INFLUENCE OF VITAMIN D LEVELS ON IMMUNE MARKERS IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE
DOI:
https://doi.org/10.22159/ajpcr.2026v19i2.57588Keywords:
Chronic obstructive pulmonary disease, Vitamin D, Immunoglobulin G,, CD markers, Inflammation, CD4/CD8 ratioAbstract
Objective: This study aimed to investigate the association between serum vitamin D levels and immune markers in COPD patients compared to healthy controls, focusing on humoral and cellular immunity.
Methods: A cross-sectional study was conducted with 75 COPD patients and 75 healthy controls. Serum vitamin D levels were measured using ELISA, and immune markers, including IgG levels and T-cell subsets (CD3+, CD4+, CD8+), were assessed via flow cytometry. Demographic and clinical data, such as age, gender, BMI, and smoking history, were collected. Statistical analyses, including t-tests and chi-square tests, were performed using SPSS-27 to evaluate differences and correlations between groups.
Results: COPD patients exhibited significantly lower serum vitamin D levels (17.19 ± 5.40 ng/mL) compared to controls (28.19 ± 3.73 ng/mL; p < 0.001). IgG levels were reduced in COPD patients (6.71 ± 1.71 mg/dL vs. 8.84 ± 1.94 mg/dL; p < 0.001), indicating impaired humoral immunity. Total T-cell (CD3+) and helper T-cell (CD4+) counts were lower in COPD patients (716.53 ± 167.31 cells/µL vs. 1024.44 ± 219.19 cells/µL; p < 0.001, and 659.33 ± 169.54 cells/µL vs. 821.23 ± 160.63 cells/µL; p < 0.001, respectively), while cytotoxic T-cell (CD8+) counts were elevated (1268.69 ± 229.69 cells/µL vs. 1029.61 ± 133.93 cells/µL; p < 0.001), leading to a reduced CD4/CD8 ratio (0.57 ± 0.28 vs. 0.80 ± 0.16; p < 0.001). Strong correlations were observed between vitamin D levels and immune markers (IgG, CD3, CD4, CD8) in COPD patients.
Conclusion: COPD patients display significant vitamin D deficiency alongside compromised humoral and cellular immunity, marked by reduced IgG, CD3+, and CD4+ levels, elevated CD8+ levels, and a lower CD4/CD8 ratio. These findings suggest that vitamin D deficiency may contribute to immune dysregulation in COPD, highlighting its potential as a diagnostic marker and therapeutic target for improving immune function and reducing infection risk in this population.
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References
1. Saadatmand K, Khan S, Hassan Q, Hautamaki RC, Ashouri R, Lua J, et al. Benefits of vitamin D supplementation to attenuate TBI secondary injury? Transl Neurosci. 2021;12(1):533-44. doi: 10.1515/ tnsci-2020-0195, PMID 34992852
2. Gombash SE, Lee PW, Sawdai E, Lovett-Racke AE. Vitamin D as a risk factor for multiple sclerosis: Immunoregulatory or neuroprotective? Front Neurol. 2022;13:796933. doi: 10.3389/fneur.2022.796933, PMID 35651353
3. Calafiore D, Fortunato L, Migliario M. Vitamin D for clinical diseases in women: An indispensable factor in medicine and dentistry. J Clin Med. 2022;11(11):3104. doi: 10.3390/jcm11113104, PMID 35683491
4. Prietl B, Treiber G, Pieber TR, Amrein K. Vitamin D and immune function. Nutrients. 2013;5(7):2502-21. doi: 10.3390/nu5072502, PMID 23857223
5. Zeng Y, Luo M, Pan L, Chen Y, Guo S, Luo D, et al. Vitamin D signaling maintains intestinal innate immunity and gut microbiota: Potential intervention for metabolic syndrome and NAFLD. Am J Physiol Gastrointest Liver Physiol. 2020;318(3):G542-53. doi: 10.1152/ajpgi.00286.2019, PMID 31984787
