晒太阳治愈肺结核

Curing TB with sunlight 

Birth of Phototherapy

　

Ultraviolet (UV) light makes vitamin D, and vitamin D turns on innate immunity to tuberculosis (TB), say Steffen Stenger (Universität Erlangen, Germany), Philip Liu, Robert Modlin (University of California, Los Angeles, CA), and colleagues. The lower absorption of UV light by African Americans, leading to lower vitamin D levels, may be one reason why this group is more susceptible to TB. 

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Figure 1

African Americans induce less of a TB-fighting peptide.

 

MODLIN/AAAS

 

Chemicals from bugs turn on the innate immune response via Toll-like receptors (TLRs). Modlin had already found that activating TLRs killed off intracellular Mycobacterium tuberculosis. Nitric oxide (NO) was the downstream mediator for this in mouse cells, but “we've been grasping for a decade to find a mechanism in humans,” says coauthor Barry Bloom (Harvard School of Public Health, Boston, MA).

 

The answer came from gene arrays. Active TLR turned on production of both an enzyme (which converts 25D3 into active vitamin D) and the vitamin D receptor. The activated pathway produced an antimicrobial peptide called cathelicidin, which attached itself to intracellular M. tuberculosis, and is a prime suspect for causing its death.

 

Serum from white-skinned donors had enough of the precursor (25D3) to keep this pathway active, but serum from African Americans was short on 25D3 and supported a much lower output of cathelicidin. The shortfall was corrected by adding 25D3.

 

The finding may explain why Hermann Brehmer's 19th century trip to the Himalayas cured him of his TB, and why the fresh air at his sanatoria helped cure others. “Our forefathers knew a lot more about this than we give them credit for,” says Modlin. Eventually, however, sanitoria coddled their patients behind glass, which would have blocked the beneficial UV light.

 

Although pigmented skin blocks out a lot of UV light, Africans and Asians probably got their fair share before the modern age introduced clothes. Now, however, supplementation may be needed. Bloom plans to test whether vitamin D supplementation can reduce TB transmission within families, speed cures by anti-TB drugs, or slow TB reactivation. “These are not trivial studies to undertake,” he says, “but it could make a big difference.”An external file that holds a picture, illustration, etc.

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J Cell Biol. 2006 Mar 27; 172(7): 958.

doi:  [10.1083/jcb.1727rr2]

PMCID: PMC2063771

Research Roundup

William A. Wells

Author information Copyright and License information Disclaimer

　

Reference:

 

Liu, P.T., et al. 2006. Science. 10.1126/science.1123933. [PubMed] [CrossRef]

 

Curing TB with sunlight  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2063771/

　

　

Treating Tuberculosis with Sunlight

In a medical reference book from the 1940s, The New People's Physician (1941), I came across these pictures of kids in classrooms and playing sports dressed only in their tighty-whities. They weren't students at a clothing-optional school. They were actually being treated for tuberculosis. In the days before antibiotics, sunlight therapy (or heliotherapy) was a popular cure for that disease.

　

"At Leysin, in the Alpes Vaudoises, Dr. A. Rollier instituted the treatment of pulmonary tuberculosis and other tuberculous diseases by means of direct sunlight. The patients spend as much time as possible in the open air, exposed to the rays of the sun."

 

 

 

"Early cases of tuberculosis in young and vigorous people benefit considerably from treatment at high altitudes. Exercise and sport of a not too strenuous nature is advocated."

 

 

 

"At Perrysburg, N.Y., tubercular children study in an open-air schoolroom, stripped to the waist."

 

 

 

"Minimum clothing and maximum exposure to the sun contribute to improving the health of these tuberculous children at Perrysburg, New York. Outdoor classes and fresh air improve general health as well."

 

 

 

"Outdoor air and sunlight, even in the New England winter, are part of the treatment for child tuberculosis patients of the Meriden State Tuberculosis Sanitarium, Meriden, Conn."

