Lupus: Vitamin D – An Environmental Factor

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Lupus: Vitamin D – An Environmental Factor




Guest:  Dr. Diane Kamen - Rheumatology & Immunology

Host:  Dr. Linda Austin – Psychiatry


Dr. Linda Austin:  I’m Dr. Linda Austin.  I’m interviewing Dr. Diane Kamen who is Assistant Professor in the Department of Medicine, Division of Rheumatology, and here at the Medical University of South Carolina.  Dr. Kamen, you have been interested in lupus since you were a medical student.


Dr. Diane Kamen:  Yeah, or even before that actually.  When I was in college, my roommate had lupus, and then when I graduated from college, at Northwestern, my first job was as a study coordinator in lupus research studies.


Dr. Linda Austin:  Really?  So, you went to medical school wanting to become a doctor taking care of lupus patients?


Dr. Diane Kamen:  Absolutely.  I knew then that’s what I wanted to do.  I worked with rheumatologists there.


Dr. Linda Austin:  What was it about lupus that captured your energy?


Dr. Diane Kamen:  It’s an autoimmune disease.  It’s like the prototype of autoimmune diseases.  And we really feel like if we could understand lupus, we could understand a lot of autoimmune diseases.


Dr. Linda Austin:  Autoimmune is a word that is very familiar to you, but not everybody knows that word.  What does that mean?


Dr. Diane Kamen:  It means the immune system, which normally protects us against bacteria, infections, foreign things, our immune system, when we have autoimmunity, has turned against our own body, our own proteins.  Our immune system can make these antibodies that actually attack our own cells.  And, in lupus, those antibodies can be against anything head-to-toe in the body.  So, patients with lupus can get rashes, brain involvement, heart involvement, lung involvement, kidney involvement, really, you name it.


We think about lupus as being a prototype in a way because if we can understand that breakdown in immune tolerance in lupus, we’d feel like we’ve come a long way in understanding all different autoimmune diseases and that we’d be getting at what it is that triggers the immune system to go haywire, so to speak.


Dr. Linda Austin:  Now, you began a very fascinating research project here as a resident.  Tell us about that.


Dr. Diane Kamen:  When I was here training for internal medicine, I knew that I wanted to do rheumatology.  Actually, I knew I wanted to do lupus research.  Gary Gilkeson is one of the rheumatologists here who is world renowned for his lupus research, both basic science and translational research in lupus.  So, I requested to work with him during my residency and had this wonderful opportunity.  The timing was just right, where clinical and research in lupus was really taking off.  He had some wonderful ideas about studies we could do looking to see why it is that African-Americans are more predisposed to getting lupus.  Not only do they get lupus more often, but they also tend to be affected with more severe lupus and more kidney involvement. 


We wanted to get at the root of that and went into the community here on the African-American sea island, Gullah, community and see if we could not only find out the prevalence of lupus and learn more about lupus here, but then see if there were environmental of genetic reasons that lupus is more predominant.  There’s a disproportionate number of African-Americans affected by it.


Dr. Linda Austin:  So, what are your ideas about that, Dr. Kamen?


Dr. Diane Kamen:  We started writing the initial thoughts and hypotheses about what environmental triggers there could be.  And one of the things that came up was the fact that we don’t see that much lupus in Africa, yet Africans living elsewhere in the world, further away from the equator, tend to get more lupus and more severe lupus. 


One of the things that can be affected by lack of sun exposure and lack of UV light exposure is vitamin D.  And we know vitamin D has immune effects as well.  We know a lot more about it now than we did when we were first starting with these initial thoughts and hypotheses.  And, fortunately, we were in the right place at the right time. MUSC was one of the centers doing a lot of early vitamin D research.  We had Norman Bell here, who’s now retired.  Bruce Hollis and Carol Wagner, here at MUSC, were doing some of the leading research in vitamin D, really exciting stuff, and getting at the cause of seeing rickets again in babies born with vitamin D deficiency and finding out that pregnant women and newborns were often vitamin D deficient. 


So, we were able to actually get in on some of this early vitamin D work and look at it in lupus.  We already were entering members of the sea island African-American community in a database.  It was an observational study we were doing to look at the progression of autoimmunity among family members of lupus patients.  And we did screening for vitamin D deficiency among the community members and found 95 percent of them were deficient.  And a large number were severely deficient in vitamin D, some of the lowest levels that had been seen.


Dr. Linda Austin:  Now, explain that and the question it raises.  Is that more common in African-Americans versus Africans living in Africa?


Dr. Diane Kamen:  Yeah.  It has a lot to do with how far you are from the equator, how much time you spend in the sun.  And, as we know, lifestyles here in the United States are much different.  We spend a lot of time working inside and staying inside.  Then, also, skin pigment, the melanin in the skin is one of the best blockers of vitamin D conversion.  So, the darker your skin, the less likely you are to convert enough vitamin D in the skin.  Most people would normally get vitamin D from sunlight exposure.  But what we’re finding is that people, at least at that time, were not taking supplements and were not getting that sun exposure, so we were seeing very severe deficiency of vitamin D.


Dr. Linda Austin:  Do you believe that it is related to lupus?


Dr. Diane Kamen:  Since that time we’ve done several studies and now we’ve even completed our first interventional trial of vitamin D in lupus, all based on the knowledge that vitamin D does play an important role in the immune system.  And it may be that this breakdown of immune tolerance to your own body happens very early on, and by the time you’ve actually developed full-blown lupus, it might be too late.  But what we have seen is that vitamin D is, of course, well-tolerated, and we do see a correlation with disease activity using some of our measures of how active the lupus is in the body.


So, when we give that vitamin D and get people up to the normal levels, we see a reduction in some of the disease activity.  That was just a small pilot study.  Now we’re doing a randomized control trial on a larger scale at multiple centers.  And we’ve gotten funding from the NIH to proceed along those same lines of research.

And, in collaboration with Gary Gilkeson, here, and some groups across the United States, at other research centers, we’ve learned just how complex lupus is and how difficult it’s going to be to get at the root cause.  It’s probably not going to be one cause of lupus in everybody.  But we do think vitamin D, as one of those environmental factors, will prove to be important.  We know it’s important for bone health and immune health.  We’re learning more and more, it seems, everyday.  It’s exciting.


Dr. Linda Austin:  Dr. Kamen, thank you so much.


Dr. Diane Kamen:  Thank you.


If you have any questions about the services or programs offered at the Medical University of South Carolina or if you would like to schedule an appointment with one of our physicians, please call MUSC Health Connection:  (843) 792-1414.

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