Vitamin D and LL-37 levels in bronchial alveolar lavage fluid of lung transplant recipients: A Retrospective Case-Control Pilot Study Open Access

Abstract

Vitamin D is a crucial pathway of the immune system. Vitamin D is known to up regulate antimicrobial peptides (AMP), known as LL-37, which are found in human monocytes and lung epithelial cells. In vitro studies found that vitamin D is necessary to induce LL-37 mRNA expression in macrophages to initiate phagocytosis of invading pathogens. LL-37 has antimicrobial activity against Gram-positive, Gram-negative bacteria, fungi and viruses. Vitamin D deficiency has been found in 47% of lung transplant patients and low levels of vitamin D have been associated with increased lung rejection and lung infection.

The purpose of this retrospective case-control pilot study is to elucidate the potential association of active vitamin D, 25 hydroxyvitamin D concentrations in bronchial alveolar lavage fluid with levels of LL-37 and to determine potential associations with acute cellular transplant rejection, lung infection and chronic rejection. However, it is possible that low vitamin D levels may predispose to acute rejection syndromes and/or chronic lung rejection after lung transplantation by predisposing to lung infection in this vulnerable population. With this background, we hypothesize that patients' who have acute cellular transplant rejection have lower levels of vitamin D and LL-37 in BAL fluid, as compared to lung transplant patients without acute rejection. Furthermore, in patients who have acute cellular transplant rejection, low levels of vitamin D are associated with an increased incidence of chronic lung rejection compared to patients with normal levels of vitamin D.

Table of Contents

INTRODUCTION……………………………………………………..…... .1-2
BACKGROUND………………………………………………………....... .3-6
METHODS……………………………………………………….….….…. .7-10
RESULTS………………………………………………………………...... 11-13
DISCUSSION………………………………………………………………14-17
REFERENCES……………………………………………………...….….. 18-20
TABLES AND FIGURES………………………………………………..... 21-34
Figure 1……………………………………………………………………...21
Table 1a……………………………………………………………………...21
Table 1b……………………………………………………………………...22
Table 1c……………………………………………………………………...22
Table 1d……………………………………………………………………...23
Table 1e……………………………………………………………………...23
Table 2……………………………………………………………………….24
Table 3a……………………………………………………………………...24
Table 3b………………………………………………………………………25
Table 3c………………………………………………………………………25
Table 3d………………………………………………………………………26
Table 3e………………………………………………………………………26
Table 4a………………………………………………………………………27
Table 4b………………………………………………………………………27
Table 4c………………………………………………………………………28
Table 5a………………………………………………………………………28
Table 5b………………………………………………………………………29
Table 5c……………………………………………………………………….30
Table 5d……………………………………………………………………….31
Table 5e………………………………………………………………………..31
Figure 2………………………………………………………………………..32
Figure 3………………………………………………………………………..33
Table 6a………………………………………………………………………..34
Table 6b………………………………………………………………………..34

About this Master's Thesis

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School	Laney Graduate School
Department	Clinical Research Curriculum Program
Degree	MS
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Medicine and Surgery
Keyword	LL-37 lung transplant vitamin D
Committee Chair / Thesis Advisor	Klein, Mitchel, Emory University
Committee Members	Martin, Greg, Emory University Esper, Annette , Emory University

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