Volume 28, Issue 1 (3-2021)                   RJMS 2021, 28(1): 0-0 | Back to browse issues page

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Khaledi S, Ahmadi S. The need to take vitamin D in prevention of COVID-19. RJMS. 2021; 28 (1)
URL: http://rjms.iums.ac.ir/article-1-6546-en.html
University of Kurdistan , sh.ahmadi@uok.ac.ir
Abstract:   (479 Views)
After its occurrence in December 2019 in Wuhan, China, the corona virus disease 2019 (COVID-19) rapidly became a pandemic, but there is still no effective treatment for the disease (1). Destroying the lung epithelial cells due to the attack of a novel coronavirus known as SARS-CoV2 results in acute respiratory problems in the disease. Besides, overactivation of immune cells due to the virus infection induces a cytokine storm that its outcomes along with the acute respiratory distress are the major causes of adverse conditions and patient’s hospitalization in the intensive care units (3). Despite using antiviral and anti-inflammatory drugs for patients, at least in some cases, the medical efforts are not effective and the disease leads to death. A growing body of research has recently been published in favor of preventive effects of vitamin D against COVID-19 and also the therapeutic effects of the vitamin in the patients (18, 19, 48). This study aimed to review the factors involved in vitamin D production, the role and mechanisms of action of this vitamin in preventing COVID-19, and decreasing the adverse effects of the disease in the patients.
Various studies have reported a positive role for vitamin D in the prevention of COVID-19 and reduction of the adverse effects of the virus infection. According to different studies, a sufficient amount of serum levels of vitamin D should be more than 30 ng/ml and the optimal amount is between 40 and 60 ng/ml (11, 18). Vitamin D is synthesized in the skin under the influence of the sunlight UV radiation (23, 25). However, due to the special climatic conditions and religious and cultural beliefs, most of the population especially women in Iran are at a higher risk of vitamin D deficiency (28, 36). Iranchr(chr('39')39chr('39'))s geographical location is between 25- and 40-degrees north latitude of the equator, and therefore the northern half of Iran is faced with a lack of sunlight needed to produce a sufficient amount of vitamin D in most seasons (37). Also, in large urban areas with high levels of nitrogen dioxide, people receive less UV radiation that is not enough for adequate vitamin D synthesis in the skin (37).
The seasonal prevalence of viral diseases such as influenza as well as decreased serum levels of vitamin D in the winter season can also indicate an association between the vitamin D deficiency and the increased risk of respiratory diseases (44). Vitamin D besides the involvement in calcium homeostasis and bone metabolism has an important role in boosting and regulating the immune system (11,12). Therefore, vitamin D via improving the immune system and production of antioxidants and anti-microbial factors could also have a potential role in preventing COVID-19. The active form of vitamin D is produced by an enzyme known as 1-alpha hydroxylase, which along with vitamin D receptors are present in all cells of the innate immune system. By activation of macrophages, the enzyme 1-alpha hydroxylase is activated in these cells and produces the active form of vitamin D. The increased production of vitamin D in macrophages leads to the release of a large number of antimicrobial agents such as cathelicidin and defensin, which in turn enhance the microbicidal effects of macrophages and monocytes (12). Inactive B and T lymphocytes lack vitamin D receptors but upon activation, they will express vitamin D receptors. Therefore, the release of vitamin D from macrophages also affects the function of surrounding lymphocytes, which will be effective in defense against viruses (12). Vitamin D also exerts its anti-inflammatory effects through various mechanisms. First, vitamin D inhibits prostaglandins production by inhibiting the enzyme cyclooxygenase 2, and therefore, exerts an anti-inflammatory effect.  Prostaglandins facilitate the migration of immune cells into the tissue and increases the symptoms of inflammation by increasing the permeability of postcapillary venules. Second, vitamin D through activating the enzyme phosphatase-5 inhibits the phosphorylation and activation of p38 mitogen-activated protein kinase (MAPK) signaling pathway, which is a specific pathway for the production of inflammatory cytokines. Further, vitamin D reduces the transcription of inflammatory cytokines genes by inhibiting the nuclear factor kappa B (NFκB) (13).  Besides, the antioxidant role of vitamin D is attributed to the increased expression of enzymes producing antioxidants such as superoxide dismutase 1 and 2, thioredoxin reductases, and glutathione (13).
Taken together, vitamin D via modulating and improving the function of innate and adaptive immune cells, and also reducing the inflammation caused by the overactivation of the immune cells could decrease the COVID-19 symptoms. Considering the current COVID-19 pandemic condition, it can be suggested that measuring the serum level of vitamin D, and compensating for the possible deficiencies via dietary and drug supplementation can be effective in preventing COVID-19.
 
     
Type of Study: review article | Subject: immunopatology

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