Abstract
Background: Vitamin D has been extensively studied for its role in immune modulation, especially in the process of tolerance induction. The loss of tolerance towards self-antigens is the basis of several autoimmune disorders; this seems to be related to lower levels of Vitamin D. A neurological autoimmune disorder due to the loss of tolerance to compounds at the neuromuscular junction is known as Myasthenia Gravis (MG).
Objective: To assess the possible correlation between altered Vitamin D levels and MG.
Methods: In this systematic review, all recruited studies compared Vitamin D levels in MG patients and healthy controls. Five studies fulfilled the selection criteria and were included in the quantitative synthesis. The meta-analysis involved data of a total population size of 450 individuals, equally divided into 219 cases and 231 controls.
Results: The results showed a statistically significant mean difference between cases and controls. The overall mean Vitamin D levels in MG patients were 4.69 ng/ml lower than control levels (95% CI -6.17; -3.22); by applying a random-effects model, this mean difference was estimated at -3.79 (95% CI -7.24; -0.33), after exclusion of data source of heterogeneity and through applying a fixed-effect model, resulted in a mean difference -5.39 (95% CI -6.91; -3.88). The p-value was lower than 0.05.
Conclusion: There are statistically significant lower levels of Vitamin D in MG patients, so routine checking and possible correction should be advised in MG patients based on the current data.
Keywords: Myasthenia Gravis, Autoimmunity, Tolerance, Vitamin D, cholecalciferol, 25-hydroxy-cholecalciferol.
Graphical Abstract
[http://dx.doi.org/10.25122/jml-2020-0145] [PMID: 33767779]
[http://dx.doi.org/10.3390/jcm10112235] [PMID: 34064035]
[http://dx.doi.org/10.1056/NEJMra1602678] [PMID: 28029925]
[http://dx.doi.org/10.1007/s10072-021-05077-6] [PMID: 33543421]
[http://dx.doi.org/10.1016/j.neuropharm.2020.108303] [PMID: 32918950]
[http://dx.doi.org/10.3389/fneur.2021.618021] [PMID: 34194378]
[http://dx.doi.org/10.3389/fneur.2020.00634] [PMID: 32765397]
[http://dx.doi.org/10.3390/nu12051248] [PMID: 32353972]
[http://dx.doi.org/10.3390/biom11111624] [PMID: 34827621]
[http://dx.doi.org/10.3390/nu12072097] [PMID: 32679784]
[http://dx.doi.org/10.1182/blood-2002-11-3521] [PMID: 12855575]
[http://dx.doi.org/10.1096/fj.201601243R] [PMID: 28363955]
[http://dx.doi.org/10.1111/php.13432] [PMID: 33866582]
[http://dx.doi.org/10.1111/j.1468-1331.2012.03773.x] [PMID: 22672742]
[http://dx.doi.org/10.1007/s00198-017-4041-0] [PMID: 28439619]
[http://dx.doi.org/10.1016/j.jocn.2018.01.047] [PMID: 29396067]
[http://dx.doi.org/10.1007/s13760-015-0512-2] [PMID: 26183131]
[http://dx.doi.org/10.1001/jama.283.15.2008] [PMID: 10789670]
[http://dx.doi.org/10.1136/bmj.g7647] [PMID: 25555855]
[http://dx.doi.org/10.1186/1471-2288-14-135] [PMID: 25524443]
[http://dx.doi.org/10.1016/j.braindev.2020.09.011] [PMID: 33139126]
[http://dx.doi.org/10.1016/S8756-3282(98)00185-9] [PMID: 10071922]
[http://dx.doi.org/10.1080/10408398.2019.1611538] [PMID: 31107101]
[http://dx.doi.org/10.1016/j.bcp.2019.07.024] [PMID: 31377232]
[http://dx.doi.org/10.1056/NEJM198205133061903] [PMID: 6280047]
[http://dx.doi.org/10.1016/S8756-3282(98)00134-3] [PMID: 9855465]
[http://dx.doi.org/10.1093/qjmed/hct208] [PMID: 24131546]
[http://dx.doi.org/10.12659/AJCR.894849] [PMID: 26822380]
[http://dx.doi.org/10.36502/2020/ASJBCCR.6208]
[http://dx.doi.org/10.1088/1742-6596/1246/1/012032]
[http://dx.doi.org/10.1034/j.1600-0404.2001.103005320.x] [PMID: 11328209]
[http://dx.doi.org/10.1111/cen.13537] [PMID: 29266368]