyvitamin D3 [1,25-(OH)2D3] was used with modifications. Examination of the conditions for incubation of the receptor--chromatin complex with tritiated 1,25-(OH)2D3 led to the selection of 25 degrees for 25 min at pH 7.4. Under these conditions the following kinetic characteristics prevailed. Specific binding was greater than 90% and the affinity of the receptor for 1,25-(OH)2D3 was 100 times greater than that for 25-(OH)D3 and 24,25-(OH)2D3 and 1.0 x 10(5) times greater than that for vitamin D3. Scatchard analysis revealed an equilibrium dissociation constant of 1.1 nM. Determination of rate constants yielded an association rate constant (ka) of 4.2 x 10(7) M-1 min-1 and a dissociation rate constant (kd) of 4.1 x 10(-2) min-1. The equilibrium dissociation constant, calculated from the ratio kd/ka, is 1.0 nM. When used as a radioreceptor assay the preparation has a sensitivity of 5 pg of 1,25-(OH)2D3 per tube and a working range of 5 to 80 pg per tube.

Calcium and 24,25-dihydroxyvitamin D: inverse relation in cows with parturient paresis

Recent work suggests a role for 24,25-dihydroxyvitamin D in inhibiting mobilization of bone. This study was undertaken to investigate its possible role in the etiology of parturient paresis, a hypocalcemic condition of dairy cows occurring at the onset of lactation. This metabolic disease was chosen to serve as a model of impaired mineral homeostasis. The animals examined were parturient Holstein cows with (N = 6) and without (N = 7) parturient paresis. Determinations of serum 1,25-dihydroxyvitamin D, serum 24,25-dihydroxyvitamin D, and serum calcium were used to evaluate the 2 groups. The hormones were isolated using methylene chloride:methanol extraction, Sephadex LH-20 chromatography, and high-pressure liquid chromatography (HPLC). Quantitation was by competitive protein binding assays. Serum 1,25-dihydroxyvitamin D levels of affected cows were not significantly different from those of normal cows. The 24,25-dihydroxyvitamin D levels of paretic cows (3.48 +/- 0.27 ng/ml) were significantly higher than in the normal cows (2.03 +/- 0.34 ng/ml) (p less than 0.01). Linear regression analysis of the data from the paretic cows revealed an inverse relationship between serum calcium and 24,25-dihydroxyvitamin D (r = -0.94). This negative correlation between serum 24,25-dihydroxyvitamin D and serum total calcium in a naturally occurring hypocalcemic disease of dairy cattle may provide evidence that this metabolite is of significance in the etiology and pathogenesis of this syndrome.

Whole-cell uptake and nuclear localization of 1,25-dihydroxycholecalciferol by breast cancer cells (T47 D) in culture

Specific high-affinity receptors for 1,25-dihydroxycholecalciferol [1,25-(OH)(2)D(3)] have been described recently in broken-cell preparations of several cultured human breast cancer cell lines including the T47 D line. It was necessary to determine whether intact breast cancer cells in culture would bind 1,25-(OH)(2)D(3) specifically and whether the next step in the proposed scheme of action, i.e. nuclear translocation, occurred. The following results were obtained. (1) Specific uptake of 1,25-(OH)(2)D(3) by T47 D cells occurs in intact cells in culture. (2) The rate of uptake is proportional to medium 1,25-(OH)(2)D(3) concentration but is slow compared with that of other steroid hormones, e.g., oestradiol, under identical conditions. Even at 0.5nm-1,25-(OH)(2)D(3) in the medium, at least 4h are required to reach maximum compared with less than 1h for oestradiol binding. (3) Estimation of binding characteristics by Scatchard analysis indicates a single class of binding sites with K(d) of 68pm and 11800 binding sites/cell, which are similar results to those obtained with broken-cell preparations. (4) Inclusion of various vitamin D metabolites in the incubation medium decreased specific binding of 1,25-(OH)(2)D(3) by the intact cells in a manner identical with their effects in the broken-cell preparation and with potencies similar to their potency on Ca(2+) transport and bone resorption in vivo. Order of potency was 1,25-(OH)(2)D(3)>(24R)-1,24,25-trihydroxycholecalciferol >>25-hydroxycholecalciferol>(25R)-24,25-dihydroxycholecalciferol >>(25R)-25,26-dihydroxycholecalciferol. (5) In the 1,25-(OH)(2)D(3)-depleted state, 80% of the 1,25(OH)(2)D(3) receptor is found in the cytosol fraction of the cells even when the subcellular fractionation is performed under low-salt conditions. By contrast after incubation with [(3)H]1,25-(OH)(2)D(3), 59% of the specific 1,25-(OH)(2)D(3) binding is found in the partially purified nuclei fraction. These data indicate that nuclear translocation of the receptor-hormone complex takes place in the intact T47 D cell. The results also support the hypothesis that the 1,25-(OH)(2)D(3) receptor is functional in this cultured breast cancer cell line, which may provide a useful model for further study of the early biochemical events in 1,25-(OH)(2)D(3) action.

