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Translational studies in critical care
S75 High Dose Vitamin D Supplementation Improves Extravascular Lung Water Index and In-Vivo Treg and LL37 Responses Post-Oesophagectomy
  1. RCA Dancer1,
  2. D Parekh1,
  3. AR Martineau2,
  4. GD Perkins3,
  5. DR Thickett1
  1. 1University of Birmingham, Birmingham, UK
  2. 2Bartsthe London School of Medicine and Dentistry, London, UK
  3. 3Warwick Medical School, Coventry, UK

Abstract

Acute Lung Injury occurs in around 25% of patients post 2 stage oesophagectomy. We have previously shown that levels of 25-OH vitamin D are low in these patients and that those patients with the lowest levels of vitamin D are more likely to develop Acute Lung Injury post-operatively. In vitro, vitamin D has been shown to promote the differentiation of regulatory T cells (Treg) and the expression of LL37 (cathelicidin), an antimicrobial peptide.

We have given 13 patients a one-off high dose vitamin D supplement 3–14 days prior to oesophagectomy. Numbers of circulating regulatory T cells were analysed both pre- and post-supplementation. Plasma levels of LL37 were measured by ELISA. Extravascular Lung Water Index (EVLWi) was measured pre-operatively, post-operatively and on the day following surgery. Changes in LL37 and EVLWi were compared with results from a cohort of patients (n=50) who had not been supplemented.

Pre-operative vitamin D levels between the two groups were significantly different. The proportion of CD3+CD4+ T cells which were CD25+CD127loFoxP3+ increased post vitamin D supplementation (median pre vitamin D=5.8, median post vitamin D=7.3, p=0.028). Whilst levels of LL37 decreased post-operatively in the cohort who had not received vitamin D, levels were maintained in supplemented patients. Post-operative EVLWi measured lower than pre-operative values in patients receiving vitamin D supplementation. This contrasts with patients who did not receive vitamin D supplementation in whom an increase in EVLWi was seen. This difference persists on post-operative day 1, with a net increase being seen in patients who did not receive vitamin D and a net decrease in those who did (see table).

Conclusions A stat high dose vitamin D supplement restored vitamin D levels in the week before oesophagectomy. This was associated with elevated circulating Treg levels in vivo and an increase in post-operative plasma LL37 expression suggesting the vitamin D supplementation was biologically active.

Patients receiving vitamin D had no perioperative increase in extravascular lung water compared to our historical cohort suggesting that vitamin D protects against alveolar epithelial damage perhaps in part due to effects on circulating Treg cells and anti-microbial peptide production.

Abstract S75 Table 1

Effects of Vitamin D supplementation on median values of Vitamin D, EVLWi and LL37

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