Vitamine D et virus?

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Probabilité de survie au COVID-19 avec ou sans supplémentation en vitamine D chez des seniors

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Impact of vitamin D on the course of COVID-19 during pregnancy: A case control study
Selcan Sinaci The Journal of Steroid Biochemistry and Molecular Biology Volume 213, October 2021, 105964

Highlights
• Pregnant COVID-19 patients tend to have lower vitamin D levels than healthy ones.
• Healthy pregnant women are likely to have vitamin D deficiency and insufficiency.
• Vitamin D deficiency may affect the course of COVID-19 in pregnant patients.
• Vitamin D deficiency can be thought of as a risk factor for severe COVID-19.

Objective
We aimed to evaluate the vitamin D status of pregnant women with COVID-19, and the association between vitamin D level and severity of COVID-19.

Methods
In this case control study, 159 women with a single pregnancy and tested positive for SARS-CoV-2, and randomly selected 332 healthy pregnant women with similar gestational ages were included. COVID-19 patients were classified as mild, moderate, and severe. Vitamin D deficiency was defined as 25-hydroxycholecalciferol <20 ng/mL (50 nmol/L), and 25-OH D vitamin <10 ng/mL was defined as severe vitamin D deficiency, also 25-OH D vitamin level between 20−29 ng/mL (525−725 nmol/L) was defined as vitamin D insufficiency.

Results
Vitamin D levels of the pregnant women in the COVID-19 group (12.46) were lower than the control group (18.76). 25-OH D vitamin levels of those in the mild COVID-19 category (13.69) were significantly higher than those in the moderate/severe category (9.06). In terms of taking vitamin D supplementation, there was no statistically significant difference between the groups. However, it was observed that all of those who had severe COVID-19 were the patients who did not take vitamin D supplementation.

Conclusion
The vitamin D levels are low in pregnant women with COVID-19. Also, there is a significant difference regarding to vitamin D level and COVID-19 severity in pregnant women. Maintenance of adequate vitamin D level can be useful as an approach for the prevention of an aggressive course of the inflammation induced by this novel coronavirus in pregnant women.

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Vitamin D-independent benefits of safe sunlight exposure
Anna S.Erema The Journal of Steroid Biochemistry and Molecular Biology Volume 213, October 2021, 105957

Highlights
• Safe sunlight exposure, in addition to the synthesis of vitamin D, can stimulate anti-inflammatory pathways.
• Safe sunlight exposure has immune-modulating functions, independent of vitamin D activities.
• Safe sunlight exposure may be correlated with susceptibility and mortality rates of COVID-19.
• Safe sunlight exposure can be associated with reduced rates of certain tumors.
• Vitamin D supplementation, where sunlight is available, may be unnecessary as sunlight can generate the required amount of vitamin D.

This review examines the beneficial effects of ultraviolet radiation on systemic autoimmune diseases, including multiple sclerosis and type I diabetes, where the epidemiological evidence for the vitamin D-independent effects of sunlight is most apparent. Ultraviolet radiation, in addition to its role in the synthesis of vitamin D, stimulates anti-inflammatory pathways, alters the composition of dendritic cells, T cells, and T regulatory cells, and induces nitric oxide synthase and heme oxygenase metabolic pathways, which may directly or indirectly mitigate disease progression and susceptibility.

Recent work has also explored how the immune-modulating functions of ultraviolet radiation affect type II diabetes, cancer, and the current global pandemic caused by SARS-CoV-2. These diseases are particularly important amidst global changes in lifestyle that result in unhealthy eating, increased sedentary habits, and alcohol and tobacco consumption. Compelling epidemiological data shows increased ultraviolet radiation associated with reduced rates of certain cancers, such as colorectal cancer, breast cancer, non-Hodgkins lymphoma, and ultraviolet radiation exposure correlated with susceptibility and mortality rates of COVID-19.

Therefore, understanding the effects of ultraviolet radiation on both vitamin D-dependent and -independent pathways is necessary to understand how they influence the course of many human diseases.

