Narrowband UVB Phototherapy for Clinically Isolated Syndrome: A Trial to Deliver the Benefits of Vitamin D and Other UVB-Induced Molecules

Prue H Hart; Robyn M Lucas; David R Booth; William M Carroll; David Nolan; Judith M Cole; Anderson P Jones; Allan G Kermode

doi:10.3389/fimmu.2017.00003

Narrowband UVB Phototherapy for Clinically Isolated Syndrome: A Trial to Deliver the Benefits of Vitamin D and Other UVB-Induced Molecules

Front Immunol. 2017 Jan 24:8:3. doi: 10.3389/fimmu.2017.00003. eCollection 2017.

Authors

Prue H Hart¹, Robyn M Lucas², David R Booth³, William M Carroll⁴, David Nolan⁵, Judith M Cole⁶, Anderson P Jones¹, Allan G Kermode⁷

Affiliations

¹ Telethon Kids Institute, University of Western Australia , Perth, WA , Australia.
² Telethon Kids Institute, University of Western Australia, Perth, WA, Australia; National Centre for Epidemiology and Public Health, Research School of Population Health, Australian National University, Canberra, ACT, Australia.
³ The Westmead Institute for Medical Research, University of Sydney , Westmead, NSW , Australia.
⁴ Centre for Neuromuscular and Neurological Disorders, Western Australian Neuroscience Research Institute, University of Western Australia, Sir Charles Gairdner Hospital , Perth, WA , Australia.
⁵ Institute for Immunology and Infectious Disease, Murdoch University, Perth, WA, Australia; Royal Perth Hospital, Immunology Department, Perth, WA, Australia.
⁶ St John of God Dermatology , Subiaco, WA , Australia.
⁷ Centre for Neuromuscular and Neurological Disorders, Western Australian Neuroscience Research Institute, University of Western Australia, Sir Charles Gairdner Hospital, Perth, WA, Australia; Institute for Immunology and Infectious Disease, Murdoch University, Perth, WA, Australia.

Abstract

Low vitamin D and insufficient sun exposure are additive independent risk factors for the development of multiple sclerosis (MS). The usual measure of vitamin D status, serum 25-hydroxy vitamin D [25(OH)D], is also a marker of recent exposure to the UVB rays of sunshine. The main evidence for a protective effect for MS development of higher 25(OH)D comes from observational studies, but this study design cannot separate out whether 25(OH)D is acting as a marker of vitamin D status, sun exposure, or both. In light of a lack of definitive outcomes in MS patients after trials of vitamin D supplementation and the ability of narrowband UVB to induce vitamin D, as well as other immune-regulatory molecules in skin, the Phototherapy for Clinically Isolated Syndrome (PhoCIS) trial was established to investigate the benefits of narrowband UVB, in addition to supplemented vitamin D, on MS development in individuals with Clinically Isolated Syndrome. We propose that the PhoCIS trial provides a fresh approach to re-defining the reported associations of 25(OH)D levels with MS development and progression.

Keywords: UV-induced immunosuppression; clinically isolated syndrome; multiple sclerosis; narrowband UVB phototherapy; trial; vitamin D; vitamin D supplementation.