2. Sunshine vitamin Vitamin D is found to act on target organs like bones, kidneys, intestinal mucosa to regulate calcium and phosphate metabolisms. Vitamin D is found to act on target organs like bones, kidneys, intestinal mucosa to regulate calcium and phosphate metabolisms.

4. Formation of Vitamin D Vitamin D is derived either from 7-dehydrocholesterol or ergosterol by the action of ultraviolet radiations. 7-dehydrocholesterol, an intermediate of a minor pathway of cholesterol synthesis, is available in the Malpighian layer of epidermis. Vitamin D is derived either from 7-dehydrocholesterol or ergosterol by the action of ultraviolet radiations. 7-dehydrocholesterol, an intermediate of a minor pathway of cholesterol synthesis, is available in the Malpighian layer of epidermis. In the skin, ultraviolet light (290-315 nm) breaks the bond between position 9 and 10 of the steroid ring. So, the ring B is opened, to form the provitamin, secosterol In the skin, ultraviolet light (290-315 nm) breaks the bond between position 9 and 10 of the steroid ring. So, the ring B is opened, to form the provitamin, secosterol

6. Vitamin D is a prohormone. i.The cholecalciferol is first transported to liver, where hydroxylation at 25th position occurs, to form 25-hydroxy cholecalciferol (25-HCC). ii.The hepatic 25-hydroxylase is a microsomal monooxygenase. iii.It requires cytochrome P-450 and NADPH. iv.25-HCC is the major storage form. Vitamin D is a prohormone. i.The cholecalciferol is first transported to liver, where hydroxylation at 25th position occurs, to form 25-hydroxy cholecalciferol (25-HCC). ii.The hepatic 25-hydroxylase is a microsomal monooxygenase. iii.It requires cytochrome P-450 and NADPH. iv.25-HCC is the major storage form. In plasma, 25-HCC is bound to "vitamin D binding protein" (VDBP), an alpha-2 globulin. In the kidney, it is further hydroxylated at the 1st position. The 1-alpha hydroxylase is located in mitochondria of proximal convoluted tubules. It requires cytochrome P-450, NADPH and ferrodoxin (an iron-sulfur protein). Thus 1,25-dihydroxy cholecalciferol (DHCC) is generated. Contains three hydroxyl groups at 1, 3 and 25 positions, it is also called Calcitriol. In the kidney, it is further hydroxylated at the 1st position. The 1-alpha hydroxylase is located in mitochondria of proximal convoluted tubules. It requires cytochrome P-450, NADPH and ferrodoxin (an iron-sulfur protein). Thus 1,25-dihydroxy cholecalciferol (DHCC) is generated. Contains three hydroxyl groups at 1, 3 and 25 positions, it is also called Calcitriol.

7. Biochemical Effects of Vitamin D The sites of action are: a. intestinal villi cells b. bone osteoblasts c. kidney distal tubular cells. The sites of action are: a. intestinal villi cells b. bone osteoblasts c. kidney distal tubular cells.

8. A. INTESTINAL VILLI CELLS  Calcitriol acts like a steroid hormone.  It enters the target cell and binds to a cytoplasmic receptor.  The hormone-receptor complex interacts with DNA and causes derepression and consequent transcription of specific genes that code for Calbindin(calcium binding protein).  Due to the increased availability of calcium binding protein, the absorption of calcium is increased.  Calcitriol acts like a steroid hormone.  It enters the target cell and binds to a cytoplasmic receptor.  The hormone-receptor complex interacts with DNA and causes derepression and consequent transcription of specific genes that code for Calbindin(calcium binding protein).  Due to the increased availability of calcium binding protein, the absorption of calcium is increased. calcium binding protein

9. B. Effect of Vitamin D in Bone I.Mineralization of the bone is increased by increasing the activity of osteoblasts. II.Calcitriol coordinates the remodelling action of osteoclasts and osteoblasts. III.It produces the differentiation of osteoclast precursors from multinucleated cells of osteoblast lineage. I.Mineralization of the bone is increased by increasing the activity of osteoblasts. II.Calcitriol coordinates the remodelling action of osteoclasts and osteoblasts. III.It produces the differentiation of osteoclast precursors from multinucleated cells of osteoblast lineage.

