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Volume 10, Issue 2 (May 2023)                   IJML 2023, 10(2): 120-126 | Back to browse issues page

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Nabi-Afjadi M, Karami H, Goudarzi K, Abasian Z, Heidari-Kalvani N, Barjasteh F et al . The Importance of Antioxidant/Anti-inflammatory Vitamins during the SARS-CoV-2 Infection. IJML 2023; 10 (2) :120-126
URL: http://ijml.ssu.ac.ir/article-1-467-en.html
The Importance of Antioxidant/Anti-inflammatory Vitamins during the SARS-CoV-2 Infection
Mohsen Nabi-Afjadi , Hadis Karami , Kaveh Goudarzi , Zahra Abasian , Nafiseh Heidari-Kalvani , Fereshte Barjasteh , Elham Bahreini *
Department of Biochemistry, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
Keywords: COVID-19, Dietary supplements, SARS-COV-2, Self-immune system, Vitamins
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Introduction
A large group of viruses that cause illnesses ranging from the common cold to more acute illnesses, such as Middle East Respiratory Syndrome (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS-COV) are coronaviruses (CoV). The new virus was unknown until December 2019, when it emerged in Wuhan, China [1-3]. The ongoing coronavirus disease 2019 (COVID-19) pneumonia pandemic is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and is spreading worldwide [4]. SARS-CoV-2 causes severe inflammation and damage to endothelial cells in the heart, liver, kidney, and gut, suggesting vascular infection rather than pure respiratory disease [5, 6]. An overactivated and misdirected immune response can cause these symptoms. High levels of interleukin (IL)-6 followed by a cytokine storm without an adequate response to interferon types I and III  are associated with severe COVID-19 disease [7-12]. Patients with major underlying medical conditions, especially those with chronic conditions such as hypertension, diabetes, coronary artery disease, and cancer, are susceptible to SARS-CoV-2 due to their low systemic immunity due to the disease itself and its treatment [13]. Therefore, strengthening the autoimmune system is particularly vital. The key ways to strengthen an individual’s immunity are maintaining personal hygiene, a healthy lifestyle, and proper food intake [14, 15]. Dietary supplements may be beneficial in managing SARS-CoV-2 infection [16]. In general, vitamins act as modulators of immune function. SARS-CoV-2 causes stress on infected host cells by increasing levels of pro-inflammatory cytokines in the blood [17]. Antioxidant and anti-inflammatory effects are natural functions of many vitamins (including vitamins A, C, and E). Oxidative stress thus happens in a series of imbalances between the production of free radicals and the organism’s ability to detoxify these molecules/ molecular fragments, resulting in cellular damage [18, 19]. Conversely, antioxidants are low- or high-molecular-weight substances (vitamins, minerals, enzymes, etc.) that counteract the harmful properties of free radicals and help prevent or repair cellular damage [20-22]. Therefore, paying attention to your diet during this period is important by following a healthy and balanced dietary pattern that includes adequate amounts of minerals, antioxidants, and vitamins. Fruits and vegetables containing micronutrients such as vitamins A and B, E, and C have been reported to boost immune system function. Antioxidants increase the number of T-cell subsets, increase lymphocyte response to mitogens, increase IL-2 production, and enhance natural killer cell activity [23]. Vitamins A, C, D, E, B6, and B12 are important for maintaining the structural and functional integrity of physical barriers (skin, gastrointestinal mucosa, airways, etc.) and, thus, the differentiation of innate immune cells. Important to proliferation, function, and migration processes. Vitamins C and E, on the other hand, and selenium protect cells from free radical damage during increased oxidative stress through differentiation, proliferation, and normal function of T and B cells. These nutrients also affect antibody production and function, contribute to cell-mediated immunity, and aid in pathogen recognition and destruction [24]. This review mentions the importance of antioxidant/anti-inflammatory vitamins during the SARS-CoV-2 infection by potentiating the immune system.

Vitamin A

As a fat-soluble vitamin, vitamin A refers to several substances, including retinol, retinal, retinoic acid, retinoids, and carotenoids. Vitamin A’s main benefits and functions are antioxidant effects, role in night vision, correct color discrimination, role in antibody formation and immune system support, and skin integrity [25]. The most common sources of vitamin A are liver and fish oil. Other sources of vitamin A include milk and eggs, green leafy vegetables, orange and yellow vegetables, tomatoes, fruit, and some vegetable oils [26]. Vitamin A (also known as the “anti-infective” vitamin) has anti-inflammatory roles related to improving immune system function and mucosal integrity, protecting the body from infection [27]. Jee et al. announced that diets low in vitamin A may have reduced the effectiveness of inactivated coronavirus vaccines in cattle and increased the susceptibility of calves to infections [28]. The effects of contamination with infectious bronchitis virus, a coronavirus, were more pronounced in chickens with severe vitamin A malnutrition than in vitamin A-rich chickens [29]. Vitamin A has been suggested to treat coronaviruses and prevent lung infections [30]. Vitamin A improves the phagocytic and oxidative function of macrophages. Vitamin A helps regulate the number and function of natural killer (NK) cells and also helps to regulate the production of IL-2 and the pro-inflammatory tumor necrosis factor alpha (TNF- α), which activates the microbial action of macrophages. Vitamin A is also involved in developing and differentiating T helper (Th)1 and Th2 cells [24].

