Daniela Gerova

Prevalence of vitamin D deficiency and insufficiency in Bulgarian patients with chronic Hepatitis C viral infection

Abstract Aims. The present pilot study aimed to determine vitamin D status in Bulgarian patients with chronic HCV infection in respect to the severity of liver disease and response to interferon-ribavirin therapy. Methods. The study encompassed 296 patients: 161 males (54.4%) aged 42.08 ± 14.87 years, 135 females (45.6%) aged 45.72 ± 14.34 years, 86.5% of them infected with HCV genotype 1. Total 25-hydroxyvitamin-D (25OHD) was determined by liquid chromatography/tandem-mass spectrometric detection. Results. The median 25OHD level of the studied cohort was 50.40 nmol/L (range: 29.6–71.05). 25OHD deficient (< 25 nmol/L) were 16% of patients, 33% showed profound insufficiency (25–50 nmol/L), another 33% were in the range 50–80 nmol/L (mild insufficiency), the rest 18% were 25OHD sufficient. Significantly lower 25OHD levels were registered in cases with advanced fibrosis compared to those with mild or absent fibrosis (37.10 nmol/L vs. 53.00 nmol/L, respectively, p < 0.05). This association remained unchanged by seasonal variations in 25OHD levels. Inverse relationship was found between 25OHD and HCV-RNA (p < 0.01). Patients with sustained virological response to therapy had significantly higher 25OHD levels, compared to patients who failed to achieve viral eradication (56.90 nmol/L vs. 45.00 nmol/L, p = 0.012). Conclusion. More than 80% of HCV-infected patients were vitamin D-deficient and -insufficient. The inverse relationship between 25OHD levels and viral load, liver fibrosis and treatment outcomes supports the hypothesis that improvement of vitamin D status may have considerable potential to amend the host defense against HCV infection and response to therapy.

Serum level of the human antimicrobial cathelicidin (hCAP18/LL-37) in patients with psoriasis vulgaris

Introduction : Psoriasis is a chronic immune-mediated inflammatory disease. Human cathelicidin (hCAP18/LL37) has been elucidated recently as a modulator of inflammation in the affected skin. Vitamin D may induce expression of this antimicrobial peptide. Our trial aimed to study the circulating level of hCAP18/LL-37 and to explore its relationship with the severity of psoriasis. Material and Methods : 79 patients with moderate to severe psoriasis (PASI >10) were included in a retrospective analysis. Stored serum samples were used for assessment of 25-hydroxyvitamin D - 25(OH)D and to measure the circulating human cathelicidin (LL-37). Results : In a study group of 79 patients we assessed mean level of 25(OH)D of 30.25 nmol/l (95% CI 25.87 – 34.62 nmol/l). Mean circulating cathelicidin was 27.17 ng/ml (95% CI 21.52 – 32.83 ng/ml). Only 8.9% of patients had LL-37 level > 54 ng/ml. Although circulating LL-37 was lower in severe psoriasis than in moderate psoriasis (24.33 ng/ml vs. 31.14 ng/ml), the variation is nonsignificant. We further evaluated the association of LL-37 with both PASI score and 25(OH)D concentration in the subgroup of patients with vitamin D deficiency (n=39). It was interesting to find a significant correlation between the level of LL-37 and 25(OH)D (r=0.38, p=0.017) and inverse association between the level of LL-37 and PASI (r= -0.30, p=0.06). Conclusion : In this pilot trial we assessed low serum levels of cathelicidin antimicrobial peptide in the patients with psoriasis. LL-37 may be discussed as related to PASI and 25(OH)D in a subgroup of psoriatic patients with vitamin D deficiency.