10. C. Effect of Vitamin D in Renal Tubules Calcitriol increases the re absorption of calcium and phosphorus by renal tubules, therefore both minerals are conserved. C. Effect of Vitamin D in Renal Tubules Calcitriol increases the re absorption of calcium and phosphorus by renal tubules, therefore both minerals are conserved.

14. Vitamin D is Hormone and not Vitamin Calciferol Points in favour of above statement are: Structurally both have “cyclo-pentanoperhydrophenan-threne”nucleus like a steroid hormone. Vitamin D (cholecalciferol) is synthesised in human skin by UV irradiation from its precursor Provitamin D3 (7dehydrocholesterol). Vitamin D as such is inactive and is only the storage form. It is converted in liver to 25-OH-D3 active 1,25 {(OH)2-D3 3 (calcidiol) and biological (calcitriol)} in kidney. Like hormones, the formation of both the biological active forms 25- OH-D3 and 1,25-di-OH-D are subject to “feed- back” inhibition. Like hormones, calcitriol has definite “target” organs like small intestine, bones and kidneys to act upon. Points in favour of above statement are: Structurally both have “cyclo-pentanoperhydrophenan-threne”nucleus like a steroid hormone. Vitamin D (cholecalciferol) is synthesised in human skin by UV irradiation from its precursor Provitamin D3 (7dehydrocholesterol). Vitamin D as such is inactive and is only the storage form. It is converted in liver to 25-OH-D3 active 1,25 {(OH)2-D3 3 (calcidiol) and biological (calcitriol)} in kidney. Like hormones, the formation of both the biological active forms 25- OH-D3 and 1,25-di-OH-D are subject to “feed- back” inhibition. Like hormones, calcitriol has definite “target” organs like small intestine, bones and kidneys to act upon.

15. Thus, it is produced in one organ and acts upon distant target organs for its activity (property of hormone). Calcitriol resembles steroid hormone in its mode of action, i.e. nuclear action. Calcitriol maintains calcium homeostasis alongwith—two other protein hormones parathormone (PTH) and calcitonin. Parathormone (PTH) is considered as a “tropic” hormone for calcitriol, it increases the calcitriol production by stimulating the enzyme “1 a-hydroxylase” in kidney tubules Thus, it is produced in one organ and acts upon distant target organs for its activity (property of hormone). Calcitriol resembles steroid hormone in its mode of action, i.e. nuclear action. Calcitriol maintains calcium homeostasis alongwith—two other protein hormones parathormone (PTH) and calcitonin. Parathormone (PTH) is considered as a “tropic” hormone for calcitriol, it increases the calcitriol production by stimulating the enzyme “1 a-hydroxylase” in kidney tubules

16. Deficiency of Vitamin D The deficiency diseases are rickets in children and osteomalacia in adults. Hence vitamin D is known as antirachitic vitamin. A. Causes for Vitamin D Deficiency i. Deficiency of vitamin D can occur in people who are not exposed to sunlight properly, e.g. inhabitants of northern latitudes, in winter months, in people who are bedridden for long periods, or those who cover the whole body (purdah). ii. Nutritional deficiency of calcium or phosphate may also produce similar clinical picture. iii. Malabsorption of vitamin (obstructive jaundice and steatorrhea). High phytate content in diet may also reduce the absorption of vitamin. iv. Abnormality of vitamin D activation. Liver and renal diseases may retard the hydroxylation reactions. v. Deficient renal absorption of phosphates. A. Causes for Vitamin D Deficiency i. Deficiency of vitamin D can occur in people who are not exposed to sunlight properly, e.g. inhabitants of northern latitudes, in winter months, in people who are bedridden for long periods, or those who cover the whole body (purdah). ii. Nutritional deficiency of calcium or phosphate may also produce similar clinical picture. iii. Malabsorption of vitamin (obstructive jaundice and steatorrhea). High phytate content in diet may also reduce the absorption of vitamin. iv. Abnormality of vitamin D activation. Liver and renal diseases may retard the hydroxylation reactions. v. Deficient renal absorption of phosphates.

