The Umbrella Review of VDR Gene Polymorphism and the Risk of Diabetes and Possible Implications in Immunotherapy

Trends in Immunotherapy

Review Article

The Umbrella Review of VDR Gene Polymorphism and the Risk of Diabetes and Possible Implications in Immunotherapy

Kalmatov Romanbek Kalmatovich, Karar Hassan Omran, , Y. K., Shatha Sadiq Al-Marayaty, Talib Kaleefa, & Makhanbetkulova Dinara. (2026). The Umbrella Review of VDR Gene Polymorphism and the Risk of Diabetes and Possible Implications in Immunotherapy. Trends in Immunotherapy, 10(1), 102–116. https://doi.org/10.54963/ti.v10i1.1104

Authors

  • Kalmatov Romanbek Kalmatovich

    Department of Pathology, International Medical Faculty, Osh State University, Osh 723500, Kyrgyzstan
  • Karar Hassan Omran

    Department of Medical Laboratory Analysis, Al Mansour University College, Baghdad 10067, Iraq
  • Yousif Kadhim

    Department of Medical Laboratory Analysis, Al-Turath University, Baghdad 10013, Iraq
  • Shatha Sadiq Al-Marayaty

    Department of Medical Laboratory Analysis, Al-Rafidain University College, Baghdad 10064, Iraq
  • Talib Kaleefa

    Department of Medical Laboratory Analysis, Madenat Alelem University College, Baghdad 10006, Iraq
  • Makhanbetkulova Dinara

    Department of Nursing, Asfendiyarov Kazakh National Medical University, Almaty A35D8X0, Kazakhstan

Received: 18 March 2025; Revised: 6 May 2025; Accepted: 5 June 2025; Published: 26 January 2026

Systematic reviews and meta-analyses investigated VDR gene polymorphism correlations with T1D and T2D outcomes. We reviewed and meta-analyzed all VDR gene polymorphism research, including clinical outcome case-control studies. We conducted a comprehensive review using systematic data analysis to evaluate the association between VDR gene polymorphism and the risk of diabetes. According to the predefined search strategy and selection criteria, the article reporting the correlations of FokI polymorphisms and the risk of T1D included 40 papers (5,406 cases and 7,507 controls). Forty-three papers (10,252 cases and 9466 controls) focused on the associations between the FokI polymorphisms and T2D risk. The articles evaluated 10,252 cases and 9466 controls. Six meta-analyses linked the Fokl gene polymorphism to T1D and T2D. Summaries were nominally significant in 50% of observational meta-analyses. We demonstrated no association between VDR gene polymorphism and T1D risk across different ethnicities. T2D risk was also highly connected to the FokI polymorphism in Asian ethnicity. Gene-environment interactions must be investigated to understand these associations. The FokI polymorphism in the VDR gene has been extensively investigated, but more research is needed to know how VDR SNPs cause DM. Diabetes risk is linked to VDR gene polymorphism in this study. Diabetes risk is linked to the VDR gene polymorphism in this study. More research and well-planned studies are necessary for certainty.

Keywords:

