Human plasma transport of vitamin D after its endogenous synthesis.
ABSTRACT Transport of vitamin D3 from its sites of cutaneous synthesis into the circulation has been assumed to be via the plasma vitamin D binding protein (DBP). We studied vitamin D transport from the skin in seven healthy volunteers who received whole body irradiation with 27 mJ/cm2 dosage of ultraviolet B light (290-320 nm). Samples of venous blood were collected serially in EDTA and immediately chilled. In KBr, plasma samples were ultracentrifuged to provide a rapid separation of proteins of density < and > 1.3 g/ml. Upper and lower phases and serial fractions were analyzed for vitamin D3 (extraction, HPLC), cholesterol (enzyme assay), and human DBP (hDBP) (radial immunodiffusion). Total plasma vitamin D (basal level < 1 ng/ml) increased by 10 h and peaked at 24 h (9 +/- 1 ng/ml). 98% of the D3 remained at the density > 1.3 layers for up to 7 d, whereas cholesterol (> 85%) was detected at density < 1.3 and all of the hDBP was at density > 1.3. In three volunteers who each ingested 1.25 mg of vitamin D2, the total plasma D2 increased to 90 +/- 32 ng/ml by 4 h, and the D2 was evenly distributed between the upper and lower layers at 4, 8, and 24 h after the dose, indicating a continuing association of the vitamin with chylomicrons and lipoproteins, as well as with hDBP. Actin affinity chromatography removed D3 from plasma of irradiated subjects, indicating the association of the D3 with DBP. These findings indicate that endogenously synthesized vitamin D3 travels in plasma almost exclusively on DBP, providing for a slower hepatic delivery of the vitamin D and the more sustained increase in plasma 25-hydroxycholecalciferol observed after depot, parenteral administration of vitamin D. In contrast, the association of orally administered vitamin D with chylomicrons and lipoproteins allows for receptor-mediated, rapid hepatic delivery of vitamin D, and the reported rapid but less-sustained increases in plasma 25-hydroxycholecalciferol.
- SourceAvailable from: Etienne Cavalier[Show abstract] [Hide abstract]
ABSTRACT: The constantly increasing requests for the measurement of serum 25-hydroxyvitamin D over the last years has led reagent manufacturers to market different automated and semi-automated methods, that being unfortunately not fully harmonized, yield different results. Liquid chromatography coupled to tandem mass spectrometry has more recently been introduced. This approach allows the distinction between the two forms of 25-hydroxyvitamin D and to measure other metabolites. This approach also requires harmonization to curtail the differences between the different analytical methods. To meet this requirement, the American national institutes of health (NIH), the CDC (Center for disease control and prevention) in Atlanta, the NIST (National institute of standards and technology) and the vitamin D Reference laboratory of Ghent University have pooled their expertise to develop a standardization program. This article reviews the main elements and the difficulties of the automated and semi-automated methods for 25-hydroxyvitamin D, from sample preparation to the analytical phase, as well as those related to mass spectrometry. It also addresses the issues related to the clinical decision thresholds and the possibility of measurements in different biological liquids.Annales de biologie clinique 02/2015; 73(1):79-92. · 0.42 Impact Factor
