Calcitriol, the active form of vitamin D, is produced in the kidneys and increases calcium absorption in the intestines and bones. It binds to vitamin D binding proteins and is transported to tissues, where it binds to vitamin D receptors to increase intestinal calcium absorption, promote bone mineralization, and regulate calcium levels through effects on kidneys, muscles, and other tissues. Abnormalities associated with calcitriol include rickets and osteomalacia due to vitamin D deficiency, as well as hypervitaminosis D from extremely high vitamin D levels which can cause hypercalcemia and tissue calcification.
4. Introduction:Calcitriol also called 1,25-dihydroxycholecalciferol, active form of vitamin D with three alcohol groupsIt increases the level of calcium (Ca2+) in the blood
5. Biosynthesis and its regulation:Produced in the cells of the proximal tubule of the nephron By the action of 25-hydroxyvitamin D3 1-alpha-hydroxylaseThe activity of the enzyme is stimulated by - PTH.- Prolactin - Decreased levels of serum phosphate
8. Transport:Vitamin D-binding protein belongs to the albumin family458 amino acids Coded by 1690 nucleotides on chromosome 4Found in -plasma, -cerebrospinal fluid -on the surface of many cell typesIt binds to vitamin D and its plasma metabolites and transports them to target tissues
14. On bones: Type 1 Collagen osteoclastinOsteoblasts Osteoclast absorption of Cain bones
16. Action on kidneysA major action of calcitriol is to regulate renal 25-hydroxyvitamin D,-1-hydroxylaseIt has been shown that calcitriol brings about a suppression of this enzymeThus it helps to regulate the formation of calcitriol by negative feedback inhibition.
17. On skeletal and cardiac muscles the rate of Ca uptake by sarcoplasmic reticulum of skeletal muscles skeletal muscle massCan cause the calcification of cardiac muscle Lead to myocardial failure
18. On cancer cells:Cancerous cells have receptors for calcitriolCalcitriol represses the cell proliferationSo it along with its analogs can be use for treating the cancer
19. On skin: melanin synthesis.preventing the skin penetration of sunlight.7-dehydrocholesterol is not converted to pre-vitamin DFeedback regulation.
20. Endocrine functions:Parathyroid Gland:Inhibits the proliferation of parathyroid cellsInhibits the parathyroid genes form transcriptionThus can be used to treat hyper-parathyroidism.Pituitary glandIncreases prolactin synthesis and secretion from pituitary cells.
21. Pancreas:vitamin D deficiency inhibited insulin secretion from the pancreas, whereas vitamin D repletion improved insulin secretion
22. Disorders related to calcitriol:Vitamin D deficiency:Type I:Type II:Body is unable to utilize vitamin D due to defect in the receptor of calcitriol.hydroxylase25,OH –D3calcitriol
23. Diseases related to vitamin D deficiencyRickets- Softening of bones in children potentially leading to fractures and deformity in bonesThe predominant cause is a vitamin DdeficiencySign & symptoms:Bone pain or tendernessdental problemsmuscle weaknessGrowth disturbanceHypocalcemiaTetany
25. OsteomalaciaOsteomalacia is the softening of the bones due to defective bone mineralizationSigns and SymptomsWeak bonesBone painMuscle weaknessHypocalcemiaCompressed vertebraeFracturesBone softeningBending of bonesPain
26. Treatment Oral administration of vitamin D. Osteomalaciadue to malabsorption may require treatment by injection of significant amounts of vitamin D.
27. Hypervitaminosis DIs tolerable But deleterious in extreme large dosage 500-1000 times than normalEffects:Immediate effects:AnorexiaThirstLassitude(fatigue) Constipation PolyuriaNausea Vomiting Diarrhoea
28. Delayed effects: persistent hypercalcemia and hyperphospatemia may resultUrinary lithasisMetastatic calcificationEffecting Kidneys