6. Jolliffe DA, Greenberg L, Hooper RL, Mathyssen C, Rafiq R, De Jongh RT, et al. Vitamin D to prevent exacerbations of COPD: Systematic review and meta-analysis of individual participant data from randomised controlled trials. Thorax. 2019 Jan 10;74(4):337-45. doi: 10.1136/thoraxjnl-2018-212092, PMID 30630893
7. Wei R, Christakos S. Mechanisms underlying the regulation of innate and adaptive immunity by vitamin D. Nutrients. 2015;7(10):8251-60. doi: 10.3390/nu7105392, PMID 26404359
8. Akimbekov NS, Digel I, Sherelkhan DK, Lutfor AB, Razzaque MS. Vitamin D and the host-gut microbiome: A brief overview. Acta Histochem Cytochem. 2020;53(3):33-42. doi: 10.1267/ahc.20011, PMID 32624628
9. Bouillon R, Okamura WH, Norman AW. Structure-function relationships in the vitamin D endocrine system. Endocr Rev. 1995;16(2):200-57. doi: 10.1210/edrv-16-2-200, PMID 7781594
10. Cantorna MT, Snyder LM, Arora J. Vitamin A and vitamin D regulate the microbial complexity, barrier function, and the mucosal immune responses to ensure intestinal homeostasis. Crit Rev Biochem Mol Biol. 2019;54(2):184-92. doi: 10.1080/10409238.2019.1611734, PMID 31084433
11. Balamurugan BS, Marimuthu MM, Sundaram VA, Saravanan B, Chandrababu P, Chopra H, et al. Micro nutrients as immunomodulators in the ageing population: A focus on inflammation and autoimmunity. Immun Ageing. 2024;21(1):88. doi: 10.1186/s12979-024-00492-7, PMID 39731136
12. Semba RD. Vitamin A and immunity to viral, bacterial and protozoan infections. Proc Nutr Soc. 1999;58(3):719-27. doi: 10.1017/ s0029665199000944, PMID 10604208
13. Mitra S, Paul S, Roy S, Sutradhar H, Bin Emran TB, Nainu F, et al. Exploring the immune-boosting functions of vitamins and minerals as nutritional food bioactive compounds: A comprehensive review. Molecules. 2022;27(2):555. doi: 10.3390/molecules27020555, PMID 35056870
14. Gholami H, Chmiel JA, Burton JP, Maleki Vareki SM. The role of microbiota-derived vitamins in immune homeostasis and enhancing cancer immunotherapy. Cancers (Basel). 2023;15(4):1300. doi: 10.3390/cancers15041300, PMID 36831641
15. Arshad S, Zaidi SJ. Vitamin D levels among children, adolescents, adults, and elders in Pakistani population: A cross-sectional study. BMC Public Health. 2022;22(1):2040. doi: 10.1186/s12889-022-14526-6, PMID 36348325
16. Rudolf-Oliveira RC, Gonçalves KT, Martignago ML, Mengatto V, Gaspar PC, Moraes AC, et al. Determination of lymphocyte subset reference ranges in peripheral blood of healthy adults by a dual-platform flow cytometry method. Immunol Lett. 2014 Nov 30;163(1):96-101. doi: 10.1016/j.imlet.2014.11.003, PMID 25450652
17. Zosky GR, Berry LJ, Elliot JG, James AL, Gorman S, Hart PH. Vitamin D deficiency causes deficits in lung function and alters lung structure. Am J Respir Crit Care Med. 2011;183(10):1336-43. doi: 10.1164/ rccm.201010-1596oc, PMID 21297070
18. Chojnacki M, Lemieszek MK. Role of vitamin D3 in selected pulmonary diseases with particular emphasis on lung fibrosis. Ann Agric Environ Med. 2023;30(1):31-44. doi: 10.26444/aaem/161583, PMID 36999853
19. Carlberg C, Seuter S, De Mello VD, Schwab U, Voutilainen S, Pulkki K, et al. Primary vitamin D target genes allow a categorization of possible benefits of vitamin D3 supplementation. PLOS One. 2013;8(7):e71042. doi: 10.1371/journal.pone.0071042, PMID 23923049
20. Fuentes-Alonso M, Jiménez-García R, López-De‐Andrés A, Zamorano- León JJ, Carabantes-Alarcón D, Jiménez-Trujillo I, et al. Time trends (2012-2020), sex differences and predictors for influenza vaccination uptake among individuals with chronic obstructive pulmonary disease in Spain. J Clin Med. 2022;11(5):1423. doi: 10.3390/jcm11051423, PMID 35268514
