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Review
. 2020 Dec 3;10(1):58.
doi: 10.1186/s13601-020-00362-7.

Nrf2-interacting nutrients and COVID-19: time for research to develop adaptation strategies

Jean Bousquet  1   2   3 , Jean-Paul Cristol  4 , Wienczyslawa Czarlewski  5   6 , Josep M Anto  7   8   9   10 , Adrian Martineau  11 , Tari Haahtela  12 , Susana C Fonseca  13 , Guido Iaccarino  14 , Hubert Blain  15 , Alessandro Fiocchi  16 , G Walter Canonica  17 , Joao A Fonseca  18 , Alain Vidal  19   20 , Hak-Jong Choi  21 , Hyun Ju Kim  22 , Vincent Le Moing  23 , Jacques Reynes  23 , Aziz Sheikh  24 , Cezmi A Akdis  25 , Torsten Zuberbier  26 ; ARIA group
Collaborators, Affiliations
Review

Nrf2-interacting nutrients and COVID-19: time for research to develop adaptation strategies

Jean Bousquet et al. Clin Transl Allergy. .

Abstract

There are large between- and within-country variations in COVID-19 death rates. Some very low death rate settings such as Eastern Asia, Central Europe, the Balkans and Africa have a common feature of eating large quantities of fermented foods whose intake is associated with the activation of the Nrf2 (Nuclear factor (erythroid-derived 2)-like 2) anti-oxidant transcription factor. There are many Nrf2-interacting nutrients (berberine, curcumin, epigallocatechin gallate, genistein, quercetin, resveratrol, sulforaphane) that all act similarly to reduce insulin resistance, endothelial damage, lung injury and cytokine storm. They also act on the same mechanisms (mTOR: Mammalian target of rapamycin, PPARγ:Peroxisome proliferator-activated receptor, NFκB: Nuclear factor kappa B, ERK: Extracellular signal-regulated kinases and eIF2α:Elongation initiation factor 2α). They may as a result be important in mitigating the severity of COVID-19, acting through the endoplasmic reticulum stress or ACE-Angiotensin-II-AT1R axis (AT1R) pathway. Many Nrf2-interacting nutrients are also interacting with TRPA1 and/or TRPV1. Interestingly, geographical areas with very low COVID-19 mortality are those with the lowest prevalence of obesity (Sub-Saharan Africa and Asia). It is tempting to propose that Nrf2-interacting foods and nutrients can re-balance insulin resistance and have a significant effect on COVID-19 severity. It is therefore possible that the intake of these foods may restore an optimal natural balance for the Nrf2 pathway and may be of interest in the mitigation of COVID-19 severity.

Keywords: COVID-19; Foods; Insulin resistance; Nrf2; Nutrients; Obesity; TRPA1.

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Conflict of interest statement

None of the authors declared any competing interest.

Figures

Fig. 1
Fig. 1
Interactions between the renin–angiotensin–aldosterone system and the endoplasmic reticulum in COVID-19 ( modified from 5)
Fig. 2
Fig. 2
Complex interactions leading to oxidative stress in diabetes (from [117])
Fig. 3
Fig. 3
Prevalence of obesity, diabetes (NCD Risk Factor Collaboration (NCD-RisC, http://ncdrisc.org) and the COVID-19 death rate (Johns Hopkins Coronavirus Resource Center, https://coronavirus.jhu.edu)
Fig. 4
Fig. 4
Links between obesity and diabetes in Ghanaians [150]
Fig. 5
Fig. 5
Geographic differences in COVID-19 death rates (Johns Hopkins Coronavirus center) and diet possibly explaining these differences
See this image and copyright information in PMC

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