Vitamin D in Prevention and Treatment of COVID-19: Current Perspective and Future Prospects

Abstract

Vitamin D deficiency (VDD) partly explains geographical differences in COVID-19 susceptibility, severity, and mortality. VDD among African-Americans, diabetics, hypertensive, and aged populations possibly explain the higher death rate, aggravated by cocooning. Vitamin D is pleiotropic, mediating bone metabolism, calcium homeostasis, and immune functions, whereas VDD is associated with inflammatory reactions and immune dysfunction, predisposing individuals to severe infections. Vitamin D modulates innate and adaptive immunity via the expression of genes that code antimicrobial peptides (AMPs). And the expression of cluster of differentiation (CD)14, the co-receptor for epidermal toll-like receptor (TLR)4. AMPs stimulate TLR2 in macrophages, increasing the conversion of vitamin D into its active form by cytochrome P450 27B1. Antiviral properties of vitamin D-induced AMPs can shift the polarization of the adaptive immune response from helper T cells (Th)1 to the more regulatory Th2 responses that suppress immune over-reactivity by preventing cytokine storm, which is already demonstrated during the Spanish flu episode. Vitamin D induces antiviral effects by both direct and indirect mechanisms via AMPs, immunomodulation, the interplay between major cellular and viral elements, induction of autophagy and apoptosis, variation of genetic and epigenetic factors. The crosstalk between vitamin D and intracellular signaling pathways may operate as a primary regulatory action on viral gene transcription. VDD may increase the likelihood of infection with enveloped viruses, including retrovirus, hepatitis, and dengue. Global data correlates severe VDD with COVID-19 associated coagulopathy, disrupted immune response and mortality, reduced platelet count, and prolonged prothrombin time, suggesting benefits from supplementation.

Key teaching points

• Vitamin D induces antiviral effects by direct and indirect mechanisms via AMPs, immunomodulation, induction of autophagy, etc.

• Epidemiology of VDD partly explains geographical differences in COVID-19 susceptibility, severity, and mortality.

• Global data correlates severe VDD with COVID-19 associated coagulopathy, disrupted immune response and mortality, reduced platelet count, and prolonged prothrombin time, together suggesting benefits from supplementation.

• Many clinical trials are underway globally to delineate the role of vitamin D in both prevention and treatment of COVID-19.

Keywords:

• Coronavirus
• COVID-19
• immunity
• pandemic
• SARS-CoV-2
• vitamin D

Acknowledgement

Authors express their gratitude to Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal for the support and facilities. In addition, authors acknowledge Dr. B Shrikar Reddy for generating Figure 1.

Disclosure statement

There are no conflicts of interest to declare.

Author contributions

NV, SJK and SSM wrote the manuscript. DB, MKM, KS, MKU, CM and MR critically evaluated the manuscript. All the authors participated in literature collection and review. All the authors approved the final draft of the article.