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ABSTRACT: To ascertain the protective role of calcitriol in the development of diabetic nephropathy and unravel the mechanism of the protective effects. In this prospective study, 69 patients were screened for type 1 diabetes, and 31 patients with type 1 diabetes were enrolled. Among these 31 patients, 24 patients had insufficient or deficient levels of serum vitamin D and 21 patients complied with calcitriol and were followed up. At baseline, these 21 patients who suffered from vitamin D deficiency or insufficiency displayed elevated inflammation markers and urinary albumin excretion in contrast with patients with sufficient vitamin D. Simultaneously, serum 25(OH)D3 level was negatively associated with serum and urinary inflammation markers, such as TNF-α, IL-6, and ICAM-1. Six months later, even though glycol-metabolism was not alleviated, all the serum and urinary inflammation markers decreased significantly. Meanwhile, proteinuria declined with inflammation markers. Calcitriol supplementation alleviated inflammation and proteinuria in patients with type 1 diabetes. Calcitriol might delay the development of diabetic nephropathy through suppressing inflammation.International Journal of Clinical and Experimental Medicine 01/2014; 7(12):5437-44. · 1.42 Impact Factor
Human Plasma Transport of Vitamin D after Its Endogenous Synthesis
John G. Haddad,* Lois Y. Matsuoka,t Bruce W. Hollis, Yuan Z. Hu,* and Jacobo Wortsman11
*Department ofMedicine, University ofPennsylvania, Philadelphia, Pennsylvania 19104; *Department ofDermatology,
Jefferson Medical College, Philadelphia, Pennsylvania 19107; ODepartment ofPediatrics, Medical College ofSouth Carolina,
Charleston, South Carolina 29425; and IlDepartment ofMedicine, Southern Illinois University, Springfield, Illinois 62794
Transport of vitamin D3 from its sites of cutaneous synthesis
into the circulation has been assumed to be via the plasma
vitamin D binding protein (DBP). We studied vitamin D trans-
port from the skin in seven healthy volunteers who received
whole body irradiation with 27 mJ/cm2 dosage of ultraviolet B
light (290-320 nm). Samples of venous blood were collected
serially inEDTA and immediately chilled. In KBr, plasma sam-
ples were ultracentrifuged to provide a rapid separation ofpro-
teins ofdensity < and > 1.3 g/ml. Upper and lower phases and
serial fractions were analyzed for vitamin D3 (extraction,
cholesterol (enzyme assay), and human DBP
(hDBP) (radial immunodiffusion). Total plasma vitamin D
(basal level < 1 ng/ml) increased by 10 h and peaked at 24 h
(9 ± 1 ng/ml). 98% of the D3 remained at the density > 1.3
layers for up to 7 d, whereas cholesterol (> 85%) was detected
at density < 1.3 and all of the hDBP was at density > 1.3. In
three volunteers who each ingested 1.25 mg of vitamin D2, the
total plasma D2 increased to 90 ± 32 ng/ml by 4 h, and the D2
was evenly distributed between the upper and lower layers at 4,
8, and 24 h after the dose, indicating a continuing association of
the vitamin with chylomicrons and lipoproteins, as well as with
hDBP. Actin affinity chromatography removed D3from plasma
of irradiated subjects, indicating the association ofthe D3 with
DBP. These findings indicate that endogenously synthesized
vitamin D3 travels in plasma almost exclusively on DBP, pro-
viding for a slower hepatic delivery of the vitamin D and the
more sustained increase in plasma 25-hydroxycholecalciferol
observed after depot, parenteral administration ofvitamin D. In
contrast, the association of orally administered vitamin D with
chylomicrons and lipoproteins allows for receptor-mediated,
rapid hepatic delivery of vitamin D, and the reported rapid but
less-sustained increases in plasma 25-hydroxycalciferol. (J.
Clin. Invest. 1993. 91:2552-2555.) Key words: vitamin D-
transport * skin * plasma proteins
Portions ofthis work were presented at the 14th Annual Meeting ofthe
American Society for Bone and Mineral Research, Minneapolis, MN,
1 October 1992 (J. Bone Miner. Res. 7[Suppl. 1]:S158).
Address reprint requests to Dr. John G. Haddad, Department of
Medicine, University ofPennsylvania, School ofMedicine, 422 Curie
Blvd., 611 CRB, Philadelphia, PA 19104-6149.