Diabetes Vitamin D Receptor Polymorphism Umbrella Review

References

  1. Roep, B.O.; Thomaidou, S.; van Tienhoven, R.; et al. Type 1 Diabetes Mellitus as a Disease of the β-Cell (Do Not Blame the Immune System?). Nat. Rev. Endocrinol. 2021, 17, 150–161.
  2. Galicia-Garcia, U.; Benito-Vicente, A.; Jebari, S.; et al. Pathophysiology of Type 2 Diabetes Mellitus. Int. J. Mol. Sci. 2020, 21, 6275.
  3. Dendup, T.; Feng, X.; Clingan, S.; et al. Environmental Risk Factors for Developing Type 2 Diabetes Mellitus: A Systematic Review. Int. J. Environ. Res. Public Health 2018, 15, 78.
  4. Hu, G.; Lindström, J.; Valle, T.T.; et al. Physical Activity, Body Mass Index, and Risk of Type 2 Diabetes in Patients With Normal or Impaired Glucose Regulation. Arch. Intern. Med. 2004, 164, 892–896.
  5. Cook, C.B.; Wellik, K.E.; Fowke, M. Geoenvironmental Diabetology. J. Diabetes Sci. Technol. 2011, 5, 834–842.
  6. Polychronakos, C.; Li, Q. Understanding Type 1 Diabetes Through Genetics: Advances and Prospects. Nat. Rev. Genet. 2011, 12, 781–792.
  7. Colberg, S.R.; Sigal, R.J.; Yardley, J.E.; et al. Physical Activity/Exercise and Diabetes: A Position Statement of the American Diabetes Association. Diabetes Care 2016, 39, 2065–2079.
  8. Hyppönen, E.; Läärä, E.; Reunanen, A.; et al. Intake of Vitamin D and Risk of Type 1 Diabetes: A Birth-Cohort Study. Lancet 2001, 358, 1500–1503.
  9. Khan, H.; Kunutsor, S.; Franco, O.H.; et al. Vitamin D, Type 2 Diabetes and Other Metabolic Outcomes: A Systematic Review and Meta-Analysis of Prospective Studies. Proc. Nutr. Soc. 2013, 72, 89–97.
  10. Sergeev, I.N.; Rhoten, W.B. 1,25-Dihydroxyvitamin D3 Evokes Oscillations of Intracellular Calcium in a Pancreatic Beta-Cell Line. Endocrinology 1995, 136, 2852–2861.
  11. Maestro, B.; Molero, S.; Bajo, S.; et al. Transcriptional Activation of the Human Insulin Receptor Gene by 1,25-Dihydroxyvitamin D3. Cell Biochem. Funct. 2002, 20, 227–232.
  12. Dunlop, T.W.; Väisänen, S.; Frank, C.; et al. The Human Peroxisome Proliferator-Activated Receptor Delta Gene Is a Primary Target of 1alpha,25-Dihydroxyvitamin D3 and Its Nuclear Receptor. J. Mol. Biol. 2005, 349, 248–260.
  13. Zmuda, J.M.; Cauley, J.A.; Ferrell, R.E. Molecular Epidemiology of Vitamin D Receptor Gene Variants. Epidemiol. Rev. 2000, 22, 203–217.
  14. Uitterlinden, A.G.; Fang, Y.; van Meurs, J.B.; et al. Genetics and Biology of Vitamin D Receptor Polymorphisms. Gene 2004, 338, 143–156.
  15. Arai, H.; Miyamoto, K.; Taketani, Y.; et al. A Vitamin D Receptor Gene Polymorphism in the Translation Initiation Codon: Effect on Protein Activity and Relation to Bone Mineral Density in Japanese Women. J. Bone Miner. Res. 1997, 12, 915–921.
  16. Nejentsev, S.; Godfrey, L.; Snook, H.; et al. Comparative High-Resolution Analysis of Linkage Disequilibrium and Tag Single Nucleotide Polymorphisms Between Populations in the Vitamin D Receptor Gene. Hum. Mol. Genet. 2004, 13, 1633–1639.
  17. Gross, C.; Krishnan, A.V.; Malloy, P.J.; et al. The Vitamin D Receptor Gene Start Codon Polymorphism: A Functional Analysis of FokI Variants. J. Bone Miner. Res. 1998, 13, 1691–1699.
  18. Miyamoto, K.; Kesterson, R.A.; Yamamoto, H.; et al. Structural Organization of the Human Vitamin D Receptor Chromosomal Gene and Its Promoter. Mol. Endocrinol. 1997, 11, 1165–1179.
  19. van Etten, E.; Verlinden, L.; Giulietti, A.; et al. The Vitamin D Receptor Gene FokI Polymorphism: Functional Impact on the Immune System. Eur. J. Immunol. 2007, 37, 395–405.
