Many of us live in areas where the sun doesn't always shine - thus the topic of Vitamin D is of interest
These authors suggest that 25-hydroxyvitamin D3 (25D) holds promise as a risk modifier for periprosthetic joint infections for a least three reasons. First, epidemiologic data demonstrate that >65% of patients undergoing arthroplasty have an insufficient or low level of total 25-hydroxyvitamin D. Second, recent epidemiologic work has suggested that vitamin-D deficiency is directly correlated with the frequency of periprosthetic infection (PJI). This coincides with literature highlighting the importance of the prohormone 25D as a locally active immune modulator for antigen-activated infl ammatory cells. The vitamin-D receptor regulates the expression of genes critical to both the innate and adaptive immune responses in humans Finally, vitamin D levels can be returned to normal with ease, rapidity, effi ciency, and low cost using an available, U.S. Food and Drug Administration (FDA)-approved, orally administered 25D3 product.
Against this background the authors examined whether 25D3 deficiency leads to increased bacterial burden in vivo in an established mouse model of PJI and, if so, whether this effect can be reversed by preoperative 25D3 supplementation.
Mice possessing fluorescent neutrophils were fed a vitamin D3-sufficient (n = 20) or deficient (n = 40) diet for 6 weeks. A group of 25D3-deficient mice (n = 20) were “rescued” with 1 intraperitoneal dose of 25D3 at 3 days before surgery. A stainless steel implant was inserted into the knee joint and the joint space was inoculated with bioluminescent Staphylococcus aureus.
Serum values confirmed 25D3 deficiency and repletion of the 25D3-rescued group. Bacterial bioluminescence and neutrophil fluorescence were significantly greater (p < 0.05) in the 25D3-deficient group. CFU counts from the joint tissue and implant were also significantly greater in this group (p < 0.05).
Rescue treatment significantly decreased bacterial burden and neutrophil infiltration (p < 0.05).
In this model of PJI (1) 25D3 deficiency results in increased bacterial burden and neutrophil infiltration, and (2) this effect can be reversed with preoperative repletion of 25D3.
Comment: It is of interest that Vitamin D deficiency may be an easily modifiable risk factor for periprosthetic infection.
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Comment: It is of interest that Vitamin D deficiency may be an easily modifiable risk factor for periprosthetic infection.
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