Authors

1 Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran

2 Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran

Abstract

Despite the classic role of Vitamin D in skeletal health, new aspects of Vitamin D have been 
discovered in tissues and organs other than bones. Epidemiological and observational 
studies demonstrate a link between Vitamin D deficiency and risk of developing 
respiratory diseases including asthma, chronic obstructive pulmonary disease(COPD), and 
tuberculosis (TB). To review the literature, we searched the terms “Vitamin D”(using the 
set operator) and “asthma,” “COPD” and “TB” in electronic databases, including PubMed/
MEDLINE, Scopus, and Google Scholar until July 2015. Non‑English articles or articles with 
unavailable full text were excluded. Both in vivo and in vitro studies were included. All the 
reviewed articles state that Vitamin D deficiency is very common among patients with 
respiratory diseases. The present data regarding Vitamin D and asthma is still controversial, 
but data about COPD and TB are more encouraging. The relevant studies have been 
conducted in different populations therefore it is not particularly possible to compare the 
data due to genetic variations. In order to point out a role for Vitamin D, large clinical trials 
with Vitamin D deficient subjects and sufficient Vitamin D supplementation are needed.

Keywords

  1. Hansdottir S, Monick MM, Hinde SL, Lovan N, Look DC, 
    Hunninghake GW. Respiratory epithelial cells convert inactive 
    Vitamin D to its active form: Potential effects on host defense. 
    J Immunol 2008;181:7090‑9.
    2. Roth DE, Jones AB, Prosser C, Robinson JL, Vohra S. 
    Vitamin D receptor polymorphisms and the risk of acute 
    lower respiratory tract infection in early childhood. J Infect 
    Dis 2008;197:676‑80.
    3. Herr C, Greulich T, Koczulla RA, Meyer S, Zakharkina T, 
    BranscheidtM, et al. The role of Vitamin D in pulmonary disease: 
    COPD, asthma, infection, and cancer. Respir Res 2011;12:31.
    4. Cannell JJ, Vieth R, Umhau JC, Holick MF, Grant WB, 
    Madronich S, et al. Epidemic influenza and Vitamin D. 
    Epidemiol Infect 2006;134:1129‑40.
    5. Abuzeid WM, Akbar NA, Zacharek MA. Vitamin D and 
    chronic rhinitis. Curr Opin Allergy Clin Immunol 2012;12:13‑7.
    6. Janssens W, Bouillon R, Claes B, Carremans C, Lehouck A, 
    Buysschaert I, et al. Vitamin D deficiency is highly prevalent in 
    COPD and correlates with variants in the Vitamin D‑binding 
    gene. Thorax 2010;65:215‑20.
    7. Litonjua AA, Weiss ST. Is Vitamin D deficiency to blame for 
    the asthma epidemic? J Allergy Clin Immunol 2007;120:1031‑5.
    8. Niruban SJ, Alagiakrishnan K, Beach J, Senthilselvan A. 
    Association between Vitamin D and respiratory outcomes in 
    Canadian adolescents and adults. J Asthma 2015;52:653-61.
    9. Nnoaham KE, Clarke A. Low serum Vitamin D levels and 
    tuberculosis: A systematic review and meta‑analysis. Int J 
    Epidemiol 2008;37:113‑9.
    10. Gibney KB, MacGregor L, Leder K, Torresi J, Marshall C, 
    Ebeling PR, et al. Vitamin D deficiency is associated with 
    tuberculosis and latent tuberculosis infection in immigrants 
    from sub‑Saharan Africa. Clin Infect Dis 2008;46:443‑6.
    11. Masoli M, Fabian D, Holt S, Beasley R; Global Initiative for 
    Asthma (GINA) Program. The global burden of asthma: 
    Executive summary of the GINA Dissemination Committee 
    report. Allergy 2004;59:469‑78.
    12. Dixon AE, Holguin F, Sood A, Salome CM, Pratley RE, 
    Beuther DA, et al. An official American Thoracic Society 
    Workshop report: Obesity and asthma. Proc Am Thorac Soc 
    2010;7:325‑35.
