Cholecalciferol 25-hydroxylation

Metabolites of vitamin D, eg, cholecalciferol (CC), are essential in maintaining the appropriate blood level of Ca ". The active metabolite, 1,25-dihydroxycholecalciferol (1,25-DHCC), is synthesized in two steps. In the fiver, CC is hydroxylated to 25-hydroxycholecalciferol (25-HCC) which, in combination with a globulin carrier, is transported to the kidney where it is converted to 1,25-DHCC. This step, which requites 1-hydroxylase formation, induced by PTH, may be the controlling step in regulating Ca " concentration. The sites of action of 1,25-DHCC are the bones and the intestine. Formation of 1,25-DHCC is limited by an inactivation process, ie, conversion of 25-HCC to 24,25-DHCC, catalyzed by 24-hydroxylase. 

The active vitamins are produced by conversion of provitamins by ultraviolet light. Ergosterol, a yeast sterol, is converted to its active form, ergocalciferol (vitamin D2), and 7-dehydrocholesterol, which is found in many natural foods and is also synthesized in man, is converted to cholecalciferol (vitamin D3). Fish liver oils are virtually the only source of vitamin D3 in nature. The most active form of vitamin D3 is 1,25-dihydroxycholecalciferol and this is produced by the hydroxylation of cholecalciferol at position 25 in the liver and then at position 1 in the kidney. 

The precursor, 7-dehydrocholesterol is converted by a non-enzymatic reaction to cholecalciferol (calciol). This reaction occurs in skin exposed to sunlight due to irradiation by UV-B light at a wavelength of about 300 nm. Cholecalciferol is transported via carrier proteins to the liver where hydroxylation at carbon-25 occurs in a reaction catalysed by a microsomal cytochrome P450 hydroxylase to form calcidiol. This compound travels to the kidney attached to specific binding proteins, where another cytochrome P450 enzyme, mitochondrial 1-a-hydroxylase, introduces a second hydroxyl group in to the molecule to form the active calcitriol. 

There seems to be no metabolic control exerted on hepatic 25-hydroxylase and so all of the available cholecalciferol is converted. Hydroxylation in the kidney however is an important control point being regulated by PTH, and indirectly therefore by calcium and phosphate concentrations. Stimulation of la-hydroxylase by PTH is via a cyclic AMP (cAMP) -dependent mechanism and longer-term regulation of the activity of this enzyme is via induction mediated by other hormones such as oestrogens, cortisol and growth hormone. Typically, the plasma concentration of 1,25 dihydroxy vitamin D is in the range 20-60 ng/1, that is approximately 1000-times lower than that of its precursor. 

In the human body, cholecalciferol and ergocalciferol undergo two metabolic transformations to yield the active vitamin D molecule. These are additions of hydroxyl groups, first in the liver to produce 25-hydroxyvitamin D and then in the kidney. The final product has the unwieldy name la, 25-dihydroxycholecalciferol, and is more commonly known by its simpler name 1,25-dihydroxy vitamin D or, even more simply, l,25(OH)2D. 

In the skin, cholesterol is converted to 7-dehydrocholes-terol by desaturation of the 9,10-carbon bond and ultraviolet light breaks this bond to produce cholecalciferol (Figure 15.12). The cholecalciferol is transported via the bloodstream to the liver where the first step in the activation of the hormone occurs, namely hydroxylation by a monooxygenase to produce 25-hydroxy cholecalciferol, which is transported to the kidney where a further hydroxylation takes place at the 1-position to produce la,25-dihydroxycholecalciferol, which is the active form of the hormone (Figure 15.13). 

Vitamin D hormone is derived from vitamin D (cholecalciferol). Vitamin D can also be produced in the body it is formed in the skin from dehydrocholesterol during irradiation with UV light. When there is lack of solar radiation, dietary intake becomes essential, cod liver oil being a rich source. Metaboli-cally active vitamin D hormone results from two successive hydroxylations in the liver at position 25 ( calcifediol) and in the kidney at position 1 ( calci-triol = vit. D hormone). 1-Hydroxylation depends on the level of calcium homeostasis and is stimulated by parathormone and a fall in plasma levels of Ca or phosphate. Vit D hormone promotes enteral absorption and renal reabsorption of Ca and phosphate. As a result of the increased Ca + and phosphate concentration in blood, there is an increased tendency for these ions to be deposited in bone in the form of hydroxyapatite crystals. In vit D deficiency, bone mineralization is inadequate (rickets, osteomalacia). Therapeutic Liillmann, Color Atlas of Pharmacology... 

On the way to calcitriol (vitamin D hormone see p.342), another double bond in the B ring of cholesterol is first introduced. Under the influence of UV light on the skin, the B ring is then photochemically cleaved, and the secosteroid cholecalciferol arises (vitamin Dai see p.364). Two Cyt P450-depen-dent hydroxylations in the liver and kidneys produce the active vitamin D hormone (see p. 330). 

Dietary causes of vitamin D deficiency are unusual except among the poor and malnourished, and in those with fat malabsorption. Reduced exposure to sunlight may then become a critical factor. Renal failure can impair 1-hydroxylation of cholecalciferol, and chronic liver disease can reduce 25-hydroxylation as well as contributing to malabsorption. 

Vitamin D is the collective term for a group of compounds formed by the action of ultraviolet irradiation on sterols. Cholecalciferol (vitamin D3) and calciferol (vitamin D2) are formed by irradiation of the provitamins 7-dehydrocholesterol and ergosterol, respectively. The conversion to vitamin D3 occurs in the skin. The liver is the principal storage site for vitamin D, and it is here that the vitamin is hydroxylated to form 25-hydroxyvitamin D. Additional hydroxylation to form 1,25-dihydroxyvita-min D occurs in the kidney in response to the need for calcium and phosphate. A discussion of the role of vitamin D in calcium homeostasis is provided in Chapter 66. 

