Lower prevalence of vitamin D insufficiency in German patients with systemic mast cell activation syndrome compared with the general population

Stefan Wirz; Hans-Jörg Hertfelder; Holger Seidel; Jürgen Homann; Gerhard J. Molderings

doi:10.1055/s-0043-121346

Zeitschrift für Gastroenterologie, Table of Contents

Z Gastroenterol 2017; 55(12): 1297-1306
DOI: 10.1055/s-0043-121346

Originalarbeit

Lower prevalence of vitamin D insufficiency in German patients with systemic mast cell activation syndrome compared with the general population

Die Prävalenz eines Vitamin D-Mangels ist unter deutschen Patienten mit systemischem Mastzellaktivierungssyndrom niedriger als in der deutschen Allgemeinbevölkerung

Stefan Wirz

¹Abteilung für Anästhesie, Interdisziplinäre Intensivmedizin, Schmerzmedizin/Palliativmedizin – Zentrum für Schmerzmedizin, CURA – katholisches Krankenhaus im Siebengebirge, Bad Honnef, Germany

,

Hans-Jörg Hertfelder

²Institute of Exp. Haematology & Transfusion Medicine, University Hospital of Bonn, Bonn, Germany

,

Holger Seidel

³CBT – Centrum für Blutgerinnungsstörungen und Transfusionsmedizin, Bonn, Germany

,

Jürgen Homann

⁴Division of Internal Medicine, Department of Gastroenterology and Diabetology, Gemeinschaftskrankenhaus Bonn, Germany

,

Gerhard J. Molderings

⁵Institute of Human Genetics, University Hospital of Bonn, Germany

› Author Affiliations

Abstract

Introduction The common mastocytosis variant systemic mast cell activation syndrome (MCAS) may underlie at least a subset of patients with irritable bowel syndrome (IBS). A critical role of vitamin D (VD) in the stabilization of mast cells (MCs) with deficiency of VD resulting in MC activation has been demonstrated. If so, supplementation of VD would be a potential therapeutic approach in the treatment of those IBS patients.

Methods We investigated in the present study for the first time systematically whether the VD level in 100 MCAS patients differed from that in the German general population (Ggp) and made a first attempt to elucidate potential reasons for possible differences by simultaneously determining the blood levels of heparin and cholesterol.

Results In contrast to the Ggp, the VD level was detected in a sufficient range (> 30 ng/mL) in 53 % of the MCAS patients (Ggp 8 %), and only 34 % had values in the range of deficiency (< 20 ng/mL; GgP 75 %). There was no correlation between VD blood level and heparin and cholesterol blood levels.

Conclusions The demonstration that in the majority of MCAS patients the VD level is not in a deficient range argues against an essential contribution of VD deficiency to the high prevalence of MCAS in Germany. Our findings do not exclude the possibility of smaller effects of VD level on MC activation in vivo. However, if such effects are present, the effect sizes seem to be too small to become identifiable in the multifactorial process of disease development.

Zusammenfassung

Einleitung Die häufige Variante einer Mastozytose, das systemische Mastzellaktivierungssyndrom (MCAS) kann in einer Untergruppe von Patienten mit Reizdarmsyndrom (IBS) ursächlich für das IBS sein. Vitamin D (VD) stabilisierte in-vitro die Mastzellen (MCs), ein Mangel führte zu einer MC-Aktivierung. Würde dies auch in-vivo zutreffen, wäre die Zufuhr von VD ein potentieller therapeutischer Ansatz in der Behandlung dieser IBS Patienten.

Methoden In der vorliegenden Studie haben wir erstmals systematisch untersucht, ob sich der VD-Blutspiegel in 100 deutschen MCAS-Patienten von dem in der deutschen Gesamtbevölkerung unterschied. Gleichzeitig wurden die Blutspiegel von Heparin und Cholesterin bestimmt, um, theoretischen Überlegungen folgend, möglichen Gründe für etwaige Unterschiede zwischen den VD-Blutspiegeln auf die Spur zu kommen.

Ergebnisse Im Gegensatz zur deutschen Gesamtbevölkerung (Ggp) lag bei 53 % der MCAS-Patienten (Ggp 8 %) der VD-Spiegel in einem ausreichenden Bereich (> 30 ng/ml). Nur 34 % der MCAS-Patienten wiesen Werte im Mangelbereich auf (< 20 ng/ml; GgP 75 %). Es bestand keine Korrelation zwischen dem VD-Blutspiegel und den Heparin- und Cholesterinspiegeln im Blut.

Schlußfolgerung Der Nachweis, dass in der Mehrheit der MCAS-Patienten der VD-Spiegel nicht im Mangelbereich liegt, spricht gegen einen wesentlichen Beitrag eines VD-Mangels zur hohen Prävalenz von MCAS in Deutschland. Unsere Ergebnisse schließen die Möglichkeit von kleineren Auswirkungen des VD-Spiegels auf die MC-Aktivierung in-vivo nicht aus. Sollten solche Effekte bestehen, scheinen deren Größen zu klein zu sein, um im multifaktoriellen Prozess der Krankheitsentwicklung identifizierbar zu sein.

Key words

vitamin D - irritable bowel syndrome - systemic mast cell activation syndrome - heparin - cholesterol

Schlüsselwörter

Vitamin D - Reizdarmsyndrom - systemisches Mastzellaktivierungssyndrom - Heparin - Cholesterin

Full Text

References

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