 

 

An LA Times article (May 28, 2007) gives some background on the popularity of sunlight therapy for TB:

 

sunlight therapy, or heliotherapy as it was sometimes called (helios is the Greek word for sun), didn't become popular until a Swiss doctor, Auguste Rollier, began championing it in the early 1900s...

 

Rollier devised a detailed protocol for how, exactly, to sunbathe for health. He was convinced that early-morning sun was best and that sun exposure was most beneficial when the air was cool. When patients, most of whom had tuberculosis, arrived at his solaria, they first had to adjust to the altitude (his clinics were in the mountains) and then to the cool air. Once acclimated, Rollier slowly exposed them to the sun.

 

The patients were rolled onto sun-drenched, open-air balconies, wearing loincloths and covered from head to toe with white sheets. On the first day of treatment, just their feet peeked out from under the sheets, and only for five minutes. On day two, the sheets were pulled a little higher, and the patients were left in the sun a few minutes more. By day five, only the patients' heads were covered, their bodies left to soak up sun for more than an hour. After a few weeks, the patients were very tan -- and hopefully very healthy. (The therapy worked for many, but not all.)

 

And according to a fairly recent article in the Journal of Cell Biology, "Curing TB with Sunlight" (Mar 27, 2006), sunlight actually is a fairly effective treatment for tuberculosis:

 

Ultraviolet (UV) light makes vitamin D, and vitamin D turns on innate immunity to tuberculosis (TB), say Steffen Stenger (Universität Erlangen, Germany), Philip Liu, Robert Modlin (University of California, Los Angeles, CA), and colleagues...

 

The finding may explain why Hermann Brehmer's 19th century trip to the Himalayas cured him of his TB, and why the fresh air at his sanatoria helped cure others. “Our forefathers knew a lot more about this than we give them credit for,” says Modlin. Eventually, however, sanitoria coddled their patients behind glass, which would have blocked the beneficial UV light.

 

Treating Tuberculosis with Sunlight  http://www.weirduniverse.net/blog/comments/treating_tuberculosis_with_sunlight

　

Tuberculosis sanatorium

 

Every year on 24 March, World TB Day commemorates the day in 1882 that Dr Robert Koch identified the tubercle bacillus as the cause of the disease. Despite advances in modern medicine, TB is still endemic in many parts of the world, causing nearly 1.5 million deaths every year.

 

Today, TB treatment often involves prolonged use of a combination of antibiotics to reduce the risk of the bacteria becoming resistant. In this photograph taken in 1937, children are undergoing a very different type of treatment, common throughout Europe from the late 19th century.

 

Sanatoriums were based on the belief of Hermann Brehmer, a German physician who thought that TB arose due the heart’s inability to irrigate the lungs. He proposed that areas high above sea level, with plentiful fresh air and good nutrition, were the key to curing the disease and established Brehmersche Heilanstalt für Lungenkranke (Brehmersche Sanatorium for Lung Patients) in Görbersdorf.

 

After Brehmer’s death, the sanatorium movement spread throughout Europe and even into metropolitan areas at low altitudes. The choice of climate was varied, from high-altitude Alps resorts such as Davos, to the dry air and sun of Arizona, USA. Soon after this photo was taken, sanatoriums began to close after the antibiotic streptomycin was discovered as the first cure for TB in 1943.

 

In 2016, TB continues to be one of the top infectious disease killers in the world and ending the epidemic by 2030 is a health target of the UN’s Sustainable Development Goals.