Receivedfor publication 9 November 1992 and in revisedform 21
Vitamin D is a precursor ofa renal steroid hormone, 1,25-dihy-
droxyvitamin D (1). This precursor, however, cannot be pro-
vided by enzymatic synthesis. Its supply depends on ultraviolet
(UV) irradiation ofthe skin or absorption from the diet. Since
few natural foodstuffs contain much vitamin D (2), observers
consider the endogenous, cutaneous production of chole-
calciferol to be the physiological mechanism of precursor
sis vs. diet-derived supply ofvitamin D (2, 6). A more efficient
and sustained supply ofvitamin D is associated with UV irra-
diation of the skin or parenteral administration of vitamin D
(2, 6). In contrast, oral vitamin D consumption leads to rapid
but less sustained availability ofsterol and a similar pattern of
increase in the hepatic metabolite, 25-hydroxycholecalciferol
Many studies have addressed the mode ofvitamin D trans-
port after oral consumption (6), but no direct studies of the
plasma transport of cutaneously-derived vitamin D are re-
ported. It has been assumed that vitamin D synthesized in skin
enters the blood stream on the plasma binding protein for vita-
min D and its metabolites(DBP)' and thisassumption isbased
on in vitro studies ofthe relative potency ofvitamin D in bind-
ing to DBP as compared with 7-dehydroxycholesterol, lumis-
terol, tachysterols3 and pre-D3 (10-12). However, other
plasma carriers are recognized and some facilitate hepatic ( 13-
15) and hepatocyte (16) entry of vitamin D, presumably via
their receptors on hepatocyte plasma membranes. Our study
addresses the nature of plasma vitamin D transport after UV
irradiation ofhuman volunteers.
Materials. KBr was purchased from Aldrich Chemical Co. (Milwau-
kee, WI). Affigel-15 resin was bought from Bio-Rad Laboratories
(Richmond, CA). Crystalline vitamins D3 and D2 and a cholesterol
enzyme assay kit for cholesterol were purchased from Sigma Chemical
Co. (St. Louis, MO).
Volunteers. The volunteer population was composed of 10 healthy
subjects (3 women, 7 men, ages 22-54 y) who had no history ofskin,
hepatic, or renal disease. None were taking vitamin D, anticonvulsants,
or glucocorticosteroids, and all subjects gave their informed consent to
the institutional review boards at the University of Pennsylvania
School of Medicine or the Jefferson Medical College.
Cutaneous irradiation. Seven subjects were exposed to 27 mJ/cm2
of UV-B light (290-320 mm). Venous blood samples were taken at
baseline, 10, 24, 72, and 168 h after the UV-B exposure, immediately
1. Abbreviation used in this paper: DBP, vitamin D binding protein.
J. G. Haddad, L. Y. Matsuoka, B. W Hollis, Y. Z. Hu, and J. Wortsman
J. Clin. Invest.
@The American Society for Clinical Investigation, Inc.
Volume 91, June 1993, 2552-2555
transferred to tubes containing 0.2% (wt/vol) EDTA, and placed on
ice. Irradiation experiments were done in January 1992.
Oral dosage. Three fasting subjects each swallowed a commercial
50,000 IU (1.25 mg) capsule ofergocalciferol, followed by 240 ml of
distilled water. Venous blood samples were obtained at baseline, 4, 8,
48 h after the oral dose. Blood was immediately transferred to tubes
containing EDTA and placed on ice.
Samplepreparation. Blood from volunteers was centrifuged within
1 h ofcollection in a refrigerated centrifuge. Plasma aliquots for total
plasma vitamin D analysis were stored at -20'C. To carry out a rapid
separation ofplasma proteins ofdensity less than and greater than 1.3
g/ml, the method of Chung et al. was used (17). In brief, unfrozen
plasma aliquots ( 1.5 ml) were dispensed into tubes containing pre-
weighed KBr (513 mg). After mixing, plasma was added to 3.5 ml of
0.15 M NaCI in ultracentrifuge tubes before heat sealing. Tubes were
centrifuged at 10'C in a Ti 65.2 vertical rotor at 65,000 rpm in an
ultracentrifuge (model L8M; Beckman Instruments, Inc., Fullerton,
CA) for 45 min. Fractions were collected via bottom punctures, per-
mitting the isolation ofthe lower (30% ofvolume, density> 1.3 g/ml)
and upper (70% ofvolume, density < 1.3 g/ml) phases.
Analyses. Quantitation of vitamins D3 and D2 was carried out as
previously reported ( 18). In brief, organic solvent extracts were applied
to HPLCcolumns and the vitamin D fractions were quantitated byUV
absorption spectrometry at 264 nm.
Cholesterol oxidase reagents were used to quantitate total choles-
terol in ultracentrifuge fractions by visible spectrometry (Sigma kit).