21. Rahérison C, Ouaalaya EH, Bernady A, Casteigt J, Nocent-Eijnani C, Falque L, et al. Comorbidities and COPD severity in a clinic-based cohort. BMC Pulm Med. 2018;18(1):117. doi: 10.1186/s12890-018- 0684-7, PMID 30012144
22. Magro R, Saliba C, Camilleri L, Scerri C, Borg AA. Vitamin D supplementation in systemic lupus erythematosus: Relationship to disease activity, fatigue and the interferon signature gene expression. BMC Rheumatol. 2021;5(1):53. doi: 10.1186/s41927-021-00223-1, PMID 34857051
23. Fermont JM, Masconi KL, Jensen MT, Ferrari R, Di Lorenzo VA, Marott JM, et al. Biomarkers and clinical outcomes in COPD: A systematic review and meta-analysis. Thorax. 2019;74(5):439-46. doi: 10.1136/thoraxjnl-2018-211855, PMID 30617161
24. Marengoni A, Vetrano DL, Manes-Gravina E, Bernabei R, Onder G, Palmer K. The relationship between COPD and frailty: A systematic review and meta-analysis of observational studies. Chest. 2018;154(1):21-40. doi: 10.1016/j.chest.2018.02.014, PMID 29477493
25. Goldring S, Warner JO, Shaheen SO, Boyle R. Early life vitamin D status and lung development. Curr Respir Med Rev. 2011;7(6):396-403. doi: 10.2174/157339811798072603
26. Gaudet M, Plesa M, Mogas A, Jalaleddine N, Hamid Q, Al Heialy SA. Recent advances in vitamin D implications in chronic respiratory diseases. Respir Res. 2022;23(1):252. doi: 10.1186/s12931- 022-02147-x, PMID 36117182
27. Kayongo A, Robertson NM, Siddharthan T, Ntayi ML, Ndawula JC, Sande OJ, et al. Airway microbiome-immune crosstalk in chronic obstructive pulmonary disease. Front Immunol. 2023;13:1085551. doi: 10.3389/fimmu.2022.1085551, PMID 36741369
28. Ji Z, Jareño-Esteban JJ, De Miguel-Díez J. Role of vaccines in COPD patients. Open Respir Arch. 2022;4(3):100191. doi: 10.1016/j. opresp.2022.100191, PMID 37496587
29. Fekete M, Pákó J, Nemeth AN, Tarantini S, Varga JT. Prevalenceof influenza and pneumococcal vaccination in chronic obstructive pulmonary disease patients in association with the occurrence of acute exacerbations. J Thorac Dis. 2020;12(8):4233-42. doi: 10.21037/jtd- 20-814, PMID 32944335
30. Ehteshami-Afshar S, Crothers K, Rodwin BA, Bade BC, Brandt C, Akgün KM. Does pulmonary subspecialty referral from primary care affect the adherence to vaccination recommendations in COPD patients? Respir Res. 2021;22(1):50. doi: 10.1186/s12931-021- 01639-6, PMID 33579277
31. Tashkin DP, Wechsler ME. Role of eosinophils in airway inflammation of chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis. 2018;13:335-49. doi: 10.2147/copd.s152291, PMID 29403271
32. Bean J, Kuri-Cervantes L, Pennella M, Betts MR, Meyer NJ, Hassan WM. Multivariate indicators of disease severity in COVID-19. Sci Rep. 2023;13(1):5145. doi: 10.1038/s41598-023-31683-9, PMID 36991002
33. Serrano-Villar S, Wu K, Hunt PW, Lok JJ, Ron R, Sainz T, et al. Predictive value of CD8+ T cell and CD4/CD8 ratio at two years of successful ART in the risk of AIDS and non-AIDS events. EBiomedicine. 2022;80:104072. doi: 10.1016/j.ebiom.2022.104072, PMID 35644125
34. Trickey A, May MT, Schommers P, Tate J, Ingle SM, Guest JL, et al. CD4:CD8 ratio and CD8 count as prognostic markers for mortality in human immunodeficiency virus-infected patients on antiretroviral therapy. Clin Infect Dis. 2017;65(6):959-66. doi: 10.1093/cid/cix466, PMID 28903507
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