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Traduction de l'étude

Avantages indépendants de la vitamine D d'une exposition sûre au soleil
Anna S.Erema The Journal of Steroid Biochemistry and Molecular Biology Volume 213, octobre 2021, 105957

Points forts
• L'exposition sécuritaire au soleil, en plus de la synthèse de vitamine D, peut stimuler les voies anti-inflammatoires.
• L'exposition sûre au soleil a des fonctions de modulation immunitaire, indépendantes des activités de vitamine D.
• L'exposition sûre au soleil peut être corrélée avec les taux de sensibilité et de mortalité du COVID-19.
• Une exposition sécuritaire au soleil peut être associée à des taux réduits de certaines tumeurs.
• La supplémentation en vitamine D, là où la lumière du soleil est disponible, peut être inutile car la lumière du soleil peut générer la quantité requise de vitamine D.

Cette revue examine les effets bénéfiques du rayonnement ultraviolet sur les maladies auto-immunes systémiques, y compris la sclérose en plaques et le diabète de type I, où les preuves épidémiologiques des effets de la lumière du soleil indépendants de la vitamine D sont les plus apparentes. Le rayonnement ultraviolet, en plus de son rôle dans la synthèse de la vitamine D, stimule les voies anti-inflammatoires, modifie la composition des cellules dendritiques, des cellules T et des cellules régulatrices T, et induit les voies métaboliques de l'oxyde nitrique synthase et de l'hème oxygénase, qui peuvent directement ou atténuer indirectement la progression de la maladie et la susceptibilité.

Des travaux récents ont également exploré comment les fonctions de modulation immunitaire du rayonnement ultraviolet affectent le diabète de type II, le cancer et la pandémie mondiale actuelle causée par le SRAS-CoV-2. Ces maladies sont particulièrement importantes au milieu des changements mondiaux de mode de vie qui entraînent une mauvaise alimentation, une augmentation des habitudes sédentaires et une consommation d'alcool et de tabac. Des données épidémiologiques convaincantes montrent une augmentation du rayonnement ultraviolet associée à des taux réduits de certains cancers, tels que le cancer colorectal, le cancer du sein, le lymphome non hodgkinien et l'exposition aux rayonnements ultraviolets en corrélation avec les taux de susceptibilité et de mortalité du COVID-19.

Par conséquent, comprendre les effets du rayonnement ultraviolet sur les voies dépendantes et indépendantes de la vitamine D est nécessaire pour comprendre comment ils influencent l'évolution de nombreuses maladies humaines.

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Rays of immunity: Role of sunshine Vitamin in management of COVID-19 infection and associated comorbidities
V. Udaya kumar Clinical Nutrition ESPEN September 28, 2021

The catastrophic pandemic engendered due to the Novel coronavirus (COVID-19) outbreak which causes severe clinical afflictions on the respiratory system has severely high morbidity and mortality rates. The requirement of novel compounds is at utmost importance due to lack of targeted drug molecule to treat the afflictions and restrict the viral infection and for the usage of prophylactic treatment to avoid the spread of the infection is of utmost importance. Vitamin D is one such naturally available multifunctional molecule, which plays an eminent role in the immune system and instigation of numerous cellular pathways further promoting health benefits and enhancing the human quality of life. This article reviews the current standpoint scenario and future prevalence of vitamin D supplementation in the management of covid-19 patients.

Novel findings of Vitamin D suggest that along with regulation of cell growth, neuroprotective and mood-stabilizing effects, it regulates the immune response also modulate cytokine Interleukin-6 (IL-6) by inducing progesterone-induced blocking factor (PIBF), given the IL-6 levels are considerably high in COVID-19 patients which increases the further complications. Vitamin D also have its effect on angiotensin converting enzyme (ACEII) inhibitor through which the COVID-19 virus makes cell entry.

Numerous research data elucidate the play of Vitamin D, in complications of COVID-19 including the most common comorbid conditions, neurological manifestations and immunological aspects makes it an ideal molecule for adjuvant therapy.

Including Vitamin D as add-on therapy in the management of COVID-19 might aid the arrest of infection and helps fight this arduous epidemic.

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Régulation de l'immunité innée et adaptative, mécanismes d'effets antimicrobiens, inhibition de la tempête de cytokines utilisant les récepteurs de la vitamine D.

