Chronic Illness Workshop

Road to Recovery

from Chronic Illness

Hosted by Christ's Church  

of Marion County

 6768 SW 80th St. 

Therapy Tip

 Many chronically ill patients experience an exacerbation of symptoms following  

natural light exposure  

due to  

excess production of  

vitamin D metabolites.  

In addition to its primary role of photosynthesizing  

vitamin D3, keratinocytes  

in the skin are also capable  

of producing 25(OH)D and 1,25(OH)2D through enzymatic actions.  

Skin that is infected with intracellular bacteria may  

be more susceptible to stimulation that produces these other vitamin D metabolites which are usually only produced upstream  

in the liver and kidneys. 

CIR Counseling  

Program

 If you would like to enroll  

in the CIR counseling program, please email

or call toll-free 888.846.2474

CIR Library Access

CIR Diet Support

Sign up to receive emails with information related to diets, exercise and weight management. The regular contact provides motivation to get started and incentive  

to persist if/when the going gets rough. If you would like to join, please send us  

an  email. 

Have you enjoyed this newsletter?

Greetings!        

Here we are, at the end of another calendar year. This is when our thoughts turn to considering where we are, where we've been and where we are going. It's hard to believe that we started our website and Nurse Counseling service five and a half years ago, and that CIR is completing our sixth year of existence!

We have come so far, learned so much and met many wonderful people along the way. We have had a lot of encouragement and support, for which we are thankful. We have been privileged to see small daily successes, as our nurses counsel patients through the tough times. We continue to reach a growing number of medical professionals with information about Inflammation Therapy and how vitamin D is misunderstood. We were thrilled to publish our first paper this year, but we are continuing to build on that achievement with oral and poster presentations at medical conferences around the world.

We are excited about what the future holds and we are working on new three-year and five-year plans.  The future of CIR is to continue to reach out and change the world by sharing new insights into chronic inflammatory diseases and the vitamin D connection. We hope you will continue to follow our story.

May you have blessed year-ending and a healthy, happy New Year!

Intracellular Bacterial Macrophage Stimulation May Cause Non-Resolving Inflammation

Macrophages are a critical part of the body's defense against microorganisms. They eat and destroy pathogens, such as bacteria, viruses and fungi. The macrophage, one of the most complex and diverse chemical factories in the body, has the ability to manufacture over 100 powerful chemicals ranging from cytokines and hormones to enzymes and prostaglandins.

Macrophage production begins in the bone marrow where precursor cells, called monocytes, mature and migrate into the blood. Monocytes are only found in the blood. After about 40 hours in the blood, monocytes begin moving into solid tissues; they invade every tissue and organ in the body.

Once a monocyte invades a tissue, it matures further and is transformed into a macrophage. Macrophages are larger, more powerful than monocytes; they reside in their chosen tissue until they die (this may be several months). Macrophages are never found in the blood; thus, there are no blood tests to investigate or measure or evaluate macrophages.

During typical periods of good health, macrophages are quiescent and secrete very little, if any, of their potent chemicals. They're primarily defensive sentinels; alert and vigilant, patiently waiting for invading pathogens, malignant cells or trauma. Once macrophages detect danger, they become activated and begin secreting powerful cytokines such as interleukin-1, tumor necrosis factor and interferon-alpha. Cytokines command the brain, liver, immune system, endocrine system and various other tissues to act as one unit in the defense of the body. With their powerful, broad spectrum effects, the cytokines in a sense declare 'martial law' and take over command and control of the body. The resulting inflammation is a sign that the innate immune system is activated and working to defend the body. Normally, the inflammation resolves when the infection is eliminated but sometimes low-grade inflammation persists.

Chronic macrophage activation and non-resolving inflammation occur in many inflammatory diseases such as rheumatoid arthritis, lupus, multiple sclerosis, osteoporosis, atherosclerosis and sarcoidosis. Much of the tissue destruction, inflammation and pathology occurring in these diseases are mediated by chronically energized macrophages. The awesome power of the macrophage is a double-edged sword. Its lethal strength is necessary in order to defend the body against invading pathogens, noxious chemicals, trauma, dying tissue and malignant cells. This same lethal strength, unfortunately, can also injure the body. In the long term, chronic macrophage activation and chronic inflammation can cause severe damage to the body. [1]

The cause of chronic macrophage activation in is unknown. A promising theory posits that intracellular bacteria, which use many strategies to survive within macrophages, provide the stimulus for persistent inflammation and are the root cause of many chronic diseases. [2-5]

1,25(OH)2D (the active form of vitamin D) regulates genetic expression of the immune system via the vitamin D receptor. One of the antibacterial mechanisms used by macrophages is production of 1,25(OH)2D). The enzyme that catalyzes 25(OH)D to 1,25(OH)2D, 1-alpha-hydroxylase (CYP27B1), is expressed in macrophages. [6-9] This extra-renal synthesis of 1,25(OH)2D is activated by cytokines (e.g., interferon-gamma, interferon-y), inflammatory molecules (e.g., lipopolysaccharide), nitric oxide (dying bacteria release NO) and intracellular VDBP (the precursor for the principal macrophage activating factor). [10-14]

The synthesis of 1,25(OH)2D by activated macrophages is not inhibited by 1,25(OH)2D (as in renal production) and this appears to be the basis for the persistent unregulated production of 1,25(OH)2D found in disease states. [15] Disease-activated macrophage are capable of generating enough 1,25(OH)2D to raise serum levels well above normal. [16-20] 1,25(OH)2D can be measured via serum assay to diagnosis vitamin D endocrine system dysregulation and thus, indirectly infer a presumptive occult intracellular infection in macrophages.

