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

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 invitro. 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.