    13. Wortsman J, Matsuoka LY, Chen TC, Lu Z, Holick MF. 
    Decreased bioavailability of Vitamin D in obesity. Am J Clin 
    Nutr 2000;72:690‑3.
    14. Celedón JC, Sredl D, Weiss ST, Pisarski M, Wakefield D, 
    Cloutier M. Ethnicity and skin test reactivity to aeroallergens 
    among asthmatic children in Connecticut. Chest 2004;125:85‑92.
    15. Rajakumar K, Fernstrom JD, Janosky JE, Greenspan SL. 
    Vitamin D insufficiency in preadolescent African‑American 
    children. Clin Pediatr (Phila) 2005;44:683‑92.
    16. Keating P, M u n i m A , H a r t m a n n J X . E f f e c t o f 
    Vitamin D on T‑helper type 9 polarized human memory cells 
    in chronic persistent asthma. Ann Allergy Asthma Immunol 
    2014;112:154‑62.
    17. Xystrakis E, Kusumakar S, Boswell S, Peek E, Urry Z, 
    Richards DF, et al. Reversing the defective induction of 
    IL‑10‑secreting regulatory T cells in glucocorticoid‑resistant 
    asthma patients. J Clin Invest 2006;116:146‑55.
    18. Banerjee A, Damera G, Bhandare R, Gu S, Lopez‑Boado Y, 
    Panettieri R Jr, et al. Vitamin D and glucocorticoids differentially 
    modulate chemokine expression in human airway smooth 
    muscle cells. Br J Pharmacol 2008;155:84‑92.
    19. Chambers ES, Nanzer AM, Pfeffer PE, Richards DF, 
    Timms PM, Martineau AR, et al. Distinct endotypes of 
    steroid‑resistant asthma characterized by IL‑17Ahigh and 
    IFN‑γhigh immunophenotypes: Potential benefits of calcitriol. 
    J Allergy Clin Immunol 2015. pii: S0091‑674900165‑7.
    20. Liu PT, Stenger S, Tang DH, Modlin RL. Cutting edge: 
    Vitamin D‑mediated human antimicrobial activity against 
    Mycobacterium tuberculosis is dependent on the induction of 
    cathelicidin. J Immunol 2007;179:2060‑3.
    21. Bossé Y, MaghniK, HudsonTJ. 1alpha, 25‑dihydroxy‑Vitamin D3 
    stimulation of bronchial smooth muscle cells induces autocrine, 
    contractility, and remodeling processes. Physiol Genomics 
    2007;29:161‑8.
  2. 22. Song Y, Qi H, Wu C. Effect of 1,25‑(OH) 2D3 (a vitamin D 
    analogue) on passively sensitized human airway smooth 
    muscle cells. Respirology 2007;12:486‑94.
    23. Kho AT, Sharma S, Qiu W, Gaedigk R, Klanderman B, Niu S, 
    et al. Vitamin D related genes in lung development and asthma 
    pathogenesis. BMC Med Genomics 2013;6:47.
    24. Sundar IK, Hwang JW, Wu S, Sun J, Rahman I. Deletion of 
    Vitamin D receptor leads to premature emphysema/COPD by 
    increased matrix metalloproteinases and lymphoid aggregates 
    formation. Biochem Biophys Res Commun 2011;406:127‑33.
    25. de Groot JC, van Roon EN, Storm H, Veeger NJ, 
    Zwinderman AH, Hiemstra PS, et al. Vitamin D reduces 
    eosinophilic airway inflammation in nonatopic asthma. 
    J Allergy Clin Immunol 2015;135:670‑5.e3.
    26. Gern JE, Lemanske RF Jr, Busse WW. Early life origins of 
    asthma. J Clin Invest 1999;104:837‑43.
    27. Warner JA, Jones CA, Jones AC, Warner JO. Prenatal origins 
    of allergic disease. J Allergy Clin Immunol 2000;105:S493‑8.