References

1. Smith, RS. The Immune System -- Briefly, Cytokines and Depression, 1997, Available at: http://www.cytokines-and-depression.com/chapter4.html
2. Todar K. Mechanisms of Bacterial Pathogenicity. Online Textbook of Bacteriology. 2008-2012. Available at: http://textbookofbacteriology.net/pathogenesis_5.html.
3. Kaufmann SH. Immunity to intracellular bacteria. Annu Rev Immunol. 1993(11):129-63.
4. Kozarov E. Bacterial invasion of vascular cell types: vascular infectology and atherogenesis. Future Cardiol. Jan 2012;8(1):123-38.
5. Nauciel C. Immune Defenses against Intracellular Bacterial Infection. In: Paradise LJ, Friedman H, Bendinelli M, eds. Opportunistic Intracellular Bacteria and Immunity. New York, NY: Kluwer Academic Press; 2002.
6. Adams J, Hewison M. Extrarenal expression of the 25-hydroxyvitamin D-1-hydroxylase.
7. Rasmussen SB, Reinert LS, Paludan SR. Innate recognition of intracellular pathogens: detection and activation of the first line of defense. APMIS. May 2009(117(5-6)):323-37.
8. Gonzalez-Mejia ME, Doseff AL. Regulation of monocytes and macrophages cell fate. Front Biosci. Jan 2009;14:2413-31.
9. Parihar A, Eubank TD, Doseff AL. Monocytes and macrophages regulate immunity through dynamic networks of survival and cell death. J Innate Immun. 2010;2(3):204-15.
10. Koeffler H, Reichel H, Bishop J, Norman A. gamma-Interferon stimulates production of 1,25-dihydroxyvitamin D3 by normal human macrophages. Biochem Biophys Res Commun. Mar 1985;127(2):596-603.
11. Edfeldt K, Liu PT, Chun R, et al. T-cell cytokines differentially control human monocyte antimicrobial responses by regulating vitamin D metabolism. Proc Natl Acad Sci U S A. Dec 2010;107(52):22593-8.
12. Rook G, Steele J, Fraher L, et al. Vitamin D3, gamma interferon, and control of proliferation of Mycobacterium tuberculosis by human monocytes. Immunology. Jan 1986;7(1):159-163.
13. Dusso AS, Kamimura S, Gallieni M, et al. gamma-Interferon-induced resistance to 1,25-(OH)2D3 in human monocytes and macrophages: a mechanism for the hypercalcemia of various granulomatoses. J Clin Endocrinol Metab. 1997;82(7):2222-32.
14. Alexander C, Rietschel ET. Bacterial lipopolysaccharides and innate immunity. J Endotoxin Res. 2001(7(3)):167-202.
15. Breslau NA. Normal and abnormal regulation of 1,25-(OH)2D synthesis. Am J Med Sci. Dec 1988;296(6):417-25.
16. Dusso AS, Finch J, Brown A, et al. Extrarenal Production of Calcitriol in Normal and Uremic Humans. J. Clin. Endocrinol. Metab. Jan 1991;72(1).
17. Hewison M, Burke F, Evans KN, et al. Extra-renal 25-hydroxyvitamin D3-1alpha-hydroxylase in human health and disease. J Steroid Biochem Mol Biol. 2007 Mar;103(3-5):316-21.
18. Lambert PW, Stern PH, Avioli RC, et al. Evidence for extrarenal production of 1 alpha,25-dihydroxyvitamin D in man. J Clin Invest. Mar 1982;69(3):722-5.
19. Hewison M, Zehnder D, Bland R, Stewart PM. COMMENTARY 1a-Hydroxylase and the action of vitamin D, J Mol Endocrinol. 2000 Oct;25(2):141-8.
20. Mawer EB, Hayes ME, Still PE, Davies M, Lumb GA, Palit J, Holt PJ. Evidence for nonrenal synthesis of 1,25-dihydroxyvitamin D in patients with inflammatory arthritis. J Bone Miner Res. 1991 Jul;6(7):733-9.

I got sick 20 years ago on Thanksgiving and was finally diagnosed 3 months later (February 1995) with CNS sarc. I'm still alive and living a normal life for a 72 year old. I'm doing a lot of things I love to do, such as, volunteering in my grandson's classroom 2 full days a week and walking about 2 miles 3 days a week. Thanks to you all! ~Sue

The terrible sinusitis that I used to get and the awful almost constant headaches that is a part of it have all but disappeared. I get funny buzzing noises in my ears that I just thought everyone had, but now realize that that is not the case and it is a condition that has a name; tinnitus. It has improved a lot. ~Sunshine