Vitamin D-Binding Protein and the Free Hormone Hypothesis for Vitamin D in Bio-Naive Patients with Psoriasis

High levels of vitamin D-binding protein (DBP) have been reported in patients with psoriasis and the possibility of DBP as a marker of inflammation has been discussed. Furthermore, high DBP levels might negatively affect free 25(OH)D concentrations. According to the free hormone hypothesis, only the free fraction of a steroid hormone is capable of exerting biological action. Thus, free 25(OH)D level could be a better biomarker of vitamin D status than total 25(OH)D level. The objectives of this study were to identify the strongest determinants for DBP levels and to test the free hormone hypothesis for vitamin D in psoriasis. Additionally, we also aimed to investigate correlations between directly measured free 25(OH)D levels in serum and psoriasis disease severity compared to total 25(OH)D levels. This was a retrospective cross-sectional study including 40 bio-naive patients with mild to severe plaque psoriasis. Psoriasis disease severity was evaluated using high sensitivity C-reactive protein (hsCRP), Psoriasis Area Severity Index (PASI) and visual analogue scale (VAS). Vitamin D metabolites including directly measured free 25(OH)D and serum DBP levels were measured. DBP levels were higher in patients with self-reported arthropathy than those without irrespective of confounding factors like sex, age and body weight. Total and free 25(OH)D levels correlated well (rho = 0.77, p < 0.0001) and both were inversely correlated to intact parathyroid hormone (iPTH) (rho = -0.33, p = 0.038 for total 25(OH)D and rho = -0.40, p = 0.010 for free 25(OH)D). Only total 25(OH)D correlated to serum calcium levels (rho = 0.32, p = 0.047). No correlations between any of the vitamin D metabolites and psoriasis disease severity were observed. In conclusion, DBP might be a new inflammatory biomarker in psoriasis, especially in psoriatic arthritis. Total 25(OH)D was a reliable measure for vitamin D status in this psoriasis cohort. However, evaluation of free 25(OH)D in patients with psoriatic disease and multiple co-morbidities and/or ongoing biologic treatment should be considered.

Automated summary

In patients with psoriasis, high levels of vitamin D-binding protein (DBP) may serve as a new inflammatory biomarker. Total 25(OH)D is a reliable measure for vitamin D status in psoriasis patients, but evaluation of free 25(OH)D levels should be considered in patients with multiple co-morbidities and/or undergoing biologic treatment.