    28. Martindale S, McNeill G, Devereux G, Campbell D, Russell G, 
    Seaton A. Antioxidant intake in pregnancy in relation to 
    wheeze and eczema in the first two years of life. Am J Respir 
    Crit Care Med 2005;171:121‑8.
    29. Litonjua AA, Rifas‑Shiman SL, Ly NP, Tantisira KG, 
    Rich‑Edwards JW, Camargo CA Jr, et al. Maternal antioxidant 
    intake in pregnancy and wheezing illnesses in children at 2 y 
    of age. Am J Clin Nutr 2006;84:903‑11.
    30. Erkkola M, Kaila M, Nwaru BI, Kronberg‑Kippilä C, Ahonen S, 
    Nevalainen J, et al. Maternal Vitamin D intake during 
    pregnancy is inversely associated with asthma and allergic 
    rhinitis in 5‑year‑old children. Clin Exp Allergy 2009;39:875‑82.
    31. Devereux G, Turner SW, Craig LC, McNeill G, Martindale S, 
    Harbour PJ, et al. Low maternal Vitamin E intake during 
    pregnancy is associated with asthma in 5‑year‑old children. 
    Am J Respir Crit Care Med 2006;174:499‑507.
    32. Devereux G, Litonjua AA, Turner SW, Craig LC, McNeill G, 
    Martindale S, et al. Maternal Vitamin D intake during 
    pregnancy and early childhood wheezing. Am J Clin Nutr 
    2007;85:853‑9.
    33. Willers SM, Devereux G, Craig LC, McNeill G, Wijga AH, 
    Abou El‑Magd W, et al. Maternal food consumption during 
    pregnancy and asthma, respiratory and atopic symptoms in 
    5‑year‑old children. Thorax 2007;62:773‑9.
    34. Miller DR, Turner SW, Spiteri‑Cornish D, Scaife AR, 
    Danielian PJ, Devereux GS, et al. Maternal Vitamin D and E 
    intakes during early pregnancy are associated with airway 
    epithelial cell responses in neonates. Clin Exp Allergy 
    2015;45:920‑7.
    35. Grubczak K, Lipinska D, Eljaszewicz A, Singh P, 
    Radzikowska U, Miklasz P, et al. Vitamin D3 treatment 
    decreases frequencies of CD16‑positive and TNF‑a‑secreting 
    monocytes in asthmatic patients. Int Arch Allergy Immunol 
    2015;166:170‑6.
    36. Drozdenko G, Heine G, Worm M. Oral Vitamin D increases 
    the frequencies of CD38+ human B cells and ameliorates 
    IL‑17‑producing T cells. Exp Dermatol 2014;23:107‑12.
    37. Hansen S, Maslova E, Strøm M, Linneberg A, Halldorsson TI, 
    Granström C, et al. The long‑term programming effect of 
    maternal 25‑hydroxyvitamin D in pregnancy on allergic airway 
    disease and lung function in offspring after 20 to 25 years of 
    follow‑up. J Allergy Clin Immunol 2015;136:169‑76.e2.
    38. Chiu CY, Huang SY, Peng YC, Tsai MH, Hua MC, Yao TC, 
    et al. Maternal Vitamin D levels are inversely related to allergic 
    sensitization and atopic diseases in early childhood. Pediatr 
    Allergy Immunol 2015;26:337‑43.
    39. Leung TF, Wang SS, Tang MF, Kong AP, Sy HY, Hon KL, et al.
    Childhood asthma and spirometric indices are associated with 
    polymorphic markers of two Vitamin D 25‑hydroxylase genes. 
    Pediatr Allergy Immunol 2015;26:375‑82.
    40. Maguire JL, Birken CS, Loeb MB, Mamdani M, Thorpe K, 
    Hoch JS, et al. DO IT Trial: Vitamin D outcomes and 
    interventions in toddlers – A TARGet Kids! randomized 
    controlled trial. BMC Pediatr 2014;14:37.
    41. Bose S, Breysse PN, McCormack MC, Hansel NN, Rusher RR, 
    Matsui E, et al. Outdoor exposure and Vitamin D levels in 
    urban children with asthma. Nutr J 2013;12:81.