 

Image credit: Child patients lying outside in beds on a terrace outside the Hospital of Alton, Hampshire, in the sun as part of their therapy. 1937. Wellcome Library, London

 

Image of the Week: Tuberculosis sanatorium | Wellcome Trust Blog  https://blog.wellcome.ac.uk/2016/03/18/image-of-the-week-tuberculosis-sanatorium/

　

光疗，维生素D和皮肤病的简要历史

　

摘要

阳光照射和皮肤病之间的最早记录可追溯到五千年前古埃及人。医学光疗法和皮肤病的现代科学时代始于1877年，当时Downs和Blunt报道暴露于光线会抑制试管中的真菌生长。持续的研究产生了越来越多的医学兴趣，即光可以治疗和治愈被认为是寄生虫的皮肤病。最终将1903年诺贝尔医学奖授予Niels Finsen，因为他的开创性研究表明，光可以成功治疗皮肤结核分枝杆菌（狼疮），这是当时常见的毁容性疾病。鳕鱼肝油在1789年英国曼彻斯特之前用作治疗佝偻病的民间疗法，1921年阳光被公布为治愈这种疾病. Hess和Weinstock在1925年的研究表明食物用紫外线（UV）照射预防老鼠佝偻病，为发现维生素D铺平了道路。光疗法治疗的皮肤病范围在接下来的几年里有所增加，直到1932年美国医学会对紫外线疗法的使用进行了审查。皮肤病学列出了34种皮肤病，其中紫外线辐射可能有用。这一时期恰逢欧洲和北美使用日光疗法治疗结核病的疗养院的发展。紫外线疗法和维生素D继续成功地用于治疗结核病，直到20世纪50年代被更有效的抗生素取代。现代光疗法发展于20世纪80年代，发现银屑病的作用光谱导致窄带UVB的发展。随后在2006年鉴定了UV光和维生素D处理的结核病的生物学机制。这涉及通过Toll样受体激活人巨噬细胞以上调维生素D受体基因，从而诱导抗微生物肽cathelicidin。紫外线和维生素D在治疗皮肤病中的作用目前是一个活跃的研究领域。

　

A short history of phototherapy, vitamin D and skin disease 

Abstract

 

The earliest record between sun exposure and skin disease goes back five millennia to the ancient Egyptians. The modern scientific era of medical light therapy and skin diseases started in 1877 when Downs and Blunt reported that exposure to light inhibited fungal growth in test tubes. Continuing research generated a growing medical interest in the potential the effects of light to treat and cure skin diseases considered as parasitic. This culminated in the awarding of the 1903 Nobel Prize in Medicine to Niels Finsen for his pioneering work showing that light could successfully treat cutaneous mycobacterium tuberculosis (lupus vulgaris), a disfiguring disorder common at the time. Cod liver oil was used as a folk remedy to treat rickets prior to 1789 in Manchester, UK and sunlight was published as the cure for this disease in 1921. The work by Hess and Weinstock in 1925 showed that food irradiated with ultraviolet (UV) light prevented rickets in rats, which paved the way for the discovery of vitamin D. The range of skin diseases treated by light therapy increased in the following years, to the point where a 1932 review by the American Medical Association on the use of UV therapy in dermatology listed 34 skin conditions for which UV radiation may be useful. This period coincided with the development of sanatoria in Europe and North America which used heliotherapy for the treatment of tuberculosis. UV therapy and vitamin D continued to be used successfully for the treatment of tuberculosis up to the 1950s when it was superseded by more effective antibiotics. Modern phototherapy developed in the 1980s with the discovery of the action spectrum for psoriasis leading to the development of narrow band UVB. Subsequently a biological mechanism by which UV light and vitamin D treated tuberculosis was identified in 2006. This involves activation of human macrophages via toll-like receptors to upregulate the vitamin D receptor gene resulting in induction of the antimicrobial peptide cathelicidin. The role of UV light and vitamin D in the treatment of skin diseases is currently an active area of research.

　

Paul Jarrett*abc  and  Robert Scraggc

 Author affiliations

A short history of phototherapy, vitamin D and skin disease - Photochemical & Photobiological Sciences (RSC Publishing)  https://pubs.rsc.org/en/content/articlelanding/2017/pp/c6pp00406g#!divAbstract