  20. Cho, Y.A.; Lee, J.; Oh, J.H.; et al. Vitamin D Receptor FokI Polymorphism and the Risks of Colorectal Cancer, Inflammatory Bowel Disease, and Colorectal Adenoma. Sci. Rep. 2018, 8, 12899.
  21. Ghaseminejad-Raeini, A.; Ghaderi, A.; Sharafi, A.; et al. Immunomodulatory Actions of Vitamin D in Various Immune-Related Disorders: A Comprehensive Review. Front. Immunol. 2023, 14, 950465.
  22. Xiang, Y.; Zhang, M.; Jiang, D.; et al. The Role of Inflammation in Autoimmune Disease: A Therapeutic Target. Front. Immunol. 2023, 14, 1267091.
  23. Mory, D.B.; Rocco, E.R.; Miranda, W.L.; et al. Prevalence of Vitamin D Receptor Gene Polymorphisms FokI and BsmI in Brazilian Individuals With Type 1 Diabetes and Their Relation to β-Cell Autoimmunity and to Remaining β-Cell Function. Hum. Immunol. 2009, 70, 447–451.
  24. Morran, M.P.; Vonberg, A.; Khadra, A.; et al. Immunogenetics of Type 1 Diabetes Mellitus. Mol. Aspects Med. 2015, 42, 42–60.
  25. Warshauer, J.T.; Bluestone, J.A.; Anderson, M.S. New Frontiers in the Treatment of Type 1 Diabetes. Cell Metab. 2020, 31, 46–61.
  26. Maxwell, L.; Singh, J.A. Abatacept for Rheumatoid Arthritis. Cochrane Database Syst. Rev. 2009, 2009, CD007277.
  27. Wang, X.; Yuan, C.X.; Xu, B.; et al. Diabetic Foot Ulcers: Classification, Risk Factors and Management. World J. Diabetes 2022, 13, 1049–1065.
  28. Huelsboemer, L.; Knoedler, L.; Kochen, A.; et al. Cellular Therapeutics and Immunotherapies in Wound Healing – On the Pulse of Time? Mil. Med. Res. 2024, 11, 23.
  29. Song, J.; Hu, L.; Liu, B.; et al. The Emerging Role of Immune Cells and Targeted Therapeutic Strategies in Diabetic Wounds Healing. J. Inflamm. Res. 2022, 15, 4119–4138.
  30. Ganesan, O.; Orgill, D.P. An Overview of Recent Clinical Trials for Diabetic Foot Ulcer Therapies. J. Clin. Med. 2024, 13, 7655.
  31. Burgess, J.L.; Wyant, W.A.; Abujamra, B.A.; et al. Diabetic Wound-Healing Science. Medicina 2021, 57, 1072.
  32. Khan, Z.; Muhammad, S.A.; Carpio, J.; et al. The Effect of Vitamin D Supplementation on Incidence of Type 2 Diabetes: A Systematic Review. Cureus 2023, 15, e36775.
  33. Sung, C.C.; Liao, M.T.; Lu, K.C.; et al. Role of Vitamin D in Insulin Resistance. J. Biomed. Biotechnol. 2012, 2012, 634195.
  34. Nazarian, S.; Peter, J.V.S.; Boston, R.C.; et al. Vitamin D3 Supplementation Improves Insulin Sensitivity in Subjects With Impaired Fasting Glucose. Transl. Res. 2011, 158, 276–281.
  35. Pittas, A.G.; Lau, J.; Hu, F.B.; et al. The Role of Vitamin D and Calcium in Type 2 Diabetes: A Systematic Review and Meta-Analysis. J. Clin. Endocrinol. Metab. 2007, 92, 2017–2029.
  36. Ioannidis, J.P. Integration of Evidence From Multiple Meta-Analyses: A Primer on Umbrella Reviews, Treatment Networks and Multiple Treatments Meta-Analyses. CMAJ 2009, 181, 488–493.
  37. Ioannidis, J.P.; Patsopoulos, N.A.; Rothstein, H.R. Reasons or Excuses for Avoiding Meta-Analysis in Forest Plots. BMJ 2008, 336, 1413–1415.
  38. Tzoulaki, I.; Siontis, K.C.; Evangelou, E.; et al. Bias in Associations of Emerging Biomarkers With Cardiovascular Disease. JAMA Intern. Med. 2013, 173, 664–671.
  39. Tsilidis, K.K.; Panagiotou, O.A.; Sena, E.S.; et al. Evaluation of Excess Significance Bias in Animal Studies of Neurological Diseases. PLoS Biol. 2013, 11, 1001609.
  40. Abdullah, S.H.; Ahmad, M.H. Enhancing Clarity and Methodological Rigor in Umbrella Reviews. Ann. Med. Surg. 2024, 86, 6352–6354.
  41. Sterne, J.A.; Smith, G.D. Sifting the Evidence—What's Wrong With Significance Tests? BMJ 2001, 322, 226–231.
