Dear Docs and friends of medical science,

Hope for resistant asthma therapy http://news.bbc.co.uk/1/hi/health/4507654.stm


A vitamin supplement may help treat asthma patients who do not respond to
standard drugs, research suggests.

People who fail to respond to steroid therapy suffer repeated attacks and are at
a greater risk of dying. A team at King's College London found the vitamin D3
could improve these patients' responsiveness to steroids. The researchers say
their work, published in the Journal of Clinical Investigation, could
potentially save patients' lives and NHS resources.

Asthma is usually treated very effectively with inhaled steroids, but for some
patients taking steroid tablets is the only option, even though they can cause
serious side effects. Some people, however, fail to respond even to high doses
of oral steroids. Researcher Professor Tak Lee said: "This research is really
exciting and points the direction towards potential new strategies for reversing
steroid resistance.

"This has major implications for how to treat patients with severe asthma and
could also substantially reduce the use of NHS resources."

Immune response

The team's results imply that steroid treatment works, at least in part, by
inducing the T-cells of the immune system to synthesise a secreted signalling
molecule, called IL-10. This molecule can inhibit the immune responses that
cause the symptoms of allergic and asthmatic disease. Unlike T-cells from
healthy individuals, or patients that respond to steroids, T-cells taken from
patients who are steroid resistant do not produce IL-10 when cultured in vitro
with the steroid, dexamethasone. However, the researchers found that when
vitamin D3 was added to the culture medium along with dexamethasone, this defect
was reversed.

The researchers gave daily vitamin D3 supplements to people with asthma who were
unresponsive to steroids for seven days. Blood tests showed the patients'
T-cells were more responsive to dexamethasone after they had taken the
supplement.

Further work needed

Lead researcher Dr Catherine Hawrylowicz said: "At the moment we only have a
preliminary experimental observation. "We now need to test the benefits of this
treatment in the clinic, and we are currently putting a proposal together to
carry out this work. "Interestingly, vitamin D3 is at present occasionally
administered to patients with severe asthma to help prevent steroid-induced
osteoporosis. "Our studies suggest that there is an additional potential benefit
to this treatment."

Dr Lyn Smurthwaite, research development manager at Asthma UK, said:
"Two-point-six million people in the UK have severe asthma symptoms, many of
whom have restricted treatment options available to them as they do not respond
to conventional steroid therapy. "This research opens up a potentially important
new avenue for developing treatments for people with difficult to control
asthma."



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