63 A major component in the generation of systemic inflammatory stress is the activation of the nuclear transcription factor-κB (NF-κB). There is an interaction between the VDR and NF-κB,64 with stimulation of the VDR downregulating NF-κB signalling,65 and results in a reduction of activated selleckchem T-cell and Antigen

Presenting Cell activity. Various studies have further demonstrated 1,25-OHD’s ability to decrease expression of pro-inflammatory cytokines (including CRP, IL-6, TNFα) both in vitro and in vivo.28,66 In a mouse model of renal inflammation Tan et al. demonstrated that administration of paricalcitol (an analogue of 1,25-OHD) resulted Metformin in a reduced expression of the NF-κB-dependent RANTES and TNFα, with less recruitment of activated T-cells and macrophages.67 Looking at this in vitro (human proximal tubule cells), while paricalcitol did not affect NF-κB nuclear translocation, it did increase VDR expression and nuclear localization, and promoted intra-nuclear association of VDR with the NFκB p65 subunit, thereby reducing RANTES gene transcription.67 Intervention trials in CKD addressing inflammation have again been limited, performed predominantly in the haemodialysis

(HD) population and yielded mixed results.68–77 There is much heterogeneity Carnitine dehydrogenase between the available published work, and it is difficult to compare studies. However, it would appear that prolonged use (>3 months) of substantial doses of 1,25-OHD (6.14 ± 1.25 µg/week) may reduce circulating inflammatory burden (as determined by IL-1β, IL-6, TNFα or hsCRP), by up to 60%.69,73,74 Whether this observation translates into clinically meaningful outcomes and is applicable to earlier stages of CKD or administration of other forms of vitamin D has yet to be elucidated. Vitamin D influences the RAS; a link first

highlighted by the inverse association between vitamin D status and high-renin hypertension,78–80 and more recently by analysis of the LURIC cohort, where Tomaschitz and colleagues demonstrated that both 25- and 1,25-OHD were independently negatively correlated with both plasma renin and circulating angiotensin II.81 However, manipulation of the RAS with vitamin D has implications beyond just hypertension and glucose homeostasis in terms of cardiac risk. In VDR knockout mice a sevenfold increase in the expression of renin and angiotensin II was demonstrated,82 and using this together with a CYP27B1 knockout model, researchers have shown that this results in blood pressure-independent increased left ventricular (LV) mass, systolic dysfunction and myocyte hypertrophy and fibrosis.