DBPwasquantitated in a radial immunodiffusion assay as reported
earlier ( 19).
In pilot experiments to assess the validity and reproducibility of
the plasma density separations in our laboratory, we analyzed
total plasma content, as well as density less than and greater
than 1.3 g/ml forDBP and cholesterol. For 16 separate human
plasma samples, most oftheDBP(89+2. 1%, SEM)and choles-
terol (94+2.3%, SEM) in plasma was recovered in the density
gradient fractions. Table I displays the upper and lower phase
distribution of the substances after centrifugation. Fig.
picts the distribution of DBP and cholesterol in continuous
ultracentrifuge fractions offasting human plasma. The DBP is
contained in the lower third ofthe gradient, whereas the choles-
terol profile reflects its association with several carriers, includ-
ing some binding to high-density lipoproteins and density
> 1.3 g/ml molecules ( 18).
At baseline, total plasma cholecalciferol levels were < 2
mg/ml or undetectable (Fig. 2 A). After irradiation, the total
Table L Distribution ofCholesterol and hDBP
in Ultracentrifuged Plasma
Density > 1.30
Data are expressed as mean±SEM foreight plasma samples in each
hDBP, human plasma proteinfor vitamin D and its metabolites.
9 1011 1213 1415 1617 181920
Figure 1. The distribu-
tion ofplasma choles-
terol (o) and DBP (+)
in ultracentrifuge den-
sity gradient fractions.
plasma cholecalciferol levels increased by 10 h, peaked at 24 h,
and decreased by 3 and 7 d.
Fig. 2 B depicts the distribution ofcholecalciferol in plasma
before and after cutaneous irradiation. As shown, almost all of
the baseline and postirradiation plasma cholecalciferol was as-
sociated with the fractions ofdensity > 1.3 g/ml fractions.
After the oral dosage of vitamin D2, large increases in
plasma vitamin D2 were observed (Fig. 3 A). Baseline plasma
D2 levels were undetectable in two subjects and
plasma in the other subject. In contrast to the cutaneous irra-
diation supply of vitamin D3, the plasma vitamin D2 levels
declined briskly toward baseline by 2 d.
The distribution of orally administered vitamin D2 in
plasma was very different from that observed after cutaneous
production of vitamin D3. As shown in Fig. 3 B, 41% of the
plasma D2 was found in the fractions ofdensity < 1.3 g/ml at 4
h after the dose. This distribution in the lower density fractions
decreased slightly by 8 and 24 h. After this large dose, it is clear
that the vitamin is associated with low- and high-density car-
When plasma from UV light-treated subjects (24-h sam-
ples) was subjected to actin affinity chromatography to remove
DBP (20), all ofthe vitamin D was removed from these plas-
mas, indicating that the vitamin D was bound to DBP.
Our results indicate that high density or nonlipoprotein car-
riers are responsible for the blood transport ofrecently synthe-
sized, endogenous vitamin D3. Since the vitamin D3 was re-
moved from these plasmas by actin affinity chromatography,
the cutaneously produced vitamin D3 was bound to DBP as
previously assumed ( 10-12). Our data conform to the recog-
nized, gradual egress ofcutaneously synthesized vitamin D3 (2,
6, 21, 22), and underscore the differences between the cutane-
ous and dietary sources of the vitamin (2).
Diet-derived vitamin D requires the components of lipid
absorption, as indicated by the association ofabsorbed vitamin
D with chylomicron carriers in chyle (23). When absorbed
vitamin D reaches the subclavian vein, some of it is presented
to the liver on the chylomicron remnants via specific receptor-
mediated uptake and some redistributes to other plasma car-
riers such as DBP, lipoproteins, and albumin (6, 13, 24-26).