    42. Bener A, Ehlayel MS, Tulic MK, Hamid Q. Vitamin D 
    deficiency as a strong predictor of asthma in children. Int Arch 
    Allergy Immunol 2012;157:168‑75.
    43. Brehm JM, Schuemann B, Fuhlbrigge AL, Hollis BW, 
    Strunk RC, Zeiger RS, et al. Serum Vitamin D levels and severe 
    asthma exacerbations in the Childhood Asthma Management 
    Program study. J Allergy Clin Immunol 2010;126:52‑8.e5.
    44. Brehm JM, Celedón JC, Soto‑Quiros ME, Avila L, 
    Hunninghake GM, Forno E, et al. Serum Vitamin D levels 
    and markers of severity of childhood asthma in Costa Rica. 
    Am J Respir Crit Care Med 2009;179:765‑71.
    45. Yadav M, Mittal K. Effect of Vitamin D supplementation 
    on moderate to severe bronchial asthma. Indian J Pediatr 
    2014;81:650‑4.
    46. Sutherland ER, Goleva E, Jackson LP, Stevens AD, Leung DY. 
    Vitamin D levels, lung function, and steroid response in adult 
    asthma. Am J Respir Crit Care Med 2010;181:699‑704.
    47. Castro M, King TS, Kunselman SJ, Cabana MD, Denlinger L, 
    Holguin F, et al. Effect of Vitamin D3 on asthma treatment 
    failures in adults with symptomatic asthma and lower 
    Vitamin D levels: The VIDA randomized clinical trial. JAMA 
    2014;311:2083‑91.
    48. Black PN, Scragg R. Relationship between serum 
    25‑hydroxyvitamin d and pulmonary function in the third 
    national health and nutrition examination survey. Chest 
    2005;128:3792‑8.
    49. Arshi S, Fallahpour M, Nabavi M, Bemanian MH, 
    Javad‑Mousavi SA, Nojomi M, et al. The effects of Vitamin 
    D supplementation on airway functions in mild to 
    moderate persistent asthma. Ann Allergy Asthma Immunol 
    2014;113:404‑9.
    50. Varney VA, Evans J, BansalAS. Successful treatment of reactive 
    airways dysfunction syndrome by high‑dose Vitamin D. 
    J Asthma Allergy 2011;4:87‑91.
    51. Cheng HM, Kim S, Park GH, Chang SE, Bang S, Won CH, et al.
    Low Vitamin D levels are associated with atopic dermatitis, but 
    not allergic rhinitis, asthma, or IgE sensitization, in the adult 
    Korean population. JAllergy Clin Immunol 2014;133:1048‑55.
    52. Martineau AR, MacLaughlin BD, Hooper RL, Barnes NC, 
    Jolliffe DA, Greiller CL, et al. Double‑blind randomised 
    placebo‑controlled trial of bolus‑dose Vitamin 
    D3 supplementation in adults with asthma (ViDiAs). Thorax 
    2015;70:451‑7.
    53. Brody H. Chronic obstructive pulmonary disease. Nature 
    2012;489:S1.
    54. Vogelmeier C, Koczulla R, Fehrenbach H, Bals R. Pathogenesis 
    of chronic obstructive pulmonary disease. Internist (Berl) 2006;47:885‑6, 888‑90, 892‑4.
    55. Persson LJ, Aanerud M, Hiemstra PS, Hardie JA, Bakke PS, 
    Eagan TM. Chronic obstructive pulmonary disease is 
    associated with low levels of Vitamin D. PLoS One 
    2012;7:e38934.
    56. Crane‑Godreau MA, Black CC, Giustini AJ, Dechen T, Ryu J, 
    Jukosky JA, et al. Modeling the influence of Vitamin D 
    deficiency on cigarette smoke‑induced emphysema. Front 
    Physiol 2013;4:132.
    57. Fischer BM, Pavlisko E, Voynow JA. Pathogenic triad in 
    COPD: Oxidative stress, protease‑antiprotease imbalance, and 
    inflammation. Int J Chron Obstruct Pulmon Dis 2011;6:413‑21.