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Diagramme montrant l'entrée cellulaire du COVID et le rôle de la vitamine D

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Traduction de l'étude

Rayons d'immunité : rôle de la vitamine du soleil dans la gestion de l'infection au COVID-19 et des comorbidités associées
V. Udaya kumar Nutrition Clinique ESPEN 28 septembre 2021

La pandémie catastrophique engendrée par l'épidémie de nouveau coronavirus (COVID-19) qui provoque de graves affections cliniques sur le système respiratoire a des taux de morbidité et de mortalité extrêmement élevés. L'exigence de nouveaux composés est de la plus haute importance en raison du manque de molécule médicamenteuse ciblée pour traiter les afflictions et restreindre l'infection virale et pour l'utilisation d'un traitement prophylactique pour éviter la propagation de l'infection est de la plus haute importance. La vitamine D est l'une de ces molécules multifonctionnelles naturellement disponibles, qui joue un rôle éminent dans le système immunitaire et l'instigation de nombreuses voies cellulaires, favorisant davantage les bienfaits pour la santé et améliorant la qualité de vie humaine. Cet article passe en revue le scénario actuel et la prévalence future de la supplémentation en vitamine D dans la prise en charge des patients covid-19.

De nouvelles découvertes de la vitamine D suggèrent qu'en plus de la régulation de la croissance cellulaire, des effets neuroprotecteurs et stabilisateurs de l'humeur, elle régule la réponse immunitaire et module également la cytokine Interleukine-6 ​​(IL-6) en induisant le facteur de blocage induit par la progestérone (PIBF), compte tenu de la Les niveaux d'IL-6 sont considérablement élevés chez les patients COVID-19, ce qui augmente les complications supplémentaires. La vitamine D a également un effet sur l'inhibiteur de l'enzyme de conversion de l'angiotensine (ACEII) par lequel le virus COVID-19 pénètre dans les cellules.

De nombreuses données de recherche élucident le jeu de la vitamine D, dans les complications du COVID-19, y compris les comorbidités les plus courantes, les manifestations neurologiques et les aspects immunologiques, en font une molécule idéale pour le traitement adjuvant.

L'inclusion de la vitamine D comme thérapie d'appoint dans la gestion du COVID-19 pourrait aider à arrêter l'infection et aider à lutter contre cette épidémie ardue.

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COVID-19 mortality risk correlates inversely with vitamin D3 status, and a mortality rate close to zero could theoretically be achieved at 50 ng/ml 25(OH)D3: Results of a systematic review and meta-analysis
Lorenz Borsche, MedRxiv 2021.09.22.21263977
This article is a preprint and has not been certified by peer review [what does this mean?]. It reports new medical research that has yet to be evaluated and so should not be used to guide clinical practice.

Background Much research shows that blood calcidiol (25(OH)D3) levels correlate strongly with SARS-CoV-2 infection severity. There is open discussion regarding whether low D3 is caused by the infection or if deficiency negatively affects immune defense. The aim of this study was to collect further evidence on this topic.

Methods Systematic literature search was performed to identify retrospective cohort as well as clinical studies on COVID-19 mortality rates versus D3 blood levels. Mortality rates from clinical studies were corrected for age, sex and diabetes. Data were analyzed using correlation and linear regression.

Results One population study and seven clinical studies were identified, which reported D3 blood levels pre-infection or on the day of hospital admission. They independently showed a negative Pearson correlation of D3 levels and mortality risk (r(17)=-.4154, p=.0770/r(13)=-.4886, p=.0646). For the combined data, median (IQR) D3 levels were 23.2 ng/ml (17.4 – 26., and a significant Pearson correlation was observed (r(32)=-.3989, p=.0194). Regression suggested a theoretical point of zero mortality at approximately 50 ng/ml D3.

Conclusions The two datasets provide strong evidence that low D3 is a predictor rather than a side effect of the infection. Despite ongoing vaccinations, we recommend raising serum 25(OH)D levels to above 50 ng/ml to prevent or mitigate new outbreaks due to escape mutations or decreasing antibody activity.

