Cholecalciferol Plus Calcium Suppresses Abnormal PBMC Reactivity in Patients with Multiple Sclerosis

Context: The active metabolite of vitamin D, 1,25-dihydroxyvitamin D [1,25(OH)(2)D], is a potent modulator of immune cells in vitro. Objective: Our objective was to determine whether the sun-dependent nutrient, cholecalciferol, can alter disease-associated cellular immune abnormalities in patients with multiple sclerosis (MS). Design: This was an open-label, 12-month, randomized controlled trial. Setting: Patients with MS were recruited from the MS Clinic at St. Michael's Hospital, Toronto. Patients: Forty-nine patients were matched(for age, sex, disease duration, disease-modifying drug, and disability) and enrolled (treated n = 25; control n = 24). Four patients were lost to follow-up (n = 2 from each group). Intervention: Treated patients received increasing doses of cholecalciferol (4,000-40,000 IU/d) plus calcium (1200 mg/d), followed by equilibration to a moderate, physiological intake (10,000 IU/d). Control patients did not receive supplements. Main Outcome Measures: At enrollment and at 12 months, peripheral blood mononuclear cell (PBMC) proliferative responses to disease-associated, MS-relevant, and control antigens were measured, along with selected serum biochemical markers. Results: At 12 months, mean serum 25-hydroxyvitamin D [25(OH)D] concentrations were 83 +/- 35 nmol/liter and 179 +/- 76 nmol/liter in control and treated participants, respectively (paired t, P < 0.001). Serum 1,25(OH)(2)D did not differ between baseline and 1 yr. In treated patients, 12-month PBMC proliferative responses to neuron antigens myelin basic protein and exon-2 were suppressed (P = 0.002). In controls, there were no significant changes in disease-associated PBMC responsiveness. There were no significant differences between groups in levels of selected biomarkers. Interpretation: MS-associated, abnormal T cell reactivities were suppressed in vivo by cholecalciferol at serum 25(OH) D concentrations higher than 100 nmol/liter. (J Clin Endocrinol Metab 96: 2826-2834, 2011)