    58. Stocks J, Sonnappa S. Early life influences on the development 
    of chronic obstructive pulmonary disease. Ther Adv Respir 
    Dis 2013;7:161‑73.
    59. Svanes C, SunyerJ, Plana E, Dharmage S, Heinrich J, Jarvis D, 
    et al. Early life origins of chronic obstructive pulmonary 
    disease. Thorax 2010;65:14‑20.
    60. Nguyen M, Trubert CL, Rizk‑Rabin M, Rehan VK, Besançon F, 
    Cayre YE, et al. 1,25‑Dihydroxyvitamin D3 and fetal lung 
    maturation: Immunogold detection of VDR expression 
    in pneumocytes type II cells and effect on fructose 1,6 
    bisphosphatase. J Steroid Biochem Mol Biol 2004;89‑90:93‑7.
    61. Nguyen TM, Guillozo H, Marin L, Tordet C, Koite S, 
    Garabedian M. Evidence for a Vitamin D paracrine system 
    regulating maturation of developing rat lung epithelium. Am 
    J Physiol 1996;271:L392‑9.
    62. Uh ST, Koo SM, Kim YK, Kim KU, Park SW, Jang AS, et al.
    Inhibition of vitamin d receptor translocation by cigarette 
    smoking extracts. Tuberc Respir Dis (Seoul) 2012;73:258‑65.
    63. Hopkinson NS, Li KW, KehoeA, Humphries SE, Roughton M, 
    Moxham J, et al. Vitamin D receptor genotypes influence 
    quadriceps strength in chronic obstructive pulmonary disease. 
    Am J Clin Nutr 2008;87:385‑90.
    64. Janssens W, Decramer M, Mathieu C, Korf H. Vitamin D and 
    chronic obstructive pulmonary disease: Hype or reality? 
    Lancet Respir Med 2013;1:804‑12.
    65. Førli L, Halse J, Haug E, Bjørtuft Ø, Vatn M, Kofstad J, et al.
    Vitamin D deficiency, bone mineral density and weight in 
    patients with advanced pulmonary disease. J Intern Med 
    2004;256:56‑62.
    66. Janssens W, Mathieu C, Boonen S, Decramer M. Vitamin D 
    deficiency and chronic obstructive pulmonary disease: A 
    vicious circle. Vitam Horm 2011;86:379‑99.
    67. Monadi M, Heidari B, Asgharpour M, Firouzjahi A, 
    Monadi M, Ghazi Mirsaied MA. Relationship between serum 
    Vitamin D and forced expiratory volume in patients with 
    chronic obstructive pulmonary disease (COPD). Caspian J 
    Intern Med 2012;3:451‑5.
    68. Zendedel A, Gholami M, Anbari K, Ghanadi K, Bachari EC, 
    Azargon A. Effects of Vitamin D intake on FEV1 and COPD 
    exacerbation: Arandomized clinical trial study. Glob J Health 
    Sci 2015;7:243‑8.
    69. Afzal S, Lange P, Bojesen SE, Freiberg JJ, Nordestgaard BG. 
    Plasma 25‑hydroxyvitamin D, lung function and risk of 
    chronic obstructive pulmonary disease. Thorax 2014;69:24‑31.
    70. MartineauAR, James WY, Hooper RL, Barnes NC, Jolliffe DA, 
    Greiller CL, et al. Vitamin D3 supplementation in patients 
    with chronic obstructive pulmonary disease (ViDiCO): A 
    multicentre, double‑blind, randomised controlled trial. Lancet 
    Respir Med 2015;3:120‑30.
    71. Holmgaard DB, Mygind LH, Titlestad IL, Madsen H, 
    Fruekilde PB, Pedersen SS, et al. Serum Vitamin D in patients 
    with chronic obstructive lung disease does not correlate with 
    mortality‑results from a 10‑year prospective cohort study. 
    PLoS One 2013;8:e53670.
    72. Kunisaki KM, Niewoehner DE, Connett JE. Severe 
    Vitamin D deficiency: A biomarker of exacerbation risk?: 
    A reply to Heulens. Am J Respir Crit Care Med 2013;187:215‑6.
