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.