T FIGURE 10-20 Vitamin D3 production and metabolism, (a) Cholecalciferol (vitamin D3) is produced in the skin by UV irradiation of 7-dehydrocholesterol, which breaks the bond shaded pink. In the liver, a hydroxyl group is added at C-25 (pink) in the kidney, a second hydroxylation at C-1 (pink) produces the active hormone, 1,25-dihydroxycholecalciferol. This hormone regulates the metabolism of Ca2+ in kidney, intestine, and bone, (b) Dietary vitamin D prevents rickets, a disease once common in cold climates where heavy clothing blocks the UV component of sunlight necessary for the production of vitamin D3 in skin. On the left is a 21/2-year-old boy with severe rickets on the right, the same boy at age 5, after 14 months of vitamin D therapy. 

PH Mattila, VI Piironen, EJ Uusi-Rauva, PE Koivistoinen. Contents of cholecalciferol, ergocalcif-erol, and their 25-hydroxylated metabolites in milk products and raw meat and liver as determined by HPLC. J Agric Food Chem 43 2394-2399, 1995. 

Vitamin D3 (cholecalciferol) can be made in the skin from 7-dehydrocholesterol in the presence of ultraviolet light (see fig. 24.13). Vitamin D3 is formed by the cleavage of ring 3 of 7-dehydrocholesterol. Vitamin D3 made in skin or absorbed from the small intestine is transported to the liver and hydroxylated at C-25 by a microsomal mixed-... 

The combination of rifampicin and isoniazid reduces serum concentrations of 25-hydroxy cholecalciferol. Rifampicin acts by induction of an enzyme that promotes conversion of 25-hydroxycholecalciferol to an inactive metabolite, and isoniazid acts by inhibiting 25-hydroxyla-tion and 1-hydroxylation (SEDA-14, 258). Children or pregnant women with tuberculosis have increased calcium requirements independent of rifampicin administration... 

Vitamin D regulates calcium and phosphorus absorption and deposition and serum alkaline phosphatase levels. The recommended daily allowance is 5 /xg, increasing to 10 to 15 /xg in older age.109 Vitamin D3 is synthesized under UVB irradiation in the skin where it is stored and released into the circulation in a complex with the vitamin D binding protein. In liver it is hydroxylated to 25(OH)-cholecalciferol, the hormonal precursor, followed by another hydroxylation step in the... 

Cholecalciferol is hydroxylated at three positions in the carbon skeleton, 1, 24, and 25. In the liver, cholecalciferol is hydroxylated to 25-hydroxycholecalciferol. Further hydroxylation reactions occur in the kidney, resulting in the formation of three new metabolites. These are 1,25-dihydroxycholecalciferol 24,25-dihydroxycholecalciferol and 1,24,25-trihydroxycholecalciferol. 1,25-Dihydroxy- and 1,24,25-trihydroxycholecalciferol are active hormones involved in calcium uptake from the intestine. 

Vitamin D j (cholecalciferol) derives from the photochemical cleavage of 7-dehydrocholes-terol and subsequent successive hydroxylations yield the active vitamin D receptor agonist... 

Both dietary and endogenously synthesized vitamin D undergo 25-hy-droxylation in the liver to yield calcidiol (25-hydroxycholecalciferol), which is the main circulating form of the vitamin. This undergoes 1 -hydroxylation in the kidney to produce the active hormone calcitriol (1,25-dihydroxy-cholecalciferol) or 24-hydroxylation in the kidney and other tissues to yield 24-hydroxycalcidiol (24,25-dihydroxycholecalciferol). 

Cholecalciferol 25-hydroxylase is not restricted to the liver kidneys, skin, and gut microsomes also have a cytochrome P450 -dependent enzyme that catalyzes the 25-hydroxylation of cholecalciferol and la-hydroxycholecalciferol, hut not ergocalciferol. Although there is some evidence that calcitriol can reduce the activity of calciferol 25-hydroxylase, it is not known whether this is physiologically important the major factor controlling 25-hydroxylation is the rate of uptake of cholecalciferol into the liver. It is the fate of calcidiol in the kidneys that provides the most important regulation of vitamin D metabolism (Wikvall, 2001). 

Most vitamin D is excreted in the bile less than 5% is excreted as water-soluble metabolites in urine. Some 2% to 3% of the vitamin D in bUe is cholecalciferol, calcidiol, and calcitriol, but most is a variety of polar metabolites and their glucuronide conjugates. In most tissues, the major pathway for inactivation of calcitriol is by way of 24-hydroxylation to calcitetrol, then onward oxidation byway of the 24-oxo-derivative, 23-hydroxylation, and oxidation to calcitroic acid (see Figure 3.3). In addition, a variety of hydroxylated and other polar metabolites have been identified in bile, and many of these onward oxidation products also undergo glucuronide conjugation in the liver (Reddy and Tserng, 1989). 

Disposition in the Body. Well absorbed after oral administration and subject to enterohepatic circulation decreased absorption may occur in subjects with impaired liver and biliary function. Metabolised by hydroxylation to active metabolites. The major metabolite is 25-hydroxycholecalciferol which is formed in the liver. This is further metabolised by la- or 24-hydroxylation in the kidneys. Most of a dose is excreted in the bile and eliminated in the faeces about 25% of a dose is excreted as conjugates. Unchanged cholecalciferol does not appear to be excreted in the urine. 

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