Abstract

Status of Fok I VDR polymorphism along with vitamin D, Vitamin D receptor (VDR), and cathelicidin levels in Tuberculosis (TB) patients compared to household contacts and implication of these findings in susceptibility to TB is not known. 150 active TB patients, 150 household contacts and 150 healthy controls were recruited from North Indian population. Fok1 VDR polymorphism was studied by polymerase chain reaction- restriction fragment length polymorphism (PCR-RFLP).VDR mRNA and protein levels were studied using quantitative real time PCR (q rt PCR) and enzyme linked immunosorbent assay (ELISA) respectively. Cathelicidin and Vitamin D levels were measured using ELISA and chemiluminescence immunoassay (CLIA) respectively. Significant association was found between Fok1 polymorphism and susceptibility to TB (P < 0.0005). VDR mRNA, VDR protein and vitamin D levels were significantly lower in active TB group when compared to household contacts and healthy controls (P < 0.0001, 0.0001 and 0.0005 respectively). Cathelicidin levels were higher in active TB patients compared to other groups (P < 0.0001). Expression of VDR and cathelicidin was significantly higher among ‘FF’ genotypes of VDR (more active form of VDR) compared to ‘ff’ genotype (less active form of VDR). ‘f’ allele was associated with increased susceptibility to TB. Higher frequency of ‘F’ allele, increased VDR expression along with increased vitamin D levels in household contacts compared to active TB group might be responsible for protection against active TB.

Highlights

  • Tuberculosis (TB) remains one of the most important causes of death from an infectious agent, with a latest World Health Organization (WHO) figures indicating an estimating 10.4 million new incident cases globally in 2017, out of which 26% incident cases are from India[1]

  • It is converted to its active form 1, 25-dihydroxyvitamin D by mitochondrial 25-hydroxyvitamin D-1α-hydroxylase in macrophages and binds to Vitamin D receptor (VDR) and acts as a transcription factor leading to the induction of cathelicidin (LL37) expression and promotion of autophagy

  • Cathelicidins are family of proteins consisting of C- terminal cationic anti-microbial peptide (CAMP) domain that is activated by cleavage from N- terminal cathelin portion of propeptide

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Summary

Introduction

Tuberculosis (TB) remains one of the most important causes of death from an infectious agent, with a latest World Health Organization (WHO) figures indicating an estimating 10.4 million new incident cases globally in 2017, out of which 26% incident cases are from India[1]. Binding of the active form of Vitamin D to its nuclear receptor VDR leads to formation of an active transcriptional complex, which increases expression of a number of proteins. One such protein is cathelicidin (LL37) which is involved in killing of M.TB. It is converted to its active form 1, 25-dihydroxyvitamin D by mitochondrial 25-hydroxyvitamin D-1α-hydroxylase in macrophages and binds to VDR and acts as a transcription factor leading to the induction of cathelicidin (LL37) expression and promotion of autophagy. After binding to its ligand, vitamin D, VDR forms a heterodimer with retinoid X receptor This heterodimer binds to vitamin D response elements (VDREs) in the promoter region of vitamin D3 regulated genes, enabling the interaction of regulatory proteins thereby mediating transcription. The Fok[1] polymorphism is one of the functional and important polymorphism of VDR gene

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