Evaluating Risk: Benefit Ratio of Fat-Soluble Vitamin Supplementation to SARS-CoV-2-Infected Autoimmune and Cancer Patients: Do Vitamin-Drug Interactions Exist?

Abstract

COVID-19 is a recent pandemic that mandated the scientific society to provide effective evidence-based therapeutic approaches for the prevention and treatment for such a global threat, especially to those patients who hold a higher risk of infection and complications, such as patients with autoimmune diseases and cancer. Recent research has examined the role of various fat-soluble vitamins (vitamins A, D, E, and K) in reducing the severity of COVID-19 infection. Studies showed that deficiency in fat-soluble vitamins abrogates the immune system, thus rendering individuals more susceptible to COVID-19 infection. Moreover, another line of evidence showed that supplementation of fat-soluble vitamins during the course of infection enhances the viral clearance episode by promoting an adequate immune response. However, more thorough research is needed to define the adequate use of vitamin supplements in cancer and autoimmune patients infected with COVID-19. Moreover, it is crucial to highlight the vitamin-drug interactions of the COVID-19 therapeutic modalities and fat-soluble vitamins. With an emphasis on cancer and autoimmune patients, the current review aims to clarify the role of fat-soluble vitamins in SARS-CoV-2 infection and to estimate the risk-to-benefit ratio of a fat-soluble supplement administered to patients taking FDA-approved COVID-19 medications such as antivirals, anti-inflammatory, receptor blockers, and monoclonal antibodies.

Keywords: COVID-19; autoimmune diseases; cancer; drug interactions; therapeutics; vitamins.

Figure 1

Flowchart diagram outlining the search strategy from initial search to included studies in this review.

Figure 2

Role of fat-soluble vitamins (vitamin A, vitamin D, vitamin E and vitamin K) in prevention and treatment of COVID-19. Vitamin A was found to regulate immune responses and cytokine production in case of SARS-CoV-2 infection while inhibiting the inflammatory reaction and antibodies production. Vitamin D was found to regulate different types of immune cells and prevents neuronal damage during and post- SARS-CoV-2 infection. On the other hand, Vitamin E was found to initiate the production of antioxidants and stimulates several immune responses in an attempt to eradicate the virus. Vitamin K deficiency was found to be accompanied with severe symptoms of the disease and thrombosis.

Figure 3

Effect of vitamin A in different cancer types and autoimmune diseases. Vitamin A has potent anticancer activity against different solid and non-solid malignancies such leukemia, lymphoma, breast, cervical, gastric, bladder, ovarian, colorectal, lung, liver and pancreatic cancers. Vitamin A was also found to have potent immunomodulatory roles that would prevent/treat/alleviate the symptoms of several autoimmune diseases such as multiple sclerosis, systemic lupus erythematosus and thyroiditis.

Figure 4

Effect of vitamin D in different cancer types and autoimmune diseases. Vitamin D has potent anticancer activity against different solid and non-solid malignancies such leukemia, lymphoma, breast, prostate, gastric, melanoma, endometrial, colorectal, lung, liver, pancreatic and bladder cancers. Vitamin D was also found to have potent immunomodulatory roles that would prevent/treat/alleviate the symptoms of several autoimmune diseases such as multiple sclerosis, rheumatoid arthritis, and Grave’s disease.

Figure 5

Effect of vitamin K in different cancer types and autoimmune diseases. Vitamin K has potent anticancer activity against different solid malignancies such breast, renal cell carcinoma, melanoma, bladder, ovarian, colorectal, lung, liver and prostate cancers. Vitamin K was also found to have potent immunomodulatory roles in multiple sclerosis and rheumatoid arthritis.

Figure 6

Effect of vitamin E in different cancer types and autoimmune diseases. Vitamin E has potent anticancer activity against different solid malignancies such breast, prostate, bladder, pancreatic, ovarian, colorectal, melanoma and lung cancers. Vitamin E was also found to have potent immunomodulatory roles that would prevent/treat/alleviate the symptoms of several autoimmune diseases such as multiple sclerosis, systemic lupus erythematosus, rheumatoid arthritis and systemic lupus erythematosus.