    73. Lehouck A, Mathieu C, Carremans C, Baeke F, Verhaegen J, 
    Van Eldere J, et al. High doses of Vitamin D to reduce 
    exacerbations in chronic obstructive pulmonary disease: 
    A randomized trial. Ann Intern Med 2012;156:105‑14.
    74. Bjerk SM, Edgington BD, Rector TS, Kunisaki KM. 
    Supplemental Vitamin D and physical performance in COPD: 
    A pilot randomized trial. Int J Chron Obstruct Pulmon Dis 
    2013;8:97‑104.
    75. Ferrari M, Schenk K, Papadopoulou C, Ferrari P, 
    Dalle Carbonare L, Bertoldo F. Serum 25‑hydroxy Vitamin D 
    and exercise capacity in COPD. Thorax 2011;66:544‑5.
    76. Hornikx M, Van Remoortel H, LehouckA, Mathieu C, Maes K, 
    Gayan‑Ramirez G, et al. Vitamin D supplementation during 
    rehabilitation in COPD: A secondary analysis of a randomized 
    trial. Respir Res 2012;13:84.
    77. Banerjee A, Panettieri R Jr. Vitamin D modulates airway 
    smooth muscle function in COPD. Curr Opin Pharmacol 
    2012;12:266‑74.
    78. Romme EA, Smeenk FW, Rutten EP, Wouters EF. Osteoporosis 
    in chronic obstructive pulmonary disease. Expert Rev Respir 
    Med 2013;7:397‑410.
    79. Duckers JM, Evans BA, Fraser WD, Stone MD, Bolton CE, 
    Shale DJ. Low bone mineral density in men with chronic 
    obstructive pulmonary disease. Respir Res 2011;12:101.
    80. Franco CB, Paz‑Filho G, Gomes PE, Nascimento VB, Kulak CA, 
    Boguszewski CL, et al. Chronic obstructive pulmonary disease 
    is associated with osteoporosis and low levels of Vitamin D. 
    Osteoporos Int 2009;20:1881‑7.
    81. Romme EA, Rutten EP, Smeenk FW, Spruit MA, Menheere PP, 
    Wouters EF. Vitamin D status is associated with bone mineral 
    density and functional exercise capacity in patients with 
    chronic obstructive pulmonary disease. Ann Med 2013;45:91‑6.
    82. Skaaby T, Husemoen LL, Thuesen BH, Pisinger C, Jørgensen T, 
    Fenger RV, et al. Vitamin D status and chronic obstructive 
    pulmonary disease: A prospective general population study. 
    PLoS One 2014;9:e90654.
    83. Chishimba L, Thickett DR, Stockley RA, Wood AM. The 
    vitamin D axis in the lung: A key role for Vitamin D‑binding 
    protein. Thorax 2010;65:456‑62.
    84. Metcalf JP, ThompsonAB, Gossman GL, Nelson KJ, Koyama S, 
    Rennard SI, et al. Gcglobulin functions as a cochemotaxin in 
    the lower respiratory tract. A potential mechanism for lung 
    neutrophil recruitment in cigarette smokers. Am Rev Respir 
    Dis 1991;143:844‑9.
    85. DiMartino SJ, Shah AB, Trujillo G, Kew RR. Elastase controls 
    the binding of the Vitamin D‑binding protein (Gc‑globulin) 
    to neutrophils: A potential role in the regulation of C5a 
    co‑chemotactic activity. J Immunol 2001;166:2688‑94.
    86. SalamonH, BruinersN, LakehalK, ShiL, RaviJ, YamaguchiKD, 
    et al. Cutting edge: Vitamin D regulates lipid metabolism in 
    Mycobacterium tuberculosis infection. J Immunol 2014;193:30‑4.
    87. Lalvani A, Connell DW. Dissecting the immunological, antimicrobial and clinical effects of Vitamin D therapy in 
    tuberculosis. Pathog Glob Health 2012;106:378‑9.