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Calcifediol Treatment and COVID-19–Related Outcomes
Xavier Nogues The Journal of Clinical Endocrinology & Metabolism, Volume 106, Issue 10, October 2021, Pages e4017–e4027

Context
COVID-19 is a major health problem because of saturation of intensive care units (ICU) and mortality. Vitamin D has emerged as a potential treatment able to reduce the disease severity.

Objective
This work aims to elucidate the effect of 25(OH)D3 (calcifediol) treatment on COVID-19–related outcomes.

Methods
This observational cohort study was conducted from March to May 2020, among patients admitted to COVID-19 wards of Hospital del Mar, Barcelona, Spain. A total of 930 patients with COVID-19 were included; 92 were excluded because of previous calcifediol intake. Of the remaining 838, a total of 447 received calcifediol (532 μg on day 1 plus 266 μg on days 3, 7, 15, and 30), whereas 391 were not treated at the time of hospital admission (intention-to-treat). Of the latter, 53 patients were treated later during ICU admission and were allocated in the treated group in a second analysis. In healthy individuals, calcifediol is about 3.2-fold more potent on a weight basis than cholecalciferol. Main outcome measures were ICU admission and mortality.

Results
ICU assistance was required by 102 (12.2%) participants. Out of 447 patients treated with calcifediol at admission, 20 (4.5%) required the ICU, compared to 82 (21%) out of 391 nontreated (P < .001). Logistic regression of calcifediol treatment on ICU admission, adjusted by age, sex, linearized 25-hydroxyvitamin D levels at baseline, and comorbidities showed that treated patients had a reduced risk of requiring the ICU (odds ratio [OR] 0.13; 95% CI 0.07-0.23). Overall mortality was 10%. In the intention-to-treat analysis, 21 (4.7%) out of 447 patients treated with calcifediol at admission died compared to 62 patients (15.9%) out of 391 nontreated (P = .001). Adjusted results showed a reduced mortality risk with an OR of 0.21 (95% CI, 0.10-0.43). In the second analysis, the obtained OR was 0.52 (95% CI, 0.27-0.99).

Conclusion
In patients hospitalized with COVID-19, calcifediol treatment significantly reduced ICU admission and mortality.

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Traduction de l'étude

Traitement au calcifediol et résultats liés au COVID-19
Xavier Nogues The Journal of Clinical Endocrinology & Metabolism, Volume 106, Numéro 10, Octobre 2021, Pages e4017–e4027

Le contexte
Le COVID-19 est un problème de santé majeur en raison de la saturation des unités de soins intensifs (USI) et de la mortalité. La vitamine D est apparue comme un traitement potentiel capable de réduire la gravité de la maladie.

Objectif
Ce travail vise à élucider l'effet du traitement au 25(OH)D3 (calcifédiol) sur les résultats liés au COVID-19.

Méthodes
Cette étude de cohorte observationnelle a été menée de mars à mai 2020, parmi des patients admis dans les services COVID-19 de l'hôpital del Mar, Barcelone, Espagne. Un total de 930 patients atteints de COVID-19 ont été inclus ; 92 ont été exclus en raison d'un apport antérieur en calcifédiol. Sur les 838 autres, un total de 447 ont reçu du calcifédiol (532 μg au jour 1 plus 266 μg aux jours 3, 7, 15 et 30), alors que 391 n'ont pas été traités au moment de l'hospitalisation (intention de traiter) . Parmi ces derniers, 53 patients ont été traités plus tard lors de l'admission en soins intensifs et ont été répartis dans le groupe traité lors d'une deuxième analyse. Chez les individus en bonne santé, le calcifédiol est environ 3,2 fois plus puissant sur la base du poids que le cholécalciférol. Les principaux critères de jugement étaient l'admission aux soins intensifs et la mortalité.