17. RICKETS : osteopenia with disordered calcification leading to higher proportion of osteoid (unmineralized) tissue prior to epiphyseal closure (in childhood) OSTEOMALACIA : osteopenia with disordered calcification leading to higher proportion of osteoid (unmineralized) tissue after epiphyseal closure (in adulthood) RICKETS : osteopenia with disordered calcification leading to higher proportion of osteoid (unmineralized) tissue prior to epiphyseal closure (in childhood) OSTEOMALACIA : osteopenia with disordered calcification leading to higher proportion of osteoid (unmineralized) tissue after epiphyseal closure (in adulthood)

18. B. Clinical Features of Rickets 1.Rickets is seen in children. There is insufficient mineralization of bone. Bones become soft and pliable. The bone growth is markedly affected. ii. Plasma calcium and phosphorus are low Normal with alkaline phosphatase (bone isoenzyme) being markedly elevated. B. Clinical Features of Rickets 1.Rickets is seen in children. There is insufficient mineralization of bone. Bones become soft and pliable. The bone growth is markedly affected. ii. Plasma calcium and phosphorus are low Normal with alkaline phosphatase (bone isoenzyme) being markedly elevated.

19. The classical features of rickets are bone deformities. Weight bearing bones are bent. Continued action of muscles also cause bone malformations.

20. The clinical manifestations include  Bow legs,  knock-knee  Rickety rosary  Bossing of frontal bones  Pigeon chest. The clinical manifestations include  Bow legs,  knock-knee  Rickety rosary  Bossing of frontal bones  Pigeon chest.

21. The deficiency of vitamin D in adults is osteomalacia which is rare. It can occur: In pregnancy and lactation: Where there is additional requirement of this vitamin and drainage of it in milk. In women who observe purdah or in climates where sunshine is scanty, calcium and phosphorus absorption is decreased. Consequently mineralisation of osteoid to form bone is impaired. Such bones become soft. This particularly affects pelvic bones. The deficiency of vitamin D in adults is osteomalacia which is rare. It can occur: In pregnancy and lactation: Where there is additional requirement of this vitamin and drainage of it in milk. In women who observe purdah or in climates where sunshine is scanty, calcium and phosphorus absorption is decreased. Consequently mineralisation of osteoid to form bone is impaired. Such bones become soft. This particularly affects pelvic bones.

22. Renal osteodystrophy Chronic renal failure results in decreased ability to form the active form of vitamin D. Supplementation with calcitriol is an effective therapy. Hypoparathyroidism Lack of parathyroid hormone causes Hypocalcemia and hyperphosphatemia. These patients may be treated with calcitriol and calcium supplementation. Renal osteodystrophy Chronic renal failure results in decreased ability to form the active form of vitamin D. Supplementation with calcitriol is an effective therapy. Hypoparathyroidism Lack of parathyroid hormone causes Hypocalcemia and hyperphosphatemia. These patients may be treated with calcitriol and calcium supplementation.

23. Requirement of Vitamin D i. Children = 10 microgram (400 IU)/day ii. Adults = 5 microgram (200 IU)/day iii. Pregnancy, lactation = 10 microgram/day iv. Above the age of 60 = 600 IU per day. Requirement of Vitamin D i. Children = 10 microgram (400 IU)/day ii. Adults = 5 microgram (200 IU)/day iii. Pregnancy, lactation = 10 microgram/day iv. Above the age of 60 = 600 IU per day.

24. Hypervitaminosis D Doses above 1500 units per day for very long periods may cause toxicity. Symptoms include weakness, polyuria, intense thirst, difficulty in speaking, hypertension and weight loss. Hypercalcemia leads to calcification of soft tissues, (metastatic calcification, otherwise called calcinosis), especially in vascular and renal tissues. Although vitamin D is toxic in higher doses, excessive exposure to sunlight does not result in vitamin D toxicity, because excess D3 is destroyed by sunlight itself. Hypervitaminosis D Doses above 1500 units per day for very long periods may cause toxicity. Symptoms include weakness, polyuria, intense thirst, difficulty in speaking, hypertension and weight loss. Hypercalcemia leads to calcification of soft tissues, (metastatic calcification, otherwise called calcinosis), especially in vascular and renal tissues. Although vitamin D is toxic in higher doses, excessive exposure to sunlight does not result in vitamin D toxicity, because excess D3 is destroyed by sunlight itself.