Vitamin D could be used to treat ABPA in Cystic Fibrosis?

Submitted by Aspergillus Administrator on 17 August 2010

A research paper due to be published in September 2010 reports the observation that some patients who have Cystic Fibrosis (CF) are prone to becoming infected with Aspergillus fumigatus and then developing Allergic Bronchopulmonary Aspergillosis (ABPA – Wiki) while others are infected but do not go on to develop ABPA.

Entitled ‘Vitamin D3 attenuates Th2 responses to Aspergillus fumigatus mounted by CD4+ T cells from cystic fibrosis patients with allergic bronchopulmonary aspergillosis‘ the research focusses on finding differences between these two types of CF patient and one of the differences noted was the lower concentration of vitamin D in the blood of patients who suffered from ABPA. In other words most patients who had ABPA also had lower levels of vitamin D.
This observation leads to an obvious next step – what happens if you increase the blood levels of vitamin D in those patients? More specifically what happens to their ABPA? That question is now open, hopefully the subject of a clinical trial and we will know the answer in due course however we have had a hint at the answer in the next part of this paper.

Some of the major symptoms of ABPA are essentially the result of an over-response to the presence of Aspergillus by part of the immune system known as Th2 – part of the inflammatory response pathway that caused inflammation when we injure ourselves of become infected.
The group carrying out this research have set up a laboratory ‘model system’ whereby cells from each type of patient were isolated and grown in culture. They can then be stimulated to induce the Th2 ‘inflammatory’ signalling pathway and their response noted. The result was that those cells taken from patients with ABPA responded by initiating inflammation whereas those taken from non-ABPA patients did not respond. Intriguingly we now have a result that parallels the clinical observation that cells in the airways of ABPA-CF patients respond to stimulation by Aspergillus by becoming inflamed whereas the non-ABPA-CF patients cells do not repond.

What happens if you add in vitamin D to each culture in the laboratory? Now cells from both types of patients do not respond with signals that would initiate inflammation – the abnormal inflammatory respond has been prevented. This is encouraging and suggests that vitamin D might be a good supplement to the diet of  CF sufferers to prevent them developing ABPA, though as this is a conclusion based on a single laboratory experiment rather than on real people we cannot be sure.

Needless to say supplementation of the diet of ABPA patients would be a very cheap and thus eminently do-able, especially as vitamin D has few notable side effects when taken in moderation. Success cannot be guaranteed however as it is very simplistic to suggest that all ABPA sufferers (CF and non-CF) have low vitamin D levels in their blood and to assume that the reason for that is dietary deficiency, but it might be worth patients self-checking their diets for foods rich in vitamin D.
Foods rich in vitamin D are oily fish, liver, cod liver oil and dairy products and of course sunshine is an important source.