Low plasma levels of cholecalciferol and 13- cis -retinoic acid in tuberculosis: Implications in host-based chemotherapy

Abstract Objective The aim of this study was to estimate the concentration of cholecalciferol and 13- cis -retinoic acid (RA) in the plasma and pleural fluid of patients with tuberculosis (TB) against controls. Methods Plasma levels of cholecalciferol and 13- cis -RA were measured in 22 patients with TB and healthy controls and their pleural fluids levels were measured in 6 TB patients and diseased controls by established high-performance liquid chromatography–based procedure. Results Cholecalciferol levels in plasma and pleural fluid of patients with TB and healthy controls were 67.45 (10.71) nmol/L and 21.40 (8.58) nmol/L compared with 117.43 (18.40) nmol/L ( P < 0.001) and 94.73 (33.34) nmol/L ( P = 0.0049), respectively. 13- cis -RA level in the plasma of patients with TB and healthy controls were 1.51 (0.72) nmol/L and 6.67 (0.81) nmol/L ( P < 0.001), respectively. 13- cis -RA was not detectable in pleural fluid. The levels of both the agents were lower in patients with TB than in controls. Conclusion It was observed that in patients with TB there is a combined deficiency of cholecalciferol and 13- cis -RA compared with healthy volunteers. Because cholecalciferol and 13- cis -RA are in equilibrium with active ingredients of vitamins A and D, we feel that there is a combined deficiency of these vitamins in patients with TB. There is an evidence that concomitant vitamin A and D supplementation can kill intracellular Mycobacterium tuberculosis in vitro. Therefore, the observations made in this study can pave the path for a trial of combined supplementation of available formulations of vitamin A and D (cholecalciferol and 13- cis -RA) for novel anti-tubercular drug therapy. Because such an approach is host-based it has potential to treat even multidrug-resistant and extensively drug-resistant forms of TB.