Résultats
L'aide de l'USI a été requise par 102 (12,2 %) participants. Sur 447 patients traités par calcifédiol à l'admission, 20 (4,5 %) ont nécessité l'USI, contre 82 (21 %) sur 391 non traités (P < .001). La régression logistique du traitement au calcifédiol à l'admission en soins intensifs, ajustée en fonction de l'âge, du sexe, des taux de 25-hydroxyvitamine D linéarisés à l'inclusion et des comorbidités a montré que les patients traités avaient un risque réduit de nécessiter l'USI (rapport de cotes [OR] 0,13 ; IC à 95 % 0,07 -0,23). La mortalité globale était de 10 %. Dans l'analyse en intention de traiter, 21 (4,7 %) des 447 patients traités par calcifédiol à l'admission sont décédés contre 62 patients (15,9 %) sur 391 non traités (P = ,001). Les résultats ajustés ont montré un risque de mortalité réduit avec un OR de 0,21 (IC à 95 %, 0,10-0,43). Dans la deuxième analyse, l'OR obtenu était de 0,52 (IC à 95 %, 0,27-0,99).

Conclusion
Chez les patients hospitalisés pour COVID-19, le traitement au calcifédiol a considérablement réduit les admissions aux soins intensifs et la mortalité.

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Implications for Systemic Approaches to COVID-19: Effect Sizes of Remdesivir, Tocilizumab, Melatonin, Vitamin D3, and Meditation
Ryan D Castle J Inflamm Res. 2021 Sep 22;14:4859-4876. doi: 10.2147/JIR.S323356. eCollection 2021.

Introduction: COVID-19 poses a chronic threat to inflammatory systems, reinforcing the need for efficient anti-inflammatory strategies. The purpose of this review and analysis was to determine the efficacy of various interventions upon the inflammatory markers most affected by COVID-19. The focus was on the markers associated with COVID-19, not the etiology of the virus itself.

Methods: Based on 27 reviewed papers, information was extracted on the effects of COVID-19 upon inflammatory markers, then the effects of standard treatments (Remdesivir, Tocilizumab) and adjunctive interventions (vitamin D3, melatonin, and meditation) were extracted for those markers. These data were used to approximate effect sizes for the disease or interventions via standardized mean differences (SMD).

Results: The data that were available indicated that adjunctive interventions affected 68.4% of the inflammatory markers impacted by COVID-19, while standard pharmaceutical medication affected 26.3%.

Discussion: Nonstandard adjunctive care appeared to have comparable or superior effects in comparison to Remdesivir and Tocilizumab on the inflammatory markers most impacted by COVID-19. Alongside standards of care, melatonin, vitamin D3, and meditation should be considered for treatment of SARS-COV-2 infection and COVID-19 disease.

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Traduction de l'étude

Implications pour les approches systémiques du COVID-19 : ampleur des effets du remdesivir, du tocilizumab, de la mélatonine, de la vitamine D3 et de la méditation
Ryan D Castle J Inflamm Res. 22 septembre 2021; 14:4859-4876. doi: 10.2147/JIR.S323356. Collection électronique 2021.

Introduction : COVID-19 constitue une menace chronique pour les systèmes inflammatoires, renforçant le besoin de stratégies anti-inflammatoires efficaces. Le but de cette revue et analyse était de déterminer l'efficacité de diverses interventions sur les marqueurs inflammatoires les plus touchés par COVID-19. L'accent a été mis sur les marqueurs associés au COVID-19, et non sur l'étiologie du virus lui-même.

Méthodes : Sur la base de 27 articles examinés, des informations ont été extraites sur les effets du COVID-19 sur les marqueurs inflammatoires, puis les effets des traitements standard (Remdesivir, Tocilizumab) et des interventions complémentaires (vitamine D3, mélatonine et méditation) ont été extraits pour ces marqueurs . Ces données ont été utilisées pour approximer les tailles d'effet pour la maladie ou les interventions via des différences moyennes standardisées (DMS).

Résultats : Les données disponibles indiquaient que les interventions d'appoint affectaient 68,4 % des marqueurs inflammatoires touchés par COVID-19, tandis que les médicaments pharmaceutiques standard en affectaient 26,3 %.

Discussion : Les soins d'appoint non standard semblaient avoir des effets comparables ou supérieurs par rapport au Remdesivir et au Tocilizumab sur les marqueurs inflammatoires les plus impactés par COVID-19. Parallèlement aux normes de soins, la mélatonine, la vitamine D3 et la méditation doivent être envisagées pour le traitement de l'infection par le SRAS-COV-2 et de la maladie COVID-19.