    88. Desai NS, Tukvadze N, Frediani JK, Kipiani M, Sanikidze E, 
    Nichols MM, et al. Effects of sunlight and diet on Vitamin D 
    status of pulmonary tuberculosis patients in Tbilisi, Georgia. 
    Nutrition 2012;28:362‑6.
    89. Selvaraj P. Vitamin D, Vitamin D receptor, and cathelicidin in 
    the treatment of tuberculosis. Vitam Horm 2011;86:307‑25.
    90. Dini C, Bianchi A. The potential role of Vitamin D for 
    prevention and treatment of tuberculosis and infectious 
    diseases. Ann Ist Super Sanita 2012;48:319‑27.
    91. Adams JS, Ren S, Liu PT, Chun RF, Lagishetty V, GombartAF, 
    et al. Vitamin D‑directed rheostatic regulation of monocyte 
    antibacterial responses. J Immunol 2009;182:4289‑95.
    92. Chocano‑Bedoya P, Ronnenberg AG. Vitamin D and 
    tuberculosis. Nutr Rev 2009;67:289‑93.
    93. Fabri M, Stenger S, Shin DM, Yuk JM, Liu PT, Realegeno S, 
    et al. Vitamin D is required for IFN-gamma-mediated 
    antimicrobial activity of human macrophages. Sci Transl Med 
    2011;3:104ra102.
    94. Overbergh L, Decallonne B, Waer M, Rutgeerts O, Valckx D, 
    Casteels KM, et al. 1alpha, 25‑dihydroxyvitamin D3 induces 
    an autoantigen‑specific T‑helper 1/T‑helper 2 immune shift 
    in NOD mice immunized with GAD65 (p524‑543). Diabetes 
    2000;49:1301‑7.
    95. Boonstra A, Barrat FJ, Crain C, Heath VL, Savelkoul HF, 
    O’Garra A. 1alpha, 25‑Dihydroxyvitamin d3 has a direct 
    effect on naive CD4(+) T cells to enhance the development of 
    Th2 cells. J Immunol 2001;167:4974‑80.
    96. Lin PL, Flynn JL. Understanding latent tuberculosis: A moving 
    target. J Immunol 2010;185:15‑22.
    97. Nnoaham KE, Clarke A. Low serum Vitamin D levels and 
    tuberculosis: A systematic review and meta‑analysis. Int J 
    Epidemiol 2008;37:113‑9.
    98. Nursyam EW, Amin Z, Rumende CM. The effect of Vitamin 
    D as supplementary treatment in patients with moderately 
    advanced pulmonary tuberculous lesion. Acta Med Indones 
    2006;38:3‑5.
    99. Wejse C, Gomes VF, Rabna P, Gustafson P, Aaby P, Lisse IM, 
    et al. Vitamin D as supplementary treatment for tuberculosis: 
    A double‑blind, randomized, placebo‑controlled trial. Am J 
    Respir Crit Care Med 2009;179:843‑50.
    100. Martineau AR, Timms PM, Bothamley GH, Hanifa Y, 
    Islam K, Claxton AP, et al. High‑dose Vitamin D (3) during 
    intensive‑phase antimicrobial treatment of pulmonary 
    tuberculosis: A double‑blind randomised controlled trial. 
    Lancet 2011;377:242‑50.
    101. Salahuddin N, Ali F, Hasan Z, Rao N, Aqeel M, Mahmood F. 
    Vitamin D accelerates clinical recovery from tuberculosis: 
    Results of the SUCCINCT Study [Supplementary 
    Cholecalciferol in recovery from tuberculosis]. Arandomized, 
    placebo‑controlled, clinical trial of Vitamin D supplementation 
    in patients with pulmonary tuberculosis’. BMC Infect Dis 
    2013;13:22.
    102. Daley P, Jagannathan V, John KR, Sarojini J, Latha A, Vieth R, 
    et al. Adjunctive Vitamin D for treatment of active tuberculosis 
    in India: A randomised, double‑blind, placebo‑controlled trial. 
    Lancet Infect Dis 2015;15:528‑34.