Vitamin B

B vitamins (e.g., B1, B2, B3, B6, B7, B9, and B12) play crucial roles in the immune system [31-36]. Vitamin B1 (thiamine), through its effects on proapoptotic proteins, mitochondrial membrane integrity, cytochrome C release, P38 mitogen-activated protein kinase activity, and oxidative stress-induced nuclear factor-κB (NF-κB) mediated several has anti-inflammatory effects. Vitamin B1 insufficiency can cause inflammation, T-cell infiltration, and overexpression of pro-inflammatory cytokines such as IL-1, TNF-α, and IL-6 [37]. The main role of vitamin B2 (Riboflavin) is to regulate the energy metabolism of all cells [38]. Keil et al. have reported that ultraviolet light and vitamin B2 effectively reduced the titer of MERS-CoV in human plasma products [39]. Vitamin B3 (Niacin) produces T cells and interleukins [40]. Vitamin B3, also known as nicotinamide, could enhance the destruction of Staphylococcus aureus through a myeloid-specific transcription factor [41]. Moreover, vitamin B3 treatment significantly inhibited neutrophil infiltration into the lungs during ventilator-induced lung injury with a strong anti-inflammatory effect [41, 42]. Vitamin B6 (Pyridoxine) has a role in lymphocyte maturation [24], and vitamin B6 deficiency has been associated with a dramatic depletion of thoracic duct lymphocytes and a reduction in lymphocyte proliferation [40]. Vitamin B12 (cobalamin) can act as an immunomodulator and increase the number of cytotoxic T cells against viral infections [24, 43]. In sepsis and systemic inflammatory response syndrome, it is believed that vitamin B12 may also be used as a therapeutic compound. Vitamin B12 helps maintain normal macrophage activity. It also has several anti-inflammatory effects, such as regulating NF-κB, a key activator of pro-inflammatory signaling pathways. It also has a proven role in bacteriostasis and phagocytosis [41, 42, 44]. Therefore, B vitamins can be selected as a basic option for COVID-19 treatment. The best sources of B-complex vitamins are whole grains, lean meats, fish, poultry, eggs, milk, seeds, beans, nuts,  and various fruits. etc. [26].

Vitamin E

Vitamin E is an antioxidant in reducing oxidative stress by binding free radicals [45]. Vitamin E deficiency stimulated myocardial injury in mice infected with RNA viruses and coxsackievirus B3 [46, 47]. Furthermore, vitamin E deficiency significantly increases the risk of bovine CoV infection in calve [48]. Vitamin E strengthens the immune system, fights pathogens such as bacteria and viruses with its powerful antioxidant properties, and maintains the integrity of T-cell membranes [49, 50]. In addition, vitamin E performs many important functions in the immune system, including cell-mediated destruction of microorganisms and antibody production [51, 52]. However, a recent study showed that vitamin E shortened the duration of influenza virus infection [53]. Meydani et al. reported that the group treated with vitamin E (received 200 IU daily) had fewer cold days per person per year [54]. These studies suggest mechanisms involved in the effects of vitamin E in the reduction of Prostaglandin E2 production by the inhibition of cyclooxygenase-2 activity mediated through decreasing nitric oxide production, the improvement of effective immune synapse formation in naive T cells and the initiation of T cell activation signals. Moreover, more activity of the NK cells and lower IL-12 production/migration were induced by vitamin E, but the underlying mechanisms need to be further elucidated [52]. Numerous foods, such as nuts, seeds, vegetable oils, corn, etc., provide vitamin E [26].

Conclusion

This study investigated the effects of vitamins on the disease of COVID-19. Corona 2019 is an acute respiratory disease caused by a new coronavirus called SARS-COV2. This disease is spreading rapidly in the cities of China and other countries. The prevalence of this disease is very high. The disease is mainly transmitted through droplet transmission and close contact with the patient. The most important ways to increase personal safety are personal hygiene, health protocols, social distancing, wearing a mask, and washing hands regularly. Dietary supplements, along with health tips, can help prevent disease. SARS-COV virus increases plasma levels of pro-inflammatory cytokines. Many vitamins (A, C, E, etc.) have antioxidant and anti-inflammatory properties. Therefore, patients should consume a healthy, balanced diet containing sufficient antioxidants and vitamins. Antioxidants also increase the production of IL-2 and the activity of NK cells. Vitamins A, C, E, B6, and B12 are important for innate immune cells’ differentiation, proliferation, function, and migration. Vitamin B6 may play a role in improving coronary heart disease by suppressing the development of a cytokine storm.
Conflict of Interest
The authors declare that there is no conflict of interest.
Acknowledgment
None.


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Type of Study: Research | Subject: Biochemistry
Received: 2022/12/17 | Accepted: 2023/05/31 | Published: 2023/05/31
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