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The Association between Vitamin D and Zinc Status and the Progression of Clinical Symptoms among Outpatients Infected with SARS-CoV-2 and Potentially Non-Infected Participants: A Cross-Sectional Study
by Sahar Golabi Nutrients 2021, 13(10), 3368;

Vitamin D and zinc are important components of nutritional immunity. This study compared the serum concentrations of 25-hydroxyvitamin D (25(OH)D) and zinc in COVID-19 outpatients with those of potentially non-infected participants. The association of clinical symptoms with vitamin D and zinc status was also examined. A checklist and laboratory examination were applied to collect data in a cross-sectional study conducted on 53 infected outpatients with COVID-19 and 53 potentially non-infected participants.

Serum concentration of 25(OH)D were not significantly lower in patients with moderate illness (19 ± 12 ng/mL) than patients with asymptomatic or mild illness (29 ± 18 ng/mL), with a trend noted for a lower serum concentration of 25(OH)D in moderate than asymptomatic or mild illness patients (p = 0.054). Infected patients (101 ± 18 µg/dL) showed a lower serum concentration of zinc than potentially non-infected participants (114 ± 13 µg/dL) (p = 0.01). Patients with normal (odds ratio (OR), 0.19; p ≤ 0.001) and insufficient (OR, 0.3; p = 0.007) vitamin D status at the second to seventh days of disease had decreased OR of general symptoms compared to patients with vitamin D deficiency.

This study revealed the importance of 25(OH)D measurement to predict the progression of general and pulmonary symptoms and showed that infected patients had significantly lower zinc concentrations than potentially non-infected participants.

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Association of Vitamin D Status with SARS-CoV-2 Infection or COVID-19 Severity: A Systematic Review and Meta-analysis
Asma Kazemi, Advances in Nutrition, Volume 12, Issue 5, September 2021, Pages 1636–1658,

This systematic review was conducted to summarize and clarify the evidence on the association between 25-hydroxyvitamin-D [25(OH)D] concentrations and coronavirus disease 2019 (COVID-19) risk and outcomes. PubMed, Scopus, and Web of Science databases and Google Scholar were searched up to 26 November 2020. All retrospective and prospective cohort, cross-sectional, case-control, and randomized controlled trial studies that investigated the relation between 25(OH)D and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and COVID-19 severity were included. Thirty-nine studies were included in the current systematic review. In studies that were adjusted (OR: 1.77; 95% CI: 1.24, 2.53; I2: 44.2%) and nonadjusted for confounders (OR: 1.75; 95% CI: 1.44, 2.13; I2: 33.0%) there was a higher risk of SARS-CoV-2 infection in the vitamin D deficiency (VDD) group. Fifteen studies evaluated associations between VDD and composite severity. In the studies that were adjusted (OR: 2.57; 95% CI: 1.65, 4.01; I2 = 0.0%) and nonadjusted for confounders (OR: 10.61; 95% CI: 2.07, 54.23; I2 = 90.8%) there was a higher severity in the VDD group. Analysis of studies with crude OR (OR: 2.62; 95% CI: 1.13, 6.05; I2: 47.9%), and adjusted studies that used the Cox survival method (HR: 7.67; 95% CI: 3.92, 15.03; I2: 0.0%) indicated a significant association of VDD with mortality, while in adjusted studies that used logistic regression, no relation was observed (OR: 1.05; 95% CI: 0.63, 1.75; I2: 76.6%). The results of studies that examined relations between VDD and intensive care unit (ICU) admission, pulmonary complications, hospitalization, and inflammation were inconsistent.

In conclusion, although studies were heterogeneous in methodological and statistical approach, most of them indicated a significant relation between 25(OH)D and SARS-CoV-2 infection, COVID-19 composite severity, and mortality. With regard to infection, caution should be taken in interpreting the results, due to inherent study limitations. For ICU admission, inflammation, hospitalization, and pulmonary involvement, the evidence is currently inconsistent and insufficient.