Vitamin D supplements support therapy for multi-resistant tuberculosis

Tuberculosis (or TB) is one of most widespread diseases in the world. It claims millions of human lives every year, especially in underdeveloped countries. A team of scientists from Queen Mary University in London has discovered that vitamin D supplements can support therapies used in the treatment of multi-resistant TB, which can otherwise last quite a long time and comes at a considerable cost. Earlier studies have shown that vitamin D generally helps prevent the disease by supporting the immune system in different ways.

Tuberculosis (TB) is the infectious disease that claims most lives. It is caused by various strains of mycobacteria that attack the lungs in particular. TB is an airborne pathogen, and most infections are latent and do not cause any symptoms. However, in immunocompromised individuals, the disease may become active and result in classic symptoms such as persistent coughing with bloody sputum, fever, night sweats, and weight loss. TB is difficult to treat because the bacteria are able to survive for years inside the white blood cells.

Vitamin D as a new way of dealing with TB

Multi-resistant TB is caused by tuberculosis bacteria that are resistant to antibiotics, Isoniazid, and Rifampicin. Multi-resistant TB is a growing global problem that is increasingly difficult to treat. The prognosis is also much more serious than it is with regular TB. The Queen Mary University scientists conducted a meta-analysis of several studies, where 1,850 TB patients were treated with antibiotics in combination with vitamin D (in different doses). The results showed that the combination with vitamin D boosted the patients’ immune defense and helped it fight the TB bacteria, especially in the patients that were diagnosed with multi-resistant TB.
According to Professor Adrian Martineau, who headed the study, vitamin D shows a whole new potential as add-on therapy given with conventional antibiotics. Martineau also underlines that the treatment of antibiotics-resistant TB is an arms race that is very difficult to win.
The British meta-analysis adds to the growing pile of evidence of vitamin D’s health properties. The scientists have shown with earlier research that vitamin D can protect against colds, influenza, and asthma attacks. Their new study is published in European Respiratory Journal.

How vitamin D counteracts TB

The lungs harbor a large number of white blood cells called macrophages. Their job is to attack and destroy infectious germs that we breathe in. As mentioned earlier, TB bacteria are tough and can survive inside the macrophages, causing the disease to reside latently without symptoms and drag out. Scientists have demonstrated the mechanisms, by which vitamin D supports a process inside the cave-like vacuoles of the macrophages. The process is called autophagy (self-consuming) and causes TB bacteria and other germs to be destroyed. Autophagy is an immune-stimulating and self-cleansing process inside the macrophages that is needed in order for us humans to resist germs and to be able to ward off infections effectively.
The scientific discovery of vitamin D’s supportive role in autophagy is useful for improved prevention and treatment of TB. The autophagy of macrophages is part of our innate, non-specific immune defense. Vitamin D also plays a role in our adaptive, specific immune defense system that includes T cells, B cells, and antibodies.
For the record, the effect of taking vitamin D hinges on whether or not there is a vitamin D deficiency to begin with, if the dosage is sufficiently high, and how long the treatment lasts. Also, magnesium is needed to activate vitamin D. Therefore, having enough magnesium is necessary for the optimal effect.

The actual need for vitamin D

The RI (reference intake) level for vitamin D aims at preventing classic deficiency diseases like rickets. Many scientists claim that our actual need for vitamin D is much higher than the RI level. Recommendations vary from 30-100 micrograms daily, and it is this dosage interval that scientists often use in studies. It is easy to synthesize that amount of vitamin D with normal sun exposure during the summer (unless you have dark skin). Our diets only provide a limited amount of vitamin D, which means that most people need a vitamin D supplement during the winter period and in situations, where it is not possible for them to get the necessary amount of sun exposure.

References

David A Jolliffe et al. Adjunctive vitamin D in tuberculosis treatment: meta-analysis of individual participant data. European Respiratory Journal 2019

Queen Mary University of London. Vitamin D helps treat lethal drug-resistant TB. ScienceDaily. 2019

Grant R. Campbell et al. Autophagy induction by vitamin D inhibits both Mycobacterium tuberculosis and human immunodeficiency virus type 1. PLoS Pathog. 2012

Gerry K. Schwalfenberg and Stephen J. Genuis. The Importance of Magnesium in Clinical Healthcare. Scientifica (Carro) 2017

Pernille Lund. Immunforsvarets nye ABC. Forlaget Hovedland. 2012