Vitamin D receptor gene polymorphism and vitamin D supplementation on clinical/ treatment outcome in tuberculosis: current and future perspectives

ABSTRACT

Introduction

Tuberculosis (TB) is a transnational public health concern, which requires more precise treatment strategies than the existing approaches. Vitamin D modulates the inflammatory and immune response to the disease. Robust evidence shows that vitamin D deficiency and its receptor gene polymorphism influence the susceptibility to TB and the outcome of the anti-tubercular treatment (ATT). However, in the different populations, these findings were inconsistent and even contradictory.

Areas covered

The current review focuses on the association between vitamin D receptor (VDR) gene polymorphism with the risk of development of TB disease and response to the ATT. Additionally, it reviews various systematic reviews and meta-analyses on the impact of vitamin D supplements on both clinical and treatment outcomes in TB patients.

Expert opinion

Although the majority of the findings rule out the benefits of the supplementation, sufficient evidence is available to warrant larger epidemiological research that should be aimed to generate possible interaction among the VDR polymorphism, vitamin D status, and the outcome in TB. We conclude that establishing such an association in different ethnic populations will help design nutrigenomics- or pharmacogenomics-based vitamin D supplementation to develop a personalized medicine approach to flatten the curve of TB disease.

KEYWORDS:

• Polymorphism
• tuberculosis
• VDR gene
• vitamin D supplements

Article highlights

• Evidence shows that deficiency of vitamin D and its receptor gene polymorphism influences the susceptibility to tuberculosis and the treatment outcome

• Despite many of the findings that rule out the benefits of the vitamin D supplementation in tuberculosis, sufficient evidence is available to warrant extensive epidemiological research to generate possible interaction among the VDR polymorphism, vitamin D status, and the outcome in tuberculosis

• The robust evidence on such interplay will help to develop a more personalized medicine approach for vitamin D supplementation in tuberculosis patients

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

SS and MR conceptualized the review. SSM, NV, SJK, TB, and LT wrote the manuscript. SSM and BSR are involved in visualization. MM, MB, and MR critically evaluated the manuscript. All the authors participated in the literature collection and review. All the authors approved the final draft of the article.