PT  - JOURNAL ARTICLE
AU  - Dancer, Rachel C A
AU  - Parekh, Dhruv
AU  - Lax, Sian
AU  - D'Souza, Vijay
AU  - Zheng, Shengxing
AU  - Bassford, Chris R
AU  - Park, Daniel
AU  - Bartis, D G
AU  - Mahida, Rahul
AU  - Turner, Alice M
AU  - Sapey, Elizabeth
AU  - Wei, Wenbin
AU  - Naidu, Babu
AU  - Stewart, Paul M
AU  - Fraser, William D
AU  - Christopher, Kenneth B
AU  - Cooper, Mark S
AU  - Gao, Fang
AU  - Sansom, David M
AU  - Martineau, Adrian R
AU  - Perkins, Gavin D
AU  - Thickett, David R
TI  - Vitamin D deficiency contributes directly to the acute respiratory distress syndrome (ARDS)
AID  - 10.1136/thoraxjnl-2014-206680
DP  - 2015 Jul 01
TA  - Thorax
PG  - 617--624
VI  - 70
IP  - 7
4099  - http://thorax.bmj.com/content/70/7/617.short
4100  - http://thorax.bmj.com/content/70/7/617.full
SO  - Thorax2015 Jul 01; 70
AB  - Rationale Vitamin D deficiency has been implicated as a pathogenic factor in sepsis and intensive therapy unit mortality but has not been assessed as a risk factor for acute respiratory distress syndrome (ARDS). Causality of these associations has never been demonstrated.Objectives To determine if ARDS is associated with vitamin D deficiency in a clinical setting and to determine if vitamin D deficiency in experimental models of ARDS influences its severity.Methods Human, murine and in vitro primary alveolar epithelial cell work were included in this study.Findings Vitamin D deficiency (plasma 25(OH)D levels <50 nmol/L) was ubiquitous in patients with ARDS and present in the vast majority of patients at risk of developing ARDS following oesophagectomy. In a murine model of intratracheal lipopolysaccharide challenge, dietary-induced vitamin D deficiency resulted in exaggerated alveolar inflammation, epithelial damage and hypoxia. In vitro, vitamin D has trophic effects on primary human alveolar epithelial cells affecting >600 genes. In a clinical setting, pharmacological repletion of vitamin D prior to oesophagectomy reduced the observed changes of in vivo measurements of alveolar capillary damage seen in deficient patients.Conclusions Vitamin D deficiency is common in people who develop ARDS. This deficiency of vitamin D appears to contribute to the development of the condition, and approaches to correct vitamin D deficiency in patients at risk of ARDS should be developed.Trial registration UKCRN ID 11994.