TY  - JOUR
A1  - Tsuprykov, Oleg
A1  - Chen, Xin
A1  - Hocher, Carl-Friedrich
A1  - Skoblo, Roman
A1  - Yin, Lianghong
A1  - Hocher, Berthold
T1  - Why should we measure free 25(OH) vitamin D?
JF  - The Journal of Steroid Biochemistry and Molecular Biology
N2  - Vitamin D, either in its D-2 or D-3 form, is essential for normal human development during intrauterine life, kidney function and bone health. Vitamin D deficiency has also been linked to cancer development and some auto immune diseases. Given this huge impact of vitamin Don human health, it is important for daily clinical practice and clinical research to have reliable tools to judge on the vitamin D status. The major circulating form of vitamin D is 25-hydroxyvitamin D (25(OH)D), although it is not the most active metabolite, the concentrations of total 25-hydroxyvitamin D in the serum are currently routinely used in clinical practice to assess vitamin D status. In the circulation, vitamin D - like other steroid hormones - is bound tightly to a special carrier - vitamin D-binding protein (DBP). Smaller amounts are bound to blood proteins - albumin and lipoproteins. Only very tiny amounts of the total vitamin D are free and potentially biologically active. Currently used vitamin D assays do not distinguish between the three forms of vitamin D - DBP-bound vitamin D, albumin-bound vitamin D and free, biologically active vitamin D. Diseases or conditions that affect the synthesis of DBP or albumin thus have a huge impact on the amount of circulating total vitamin D. DBP and albumin are synthesized in the liver, hence all patients with an impairment of liver function have alterations in their total vitamin D blood concentrations, while free vitamin D levels remain mostly constant. Sex steroids, in particular estrogens, stimulate the synthesis of DBP. This explains why total vitamin D concentrations are higher during pregnancy as compared to nonpregnant women, while the concentrations of free vitamin D remain similar in both groups of women. The vitamin D-DBP as well as vitamin D-albumin complexes are filtered through the glomeruli and re-uptaken by megalin in the proximal tubule. Therefore, all acute and chronic kidney diseases that are characterized by a tubular damage, are associated with a loss of vitamin D-DBP complexes in the urine. Finally, the gene encoding DBP protein is highly polymorphic in different human racial groups. In the current review, we will discuss how liver function, estrogens, kidney function and the genetic background might influence total circulating vitamin D levels and will discuss what vitamin D metabolite is more appropriate to measure under these conditions: free vitamin D or total vitamin D.
KW  - 1,25(OH)(2) vitamin D
KW  - Bioavailable vitamin D
KW  - Calculated free 25(OH) vitamin D
KW  - Free 25(OH) vitamin D
KW  - Free vitamin D
KW  - Directly measured free vitamin D
KW  - Genetic polymorphism
KW  - Total 25(OH) vitamin D
KW  - Vitamin D-binding protein
Y1  - 2107
U6  - https://doi.org/10.1016/j.jsbmb.2017.11.014
SN  - 0960-0760
VL  - 180
SP  - 87
EP  - 104
PB  - Elsevier
CY  - Oxford
ER  -