  42. Ioannidis, J.P.; Tarone, R.; McLaughlin, J.K. The False-Positive to False-Negative Ratio in Epidemiologic Studies. Epidemiology 2011, 22, 450–456.
  43. Zeng, Q.; Zou, D.; Wei, Y.; et al. Association of Vitamin D Receptor Gene rs739837 Polymorphism With Type 2 Diabetes and Gestational Diabetes Mellitus Susceptibility: A Systematic Review and Meta-Analysis. Eur. J. Med. Res. 2022, 27, 65.
  44. Yu, J.; Sharma, P.; Girgis, C.M.; et al. Vitamin D and Beta Cells in Type 1 Diabetes: A Systematic Review. Int. J. Mol. Sci. 2022, 23, 14434.
  45. Najjar, L.; Sutherland, J.; Zhou, A.; et al. Vitamin D and Type 1 Diabetes Risk: A Systematic Review and Meta-Analysis of Genetic Evidence. Nutrients 2021, 13, 4260.
  46. Liu, Y.; Guo, X.; Huang, S.Y.; et al. Evaluation of Association Studies and a Systematic Review and Meta-Analysis of VDR Polymorphisms in Type 2 Diabetes Mellitus Risk. Medicine 2021, 100, e25934.
  47. Ran, Y.; Hu, S.; Yu, X.; et al. Association of Vitamin D Receptor Gene Polymorphism With Type 1 Diabetes Mellitus Risk in Children: A Protocol for Systematic Review and Meta-Analysis. Medicine 2021, 100, e26637.
  48. Zhai, N.; Bidares, R.; Makoui, M.H.; et al. Vitamin D Receptor Gene Polymorphisms and the Risk of Type 1 Diabetes: A Meta-Regression and Updated Meta-Analysis. BMC Endocr. Disord. 2020, 20, 121.
  49. Yu, F.; Cui, L.L.; Li, X.; et al. The Genetic Polymorphisms in Vitamin D Receptor and the Risk of Type 2 Diabetes Mellitus: An Updated Meta-Analysis. Asia Pac. J. Clin. Nutr. 2016, 25, 614–624.
  50. Wang, G.; Li, Y.; Li, L.; et al. Association of the Vitamin D Binding Protein Polymorphisms With the Risk of Type 2 Diabetes Mellitus: A Meta-Analysis. BMJ Open 2014, 4, 005617.
  51. Tizaoui, K.; Kaabachi, W.; Hamzaoui, A.; et al. Contribution of VDR Polymorphisms to Type 1 Diabetes Susceptibility: Systematic Review of Case-Control Studies and Meta-Analysis. J. Steroid Biochem. Mol. Biol. 2014, 143, 240–249.
  52. Wang, Q.; Xi, B.; Reilly, K.H.; et al. Quantitative Assessment of the Associations Between Four Polymorphisms (FokI, ApaI, BsmI, TaqI) of Vitamin D Receptor Gene and Risk of Diabetes Mellitus. Mol. Biol. Rep. 2012, 39, 9405–9414.
  53. Krisnamurti, D.G.B.; Louisa, M.; Poerwaningsih, E.H.; et al. Vitamin D Supplementation Alleviates Insulin Resistance in Prediabetic Rats by Modifying IRS-1 and PPARγ/NF-κB Expressions. Front. Endocrinol. 2023, 14, 1089298.
  54. Al-Shoumer, K.A.; Al-Essa, T.M. Is There a Relationship Between Vitamin D With Insulin Resistance and Diabetes Mellitus? World J. Diabetes 2015, 6, 1057–1064.
  55. Ballard, M.; Montgomery, P. Risk of Bias in Overviews of Reviews: A Scoping Review of Methodological Guidance and Four-Item Checklist. Res. Synth. Methods 2017, 8, 92–108.
  56. Brini, S.; Brudasca, N.I.; Hodkinson, A.; et al. Efficacy and Safety of Transcranial Magnetic Stimulation for Treating Major Depressive Disorder: An Umbrella Review and Re-Analysis of Published Meta-Analyses of Randomised Controlled Trials. Clin. Psychol. Rev. 2023, 100, 102236.
  57. Imamura, M.; Maeda, S. Perspectives on Genetic Studies of Type 2 Diabetes From the Genome-Wide Association Studies Era to Precision Medicine. 2024, 15, 410–422.
  58. Choi, G.J.; Kang, H. Introduction to Umbrella Reviews as a Useful Evidence-Based Practice. J. Lipid Atheroscler. 2023, 12, 3–11.
  59. Choi, G.J.; Kang, H. The Umbrella Review: A Useful Strategy in the Rain of Evidence. Korean J. Pain 2022, 35, 127–128.