1685 The active form of d vitamin, calcitriol 1,25(OH)2D3 and natural PPRgamma agonist, -3 polyunsaturated fatty acids (PUFAs) might serve as a negative feedback loop to prevent excessive inflammation in patients with severe atopic dermatitis

Tuesday, 7 December 2010
The function of vitamin D is promoting cell differentiation, cell maturation and inhibiting (uncontrolled) cell proliferation. VDR is expressed by almost all immune cells, including activated CD4+ and CD8+ T cells, B cells, neutrophils, and APCs . 1,25(OH)2D inhibits Th-1 type immune function in adult (memory) cells, induces T regulatory cells, and enhances phagocytosis by white blood cells. Vitamin D inhibits the activation of T cells, and promotes tolerance in dendritic cells.39,40 VDR has also been implicated in toll-like-receptor (TLR) signaling and regulation of the innate immune response in macrophages. Current evidence indicates that PUFAs can prevent the development of inflammatory diseases by affecting different steps of the immune response.

Case reports:

14 months old girl, known with severe atopic dermatitis, debuted at first days of life, had relapsed several staphylococci cutaneous infections, vasculitis like syndrome without positive verification of PCR/Antibody of Herpes family virus and was many times in treatment with per os and i.v. antibiotics. In the first 9 months of age exclusive breastfeedings, but due to event stimulation after mothers diet, stopped.  Started with diet restriction, only specific milk formula Neocat, PUFAs , calcitriol and probiotics(LGG). Results: 1) before immunomodulatory therapy, only with skin care and topical CS, intermittent topical calcineurin inhibitors and pruritis control: very high IgE over 5000, over 100 for cows milk, eggs and cross reaction almost of all, one that was normal was fish and shrimps IgE, high Eo counts, 1.68, thrombocytosis  and Neu-peni. Calcitrol 204, normal levels of immunoglobulin’s, C1q concentration 77%, slightly below ref. intervals, reduced activity of complement via the MBL pathway and decreased concentration of B cells. 2) After: normalization of Le and Tr counts, especially nice response in Eo are decreasing to 0.53, reduction in IgE level to 2500.EDTA blood for T, B and NK cell: normal proportions and concentrations of T and B / NK lymphocytes, nice response of virgin Tcell, normal exposure of adhesions molecules, normal T cell proliferation by polyclonal stimulation, normal value of somatic mutation. There are no signs of maternal engraftment on the CD4/CD8 separated cells. There is not sign of STAT3 deficiency. Clinical benefit, much better without signs of acute infections and severe itching, almost normal skin without lesions, normal growth.