Randomized Controlled Trial of Calcitriol in Severe Sepsis.
Am J Respir Crit Care Med. 2014 Jul 16;
Authors: Leaf DE, Raed A, Donnino MW, Ginde AA, Waikar SS
Rationale: Vitamin D and its metabolites have potent immunomodulatory effects in vitro, including upregulation of cathelicidin, a critical antimicrobial protein. Objectives: We investigated whether administration of 1,25-dihydroxyvitamin D (calcitriol) to critically ill patients with sepsis would have beneficial effects on markers of innate immunity, inflammation, and kidney injury. Methods: We performed a double-blind, randomized, placebo-controlled, physiologic study among 67 critically ill patients with severe sepsis or septic shock. Patients were randomized to receive a single dose of calcitriol (2µg I.V.) vs. placebo. The primary outcome was plasma cathelicidin protein levels assessed 24 hours after study drug administration. Secondary outcomes included leukocyte cathelicidin mRNA expression, plasma cytokine levels (IL-10, IL-6, TNF-ɑ, IL-1β, and IL-2), and urinary kidney injury markers. Measurements and Main Results: Patients randomized to calcitriol (N=36) vs. placebo (N=31) had similar plasma cathelicidin protein levels at 24 hours (p=0.16). Calcitriol-treated patients had higher cathelicidin (p=0.04) and IL-10 (p=0.03) mRNA expression than placebo-treated patients 24 hours after study drug administration. Plasma cytokine levels (IL-10, IL-6, TNF-ɑ, IL-1β, and IL-2) and urinary kidney injury markers were similar in calcitriol vs. placebo treated patients (p>0.05 for all comparisons). Calcitriol had no effect on clinical outcomes nor were any adverse effects observed. Conclusions: Calcitriol administration did not increase plasma cathelicidin protein levels in critically ill patients with sepsis and had mixed effects on other immunomodulatory markers. Additional phase II trials investigating the dose and timing of calcitriol as a therapeutic agent in specific sepsis phenotypes may be warranted.
PMID: 25029202 [PubMed - as supplied by publisher]