Lecture 9 Cancer Prevention or Exacerbation

Lecture 9 Cancer Prevention or ExacerbationFolate and Vitamin DEvidence based medicine aims toApply best available evidence from clinical trials to clinical decision makingAssess strength of evidence with respect to riskbenefits of treatmentdiagnostic testsLevels of evidenceI RCTs metaanalyses systematic reviewsII Cohort case control studiesIII opinions case studies expert communitiesPhases of clinical trialsPhase 1 Safety ScreeningPhase 2 Dosefinding initial efficacyPhase 3 Final testing efficacy and compare to current RxPhase 4 postapproval studiesClinical evidence against smoking based on prospective cohort epidemiologyLow 25OHD predicts multiple sclerosis MS125OH2D affects antigen presentationTh1 development125OH2D influences Th1Th2 developmentLinking vitamin D with MSGeographical variationImmunomodulation of 125OH2DSeason of birthVDDR1 and concurrent MS case studyRelapseremission and increasedecrease 25OHDOral vitamin D intake UVB radiationDecreased 25OHDSeasonal MRI activityA phase 12 dose escalation study of high dose of vitamin D supplementation in MS patients randomized openlabel matched intervention trialSummaryMean serum 25OHD concentration 420nmolL without significant changes in serumurinary Ca measuresDosing regimenphysiologically attainable 25OHD concentrations at 1yrNo significant adverse effectsTreatment groupimproveLymphocyte proliferation assayT cell proliferative response to MSassociated antigentic stimulation were significantly reduced in treated