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Seidowsky A, Villain C, Vilaine E, Baudoin R, Tabarin A, Kottler ML, Cavalier É, Souberbielle JC, Massy ZA. [Hypercalcemia and inactive mutation of CYP24A1. Case-study and literature review]. Nephrol Ther 2017; 13:146-153. [PMID: 28456639 DOI: 10.1016/j.nephro.2017.01.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 01/13/2017] [Accepted: 01/14/2017] [Indexed: 02/07/2023]
Abstract
We present the case of a family whose members have high levels of serum calcium (hypercalcaemia) by loss of function of the enzyme vitamin D 24-hydroxylase due to bi-allelic mutations in the CYP24A1 gene: c.443 T>C (p.Leu148Pro) and c.1187 G>A (p.Arg396Gln). 24-VITD hydroxylase is a key player in regulating the circulating calcitriol, its tissue concentration and its biological effects. Transmission is recessive. The estimated prevalence of stones in the affected subjects is estimated between 10 and 15%. The loss of peripheral catabolism of vitamin D metabolites in patients with an inactivating mutation of CYP24A1 is responsible for persistent high levels of 1,25-dihydroxyvitamin D especially after sun exposure and a charge of native vitamin D. Although there are currently no recommendations (French review) on this subject, this disease should be suspected in association with recurrent calcium stones with nephrocalcinosis, and a calcitriol-dependent hypercalcaemia with adapted low parathyroid hormone levels. Resistance to corticosteroid therapy distinguishes it from other calcitriol-dependent hypercalcemia. A ratio of 25-hydroxyvitamin D/24.25 hydroxyvitamin D>50, is in favor of hypercalcemia with vitamin D deficiency 24-hydroxylase. Genetic analysis of CYP24A1 should be performed at the second step. The current therapeutic management includes the restriction native vitamin D supplementation and the limitation of sun exposure. Biological monitoring will be based on serum calcium control and modulation of parathyroid hormone concentrations.
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Affiliation(s)
- Alexandre Seidowsky
- Service de néphrologie, hôpital Ambroise Paré, université Versailles-Saint-Quentin en Yvelines, AP-HP, 9 avenue Charles-de-Gaulle, 92140 Boulogne-Billancourt, France; Service de néphrologie-hémodialyse, hôpital Américain de Paris, 63, boulevard Victor Hugo, 92200 Neuilly-sur-Seine, France.
| | - Cédric Villain
- Service de néphrologie, hôpital Ambroise Paré, université Versailles-Saint-Quentin en Yvelines, AP-HP, 9 avenue Charles-de-Gaulle, 92140 Boulogne-Billancourt, France; Université Versailles-Saint-Quentin, inserm U-1018, CESP équipe 5, EpRec, 55, avenue de Paris, 78000 Versailles, France
| | - Eve Vilaine
- Service de néphrologie, hôpital Ambroise Paré, université Versailles-Saint-Quentin en Yvelines, AP-HP, 9 avenue Charles-de-Gaulle, 92140 Boulogne-Billancourt, France; Université Versailles-Saint-Quentin, inserm U-1018, CESP équipe 5, EpRec, 55, avenue de Paris, 78000 Versailles, France
| | - Roselyne Baudoin
- Service endocrinologie diabète et nutrition, CHU de Bordeaux USN, avenue Magellan-Haut-Lévèque, 33604 Pessac, France
| | - Antoine Tabarin
- Service endocrinologie diabète et nutrition, CHU de Bordeaux USN, avenue Magellan-Haut-Lévèque, 33604 Pessac, France
| | - Marie-Laure Kottler
- Service de génétique, CHU de Caen, hôpital Clémenceau, avenue George Clémenceau, 14033 Caen, France
| | - Étienne Cavalier
- Department of clinical chemistry, University of Liège, CHU Sart-Tilman, 4000 Liège, Belgique
| | - Jean-Claude Souberbielle
- Laboratoire d'explorations fonctionnelles, hôpital Necker-Enfants-Malades, 149 rue de Sèvres, 75014 Paris, France
| | - Ziad A Massy
- Service de néphrologie, hôpital Ambroise Paré, université Versailles-Saint-Quentin en Yvelines, AP-HP, 9 avenue Charles-de-Gaulle, 92140 Boulogne-Billancourt, France; Université Versailles-Saint-Quentin, inserm U-1018, CESP équipe 5, EpRec, 55, avenue de Paris, 78000 Versailles, France
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de Paula FJA, Rosen CJ. Vitamin D safety and requirements. Arch Biochem Biophys 2011; 523:64-72. [PMID: 22179017 DOI: 10.1016/j.abb.2011.12.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Revised: 11/30/2011] [Accepted: 12/02/2011] [Indexed: 12/22/2022]
Abstract
Vitamin D an ancient secosteroid is essential for mineral homeostasis, bone remodeling, immune modulation, and energy metabolism. Recently, debates have emerged about the daily vitamin D requirements for healthy and elderly adults, the safety and efficacy of long term supplementation and the role of vitamin D deficiency in several chronic disease states. Since this molecule acts as both a vitamin and a hormone, it should not be surprising that the effects of supplementation are multi-faceted and complex. Yet despite significant progress in the last decade, our understanding of vitamin D physiology and the clinical relevance of low circulating levels of this vitamin remains incomplete. The present review provides the reader with a comprehensive and up-to-date understanding of vitamin D requirements and safety. It also raises some provocative research questions.
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Affiliation(s)
- Francisco J A de Paula
- Department of Internal Medicine, School of Medicine of Ribeirão Preto, University of São Paulo, Av. Bandeirantes 3900, Ribeirão Preto, 14049-900 SP, Brazil.
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Vitamin D, nervous system and aging. Psychoneuroendocrinology 2009; 34 Suppl 1:S278-86. [PMID: 19660871 DOI: 10.1016/j.psyneuen.2009.07.003] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2009] [Revised: 07/04/2009] [Accepted: 07/06/2009] [Indexed: 01/08/2023]
Abstract
This is a mini-review of vitamin D(3), its active metabolites and their functioning in the central nervous system (CNS), especially in relation to nervous system pathologies and aging. The vitamin D(3) endocrine system consists of 3 active calcipherol hormones: calcidiol (25OHD(3)), 1alpha-calcitriol (1alpha,25(OH)2D(3)) and 24-calcitriol (24,25(OH)2D(3)). The impact of the calcipherol hormone system on aging, health and disease is discussed. Low serum calcidiol concentrations are associated with an increased risk of several chronic diseases including osteoporosis, cancer, diabetes, autoimmune disorders, hypertension, atherosclerosis and muscle weakness all of which can be considered aging-related diseases. The relationship of many of these diseases and aging-related changes in physiology show a U-shaped response curve to serum calcidiol concentrations. Clinical data suggest that vitamin D(3) insufficiency is associated with an increased risk of several CNS diseases, including multiple sclerosis, Alzheimer's and Parkinson's disease, seasonal affective disorder and schizophrenia. In line with this, recent animal and human studies suggest that vitamin D insufficiency is associated with abnormal development and functioning of the CNS. Overall, imbalances in the calcipherol system appear to cause abnormal function, including premature aging, of the CNS.
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