    103. Martineau AR, Wilkinson RJ, Wilkinson KA, Newton SM, 
    Kampmann B, Hall BM, et al. A single dose of Vitamin D 
    enhances immunity to mycobacteria. Am J Respir Crit Care 
    Med 2007;176:208‑13.
    104. Holick MF. Vitamin D status: Measurement, interpretation, 
    and clinical application. Ann Epidemiol 2009;19:73‑8.
    105. Holick MF, Binkley NC, Bischoff‑Ferrari HA, Gordon CM, 
    Hanley DA, Heaney RP, et al. Evaluation, treatment, 
    and prevention of Vitamin D deficiency: An endocrine 
    society clinical practice guideline. J Clin Endocrinol Metab 
    2011;96:1911‑30.
    106. Vieth R. Vitamin D nutrient to treat TB begs the prevention 
    question. Lancet 2011;377:189‑90.
    107. Douglas AS, Strachan DP, Maxwell JD. Seasonality of 
    tuberculosis: The reverse of other respiratory diseases in the 
    UK. Thorax 1996;51:944‑6.
    108. Martineau AR, Nhamoyebonde S, Oni T, Rangaka MX, 
    Marais S, Bangani N, et al. Reciprocal seasonal variation in 
    Vitamin D status and tuberculosis notifications in Cape Town, 
    South Africa. Proc Natl Acad Sci U S A 2011;108:19013‑7.
    109. Schaaf HS, Nel ED, Beyers N, Gie RP, Scott F, Donald PR. 
    Adecade of experience with Mycobacterium tuberculosis culture 
    from children: A seasonal influence on incidence of childhood 
    tuberculosis. Tuber Lung Dis 1996;77:43‑6.
    110. Thorpe LE, Laserson K, Cookson S, Mills W, Field K, 
    Koppaka VR, et al. Infectious tuberculosis among newly 
    arrived refugees in the United States. N Engl J Med 
    2004;350:2105‑6.
    111. Strachan DP, Powell KJ, Thaker A, Millard FJ, Maxwell JD. 
    Vegetarian diet as a risk factor for tuberculosis in immigrant 
    South London Asians. Thorax 1995;50:175‑80.
    112. Williams B, Williams AJ, Anderson ST. Vitamin D deficiency 
    and insufficiency in children with tuberculosis. Pediatr Infect 
    Dis J 2008;27:941‑2.
    113. WilkinsonRJ, LlewelynM, ToossiZ, PatelP, PasvolG, LalvaniA, 
    et al. Influence of Vitamin D deficiency and Vitamin D receptor 
    polymorphisms on tuberculosis among Gujarati Asians in West 
    London: A case‑control study. Lancet 2000;355:618‑21.
    114. Bellamy R, Ruwende C, Corrah T, McAdam KP, Thursz M, 
    Whittle HC, et al. Tuberculosis and chronic hepatitis B virus 
    infection in Africans and variation in the Vitamin D receptor 
    gene. J Infect Dis 1999;179:721‑4.
    115. Coussens AK, Wilkinson RJ, Hanifa Y, Nikolayevskyy V, 
    Elkington PT, Islam K, et al. Vitamin D accelerates resolution 
    of inflammatory responses during tuberculosis treatment. 
    Proc Natl Acad Sci U S A 2012;109:15449‑54.
    116. Alyasin S, Momen T, Kashef S, Alipour A, Amin R. The 
    relationship between serum 25 hydroxy Vitamin D levels and 
    asthma in children. Allergy Asthma Immunol Res 2011;3:251‑5.
    117. Quint JK, Wedzicha JA. Is Vitamin D deficiency important in 
    the natural history of COPD? Thorax 2010;65:192‑4.
    118. Uitterlinden AG, Fang Y, Van Meurs JB, Pols HA, Van 
    Leeuwen JP. Genetics and biology of Vitamin D receptor 
    polymorphisms. Gene 2004;338:143‑56.
    119. Gibney KB, MacGregor L, Leder K, Torresi J, Marshall C, 
    Ebeling PR, et al. Vitamin D deficiency is associated with 
    tuberculosis and latent tuberculosis infection in immigra