A possible direct effect of 24,25-dihydroxycholecalciferol on the parathyroid gland in patients with chronic renal failure

Seventeen undialysed adult patients with chronic renal failure took part in a controlled study of the effects of 1,25(OH)2D3 and D3. After a 6-month observation period the patients were allocated at random to two groups for 6 months of treatment with either 1,25(OH)2D3 (mean dose 0.5 microgram daily) or D3 (dose 100 microgram daily). The treatment was then discontinued and the patients were studied for a further 3 months. In the 1,25(OH)2D3 group the mean serum concentration of 1,25(OH)2D rose significantly during treatment, whereas serum concentratins of 25OHD and 24,25(OH)2D remained unchanged. In the D3 group there was a highly significant increase in serum concentrations of 25OHD and 24,25(OH)2D, whereas serum 1,25(OH)2D remained unchanged. There was a significant fall in serum iPTH in both treatment groups. This fall was unrelated to serum calcium in the D3 group unlike the findings in the 1,25(OH)2D3 group. The data support previous experimental evidence that serum iPTH can be suppressed by 24,25(OH)2D3 and suggest that this analogue may be of clinical importance in the treatment of chronic renal failure without inducing hypercalcaemia.

Serum 25-hydroxycholecalciferol levels in women using oral contraceptives

A study has been made of the serum 25-hydroxycholecalciferol (25-HCC) levels in six groups of women. Significant differences were found between the one pregnant group and the two reference groups as well as between the one pregnant group and two of the three groups using oral contraceptives. No significant differences were found between the reference groups and the ones taking oral contraceptives with oestrogenic concentrations of 0.05 mg or 0.03 mg ethinyl oestradiol for more than one year. It can therefore be concluded that in contrast with most other vitamins, the serum 25-HCC levels are not influenced by the use of oral contraceptives with different oestrogenic concentrations, even over a long period of time.

Vitamin D metabolism: update for the clinician

Vitamin D3 must undergo two hydroxylation steps before it becomes fully active: 25-hydroxylation in the liver and 1- or 24-hydroxylation in the kidney. Parathyroid hormone, serum phosphate, and serum calcium are important in regulation of renal production of 1,25-dihydroxy vitamin D3 (1,25-[OH]2D3) and 24,25-dihydroxy vitamin D3. An enzyme involved in renal hydroxylation is deficient or defective in patients with chronic renal failure, the Fanconi syndrome, vitamin D-dependent rickets, hypoparathyroidism, and pseudohypoparathyroidism. Altered vitamin D metabolism also occurs in various hepatic diseases, postmenopausal osteoporosis, and anticonvulsant osteomalacia. Recently, 1,25-(OH)2D3 was approved for treatment of renal osteodystrophy. In physiologic doses, it predictably corrects many of the clinical and biochemical abnormalities associated with this disorder.

The estimation of vitamin D and some metabolites in human plasma by mass fragmentography

A mass fragmentographic assay for vitamin D3, 25-hydroxyvitamin D3, 25-hydroxyvitamin D2 and 24,25-dihydroxyvitamin D3 is described. After extraction of plasma with methanol and dichloromethane, Lipidex 5000 chromatography was used to separate the plasma extract into three fractions (a vitamin D fraction, a 25-hydroxyvitamin D fraction and a 24,25-dihydroxyvitamin D fraction). Cholesterol was removed from the vitamin D fractio by thin-layer chromatography. :After addition of vitamin D2 to each fraction, isotachysterol trimethylsilyl ethers were formed. Recoveries prior to gas chromatography-mass spectrometry were assessed by the use of tritiated standards added to the plasma before extraction. Using this procedure, normal ranges were established (vitamin D3: 3--17.7, 25-hydroxyvitamin D3: 5.9--35.2, 25-hydroxyvitamin D2: 0.6---1.0 and 24,25-dihydroxyvitamin D3: 0.6--2.9 micrograms/l).