The primary role of 1
α,25-dihydroxyvitamin D
3 (1,25(OH)
2D) is to maintain calcium and phosphate homeostasis in vertebrate organisms via actions in the intestine, bones, kidneys, and parathyroid glands. However, it is well known that physiological roles of 1,25(OH)
2D reach much beyond calcium and phosphate homeostasis. For example, 1,25(OH)
2D induces differentiation and inhibits proliferation of various normal and cancer cells, including osteoclasts, keratinocytes, and monocytes. In 1981 the group of Suda observed that 1,25(OH)
2D was able to induce differentiation in the M1 murine myeloid cell line [
1] and that it extended the survival of mice inoculated with leukemia cells [
2]. Since then many research projects have been performed in order to prepare ground for clinical use of 1,25(OH)
2D or of its low calcemic analogs in leukemia treatment [
3–
5].
There are two major signal transduction pathways activated by 1,25(OH)
2D in target cells. The most important and the best documented is the so-called “genomic pathway,” with its most important player a vitamin D receptor (VDR). The less well described is “nongenomic pathway,” which consists of intracellular signalling molecules, such as mitogen-activated protein kinases (MAPKs), phosphatidylinositol 3-kinase (PI3K), and others, activated by mechanisms that are not fully understood now [
6]. It is believed that both pathways need to be activated for full biological activity of 1,25(OH)
2D and that the most probable mediator of these actions is a putative membrane VDR (mVDR) [
6].
VDR belongs to the superfamily of intracellular receptors for steroid and thyroid hormones. 48 members of the superfamily have been identified in humans; they act as ligand-induced transcription factors [
7]. Most of the superfamily members, in order to be biologically active, form homo- or heterodimers. For VDR, retinoid X receptor (RXR) is a dimerization partner. VDR upon ligation undergoes conformational changes that allow binding to specific sequences in promoter regions of target genes, called vitamin D response elements (VDREs). VDREs are composed of two repeated half-sites with the consensus sequence AGGTCAcagAGGTCA (VDRE-DR3). Binding of 1,25(OH)
2D to VDR enhances heterodimerization with RXR and allows binding of the coactivator complex, known as vitamin D receptor-interacting protein complex (DRIP) [
8] and of other proteins, histone acetylase among them. Acetylated histones relax chromatin structure to make DNA accessible and permit initiation of transcription of target genes [
9]. VDR may be ligated not only with 1,25(OH)
2D but also with other compounds such as lithocholic acid, docosahexaenoic acid, arachidonic acid, or curcumin [
10]. Moreover, there are about 300 compounds closely related to 1,25(OH)
2D, called 1,25(OH)
2D analogs, which can bind VDR and exert changed biological properties. Subtle conformational changes in VDR structure caused by analogs can produce antagonistic, agonistic, or even superagonistic effects. There are even some analogs that exert semiselective activities, with lowered calcemic and increased antiproliferative and cell differentiating effects [
11].
The VDR protein is expressed at low concentrations in target tissues and cultured cells with the level of receptor expression ranging from a few copies of the VDR/cell to 25

000 copies/cell [
7]. Among blood cells VDR is expressed in Tcells, Bcells, monocytes, neutrophils, platelets, macrophages, and dendritic cells. Also many different myeloid leukemia cell lines, blocked at various stages of maturation, expressed mRNA for VDR; however, the expression levels were variable [
12]. Addition of 1,25(OH)
2D to certain acute myeloid leukemia (AML) cells induces dramatic changes in their phenotype and function; however, the extent of these changes is various in various cell lines.
The activation of MAPK/Erk1,2 signal transduction pathway in AML cells in response to 1,25(OH)
2D was for the first time reported in 1997 [
13], and it was later shown to be important for the process of AML cell differentiation [
14]. The exact mechanisms of how MAPK/Erk1,2 participate in the differentiation process are not known; however, they are being connected with a proliferative phase of AML cells differentiation [
15]. MAPK/JNK pathway, whose activation was reported later [
16], appeared to be involved in a subtle way in regulation of 1,25(OH)
2D-dependent transcription factors [
17]. Another MAP kinase, p38, has antagonistic effects to both MAPK/Erk1,2 and MAPK/JNK [
16,
18]. Also activation of PI3K signal transduction pathway in AML cells exposed to 1,25(OH)
2D has been reported [
19] and was later shown to be responsible for activation of myeloid zinc finger-1 (MZF-1) transcription factor, which in turn participates in regulation of proteins crucial for macrophage function [
20].