Vitamin D supplementation as a rational pharmacological approach in the COVID-19 pandemic

Abstract

The COVID-19 pandemic has reached most of the countries worldwide causing death, which often results from an inflammatory storm associated with severe acute respiratory syndrome (SARS). This has prompted researchers to seek specific novel and definitive treatments urgently. In this context, it is interesting to evaluate the preventive and therapeutic effects of existing pharmacological agents that could be useful. In this regard, vitamin D supplementation, particularly in individuals likely to be deficient, may be a promising option. Vitamin D is a hormone that modulates many of the same inflammatory and oxidative signaling pathways triggered during COVID-19. For example, vitamin D suppresses the actions of the renin-angiotensin system, which has a determining role in the pathophysiology of the inflammatory response related to COVID-19. This paper analyzes the evidence that vitamin D supplementation might be a valuable preventive/therapeutic measure in groups at risk for or infected with COVID-19. It also discusses how clinical studies could be best designed to evaluate the possible advantages of vitamin D supplementation for the benefit of public health during the pandemic.

Keywords: COVID-19; inflammation; oxidative stress; renin-angiotensin system; vitamin D.

Fig. 1.

Cellular interactions of angiotensin and vitamin D receptors. RAS, renin–angiotensin system; RXR, retinoid X receptor; VDRE, vitamin D response element; 1,25(OH)₂D3, 1,25-dihydroxyvitamin D3. [Reproduced from Ferder et al. (20) with permission.].

Fig. 2.

Graphic overview of vitamin D main signaling pathways as a new potential treatment in COVID-19 lung infection. Solid lines indicate stimulation/induction, whereas dashed lines indicate inhibition/blocking.