Since DBP is presentin lymphand chyle,some ofthe absorbed
vitamin D redistributes to DBP during chyle transport (26,
27). The hepatic ingress of vitamin D is modulated by its
plasma carriers, and experiments with liver perfusions ( 14, 15)
Plasma Binding ofVitamin DafterItsSynthesisin Skin
HOURS AFTER UV LIGHT EXPOSURE
HOURS AFTER UV LIGHT EXPOSURE
Figure 2. (A) Total plasma vitamin D3 concentrations before and
after whole body UV-B light irradiation of seven subjects. Mean val-
ues and SEM are shown. Vitamin D2 was not detected (<
in any of the samples. (B) The distribution of vitamin D3 in density
gradient fractions ofplasma obtained before and after UV irradiation.
Vertical bars depict the SEM.
and hepatocytes ( 16) indicate that carriers with liver mem-
brane receptors (chylomicron remnants, LDL) greatly facili-
tate hepatic vitamin D uptake. In contrast, albumin and HDL
are less facilitative, and vitamin D bound to DBP is least apt to
enter the liver or hepatocytes ( 15, 16).
Many previous reports of vitamin D's disposition in vivo
are difficult to reconcile, and this is probably due to the various
modes of parenteral vitamin D administration, including or-
ganic solvents ( 15, 28), intralipid ( 13), plasma (29), and oily
depot injections (9). In addition, although DBP is the only
stereoselective plasma carrier of vitamin D, most of the other
lower affinity carriers are in high concentration in plasma.
When simply mixed with plasma directly, vitamin D does asso-
ciate, to some extent, with non-DBP carriers ( 15). It seems
likely, therefore, that administration of vitamin D intrave-
HOURS AFTER VITAMIN D2 ORAL DOSAGE
HOURS AFTER VITAMIN D2 ORAL DOSAGE
Figure 3. (A) Total plasma vitamin D2 concentrations after oral dos-
age to three volunteers. Mean values and SEM are shown. Basal con-
centrations were undetectable in two ofthe subjects. (B) The distri-
bution of vitamin D2 in density gradient fractions ofplasma obtained
before and after oral dosage of vitamin D2. Vertical bars depict the
nously in solvents (e.g., propylene glycol, ethanol) will result in
the vitamin's association with non-DBP carriers to some ex-
tent. Since non-DBP transport results in more rapid hepatic
uptake ofvitamin D ( 14, 15), the plasma kinetics ofadminis-
tered vitamin D and the subsequent appearance of 25(OH)D
in plasma are clearly affected by the modes ofplasma transport
and the prevailing stores of vitamin D (2, 6, 22).
Comparisons of the bioavailability of vitamin D adminis-
tered by various routes have been made. Whole body irradia-
tion with effective UV light has resulted in plasma 25(OH)D
levels comparable to those observed during oral consumption
of0.25 mg of vitamin D daily (30). Single, intravenous doses
of large amounts of vitamin D result in relatively rapid in-
creases of plasma 25(OH)D not unlike results seen after a
single, large, oral dose (9). It appears probable that these brisk
J. G. Haddad, L. Y. Matsuoka, B. W Hollis, Y. Z. Hu, and J. Wortsman
25(OH)D responses are due to the initial association of ad-
ministered vitaminDwith non-DBP carriers. Oilydepot (intra-
muscular or subcutaneous) injections oflarge doses ofvitamin
D result in a more gradual egress from depot sites and more grad-
ual increases and sustained plasma 25(OH)D levels (9, 31).
Since cutaneous production ofvitamin D3 results in a grad-
ual and more sustained plasma availability ofvitaminDand its
bioactive product, 25-hydroxyvitamin D, this source is physio-
logically attuned to the recognized, intense economy of vita-
min D stores (2, 6). Rapid hepatic delivery of vitamin D can
result in its waste with the appearance of inactive forms, in-
cluding water-soluble conjugates (2). Our present results
clearly indicate that DBP plays a central role in the physiologi-
cal economy ofcutaneously derived vitamin D3.
We are grateful to Dr. J. Strauss of the University of Pennsylvania
Reproductive Biology Division for helpful discussions and to Dr. M.
Kamoun and Dr. L. Kricka ofthe University ofPennsylvania, Depart-
ment of Pathology and Laboratory Medicine for helpful discussions,
loan ofequipment, and pilot analyses.
This work was supported in part by National Institutes of Health
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PlasmaBinding ofVitamin DafterItsSynthesisin Skin