Clara Crescioli* and Salvatore Minisola Pages 2671 - 2686 ( 16 )
Background: Vitamin D deficiency is considered a risk factor for autoimmune diseases. Vitamin D and its analogues have been proposed as therapeutic tools in autoimmunity considering their exquisite immunoregulatory effect against over-reactivity towards tolerance. Autoimmune diseases, nowadays recognized as emerging non communicable diseases, are characterized by a significant female bias. This sexual dimorphism seems related to sex hormones, which differently affect male and female immune systems. Males show higher immunosuppression, maybe due to androgens; the greater female immunoreactivity and competence, likely related to estrogens, lead to a greater resilience to infections but also to a higher risk for autoimmunity. Higher interest could be given to vitamin D-based supplementation or therapy for autoimmune diseases in relation to gender as well. <P></P> Objective: This review aims to discuss the role of vitamin D in autoimmune diseases with a view inside gender-related differences, in light of the interplay between vitamin D and sex hormones, especially estrogens. <P></P> Results: Some beneficial effects against autoimmune processes seem to be allowed by vitamin D acting in synergy with estrogens. This observation suggests that possible differences of vitamin D effects depend on the context in which this hormone is active. <P></P> Conclusion: Rather sex-related differences of “absolute” vitamin D levels, the role of gender- dependent factors affecting vitamin D action seems to be critical. Gender and sexual hormones could be included as variables when evaluating the potential power of vitamin D receptor agonists as novel pharmacological tools to approach autoimmune diseases.
Vitamin D, autoimmunity, sex hormones, gender, therapy, personalized medicine.
Department of Movement, Human and Health Sciences, Section of Health Sciences, Unit of Endocrinology, University of Rome “Foro Italico”, 00135 Rome, Department of Internal Medicine and Medical Disciplines, Sapienza University of Rome, Rome