Changes in the immune response against SARS-CoV-2 in individuals with severe COVID-19 treated with high dose of vitamin D - 27/05/22
, Guiomar Casado h, 1, Lorena Vigón h, 1, Sara Rodríguez-Mora h, i, Elena Mateos h, i, Fernando Ramos-Martín h, Daniel López-Wolf j, José Sanz-Moreno k, Pablo Ryan-Murua l, María Luisa Taboada-Martínez m, María Rosa López-Huertas h, i, ⁎ , Miguel Cervero n, 1, Mayte Coiras h, i, 1, ⁎ on behalf of Multidisciplinary Group of Study of COVID-19 (MGS-COVID)1
Contributing members of the Multidisciplinary Group of Study of COVID-19 (in alphabetical order)
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Abstract |
Main cause of severe illness and death in COVID-19 patients appears to be an excessive but ineffectual inflammatory immune response that may cause severe acute respiratory distress syndrome (ARDS). Vitamin D may favour an anti-inflammatory environment and improve cytotoxic response against some infectious diseases. A multicenter, single-blind, prospective, randomized clinical trial was approved in patients with COVID-19 pneumonia and levels of 25-hydroxyvitamin D (25(OH)D) of 14.8 ng/ml (SD: 6.18) to test antiviral efficacy, tolerance and safety of 10,000 IU/day of cholecalciferol (vitamin D3) for 14 days, in comparison with 2000 IU/day. After supplementation, mean serum 25(OH)D levels increased to 19 ng/ml on average in 2000 IU/day versus 29 ng/ml in 10,000 IU/day group (p < 0.0001). Although levels of inflammatory cytokines were not modified by treatment with 10,000 IU/day, there was an increase of anti-inflammatory cytokine IL-10 and higher levels of CD4+ T cells, with predominance of T central memory subpopulation. Cytotoxic response against pseudotyped SARS-CoV-2 infected cells was increased more than 4-fold in patients who received 10,000 IU/day. Moreover, levels of IFNγ were significantly higher in this group. Beneficial effect of supplementation with 10,000 IU/day was also observed in participants who developed ARDS and stayed at the hospital for 8.0 days, whereas those who received 2000 IU/day stayed for 29.2 days (p = 0.0381). Administration of high doses of vitamin D3 as adjuvant of the standard care treatment during hospitalization for COVID-19 may improve the inflammatory environment and cytotoxic response against pseudotyped SARS-CoV-2 infected cells, shortening the hospital stay and, possibly, improving the prognosis.
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Highlights |
• | Treatment with 10,000 IU/day of cholecalciferol was safe during severe COVID-19. |
• | Anti-inflammatory cytokine IL-10 was significantly increased in 10,000 IU/day group. |
• | Individuals who received 10,000 IU/day of cholecalciferol showed increased CD4 count. |
• | Individuals with ARDS in 10,000 IU/day group stayed at the hospital less time. |
• | The 10,000 IU/day group showed increased antiviral cytotoxic activity. |
Keywords : COVID-19, SARS-CoV-2, Vitamin D supplementation, Immune cytotoxic response
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